We had a full day of mobile clinic this week that would begin in a region called Mang’ola and our first stop would be the village of Barazani. This region has a special significance to FAME as it is where the first mobile clinics were held just as FAME began their operations as a clinic. These mobile clinics, though, were far different than what we provide today, mainly in the fact that we would travel there as a huge group, and spend the week in the region, typically camping out in government buildings with a mattress and a blanket. They were huge affairs that required a ton of logistics given the number of personnel that were traveling together and the support services that were required.
Though not of the same magnitude, we have carried on the FAME tradition of the mobile clinic with our neurology team’s trips to the Mbulumbulu region, Rift Valley Children’s Village, and now to the Mang’ola region for this visit. We had our two vehicles (Turtle and Myrtle) all packed with supplies and the necessary staff to spend the day at the Barazani dispensary seeing neurology patients or anything else that needed our expertise such as the psychiatry patients whom we treat here as well. The drive to Mang’ola is along what is now a good road, but that can always change in a moment with the weather. I recall driving through Barazani years ago with the big mobile bus that we used as a mobile lab when we encountered a washed-out ravine that was nearly impassible at the time and required extensive repairs before proceeding.
Lake Eyasi is a very remote region and historically very old. It is the largest of the Rift Valley lakes (Natron and Manyara being two others) and the home of the Hadza (or Hadzabe) who are the last bushman of Tanzania, still hunting with bows and arrows for their food. The other unique feature of the Hadza is that they are one of the several tribes in the world who speak click language, using clicks as additional consonants in their alphabet. They live several hours away from Barazani on the shore of Eyasi, though we continue to see members of their tribe both at FAME and at mobile clinics on occasion. Several years ago, Mike Baer, one of my residents who had traveled here in 2019, wrote a wonderful story about a member of their tribe who had suffered a stroke and the fact that there are so few of them remaining in the world (https://fameafrica.org/journal/2019/10/3/one-of-only-1500).
Our journey began quite early in the morning as it would take over an hour for the drive to Barazani, and that was if everything went well, and they were no unexpected events along the way. The junction of the tarmac and the road to Mang’ola is just west of town on the way to the Ngorongoro gate. The tarmac, though, is heavily trafficked by safari vehicles on their way to the Crater and beyond, so there is now a traffic control station to register all those commercial safari vehicles travelling to parts beyond. I had no intention in stopping to check in since we we’re to a mobile clinic rather than a game drive, though, as I approached, I was flagged down by the traffic officer to stop. I will usually have one of the Tanzanians explain our circumstances to the police since, ashamedly, my Swahili remains extremely poor beyond saying hello despite the 15 years that I’ve been coming here. As soon as I heard Annie begin laughing, though, I knew we were in good shape as it turned out that the female office was one of her patients at FAME. After a brief chit chat in Swahili which, of course, I couldn’t understand, we were once again on our way.
The drive along the Mang’ola road is gorgeous and travels through very rich farmlands and villages for the farmers and other workers who still toil the soil by hand rather than technology. In the mornings and the evenings, the workers walk along the road with their hoes slung over their shoulders in a fashion that would be reminiscent of another century back at home. There are many vehicles including larger trucks that ply this road all day long and into the dusk bringing produce and people to and from the Lake Eyasi region.
I’ve been coming to this clinic in Barazani for over five years now and it has never disappointed in the excellent turn-out we receive, both in the volume of patients seen as well as the widely varied pathologies represented. The clinical officer in charge, Dr. Damien, has been the same for the last several years, and has also been gracious and hospitable in a manner that has always been so helpful to us. As soon as we arrive, he scrambles around to help us find the necessary furniture for us to get started and to determine just which rooms we could be using. One thing that was added just within the last year and was incredibly appreciated perhaps as much and anything else at the clinic, was their new Western Toilet. African toilets, like most of the rest of the world, are “squatty potties” and, though are just fine for those of us of the masculine gender going “number one,” require a bit more balance and finesse for anyone else.
I was thankful to see the furniture I had previously donated to the clinic was still present and being used as that is perhaps one of the scarcest pieces of equipment that is needed for our mobile clinics. Having no tables or chairs in the exam rooms and no benches for the patients to sit on makes it very difficult for us to see patients, let alone examine them and write the histories that we need to keep as part of the patient’s file. Because of the way that the FAME EMR has been structured, it can only be used on site while on a FAME network. Though it would be very nice for those times in the US that I’m consulted on patients, it would certainly not be considered a priority for FAME
Barazani itself is a very dry and dusty place and has the feel of the last outpost of civilization at times. The dispensary, which is on the far side of town for us, requires that we drive the length of the mostly washed-out road, passing by places of business that are typically bustling with activity, loading, and unloading supplies onto large trucks that are coming and going. Onions are the primary produce that is grown here, though after our visit to the lake later in the day, it became very clear that truckloads of tiny, dried perch were being shipped out from the area after having been netted in the lake.
The clinic building itself is very basic but had all of the necessities for us to run four clinic rooms and a steady flow of patients along the way. Much to Christina’s dismay, there were plenty of wasp’s nests just outside the doors and there were also small bats hanging under the eaves just outside on the large porch where we were staffing. If you walked over to them, they were scurry across the wall, but none flew away. As is everywhere in Africa, there were tons of birds singing away throughout the day and the plants, all of which Dr. Damien had planted, were lovely. At lunchtime, we had a new treat that was on a trial basis. We had previously brought box lunches, similar to what you take with you on safari, from one of the Karatu establishments that were priced very fairly, but unfortunately were not as appetizing as we had hoped. I had contact Gibb’s Farm to see if they could make us lunches for the week at perhaps a discounted price and, thankfully, they were gracious enough to be willing to do that as they were not overburdened with making lunch boxes for safari guests during the low season. The lunches were awesome and a real hit with the residents and staff alike. After the dust of the drive and the busy morning, it was a nice break to be able to eat a good lunch before seeing patients again in the afternoon.
The afternoon was going well which gave us the option of driving down to the shores of Lake Eyasi for a visit with the fisherman that we’ve met there before. Little did we know, though, that there had been a population explosion not only of the fish in the lake, but also the many fishermen who had come from all parts of Tanzania, some with their families, to reap the benefits of this event. They had created a small city of hundreds of tents along the beach at Barazani, and elsewhere along the lake I would imagine, with huge mounds of dead fish rising well over six feet scattered across the beach. They would bring their nets far out into the lake using small dories and then haul them back towards the shore manually with the result being an incredible amount of these tiny perch-like fish caught in their nets. They would then scoop them out with buckets into large wheelbarrows to bring in further on shore to lay them out to dry.
It was a huge operation that I had not seen before, despite having visited the lake several times in the past. It’s clear that this massive explosion of the population of fish in the lake only occurs at a specific time of the year and we had simply missed it in the past. The smell of hundreds of piles of dead and drying fish was immense and pungent and remained in our noses for a long time following. We were told that the fish would be ground into meal to use for chicken feed.
We left the lake a bit later than expected for the long drive home in waning light of the evening. The road, which is dirt and gravel for the most part with some fairly rocky stretches is driven at 60-80 kph – not a speed for the faint of heart. At one point, a herd of goats and sheep shot out from some bushes to run across the road directly in front of Turtle traveling at a fair speed. I slammed on the brakes, but trying to stop a vehicle the size of Turtle on a dirt road isn’t an easy task. We were sure that we killed at least one of the animals and I was already preparing in my mind how to negotiate with the owner when we discovered that all the animals had escaped alive. Driving home in the late evening is always a risk as that is when all the herds of livestock are being driven home by their owners, undoubtedly having to cross the roads.
We made it home just a bit worse for the wear, but safe and sound. Tomorrow morning, we would be returning back to Mang’ola on the same road, but to a different village, Mbuga Nyekundu.
