Sunday, September 26 – A balloon ride for Kelley and Paul, more cats and a visit to Kitashu’s family…

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Paul and Kelley’s balloon ride

Our second night in the Serengeti seemed to be pretty uneventful, though, as we later discovered, the lions had been busy in the night quite nearby camp. As we weren’t leaving on a pre-dawn expedition again, it was quite clear that all were accounted for in our party and we were the only ones at camp once again. Though there had certainly been an influx of tourists over the last months, the numbers still remained down due to COVID and I know that the camp staff were more than happy to have us there. I should say that everyone was at breakfast other than Paul, Kelley and Vitalis. They had all risen before 5:00 am as they Paul and Kelley had a date with the balloon gondola and Vitalis had volunteered to drive them to the launch site.

As I had mentioned before, Leonard’s brother, Jones, has been a balloon pilot in the Serengeti now for over ten years and, when the planets seem to align, there are often opportunities for a few of us to go up in the balloon with him for a reduced cost, crucial to our ability to do so, as the experience is quite expensive. Back in 2014, Danielle Becker and I had spent a week in Serengeti and, on boarding our flight in Arusha to head to the Northern Serengeti to watch the migration, we bumped into Jones, who was heading to the Central. He volunteered that, if possible and they had some open seats, he might be able to get us on a flight with him when we arrived in the Central Serengeti. Well, things worked out and Danielle and I had an amazing time and the experience of a lifetime.

You arrive to the launch site in the pitch black darkness that is the night in Africa and, when your eyes finally adjust to the darkness, you realize that there is this enormous balloon laid out on the ground and beginning to fill from the hot air that is being supplied by the jet burners on the top of the gondola. The gondola, by the way, is lying completely on its side for that is how you take off – once the balloon is filled with hot air and begins to ascend, it drags the gondola along the ground for a bit until it stands fully upright and lifts off. There are nine compartments in the gondola, four on each side and a larger center compartment for the pilot. There are two passengers typically in each of the compartments, as well as a bolster pillow that is for takeoff and landing, allowing you to lay back with your knees and legs above you resting on the bolster. You’re buckled in and, once aloft, are standing up and watching the simply incredible scenery. There are two balloons that usually fly in tandem and you slowly make your way across the Serengeti Plain at slow pace with the pilot guiding the balloon based on what thermals are at what altitudes.

The feeling of being in a balloon is that of simply floating in complete silence as long as the burners are off, which, when they are on to gain altitude, do make a noise that sounds a bit like a soft jet engine for it is burning gas to create the hot air that makes these balloons float. The flight is about an hour and you’re constantly going up and down so you’re heading in the right direction, but there is much more silence than there is noise. If you spot animals, the pilot will usually try to take you down so see them up close. You are often flying below treetop level which can be a bit nerve wracking, but the pilots are incredibly experienced and I know that Jones has trained in Europe and the US and continues to receive training even though he’s been a pilot for so many years. Landing is interesting as it is essentially a controlled crash, lowering the gondola to the ground while the balloon is still traveling with some speed, albeit slow, and being dragged for some distance on your side as the gondola just falls over while you hang on for dear life.

Once on the balloon is officially down, though, it’s time to proceed to the breakfast spot where they have tables set up for everyone from both balloons to enjoy a totally homemade breakfast with eggs, meat, fruit, toast, orange juice, and, of course, the traditional champagne that is drunk with every successful flight, or at least that is what they have told us.

It was an amazing adventure when I went up and I knew that Paul and Kelley were going to have a wonderful time on their trip and I was happy to be able to do it for them. What I didn’t know, though, was that Jones had decided to put Vitalis on one of the balloons as he had never been up on one despite having led safaris here on hundreds of occasions. I found this out later, when Jones, instead of Vitalis, came back to the camp with Turtle and told us that he would be driving us for the morning until we met up with the others at the Visitor’s Center.

Meanwhile, the rest of our team, including Kindu, who had stayed back at camp with us, were treated to a delicious breakfast of eggs, fruit, beans, veggies and toast. Though we were all packed up, we had wanted to take a walk to the nearby hippo pool after breakfast, led, of course, by our camp manager, Lydia. We all followed in close proximity as we walked between two of the tents on the opposite side of camp and were soon walking along a fairly open area in the direction of the pool. We couldn’t go before breakfast as the hippos may have still be out of the water, grazing, which they do for most of the night, eventually making their way back to their pools for the day to stay cool. Hippos are very neurotic and anxious and, coming upon one out of the water, you must be extremely careful as they are the most dangerous animal in Africa and responsible for more human deaths than any other animal.

So, on our little trek to the hippo pool, we were going to make certain that we did not run into any of these humongous animals with canines the size of sabers for we all did wish to make it home in one piece. As we crossed an open area bringing us nearby the shore of the small creek (called Turner Spring) where the hippos would be relaxing in the water, what we did not expect to see was a pride of lions on the other side of the water, seemingly chilling in the morning sun, though, as we would find out shortly, there is only one time that lions like to chill and that is after they’ve eaten. With the lions in plain sight of all of us, and us in plain sight of the lions, we all decided, and clearly supported by Lydia, that the best strategy at the moment would be for all of us to reverse our direction, head back to camp and come back with the protection of our vehicles. Or, for those fans of Hanna-Barbera and their cartoon character, Snagglepuss, we decided to quickly “exit stage right!”

I truly doubt that we were ever in any real danger, but seeing lions while on foot is just something that you don’t expect. We made our way back to camp and, after packing the vehicles for our departure, headed back over the hippo pool to check things out. Sure enough, on the opposite back were not only two males and two females, one with the tiniest of cubs, but also another male down at the waterside guarding their freshly killed Cape buffalo from the night before. Apparently, several of the camp staff had heard a commotion over the night that must have been the battle which, it became quite clear, the buffalo had lost and we were now watching a solitary male lion attempting to drag the massive carcass further up the bank through the tall grasses. We watched the lions for a bit, then checked out the hippos in their pool, all from the safety of our vehicles. Eventually, though, it was time to make our way to visitor center, where the balloon crew would be dropping off Paul, Kelley and Vitalis, and we would once again be together.

Dragging a Cape buffalo carcass up off the riverbank

We eventually began our slow exodus from the Serengeti by leaving Seronera and the Central Serengeti to make our way back to Naabi Hill and depart from the park. We took a side route, though, staying close to water in the hope that we might find more leopards, and, sure enough, were able to find two more of these powerful cats to bring our total to three for the weekend. Shortly after, while on the main road, we came upon a gathering of several vehicles, usually indicating there’s a cat in the area, with a number of very impolite tourists and drivers who just could not wait their turn to see what was lying under the tree. It was quite annoying and Vitalis was not at all in the mood to put up with it, and though it took several minutes to get a short view, we eventually did and found three cheetahs lying under a tree in the heat of the day. For the weekend, our final tally was 33 lions, four cheetah, three leopards and a black rhino. The group had seen the big five in a single weekend considering we had seen plenty of elephant and Cape buffalo along the way.

A leopard in the tree with its kill (above him on the branch)
Striped mongooses

The road back to Naabi Hill Gate was significantly dustier than it had been days before with the rain, with each passing vehicle producing dust clouds that seemed to be endless at time. No matter, though, as were still in the magical Serengeti and there were still sights to see. We stopped at the gate to eat our lunches and there were so many safari goers that there wasn’t a table to spare and we ate sitting on benches which served us quite well. Departing the entrance, we were back in the Ngorongoro Conservation Area now and on our way to visit Kitashu’s boma on the crater rim, just off the main rim road. I’ve visited Kitashu’s family on a number of occasions now and it is always very special to see all of his relatives and all the children there. Kitashu’s wife and children were living there until this year, but have now moved to Karatu as his son is attending the Tumaini School, one of the better private schools in town. He no longer has to commute to the crater, though still goes home on many weekends to tend to his livestock that are still at the boma.

Kitashu’s hut

Driving into the boma is always a treat as everyone is out to greet us and there are children galore. We always bring gifts for his mother and father that consist of staples such as rice, oil, sugar, soap, salt, tea and other things as well as “pipi,” or candy, for the children. For nearly all of our visits, Kitashu has always insisted on preparing a goat roast for us as this is sign of respect and an honor for them to cook for us. And I will have to say that there is nothing like Maasai goat cooked on a stake over an open fire. Despite the fact that there are no seasonings used, it is one of the tastiest meats you can imagine and is sliced fresh for us on the hillside overlooking the lovely hills of the Ngorongoro Highlands that surround his village on all sides. This is a true delicacy and I’ve always been glad that the residents can share these experiences as they are like no others.

In addition to our goat roast and handing out pipi to the children, there has also been the tradition of everyone dressing in shukas (the plaid cotton wraps worn by the Maasai men and women) and also having our female residents wearing the beaded collars and other jewelry worn by the Maasai women. Then everyone is taught how to dance with the women singing and chanting while they dance and the men performing their famous adumu, or jumping dance, that is their tradition throughout Tanzania and Kenya. The women’s dance is performed with far less athletic prowess and tends to involve more of the shoulders and upper body.

Our day was now complete and it always seems to be a race to get to the gate by 6:00 pm so we don’t have to spend the night on the crater rim. We actually were able to make it with at least 15 minutes to spare this time. Both Kitashu and Leeyan caught rides back to Karatu with us as they both had to be at work with us the following morning and we had plenty of room in the two vehicles. The last two Sundays we had chosen to eat out at Patamu after getting home from our game drives, but none of us were up to it tonight and we decided to scrounge at home for food. Besides we had eaten quite a bit of goat at the boma were in no danger of starvation. We would begin our last week at FAME tomorrow and I think everyone was beginning to realize that our wonderful month was coming to an end soon.

Saturday, September 25 – A full day of game viewing in the Serengeti and lots and lots of lions…

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Everyone had gotten a good sleep, though for some, hearing all the sounds of the wild animals so close to camp for the first time was probably a bit unnerving. As much as you might think that we would all make easy prey for a pride of lions given the only surface between us and the outside world is the canvas of a tent, easily shredded by their sharp and powerful claws, but that just doesn’t happen. The roars of a male lion at night or the frequent “whoops” of the hyenas chatting among themselves does little to keep the imagination from wandering too far from reality and in those moments of semi-consciousness, drifting off to sleep, one becomes easy prey to these machinations of the mind. Amazingly, though, everyone survived and the order of appearances at the mess tent was quite predictable – I had my cup of tea mostly down as the girl’s tent appeared, followed by Paul and Kelley, and, eventually, Akash and Phillip decided to grace us with their presence. No worries, though, as the sun hadn’t quite arisen yet and we had the who park to ourselves it seemed.

Kelley, Akash, and Phillip on the lookout

I had stayed in this cluster of camps before and was familiar with the route we’d be taking, traveling far beyond Maasai Kopjes in mostly a southeast direction and our main object was to look for big cats, though had we spotted a caracal or serval, we would have taken those as well. The balloons had launched from near Seronera and were already afloat, though they were too distant for us to hear the intermittent blast of their burners as they would rise and fall to ride the thermals. I had taken a balloon ride with Leonard’s brother, Jones, who is a balloon pilot in the Central Serengeti, back in 2015 with Danielle Becker as we only paid the concession fee of $50, far less than the $500 or more normally charged for the experience. It was truly the experience of a lifetime, though, and, to be totally honest, would have been worth the $500 had I known before.

We wasted little time in spotting a number of vultures circling above and as we drove to the area, spotted several hyenas near a den that had little concern of our presence. As we drove by them in the direction of the vultures, though, we came across remnants of a hyena carcass that had likely been killed by the hyenas themselves and was eerily staring off into the distance with empty sockets as the eyes are a delicacy for the vultures. It had most likely not only been killed by other hyenas, but also eaten by them before the vultures had their turn at the table, a common occurrence among these scavengers.

Munching on a tasty snack

After traveling a short distance, we came upon our first pride of lions that consisted of a few females and three small cubs, all of the same age and very likely immediate siblings. They were resting, but were active enough for our purposes, although had they been hunting, that would have been extra special. Watching a pride of lions hunting is always an amazing experience, but you just have to be lucky enough to be at the right place at the right time. You also have to be very patient and willing to follow the lions for some time as they are obviously very methodical. Lions have a much worse kill rate than the cheetah and the leopard as their stamina is poor and they must be very close to their prey to deliver the final blow. I have watched many a lion hunt that ended in a failed attempt for one reason or another. Leopards are totally stealth when they hunt and cheetah are, as we all know, the fastest land animal and capable of amazing acceleration that I can attest too first hand.

“Mom! You’re messing up my mane”

We watched the lions as they all got up and eventually made their way to a nearby kopjes where they had a watering hole on top of the rocks that had obviously collected rain water from the day before. The male positioned himself up higher on the rocks while the two females and three cubs made their way to a depression in the rock that we were unable to see, but it was clear they were rehydrating. The sun was intense, but the temperature was quite cool even though we were approaching 10 AM and breakfast time. We continued for a bit until we found a very nice place to all have breakfast, under an acacia tree, where there were no animals nearby, at least that we were aware of. The camp had made us all very nice breakfast bags, but hadn’t included any vegetarian meals for Akash, a strict vegetarian, or Cat, a pescatarian. Cat could make do with what they supplied, but Akash did have to sort through to make sure he had enough to eat.

After breakfast, we were back on the trail of big cats and ran across many more lions, including a pair of brothers, who looked like Mufasa and Scar from Lion King, though it became very clear in the right wind, that the one who looked most like Scar was, in actuality, a relative of Fabio, as he must have just come from the hairdresser and wanted to show off his gorgeous coif. Regardless of whether we were in a Disney movie or at a fashion show, the brothers took very little notice of us and we eventually moved on in search of more sightings.

Another pride of lions popped up not long after, though it was unclear if they were related to these males or not, but there was a radio collared female with two juveniles sitting on a termite hill who we watched for a few moments, only to spot another five or six of their pride lying in the grass a short distance away who were originally well camouflaged. They all eventually got up and slowly made their way along with the collared female and two juveniles off towards one of the close kopjes, most like to rest in the shade of a tree or find a watering hole.

Fabio!

Somewhere in here, we found a nice place to eat lunch in a similar fashion to our breakfast and shortly thereafter found our first cheetah. He had a full tummy for sure and looked like he was originally just chilling under a tree digesting his lunch, as were we, but he wasn’t happy with our presence and eventually trotted off to find another tree to chill under.

An impressive wildebeest imatation
A motley crew

So now we were in search of a leopard, as this would complete the Big Five for the entire group. The big five are the traditional animals that were hunted as big game and the most dangerous to go after as each one would present a challenge in that they could easily charge the hunter killing him. The traditional Big Five consists of the leopard, lion, elephant, Cape buffalo, and the rhino (both the white and the black rhinos). If you are searching the Big Five in southern Africa, you’re in luck as the larger white rhino is far more numerous easy to find compared to the critically endangered black rhino of East Africa. Being able to spot the Big Five in a single weekend is therefore rather challenging in Tanzania.

An oribi

Leopards like to live near the water which is vitally important for them in their hunting strategy which is to sneak up on its prey and pounce rather than chase them. The most common place to find them during the daylight hours is in the trees along the many streams and rivers of the Central Serengeti, though I have also seen them on the ground on a number of occasions and once on the rocks of a large Kopjes. When the leopard walks through the grass, it does so with its tail held high in the air and it is often easy to spot and follow that way.

They are massively strong and agile in a manner much different than the lion and probably closer to the tiger. They will drag their prey into their tree after killing it, keeping it from the hyenas and the lions, the latter of which will rarely climb a tree to challenge a leopard for its prey. Driving through leopard areas during the calving of the wildebeest, you will often see old carcasses in the trees that were left by the leopard after devouring the majority of the meat.

Akash and Cat loving the Serengeti

Driving through a typical area to spot a leopard with the sun getting low and our time running out for the day, we came upon several vehicles looking into the trees and, sure enough, there was a large, male leopard in the bottom branches of the tree, lounging in the late afternoon sun. Our group had seen their big five in less than 24 hours! We watched the leopard from several angles for some time as it moved around in the tree from time to time, but did not come out of the tree. Had we stayed and watched it for some time, we may have been able to see it begin a hunt, but leopard kills are very rare and I’ve never seen one. Having completed our “hunt” for the leopard, though, while there was still daylight, we decided to get back to the camp with time to walk around a bit.

Akash’s award winning photo

It’s great to maximize your time game viewing, but it’s also nice to relax a bit at camp where they will typically have a fire going for the evening to watch sunset and eventually the stars. Here it’s called “bush TV” and it’s far more interesting than watching anything that may be on the television and certainly a respite from watching cable news. Lydia, our camp manager, walked us over to view a huge female crocodile that had a nest and had laid eggs just on the other side of the stream from the back of our tents. She was easily ten feet long and huge, but was busy protecting her nest and had no interest in us. Besides, she was a tad bit closer to the girl’s tent than mine. In reality, though, she was probably only fifty feet from the back of the tents. Tomorrow morning, since we weren’t going out at sunrise, we’d walk to see the hippos.

Today was also Kelley’s birthday and the camp, of which we were the only guests, by the way, had a birthday celebration for her with a small cake that they baked and they came out singing the Swahili birthday song with everyone dancing and banging pots or clapping. The other exciting news is that Jones, Leonard’s brother, had secured two seats for us on the morning balloon flight, and since Paul and Kelley are getting married in March, I decided to have them use the two seats as their wedding present. They would have to get up at 4:30 AM to get to the balloon launch area as it goes up before sunrise, but I knew it would be well worth it for them.

Friday, September 24 – A late start for the Serengeti, Oldupai Gorge, rain at Naabi Hill Gate, and a rare sighting…

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It’s often quite difficult to fully explain what goes into setting up a visit to the Serengeti or even to the Ngorongoro Conservation Area, and I’m not even sure I entirely understand the process, but dealing with the Tanzanian government and their online systems when it’s not several months in advance is apparently very tricky. You would think that I’d have learned this a long time ago given my twenty-four trips here, but for some reason I have chosen the insanity route on this one (“insanity is doing the same thing over and over again and expecting a different result” likely misattributed to Einstein though may as well have been) and this morning was no different. I would attempt to offer some defense for my reasoning, though even that is quite weak. The trips are quite costly and I am always worried about the sticker shock for the residents when I tell them the cost, yet when it comes time to pony up in the end, it has been a rare occasion that anyone has not participated and, in those two cases, there were other reasons such as several years ago when Daniel Cristancho had already booked a safari for he and his then fiancé, now wife, Roxanne, immediately after our time at FAME.

The view from the overlook at Oldupai Gorge

Our trips are always booked at the last minute thanks to the hard work and dedication of my long-time friends, Leonard and Pendo Temba. If not for them, I wouldn’t be here now, and it’s been with their help that I have been able to navigate much of what has become an incredible experience for those residents and others who accompany me to FAME and Tanzania twice a year. Our Ngorongoro Crater trip last weekend had gone seamlessly despite having to book the trip in the computers days in advance. The Serengeti adventure has more moving parts, though, that includes the transit fees across the Conservation Area (booked on a daily basis), entry fees into the Serengeti (that are booked on a 24 hour clock from when you enter), lodging fees for the camp (that also includes three meals a day), and camping fees for the Serengeti National Park (in addition to the fee to the tented camp). And this didn’t include the second vehicle cost as there were eight of us plus the driver which was just too many to cram into a second vehicle.

Looking west from the Oldupai overlook at the sedimentary layers

Vitalis and Kindu, our guides, were meeting us at the houses at 8 AM sharp for our departure, though we would first have to go to the bank to use all of our cash to pay for the park fees that would be deposited into the park accounts. There has been a long-standing issue in Africa with counterfeit American dollars since I first came here 2009 meaning that they only take bills that are recent and fresh (which doesn’t make all the sense in the world to me as counterfeit bills are usually hot off the press), and though I know that I’ve told everyone in advance, they don’t seem to believe me. Honestly, I go to the bank teller and tell them I want bills after 2009 that are fresh and I only bring large denominations for converting into TShillings for the best rate. So, after having to exchange some of the other’s bills that were old or worn looking for my fresh bills (I’ll carry back the old bills to States as they are fine there), I still ended up with several thousand dollars in 20s that were probably in somewhat iffy condition.

Looking south

It was this cash that Vitalis went into the bank with that morning, and though I don’t that was the only issue, it was one of them and it was not until over two hours later that we were finally on our way out of Karatu and to the Ngorongoro Gate. It was a painful wait even for me, who well understands why we use the expression “TIA” (this is Africa) here, but the others, I think it was a bit intolerable. Still, we had no other options and just had to wait outside the bank in our vehicles, though many ran across the street to the downtown Lilac Café for snacks and the bathroom. Once on our way, it was a quick hop to the Lodoare Gate with our two vehicles, one for the girls and one for the boys as there were of each. As we rose slowly up the road towards the Crater, the rim became completely shrouded in the mist of the low lying clouds, entirely enveloping us and blocking the hope of any view down into the crater for most of our drive around the rim road. This road, windy and curvy, often only wide enough for a single vehicle, is the only route to the Serengeti and is driven by large trucks and buses transporting goods and people across Northern Tanzania towards Mwanza on Lake Victoria and back.

The Oldupai overlook and Professor Masaki

Our plan was to initially visit Oldupai Gorge which lays immediately on the other side of the crater on our way to the gate for Serengeti National Park. One of the directors there is an old friend of mine and I have stopped by to visit on several occasions in which he has been able to give us guided tours that have included Leakey’s camp before it was open to the public. I have always used the correct and traditional spelling of this park that comes from the Maasai name for the local sisal plant that grows in the region, rather than the anglicized and misspelled “Olduvai” that unfortunately occurred when the name was first put in print by the founder of the site long before Louis and Mary Leakey did their ground breaking work here that began in the 1930s. This Western version of the name has been carried forward, though there are efforts to revert back to the current usage of the word that will probably take several more years effort to take hold.

Professor Masaki

After eating lunch in full view of the Gorge and the amazing sediments that have yielded the birthplace of humanity and oldest man, we took a fairly quick tour with Professor Masaki guiding us through the brand new museum on site that contains mainly casts of the most important fossils of early man, but many original fossils of ancient mammals that populated the region during the reign of each of the species of hominoid that the museum is divided into, ending at the near present with homo sapiens. I could have easily spent days just in the museum as I know the others could have also done, but unfortunately with the late start, we needed to make our way to Serengeti, otherwise we would be reaching our camp far too late for dinner and we still had more to see here in the gorge. We descended into the gorge, making our way down to the volcanic bedrock in the river bed, driving over large patches of bare rock as we did. From the bottom, looking up at the sediments, the many layers exposed by erosion that have created the single most famous site for human fossils in the world, it is easy to see why the Leakeys spent over twenty years working here before they made their most important discovery, Zinjanthropus, or simply, “Zinj.”

Cat enjoying the sights

The site where Mary made this discovery is marked and there is a small display acknowledging the importance of this remarkable event that forever changed our understanding of human evolution. Though massively understated, anything more here would take away from the remoteness and ruggedness of the region that is necessary to understand the challenges that would have been faced working here in the past or even now. The sun beats down with such intensity that anything inanimate is completely bleached of all color and surviving here is hard to imagine. The topography and paleobotany of this region, though, was quite different during the epochs of early man here, which is why they flourished and what has made Oldupai the remarkable and rich treasure that it became. For those of us who have concentrated on physical anthropology in the past, this is Mecca.

The “Zinj” site where Mary Leakey found Zinjanthropus

We still had one more stop at the site, though, and that was to drive to Shifting Sands, an important cultural site for the Maasai. Shifting Sands is about a 25 min drive, much of it without road, from the main part of Oldupai Gorge and can be seen from a distance as you approach it, looking like a tall mound of rich black sand that is several meters high. I have visited here on several occasions and have been equally impressed each time. The mound, which has a crescent shape on the leading edge that looks like a cornice of snow in the high mountains, is constantly moving in one direction across the plain, traveling approximately 5 meters every year. It’s location in the past years is marked with columns that have been place over the last ten years or so.

The gang

Shifting Sands was created by an eruption of Ol’ Doinyo Lengai, or The Mountain of God in Maa, the language of the Maasai. This is why the site is so very important to the Maasai of this region. They will travel here from far away for various ceremonies or to gain good fortune. The sand does not scatter as it is heavily magnetic and sticks together, slowly moving across the land at its slow pace, leaving very little of itself behind as it has been traveling for thousands of years. I have seen photos of visitors standing on the mound, but no one I have ever been with has done so as there is a clear energy about the place that is to be respected. Maasai do stand on top, but Shifting Sands is a religious site to them and should not be defaced in any way such as with the footsteps of Westerners.

Shifting Sands

As we were so behind in our schedule to get into the Serengeti park proper (for all of the region of Oldupai and this part of the Conservation Area is technically part of the same geologic formation), we left directly from Shifting Sands to head across the plains and eventually intersect the main road as we crossed the border into the park, for there you can only stay on roads and not drive cross country. It wasn’t the easiest route to follow, even for seasoned guides like Vitalis and Kindu, though the missteps were few and of no consequence. As we approached the part, it was clear we were in for some very unseasonable precipitation and by the time we reached Naabi Hill Gate, where our paperwork had to be presented for us to not only leave the Conservation Area, but also enter the park, the rain was quickly coming down quite heavily and the roads were wet and slippery.

Shifting Sands

As you enter the Serengeti through Naabi Hill Gate, the road ascends northwest in the direction of the Central Serengeti and the area of Seronera. The Central Serengeti is dominated by the kopjes, or the large rock outcroppings that were depicted perfectly in the Lion King and represented by Pride Rock. All life is centered around these little oases that are each like a tiny island in a sea of the Serengeti plains. Some are more famous than others and many are scattered far and wide, while others may look like an archipelago or pearls on a necklace. You begin to see some smaller kopjes shortly after entering the park, but they become larger and more numerous as you travel north towards Seronera. Also, you begin to see smaller groups of lions under the many trees along the roadside, typically parts of prides that are out hunting or may have been hunting and are now resting in the shade in the typical hot sun, though now it was a pouring rain.

As we drove north, we received word of a very rare sighting here in this part of the Serengeti, a black rhino, an endangered species that is kept very close tabs on wherever they are as they are and each of their whereabouts are constantly known. The Moru Kopjes, off to our west is a place where there are rhinos nearby, but recently, they have enacted a separate fee to visit this area and hopefully spot a rhino, though I’ll have to admit that I’ve been there a number of times in the past when there was no extra fee and had never seen one. We turned off the main road onto a muddy mess of a trail that more like a slip and slide than anything else, but there were several other vehicles there as well so it looked like the search was on.

I’ll have to put a plug in here for Land Rovers, of which Turtle is one, versus Land Cruisers, which is what our other vehicle is. On these types of roads, a Rover will never get bogged down or stuck, but Cruisers are not nearly as sure footed. It’s easily seen in whether like this as all of the other vehicles were Land Cruisers and were constantly slipping whereas Turtle handled the mud like it was an ordinary day. Probably 95% of the safari vehicles used today are Land Cruisers, more a fact of good marketing by the Japanese manufacturers (i.e. Toyota) and the fact that Land Cruisers require less maintenance, but when they do, it’s much more expensive. The Land Rover requires more TLC, but when given, it performs like no other.

Sure enough, in a matter of minutes, we had the rhino in sight and though it was quite a distance, being the size of a Volkswagen beetle makes it easy to spot with our binoculars. It was roaming along minding its own business and grazing on grasses as it went. It appeared to be a male and was incredibly beautiful and impressive to see on the open plain. I’ve been lucky enough to see rhinos a number of times in the crater, where there are just shy of 30 living there, and had also seen a mother and her calf in the Northern Serengeti in 2015, but had never seen one here in the Central Serengeti. It made me realized just how serendipitous it is to spot these rare animals, such as the caracal last weekend, for had we been on time getting out of Karatu this morning, we would have mostly like missed it.

We watched the rhino so some time, but it was getting late and we took a more indirect route to routine to the main road, stumbling upon two very young lion cubs that were in a tree and next to a small ravine. It was clear that they had been put here by their mother, who had likely gone on a hunt and these were far too small to assist in that activity. They looked very skinny, though after seeing others later, they were not likely to be malnourished, but just not fat from a recent kill perhaps.

We made our way to our camp in the pitch black that is Africa, with animals appearing on the side of the road unexpectedly, or running across at inopportune times so as to make the going a slower than in the daylight, but Vitalis found our campsite which was near Turner Spring. In fact, the campsite faced the spring, where there were plenty of hippos that we would later see in the light of day as they leave the water to feed at night and are the most dangerous in that setting. The camp was marvelous and was a semi-permanent one with raised wooden platforms for all the tents including the mess tent and lounge. We had four tents between us with Emily, Cat and Denise in one, Paul and Kelley in another, Akash and Phillip in another, and me alone in the fourth. I decided not to subject anyone to my snoring. We had an amazing dinner shortly after arrival and everyone went right to bed after, tired from a long day of exploring and excited for the day tomorrow. We would leave camp before sunrise and bring both breakfast and lunch with us, prepared by the camp.

Thursday, September 23 – A second day at Rift Valley Children’s Village and a tour of the village…

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Phillip and Cat ready to present

As it was Thursday, it was another day of education and Dr. Ken had asked us for a presentation on psychosis, something we see quite often here and end up being the primary doctors treating it as there are no psychiatrists to be found anywhere in the area, a sad fact for most of Africa. I have had patients brought to us who were acutely psychotic and potentially dangerous and have had to give them intramuscular injections of a combination of haloperidol, a very strong antipsychotic tranquilizer that can stop an elephant with enough of it, and lorazepam, a milder, but very effective anxiolytic (antianxiety) medication.

Phillip and Cat giving their lecture on psychosis
Emily ready to start the morning

To be honest, I’m not sure if the incidence of schizophrenia is actually higher here than at home, but I’ve seen so many patients over the years as well as those who follow on a regular basis, that it would not surprise me in the least if it were higher here. Possible causes would probably be similar to that of epilepsy – childhood infections and injuries. Throughout the country, the patients are treated by the district mental health officers who may be clinical officers or nurses.

Robert photographing some of the children

The district mental health officer in Karatu is a nurse, or least was several years ago when we encountered them regarding a clearly psychotic patient who had been brought into one of our mobile clinics by her husband. She was not doing well at all and we had suggested a course of medication to the husband who promptly called the health officer to let them know. He was told that we were not to be trusted and that we were trying to poison her. Interactions like this with government health workers or district or regional medical officers have been extremely rare and, for the most part, have always been very positive. But, as you can see, things can go differently on occasion. With our patient at mobile clinic, all we could really do was simply explain that we supported a different approach to the situation than the mental health officer as we certainly didn’t want to destroy their therapeutic relationship given that we’re here only every six months.

Paul catching up on emails while Kelley is reading her book

Cat and Phillip partnered on the talk today and both contributed explaining that not everything psychotic is schizophrenia and going through the definitions of all the disorders in which you can see psychosis as well as how to treat them. They did provide a very nice chart that included all the different diagnoses with distinguishing features and primary treatments for each. In the end, the main medication we have here to treat any patient with psychosis is olanzapine and so the majority of treatments pointed in this direction.

After the lecture on psychosis and morning report, we rounded everyone up for the drive again to Rift Valley Children’s Village. We were anticipating the same numbers today, but sometimes you can be surprised as patients may come out of the woodwork, or coffee fields as the case may be, to be seen for their medical care which is always fine with us given that’s the reason we’re here. We did have a little more time in the morning as things were slower, but somehow ended up with extra afternoon patients requiring them to split into four rooms, taking Africanus’s office as the fourth. Philip had been working in there to keep up with the patient database, but that worked out as he simply sat in working on his computer without disturbing anyone.

Attracting a crowd
Paul giving a piggyback ride

I had forgotten to mention yesterday that one of the highlights of our visit to RVCV is always the lunch that we’re served. Normally, there are always a number of volunteers here at RVCV, but now with the pandemic, there are no volunteers and everything is pretty much being done by the full-time staff with the help of some of the older “children” from the village. In the pre-pandemic era, lunch was always served for all of the volunteers, which included us on our visits, having been home cooked by the mamas who have been doing this forever. In addition to our lunch, they are constantly baking bread and cookies as well, but the lunches are always delicious and fresh and like nothing else you can get in Tanzania.

Kelley entertaining some children
Leeyan working with Denise on a patient
Cat taking a history with Phillip catching up on work in the background
India helping to translate for us with a patient

Yesterday, we had vegetarian chili over rice with salad and fruit and today we had the most scrumptious fresh buns with chicken salad , fresh salad and fruit. Though I do love the lunches at FAME – rice, beans and mchicha five days a week, pilau and coleslaw on Thursday and Ugali, meat and mchicha on Tuesdays – the lunches at RVCV are on another level. Speaking of the lunches at FAME, for some odd reason, they didn’t serve ugali during our entire time there this month which was the first time ever and I’m really not entirely sure why. Cat, Denise and Emily were all looking forward to it, but it never showed up.

Akash completing his notes
Annie checking reflexes like the good neurologist that she is
It was a cold day so Kelley borrowed Paul’s jacket

We did have a chance to spend more time with the children today as you can see from the photos. It’s always a pleasure to be there and an incredibly refreshing experience. It has always been one of the highlights of the residents visit to Tanzania. We were all excited today as we would be leaving for the Serengeti in the morning. We had booked two nights at a tented camp in the Central Serengeti which is just such a magical place that it shouldn’t be missed. In March of 2020, the group had missed this trip, in addition to the money we had paid, because of having to scramble out of the country with the oncoming pandemic. It was a tragic loss and I hope someday that they’ll make it back here, but know that probably won’t be. Because of the size of the group, we had booked an extra vehicle besides Turtle, along with two drivers. We also planned to visit Oldupai Gorge on our way. We decided to make sandwiches once again rather than buying box lunches. I gave Turtle to Vitalis, our driver, in the evening after returning home so he could give it a good cleaning and we’d be off in the morning at 8 am, or so we thought.

Partners in crime 😀

Wednesday, September 22 – A visit to Rift Valley Children’s Village…

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The view of our patients waiting before we get started

With the long and dusty drives to Mang’ola now behind us, it was time for our shorter and more sedate drives to Rift Valley Children’s Village near the village of Oldeani and in the middle of a very rich agricultural region growing coffee and large fields of other crops. With the shorter drive, we were able to leave much later, giving us time to attend morning report, or for others to escape to the Lilac for coffee and breakfast. I have been visiting RVCV since my very first visit to FAME to work with the clinic. Early on, FAME had been providing semi-monthly medical clinics to RVCV to care not only for the children who live there, but also for the local villagers and area that surrounded them. Over the last years, though, our neurology clinic every six months is all that remains of the mobile clinics to RVCV. All toll, I have visited there on dozens of occasions considering this is my 24th visit to FAME and we attend there on at least two days every visit.

Prosper, Anne, Denise, Emily, Phillip and Cat getting instructions from Africanus
The group getting a tour of the administration rooms from Africanus. Note that Cat is standing the closest to the coffee table in the foreground so she can get there the quickest

Rift Valley Children’s Village is an incredibly unique institution that first opened in 2004 when India Howell and her associate, Peter Mmassey, decided to adopt 17 orphaned children and create a home for them. From that humble beginning, the village has now grown to a home for over 100 children who have all been adopted by India and Peter, spending their lives in the comfort of their family rather than having the fear of adoption hanging over them. Along the way, India and Peter have not only raised those children who have called RVCV their home and family, but have also created mechanisms to better the community concerning health, education and economy. The Tanzanian Children’s Fund now also oversees a dispensary at the village with a clinical officer (Africanus, who first came to FAME and worked with our neuro group several years ago, before working with FAME formally and then moving to RVCV), funding for the local schools to assist with hiring extra teachers at both the primary and secondary levels, and an economic project, the Rift Valley Women’s Group, training women from the local village to manufacture and market local crafts and enabling them to support their families.

Denise, Phillip and Revo in one of the examination rooms
A peeping Tom…

I have known and worked with several of the older “children” that have grown up at RVCV and they have all be totally remarkable. A number of them have gone on to the university to study medical fields. Selina, who had worked with our neurology team for several years as a translator eventually found work as a nurse at FAME and when we arrive this visit, she had just had a baby. I am reminded on every visit to RVCV just what an amazing place it is and how incredibly well-adjusted the children are which is no surprise given the amount of love they receive from the family they now have. There are multiple houses for the children, each one for a particular age group and sex and each with its own house mother who cooks and cares for the children that she supervises. There is a pre-school within the village and the primary school is adjacent to the village while the secondary school is a further distance away. The test scores of the children of these schools far exceeds the national average meaning that far more children advance to secondary school and university when it is time.

Kelley teaching Paul her card game in between staffing patients
Paul staffing with Cat, Emily and Leeyan

When we arrive at the village, there are always patients sitting outside on benches waiting for us and all have been checked in by Africanus with their charts split into pediatric and adult cases. Our patient list includes not only Mama India’s children from the Village, but also local children and adults from the surrounding area who have come to see us for their neurological problems. Many of the patients we have seen before, some for years, and they have returned religiously to receive their medications, many of who have epilepsy and have been well-controlled. In between our visits, Africanus has been managing their care with occasional emails to me about specific patients and perhaps medication adjustments. The patients from the Oldeani ward who receive their care from the dispensary all get their medications for free so compliance is less of an issue here.

Akash examining a child with Anne’s helps

Rift Valley Children’s Village and the Tanzanian Children’s Fund are the main reason that FAME is where it is in Karatu, only 45 minutes away when the roads are good, as India suggested the location to Frank and Susan with one of the main reasons so that FAME could provide the medical care to her children and the surrounding community. From their beginnings, FAME and RVCV have remained inexorably linked and continue to be for the health of their communities.

Dr. Anne with her patient
Kelley multitasking

The drive to “Rifty” is an incredibly lovely one that courses through expansive cultivated fields and homes of the farmers, often on the hillside, that are mud huts with thatched roofs adorning a small solar panel to charge their phones. Our road drops down into the ravines on several occasions, a steep decline on rocks and ruts as well as the large angled gutters to divert the rain water and keep it from completely destroying our path. It is the dry season now so there are no worries about travel, but in the wet season, this road becomes a slick and muddy mess that is always a challenge.

Prosper, Kitashu and Joel in the pharmacy
Kelley staffing with Phillip, Denise and Revo while Paul is staffing with Anne and Akash in the background

My first driving in Tanzania was on this road when I was traveling in a small truck with other FAME workers who had just learned to drive. Two of them were unable to make a sharp first gear turn at the bottom of a ravine and then keep the car moving steeply uphill without stalling it. Eventually, I offered to get it up the hill and they all gladly accepted so I drove the rest of the way to the village. When we were ready to head home, I again offered to drive if they wanted me to and, much to my delight, they accepted my offer. I have been driving here ever since and do consider it a badge of honor as it is not common and I am always complimented on my driving by the Tanzanians. Those who know me well will understand this.

Kitashu and Joel sorting through our box of medications
Akash, Paul and Anne discussing a patient

I believe I heard a huge sigh of relief from everyone in my car (the FAME staff rode in a RVCV Land Rover that had come to pick them up) as we pulled into the children’s village for our visit as despite how gorgeous the drive is, it is still tremendously bumpy. We piled out of the vehicles and everyone was introduced to Africanus and the RVCV staff who would be assisting us for the day. It is incredibly orderly here unlike most of our other mobile clinics as Africanus has already triaged all of the patients and pulled charts on those who had seen us in the past. Having past history on patients is essential, especially in those who have been on medications in the past and it’s necessary to know which ones may have worked and which ones hadn’t. Unfortunately, we do not have the FAME EMR here to retrieve records which was a significant problem with one of our patients today as you will see.

Paul, Denise, Kelley, Revo and Phillip discussing a patient

We saw many epilepsy patients today and the vast majority were well controlled on their medications. We can’t check labs here, but for those patients needing labs, they can get them at FAME as part of this visit and RVCV supplies all of the transportation to and from FAME for any patients needing to go there. There are typically cars going to Karatu several times a day to pick up supplies and transport patients. One of the patients that came in today to see us was a 12-year-old boy with Duchenne’s muscular dystrophy who we had followed in the past. He was severely quadriparetic now and had to be carried by his mother to get into his wheelchair at this point. He was still swallowing and breathing fine, but who knew how long that would last. His mother and he were incredibly stoic and clearly knew the score since he had two older siblings who had died of the disease previously. We had tried using steroids on him in the past, but to little avail and they were no longer appropriate given the extent of his disease and his deficits. This condition is no more treatable in the US than it is here, but somehow there just seems to be a stronger sense of helplessness here, perhaps borne out of the general lack of medical care here or perhaps due to the difficulty of obtaining aggressive rehabilitation. We would continue following the young man and attempt to make his life easier, though his fate is obviously sealed and he does not have much time left.

Kelley and Paul discussing a patient with Cat and two RVCV staff

The interesting patient we saw today was a bit more of mystery for us, or at least she was until we were finally able to access her FAME records later after we returned home. She was brought in by her daughter who had helped to supply the necessary background information, but apparently this was not at all accurate and made little sense to what she looked like clinically. She had a hemiparesis also involving her facie that had been progressing since it began months ago. The patient had apparently been seen initially at FAME, received a CAT scan and was then transferred to another facility. Then the daughter said she was told that it was a bleed that was outside of the brain, but inside the skull which certainly sounded like a subdural hematoma that may have been expanding. There was still something that was not right about the history or her examination and it was eventually decided that she would come to FAME to see us after the weekend to see us after we had a chance to fully review her records and hopefully look at the CT scan she had had and get a repeat one if that was felt necessary.

Two of the children we encountered at the village

We finished up our work at the Village having seen a good number of patients and made our way back to FAME. I always drive an alternate route on the way home that takes us through difficult fields and bypasses some of the bigger bumps. It does travel down and then up some very steep hillsides though that are taken quite slowly (first gear all the way uphill), but the views are again spectacular and he weather was truly gorgeous. As we’d be back to the village again tomorrow we were able to leave our box of medications there in the pharmacy and we a list of the additional medications needed to restock that would be obtained from FAME. It was an early evening at home to relax.

Prosper taking photos

Tuesday, September 21 – Another long and dusty drive to Mang’ola and a visit to Mbuga Nyekundu…

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The clinic at Mbuga Nyekundu

Our visit to Barazani yesterday had gone well, though we hadn’t seen the same numbers of patients as we had two years ago when we were still living in a pre-pandemic world. I heard later that there was some confusion in the Mang’ola region that patients couldn’t come to see us unless they were vaccinated which certainly wasn’t true, but that certainly would have been an explanation for why we saw about half the number of patients. Very few patients in this region, or in any region for that matter, of Tanzania have been vaccinated at present and it has to do with a number of factors that have occurred here over the last 18 months.

Joel getting the pharmacy ready to dispense medications
Kitashu taking a short breather

To begin, we were here in March 2020 when COVID-19 had hit the US in such a dramatic way with NYC being pretty much ground zero once again. We continued to do our work as it was actually much safer here than it was at home, but when the State Department said to “shelter in place” or return home, we scrambled to rebook flights and made it home to a country that was in the throes of a health disaster unlike any we’ve ever seen in our lifetime. Meanwhile, the pandemic never hit Tanzania in the numbers it did in our country. Remember, this is a country of over 60 million people, one-fifth the size of the US, and the hospitalizations and deaths that have accumulated have in no way approached the numbers that we have seen at home. Though people have attributed that to the fact that there was no testing here would not even come close to a logical explanation as even without testing, hospitals would have been swamped and there would have been bodies in the streets had it even been a small fraction of what we saw at home. And this is a country where you could not find a mask on the street if your life depended on it (and it was just that at home) other than at some health institutions and, even that, was a rarity.

Dr. Anne and Denise working together with a patient
Staffing a patient with Paul

This is not to say that there was no COVID here in Tanzania as there certainly was and it came in three waves that hit in small numbers, but when it did, there were deaths and, tragically, it was the gatherings for funerals that in the end were the downfall for a number of high profile political officials. Hospitals required isolation wards for those patients who presented with symptoms suspicious for COVID so that they wouldn’t infect other patients and caregivers. Since the very first moment of the pandemic, FAME became a leader in the health community of Karatu district, enacting protocols designed after those in the US to prevent the spread of the virus and they did this very successfully. Everyone is masked and all patients are screened for symptoms and fever just as we have been doing in the US since the very beginning. FAME served to educate all of the government health workers in the district and has continued to provide the same services including being the test site for tourists having to get their COVID PCR test prior to traveling back home.

Revo, Cat and Emily evaluating a patient
Akash, Phillip and Leeyan working with a patient

With the death of President Magufuli last March (during our visit, I might add), Tanzania’s vice-president, Samia Suluhu Hassan, succeeded him and quickly realized that she needed to move the country from denial of the virus to acceptance and even more quickly begin to adopt practices that would hopefully protect the country from future waves of the virus. One of her first steps was to accept a shipment of vaccine from COVAX, the international coalition led by the WHO to supply COVID vaccines in an equitable manner internationally and specifically to low-income countries in need of access. At the end of July, Tanzania received the first shipment of their one-million doses. This was certainly an incredible milestone, but unfortunately, this is a country of over sixty-million people and a nation that had denied the existence of COVID until only recently.

Joel discussing a prescription with a patient

The disastrous consequences of the latter of these two facts is that it is my understanding that less than half of those one million doses have even been put into patient’s arms at the present meaning that the percentage of the population that has been vaccinated here is less than 1% compared to the nearly 70% vaccination rate in the US. The difference here, though, is that those who are unvaccinated are not making a political statement, but rather doing it because of lack of knowledge or misunderstanding. I have heard from people here that say they’ve been told that young woman receiving the vaccine will no longer be able to become pregnant. It is on this background that the battle against the pandemic will be fought in Tanzania and many other nations of Africa and, as we have now learned in the most dramatic of fashions, there are no borders when it comes to disease, especially a global pandemic. If the need for increased global health efforts has not been evident to you before, it should be now.

Dr. Anne and Denise with a BPPV patient about to perform a Dix-Hallpike maneuver
The Dix-Hallpike

Our drive to Mang’ola was again an incredibly dusty and bumpy ride. Remember, I am driving a stretch Land Rover that can seat nine passengers meaning that there is a rear row of seats that sit well behind the rear wheels, having the added advantage, or disadvantage, of a tremendous amount of extra bounce when it comes to those extra big bumps. Though it is certainly not anyone’s intention to hit these bumps at high speed, just imagine driving at 80 kph in the dust and on the washboards and trying to slow the vehicle down when you see these at the last moment. I don’t use this as an excuse as much as an explanation for poor Philip who I think sat most often in the back of Turtle on our treks and probably hit his head on the room a time or two. There are certainly disadvantages to being tall.

Kelley gets into the trenches
Paul now confirming

The road to Mbuga Nyekundu leaves the main road to Barazani as you enter the region of Mang’ola and it sits in a valley that is more distant from Lake Eyasi. The district dispensary there is rather large and, though there was amble space for us, there were no desks or chairs in the building we had used in the past, which meant that they all had to be carried from the other building. Kitashu once again took care of the organization and with everyone’s help, we soon had three examination rooms set up to get through the patients that had already accumulated for us to see. Dr. Anne once did her announcements to the patients regarding what types of conditions that we see so as to triage out patients with non-neurologic conditions who would be better seen by the clinical officer stationed here and who delivers care to the community on a regular basis.

Kelley staffing a patient with Cat and Emily

The weather was incredibly dry and dusty and there was a strong wind that blew through the community reminding me of my days exploring through the inland deserts of California as the landscape was also quite similar. It was not hot at all, but the dry wind felt as though it sucked all of the moisture out of your body and for someone like me, who drinks very little water to begin with, it was a firm reminder to hydrate. It was decided that we would eat our lunch inside the building, not only to avoid the wind and dust, but also because we want to be sensitive to the patients and community by not eating out of lunchboxes in front of them. We’ve also done this from day one on our mobile clinics as it very often the case that we’re enjoying a meal when the patients and villages may get only one meal a day and are most frequently underfed and malnourished. The number of nutritional anemias here is quite large, but you must also remember about deworming younger patients at least one a year as it has been shown not only to help the anemia, but also to improve academic performance.

Emily, Revo and Cat staffing a patient with Kelley and Paul

Akash had both of the more interesting patients today. The first was a young man who came in with patchy sensory complaints that had been going on for some time and, though they were certainly neuropathic sounding, the patchy nature of them argued against the more typical length dependent process, such as what we seen commonly in Diabetes, and he had to give some more thought to this patient. His examination failed to yield any additional clues other than confirming the he indeed had something other than a common neuropathy. There were some additional clues that can’t recall at the moment, but with further questioning, it turned out that the man’s father actually had leprosy, but had passed away previously. After discussion with Paul, it was felt that this patient actually leprosy and would require further treatment in a center that deals with this diagnosis and does exist here in Tanzania for this and other diagnoses such as tuberculosis and anthrax due to their specialized nature of treatments.

Revo, Cat and Emily evaluating a patient

The other patient was a child with a much simpler diagnosis of cleft palate, something that is actually treated for free by the government and so there should be no barrier to the child getting surgical correction for this condition. Although the treatment is free, there is still a cost for the family as it requires that they travel to a government center that deals with this and that usually means the parents and other siblings would have to travel somewhere, find a place to live during the procedure and take care of whatever other expenses there might be other than just the surgery. Things are not always as simple as they sound here and “free” treatment may not always come without a cost. This is not unlike home in many ways and is why we have the Ronald McDonald house at CHOP so that families can have somewhere to stay for extended periods if necessary.

Staffing resident clinic

Our clinic wound down and it was eventually time for our departure from Mbuga Nyekundu. Thankfully, now knowing the way home, we would not have to drive with the other vehicle making the dust more manageable, though not entirely as there were certainly lots of trucks and other vehicles on the road that we would either overtake or were driving in the other direction to turn up enough dust to still make it miserable. We arrived home before sunset, though, and had time enough to run to Teddy’s as Kelley and Paul had wished to have some clothes made, as well, and the others needed to try on a few things. Amazingly, having never had anything made during a visit here, the group talked me into making a pair of shorts with some of Emily’s left over fabric. The cost to make the shorts was 10,000 TSh or slightly more than $4.00, so it wasn’t like I was taking a big risk regardless if I never ended up wearing them.

Trying on their new clothes

We finished at Teddy’s and drove home for the evening, having had a very full day of work and driving and it was now time for rest and relaxation. We still had two days of mobile clinic left in the week, though they were much shorter drives to the idyllic site of the Rift Valley Children’s Village, a place that is always wonderful to visit for so many reasons. Friday, we would be heading to the Serengeti for two nights and everyone was clearly looking forward to that, including me. We would have drivers and two vehicles and, even though driving on a game drive is one of my favorite things in the whole world, it is nice to be driven once in a while and I would be free to take photos as well.

Cat, Denise, Emily and Phillip in their new clothes with Teddy

Monday, September 20 – A long drive to Mang’ola and a surprise visit to the beach…

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The team at Barazani

Our day in the Crater and visit to the Crater Lodge had been incredibly memorable and now it was time to get back down to work. Mobile clinic has been a staple of our month of neurology here at FAME over the last ten plus years and began initially at the suggestion of Paula Gremley, an expat who had lived in Tanzania for over sixteen years when we first met, and had partnered with FAME during the early days. After one of our larger mobile clinics to the Lake Eyasi region where we spent a week in the bush, she had suggested that we travel to the Mbulumbulu region nearby Karatu to visit some smaller villages and provide neurology care for individuals who, even though travel to FAME was possible, were not aware that treatments possibly existed for their conditions. We had traveled originally as a very small group – me, Paula, a clinical officer and a nurse as well as Paula’s associate, Amiri, who did the driving. We visited several villages during each of my visits and continued doing so long after the Lake Eyasi clinics ended, thus maintaining the tradition of FAME’s work in communities remote from Karatu.

A huddle before seeing patients
Getting ready to see patients

These clinics have become an integral part of our work here and have typically occurred during the third week of our visit as this seemed to work the best in regard to the timing of visits and the ability to have some of our patients return at the end of our time here before we left. During the pandemic, though, we were unable to have the clinics due to safety concerns and so, it had been well over a year since we had traveled away from FAME other than to Rift Valley Children’s Village. Though we hadn’t originally planned to do any mobile clinics this visit, the opportunity presented itself for us to travel to the region of Mang’ola for one or two days to provide neurologic care in this community. When we had last traveled there in March 2020, we had seen our highest daily volume and it seemed to make sense for us to travel back to both the town of Barazani and the village of Mbuga Nyekundu, both near Lake Eyasi.

Joel taking vitals on a patient
The dream team

Lake Eyasi has to be one of the more remote regions that I have visited, or at least it has the feeling of being so. In the early days of FAME, we used to travel to the village of Gitamilanda which was much further along the shore of the lake and where the Hadzabe, the last hunter gatherers of Tanzania, lived alongside the Datoga. In comparison to Gitamilanda, Mang’ola and Barazani seem like a metropolis, but in reality, this is also a very remote region with little in the way of resources. The drive from Karatu is a tough 1-1/2 hours along one of the bumpiest and “wash-boarded” roads you could ever imagine. The trick to driving these roads is to do so at a fairly high speed to make the bumps less noticeable, or perhaps it’s just to get there quicker and suffer less. Regardless, it is a torturous drive and I suspect much better for the driver than for the passengers, considering we had two vehicles packed full with passengers.

Kitashu, Joel and Prosper with a patient
Anne and Emily reviewing a JAR Guide

I drove the entire neuro crew in Turtle since there now eight of us including myself, meaning that we had a single empty seat in the middle back that was vacant. We rented another vehicle and driver from Kudu Lodge for the support staff that included Dr. Anne, Dr. Revo, and Dr. Leeyan, all our interpreters, and then Joel, our nurse, Kitashu, our coordinator, and Prosper, our volunteer coordinator who would take photos for FAME. We brought with us all the medications that we might need to prescribe to the patients we would be seeing and all of the tools that we’d need for our work. We had picked up box lunches in town for everyone and had plenty of water to last for the day or a possible breakdown along the way. We drove in tandem with Turtle following as I wanted to make sure I remember the way, but this also meant that we would have to eat the dust of the other vehicle and given the dry gravel roads we were driving on, there was plenty of dust to spare.

Paul supervising a patient evaluation
Emily and Anne examining a patient

We had planned to leave at 7 AM, but by the time we picked everyone up in town, got the lunch boxes and other necessary supplies, it was more like 7:30 before we got onto the road. We had a bit of tarmac until the turn-off for Mang’ola and then it was gravel and washboards for the remainder of the drive until we reached our destination. Despite the condition of the road, the drive is absolutely gorgeous as it travels through spectacular countryside. We travel through numerous ravines that look as though they are completely washed out every year due to the torrential rains that must come down during the wet season. There are places where we are driving over long stretches of rock and others where you would have to avoid a complete lane having been washed out. Needless to say, you had to be on your toes every moment of the drive as you never knew what was coming next or whether a herd of cattle might be crossing the road around the next turn. Challenging is an understatement.

Emily and Anne examining a patient
Akash and Leeyan with a patient and their mother
Akash examining a patient with Leeyan. Denise scribing

As we came over the last hill, Lake Eyasi lay before us looking like a mirage in the middle of a vast desert, but, in fact, it is one of the very large lakes that populate the Great Rift Valley that runs diagonally through all of East Africa. It is the same Great Rift Valley that became the cradle of mankind several million years ago and populated the remainder of our planet with our species. We drove through the dusty streets of Barazani heading towards our destination which was the local dispensary where we had visited previously. Local dispensaries are the small government health clinics that provide the vast majority of care in Tanzania and are typically manned by a clinical officer (the equivalent of a nurse practitioner) who provides all of the necessary medical care that doesn’t require a trip to a major facility. They will even do minor surgical procedures in the local dispensaries and certainly all of the deliveries that do not require C-section.

Phillip scribing for Cat
Cat and Revo staffing patients with Kelley and Paul

The clinic had already anticipated our arrival though it still required that we organized the rooms with the necessary equipment for us to see the patients here. In the past, we have worked in rooms with only beds, labor and delivery rooms, desks in the middle of an open area in the forest and the likewise, but here we actually had decent rooms that in short order were equipped with at least a desk and several chairs or a bench to accommodate the patient and the caregivers. I had opened all of the windows to get some type of ventilation, but the large metal doors kept slamming in the breeze with a bang so I quickly whittled several door stops from the local foliage to keep the doors open. Necessity is the mother of invention they say.

Anne, Kitashu and Joel going through our patient charts at Barazani
Prosper and Akash discussing photography

Once everyone was settled in, we began seeing patients and there were a moderate number there as we’d been here several times before and the local population were aware of our coming today. Dr. Annie gave her standard talk to the patients who had gathered regarding the types of illnesses that we treated and that we were not here to treat general medical conditions or joint pain. This is often an issue for us as many patients come because of the flat fee that includes a month, or sometimes more, or medication. This screening is essential as we are not here to replace or compete with the local medical officer by doing general medical work and have always made sure to maintain that boundary. The day was a steady smattering of both new and return patients as well as patients with various neurologic conditions. One patient we saw had, in addition to her neurologic issues, which were minor, very significant medical issues with marked edema and hypertension. I believe that her neurologic treatment would have consisted of amitriptyline, though without knowing what her cardiac status was, we did not feel comfortable prescribing this her without an EKG or labs. We eventually recommended that she come to FAME for a medical evaluation and laboratory tests to confirm that she could tolerate the medication.

Finished for the day
The spit of land
A view of the beach at Barazani

We had finished seeing all of the patients within a reasonable amount of time meaning that we might be able to do a bit of site seeing prior to our departure from Mang’ola. Since the town is on the shore of Lake Eyasi, though, there had to be a beach somewhere close and the others offered to take us there. I had no idea of what to expect, but it certainly seemed like it would be something fun to do, or at least a great exploration. I had been to the lakeshore of Eyasi far southeast of Barazani a number of years ago on one of our visits, but the lake in that region was mostly dry at the time and we were able to walk far out into the lake on the mud flats. As we had come into town earlier in the day, the lake was clearly quite full and I was sure there must be a reasonable beach for us to find. We had the two vehicles and I had no idea where we were going, but we wound in and out of homes along the way, driving much further than I had anticipated, at times the road becoming much narrower than our vehicle, until after long last we could see the water.

Getting their feet wet

As we approached, there were tents that made me thing people were camping here, but, in fact, we had come upon an encampment of fisherman and their families who were clearly living on the beach during the fishing season. There were rather primitive boats pulled up onto shore and the lines for nets strewn across the beach. We drove out onto a spit of land where there were cattle and goats grazing and parked our vehicles at a high point on the land a bit away from the water, but close enough for us to keep our eyes on them. Everyone clambered out to enjoy the sand and the water and to watch the fisherman working their nets. What we later came to realize was that the nets were strung far out into the lake with glass globes as floats that you could barely see as it was directly looking into a very strong sun reflecting off of the water. It was a gorgeous scene, though, and there was absolutely no sense that we were intruding in any way. There were children running around who were appropriately shy upon our arrival, but eventually warmed up to us as I had no trouble at all entertaining them with my camera, which they thoroughly enjoyed and managed to take a few photos that were halfway decent.

Joel capturing a selfie
Turtle and our other vehicle on the beach

We all watched as the fisherman slowly dragged their nets onto shore, using old burlap sacks as slings around their bottoms while they creeped backwards in unison, tugging on the ropes. It was a long and arduous task to slowly haul in their nets, obviously heavily laden with the tiny sardines that are brought in and dried in the sun, then serving as a staple protein for many. At one point, Kitashu apparently asked one of the fisherman if he could take some of us out on the lake in one the boats, which he agreed to do and promptly found enough volunteers for at least two boats full even though it was clear that the boats were not completely watertight, thus leaking water and requiring them to be continuously bailed during their voyages. Someone did comment on the fact that everyone was voluntarily, and excitedly at that, getting into a boat that was knowingly sinking and somehow this didn’t seem like a very smart idea. Regardless of the poor seaworthiness of the boat, everyone did seem to have a wonderful time, though, paddling out onto the lake without the fear of sinking, or, if they did, they didn’t mention it nor did they seem to mind. There were enough fearless thrill seekers for two complete boat rides out onto the lake and, had the boat actually sunk along the way, I’m sure they probably could have swum or walked to shore without difficulty.

Getting ready for a voyage
Revo waving goodbye

At one point, we began helping the fisherman drag in their nets, but this didn’t last for long as it was clear that it was going to take some time to get it close into shore and, with a long drive home, the daylight was quickly waning. We did have enough time, though, for Denise to try out one of their butt slings and in doing so, she got some necessary instruction from one of the younger fisherman along the way. I joked that I thought being hooked up to the same line hauling in the fish meant that they were now married, but, that didn’t seem to be the case and we were allowed to leave with Denise and without a fight thankfully. Though we were clearly outnumbered by the many fisherman and their families, I am certain that it would have been an even battle in the end.

Taking off on their voyage

Our visit to the beach had been a truly unexpected and lovely experience, but that is so often how things happen here. It is perhaps this spontaneity and near expectation of the unexpected that makes everything so exciting on our visits. This is certainly the case when out on safari as you never know what you might along the way such as our caracal experience in the crater and our visit with Philippo whom I had never met before despite having traveled the Gibb’s road dozens and dozens of time before. Each day here brings a new adventure.

The happy crew returning from the sea
Be careful who you attach yourself to a fish net with…

We left the town of Barazani with great memories and the knowledge that we had left part of ourselves with the patients and the fisherman of this remote and dusty town. We would be heading back to another village in Mang’ola tomorrow and who knew what our next wonderful adventure would be along the way. The road home was long and dusty and bumpier than you could ever imagine, but no one complained for this is Africa and the experiences will last a lifetime.

Dragging the net in…
The full moon above

Sunday, September 19 – A day in the Crater…

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Driving Turtle in Ngorongoro

Ngorongoro Crater, or just The Crater, is perhaps one of the most unique sites in the world, let alone Africa, for a number of reasons. It is a World Heritage Site, along with the Serengeti, and between the two, are arguably the top game viewing locations in Africa for many reasons. Ngorongoro Crater is the world’s largest completely intact and unbroken dry caldera meaning that it was formed by the collapse of a massive mountain following its eruption and is believed to have occurred approximately 2.5 million years ago. It is a giant bowl that is between 10 and 12 miles in diameter and over 2000 feet deep with very steep walls that are accessed by three only three roads, one ascent, one descent and one two way. The crater is filled with animals that do not migrate with the others and it contains virtually every animal other than giraffe, as it is too steep for them to climb down, and crocodiles, as there are no flowing rivers in the crater. There is a very large alkaline lake in the center that changes in size throughout the year with the wet and dry seasons. Of the animals in the crater, the most notable is its population of the rare black rhino that remains endangered, but is growing in number with the strong protection of the Ngorongoro Conservation Area Authority and the Tanzanian government.

A bateleur – a small African eagle
Possibly an augur buzzard?

So, it is with this introduction that we all arose on a Sunday morning, with Paul and Kelley having finally arrived, to travel to this truly remarkable place. The weather was the best we had seen for a morning since we’d been here with totally clear skies and the sun just beginning to peak out from over the trees and surrounding mountains. We had our binoculars, our cameras and enough reference books to have done a research study had we chosen to do so. We had also packed a lunch of sandwiches and snacks and I suspect that the residents were already eyeing them anticipation as we pulled away from the volunteer house at around 6:15 AM as the gate would be opening at 6:30.

Caracal in Ngorongoro Crater
East African caracal

The drive to Lodoare Gate took only about 20 minutes and there were few vehicles and no baboons on are arrival. The baboon troop here are notoriously aggressive given the number of tourists that come through each day, all with lunch boxes in their vehicles that are ripe for a heist if one were to leave their window open even a crack. They can spot a lunch box from a mile away and be in and out of a car within seconds before anyone knew what happened. I recall one such occasion a number of years ago with Danielle Becker when we had left the window open enough for the baboon to squeeze through and suddenly we had a screaming monkey in the front seat with a lunch box in its hands. I threatened him with my camera that had been in my hands at the time and even though photographic evidence of the scene would have been wonderful, I chose instead to keep the of us from being mauled and left the thief to exit with his reward. We were both a bit shaken, though no worse for the wear and we continued on in our trip, minus one lunch box that was now being enjoyed greatly by a baboon family.

East African caracal
Caracal approaching the two jackals in search of it’s prey

Though the highway from Arusha that travels through Karatu is paved, that luxury ends here at the Lodoare Gate when entering the Ngorongoro Conservation Area. What many don’t realize, though, is that this is still the main, and only, highway that travels into the Serengeti and across Northern Tanzania on its way to Mwanza on the shores of Lake Victoria. Large trucks filled with cargo pass through this gate every day, making their way up to the crater rim and on to the Serengeti with destinations far to the west. The road up the rim, some 2000 feet above us, snakes up the mountainside as it hugs close to the slope with sharp turns and exposed walls frequented by elephants who carve out the dirt looking for iron and other minerals to ingest. It is a primordial forest that we’re traveling through with trees reaching for the sky from the depths far below us down the mountainside. Up and up we travel further until we finally level off and approach the edge of the crater at the overlook with its unobstructed view of one of the most amazing sights in the world – The Crater. It is a similar view as looking into the Grand Canyon, though here there are structures to interrupt the openness that has been created the massive caldera. All of the features of the crater floor can be easily identified and herds of animals can be seen with the naked eye.

The jackal with the caracal’s rabbit
East African caracal

As we leave the overlook and begin to head around the rim on the crater road with glimpses of the caldera through the overgrowth from time to time prior to our arrival of the ascent road. They are working on the descent road at the moment and it is closed, so the ascent road is open in the mornings instead for one way traffic down to the crater floor. There is certainly a sense of traveling back in time as you descend and the anticipation of reaching the floor with all its wildlife grows with every switchback we take. It was a bit confusing for me as I have never come approached the crater floor from this direction, having always arrived on the descent road during my dozens of visits having driven here before. We first entered the Lerai Forest where there are frequently many elephants and, I have been told, a leopard or two, but I have yet to spot one here.

Phillip on safari
Binocular shot of zebra

We eventually wound our way around to where the descent road first reaches the floor, enabling me to get back on track with my normal routine as I began to drive around the periphery of the crater where there were huge herds of wildebeest, Cape buffalo, Thomson and Grant gazelle and zebra. I looped back towards the lake road that had been blocked by some rocks indicating that it must have been flooded up ahead, but there were several vehicles that had already gone through and were in front of us so it was clearly safe. We quickly spotted a jackal running with something in its mouth that turned out to be a rabbit on closer inspection and it was closely followed by another jackal that was hoping to share in their prize. As we sat watching the two jackals dancing across the landscape with their prey, we saw what we initially thought to be a third jackal when we suddenly realized, much to our surprise, that it was actually a caracal!

The tree at the lunch spot
The gang at the lunch spot

The caracal is a fairly rare cat that is typically never seen because it is primarily nocturnal in its activities. It is described as a either a big small cat or a small big cat (or perhaps a medium cat), but it fits in somewhere between the cheetah and the serval with its prey consisting of small mammals, birds and rodents. In my many dozens of trips to the crater and the Serengeti, I have seen only one. Here was a caracal in the morning hours chasing after two jackal with a rabbit. What didn’t make real sense was seeing the caracal chasing after the jackals, as it should have been the other way around, until I realized that the jackal had most likely stolen the rabbit from the caracal who was now trying to recover what was rightfully his to begin with. We had an amazing and lengthy view of the caracal during this struggle, never having recovered its meal, and it eventually gave up, but continued walking parallel to the road and in plain sight for us. It is a beautiful cat with its tufted ears and sleek coat of light tan and watching it run across the shore of the lakebed was truly an experience to remember. I made certain to let everyone know just how lucky they were to have seen such a rare animal on their first visit to the crater.

The tree at the lunch spot
The residents at the lunch spot in the Crater

We next made our way across the floor of the crater to one of the highest points in the crater itself, Engitati Hill, where the view from high up is spectacular and looking down at the marshy area in from of us, where scores of animals including many elephants, though we were mostly wishing to see a rhino. It was unfortunately, rather breezy on the floor of the crater today and, because of that, the rhinos were in hiding as their eyesight is so extremely poor and they are totally reliant on hearing for their protection and defense. So, we made our way down off the hilltop and slowly proceeded to the lunch spot by way of the Munge River, looking all the way for lions, which in the absence of the rhino, was what everyone wanted to see despite my reminding everyone of just how lucky they were to have seen the caracal.

Hippos in the lake at the lunch spot

We reached the lunch spot at Ngoitokitok Springs just in time to get a good spot as it does get pretty crowded here at lunchtime. There is a small lake with a number of hippos and, most importantly, bathroom facilities. The setting is absolutely gorgeous and everyone is free to get out of the vehicle and walk around, though there are times that lions like to visit the lunch spot which does create a bit of a commotion. They typically don’t approach any of the vehicles, though when Sean was here several weeks ago, there was a single lion who was wondering a bit close to those eating their lunches necessitating a ranger to lure him away with chunks of meat. Likewise, the hippos all remain in the water without any interest in the tourists along the lakeside or frequenting the large and beautiful tree that serves as a great photo spot.

Me having a juice outside at the Crater Lodge

The most threatening animal in the crater, at least for humans, is the black-shouldered kite, a small raptor bird that inhabits the crater and with a wingspan of up to a meter, soars on the high thermals in search of their prey. Their prey consists of rodents, large insects and reptiles, unless, of course, they reside in the crater where they have adapted their behavior to prey upon unsuspecting tourists whose guides have failed to caution them against eating outside in full view of these incredibly accurate dive bombers. It almost never fails that at least one tour party will fall prey to these hunters and today was no different than other times I’ve been here. Towards the end of our stay, sure enough, a couple with their guide sat comfortably on the rocks overlooking the lake and the big tree with their lunch boxes and once they were fully engrossed in this idyllic setting with their lunches in hand, the kites struck. There were three of them who swooped down in succession, stealing everything possible in almost no time at all while the guests scattered over the rocks trying to evade the diving birds.

Having drinks in the main house at the Crater Lodge

Perhaps the strangest thing I saw at the lunch spot, though, was the zebra-covered ice cream truck that I’d never seen there before serving ice cream popsicles. I’ll have to admit that it did detract somewhat from the rugged image of being on safari in the crater, but it was also fantastic to be eating a salted caramel chocolate-covered ice cream popsicle after a long morning of driving. They had to be eaten quickly, though, as they seemed to begin melting almost immediately and even before you unwrapped them.

A panorama from the Crater Lodge
Ladislaus and the gang with a view of the crater beyond

After lunch, we drove to the hippo pool which had unfortunately changed drastically changed its topography and we were unable to get close to the hippos, though there plenty of water birds to watch that were pretty close. We did see one small group of lions very far off in the distance who were sleeping which is the typical state that lions are found in during the day. We drove back through the Lerai forest one last time before turning around and heading up the ascent road on our way out of the crater. The visit had been wonderful and given it was everyone’s first visit to the crater, it was an incredibly successful day.

Walking down to the main house of the tree village at the Crater Lodge
Dining table at the Crater Lodge

We had one last visit to make along the crater rim and that was to the Ngorongoro Crater Lodge, perhaps the most expense and fanciest lodge in all of Northern Tanzania. The Crater Lodge first existed years ago as a hunting camp and was eventually converted into a high end resort that caters to the most elite visitors who are quite often very famous. I have a very good friend there who I have known for several years and is now one of the managers, and he usually has us visit for coffee or a drink to show his thanks for the work we do here. Last year, I brought a carful of Tanzanians from FAME for a visit and it was really wonderful for them to have the opportunity to see such place as none of them had ever done so, nor would it be something they could have ever imagined. We all sat together in one of the large main houses where the guests would normally eat, but because of the pandemic, they were still closed. Our neuro team felt the same way perhaps about visiting such a resort, as few of us would ever have the opportunity to stay there, though, it was still very special to visit and enjoy a beer, a glass of wine, or simply a Stoney Tangawizi.

Paul and Kelley at the Crater Lodge overlooking Ngorongoro Craater
Paul and Kelley at the Crater Lodge

We left the Crater Lodge with just enough time to get through the Lodoare Gate, as it closes at 6 PM and, if you do not make it in time, you are stuck in the Conservation Area for the night. We arrived to the gate with about 10 minutes to spare, far more time than we’ve had in the past on several occasions. It had been a wonderful day in the crater and a total success. We drove into town after sunset and, as we’re on our own for dinners over the weekend, needed to find some food. Meals here take a minimum of an hour once you order, so you can usually plan to spend nearly two hours when you head out for dinner and we were all absolutely worn out from the day considering we had been on the go for the last twelve hours. We ended up at Patamu once again after the first place we went to seemed deserted including the staff, which wasn’t a good sign. The cold beer did hit the spot, but we were all starving so the hour or more wait for food was torture. We were finally served and the food was delicious so at least that was a consolation. It was back to the Raynes House and a bit of relaxation before bed. We were all excited as tomorrow we would be leaving at 7 AM on our first mobile clinic to Mang’ola.

A heavy lift

Saturday, September 18 – A half-day in the clinic, Paul and Kelley arrive as Sean and Kerry depart…

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A spoonful of honey…

Today had been planned for a half-day in clinic, which was good given the issues with getting Paul and Kelley here on time. For the last several years, we have inserted two “wellness” afternoons for the residents during their time here that would essentially mimic the procedure back used at home, though the wellness days are normally to take care of personal matters such as doctor’s appointments and the such, none of which occurs here. I have never argued with the request, of course, as it keeps the moral up for the residents, who are typically working six days a week and could use a break. My only argument to this plan has been that the entire month working here is really just like one big continuous wellness day given what we are doing here and the pleasure that comes from it. Regardless, I was instructed to insert tow half days for the residents which means it’s a half day for me as well.

Anne and Akash about to check head circumference with Cat’s moral support

There is no morning report on Saturday and it was Sean and Kerry’s last morning with us, so we all elected to go to the Lilac Café for breakfast and coffee. The Lilac Café opened around the same time as the inpatient hospital did as it became readily apparent that there needed to be a kitchen not only to serve the inpatients, but also to provide meals to the families who were here to visit their loved ones. Thankfully, it also serves as a place for a good meal, coffee, or even a cappuccino when one is needed. It has also served as home base for the medical students who have come us as a good portion of their work is data entry which can easily be accomplished with a good cappuccino and a cookie. Our breakfast there was incredibly relaxing and Anne, Revo, Leeyan and Kitashu eventually joined us, though none but Anne were tempted by the available options on the menu. I suspect that they all ate at home prior to coming.

Akash and Anne trying to get a head circumference on a squirming young girl

During our breakfast, I heard from Kelley and Paul who had arrived on time in Dar es Salaam on schedule and now it was a matter of figuring out what the airline was going to do to help us. I had purchased tickets with FlightLink, a local Tanzanian airline, to fly them to Arusha with an arrival time of noon, rather than the 8:30 PM that their original Precision Air flight had slowly morphed into which would have meant that they wouldn’t be here in the morning to leave for the Crater, something Kelley had never done, nor had Paul. They had arrived too late to have even conceivably made a morning flight that the airline had later suggested, so I was on the phone all morning with Penn’s travel agency to see what we could do.

Success!

After multiple calls to the agency, who were very helpful, and numerous calls by them to Qatar, it had finally been determined that if they did not board the final leg of their originating flights, then their return trip home would be forfeited with no hope for a refund. Meanwhile, during these conversations, the two of them had boarded the FlightLink flight to Arusha which meant that they were absolutely not going to board the Precision Air flight they had originally been booked on. Qatar chose to take absolutely no responsibility for the repeatedly delayed code share flight with Precision, a flight whose time was no longer acceptable to them. To make matters worse, Qatar suddenly offered an earlier flight on Precision that had not been offered earlier, but since they were already in the air, that was an impossibility.

Revo, Denise and Emily evaluating a patient

We were told by Qatar that the only option we had was to cancel their remaining flights and then rebook the return flights, but this had to be done prior to their previously booked, and massively delayed, flight took off, otherwise everything would forfeited and the property of Qatar Airways. The cost to rebook would be around $400 for each passenger. It was complete highway robbery in my mind and we were being held hostage to their technicalities without any chance for recourse or someone with common sense looking at the situation. World Travel was totally sympathetic, but Qatar Airways was completely unwilling to listen to reason. So, in the end, I made an executive decision to cancel their existing flights and rebook the returns for the additional fee, all while they were in the air, as there appeared to be no other choice in the matter. World Travel did offer to have their Qatar rep pursue the issue on our behalf, but I think it is very doubtful that anything will change after the fact. The important thing from my standpoint, is that the two of them arrive to FAME safely and the fact that they’ll be able to make the trip to Ngorongoro Crater was certainly an additional factor as we had already paid for that with the Conservation Authority who manages the Crater.

The MRI of our patient with probably spinal AV fisula

Meanwhile, we had to finish up our morning clinic to be free in the afternoon and perhaps the most interesting patient that we had wasn’t here at all, but his MRI was. The young boy who we had seen last week with back pain and unilateral leg weakness had undergone an MRI of the thoracic spine that was quite abnormal, but not in any typical manner that one would normally see. Unfortunately, Kerry had left this morning for the Serengeti as she would have been the perfect person to have reviewed the scan given the fact that she is a pediatric neurosurgeon. Thankfully, Sean was still here to review the study and we were all in agreement that there was a significant posterior extramedullary, intradural process that appeared to represent either flow voids representing spinal arteriovenous fistulas or a spinal subdural hematoma. Never the less, what we saw was compressing his spinal cord and undoubtedly causing his pain and neurologic deficits.

Paul and Kelley moments after their arrival to FAME

Now, the question was what to do about it. There is no place in Northern Tanzania that could deal with this type of a problem as he was going to need advanced imaging such as a spinal angiogram or spinal MRA, both studies that would require the proper center to administer them and then the surgeon to fully evaluate him clinically along with the studies. Quite atypical of the normal situation here, though, the boy’s family did have the resources to take him wherever the best center would be in Africa, Europe or Canada. Due to their insurance, they could not travel to the US to be evaluated or have surgery. We made the necessary inquires regarding various centers around the world and made the necessary recommendations to his family, who will hopefully be able to take him to a center that will be able to deal with his problem.

Akash and Denise on their walk to Gibb’s Farm

Clinic was finished by lunchtime (typically 1-2 PM here) and we all made our way home for the afternoon. Kelley and Paul had landed in Arusha by now and were making the trek to Karatu, typically about 2 hours, which was better than the three hours needed to make it all the way to Kilimanjaro. I choose to stay at the house, while most of the others decided to make the hike again to Gibb’s Farm as Akash had not done it before and Denise wanted to check if they had her sunglasses she thought she may have left the last visit. While at Gibb’s, they did take the opportunity for cold drinks and Akash was introduced to Stony Tangawizi, a strong ginger flavored soft drink made here in Tanzania by the Coca Cola Company. Meanwhile, Kelley and Paul arrive to FAME after their lengthy flights and detour in Dar. They were no worse for the wear, but were certainly exhausted. I sat and caught them up on recent events here at FAME and how things were going and what the plans were for the following day going to Ngorongoro. I had planned to pick up the residents (other than Emily who had stayed behind) at the carver’s shop or our new coffee supplier and was going to take Paul and Kelley, but seeing how exhausted they were, suggested that they both take naps and we’d wake them up for dinner later in the evening.

Akash discovers the wonders of Stoney Tangawizi

We drove up the Gibb’s Farm Road, back to Philippo’s farm to meet the others who had been shopping there and next door at the wood carver’s where Denise was determined to get a large painting that she liked. I had asked Philippo to save us some honey the next time that he was harvesting some, and he promptly brought out five small jars of the golden brown liquid that was like treasure to us. I quickly bought all five jars, figuring that we could work out who would be taking some of this amazing product later. Others bought more coffee and there was a huge crowd of Tanzanian guests visiting to sample his coffee. Denise did manage to get her painting for a relative steal. I drove everyone home after their hike and shopping spree and we hung out at the house until it was eventually time to wake up Paul and Kelley and to head out for dinner.

Ngorongoro Highlands coffee
Bottles of honey

We ended up returning to the Golden Sparrow, but this time our mission was only for dinner and no dancing as we would be leaving early in the morning and needed to get home to make our safari lunches of peanut butter and jelly sandwiches for the following day. Though its precursor, Carnivore, had served only chicken and chips, the Sparrow has a full menu with many other items. Cat, as a pescatarian, had ordered fish and Akash, a devout vegetarian, had ordered lots of carbohydrates and a few vegetables, while the rest of us chose various versions of chicken with sides of chips (fries) or ugali and vegetables. Every restaurant here takes around 45 minutes to an hour to bring your food, so it was not at all unexpected that we enjoyed a drink before dinner was even close to having been served. We all traveled home with the same thought in mind as we’d be heading to the Crater early tomorrow morning with the anticipation of seeing the incredible sights of animals at the bottom of a caldera that is over ten miles in diameter and 2000 feet deep.

Emily and a bottle of Konyagi outside at the Sparrow (of course she wasn’t drinking it 😉

Friday, September 17 – A few difficult cases, stopping by Teddy’s duka and a visit with Daniel Tewa…

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The FAME team of doctors with Dr. Kerry and Dr. Sean

There was no educational lecture this morning so that meant a half hour more of sleep for most everyone. I’m usually the earliest one up in the morning as I like to get some things done, but Emily has also been up very early (though at least she’s in bed early as opposed to me) so there’s always been hot water ready to go for my tea. The mornings here are usually quite gorgeous, but the weather pattern has been dense clouds and very cool in the morning, perhaps another sign of the ongoing climate change that so many in Washington have chosen to ignore despite all the science to the contrary. Thankfully, for the moment, though, the skies have typically cleared by noon and the afternoons have been quite pleasant and occasionally warm. This is not the coldest month of the year here for that is in July, but it can still be very brisk in the highlands where we are located, and even colder on the rim of the crater several thousand feet above us.

Our lunch table behind the cantina – rice, beans, mchicha, pilipili, and banana. A definite favorite

Kelley Humbert and Paul Novello, two colleagues from Penn, would be arriving tomorrow to join us and we were having some issues with their travel. Kelley had been here in October 2016 as a resident and is now a neurohospitalist at Penn, while Paul, also a neurohospitalist, had never been to Africa. They had left Philadelphia yesterday on Qatar Airways and because we would be heading to Ngorongoro Crater on Sunday and they wanted to join us, the connections were through Dar es Salaam on a Precision Air flight. That leg kept getting bumped later and later on Saturday such that it meant they would arrive to Kilimanjaro too late to make the drive to Karatu – night driving is incredibly dangerous here due to both animals wondering into the road and crazy commercial drivers who pass when it’s unsafe.

A difficult discussion

Kelley spoke with our travel agent prior to leaving Philadelphia to inquire about just not using the last leg of their flight and booking on a different airline arriving in Kilimanjaro earlier. Unfortunately, they were told that doing that would void their return flights. They arrived into Doha at around 5 pm today and, thankfully, the airport had excellent WiFi so we could stay in touch about their trip. I had to make an executive decision, though, and booked them flights from Dar to Arusha that would depart shortly after they arrived there and would get them to Karatu early in the day meaning they would come to the Crater with us. I would have to speak with them once they arrived in Dar and that would be tomorrow morning.

Dr. Anne and Emily delivering difficult news to a family

Meanwhile, we did have a clinic to run today and had plans to visit my good friend, Daniel Tewa, in the late afternoon for coffee. More about Daniel later. The two patients that stood out during today’s clinic were both difficult, but in very different way. The first patient was a young woman who had been involved in a very bad motor vehicle accident earlier in the year, not only suffering multiple traumatic fractures of her limbs, but also a very serious head injury that left her non-communicative and bedridden. Her family had brought her to us to see what we had to offer in the form of rehabilitation or anything that could help her get better. Unfortunately, her injuries were devastating and irreversible, but it was unclear whether her family had ever been told that or not. Emily had done her best to obtain a detailed history from the family, though in the end, it really didn’t change what we had to tell them. Ultimately, it required a discussion that was very difficult and involved both Emily and Anne that took not only quite a bit of time, but also their energy as it was very draining. The patient did have a very large sacral decubitus ulcer (bed sore) that was originally concerning, though in the end, it turned out that it was being dressed at home by one of FAME’s nurses so we were reassured that it was clean. How long the patient would survive in this condition was something that no one could really tell, but in the end, she would probably succumb to a systemic infection or something similar and there was very little that could be done to prevent it.

Dr. Anne and Emily speaking with the family of the neurologically devastated young woman

The second patient that stood out to me appeared at the very end of the day and was actually someone who arrived after I had told Kitashu that we were finished with patients. It’s essential that we have a time after which we stop seeing patients, otherwise, we would be stuck in clinic all evening long as patients would continue straggling in to see us and it would never end. Most of the patients we see are from the Karatu region and though it is certainly not the most convenient to return the next morning if we ask them to do so, sometimes that is necessary given our volume. This patient was brought over to us and I agree that we could see her before realizing that she had a bag full of records and prior imaging.

Revo, Cat, Anne and Emily all contributing to our final patient with a bag of records and radiology studies

Her complaints were varied and numerous and very little of her story made a lot of sense to us outside of her having fairly simple radicular symptoms in the lower extremity that didn’t require our involvement necessarily. What made matters even more difficult was that she had undergone a multitude of testing at a number of different sites and though she had the results of all of the testing, it didn’t make much sense to us. It seemed that she had been evaluated at some point for demyelinating disease, or multiple sclerosis, which really doesn’t exist much here given that we are on the equator and when we reviewed her MRI scan of the brain that had been read as possible MS, it was much more consistent with small vessel ischemic disease, a common problem, especially in those with hypertension, a condition from which she also suffered. In the end, all that we really had to offer her was to treat her hypertension better, take a baby aspirin and put her on a statin medication to keep her lipids low. Anne did her best to explain everything to her in detail, though she continued to want more explanations of everything until even Anne, the most thoughtful and concerned clinician I know, had become completely exasperated.

Teddy in her new shop sorting through clothing
Dr. Sean tying his bow tie with Akash’s help

As we had planned a visit to Teddy’s late this afternoon prior to heading to Daniel Tewa’s home, everyone abandoned Anne and her patient so we could change and get Turtle for the drive. Anne was coming with us, of course, to help at Teddy’s as it always helpful to have her along since Teddy’s English, is about as good as my Swahili, meaning that we both need a translator, hence Anne’s participation in the venture. By the time we had returned to the pick-up Anne, she had finally finished with her patient and was ready to head out. Teddy, had also moved her shop since the last time I was here which meant that we had arranged to meet her at Happy Days with her boda boda (motorcycle) driver so she could then show us the way. Kerry, who had a number of clothes made, would be leaving town in the morning which meant that her orders were the priority for this visit, while Sean, who would also be leaving tomorrow, did have a bowtie made that he would pick up. All of the other clothes could wait if necessary.

Philip, Akash, Denise and Emily watching an Indian soap opera in Swahili. Talk about lost in translation
Sean checking out his bow tie in the mirror

At Teddy’s shop, Kerry immediately went to work modeling her clothes for us (they were all great and fit perfectly which was amazing how given the little time she had been given to create them) and Sean modeled his bowtie, which, I will have to admit, was just a bit much with his scrub shirt and in the middle of East Africa. The effect was there, though, and everyone was tickled with her work and looking forward to our subsequent visit for everyone else’s clothes to be presented. I had met Teddy through a previous long-term volunteer here and she has continued to do wonderful work for all the residents and others who have wanted pieces made from the colorful and bold kitenge cloth that is worn here. Her new shop (and home) is also very nice as it is not only her workshop for making clothing, but also a neighborhood duka (shop) where the local residents come to buy sundries, many of them stopping by while we were there. It is so important that we support the local merchants like Teddy while we are here, though most of her work is for the local population and I am certain that we are the only outsiders that visit her.

Dr. Sean over the top with his bow tie
Teddy at work

Once finished with our fitting session, we hightailed over to Daniel Tewa’s home for the daylight was quickly waning and I wanted to make sure we had plenty of time to spend with him. I have spoken of Daniel many times in this blog, but he is an incredibly special person not only to me, but to his Iraqw community. I had first visited Daniel in 2009 when I was here on safari with my two children and we had chosen to do some volunteering at the end of our trip. Not knowing where we would be volunteering in advance, Thomson Safari had paired us with the village of Ayalebe here in Karatu and we spent three days painting the local primary school during which time Daniel joined us. This was also the time I was introduced to FAME by our guide, Leonard, forever changing my life and cementing life-long friendships not only with Leonard, and eventually his family, but also with Daniel and his family.

Daniel Tewa and me on my very first visit back in 2010

When I had decided to come back a year later to work at FAME, I contacted Daniel and he not only remembered me, but also immediately asked me how Daniel and Anna, my two children, were doing. When I visited him for dinner that very first trip back to Karatu in 2010, he told me that of all the hundreds of foreigners (for he gives cultural visits for the tour companies at his home) who had visited him during their safaris, I was the only one who had reached back out to him and the only one who had come to his home for dinner. He told me of how incredibly honored he was to have me visit his family and home, but it was I who was the one that most honored. Since that time, Daniel and I have become attached by that special bond of friendship and family and despite the fact that we see each other only twice a year when I am here, we are both keenly aware of each other’s existence in the universe. Each time that I am here, Daniel has had the entire group of residents and others with us over to his family’s home for dinner and it has always been one of the most remarkable and memorable experiences for each of them.

Entering Daniel Tewa’s Iraqw house

Daniel is a truly unique individual. He is someone who grew up during the time of Tanzania’s independence and has seen the country grow into what it is today. Having only a seventh grade education, he is one of the most informed people that I know, always telling us more about U.S. politics and history than most of us know and being the one to inform us of current events back home when we visit him as we do not pay attention to any new back home when we are here, either intentionally or unintentionally. He has twelve children, most of whom have been to college and are working in various parts of the country as accountants, court advocates, or in tourism. He continues to farm his property that is on the Gibb’s Farm road here in Karatu as well as land that he has near Haydom, several hours away. He is an authority on everything Iraqw and Tanzanian and every time we visit, I learn something new about him and this amazing country. As we all sat outside in the fading sunlight of this remarkable land, he tells us stories about our homes that most of us had never heard and stories about Tanzania. He serves us African coffee that is boiled with milk and water and is to die for. I had decided that it probably wasn’t totally appropriate for us to have dinner indoor given the pandemic, so we were just visiting for coffee today, but the experience was the same.

Daniel and his house in March 2020 demonstrating throwing spears under a rainbow

One of the highlights of going to Daniel’s home is a visit to the Iraqw house that he built in 1992 and continues to be visited by students and scholars of Tanzania history. After the Maasai had come to this region several hundred years ago, they began to cause trouble with the Iraqw over their cattle, which the Maasai believe were all given to them by God. I have heard this story from enough individuals of many of the tribes here over my years of visiting that I do believe it to be at least reasonably accurate. The Iraqw home was built underground so that it would protect the family and their animals, all of which would be in the house at night for protection. You could hear whether anyone was walking on top of the house at night and then protect against an attack.

Daniel Tewa’s goats including the little young one bouncing on the right

Before the Maasai had come to this region of East Africa, the Iraqw had lived in a Bantu style of house that is now quite common here. When Tanganyika, and then Tanzania, became an independent country in 1961, and then 1964, respectively, with its union with Zanzibar, there were over 120 individual tribes, all of which had their own villages and cultures. Julius Nyerere, the father of the country and their first president, quickly realized that it would be impossible to build a country of such distinct cultures in regard to the infrastructures, so he required that villages become multi-cultural and outlawed such unique features as the Iraqw house. Daniel’s home was built as a historical reminder and he and his family live in a Bantu style home currently. The Iraqw and the Maasai eventually signed a peace treaty, but that was not until 1986. If you search the blog for “Tewa,” you will find numerous photos and references to prior visits with Daniel and his family. For today, everyone was thrilled to sit outside in the gorgeous Tanzanian evening light with the sun setting in the distance, sipping Daniel’s African coffee and hearing stories of the past, present and future.