Ever since changing the structure for the residents of the FAME rotation from 4 weeks to two three-week sessions twice a year, it has meant that there would be a changeover weekend midway through the six weeks. This change occurred with the fall trip in 2022 and was prompted by increasing interest by the residents as well as an increase in both Penn’s and CHOP’s neurology residencies. For the first three of these six-week sessions, I had felt it necessary to transport the departing residents to the airport myself on Saturday, spend the night in Arusha with the Temba family, and then pick up the arriving residents the following morning and travel back to FAME with them. Given the three-hour drive to the airport along with the hour drive back and forth to arusha, this meant a total of eight hours of rather arduous driving until I was back at FAME – though the arriving residents had all traveled over 24-hours to get to Tanzania, I’m pretty certain I was at least as exhausted as any of them after that trip.

Thankfully, the voice of reason arrived with me in March 2023, and though I will admit that I’m not the easiest to convince, by the following year, I had come to my senses. Jill had arrived with me that March and had accompanied me for that somewhat brutal transport to and from the airport with an overnight in Arusha, and, in a very sensible and matter of fact manner informed me that there was a better way of doing things. For the following March, it was merely a matter of my arranging transport to the airport for the departing residents and pickup of the arriving residents the following morning. Not only was I now spared from schlepping needlessly to and from the airport on an overnight journey in Arusha, but Jill and I had the opportunity to experience one of the local lodges overnight for a relaxing visit, a swim, and some lovely food. It just took someone with a bit more commonsense (or, more than likely, much more) than I have been accused of possessing.

Our last day of clinic on Friday was another half day to allow everyone plenty of time to pack up and ready themselves to depart. As Kyle was booked on a morning flight out of Kilimanjaro, it meant that he would have to leave this afternoon and overnight at the airport in the KIA Lodge. Transporting tourists during the nighttime hours is prohibited in Tanzania due to the high risk of accident and injury. Motor vehicle accidents and traumatic injuries including head trauma are significantly more frequent in low to middle income countries (LMIC) worldwide and perhaps even more so in Tanzania. Trauma is one of the risk factors for epilepsy, and this is one of the biggest reasons why 90% of epilepsy worldwide exists in LMIC, and exactly where there are the fewest neurologists to care for them.

There are many reasons for this increase in traffic accidents at night, not the least of which and perhaps the most unique is that there are wild animals roaming the countryside, most of whom are more active at night and many of whom are larger than the vehicles they’re up against. Encountering an unexpected elephant, giraffe, or adult Cape buffalo in the road is generally a very disappointing experience and doing so in the dark and at any speed can be even more so. The other reasons for the number of accidents has to do with the general condition of the roads and the vehicles traveling on them. There are no vehicle inspections here for safety measures and, as such, vehicles are kept running far beyond what would be reasonable anywhere else. Land Rovers thirty years old and beyond are commonly driven by the local residents, often completely packed with passengers both on the inside as well as those riding on the roof, frequently on top of packages stacked so high it’s hard to believe the cars don’t just topple over before they even begin to move.

In addition to the restriction on nighttime travel, the disruptions in air traffic through the Middle East since someone unilaterally (and quite frankly, illegally) chose to attack Iran, has unfortunately required more coordination for resident transport given the fact that we now have a random scattering of departure and arrival times as the flight itineraries have by necessity become more creative. Thankfully, Vitalis, our fearless safari guide and friend, has stepped up to help handle the transports as they are financially rewarding for him, and he’s proven to be incredibly dependable for the task. Having someone you know drive you three hours to the airport as opposed to a random driver is far more pleasurable for a multitude of reasons, not to mention the ability to stop along the way if necessary.

Vitalis came to pick up Kyle Friday afternoon and transport him to the KIA Lodge, and was back on Saturday to transport Shannon, Becca, and Colin to the airport as well. Colin would not be flying home, though his wife, Karin, was arriving that evening for them to depart on a combination game drive and visit to Zanzibar. I was quite happy when the residents elected to stay at home on Friday evening rather than go out for dinner as it gave me some time to relax and catch up on work. Vitalis arrived on schedule at 11:00 am to transport the three to Kilimanjaro, with a quick stop at the Galleria for some last-minute shopping.

With the residents having departed, I was now free to spend time on my own. I had planned to do a bunch of busy work for the afternoon with a late visit to the Galleria to pick up a small gift for Milla, whose birthday I had been invited to the following day. Besides, my mouth was watering for their Thai chicken curry dish at the Ol Mesera restaurant and I had no other plans for dinner. I visited local friends later on in the evening and slept in our empty house, awaiting the arrival of the next group of residents on the following day, once again collected and transported by Vitalis for his third trip that weekend. I relaxed and worked in the morning, wrapped Milla’s present in plain white paper that I had sitting around, and walked to the canteen for my favorite lunch of rice, beans, and mchicha with plenty of pili pili (fresh hot sauce). Milla’s party was at 2:00 pm, and considering she was turning seven, there were more screaming children slowly arriving than I felt comfortable with, eventually excusing myself to make ready for the arrival of the next group of residents.

I had told Vitalis to stop at the Ol Mesera restaurant on their way as they’d be hungry for lunch most likely, so it wasn’t until after 3:00 pm that they arrived – Harry, Geena, and Maria – exhausted from their long flights, but quite happy to have finally arrived in paradise. Having been in the same situation a multitude of times, I know how very much they appreciated their showers and short naps prior to heading out later for dinner at the Lilac Café later this evening for dinner.

Tomorrow would be Ground Hog’s Day for me – a new group, orientation, EMR teaching, and starting their first week at FAME clinic followed by a day in the crater, mobile clinics, the Serengeti, and wrapping everything up once again, only to return in six months and do it all over again. Don’t get me wrong, though, for I love this work more than anyone could ever imagine and there is nothing else I’d rather be doing with my life – Tanzania, the roads, the dust, the smells, the people, the animals, the culture, my patients, and especially FAME, have all become such a large part of my very being and for that, I will be forever grateful.