Wednesday, March 5, 2014 – Day Two of FAME Neurology Clinic

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Day two in the clinic and we still have interesting neurology patients coming. After a few initial patients for the day we decided to have Megan work with Dr. Gabriel and touch base with me regarding them while I began to work with Jacob as an interpreter so we could see more patients and not run as late as we did yesterday. One of the first patients we had was a little 5 month old baby born with a myelomeningocele and hydrocephalus (a Chiari II malformation) and who had been operated on in Arusha for the both the spinal cord problem as well as having a VP shunt placed, both at Arusha Lutheran Medical Center. The baby had done very well, but had no lower extremity movement. We really had little to offer then other than to take care of referring her to the rehab facility at Monduli where her family can get the instruction they need. The mom asked if we thought the baby would ever walk and it wasn’t easy to tell her that she probably wouldn’t, though I’m sure she had been told that before.

Roza Andrea came back to clinic to see me. She is the young girl with Sydenham’s chorea bacterial endocarditis who I had seen a year ago with Danielle and who we’ve continued to treat. She had another exacerbation of her movements in November and saw Gabriel at the time. We treated her with another course of steroids at the time and she had some significant improvement in her movements. She is a real success story all in all, but I sure wish her movements would go away for good at some point. She is doing tremendously better, but I can tell that both she and her mother seem frustrated at times. Time will tell.

We worked straight through until 2:30 in the afternoon and finally took a lunch break, but found that we had few patient later in the day so things were much slower. We were actually able to leave on time today and took a nice long walk along with Joyce right before sunset. A nice breeze started up and it was another gorgeous evening. We walked for over an hour and had a relaxing dinner on Joyce’s new veranda watching the final wisps of sunlight coming over Mount Ngorongoro and finally the local bats making their rounds searching for insects over our heads. It doesn’t get much better than that!

Here’s a photo of our busy clinic during the midday today. Roza is standing in the foreground in the read jacket.

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Best to everyone,

Mike

Tuesday, March 4, 2014 – Our First Day of Neurology Clinic

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Walking to the first day of clinic in the bright warm sunshine of an East African morning has to be one of the most inviting experiences and it remains so for after all these visits. It’s been so long for me that I can only imagine what it’s like for the first time. As inviting as it must be on that first visit, though, there is still the apprehension of new faces, a new place and those expectations that we all place on ourselves. And so begins another journey.

FAME began as single outpatient clinic offering it’s services and is now a complex care facility managing not only five times as many visitors as it did a mere four years ago, but providing inpatient, surgical and laboratory services that are available in few places so remote. Our schedule is to provide a neurology clinic at FAME during our first week here and then to provide neurology services in several villages that are somewhat distant from FAME where the journey may be a hardship for the patients or they may be simply unaware of the services available or the need for them. And of course we’ll take a day here and a day there to go on safari and see the amazing wildlife that shares the countryside.

William, our outreach coordinator, does an incredible job getting the word out in the Karatu district as well as in the village areas of our impending arrival which was evidenced today by the number of patients that showed for our first day of clinic. We were unable to see them all and had to ask a number of them to come back tomorrow or in the days to follow. There is such a need for specialty care here that is so clear which makes the rewards so great. The doctors. clinical officers and nurses here are like sponges for information and with each visit it is so clear that they retain most, if not all, of what we have taught the time before.

And so it begins, another adventure, another experience where it is difficult sometimes to identify who is the teacher and who is the student as it all melds together and makes it all worthwhile. I’ll leave you with a photo of the student teaching, Megan evaluating a patient with Dr. Gabrielle, both incredibly capable clinicians and learning from each other….I can’t think of a more amazing place to be right now.

Megan's first day of neurology clinic at FAME

Megan’s first day of neurology clinic at FAME

Good night.

Mike

Monday, March 3, 2014 – Arusha to Karatu

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Fischer’s Chameleon (and Megan’s hand)

I will warn everyone in advance – no photos of cute children this time. Only one photo of our wonderful safari this morning in Leonard’s front yard searching for the elusive old world chameleons. For those of you who are not reptile aficionados you may not understand, but these chameleons are the most fascinating and wonderful of all lizards. And amazingly, or perhaps thankfully, Megan is as interested in wildlife, and reptiles specifically, as I am so we were on the hunt together. Yesterday we were able to catch one and enjoy its company for a brief time before setting it free again on it’s tree, but today, we spotted three of them in the front yard and caught another that you see here on Megan’s hand. They are truly amazing and a vestige of some time long ago when dinosaurs roamed the earth, or so it would seem. At least it’s fun to think that way. So here it is in all of it’s full living color(s) along with Megan’s hand:
We spent the rest of the morning (when not on wild animal hunts) with the Temba boys (and by the way, Lennox is 8 years-old and not 11 as I mistakenly typed yesterday) before they had to leave for school and then ran errands with Leonard in Arusha. A trip to pay the tariffs on the Land Cruiser so when we get stopped at the police roadblocks for their “safety inspection” (otherwise known as a shakedown) they won’t be able to find any deficiencies. We were stopped about 1 km after we left Arusha and quite happy to have had the stickers appropriately attached so they just smiled and waved us on our way.

It was uneventful trip across the Rift Valley here towards Lake Manyara and a gorgeous day. The view of the lake from on top of the rift was as amazing as ever and the lake was filled with flamingoes making it look like the water had turned pink. Since it’s the wet season everything is lush and green and coming into Karatu through Rhotia Valley reminds me every time what an truly beautiful place this is and how lucky I am to be here and to keep coming back.

FAME has continues to grow, now with the ORs up and running and a third volunteer house that Joyce has built. Megan and I will get to work tomorrow bright and early and how much we’re looking forward to that. We’ll be here for four days and then off to Oldeani and the Rift Valley Children’s Village on Saturday for a mobile neurology clinic. We hope to take the day off on Sunday and then more mobile clinics next week to the villages along the upper rift.

Thanks and more to come,

Mike

Sunday, March 2, 2014 – Arusha, Tanzania

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Welcome to the first installment of my spring 2014 trip to FAME and Tanzania. I’m typing this from my iPhone (with a bluetooth keyboard, thankfully!) as my iPad SIM card didn’t want to work on arrival and is now our first destination tomorrow morning to make that happen as my iPad is essential while traveling here not only for my email, etc., but also as my navigation system for getting to the villages.

Megan and I had an incredibly uneventful trip here with a smattering of fortunate events. The first was to have been randomly given a TSA pre-check boarding pass which meant that I didn’t have to take all the electronics out of my carryon bag that I had so carefully wrapped – two MacBook Airs for FAME, my old iPad for FAME, my iPad and a brand new iPhone 5S for someone here. We had time in the club at Newark which totally blew Megan’s mind as she had never had the opportunity to relax in an airline club. The little perks of frequent travel. Our Amsterdam airport visit was short and the flight to Kilimanjaro went quickly – helped by a few movies and some sleep. We were through the immigration line quickly and our bags were nearly the first to arrive! We found Leonard and Pendo and hit the road for the hour drive to their home.

It was great to see both Lennox (now 11) and Lee (nearly 5) first thing this morning and they took to Megan immediately. I’ll have to admit, it’s so great to have Megan here as a bit of a buffer with the boys (Danielle will greatly appreciate that comment) as they can be a bit overwhelming at times, or perhaps most of the time. We spent a quiet day at home though Megan did accompany Pendo to the salon to get a bit of Tanzanian culture along the way. This afternoon, Megan and I took both boys out for a visit to a nice shop and then to town where I caved in and bought them ice cream at a nice little shop.

Tomorrow we’ll be up early to do some last minute errands in Arusha and then it’s off to Karatu and FAME where we expect to be sometime in the afternoon. I can’t wait to get back there. It will be my eighth visit and I plan to keep doing this. Megan is a great traveler and having grown up in Indonesia makes her totally accustomed to a third world culture. She’s a natural at this.

I didn’t do any photography today other than a few photos with my iPhone that I will attach. Lennox and Lee acting totally themselves in one and entertaining Megan in the other.

Lennox and Lee

Lennox and Lee

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It’s wonderful to be back in my second home and I’m looking forward to the next two weeks here.

All the best,

Mike