As luck would have it, our team of residents departed Friday night, February 27, with President Trump and Prime Minister Netanyahu apparently having already made the decision to attack Iran on the following morning, without the consent of congress, of course, and for reasons that remain unclear. Ozi, one of our adult neurology residents, had departed from New York City, where she had been interviewing for residency, and was on her way to Doha, Qatar, when her flight was suddenly diverted to Rome. Thankfully, she contacted me right away and we were able to book her on an Ethiopian Airlines flight later that night to Addis Ababa and then to Kilimanjaro, where she would be arriving later in the morning on Sunday, and here to FAME later in the Afternoon.
The other three residents were not so lucky, unfortunately. Their flight, which was on American traveling to Doha, reached all the way to the other side of Spain before it was finally diverted from continuing on to Doha where the airspace was now completely closed due to the expected and already ongoing retaliatory strikes from Iran on Israel and other Gulf States where American bases or other high value targets were located. Rather than finding an airport in Europe or North Africa as had been the case with Ozi, though, it was apparently decided that their flight would make U-turn and travel all the way back to Philadelphia, arriving midday on Saturday and no closer to their destination than they had been the night before. Thankfully, the residents were incredibly resourceful and immediately began to look for additional flights that didn’t fly anywhere near the Middle East and weren’t exorbitantly priced. Luckily, they found a very convenient flight on Swiss Air through Zurich and on to Kilimanjaro that although had an extra stop, would be the safest of all. It wouldn’t leave until Monday, but it was better late than never as the other option of abandoning their plans would not have been fair to the residents, who have been looking forward to this experience for several years, or to our Tanzanian neurology patients who had been patiently waiting six months for our return.
Having to fend for ourselves for dinner on the weekends, and without groceries in the house as we had just arrived, we all decided to travel to the downtown Lilac Café where you can always get a delicious meal, as long as one is not in much of a hurry. I loaded everyone – myself, Jill, Ozi, along with three other board members, Kathy, Ke, and Barb, and two other volunteers, Alex and Ann. We were home early enough as we knew that tomorrow would be an interesting day as we were down three of the four residents and regardless of the fact that we don’t announce clinic starting on Monday, patients always seem to know that we’re in town.
Our house emptied out on Sunday as my fellow board members and their partners had departed for other parts nearby, freeing up room for Ozi, and the others who would be en route to arrive shortly. Ke Zhang, our youngest board member and someone who has been a huge part of FAME for even longer than me, was hanging around until tomorrow and would have roomed with one of my residents had he arrived on time. Ke first met Frank and Susan in 2008 when he was still a sophomore at MIT and was participating in a global project with school spending time at Rift Valley Children’s Village. As is so often the case here, that chance encounter changed the entire course of his life as medicine hadn’t been on his radar at the time, but with his involvement and visits here, he subsequently went to Yale for medical school and subsequently finished an interventional radiology fellowship at Mass General, and is now on faculty at Brigham and Women’s Hospital, or “The Brigham,” in Boston. As pretty much of a techno nerd, Ke has been involved in developing nearly all of the FAME technical infrastructure and is now looking forward to becoming involved in the actual clinical aspects of FAME from a radiology standpoint.
Currently, the vast majority of our radiology, and especially our CT scans, are read by Alex Baxter, an academic radiologist from the New York City area, who has volunteered for this immense job now for a number of years and has been a huge FAME supporter along the way. Alex just happens to be visiting currently which will be great given the number of abnormal CT scan of the brain we anticipate while here seeing our neuro patients.
We typically reserve our first Monday here at FAME for orientation of the residents as well as training on the electronic medical record (EMR) that’s used here, so we don’t start seeing patients officially until the afternoon, but given the fact we’re missing a significant chunk of our workforce and not wanting to duplicate efforts, we’ve decided to delay things until the rest arrives on Wednesday. Thankfully, the EMR was a snap for Ozi to learn (much more difficult for old folks like me) and she had no problem seeing the several patients that showed up for us to see.
While I normally introduce the entire team at morning report on everyone’s first Monday, I would have to do this in parts given the other’s arrival midweek. As is usually the case, though, there was a neuro patient that came in the night before who needed our input which unfortunately turned out to be an elderly patient who had suffered a very large intracranial hemorrhage that would not have been survivable back home. The hemorrhage was very large with midline shift and was most likely hypertensive in nature. Ozi and Annie did go to see the patient later in the morning to document her status and confirm that she would be placed on palliative care.
Thankfully, we were able to adjust the radio announcement that would go out today regarding our neuro clinic so we shouldn’t expect the huge volume of patients tomorrow, Tuesday, though we could only do so for so long. Our remaining residents would be arriving to Kilimanjaro Airport on Tuesday evening, though would have to overnight at the KIA Lodge at the airport as we’re not allowed to travel at night due to safety concerns. Traffic accidents are quite common, and to a much greater degree in the dark, while game animals roam free throughout the countryside and can often stray into the road. The residents will be picked up early in the morning and hopefully be here by around 11 am. I suspect we’ll have plenty of patients to see, but we always get through the list somehow.
One interesting patient we saw yesterday, and who we had come back this morning, was a 6-year-old Maasai boy whose parents brought him in to see us after he developed sudden onset of a dense left hemiplegia 19 days earlier. They are from the Ngorongoro Conservation Area where any medical care is quite sparse, and the boy hadn’t been seen by anyone before coming to FAME. His CT scan appeared to demonstrate a subacute right frontal infarct with dystrophic calcification, though one wouldn’t expect the latter finding so soon. The family also described lots of arthralgias and myalgias in the past, so we though this could certainly be sickle cell disease, his test was negative when it returned today. He was severely anemic, though, with a Hgb of 5, so we admitted him for a transfusion at the very least and will hopefully come up with some other thoughts as far as his differential. Unfortunately, there is very little to offer at this point in regard to the stroke that he’s already suffered.
I’m also including a few photos that were taken during our in-person board visit at the end of last week. The US FAME board is a group of truly amazing individuals, all of whom are thoroughly devoted to the work that’s done here in Tanzania, and work tirelessly to ensure the continued funding necessary for the operations of FAME Hospital. Many of us on the board are also volunteers and come to work on a regular basis, though we also have several non-medical board members for whom these in-person board meetings in Tanzania that occur every three years are an opportunity for them to see just what is happening on the ground here and the tremendous progress that has occurred since the opening of FAME’s medical facility nearly twenty years ago. During these several days, we not only met with each other to discuss what we each have to do to make certain that FAME continues into future, but we also met with our FAME Tanzanian management team, FAME staff, and toured the programs of our most important partner in Tanzania, the Tanzanian Children’s Fund and Rift Valley Children’s Village.
It was an inspiring weekend working with such an impressive group of individuals, both those on the board as well as the many employees who have made FAME their home, all of whom are here with the same purpose and who, despite the varied backgrounds and stories of how they came to be at FAME, have dedicated their lives and work to make FAME the very best it can be for now and forever.
