The Neurology Mobile Clinics have been a part of our work here at FAME since the very beginning of my involvement and prior to bringing residents with me. FAME had been providing monthly week-long expedition-style clinics to the Lake Eyasi region serving the Hadzabe (the last, and vanishing, hunter-gatherers of Tanzania who speak one of the click languages of Africa) and the Datoga (a pastoralist tribe similar to the Maasai but who migrated to Tanzania long before them) several years prior to my arrival – this had been funded by a three-year grant from another non-profit, Malaria No More. I was lucky enough to have gone on several of these road trips before the funding ended, traveling to some of the most remote regions of Tanzania where there are literally no roads, or at least we didn’t travel on them, and sleeping for a week in primitive conditions with bucket showers using hot water (when it was available) heated by the local women over open fires. I remember these trips as perhaps some of the most adventurous and exciting experiences I’ve had, and it clearly brought back memories of my Forest Service firefighting days.
Our very first neurology mobile clinic, which occurred in the spring of 2011, was a much smaller version of what we provide today as it involved only me with an outreach team, a nurse, and a box of medicines that we needed. It was a rather spur of the moment decision to travel to the Mbulumbulu area of the Karatu District and see patients in villages such as Kambi ya Simba and Upper Kitete. We continued to provide services to these villages over the years and once I began to bring residents, the mobile clinics became tremendously bigger events that requires much more planning and logistics, advance outreach to the villages, and multiple vehicles to accommodate the three to four residents along with their interpreters, along with our support team. As we felt the Mbulumbulu region was eventually saturated and the villagers were aware of the services we could provide at FAME, we began to look for new areas that could use our services.
Visiting a village to provide our neurological care, though, is not always as simple as it sounds. Lots of prep work is required to survey not just the need for our care (which is pretty much universal), but also how we will fit in with the already existing care that is being provided at the government dispensary by the nurse or clinical officer employed by the government to take care of the villagers in the area. That essentially means that our advance outreach team needs to meet not only with that nurse or clinical officer to make sure that we are welcome, but also with the village committee who makes these decisions and is willing to let us come in and see their residents in need of neurological care. Despite the fact that we are coming in to provide only neurological assessments (general medical care is already provided by the government clinician and the last thing we want to do is step on anyone’s toes or suggest that we can do things better) and do so for the same subsidized cost we do at FAME (5000 TShillings or the equivalent of $2 for the visit, any labs that are needed, and a month worth of medication), it’s not always quite as obvious as it sounds in regard to whether we’re welcomed or not.
We’ve had a village go out of its way to give us the cold shoulder after having worked with them for several years over simple misunderstandings and we even had a village demand that we pay them for every patient of theirs that we see as they were certain that FAME was profiting from the work that we were doing when in fact, it’s quite the contrary – FAME has been, and will always be, a very heavily supported NGO that relies on its US non-profit organization to provide funding from private foundation grants and, even more so, from individual donors such as yourself who give to this amazing organization that has helped so many thousands of people in a region of the world with such incredibly limited access to medical care (if that sounds like a pitch for you to hit the “DONATE TO FAME” button on my home page, then you’ve read it correctly and I’ve done my job).
Even today, though the dispensary clinical officer seems enthusiastic and commits to working hard to make sure there are patients for us to see when we arrive, we have occasional clinics where there is a paucity of patients and it no longer makes sense for us to bring two vehicles full of staff, buy lunchboxes, and spend money for our outreach to travel in advance to the areas and spend money on announcements if we have few patients. Over time, we’ve committed to those centers who have not only seen the value of having us visit but have also assisted us in making sure there is work for us to do when we arrive.
On Monday and Tuesday of this week, we would head to the Rift Valley Children’s Village (RVCV), a remarkably magical place that is very different than the other villages we visit on our neurology mobile clinics, but in a similar fashion we’re able to make a huge impact in the neurological health of patients who would otherwise have very limited access to specialty care. The Children’s Village first opened in 2004 and was founded by India Howell and Peter Mmassy when they decided to take in either orphaned or at-risk children, but into a home rather than an orphanage. All the children are essentially adopted by the parent organization, the Tanzanian Children’s Fund that has continued to support the Children’s Village as well as numerous other programs including partnering with the local village to improve education, working with the local women to teach them trades and starting businesses with microfinance (The Rift Valley Women’s Group), and, finally, which is where FAME and we come in, healthcare for the Oldeani villagers.
The location of FAME in Karatu has everything to do with the RVCV, as it was suggested by Mama India to be close enough to provide the necessary medical care for her children and the village of Oldeani, but not too remote to prevent easy access to the Karatu district which made Karatutown the obvious choice. In the beginning, FAME would provide health services at RVCV every two weeks, and it was during these clinics, that we first began to provide neurological care as a separate team. The biweekly medical clinics were discontinued several years ago for a number of reasons, but we have continued to provide the neurology clinics every six months. Equally important, the Tanzanian Children’s Fund hired an incredible clinical officer, Africanus John, who briefly worked with us initially as a translator, but was quickly hired by FAME where he worked for a short time before moving over to the Children’s Village. In the last several years, he has developed an amazing medical clinic that is located adjacent to the Children’s Village and is available not only to the children, but to the Oldeani Villages, whose medical care continues to be covered.
Africanus and his assistant, Ema, also a clinical officer who previously worked with us as a translator, do all the outreach so that we have lots of follow up patients as well as new patients with neurological issues. They also have paper charts that are kept in the clinic, and they do the work of preparing everything for us along with triaging the patients and taking vitals, so all we have to do is show up and start seeing patients. The facility that was build is also incredible and is a far cry from the much more rustic, and often primitive, government health dispensaries that we work in at the other mobile clinic villages. To say that working at the medical clinic at RVCV is a joy would be a gross understatement – it is a breath of fresh air in an otherwise challenging environment in which to provide healthcare.
Since Wednesday of the week would be the 7th of the month meaning that it was Maasai Market Day in Karatu, it was decided that we’d stay at FAME for clinic rather than go out on mobile clinic – the market in Karatu is the largest in the district and a great many people attend it meaning that it would make it more difficult for patients to see us, and also many of the staff that accompany us on mobile clinic shop at the market which would greatly inconvenience them since it only occurs twice a month.
On Thursday, we would head north to the village of Basodawish which is about 30 minutes out of Karatu on the road leading to Endabash and Mbulu (not to be mistaken with Mbulumbulu). The region surrounding the village is incredibly fertile and there are many, many farms in the area, yet the population there are among the poorest in the district. Food For His Children is a US non-profit, Tanzanian NGO that provides assistance for marginalized families and communities in this region, though despite this help, these families have very little and are in great need. The dispensary at Bisodawish is very basic at best, and it took some time for us to find the furniture necessary to have three serviceable examination rooms for the residents to see patients. We had lots of patients, though, and they seemed to keep showing up as the afternoon went on, but at least we didn’t have to turn anyone away. Patients filtering in after lunch is very common as after patients are seen, they go home and tell others who then make their way to see us in clinic.
We’d be leaving for the Serengeti in the morning, so I had to get Vitalis our vehicle for him to check it out before our departure. Turtle was running well as we’d been keeping up on repairs which is typical for the Land Rover, but it needed a good wash and the dust needed to be blown out of the interior after the week of dusty mobile clinics.
