Mobile clinics have been a part of FAME from its inception, though early on they were a much bigger production involving an entire team of physicians, nurses, lab personnel, and a host of support staff traveling for an entire week to a remote region along Lake Eyasi and providing general medical care to the Datoga and Hadzabe tribes who lived in that region. They were done monthly, that is when the roads were passable, and were funded through a grant by another non-profit, Malaria No More, that lasted until around 2011. At about the same time as those full-on expedition style mobile clinics were winding down, I began to travel to some of the smaller villages in the region, along with the help of a lovely social worker, Paula Gremley, and her associate, Amir Bakari Mwinjuma, to see neurology patients and to provide them medications, if necessary.
What initially began as more of an impromptu visit by a small team from FAME with a single vehicle and with a single neurologist, me, has now morphed into what has become a major component of the neurology work we’re doing in Tanzania – a full team of neurologists, a social worker, interpreters, a nurse/pharmacist, one of our volunteer coordinator for any logistical issues that arise, and a FAME driver in two vehicles (I drive the second one). The clinics can be as far away as over an hour to reach, or sometimes shorter, though all require a full day of work to see the patients there, or at least to be available for the full day in case they show up. We don’t have a means of confirming the number of patients in advance, and even if we did, the situation could change at a moment’s notice with the weather, timing of planting or harvesting, or a host of other things that can interfere with their ability to travel to clinic and drop everything else in the process.
Over time, we have traveled to many villages, some of which have remained on our schedule, others that have not, and still others that we’ve found in need during our travels. One such village is Basodawish, a small village about 30 minutes away from FAME on the Endabash Road that heads south out of Karatu through lovely farming communities in a region that is almost entirely Iraqw. We first traveled here a few years ago and not only found the community to be in great need, but also extremely poor with difficulties to even cover the cost of transportation to be seen at FAME, only further necessitating our visits there. Though it’s unfortunate that we can only come every six months, it will still be of great help with many of the patients living there, but important to keep in mind that most will be obtaining their medications from the local “duka la dawa,” or pharmacy, meaning that medications such as levetiracetam for seizures are not always available in the smaller village pharmacies.
One other feature of Basodawish was that there was significant support in the community through an organization that FAME has partnered with, Food For His Children, a local non-profit, NGO focusing on the poorest of the poorest and helping to develop sustainable community empowerment through initially providing a goat along with support, reducing dependency, developing safe housing, and eventually businesses. When we had first arrived to Basodawish, the health center there had very little – we worked on dirt floors with little in the way of furniture, perhaps a plastic chair or two and makeshift tables. What they did have, though, was an interest in bettering themselves. With a donation to FAME, I was able to provide the necessary furniture for our clinic to function when we’re there – benches for the patients to wait on as well as desk chairs and tables. When we arrived on this visit, the dirt floors we had worked on previously were now tiled and the walls painted. The furniture I had provided was still present and ready for our use – it is these simple things that make it clear the community is trying to help themselves and will be successful.
We saw a good number of patients here, eighteen in all, which were mostly epilepsy, some of whom had significant developmental delays, though others which were idiopathic (no clear etiology). One unfortunate elderly woman had to be carried in by her family as she had a severely flexed cervical spine and a severe spastic quadriparesis – it was very clear that she had cervical spondylosis and compression of her spinal cord, though unfortunately, her extremity weakness had been present for over 9 years with very little in the way of changes for better or worse and her examination was entirely consistent with a cervical compression and myelopathy. Whether we sent her for imaging studies or not, she was not a candidate for surgery as it would not benefit her in any positive fashion.
As far as the epilepsy cases were concerned, it was very important here in Basodawish not to give in to the tendency of prescribing levetiracetam, which in the states is used most often as it is the least complicated thing to dose, but it is also significantly more expensive here in Tanzania, and, as I had mentioned before, is commonly not available in the smaller villages at their duka la dawa. There are several other very fine antiseizure medications we have here, namely carbamazepine and sodium valproate, that work well, are generally much less expensive, and are available in most of the local dukas. Even lamotrigine is less expensive to use than levetiracetam, though I will say that we’re thankful to have the latter medication for those patients where something needs to be loaded quickly, even though through an NG tube.
With the number of patients in Basodawish (which was moderate) we were able to hit the road early enough to go into town to buy Kitenge cloth for Teddy to make some clothes for everyone, and had actually planned to visit her shop, though we bumped into her in town, only to discover that her car was on the fritz and being fixed by the fundi so she wouldn’t be available until tomorrow evening. The Kitenge cloth throughout both East, Central, and West Africa are all very similar and incredibly colorful in their designs that are predominantly abstract in nature, though on occasion you’ll find a more realistic design, mostly of African animals. The bolts of Kitenge come in several meter lengths, enough to make several pieces of clothing from each, and typically cost around 30,000 Tanzanian shillings, or approximately $12 USD.
As we were in the central part of town and very close to the market we usually shop in for groceries, the team stopped by and grabbed a few things we were out of at home. I stayed in the vehicle while everyone was shopping as it’s the safest since we can’t lock Turtle and everyone’s things were still inside. We haven’t been able to lock it up since its had so many overhauls and revisions to the doors that it’s pretty much of a Frankenstein at this point, sharing parts from various other vehicles. I had parked on the side of the road and was sitting in the car when two policemen on a motorcycle suddenly appeared in front of me and were pointing to a “no parking” sign several car lengths in front of me that I had thought wasn’t referring to where I had parked. No such luck, though thankfully they merely asked me to move rather than ticketing me which would have been more consistent with my history driving in Tanzania. Several years ago, I had received three tickets in less than 24 hours, though have learned my lesson since then.
We returned home for dinner and a relaxing evening in the house. Our visit with Teddy was rescheduled for tomorrow evening and we would be spending the day at Rift Valley Children’s Village which is always one of the highlights of a visit to FAME.