Monday, March 10, 2014 – Mobile Clinic to Kambi ya Simba

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Safari in Kiswahili really means journey so I guess technically we were on safari again today, but not in a national park. Our journey today took us to the village of Kambi ya Simba (Lion Camp) which is about an hour’s drive from Karatu and FAME. The village sits in a very fertile valley some kilometers west of the village of Rhotia and is on top of the escarpment of the Great Rift Valley and high above the Masai Steppe. I have been coming to this village for the last two or three years to do what I’ve coined as a “mini mobile clinic” in deference to the five day, near campaign style mobile clinic that we used to run at Lake Eyasi (where the Hadzabe or the last hunter gathers in Tanzania live) and whose funding ran out a bit over one year ago. This is why neurology mini mobile clinics have become an important part of FAME’s services and one of their main outreach programs.

We arrived to the village to find a fair number of patients waiting for us, but it turned out to be a very manageable 21 patients which is pretty reasonable for neurologists to see in one day if Megan and I worked separately which was fine. Every patient we saw was totally appropriate from a neurological standpoint which is a great improvement over past clinics I’ve run. This is mostly because William, our outreach coordinator, has really worked hard to educate not only himself, but also the communities on what type of medicine we’re offering.

We worked at Kambi ya Simba until around 4:30 pm and then left for home. The clinical officer there worked at FAME briefly and while we were seeing patients asked if William and I could come over to his house for a minute. I didn’t want to insult him and so we did go to visit him quickly only to find out that he had a huge spread of food for us along with his two infants. The only problem was that we had already eaten our lunch which meant that I had to manage to squeeze a second lunch so as not offend and dishonor his family.

Good news regarding young Toby, the boy from Oldeani that we brought back to FAME with us on Saturday. As best we could tell this evening he hadn’t had any further seizures today which was  a big step forward for him. The stroke patient was also moving her right leg spontaneously which means she may at some point be able to at least weight bear and stand on the leg.

It’s late here and we’ve got another mobile clinic tomorrow at Upper Kitete which is further along the rift than Kambi ya Simba and takes nearly twice as long to get to.

Hopefully more pictures soon when I get a chance to look at them.

Love,

Mike

Sunday, March 9, 2014 – Safari in Lake Manyara National Park

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Today was a wonderful day. It had nothing to do with the fact it was my birthday (as I am unfortunately away from my family), but rather I am somewhere that I have come to love as a second home and doing something that I think is meaningful and helpful to others and enjoying every minute of every day doing it. And while having all of that I am still able to get away and do several things that I also truly love – to drive on my own in East Africa, the cradle of humanity, and to take a group of friends on safari with me as their driver/guide to one of the most beautiful parks in Northern Tanzania.

We got up very early so we could get to the park, but stopped by the hospital to see our young seizure patient only to find him having another seizure. We had to give him some more valium and reeducate the nurses as to what a non-convulsant seizure looks like and to treat it with diazepam.

The weather for our safari was awesome. Not a cloud in the sky until the end of the day. We got through the gate at about 7:30 am and I think we were probably the first vehicle in other than the few tourists who had stayed at one of the two pricey resorts within the park. We immediately saw tons of monkeys – baboons, blue and vervet. They were just about everywhere and lots of little babies since this is the right time for them. We even saw a large group of blue and vervet youngsters playing together which is something none of had ever seen before. There were large herds of Cape buffalo, zebra and wildebeest and we got a good view of some hippos and their babies albeit from a distance (not nearly as close a view as Danielle and I had last March in the Crater).

Then as we came around a turn there was a large female lion just walking right in our view and I think we all screamed. She walked into some bushes and we drove forward a bit but couldn’t find her. Just about that time another vehicle came from the other direction as we were backing up to the original spot and we told them what we saw. We looked for her once again and then went back again to the original spot and the other vehicle had spotted the pride sitting under some trees. There were eight in all and three of them were larger cubs! We sat and watched them mostly sleeping for quite a while. We came back later in the day but they had moved to another location by then.

We eventually saw a number of elephants and giraffe along with many herds of impala, both harems and the bachelor herds. Lots and lots of birds which made Megan quite happy as she is definitely a bird person having a cockatoo at home as a pet. The large hornbills were fabulous.

We eventually left the park at 5:30 – ten full hours of safari!

The young boy in the ward had three seizures during the day which broke with valium and we’ll reassess him today. In between his seizures he’s awake and normal. We’ll have to get him under control soon.

Love,

Mike

Saturday, March 8, 2014 – Rift Valley Children’s Village and Oldeani Clinic

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Today we were scheduled to go to the Rift Valley Children’s Village and small adjacent village of Oldeani. Fame runs a clinic there twice a month, but this was the first time we had done a neurology mobile clinic side by side. We packed up all of our medicines and supplies and drove separately from for the 45 minute drive through beautiful countryside to reach the Children’s Village. We were met by India Howell and quickly saw the large group of patients to be seen by us, not to mention the patients there for the regular clinic. There were 20+ patients for us to see and they were all very appropriate neurology patients which means they take longer than the regular patients the other side was seeing. The photo I’ve included is just our group of neurology patients and not the general medicine patients. Not just deworming and giving antibiotics, but taking seizure histories and the such is quite a bit more time consuming.

Waiting to be seen at Rift Valley Children's Village

Waiting to be seen at Rift Valley Children’s Village

After seeing several patients, though, we were quickly called out of our room for a young man who had collapsed out front. Luckily it was a patient we had seen yesterday at FAME and who we had asked to come back and see us today which he had done I guess in a sense. He was having continuous non-convulsive seizures and was unresponsive. We wanted to give him some IM Valium which took a bit longer to get organized then we wished, but eventually got taken care of. You can see in one of the photos Megan attending to the young boy with his mom and a nurse to give his IM injection. Several Mamas stood around him holding their skirts in a way so as to give him some privacy considering the crowd of patients we had. And as we couldn’t convince anyone to watch him for us to make sure he didn’t stop breathing, we simply put him in a chair in our room so we could keep an eye on him and continued seeing patients with him in the chair. His mom came in and out and he basically kept seizing for another 4+ hours even with another dose of Valium. We had no way of putting in an IV.

Later in the afternoon it was readily apparent that the kid was not waking up so we made the decision to bring he and his mother back to FAME to get an IV in him. We carried him to the car and put him in the front seat with Megan and got everything loaded. We were unable to see probably nine additional patients which was unfortunate, but we’ll have them come to FAME and see them next Friday. As we drove out of the gate of the village to find Tobias’ mother and were waiting near their home suddenly he amazingly just woke up and looked at Megan. His mother hoped in and we decided to bring them back to FAME regardless. He chatted with Megan the whole way back to town and played with the toy giraffe she uses to examine children. On the way back and almost to the tarmac, the Land Cruiser started smoking a little and we had to stop to check things out. Turns out we had lost the AC belt, but since we don’t use the AC ever here and the car didn’t seem to be overheating I felt it was probable smoking when the belt disintegrated and wouldn’t cause any further harm so off we went. We dropped all the employees with us off at their homes on our way through town so it ended up being just Megan and me along with Tobias and his mother in the car. As we were just about to get to the gate at FAME he looked like he went to sleep, but off course was having another seizure. I had to carry him into the ward unannounced and put him in a bed. He was in tonic extension at the time and still remained otherwise non-convulsive. We got an IV in him quickly this time and gave him some more Valium and he snapped out of it pretty quickly.

Our plan was to switch him from phenobarb to carbamazepine and so we quickly got his first dose in tonight before he seized again. What an experience and it certainly rivals Danielle’s seizing infant from last year. Very little can prepare you for such experiences and Megan did a stellar job given the very tough situation. These are the memories that will remain with us forever.

We ended the evening with a nice get together at the Lilac Cafe for all the volunteers and some local ex-pats I’ve met before. Tomorrow we’ll be on safari in Lake Manyara and then we start our mobile clinics on Monday. Another busy week here.

Young Thobias at clinic

Young Thobias at clinic

More remarkable adventures to come.

Mike

Friday, March 7, 2014 – FAME Neurology Clinic

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Well, we’ve finished our fourth day of neurology clinic at FAME and will be starting the mobile clinic portion of our visit tomorrow. It has been the best clinic so far in regard to the volume of true neurology patients here at FAME and William, our outreach coordinator has done a remarkable job recruiting patients for us. Tomorrow we head to Oldeani and the Rift Valley Children’s Village. The RVCV is an amazing home to around 80 or so children that have been adopted by India Howell as it is her concept that this should be the children’s home and that they should feel safe and not worry about being taken from their family.

We started off today by seeing three boys being brought from Mto wa Mbu who have been unable to walk for some time. The first was a Masai orphan who has been unable to walk for several years and his weakness has not been progressive. We believe he suffered polio or a similar viral illness affecting the spinal cord. Then we saw two brothers with a progressive muscular disorder and most likely a muscular dystrophy, but which one? We immediately contacted our gurus at Penn to see what they thought and got responses very quickly. Here is a photo of the three boys, the two brothers being on the outside.

Young boys from Mtu wa Mbu

Young boys from Mtu wa Mbu

We seemed to be pulled in all directions today and Megan and I had to split up again to get everything done. I saw a good epilepsy case at the end of the day as did Megan and we regrouped in the ward to finish up examining our stroke patient who had improved some.

After clinic we took care of our emails to the specialists at home and then drove up to Gibb’s Farm for drinks on their veranda which has one of the most spectacular views of all time with lots of birds and other wildlife surrounding us. Dinner there was amazing as usual and at $25 (local’s price) it is one of the best buys around.

Tomorrow is Oldeani as I mentioned and then Sunday we will be on safari at Lake Manyara.

Mike

Thursday, March 6, 2014 – FAME Neurology Clinic

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Well, I spent half and hour last night and again early this morning typing my daily log only to have it vanish from my iPad when I was inserting a photo…..ouch! Megan had a lecture to give this morning at 8am so we had to run up a bit early to set up and now I’m behind. Luckily, it was raining last night which means the patients come up a little later in the morning so I have a few free moments….I think.

Thursdays are supposed to be slow here, but someone must have announced a special rate or something as we were pretty much swamped throughout the day. Megan and I started off seeing patients together, but had to split up after lunch to get everyone seen. We had a family with pretty classic migraines and medication overuse headaches. The usual complement of “GBM” or general body malaise with aches and pains. The last patient was a cute 9 year-old boy with a two year history of sleepiness that was mostly in the morning and was unable to stay awake in the office with us. A pretty good MSLT watching him with near zero sleep latency. No history of cataplexy, but pretty certain he has narcolepsy and was able to put him on some Ritalin and will see him in a week. Also sent an email off to Larry Brown at CHOP and had a reply from Larry and another sleep specialist there within an hour. Pretty good seeing a kid here and having feedback from the best pediatric hospital in the US that quickly.

Waiting to be seen at FAME

Waiting to be seen at FAME

Had dinner last night with my friend Daniel Tewa. I visit with him and his family at least once while I’m here and it’s great for whoever’s with me to come along and visit a Tanzanian family in the area. Daniel is also Iraqw, one of the indigenous tribes in Karatu and has an Iraqw underground house on his farm that we got to see. Dinner is usually an experience as it is a traditional meal, but since Megan is a vegetarian and they weren’t sure what to do, his daughter (whose house we were eating at) had her uncle come help cook. Problem is that he was a chef at Gibb’s Farm for a time and prepared an incredible meal. Megan wasn’t subjected to some of the unusual foods that Danielle got to try last year (much appreciated) though we did each get to drink warm whole milk with dinner. Daniel and his family are very special and treat us like their family so it is a wonderful experience.

Got to run and see patients right now.

Here is a photo of Daniel’s daughter at the grinding stone in his original Iraqw house alongside a wonderful huge twined storage basket. Craig, Sheila, Brian and Bob will very much appreciate the basket. Also a photo of a busy clinic yesterday.

Daniel Tewa's daughter demonstrating grinding maze in original Iraqw underground house

Daniel Tewa’s daughter demonstrating grinding maze in original Iraqw underground house

Later,

Mike