October 26, 2016 – A day to begin winding down….

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I have been here now for nearly a month and between us, this is our 16th day of neurology clinic and the patients continue to come. We had planned for today to be a day to catch up at the end and complete our data entry for the patients that we’ve seen and a chance to take the “neuro team” all out to dinner for an evening on the town. It’s been an incredible visit so far and both Kelley and Laurita have easily managed to become a part of the family here such that it will be very hard for them to leave. The work here is like that. It’s so easy to get caught up in your own life at home and your own work schedule, but here that doesn’t happen. Everyone is working together for the same goal and the pace is much different. There are none of the pressures that we always seem to be under and which occupy so much of our energy to deal with. Here it is pure and simple. We wake up, we walk to work, we see a large number of patients, most of who have very little in the world, but have done what they could to get here to see us because they are concerned. We practice medicine as it has been practiced for centuries, listening to the patient and examining them, making an assessment and offering a treatment plan. Sometimes we have something to offer and other times we don’t, but we take our time explaining to them what we believe is going on. It is this time honored tradition that has brought each of us to medicine and has brought each of us here to Tanzania. This is what we have been seeking.

Our little patient with infantile spasms who's doing well

Our little patient with infantile spasms who’s doing well

Each day was truly “unadvertised” this week, but yet we have patients seeking our care that have often traveled far and cannot be sent home. And they are all patients in need of our services. Today was Kelley’s day for pediatric neurology and she was very happy to have me sit in on her cases as they were all complicated. First was a young child who had been seen by Dr. Jackie in March and diagnosed with infantile spasms and developmental delay. Infantile spasms are typically associated with a very poor prognosis and we had seen them two weeks ago and the child had been off of their antiepileptic medication for about a month and had had no return of the spasms. We wanted to leave the child off the medication if possible so asked them to return and that we would contact Jackie in the meantime, which we did and she suggested leaving the child off medication unless either the seizures returned or she regressed in functional status. Neither had occurred so we opted to leave her off the medication, but to return if she had more events or had any functional regression. The family was quite happy with those plans and we sent them on their way.

The cutest little patient we've seen yet who had febrile convulsions

The cutest little patient we’ve seen yet who had febrile convulsions

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The next patient she saw was an 18 month old boy who had been having a number of febrile convulsions, perhaps monthly, but with an episode of complex febrile convulsion in July as the event had included focality with the child shaking on one side only. We always worry with that type of seizure as there could be something structural intracranially, but the baby had been seizing for some time and his exam was entirely non-focal. He was very well advanced developmentally and was bright and interactive in every aspect. We told his parents that the seizures were febrile, but there was an increased risk of epilepsy due to the complex nature of the one seizure. Unfortunately, there really is no good data on the subject and the jury is still out. It is still felt, though, that daily treatment with a prophylactic medication may have to greater risks than benefits. We did not prescribe an antiepileptic medication for the child, but did decide to send an email home to Jackie to see what she would do in the situation. I believe we’re not far from starting medication, but we’d love to have her thoughts first and can easily bring the child back in if she feels otherwise. Meanwhile, he had to be one of the cutest babies we had seen while here and he definitely entertained us during the visit. I have a little frog with a light that I had found at CHOP and he loved playing with it, but was not very happy when he found out that I was not giving it to him to keep.

Kelley demonstrateing excellent use of both hands in the patient

Kelley demonstrateing excellent use of both hands in the patient

I asked at the end of the visit if we could take him home with us

I asked at the end of the visit if we could take him home with us

The very next patient for Kelley was another baby with a much different story. She was 14 months old and her mother’s pregnancy with her had been normal and she was normal at birth by report. But then, at 3 weeks of age, she began to have multiple seizures per day and her parents didn’t bring her to a hospital to be seen for at least a month. At that point, she was placed on phenobarbital which she remained on, but continued to have seizures, though perhaps a bit less frequently. She was having them perhaps several times a month, but then began having more seizures again most likely as was now underdosed on the phenobarbital because of her growth. The child was developmentally very abnormal doing very little on her own and was not crawling. Though she was initially sleeping when Kelley went to examine her, it was readily apparent that she was quite abnormal with nystagmus and a right gaze preference, failed to attend whatsoever once awake and couldn’t hold her head up. She was spastic throughout all of her extremities. It was pretty heartbreaking as I don’t think her parents really understood how grave the situation was at the beginning. I will have to admit that these are the children I chose not to see in practice ( I always said that I didn’t see floppy babies!) and so we also emailed Jackie about this child to her input. We of course adjusted her dose of phenobarbital which was the obvious thing to that even we were capable of as big people neurologists. I should mention to you here that on my first trip to FAME in 2010 and when arriving to clinic one morning with a long line of patients, half of them being children, I lamented to Frank that I’m not really a pediatric neurologist, at which point he quickly replied to me, quite seriously, “right now, you’re the closest thing that Tanzania has to a pediatric neurologist.” I learned my lesson then that we have to make do with what we have and do our very best for each and every patient.

Laurita evaluating a headache patient - Kichwa!

Laurita evaluating a headache patient – Kichwa!

Laurita had a very interesting elderly patient whose problem was that she had episodes where she would begin singing and praying, but would still be responsive during the episode. This had been going on for many years and, of course, occurred during the visit when she began chanting and rocking in her chair. Laurita came out to get me so I could observe the episode which was clearly a conversion disorder and not a seizure or, as often they are considered here, demon possession. She was very responsive during the episode and could answer simple questions, but continued for some time with her singing. We later got the history that these episodes had started when she had killed a snake and some blood had gotten on her face during the event. When she went to wipe the blood from her face, some of it got into her mouth and this is what precipitated the behavior. We recommended using an antipsychotic medication to see if it could decrease the episodes, but what she really needed was psychotherapy which just isn’t available here in any shape or form. One might think that she could get some help from her church, but unfortunately it is often the pastors at the churches who propagate the demon possession explanation for them which only worsens the stigma to the patient and family.

Laurita evaluating her patient with episodes of singing and prayer

Laurita evaluating her patient with episodes of singing and prayer

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Sometime after lunch we were called to the ward to evaluate a patient with weakness and numbness in her legs. She was a 65-year-old woman with a 9 month history of progressive weakness and sensory loss and hadn’t been able to walk for over two months. She also had significant weight loss and during her examination was found to have a very large supraclavicular lymph node quite worrisome for a malignancy. We sent off all of her lab work which returned with an extremely high platelet count and an erythrocyte sedimentation rate of greater than 120, both also very worrisome indicators for malignancy. Neurologically, she had brisk reflexes in the legs and poor rectal tone, both suggestive of a spinal cord process. Top on our differential was a primary malignancy with a metastatic lesion to her lower spine and compression of her spinal cord. Unfortunately, none of this bode well for her prognosis and now it was time to make decisions about her care. If we obtained a CT scan, which would cost her family a significant amount, it would not likely change her management as the very best we could hope for would be sending her to Dar es Salaam to the only neurosurgeons in Tanzania to remove a tumor that would not improve her neurologically and then they would have to deal with the primary malignancy. We had no evidence that she had tuberculosis and given the large lymph node which was painless and hard making it more likely to be malignant rather than reactive from an infection. A discussion would have to be had with the patient and her family about her prognosis and whether they had the resources and/or the desire to know what was going on given the most likely scenario that she wouldn’t improve neurologically and would eventually succumb to this process. I will try to post the outcome of that conversation when it occurs. Regardless, it was a very good educational experience for both Laurita and Kelley not only as far as the evaluation of the patient was concerned, but also the discussion over treatment recommendations.

Evaluating our patient in the ward with likely metastatic disease to her cord

Evaluating our patient in the ward with likely metastatic disease to her cord

We finished a bit earlier which was good as we all had plans to go out for dinner with the entire neuro team and were heading to Carnivore for grilled chicken, chipsees (French fries), grilled plantains and beer. We had Dr. Badyano, Sokoine, Angel and Alex along with the three of us. The chicken here is the most tasty around we always look forward to this visit. Best of all, they play wonderful African dance music and have a small dance floor that we all monopolized until the wee hours after dinner (here that means 11pm). We all returned safely home after dropping off Angel and Badyano at their homes and went to bed for some sleep looking forward to our final clinical day here at FAME on the morrow. Each of us, though, knew that we would be missing FAME in very short order and would be leaving with heavy hearts.

Kelley during a lighter moment - no, she isn't demonstrating right eye ptosis

Kelley during a lighter moment – no, she isn’t demonstrating right eye ptosis

October 25, 2016 – And more neuro patients….

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Tuesday morning was once again time for our educational talks and there was a special request for Kelley and Laurita to cover the causes and evaluation of patients with altered mental status, a very broad topic that was quite a challenge for them to prepare. Like the pros they are, though, they tackled it with enthusiasm and came up with an excellent presentation that fully covered the topic. Once again, they had the full attention of the entire medical staff and when it was clear that they weren’t going to be able to finish the presentation in the time allotted (Dr. Lisso again did not cut them off which is always an excellent sign that they’re doing a good job) they were asked to finish the lecture on Thursday morning which is not a typical morning for educational lectures. Not only that, but the lecture that had gotten bumped for the altered mental status evaluation, headaches, was now being move to Friday morning, the morning we’re leaving for Arusha, but both Kelly and Laurita were more than willing to give the lecture before we leave that day. So, all in all, there will three educational lectures this week when there is normally only one.

Morning lecture

Morning lecture

At morning rounds, we discovered that our young boy with meningoencephalitis was actually somewhat improved as he responded slightly. The night before, on our way home, Kelley had brought up the thought of covering him for listeria, which causes a brainstem encephalitis, as he did have some of these features on presentation. We stopped by the ward and wrote orders for ampicillin to cover him for Listeria. He continued to have fevers and had also had a few more seizures so we were keeping him on his anticonvulsant medication, but were considering adding another if he continued.

Patients in our neurology "waiting room"

Patients in our neurology “waiting room”

Our young woman with Sydenham’s chorea was actually doing better after receiving the steroids, antibiotics and more diazepam to help her sleep the night. She was still having some confusion, though, and we knew it would take some time for everything to clear. Frank and I had a long discussion with her mother who was now also staying at FAME and tried to explain the nature of this disease to her. They are rural Maasai so it is very difficult to explain the nature of an infectious and Neuro-immunological disorder that isn’t contagious and wasn’t caused by anything her daughter or she did wrong, but just happens to some people when they develop a strep infection. She would be going home at some point and would probably still have some of her movements and confusion and we wanted to make certain that her family wouldn’t take her to a traditional healer or shaman where they might try to exorcise her. We frequently see patients here at FAME after they’ve been to a healer and they have lots of marks and burns on their bodies from attempted treatments or they’ve ingested local herbs that have unknown toxicities or effects. We also explained to her mother that this wouldn’t get better immediately, but would take at least several weeks to notice any possible benefits and that she would have to come back to be followed.

Laurita examing her patient with complaints of neuropathy and massive tophi

Laurita examing her patient with complaints of neuropathy and massive tophi

Laurita had a very interesting patient with the largest gouty tophi any of us had ever seen. Gabriel told us that this wasn’t as uncommon here as both of us thought as many patients are unfortunately non-compliant with their medications and many can have tophi such as this patient had. The reason he was seeing us, though, was because of his symptoms of neuropathy which were undoubtedly related to his gout. His examination confirmed his neuropathy and he was treatment with medication for symptomatic relief and hopefully he will be compliant with it.

Gouty tophi of the hand

Gouty tophi of the hand

A very large gouty tophus

A very large gouty tophus

No other patients stood out for the afternoon, but we were able to finish in a reasonable time today. I had driven downtown to pick up some things from one of the fabric stores after lunch, but they hadn’t given me everything for some reason, most likely because I was by myself and I’m not sure how clearly I had gotten the message across to them. So Kelley and I decided to run back down there before they closed for the evening and brought Selina along with us to help with any interpretation. It turned out that they had really failed to give me several things and it was unclear if they just weren’t sure if I was supposed to be picking up stuff for everyone or what. We had all ordered a number of things from them and given them quite a bit of business they wouldn’t have otherwise gotten so it seemed reasonable to us that they would want our business. We were never entirely sure, though, and that is something that is often the result of the cultural spread.

Kelley examining her patient

Kelley examining her patient

We returned home before sunset and once again sat on he veranda overlooking the beautiful hills that opened up in front of us. Dr. Liz, another volunteer from the US who has been here several times with me, arrived yesterday afternoon and joined us on the veranda to reminisce as well as to catch up on each other’s lives and the events of the day. We had the last of our prepared dinners as we’d be going out for the next two nights before we leave. What seemed like such a long time for us to be here now seems like it has slipped away so quickly and we are all becoming very sad at the thought of leaving soon.

A very pleasant patient

A very pleasant patient

October 24, 2016 – And back to neurology clinic at FAME….

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I think we were all quite exhausted on Monday morning after our weekend safari and despite a good night’s rest we were all dragging a bit. We had already spent nine full days seeing neurology patients at FAME and four days of mobile clinic yet it seemed that our patients were still coming in droves. When clinic opened at 8:30am (in Swahili time that’s 2:30 as the day begins at 6am with the sunrise) we immediately had over twenty neurology patients to see us and they were still coming.

Nurse Barbara and Dr. Verena evaluating the young boy with meningoencephalitis

Nurse Barbara, Nurse Safi, and Dr. Verena evaluating the young boy with meningoencephalitis

Meanwhile, there had been an admission last Friday of a young boy who presented with seizures and altered mental status who they wanted us to see. They had done a lumbar puncture on Friday, but not all studies had been run on the fluid and all we were told was that the fluid had been cloudy and there too many white blood cells per HPF (high powered field on the microscope) meaning that he very like had a meningoencephalitis and probably viral given some of his other labs such as elevated liver function tests. He had been put on antibiotics, but when we asked about acyclovir they hadn’t considered it. When I tracked down our pharmacist to ask about obtaining the medication we always put these patients on in case of herpes encephalitis, I discovered that it is virtually unobtainable here having to purchase it from Nairobi at a cost well beyond FAME’s means as it would have cost $500 dollars a day for fourteen days to treat this child. Luckily, it didn’t appear that he needed it though he continued to have some seizures and did remain intermittently febrile. We wracked our brains throughout the day to make sure we weren’t missing anything with this child as he was very ill and we certainly wanted to give him the best chance to improve. We did add one other antibiotic on our way home that evening to cover one other possible infection, but otherwise we had no new thoughts.

Kelley evaluating the young boy with meningoencephalitis

Kelley evaluating the young boy with meningoencephalitis

Documenting the old fashioned way!

Documenting the old fashioned way!

We had our usual compliment of patients that included one Maasai woman who I have seen for several years with seizures. She has remained well controlled on lamotrigine which is the best drug for her given her age and likelihood that she’ll become pregnant in the coming years. She did have a baby last January who I had seen in March as her husband brings her back for follow up religiously every time that I am here. He had invited me to his boma for a goat roast last time I was here and wanted us to come this time, but I explained to him that we were leaving in several times and unfortunately didn’t have time to make it there. We both agreed that we would do it for certain in March and Sokoine now has his phone number and location so we’ll visit earlier in the trip next March. I haven’t yet had someone cook me a goat so that should be very exciting indeed.

Examining our young Maasai woman with epilepsy

Examining our young Maasai woman with epilepsy

Her husband and baby

Her husband and baby

Sometime in the mid morning ( I can’t recall if it was before or after chai), Frank called me over to his office to see a patient who had been brought from a fair distance to see him. It has been billed as a psychiatric patient, but he wasn’t certain and as I walked through the door of his office I immediately recognized what the patient had. She was a fifteen-year-old Maasai girl brought by someone from her school and she had been having strange behaviors and movements for several days. Her family thought that she was possessed, but thankfully she hadn’t yet been touched by any local healers. As soon as I saw her movements I recognized that she had Sydenham’s chorea, a very rare disorder in the States that is caused by an untreated Strep infection. It causes neuropsychiatric manifestations in patients in addition to the infection which is very dangerous as it can cause a bacterial endocarditis that has a predilection for the mitral valve, often destroying it and causing a serious problem if left untreated. I asked Frank to check and he said that she did indeed have a murmur. I explained to the situation to the American teacher who had brought her here and we suggested that she stay here at FAME for several days while we initiated both the antibiotic treatment as well as treatment for her uncontrolled movements. Her mother was called and agreed to travel to FAME from the Arusha area as she wanted to be here if she was going to be admitted. Her movements were very impressive and it took 30 mg of diazepam to get her some rest that night and that dose was repeated again during the night amazingly.

Our 15-year-old with Sydenham's chorea

Our 15-year-old with Sydenham’s chorea

We had diagnosed a young girl with the same disorder back in December 2012, and after over a year of treatment she was finally without any movement or issues, though the last time I saw her was in March of this year. We had impressed upon her family that she would need continuous prophylactic antibiotics for many years to ensure that she didn’t develop another episode of endocarditis, but they moved to Mto wa Mbu and it become more difficult for her to come back here for her checkups. I am hopeful that she’s still receiving the antibiotics to protect her heart. This young woman I saw today will also require the same treatment with immediate antibiotics for the acute infection, long term prophylactic antibiotics (until the age of 40!) and a long course of steroids to control her movements which are the result of an immune-mediated response. It is very rare to see these patients here and extremely rare to see them in the States, so I was quite happy that both Kelley and Laurita would be able to see this patient with such a classic and now rare neurological disorder. It is something that will remain with them forever.

Laurita evaluating an elderly patient with Selina's help

Laurita evaluating an elderly patient with Selina’s help

Kelley evaluating an elderly patient

Kelley evaluating an elderly patient

Kelley and Dr. Gabriel evaluating a patient

Kelley and Dr. Gabriel evaluating a patient

Laurita also had a very complicated patient that came to see us from Arusha and required well over an hour of her time. She was a young woman who had developed eclampsia following a delivery around the first of the year and had suffered two intracranial hemorrhages. She underwent surgery to evacuate them with an excellent recovery initially, but then developed an intracranial abscess requiring additional surgery, suffered seizures, then hydrocephalus needing a shunt placed. She underwent an immediate replacement of her shunt and subsequent to that lost her ability to speak. We had most of her CT scans to review and an MRI that she had obtained in Dar es Salaam as well as her examination. Unfortunately, it appeared that she had suffered some damage from the placement of her first shunt that explained her difficulty speaking and there was very little that we had to offer her as far as treatment or therapy. She was extremely abulic as a result of the frontal lobe damage she had from the initial hemorrhages and with all the deficits, she was extremely disabled. It was a very sad case as even with rehabilitation she will likely recover very little.

Kelley evaluating an elderly gentleman with a history of stroke

Kelley evaluating an elderly gentleman with a history of stroke

Given the complexity of cases today, things were moving a bit slow in the afternoon making it necessary for us to work well into the evening which also meant that Sokoine and Selina would miss the staff bus to town at 4:30 and had to find an alternative means of getting home. Luckily that was taken care of by one of the other FAME staff vehicles as I had work to do this evening along with Laurita and Kelley. We ended up staying in the volunteer office until 8:30pm as they both had to work on their talk for tomorrow morning and needed the use of the Internet, which if you remember, runs incredibly slow if it runs at all. Starvation finally got the better of us, and especially Laurita, so we all went home to eat our prepared dinners of roasted chicken, potatoes and green beans. Somehow, Kelley managed to go back up to the volunteer office to complete her talk, but I’ll have to admit that I was far too exhausted to do any more work and chose rather to go to bed and set my alarm for well before sunrise. We had all worked very hard today and I sensed a bit of frustration in everyone with the late hour that we finished so decided to make sure we wouldn’t run into the same situation tomorrow and planned to speak with Sokoine regarding this in the morning. Regardless, we had seen some very interesting patients once again and fulfilled our purpose for being here, not only in regard to educating the doctors here as well as my residents, but also myself included.

A young Maasai woman with epilepsy

A young Maasai woman with epilepsy

October 23, 2016 – Lions, lions and more lions….

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Spending the night on the African savannah in a tent, even with a hard floor and plumbing, is a very unique experience. Soft breezes continually buffet the fabric in a pleasant and relaxing fashion throughout the night while the nearby nocturnal wildlife make their presence known. Depending on the location, we commonly hear hyenas or lions that sound as though they may be right outside the tent. We were so tired from our safari the day before that we all slept quite soundly and were ready for the new day. I had planned to use the outdoor shower, but reconsidered as it was a bit chilly so I enjoyed my shower inside instead. Before breakfast, I readied my cameras for the day ahead and headed off to the dining tent for another wonderful meal.

Lions on the watch

Lions on the watch

Lions on the watch

Lions on the watch

We ate outside with the soft rays of sunrise beginning to cover the plains in front of us with the start of a new day. Breakfast was a buffet this morning as there were a few more guests at the lodge and we enjoyed eggs, mushrooms, bacon, sausage, potatoes and homemade granola again. Oh yes, the wonderful pancakes or crepes with syrup. All of this was preceded, of course, by the requisite cup(s) of freshly brewed local coffee. As we would not be returning to the lodge after our safari today, we thanked all the staff for their amazing service and picked up our lunch boxes for later in the day. When staying in the tented camps, it is the common practice to give the camp manager a tip to divide among his staff thanking them for their fine service. When we gave the manager our tips, I am not sure that it was totally expected and they were all very thankful for our generosity. This really was an amazing stay for us and it was probably one of the nicest places I have visited in my time here. I will definitely return to the Tarangire Simba Lodge in the future and may well make it part of the resident’s “cultural experience” here.

Pelican in flight

Pelican in flight

Pelican in flight

Pelican in flight

Having battled the tsetse flies yesterday, we were all a bit weary of encountering them again this morning so began our trip with the top down on our vehicle and the windows mostly closed. Yusef had his cracked slightly and Laurita was a bit more daring having her window open about half way much to Kelley’s dismay. We went through the gate again and began our drive through the acacia woodland, or home to the notorious tsetse. A few flies got into the vehicle through Laurita’s window and we were able to dispose of them rather quickly. We didn’t kid ourselves, though, as we knew we would run into them again during the day and only hoped that they would be manageable. We took a different route to the river area this morning and crossed in a dry area as we headed for the public campsites to see what we could find. We quickly ran into a small group of lions positioned strategically on a small hill overlooking one of the prime watering holes in the area. They were clearly planning some type of ambush as there were herds of zebra and wildebeest in the area and we were definitely hoping to be there for the event if at all possible.

An unsuspecting warthog

An unsuspecting warthog

Displaced lions

Displaced lions

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The group included three adult females and three adolescent youngsters. Initially resting, it was clear that they were maintaining a very close watch on the watering hole as well as the surrounding area in hopes of a meal. As we sat watching warthogs meander towards the water and hoping that they wouldn’t see the lions or react in any way, we were rooting for the lions with the hope that they would attack. One of the younger ones at one point charged after a warthog, but it was of no use as they were too far away and easily scurried out of reach of the clumsy lion with ease. There were herds of zebra and wildebeest in the area and one group of zebra were definitely moving slowly towards to the watering hole, The stallion leading the group continually inched closer, but unfortunately, he was moving across one of the access roads and as vehicles came and went from the spectacle, he would get spooked and move away from the water. This went on for some time until finally a group from the other side slowly walked to the watering hole while two of the older felines began to organize for an attack. The zebra had just gotten to the edge of the water when the lions seemed to prematurely jump. They ran down to the beach, but the zebra were to quick for them and were spared another day. At this point, we were not very impressed with the skill of these lions to say the least.

A failed attack

A failed attack

There were over fifteen vehicles now all positioned at various locations around the watering hole in hopes of seeing a successful lion kill. The guides were all trying to predict where the attack would occur and jockeyed each of their vehicles attempting to get the best view for their safari guests. In March of last year, we had followed a group of four females for most of a morning waiting for them to make a kill and were lucky enough to see it happen right in front of us and all alone. A lion kill, or an attack by any of the bigs cats, is perhaps one of the most impressive things I’ve witnessed in nature and an event that is not to be missed if possible. It is truly nature at its most raw and uncensored. It is incredibly powerful and you feel as though you are part of it, though it can only be watched with the realization that it is not a show for our benefit and that the prey would have died whether we were there or not. It is something not to be missed.

Weary lions

Weary lions

We continued to watch the lions for some time hoping that they would be more successful, but when we saw a family of elephants moving towards the watering hole we knew there would soon be some sparks flying. As I mentioned yesterday, lions and elephants are deadly enemies and the elephants would love nothing more than to stomp a lion to death if given the chance. So, as the elephants moved closer, they immediately attracted the attention of the lions who watched carefully as they approached. When the elephants got the scent of the lions and realized where they were, several of them made a beeline for the hill where the lions sat and very quickly displaced them from their resting place. Once the lions were on the retreat, the elephants again focused on the watering hole and began to drink and carouse as if it were a big punch bowl. The lions, meanwhile, having been evicted from their lofty perch above the watering hole, reconvened on the flat nearly in front of us so we could get some great photos, but we had still wanted to see a kill, unfortunately. We had been watching them for the better part of an hour or so at this point and decided to move on to see more things before lunchtime.

Our small group of lions

Our small group of lions

We drove through the Small Serengeti region of the park, named for the close resemblance to the wide open plains of this famous region of Tanzania several hours away from us. There were herds of zebra, wildebeest and Cape buffalo in this area, though we were really on the lookout for cheetahs as the grasses here are the right height for them to hunt while remaining hidden. This is also the area where we were stuck in the mud for hours last March during the wet season so I am always a bit reticent about driving here even though it’s now dry and someone else is driving. We circled through the Small Serengeti on several roads and eventually drove back towards the river as it was approaching lunchtime and we were heading for a new picnic area on the other side. The main picnic area of Tarangire is typically very crowded with vehicles and people, but has a beautiful overlook of the river and all the animals there are midday. Unfortunately, the Vervet monkeys have also figured out that it is the perfect place to find an easy lunch and they love to harass visitors with the hope that they more score a few scraps here or there. One such pair of Vervets planned a sneak attack on Megan Richie and me a few years ago and turned out to be far more aggressive than we had thought they’d be. I grabbed the food and Megan, having grown up in Indonesia and quite comfortable with these situations, decided that she’d protect me only to find out that one of the monkeys didn’t scare very easily. We were leaving the following day and I was quickly trying to figure out in my mind how I would explain to my chairman having had my resident mauled by a usually cute Vervet monkey in Tanzania. Thankfully, it did not come to that and Megan realized she had met her match so the two of us exited stage right with our food in hand to find another location for lunch. Had they been baboons, I don’t think we would have been so lucky.

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A view from our lunch spot

We crossed the river and drove to the new lunch site which is high up on another overlook with views of much of the park. We didn’t have the picnic lunch we had had yesterday, but rather box lunches with lots of goodies. I’m certain that Laurita gravely missed the wonderful pasta of yesterday, but I knew she would make do with the lunch at hand. A hamburger, samosa, hard boiled egg, apple, and a piece of chocolate again. Not nearly as luxurious, but it quelled our hunger and we sat in the shade for a time before piling back in the Land Cruiser in search of new sights.

A mating pair of lions

A mating pair of lions

We drove to the river and crossed again and headed up a road that we had been on yesterday so I wasn’t quite sure where we were going as this lead to the Silale swamp and I didn’t think we were going back there. Within a few hundred yards, though, we immediately encountered a small group of lions lying in the shade of an Acacia tree. One of the other guides at the lunch area had apparently shared this information with Yusef at the picnic site so he had traveled to this spot with the hope that the lions would still be hanging out here. It was a male and three females and it was close enough to the river crossing where we had seen the group yesterday that they were undoubtedly one in the same. Lions roam over a very large area and are very territorial so you will never see two groups or prides that close. We sat watching them for a number of minutes when the male decided to get up and mosey over to one of the females. She quickly sat up and then it was readily apparent that they were a mating pair when he quickly mounted her. As quickly as it started, it was over and we were all amazed, especially Laurita and Kelley who swore that it was the highlight of their safari to see such an event. I knew that when lions mate they do so every 30 minutes for several days and Yusef informed us that the reason is that the male lion’s penis is very short so this is required to ensure that the female becomes pregnant. Since we knew that there would be another show very soon we decided to wait and were surprised when the male got up again in about 15 minutes readying himself for the next episode. This time he mounted one of the other females so it was obvious that at least two of them were in estrus. Both growl very intensely during the mating and it was again over almost as soon as it started. We were all by ourselves in the middle of nowhere watching these lions so we were in no rush to leave and continued to watch them for some time during which we witnessed a total of four matings with the two females. It is something that I’ve seen a few times before, but never with the enjoyment of listening to Laurita’s and Kelley’s commentaries that were hilarious even if half of them were in Spanish. Regardless, their laughter was the same in any language and equally infectious as you can only imagine the jokes being made at the expense of the lions mating ritual given the very short duration of each encounter despite it going on for days.

An afternoon feast

An afternoon feast

We eventually departed our little pride of procreating lions and were heading along the river in the direction of the main gate. After some time I asked Yusef if we could head back to the lions we had watched in the morning and he informed us that he had heard on the radio that they had actually made a kill while we were engrossed in the lions mating and that was where he was actually heading. So off we went at a somewhat faster clip as we all held on so as not to be thrown into the side of the vehicle which can easily break a rib or at the very least leave you quite bruised. We came upon the watering hole to a gaggle of vehicles with everyone focused on the very same group of lion sitting down to an afternoon meal of fresh wildebeest. The kill had occurred perhaps 30-60 minutes prior to our arrival and several of the lions were already satiated and lying in the shade as the kill was directly in the sun. We watched as one of the adults and the three younger lions all sat along the belly of the prey and quite intently ripping chunks of flesh and cracking bones that was audible to us even 50 yards away. Occasional spats would occur regarding someone’s position in the pecking order or at the kill, but they would only last a moment and then each would immediately go back to their ripping and shredding.

An afternoon feast

An afternoon feast

As we were watching this, a number of elephant families were approaching in the distance on their afternoon trek from the river back to their homes in the hills and they were clearly looking forward to a rest stop at the watering hole. It would be interesting to see what would happen when the elephants approached the watering hole this time as the lions had a kill and we knew what had happened earlier in the day when the elephants had won out. This time, though, the elephants left the lions alone on their side of the watering hole and merely strode to the other side and began drinking and throwing water on their backs. It seemed clear that the elephants knew that the lions would likely defend their kill and wouldn’t be so easily dislodged this time. We eventually left this scene to head out of the park and make our way back to Karatu. We had had a wonderful two days in Tarangire despite the tsetse flies and other than a few bites here and there, they were a distant memory. We had seen the darker side of Kelley (yes, there is a dark side) as she gleefully executed tsetse after tsetse with the assistance of Laurita and me, though it was clear that she enjoyed their demise much more than either of us did.

The drive back to Karatu was unusually quick. We dropped Yusef off on the tarmac as he had to meet with some friends and we made our way back to FAME. Alex had said he was cooking us dinner tonight and little did we know what feast he was planning for us tonight. Kelley and Laurita were in their pajamas when we went over to his house next door and I was wearing my gym shorts and T-shirt. Shortly after our arrival for dinner, the rest of the FAME family showed up – Susan, Frank, Verena, Nurse Barbara and Annie Birch – so we gave excuses for our dress as we hadn’t been aware of the guest list. Joyce wasn’t feeling well so missed an incredible meal of real Gyros with homemade pita, sauce, wonderfully seasoned beef, homegrown lettuce and tomatoes and a rice and feta salad. Alex is an amazing cook and we were grateful for this meal after coming home from our weekend safari. We had seen nearly everything we wanted to see in Tarangire save for a leopard, so the girls will just have to return here someday to realize that experience. They did get to spend time at a wonderful lodge with a wonderful staff which also something to experience here. Needless to say, we were all very much looking forward to our beds this night as were were all very, very tired, but also very fulfilled.

October 22, 2016 – On safari….

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We awakened before sunrise as we had planned to get an early start for our safari today. We all met in the dinning area at 5:45am for an early breakfast and were greeted by the wonderful staff. Fresh coffee and juice, pancakes (crepes), homemade granola and eggs to order were on the menu this day. We talked again about our plans for the day and where we would be heading in the park. I was very excited because I hadn’t been to many regions of Tarangire since my original visit here in 2009, and it is a very large park with some amazing sights. Today we planned to visit the Silale Swamp which was at the very far end of the park and opposite the main gate that I normally used to enter when we come to visit for day trips. It would be at least several hours to reach this region.

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Yusef and Kelley checking in at the Sangaiwe gate

Kelley and Laurita (?) at the gate

Kelley and Laurita (?) at the gate

The Sangaiwe gate was only a few minutes from the lodge and we entered the park just after the gate opened. Like most entrances to the parks, they take no cash and only credit cards so as to minimized theft by the workers which had been a significant problem in the past. Because I have a resident permit, I’m able to get into parks other than Ngorongoro for half the price of the normal day rate of which is a bit over $50 now with the new 18% tax that has been imposed (or finally instituted) after President Magafuli took office last October. Though it was a shock when it occurred overnight, the new prices and taxes for the parks and the Crater will hopefully all be for the best as they are intended to all benefit the wildlife and conservation here. Tourism and the wildlife they have here in Tanzania are their greatest financial assets not to mention the importance to our planet in the preservation of these unique species that have been so impacted by the presence of humans over the last several hundred years.

Smuggler's hide - a hollow Baobob tree

Smuggler’s hide – a hollow Baobob tree

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Lions resting in the shade at midday

The Sangaiwe gate is located about 45 minutes from the river area which is where most of the animals congregate during the dry season. Tarangire is a region that is dominated by a river ecology so that during the dry season all of the animals travel from the surrounding hills to obtain water from the only source available. Families of elephants, large herds of wildebeest, zebra, and Cape buffalo migrate to the river on a daily basis. Meanwhile, Grant’s and Thompson gazelle, who don’t migrate and need much less water are found in the open areas of the park and countless groups of Impala reside in the woodland regions. Waterbuck, reedbuck, elan, and dikdik are scattered amongst the others throughout. Tarangire is also known for it’s exquisite birds including numerous types of vultures, eagles, hawks, plovers and Kelley’s favorite, the Lilac breasted roller.

A lilac-breasted roller in flight

A lilac-breasted roller in flight

A lilac-breasted roller making a landing

A lilac-breasted roller making a landing

As we leave the gate we begin our drive along the higher woodlands that are unfortunately the home to tsetse flies. These are the flies that carry trypanosomiasis, or sleeping sickness, but thankfully don’t in this region of Africa otherwise we would have been in big trouble long ago. The tsetse is a blood sucking fly whose bit is very painful (much worse than a mosquito) and they are masters of stealth until you feel the severe pain of their bite. Humans are obviously not their primary target otherwise they wouldn’t be so numerous and they are usually bothering the other large animals around including all the antelope and the Cape buffalo. They are attracted to anything that moves and this typically means a large animal, but in our case it means our vehicle and, unfortunately, us inside. They are like guided missiles and once locked on their target they are relentless and tireless in their quest to bite us. Since I’m riding behind Kelley and Laurita, I can watch their backs and swat the flies off and all that is available on me are my shoulders as my shirt is flapping enough in the back with the movement of the car and the wind so as to keep them off. The morning was fairly cold and I wore my only fleece which happened to be blue, a color they are attracted to while I had forgotten that they also like black which both Kelley and Laurita were wearing. Oops! Needless to say, we were all a setup for an impending tsetse fly disaster. It wasn’t pretty, but since it was their first exposure to these little conveyors of agony, the girls were only moderately annoyed, but worse was to come later in the day.

A tawny eagle

A tawny eagle

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Once out of the woodlands, the tsetse pandemonium abated and we once again relaxed to enjoy the truly amazing sights of this park. As we traveled along the various river circuits whose trails were dry and dusty, but had been very wet and slippery in March during our visit. The early animals were just arriving to the river while the majority were still traversing the plains from their homes in the hills. When you see several safari vehicles stopped in one location, it usually means some kind of large cat, either a lion, cheetah or leopard, and this morning as we approached one of the river crossings we came upon this scene. Far up the dry river bed was a lioness just laying in the shade, but it was enough to attract a crowd. A family of elephants were milling about high above the river bed, though eventually decided it was time for cool mud and ambled down a path that was immediately next to the relaxing lioness. Not necessarily mortal enemies such as the big cats are to each other (lions will kill cheetahs on sight), elephants do not tolerate lions for a moment and when they realized her presence, they immediately charged after her, chasing her further away from us down the river bed. We turned our vehicle around to follow the lioness and after a few moments spotted the rest of her pride under a tree in the distance, a male and several other females doing what lions do during the which is mostly to sleep.

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The watering hole at midday

Making a stretch for lunch

Making a stretch for lunch

A herd of Cape buffalo

A herd of Cape buffalo

It was still quite early as we began our drive over one of the hills towards the Silale Swamp, a very important natural area for the animals here. The swamp is massive and occupies the majority of the valley it sits in. It is very green even in the dry season and families of elephants can be spotted everywhere along with groups of buffalo. Wildebeest and zebra don’t seem to wallow through the mud of the swamp which I suspect is more for safety reasons as they would probably become mired and when speed is your main defense, that would be serious problem. The Cape buffalo use their size and horns as their defense against predators as well as their strength in numbers while the elephants are much less often targets of predators other than the smaller babies.

Kelley and Laurita getting shots of the cheetahs

Kelley and Laurita getting shots of the cheetahs

A cheetah up close

A cheetah up close

While over on the swamp side, Yusef heard news of some cheetahs a distance away across the river. Initially it was decided we’d lunch first, but then he decided to hightail it to the cheetah sighting so we all held on for dear life while we sped across the countryside in search of the world’s fastest land animal. It turned out that the location was up Tarangire Hill, a landmark far down river and when we came up the location, there were two cheetahs laying in the shade of a bush and several vehicles already watching them. Cheetahs are the most elegant of the cats and it is their speed that they are known for rather than their strength. It was so exciting for Laurita and Kelley to finally get to see a cheetah and now here were two. One cheetah was lying in the middle of the bush and more difficult to see, but it eventually came out and the two cheetahs greeted by washing each other’s face with their tongues. They didn’t seem to be interested in hunting so we watched them for a bit and then left to drive back over to the lunch spot overlooking the Silale swamp.

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The lodge had packed us a picnic lunch rather than the usual lunch boxes and we found the perfect table that had a great view of the swamp with all it’s elephants and flocks of birds laid out before us. Lunch included a large container of pasta with ham, peppers and onions that was out of this world good, hamburgers, small individual quiches, apples for desert along with a small chocolate bar. We were all starving as we had stopped for a later lunch and it was so relaxing to sit in the shade and share such a feast among friends. The leftover pasta and anything else went to some young workers who were digging a new foundation near the bathroom in the heat of the midday.

A male secretary bird strutting his stuff

A male secretary bird strutting his stuff

Mr. and Mrs. Ostrich (with the Mrs. putting on a show for him)

Mr. and Mrs. Ostrich (with the Mrs. putting on a show for him)

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After our rest, we all climbed back in the Land Cruiser for our second half of the day and decided to head back to visit the cheetahs we had seen before. They were still there, though perhaps somewhat more visible as they had adjusted themselves to avoid the strong midday sun. They were still the same gorgeous creatures we had seen just recently and were interacting again with each other. Cheetahs are typically solitary animals who hunt alone as well, but you will occasionally see them in pairs and much less frequently three of them together. When this happens, they are all of the same sex and almost undoubtedly males and often brothers. Females never travel together. Two years ago I had seen a threesome of males here in Tarangire on the small Serengeti drive. We decided finally to leave our two cheetahs, though it was admittedly difficult as they were the first for Laurita and Kelley and they are definitely amazing animals to see up close.

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A cheetah greeting

A cheetah greeting

The remainder of our afternoon was spent driving along the river in search of other sights, but the tsetse flies were definitely becoming more of a nuisance and I was quite worried about Kelley’s sanity. She seemed to be our tsetse magnet, that person you always like to have along as the biting insects seem to favor them for some reason giving the others a bit of a reprieve. Unfortunately, Kelley was not quite as enthusiastic with her assumed role and had taken it upon herself to personally annihilate as many of these pests as she could using one of my work gloves I had brought along in the car. She enlisted Laurita who seemed to muster a similar hatred for the flies and chose to use the other glove as her weapon of choice. Between the two of them, they managed to scatter the lifeless carcasses all over the floor in short time. I would not want to run into these two in a dark alley if they had a grudge for any reason and especially if I saw them carrying those work gloves. Traveling back through the acacia woodlands where the bulk of the tsetse flies were earlier in the day, first Kelley and then Laurita covered themselves up in Maasai shukas (blankets that we had in the car) so very little of them was exposed for the flies, but they were somehow still occasionally finding their target and there would be on onslaught of brief action before covering themselves up again. I certainly wasn’t immune to the flies, but did seem to have less of them bothering me along the way so enjoyed watching the two of them ranting and raving in between my less frequent run ins with these devils.

The pair of cheetahs

The pair of cheetahs

A male waterbuck striking a pose

A male waterbuck striking a pose

We arrived back to camp just before six which was perfect as the gate to the park closes then and we had to be out by then. We were again greeted with cold washcloths and looked forward to relaxing for a few moments in our rooms though Laurita apparently went right to the observation deck where she could get internet coverage. Both girls are avidly playing in the resident fantasy football league and had to make sure their lineups were set for the following day. We later all met on the deck and enjoyed a cold beer together after a long day in the vehicle on our game drives. We had seen so much that day and we enjoyed reminiscing about the events including the war with the tsetse flies. We sat outside under the stars for dinner and later laid again on the deck to watch the Milky Way and shooting stars and this time even decided to try some long exposure photos. I had somehow left my quick release plate at home so my tripod was useless and we used a towel to prop up our cameras and get some photos. It was finally time for bed so off we went to our tents for a relaxing night with thoughts of more game drives tomorrow.

The Milky Way

The Milky Way

A shooting star

A shooting star