The Rift Valley Children’s Village is a very special place for so many reasons, and I have been traveling there for the last 15 years as part of my work with FAME to provide neurologic care to the children living there as well as to those residents in the Oldeani district that surrounds the village. In fact, FAME’s location in Karatu has a great deal to do with its proximity to RVCV as the ability to provide medical care to the village and their community was something that Mama India, founder of RVCV and the Tanzanian Children’s Fund, recognized this and had suggested to Frank and Susan that it would be the perfect location for a medical center and hospital as the entire area was vastly underserved medically. As they say, and the rest is history, for the partnership has been integral to the success of both organizations.
Early on, FAME provided twice monthly medical clinics at RVCV, and we would typically tag along to see the neurology patients. For a number of reasons, though, it became more efficient to send patients to FAME for their care, but we have continued the neurology mobile clinics there twice a year when we are in Tanzania. Today (Wednesday) would be our first of those clinics for this season, and we would also be there tomorrow. Africanus, a wonderful clinical officer who began his career working with neurology at FAME as a translator and was then hired by FAME, moved over to take over the entire clinical operation at RVCV, and has developed an amazingly organized medical clinic including a new building that has truly upped the level of care that patients are receiving there. Early on, India recognized the need for better health care not only for her children, but also for the community as her children were going to school with the other children and having an unhealthy environment was not good for anyone. This philosophy has proved to be incredibly successful over the years based on the health of the community and how well all of the children have done with their education.
We left Karatu in the direction of the Lodoare Gate into the conservation area and turned off the tarmac after about 12 kilometers onto a road that is somewhat ominously named, “African Massage Road.” Besides being an incredibly bumpy road that during the rainy season can become nearly impassible, it also traverses some of the most gorgeous and idyllic farmland that one could ever imagine. The road initially travels along a ridgeline bordering the deep valleys that are common here and then descends to the bottom of the valley along a very steep and rocky road. On descending into the second valley and crossing a stream at the bottom, the road makes a very sharp hairpin turn and quickly ascends again up the opposite wall.
This turn is quite memorable for me as it is the very place I drove in East Africa and was on one of my very first trips here. We were in a small Toyota crew cab pickup, and neither the driver of the vehicle, nor anyone else in the car, could get it moving up the hill without stalling. After several unsuccessful attempts by the Tanzanians, I offered to jump in the driver’s seat and take us up the hill and on to the village. When it was time for us to depart, they asked if I was Ok driving home as well, at which I practically jumped into the cockpit for I could think of nothing more exciting than driving in East Africa and it fulfilled a childhood dream in doing so. Since then, I have driven thousands of miles in Tanzania, mostly on dirt roads and in Land Rovers, something I never thought would have been possible in my lifetime.
Though the African Massage Road isn’t the worst road here in Tanzania, it can become very treacherous in the rains and change at a moment’s notice when the rains come. Even the level stretches of the road will become a slip and slide with the rear end of the car swaying from side, but the most fun is going down the steep inclines as you can’t even think about tapping your brakes which will cause the vehicle to begin sliding down the hill with very little control. In this situation, it’s imperative that you use the engine as your brake by using lower gears and even shifting the transfer case into low range.
The drive on Wednesday was perfectly dry, but then it rained heavily that night and made for a much more thrilling drive on Thursday. Going home the first day, I had taken a shortcut which is a favorite road of mine for its sheer beauty, but it is also a more exciting road to drive, and it has a very steep descent into the bottom of a valley, and then a correspondingly steep ascent that is very bumpy and requires maintaining your momentum throughout. I didn’t even try that road on our return trip the following day, for if I had, I was worried there might have actually been a mutiny aboard. Thankfully, no one drove stick shift to have taken over the wheel, so that was reassuring.
We saw many interesting patients over the two days we spent there, though we have no access to labs or our CT scanner while we’re there and, if any studies are required, the patients are sent to FAME the following week and would be seen in follow up after those studies were completed. Ashley saw a young 6-year-old child with a year’s history of gradual onset of inability to ambulate, but without bowel or bladder dysfunction. On examination, she was clearly myelopathic making us most concerned for a tethered cord, a condition in which the spinal cord, which lengthens at a small amount than our spine such that the end of the cord is actually at the L1/2 level normally in adults, is tethered, or fixed, and becomes stretched and injured. The treatment for this condition, when it exists, is surgical. We recommended that she come to FAME the following week so that we could run some labs and discuss further evaluation.
Another child was seen, with a long history of epilepsy that had been well controlled but now presented with a right hemiparesis and left facial weakness. Having what are referred to as crossed motor signs with the body and face localizes to the brainstem after the corticobulbar motor fibers have crossed in the pons and the corticospinal fibers going to the body have yet to do so at the pyramidal decussation in the medulla. We had recommended an MRI scan which really would be the study of choice for any pathology of the brainstem, but it was unclear whether that was something that would be in the means of the clinic or the family. Having the child come to FAME for a CT scan would be worth a consideration, but we would wait until next week for more direction.
The ride home was uneventful, other than taking the shortcut I had described earlier, and it was a quiet evening at home for us, other than the fact that Denzel, Annie’s son, developed fevers and she had to bring him to FAME to be seen. He subsequently had some nausea and vomiting the next morning such that Annie had to miss our Thursday trip to RVCV. It had rained and rained overnight, making the African Massage Road more of a mud bath and causing a bit of silence in the car until we arrived safely, but we did and were ready to see patients. Unfortunately, with the rain and mud, clinic was a bit less well attended than the day prior.
One of the huge benefits of traveling to RVCV for our mobile clinics are the lunches we are served. They have a significant number of volunteers on a regular basis at RVCV, and they have a wonderful volunteer kitchen where the mamas bake fresh bread and serve incredible food. Wednesday’s main course was tuna salad and egg salad sandwiches with fresh fruit and a green salad. Freshly bakes cookies were there for dessert. On Thursday, we were served rice with either beef or chicken over it along with the fruit and green salad. The Tanzanians typically don’t eat with us for lunch, which bothered me early on until I was finally told that it was their choice as they didn’t like the food being served to us and would rather eat their traditional African food than ours.
We had planned to go out to the Sparrow on Thursday night for some dancing, but with Denzel sick, we couldn’t possibly have proceeded without Annie in tow, so it was postponed until next week. We would be leaving for the Serengeti first thing in the morning, and I had to get Turtle to Vitalis so he could make sure that everything was shipshape. Leonard had offered to have us take their Land Cruiser, but with the recent rains having come, we all agreed that that Land Rover would be a better choice despite the fact that it had less creature comforts than the new Land Cruiser. Unfortunately, Vitalis’s Noah (van) that he was taking had a tire problem on its way and he had been stuck in Mto wa Mbu for two hours, ending up arriving very late in Karatu. We ended up deciding to have him come to our house at 6:00 am to pick up the vehicle and begin our trek once again to visit the Serengeti. Everyone was super excited, and we had our lunch prepared for the following day.
