Thursday, September 18, 2014 – Old Friends and Muscular Dystrophy

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Our first three days of clinic have been amazing in regard to the number of patients we’ve seen and the diversity of diagnoses. Lots of epilepsy to keep Danielle happy and lots of pediatrics to keep Doug happy as a clam. We had another very busy day and in the first four days were we’ve now seen 94 neurology patients with lots of mobile clinics to go.

Most of the patients we see here at FAME are either Maasai, Chagga or Iraqw with a smattering of other tribes. There are actually 120+ tribes in Tanzania which is an amazing diversity and has been a real challenge since their independence to unit the country. This diversity, though, is what makes Tanzania the country that it is both culturally and aesthetically. Practicing at FAME in the Karatu district we often need multiple interpreters to help with our evaluation. Most of the Maasai women from the boma do not speak Swahili and only speak Maa (Maasai literally means those who speak Maa) and we often run into Maasai men who only speak Maa. There are few Maa interpreters, but we have several here at FAME which is a real bonus so we don’t require double translation. Same with the Iraqw language as none of these languages have very much in common. We deal with this everywhere we travel often using local townspeople to help us with the translating duties.

Monday we got to see Roza in followup. She is the 15 year-old that Danielle and I diagnosed with Syndenham’s chorea in December 2012 and who we have followed since then. It is an amazing story of making a diagnosis by internet, initiating treatment prior to arriving and then following up to finally see the patient in person. Danielle and I first evaluated Roza in March of 2013, I saw her by myself the following September and then Megan and I saw her together last March. When I last saw her the movements were persistent and bothersome for her, but this visit they are now almost imperceptible and she has blossomed into a beautiful young woman who has so much ahead of her. She is doing well in school and just took her national examinations to see whether she can continue in school or not. She is very optimistic and has reason to be. Roza’s story encapsulates the importance of FAME, it’s mission and our work. Had they not sent the video of her when they did and had Danielle and I not seen it right away Roza very likely wouldn’t be here to grace us with her lovely smile. She was that sick and in need of the right treatment and it is a very tough diagnosis for a non-neurologist to make.

Roza on the left with Danielle and Roza's mom

Roza on the left with Danielle and Roza’s mom

Doug got some amazing experience with neuromuscular cases over the last two days seeing a number of boys brought by a Norwegian gentleman who runs an orphanage in Mto wa Mbu (Mosquito River) and also helps out with the local Maasai. He brought a young boy back who I had seen last September and diagnosed with muscular dystrophy (probably Duchenne). He is obviously no better, but also not much worse and I had initiated steroid therapy last year when I had originally seen him so that may have helped a bit. Doug also saw two of three brothers with muscular dystrophy yesterday. Now keep in mind that Doug is pretty certain that he’s never cared for an outpatient muscular dystrophy patient in his training career to date. He’s seen and diagnosed three so far here and has more on their way from Mto wa Mbu coming. An amazing teaching experience!

A young Maasai boy with muscular dystrophy and his mom

A young Maasai boy with muscular dystrophy and his mom

Doug examining our patient

Doug examining our patient

Finally, Danielle and I had the privilege to see elderly Maasai women today who was so amazingly elegant and just glowed with a sense of grace. Her facial expressions had both of us totally in enthralled and it was impossible to watch her and not have such a sense of security and warmth. This is Tanzania. Danielle also spent the day teaching Dr. Isaac the neurologic examination and by the end of the day he was a pro.

Danielle evaluating a very elegant patient with Dr. Isaac assisting

Danielle evaluating a very elegant patient with Dr. Isaac assisting

Another successful day in clinic with Danielle and Doug. Many more to come.

Lala salama,

Mike

September 15-17, 2014 – FAME Neurology Clinic

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I apologize for the long pause in emails, but things got hopping here pretty much from the get go and we’ve finally had chance to catch our breath.

Sunday after our safari was pretty much a day of rest and unpacking. We didn’t work, but were able to catch lunch with everyone in the canteen – my favorite, rice and beans with some Mchicha (a dark green vegetable similar to spinach but chewier) on the side. The weather has been cooler than usual with a bit of rain here and there so everything is green rather than the normal dry season shade of brown. Doug (our pediatric neurology volunteer) arrived right around 5 pm after 40+ hours of travel. His last flight was through Addis Ababa with an overnight layover that I’m sure he will never do again.

Reunited, we walked to clinic on Monday morning mostly refreshed and ready for new challenges. Rounds in the hospital ward here begin at 8:30 am and there was a little Masai boy on the ward who had been waiting there for a week or so for us to see. It was tough from the descriptions to tell exactly what he had, but when we say him it was very clear to the three of us that he had some post encephalitic encephalopathy with frequent seizures (multifocal) and probably progressing into Lennox-Gastaut syndrome. Very sad, but at least we were able to identify for everyone what the actual seizures were and to make some medication changes to benefit him. Overall prognosis, though, is very, very poor. That was just the beginning.

Doug examining a young Maasai boy who presented in status epilepticus

Doug examining a young Maasai boy who presented in status epilepticus

We walked to clinic a little late after our rounds and found that there was already a line of patients waiting for us. We split into two groups with Doug and Danielle seeing most of the pediatric and epilepsy patients while I saw most everything else neurologic. The patients we’ve seen for the last three days have been great neurology patients with lots of epilepsy for Danielle and lots of peds for Doug. They’ve seen newly diagnosed muscular dystrophy and a case Ohtahara syndrome among others. The clinic had a record setting day on Monday breaking 100 patients for the first time and beat it on Tuesday with 112 patients. We contributed 21 patients on Monday, 26 patients on Tuesday and 22 patients again today.

Unfortunately, because of the volume we weren’t able to work with clinical officers and had to use interpreters which means we weren’t able to do as much teaching as we’d like, but we still have lots of time here.

After work today we ran down to town and walked around for a while taking in all the wonderful sights. Doug summed it up well by describing the scenes as “authentic.” This is such a different culture here and something that is so hard to actually describe in print. It is an amazingly vibrant world here full of so many colors, so many different sounds and smells that your senses are on high alert. Anyone with even a thread of adventure couldn’t help but be totally in their element. This is a place for those wanting adventure and they will find it immediately.

Lala salama,

Mike

Saturday, September 13, 2014 – The Serengeti and Oldupai Gorge

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Our last morning in the Serengeti waking to the sounds of all the wonderful animals. The hyenas were pretty active last night which means that they probably found some kill to scavenge nearby and were fighting over it. It was another beautiful day with bright sunshine at breakfast and ready for our game viewing as we leave the park through the southern entrance at Naabi Hill that borders the Ngorongoro Conservation Area. I was in the Southern Serengeti two years ago in April watching the great migration there with huge herds of wildebeest with their babies and all the big cats that come with the game animals. Then it was green and lush with the heavy rains. Now it is brown and dusty and dry. It really reminds you of the seasons here – it is wet or dry.

A scary Cape buffalo

A scary Cape buffalo

Shortly after the start of our drive we came upon two cheetah hunting together. They were either two males or two females as the opposite sex do not spend time together in the cheetah world. They could have been siblings or just close friends joining forces. We watched them for a bit until we had to leave as we had to be through the Naabi Gate by 10 am and we still had a ways to go.

A pair of hunting cheetah

A pair of hunting cheetah

The view from up high on Naabi Hill is fantastic as you can see in all directions for many, many miles. It isn’t the border of the park, but where most visitors see the Serengeti for the first time. The actual border is a few kilometers down the road and is quite inauspicious.

Danielle, Abuu and me atop Naabi Hill

Danielle, Abuu and me atop Naabi Hill

Our next stop was to Oldupai Gorge which was a spur of the moment thing as I had been there once before but had never driven down into the Gorge which we were hoping to do this time. Oldupai (which is the correct spelling as the original and better known Olduvai was a misspelling by the first European visitors of the Maasai name for a plant that is all over the area and is the Oldupai plant) Gorge is the mecca of anthropological sites and is perhaps the most important site on earth. Louis and Mary Leakey (well, really Mary mostly) found a fossil there dating to 1.9 million years ago that was named Zinjanthropus and was the oldest fossils to date of ancient man. We went through the museum there and then listened to a short lecture by a local guide, Lucas, who was a local Iraqw elder from Karatu who knew an immense amount about the gorge, the Leakeys and anthropology. We drove down to one site to find fossilized bone fragments (of game, not humans) lying all over the surface from 1.6 to 1.9 million years ago. Then we went to the “zinj site” which is where Mary first saw the exposed jaw of Zinjanthropus and change the who world of anthropology with her find and continued to work there for many years, long after her husband’s death.

Collecting fossils in Oldupai Gorge (too bad I couldn't bring them home!)

Collecting fossils in Oldupai Gorge (too bad I couldn’t bring them home!)

Our guide, Lucas, me and Abuu holding some monster fossils at the site where Mary Leaky found Zinjanthropus

Our guide, Lucas, me and Abuu holding some monster fossils at the site where Mary Leaky found Zinjanthropus

After Oldupai it was back to FAME and the end of our fantastic journey in the Serengeti and the beginning of our next journey seeing patients and educating the doctors and nurses here about treating neurologic diseases.

Mike

Friday, September 12, 2014 – Lions, Leopards, Cheetah, Serval and more…

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Our last full day in the Serengeti. We had decided to go on an early morning game drive before sunrise and brought both breakfast and lunch boxes with us so we could stay out all day. It was another completely gorgeous day with not a cloud in the sky and very brisk. As we headed out along the Seven Hills Road (named obviously for the seven hills in a line) and reached the first hill we decided to have breakfast with some of the local inhabitants so had a family of rock hyrax sunning on some rocks nearby in the early morning rays and I’m sure thoroughly enjoying our company or perhaps somehow imaging we might throw them a morsel of the delicious egg sandwich the camp packed for us.

A family of rock hyrax

A family of rock hyrax

We had some amazing sightings today and the first was a cheetah hunting who we were able to follow along for some time and looked multiple times like it was going to take off after some gazelle nearby but the grasses were much too short (well planned by the gazelle) for too long a distance for the cheetah to make the surprise run necessary to get the jump on them so the game was finally over.

A lovely cheetah

A lovely cheetah

After leaving the cheetah and looking for game Abuu heard about a leopard on the short wave and we were off to the races. We arrived at the site with at least 30 other safari vehicles which was a real sight. The guest of honor was in the tall grasses and after a short jaunt climbed a nearby tree with ease and made himself comfortable. Abuu explained he was a male because his back legs were not straddling a branch, but both on the same side so as not to sing soprano. At  this point we celebrated as Danielle had ” bagged” her big five – that being the elephant, lion, rhino , Cape buffalo, and last but not least, the leopard. These were named by the original big game hunters in Africa (Hemingway included) as the five game animals that you needed to kill or they would kill you. We are now bagging them with cameras thankfully and they will hopefully continue to thrive that way.

A lounging leopard

A lounging leopard

We next drove to the Lake Magadi region of the Serengeti near the Moru Kopjes and found the largest herd of Zebra that Abuu had ever seen. They were making a river crossing near some elephant and Cape buffalo and all were a bit on the nervous side it seemed. The herd essentially split into several lines to cross the river and went around the car on both sides. They were so noisy it was incredible as each stallion maintained command of his family and there were so many of them. We decided to have lunch and continue to watch the herd for some time. There were flamingos (both greater and lesser) on Lake Magadi and close by to the road was a lone lion cub sitting on tree branch looking very afraid and very alone. It was probably left by it’s mother while she was hunting, but lions are not the best of parents in this regard and it was unclear when or whether this little cubs mother would come back before it was lost to some predator. Very sad, but that’s daily life in the Serengeti.

An enormous herd of zebra

An enormous herd of zebra

And many more....

And many more….

On our way back to the Seronera area we found another serval cat, this one deciding to cross the road right in front of us for photos. They are such an interesting cat with very long legs and a bright orange coat.

A not so shy Serval Cat

A not so shy Serval Cat

The finale of the day, though, was when Abuu heard something on the radio and raced to find another leopard walking across the high grass in full sight. It walked for some time with lots of safari cars following and looking like it was planning to hunt some of the antelope in the distance. We watched it in this mode for perhaps 45 minutes when it finally decided to give up and climb a tall tree nearby. We continued to watch it in the tree and were about to leave when Danielle said we should stay another two minutes. The sun had mostly set, but shortly thereafter the leopard climbed out of the tree and began to walk through the grasses again. It finally seemed to settle sitting on a downed tree nearby and as it was getting quite late it was time for us to head back to camp. Driving in the Serengeti is permitted during daylight hours only and they are pretty strict on monitoring this.

A rare leopard on the move

A rare leopard on the move

An amazing close-up of the elusive leopard

An amazing close-up of the elusive leopard

Coming down from its perch

Coming down from its perch

Back to camp for dinner and our last night on the Serengeti. Tomorrow we head out through Naabi gate in the Southern Serengeti and then back to Karatu to work at FAME. We’ll pass by Oldupai Gorge where Louis and Mary Leaky did all of their monumental work on early man.

Best,

Mike

Thursday, September 11, 2014 – The Central Serengeti

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Well, today was another truly amazing day, but not because I’m in the Serengeti (which alone is something that most people can only dream about), but because we were able to take a hot air balloon ride across the Serengeti this morning at sunrise. Leonard’s brother just happens to be a balloon pilot here in the Serengeti and invited both Danielle and me to go on the balloon ride here as his guest which means we just had to pay the park concession fee which is a small fraction of the actual cost. It would have not been possible otherwise. We got picked up at 5:45 this morning to be taken to the balloon launching site, climbed aboard the balloon gondola lying on our backs with our feet up on the seat cushions as the gondola was lying on it’s side awaiting the balloon to lift us up.

Our view of a neighboring ballon

Our view of a neighboring ballon

Our view of sunrise on the Serengeti

Our view of sunrise on the Serengeti

Zebras from our baloon

Zebras from our baloon

The wide open Central Serengeti from aloft

The wide open Central Serengeti from aloft

This was my very first balloon ride and it was a beautiful morning here as they all have been. The ride lasted about an hour and afterwards we had some champaign to toast the flight (a ballooning tradition apparently) followed by an incredible breakfast on the Serengeti for all three balloons that flew this morning. Wow! What an incredible experience and far exceeded what I had imagined it would be like. It was made even more special with Jones as our pilot as I know how proud his brother is of him for that accomplishment.

Abuu met us at the visitor center where we were dropped off and we began our game drive for the day. The first thing we came upon was huge pride of lions under some trees with lots and lots of cubs and watched them for a bit only to then watch the dominant female and three of her sisters suddenly get up and head off for a hunt. It was amazing to follow along with them as they were strategizing for the proper position and such, but ultimately the hunt pooped out and never fully materialized. We watched them for quite some time and finally decided to call it quits ourselves. The good news is that we heard on the radio later that they never completed their mission and called off the hunt fully as well.

A mating pair of Serengeti lions

A mating pair of Serengeti lions

We spent the remainder of the day traveling between the Serengeti Hills (there are seven of them all numbered) and the various kopjes. The Masai Kopjes are the largest of these and they are rock outcroppings scattered throughout the central and southern Serengeti as the word “kopje” means little head in Dutch. During the day we saw at least three additional large prides of lions, most with plenty of cubs. They are usually sleeping pretty soundly during the day as was the last pride we ran across and since we were all alone miles from anywhere we decided to make animal calls and whatever else we could think off to just get them to notice us so we could take a few photos. I suddenly had this thought that perhaps they would like music and since I had my iPad with me I decided to play them some traditional Tanzanian folk music that I had. I put it on and all the lions immediately looked up and right at us. Abuu was in total stitches over the whole affair as it turned out the song I played was a traditional song from his tribe that he used to sing as a child. It was pretty hilarious I guess to have these lions in the middle of the Serengeti responding to a crazy mzungu (a white person – me) playing Tanzanian folk music and the only Tanzanian in the car unable to stop laughing. It was a wonderful moment.

Up close and personal

Up close and personal

A cozy pride of lions

A cozy pride of lions

On the way home I spotted a serval cat in a marshy area and we got some great photos of him. They are a tall, small cat that looks like a cross between a cheetah and a leopard, only much smaller than either of those cats. They are well spotted and very beautiful. Earlier in the day we had also spotted another cheetah. We watched sunset before getting to camp and had a lovely dinner back at camp.

A wonderful Serval Cat

A wonderful Serval Cat

Overall, it was another spectacular day on the Serengeti dominated by pride after pride of lions and amazing weather all kicked off by an incredible balloon flight for a totally different perspective on this miraculous landscape. As you’ve guessed there are not enough superlatives to describe the Serengeti. Hope you’ve enjoyed it as much as we have.

Mike

Wednesday, September 10, 2014 – Northern to Central Serengeti

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Sorry for all my emails coming through at once, but we had no cell service/internet until we reached the central Serengeti today. Danielle was going through withdrawals, but I am happy to say she survived. Currently she’s downloading and  sending emails using a WiFi hotspot I have set up on my iPad and she’s very, very happy.

Meanwhile, back to the Serengeti, Tanzania and East Africa. No matter how often I visit this country I am never bored and I am simply amazed driving along the same strip of dirt road I did even the day before. It’s just a magical place and I wish everyone could experience it.

We left our camp this morning around 8 am after getting up early to watch sunrise. It was gorgeous and made even more thrilling considering we had the constant bellowing of a male lion  just outside of camp. It was a tough call whether to watch the sun coming up or the edge of the trees to make sure the lion didn’t come running after us. Danielle and I were trying to decide who could run faster and I’m afraid I’d have to say she had the advantage. Luckily the lion wasn’t hungry. He had been bellowing all night so I think he was actually looking for a mate and not a meal. Neither of us would have satisfied his need.

Saddle-billed stork

Saddle-billed stork

Driving from Bologonja through Lobo we took a large game loop heading to the Seronera or the Central Serengeti. Towards the end of the loop we arrived immediately after a lioness had taken down a zebra colt. When I say immediately it is meant to convey that that zebra was still alive on our arrival and the lioness was still clamped down on its throat to finish suffocating it. The zebra herd wouldn’t leave the vicinity and they were all bobbing their heads as a sign of loss and the stallion was challenging the lioness repeatedly. She then began to drag the dead animal away as she most likely had very little cubs that she had hidden somewhere. It was an amazing feat to see her dragging this pretty weighty carcass albeit a baby some several hundred years then down a 15 foot embankment and up the other side and onto a kopjes (exposed mound of large boulders dotting the Serengeti and meaning “little heads” in Dutch. We never got to see the cubs, but they were surely in there. What a sight and what an experience.

A fresh kill for the lioness

A fresh kill for the lioness

Dragging her prey to her cubs

Dragging her prey to her cubs

Our next encounter was with a cheetah on the open plain. The funny thing was that I was sitting down for a sec and Danielle was standing and spotted the cheetah simply screaming “cheetah, cheetah, cheetah” as quickly as one can with me replying “where.” I think she screamed once more and I grabbed my camera to take some shots. She looked like she was hunting, but was heading away from us and all the thompson gazelle knew exactly where she was making it very difficult for her to catch anything. She’s fast, but not that fast and they have to have some element of surprise to catch the fastest antelope with running out of juice. Danielle bagged her cheetah so we’ve had plenty of lions, a couple of rhino, lots of antelope, giraffe, Cape buffalo, and more. Now we just have to see a leopard over the next several days and our game viewing would be complete.

A cheetah on the prowl

A cheetah on the prowl

After that we saw loads of hippos in two hippo pools, a huge herd of giraffe immediately next to the road and almost close enough to touch and then some amazing elephants. We pulled up an appropriate distance form them so as not to threaten them especially since they had lots and lots of babies, but another safari car pulled around us and blocked our view not to mention parking much too close. Slowly the elephants made their way up the road and we just sat there several feet away from them enjoying watching the babies play and the adolescents fighting.

Playful children

Playful children

Keeping clean....

Keeping clean….

Grey-backed Fiscal Shrike

Grey-backed Fiscal Shrike

Our camp in Seronera is also gorgeous and while typing this email an entire heard of elephants wandered in front of us about a couple of hundred yards. The sun is close to setting and we have plans for sunrise game drive tomorrow so it will be early to bed and early to rise…..

A quick mention about Abuu our guide. He has been a treasure to have along and so easy going and has a great sense of humor. He is such a friend to both of us. If anyone has any interest in taking a safari here I could highly recommend Abuu, these camps and a similar itinerary to ours for at least the Serengeti part of things. Add on Ngorongoro Crater, Lake Manyara and Tarangire and you’d have an amazing safari.

Kesho,

Mike

Tuesday, September 9, 2014 – The Northern Serengeti

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A very windy night in the tent and a cool morning, but we’re on the Serengeti so who can complain. Our camp looks out over a small valley/plain with small herds of wildebeest, zebra, topi (an odd antelope that looks like someone just patched ill-matching parts together) and more roaming just in front of us all morning (this evening there was a male lion doing his grunting call just outside of camp to make things more exciting).

We headed off on our game drive this morning with plans to be back for lunch in camp rather than the usual box lunch. We took a very long drive from our camp at Bologonja through a very long game circuit heading towards Lobo. We first found a male and female lion that were obviously a mating couple and watched them for a bit before heading off to see more We saw another group of six lions in the same area and likely from the same pride and that was by pretty early in the morning. After that it was driving the main game circuit to Lobo along some hills with breathtaking views of the Serengeti as far as the eye could see. In addition to the standard fare of antelope (wildebeest, hartabeest, thompson gazelle, topi, eland, impala and dik dik) we also saw lots of Cape buffalo and a few elephants. We also ran across vervet monkeys, baboons and both rock and ground hyrax.

A male and his mate

A male and his mate

Vervet monkey in a tree

Vervet monkey in a tree

On our way back for lunch (for which we were already late and soon to be much later) we also ran across a large herd of elephants with several babies who were heading for a watering hole for mud and dirt bath that we got to watch for some time. It was glorious to see them socializing so much  and to see the moms so protective of their babies.

At the watering hole

At the watering hole

We took a late afternoon/evening drive that ended up with a large male lion devouring a wildebeest and another mating couple in the near vicinity. Oh yes, and not to forget the ostrich and their mating dance culminating with the expected outcome – it was actually not the first time I’ve seen these enormous birds mate.

Guarding his meal

Guarding his meal

Sunset was amazing as was our dinner. We will be departing for the Central Serengeti in the morning at 8 am. We’re hunting for a cheetah for Danielle as she’s not seen one before, but of course we’ll look at everything along the way.

Sunset in the Northern Serengeti

Sunset in the Northern Serengeti

Will hopefully have internet tomorrow.

Lala salama,

Mike

Monday, September 8, 2014 – The Great Migration

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The morning in Arusha began bright and beautiful which was an omen for the day I think. An early breakfast, goodbyes to the boys and off to the airport for our flight to the Serengeti. We were flying out of the small Arusha airport to the Kogatende Airstrip with a quick stop at the Lobo airstrip on our way to the Mara River. We were in a Cesna 208 with perhaps six other passengers and it was cloudy most of the way (unfortunate as we flew directly over Oldoinyo Lengai, or Mountain of God to the Maasai), but the clouds opened up the minute we hit the Serengeti and you could see forever.

We disembarked (perhaps too formal of a word for having landed on a dirt airstrip in a single engine plane where the pilot helps unload the luggage) at Kogatende and met up with Abuu which is a good thing since we would have been totally stranded literally in the middle of nowhere if hadn’t showed up. Not 100 yards on to the road leaving we immediately ran across a scavenger festival which was occurring at the expense of a wildebeest that looked like it had died of natural causes. There were tons of white-faced and white-headed vultures with a half dozen Marabou Storks just to add some sense of total chaos to the situation. Needless to say it wasn’t very pretty, but ultimately part of the circle of life to quote the Lion King. We watched for some time and when we drove back by two hours later, the bones had been picked totally clean.

We drove along the Mara River looking at the various crossing sites for the wildebeest. They actually have the crossing sites numbered here which gives you some sense of the fascination with this aspect of the Great Migration. We sat with a large herd of wildebeest and zebras taking lots of photos and hoping they would mosey down to the river, but they really just kept moving back and forth without any apparent intention to satisfy the 10 or move vehicles hovering nearby. After waiting perhaps 1 to 1-1/2 hours (and eating our lunch of course as Danielle was hungry) we were sitting there with all the other vehicles when Abuu suddenly shot off like a bat out of hell and we were suddenly entered into what reminded me of an Oklahoma Sooner style stampede to the river to view the crossing. I must admit, though, that it was one of the most impressive sights I’ve ever seen. There were no crocodiles in the vicinity so everyone made it safely and in probably 20 minutes or so it was all over.

Wildebeest crossing the Mara River

Wildebeest crossing the Mara River

The Great Migration

The Great Migration

We left the crossing area to drive along the Mara looking for other sights along the way. Lots of hippos  everywhere. Some sunning themselves on the beach and others in the river. They have no natural predators so they have to little to worry them. After a bit I spotted a zebra carcass lying in the river and when I took a closer look with my binoculars quickly realized that there were two huge crocodiles hastily disposing of it. And when I say huge, I mean really huge. They were at least 10 or 12 feet and probably more. They were playing tug of war with the carcass and then began to fight so between that and there death rolls there was quite a bit of action.

Two ten-foot Nile crocodiles battling over a zebra

Two ten-foot Nile crocodiles battling over a zebra

As we continued our drive along the Mara and then turning south to head to our camp, we ran across a group of hyena displaying their bazar social behavior – there was a male and female mating for what seemed like forever with the alpha female (we’re presuming) protecting them from three other hyenas who were trying to break up the mating. Abu said that the alpha female had decided who and when any mating would take place and between who. Pretty interesting social structure to say the least.

Mother and baby rhino in the Northern Serengeti

Mother and baby rhino in the Northern Serengeti

We arrived to our camp just before sunset and got settled in our tent which is pretty amazing – much bigger than anything I expected and very, very comfortable. They actually have flush toilets in this seasonable camp which is a pretty amazing feat to say the least. In addition, their showers have both hot and cold water that they fill in separate buckets in the morning so you can actually adjust the temperature of the water rather than be at the mercy of the “cook” heating it on the fire. We had a wonderful dinner, relaxed a bit and hit the sack ready for new adventure in the morning.

Mike

Sunday, September 7, 2014

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Lee, Lennox, Danielle and Deborah

Lee, Lennox, Danielle and Deborah

Always great to wake up here to the sounds of life in Tanzania – people walking to market, a few car horns, the askari raking the yards and all the wonderful birds in the trees. It’s cool and overcast this morning, but the clouds will burn off shortly and the warm equatorial sun will dominate the day. This is the dry season though it’s been raining a bit in the last weeks here in Arusha as well as the Serengeti. This will be good for game viewing with the grasses somewhat taller than usual for the vast herds of wildebeest, zebra, Cape buffalo and all the various antelope that inhabit the massive Serengeti and Masai Mara. We’ll be starting tomorrow along the Mara River famous for the images of wildebeest herds crossing en mass. They follow the grasses and it is always tough to predict their movement that varies from year to year. This is the largest migration on earth and has been occurring annually for millions of years.

Spent the morning with the kids playing outside and doing what I love best in the front yard – catching old world chameleons! This is a sport that was perfected last March with Megan and will continue on. They are the most wonderful of lizards that try to intimidate with hissing and opening their jaws but don’t know how to bite as that isn’t how they catch their prey so they are only bluffing. Their fully independent eyes see a near full circle front and back and somehow their brains interpret this information. They are truly unique.

Danielle and I went to the Masai Market by noon to shop which is another experience altogether. Rows and rows of shops each with almost identical stock and each owner hawking for you to buy from them to help them out. It is an overwhelming experience for certain. Danielle had things to buy and so we spent a couple of hours going up and down the aisles looking for things that caught our eye with everything looking so similar. Of course, I was looking for something totally different – ebony chunks to use as pedestals for my baskets, standing straight with lots of character. Ebony is a wonderful wood with the black dense interior of the tree and the outer brown bark that is so thick. We survived our shopping trip thankfully and met with an expat patient of mine here for coffee at a very old hotel in Arusha and caught a ride home with them to the Tembas house.

Lee, Lennox, Michael and Deborah

Lee, Lennox, Michael and Deborah

Leonard and Pendo had family over to meet us for a late dinner and now it’s off to bed. We’re leaving very early in the morning to head to the airport and off to the Serengeti where our real adventures will soon begin.

Friday and Saturday, September 5 & 6, 2014

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Welcome to the next installment of my Rift Valley Adventures, or the fall 2014 chapter of FAME Neurology clinic. This trip will include a five day visit to the Serengeti at the front end of the trip with several days in the northern Serengeti hopefully during the great migration. Though I have been going to the parks now and guiding for the last several years, I haven’t been back to the Serengeti since 2009 and this time will have a driver/guide so that will free me up to take some good photos (hopefully). We will also be at FAME for two plus weeks so will have lots of stories there of course.

Our flight to Amsterdam went well, though not uneventful. Several hours in there was that announcement that I’ve always dreaded hearing asking if there was a doctor on the flight. My first reaction was to see if Danielle had heard it which she had, and so there was no way I could possibly have ignored the request (not that I would have done so). With some trepidation, though, we got up and looked forward and aft to see where any commotion was. I spotted a few people in the aft gallery and started back with Danielle on my heels. We arrived to find several flight attendants and an elderly woman sitting leaning against the bulkhead. We were told she had been coming back to use the bathroom, apparently became faint and sat down whereupon she blacked out briefly and then awakened. The attendant pointed out to us that she had lost her urine (quite obvious though considering the long trail of liquid on the galley floor) and I immediately knew what was going through Danielle’s mind and what her next question was going to be given her specialty (I only let her ask it first, though, out of courtesy in as much as I wouldn’t have taken that satisfaction away from her). “Did you notice whether she had any shaking?” (i.e. did she have a seizure so I could immediately pounce on this clinical opportunity) Oh well, that would have been all too convenient to have a fellow passenger suffer a seizure with two neurologists on board (and the only physicians to have responded to the distress call). I checked her pulse and it was very thready and slow and she was very pale. Plain old vasovagal syncope, but luckily something even we could handle (thankfully). She spoke only Italian and once we got an interpreter there it turned out she suffered from low blood pressure, took no medications and had no medical problems otherwise. Catastrophe averted we went back to our seats after a bit with some thanks and our prides intact knowing that even a neurologist can manage some emergencies. Sorry, no photos on this one.

Thankfully our flight from Amsterdam to Kilimanjaro was less eventful and filled with some sleep albeit a bit restless. Arrived at Kili to find our baggage arrived (always an adventure) and met with Abuu (Leonard’s friend and our driver/guide in the Serengeti for the next five days) outside the airport. It’s unseasonably cool here now, but it’s always gorgeous no matter. As usual, Pendo had an incredible dinner waiting for us and then off to sleep after our 18+ hours of travel here. Lala salama!

Mike