One might think that traveling to the same place every spring and fall for the last fifteen years might become a bit old hat, or even boring, and though I’ll have to admit that the logistics of now taking upwards of a dozen or more colleagues with me can become a bit burdensome at times, my passion for the work we’re doing here at FAME has not waned one bit over that time. Since my first visit in 2009, when it was only a year old and all that existed was a single outpatient building, FAME’s campus has continually grown along with the volume of patients that are cared for annually, now well in excess of 30,000, and it has become one of the premier health care facilities in Northern Tanzania, providing patient-centered care to a vast region of the country with a referral base of nearly three-million residents.

What defines FAME in my mind, though, is not the volume of patients who are seen each year, nor the number of emergency patients who are cared for in our brand-new, and frankly unique, emergency room, but rather it is defined by those who work here each and every day, many of whom who have done so since the very beginning, and consistently return to ensure that what was started as simple dream over twenty years ago will continue into the future. This is the FAME family – each and every worker, from the doctors and nurses to the housekeepers and grounds keepers, from our administration to our kitchen team, from our social workers to our drivers, from our volunteers to our laboratory team, from our security team to our pharmacy team (and anyone I’ve forgotten) – made up of those who have believed and worked hard to turn a dream into a reality.

There was clearly something that drew me back here following that short visit in 2009, one that had been on a whim and so serendipitous, and though I hadn’t realized it at the time, that decision would change the entire course of my life in such an incredibly positive manner. Despite difficult life events over the next few years, I not only managed to make it to FAME to volunteer in 2010 but have continued to do so two times each and every year since, making this current trip my thirty-second to Tanzania, something that I never would have imaged possible.

So it is on this background, and because of the FAME family that I have become a part of, that I have continued to return. But it is equally those one-hundred plus others – medical students, residents, fellows, and colleagues – who have accompanied me here and have had the opportunity to experience that same incredible sense of gratitude and accomplishment that I have on each and every one of my visits to this truly magical and unique place that has changed so many lives that its touched in so many ways.

Our visit this fall was to be a bit different, with fewer than the normal number of residents, an epilepsy fellow, a medical student, and an awesome trio of junior attendings – each of whom have accompanied me here before as residents and have now elected to return based on their previous experiences. We have again planned two three-week sessions with similar scheduling as we’ve done in the past to include our FAME neurology clinic, mobile clinics to some of the more remote villages in the Karatu district, game drives to some of the parks, and cultural events that I have developed over the years to introduce everyone to the wonderfully colorful people of Northern Tanzania.

But first, we had to get there. I mentioned the logistics previously, which can become fairly cumbersome at times, but just imagine trying to coordinate flights, evacuation and travel health insurance, licensing, visas, and all the other little pieces of information that go into getting a large group comfortably and successfully transported half-way across the world to a place that is foreign to nearly everyone and where simple travel can often be a major undertaking and is not to be taken lightly. Simply put, Tanzania is not a place where one can get off the airplane and find their way around in any sense of the imagination. It requires careful planning and the knowledge of how things operate here, which are almost entirely opposite of how things are done at home. Arriving without a plan is simply not an option.

For me, the two most stressful parts of my trip are checking in with my luggage at the airport and going through customs once arriving to Tanzania. I am typically traveling with a minimum of two fifty-pound duffels, or possibly three as was the case for this trip, as I have a number of things that I am usually bringing to FAME for the work we’re doing there, as well as a few gifts here and there for friends in Tanzania where Amazon does not exist. In addition, I have a tremendous amount of camera equipment that includes an extra high-end digital SLR with a huge lens that is for the residents to use mainly because I am not thrilled with loaning my camera to anyone, and I want them to experience what it’s like to take photos on a game drive. My luggage is usually always at the maximum weight limit, and it always seems that no matter how many times I weigh them at home, they’re a pound or two over at the airport. This time Cat Kulick was able to check one of my bags for me to save a $100 excess luggage charge.

We were flying to Boston from Philadelphia first and, of course, our flight was delayed so that we had to make a brisk walk between terminals just to make our second flight to Doha, Qatar. We boarded the flight, hoping that our luggage would also make it (it did), but there was a mechanical problem with our plane that resulted in a 4-1/2-hour delay. We stayed on the plane for most of that, but there was an issue with the A/C in the plane (either that was the mechanical problem or they couldn’t run it with the mechanical problem that existed) and we had to deplane with all our carry-on luggage at one point and then reboard which is not a simple undertaking for a huge wide-body jumbo jet. We were finally on our way to Doha and thankful for the eight-hour delay that we had in Doha and would now be a 3-1/2-hour layover. Our flight to Kilimanjaro took off on time at 1:55 am and was uneventful, getting us there just after 7:00 am.

Now for the second stressful part of my travels – Customs. I have been bringing over medications that we use to treat our neurology patients for at least the last ten years and have never had an issue at the airport given that all the medications are registered here in Tanzania, none are expired, and all are sealed. These medications are donated to FAME and are dispensed to our neurology patients in clinic as part of their visit when they see us. Though it should not surprise me that this practice would eventually catch up with me as regulations change over the years, or perhaps they are enforced my rigidly, it didn’t ease the pain when I spent well over an hour, initially with the customs agents, and then with someone from TMDA (Tanzania Medicines and Medical Device Authority) who were adamant that I would need a permit to bring the medications in this time. In the end, I had to make a list of the medications which I brough, their cost, how many tablets and bottles of each medication, and then surrender the entire lot to them until we obtained a permit. In the future, I will plan more accordingly, but that didn’t help me on this occasion.

Delayed leaving the airport, we made our way to Arusha with Pendo, who is one of my Tanzanian family and Leonard’s (the safari guide who first brought me to FAME in 2009) wife, where she made a lovely brunch for us weary travelers that included pancakes, scrambled eggs, sausage, fried potatoes and onions, and watermelon. After a short rest, we left her house to pick up my short Land Rover (Myrtle) which I would be driving to Karatu, two hours away, with the others. The stretch Land Rover (Turtle) would be ready in a few days and brought to us when it was. Off we departed for the Great Rift Valley, then up to the Ngorongoro Highlands and finally to the campus of the Foundation for African Medicine and Education. Having only slept for four hours on the second flight and having no sleep on the third flight (the gentleman sleeping in the middle seat had his elbow on my side of the armrest and squarely in my ribs), it was a real chore for me to make that drive in the warm sun as everyone else in the car was intermittently falling asleep. We eventually made it here to FAME and the Raynes house. Pendo had packed us lunch, there were groceries in the kitchen, and the kuni boiler was fired up for hot showers – as they say, “Life is Good.”

We were all mostly drained after dinner and everyone went to bed early – me, Cat, Joe Geraghty, and Julian Gal. Another member of our team, Jack Cook, would be arriving at 1:00 am to Kilimanjaro International Airport and would be picked up and brought to FAME first thing in the morning as there is no traveling at night for non-Tanzanians due to the risks involved with hitting wild animals or traffic accidents due to the crazy bus drivers who careen from city to city in behemoth buses at speeds that are genuinely unsafe. Tomorrow would be our first day in clinic after morning report and an orientation on the new electronic medical record here at FAME. With our small group, we would have our work cut out for us as Cat and Julian are planning to spend time working with the Brain Capture EEG device we now have here and are trying our best to implement completely. Regardless, the first day of clinic is always exciting for those who have never been here before, and even for those who haven’t been here for four years such as Cat.