After traveling to the Crater yesterday and spending the evening at Annie’s house, it was time to prepare for our first neuro mobile clinic. The mobile clinic concept has its origins in the very beginning of FAME when Frank and Susan would travel to local villages in the Karatu district with an entire crew – doctors, nurses, and lab techs, as well as a dancing troop that would help teach the local population about the issues with unsafe water and malaria. When I first came to FAME in 2010, I was able to participate in these clinics to the Lake Eyasi region (where we were heading today) that would last a week and would involve about half of the FAME staff. We traveled far down the shore of Lake Eyasi to villages were the Hadzabe and Datoga lived, holding clinic for the day and spending the evenings around a campfire sharing stories about the day and other aspects of the world in general. I specifically remember the nights and the early mornings before sunrise as there was absolutely no light pollution and the stars were incredible.
As we were on hallowed ground in the world of anthropology, one of my first true loves, I remember calling my mom, the one who had instilled in me the love of nature and the inquisitiveness that has led me to where I am today, early one morning to excitedly tell her that I was standing on ground that Australopithecus had walked millions of years ago. It was not long after, or perhaps even when I had called her, that she developed dementia and passed away two years later. She was a truly remarkable person who I think of quite often and wish she were still here to share in the work we are doing as she is as responsible as anyone for it having happened.
Our neuro mobile clinics began in 2011 at the urging of Paula Gremley, a tireless social worker in Northern Tanzania who had worked with FAME in the early years. One day, she asked me if I’d like to accompany she and her co-worker, Amiri, to travel to a few close by villages to see neurology patients. It took little convincing for me to jump in their Land Cruiser along with a nurse (to distribute medications) and a clinical officer (to translate for me), and off we went to the Mbulumbulu region of the Karatu District. That very first clinic at Kambi ya Simba (we are still going there fourteen years later) was held under a blue sky in an opening in front of their small church and was the beginning of what would become a sustainable effort to bring neurology to the villages where there were many patients who weren’t aware they had treatable disorders such as epilepsy.
Our clinics, which have covered a number of the regions around Karatu, are now comprised of bringing the team of neurology residents along with our translators, a social worker, a nurse to dispense medications, a FAME driver for the second vehicle, and an outreach coordinator. We travel in my two Land Rovers and bring all the necessary medications to provide prescriptions for the patients we see, and to refer patients back to FAME for any additional testing such as labs, echocardiograms, or radiology studies. There is readily available transportation to Karatu and FAME by bus for the patients we are seeing in all the villages, though the patients often are unaware that they have treatable conditions making our traveling to the villages so necessary. Once we’ve identified patients who we can provide some relief, it’s our hope that they can travel to FAME for refills of their medication, though often, the issue not a matter of whether they can travel or not, but whether they can afford the refills of the medications we’ve provided. At the present time, we do the best we can, but without specific funding for this purpose, we’re unable to provide more than a month or two of medications when we see them in clinic.
Traveling to villages to provide these neurologic services also requires the cooperation of the clinical officers and staff at the dispensaries we visit. Those dispensaries that have welcomed our efforts had continued to receive our support, and each visit here, we will travel to six or more of these clinics to maintain the sustainability that is so important to providing health care and is so important in obtaining the trust of the communities we have served. As mentioned, we have continued to provide services to the Mbulumbulu region and Kambi ya Simba since 2011 every six months. What began as an open-air clinic in the middle of the village now utilizes a much more modern facility that was built several years before the pandemic, and we are provided multiple examination rooms to see patients there. Rift Valley Children’s Village has also been a site that have supported with neurology clinics from the very beginning of my work here, but that’s been a given considering the connection between FAME and the Children’s Village. The region of Mang’ola and Lake Eyasi, where we will be heading today to the town of Barazani has been a site that we have gone to now for probably six years and we have seen a great many patients there with neurologic illnesses. The village of Mbuga Nyekundu, where we will be heading tomorrow, is also in the Mang’ola region and has a gorgeous new dispensary for us to work in. On Wednesday of this week, we will be traveling to Mang’ola Juu, a very small village on the slopes of Oldeani Mountain that has perhaps the most primitive dispensary, though many patients in their area. Lastly, the village of Basodawish is the most recent addition to our mobile clinics and has been very receptive to making announcements in their region so that we have had many patients to see there.
I had hoped to have our second vehicle here in time for the today’s clinic, but unfortunately that was not the case as there was more shida with heavy rains knocking out a few bridges making travel difficult. Additionally, only one of the wipers was apparently operational, making travel in the rain that much more difficulty, as well as the fact that the police at the traffic stops weren’t very understanding and kept interrupting their travel requiring them to repeatedly explain the situation every time. Thankfully, Saidi had a friend with an identical Land Rover to Myrtle that we could rent for the day, and he would allow me to drive which was obviously an issue as I didn’t want to take another FAME driver away from FAME. We had to strap our medications and supplies to the top since we have fewer seats than anticipated, though it all worked out in the end, and I drove the vehicle we were renting for the day. Once everything was sorted out, which put us behind by approximately one hour, which actually wasn’t too bad all things considered. We were finally one our way out of town and heading in the direction of Lake Eyasi, which in the past was a very questionable road frequently washing out at the mere sign of a drizzle, though has been completely reconstructed in the recent years and is much more pleasant to drive.
The trip was essentially uneventful as we drove through incredibly rich farmlands growing predominantly corn (maize) and onions with workers in many of the fields either planting or harvesting as we couldn’t tell which they were doing. This region is a very significant exporter of produce to other areas of Northern Tanzania, and particularly of onions as I recall that on numerous occasions, we’ve stopped so our Tanzanian colleagues could purchase bags of onions for next to nothing. Our journey skirts around the foothills of Oldeani Mountain until we finally approach Lake Eyasi, viewing it in the distance. The lake is one of the Rift Valley lakes (Eyasi, Manyara, and Natron) that have formed with this geographic feature that runs through East Africa.
The town of Barazani is a rather desolate place that lies on the shore of Lake Eyasi and is primarily agricultural in existence. There are some fishermen who live right on the beach, harvesting small fish that live in the lake with long nets that they drag out with boats and then haul onto the beaches pulling out large quantifies that are then dried in huge piles. The dried fish are supplied to be ground up as chicken food and are shipped throughout the country. We’ve visited the beach before on numerous occasions and have even jointed the fisherman in the boats and have even helped them haul in their nets ashore using burlap sacks wrapped around our bottoms. The smell of the fish at the height of the harvest is incredibly strong and a bit nauseating for the uninitiated.
We pulled up to the Barazani dispensary, where we have been coming for several years, and the clinical officer, who has also been there for the entire time we’ve been coming, came out to greet us immediately. We have had a great working relationship here and have seen a great many patients here in the past, at times even a bit overwhelming having to ask patients to come back the following day to see us. It was also well baby day today at the dispensary, so all the infants and their mothers were waiting to be seen by the nurse there, though I know that Riley had hoped they were all there to see her. The number of patients here were less than we had hoped for to start, but it was early and once word got out that we were there, perhaps more patients would show up for us.
Our outreach coordinators spend time visiting these villages where we have our mobile clinics in advance of our arrival, though it is often a matter of what the weather is like or whether it is planting or harvesting season with the need for everyone to be in the fields. Today, though, we ended up only seeing fifteen patients or so which is really about half as many as we would like to see in the day. The resources to get here are obviously the same no matter how many patients we end up seeing, but the expense per patient is clearly the greatest with the fewer patients we are seeing. Besides, the more patients we see here, the better for everyone as it provides a greater experience for my residents and teaching opportunities for the Tanzanian clinical officers. Spending the day at a mobile clinic with few patients to see can be quite a disappointing experience.
We departed Barazani at around 4:30 PM and it took us about an hour to get home. The weather was still gorgeous for the trip home, and everyone was pretty beat when we finally arrived and unpacked our gear. The word was that my other Land Rover would finally be arriving sometime tonight, though I thought to myself that I would believe it when it finally happened. Amazingly, Turtle finally showed up around 9 pm, my to my surprise as I was about to go to bed, but here she was with the driver/mechanic. The plan was to have him drive us tomorrow to make sure everything was good, so I told him to head into town and meet us at 7:30 am in the FAME parking lot as we would be departing at 8:00 am for our next clinic. My fingers were still crossed that the whole thing hadn’t been a dream.
