(Note: there are no photos of Kafika House out of respect for the children and for security reasons)

The education lecture for the morning had been cancelled this morning as we would be having a monthly morbidity and mortality (M&M for those in the medical field) conference tomorrow morning. These conferences are typically large affairs with the entire staff participating and are meant to be a learning experience for everyone involved. Back home, M&M conferences are held by every department and are considered protected in a legal sense in that any and all information pertaining to the conference is not discoverable during a legal proceeding. This allows for an open and impartial discussion by all parties involved without fear of repercussions, legal or otherwise. Though at home, M&M conferences are closed to anyone from outside the departments involved (as an example, we would never invite interviewing residents to an M&M), all the volunteers were invited to attend the conference here.

It was our last full day of neurology clinic for the current group of residents and our morning was going particularly slow as it had rained overnight into the morning which always portends a slow start given the difficulty of travel until the roads dry. Jill and I had arranged to visit the Kafika House at 2 pm with Pete, our visiting pediatrician from Australia, whose sister just happens to be the founder of the non-profit that runs the program. Jill would typically take the school bus home after lunchtime, but that can often be a lengthy ride, so I had decided to drive over to the black rhino to bring her back to FAME for lunch prior to us leaving with Pete. Given the fact that there were few patients showing up to clinic, this didn’t seem like it would be an issue at all, and Marissa was totally fine with holding down the fort in my absence.

There are three routes that one can take to reach the Black Rhino International Academy from FAME. The shortest and most direct route takes you alongside the fields behind FAME where we have often taken walks over the years, but in the best of circumstances, this route is heavily rutted and, after a rain, can become nearly impassable. The safest route to take for a number of reasons, but it is also the longest by both distance and time, is to drive all the way out to the tarmac, head out of town, and then turn onto the Shangri-La Road which takes you to the Black Rhino. I chose the middle route that takes you up behind the Highview Hotel and then down a fairly steep and rutted road, but one that is easily passable. Unfortunately for me, it wasn’t completely passable to everyone. Three quarters of the way down a long and muddy road that is a single lane, there was a large dump truck that had become stuck while trying to back into a property.

Initially, I was quite patient and more than willing to wait a few minutes while they figured things out, but when they broke out the shovels and began digging, I figured it was time for me to bail. Unfortunately, that meant that I would have to reverse Turtle (Saidi had borrowed Myrtle to go into town to pay for my medical license) up a very steep, muddy, and rutted one lane, at best, road in a vehicle that was the size of a small tank. You’ve heard me sing the praises of the Land Rover before, but I’m telling you, they can drive anywhere on any type of terrain (that is as long as they are running). I put the transfer case into low range and began backing up the hill using my mirrors, and Turtle didn’t miss a beat. I had to drive down to the tarmac to get to the school and had gotten out of a mess, but was now running late, and Jill was wondering where I was as I didn’t have a signal where I had been so couldn’t tell her why I was running late.

When we finally got back to FAME, it seemed that someone had opened the flood gates as there were numerous patients now being seen, plus a young boy in the ED who was in focal status but had been like that for at least a month. Marissa had everything well under control, though I did feel a bit guilty as I’m sure it was more stressful than what she had signed on for. In fact, by the time we had arrived, I’m pretty sure that she had taken care of staffing everyone along with dealing with the focal status boy.

The 13-year-old boy in the ED had apparently had epilepsy since he was very young, and other than a brief trial of phenobarb when younger that either knocked him out or didn’t help his seizures, he had been on no other medications and continued having infrequent focal seizures while on no treatment for most of his life. Something had changed over the last month, though, and he began having multiple seizures per day that were, thankfully, still focal. He was initially given lorazepam in the ED which stopped his seizures and was then loaded on levetiracetam to prevent his seizures from returning. Though carbamazepine is a fine antiseizure medication for focal epilepsies, and is quite inexpensive, it can’t be loaded quickly and takes days to get a decent level in someone. Levetiracetam, a much newer medication, can loaded more quickly, either orally or intravenously (though we have no IV formulation here), making it a much more viable option in this situation.

With everything in good order in the clinic, thanks to Marissa, Jill and I went to grab a quick lunch before heading to Kafika House with Pete. Today’s lunch was pilau, most everyone’s favorite (mine is still the rice and beans) including Charlie, who knows the days of the week by whether there is choma (meat) included in the meal that day as he benefits greatly from the gristlier bits that can be inedible. Unfortunately, this has been an extremely bad habit for Charlie, and despite trying to break him of this habit on numerous occasions, it has gone for naught, and Charlie can safely be described as a “big boy.”

Pete had offered to drive us to Kafika House, which is very near Gibb’s Farm, and I rode in the back seat with his two children, Ollie and Astrid, in their car seats. Coletta, their nanny sat in the third row for the ride up. Astrid, who has to be one of the happiest children any of us have ever seen (though Pete corrects us noting that she is until she’s not), kept me entertained for the entire ride with both of us blowing raspberries at each other in succession or playing peek-a-boo.

Kafika House, (https://kafikahouse.org/) which began as Plaster House, but changed its name last year due to the types of patients they were seeing, was started in 2008 by Pete’s sister, Sarah, as a rehabilitation center for children who were undergoing surgical correction for orthopedic conditions and would require prolonged rehab after their surgery. Their model, which is to locate children in need of these surgeries in the communities as well as those who arrive at their doorstep, provide presurgical evaluations, then surgery that will take place at the hospital, and then back to Kafika House where they will remain for the entirety of their rehab, which may be several months.

They had originally partnered with Arusha Lutheran Medical Center (ALMC) in Arusha as far as a location for their surgery but have since branched out as the conditions which they treat have expanded. In addition to the orthopedic issues some children have, they are also now providing both plastics (cleft lip and palate, burns) and neurosurgical (spina bifida and hydrocephalus) procedures using surgeons that will often come from the US just for the surgical days or some surgeons who are in country. They are currently doing around 1000 surgeries per year in total.

The significance of all this, in addition to the simply amazing organization that Kafika House has become, is that they have partnered with FAME for their site in Karatu and where their surgeries will occur. Once or twice a month, we will have a small group of 6-10 young children show up at FAME for their preoperative evaluations and they will march down the hallway in between their various testing stations. They will typically come back in the following days for their surgery, spend one night here in the surgical ward postoperatively, and then will be transported up to Kafika House where they have a full complement of nurses to manage anything including IV antibiotics for those patients requiring them.

Kafika, which I am told loosely translates to “have arrived,” is the perfect name for this organization for when pulling through the gates, you absolutely feel as though you have arrived, and there is little question as to the healing power of this loving and tranquil place. Kafika House is located in the previous residence and grounds of Margaret Gibbs, the matriarch of Gibbs’ Farm and longtime resident of Karatu. As we took our tour of the property and visited the different rooms full of laughing and children, many with their mothers if they were young, the loving and healing nature of this place could not help but emanate from every corner of the house and elsewhere. On the porch, looking out over the magnificent landscape that slowly blends into that of the conservation area beyond, children with casts on one or both lower limbs sit pleasantly in chairs or on mats and are clearly in the place they were meant to be. There is little question that they have arrived.

We had a quiet evening at home, though there was a definite groundswell from the residents that involved an evening at the Golden Sparrow, Karatu’s long-standing disco/night club for dancing and consumption of Konyagi, Tanzania’s local gin that is referred to as “The Spirit of the Nation.” We have always said, “what happens at the sparrow, stays at the sparrow,” but there have been multiple postings by me of photos and videos, so I can honestly say that is not entirely true. Neither Jill nor I were up to an evening out due to stomach issues, but even more so, the two of us had taken secnidazole earlier in the day that necessitated neither of us drink alcohol for at least 48 hours. It was a legit excuse, so I drove all the residents (Marissa had bowed out as well) down to town with the promise that they would get home safely by cab. Annie and Hussein had also joined them later in the evening so I was happy to know there would be someone looking out for them. Surprisingly, they were all up, bright eyed and bushy tailed, for our 7:30 am M&M conference the following morning.