Little Grace Joel

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I’m posting a bit out of order since I have yet to write about our last day at Ndutu, but as you will see it is out of a sense of urgency more than anything else.

Last night we were asked to see little Grace Joel in the ward. Grace is an adorable child who I have gotten to know from previous visits to FAME. She is now 5 years-old and was diagnosed with acute lymphocytic leukemia when she was around 3. FAME has continued to care for her as she lives in this area, but her cancer treatment has been delivered predominantly in Dar es Salaam at Muhimbili University which is where the government provides national cancer care. Dar is a 10+ hour bus ride from Arusha and even further from Karatu.

Grace was here to receive an oral chemo treatment and began complaining of an increasing headache yesterday. Payal assessed her and also spoke with the pediatric cancer specialist at Muhimbili this morning to discuss Grace’s treatment. She needs an urgent CT scan and a lumbar puncture, but unfortunately we can’t do those things here at FAME and even if we sent her to Arusha for the CT scan we wouldn’t be able to run cytology here to help differentiate whether her problem is due to worsening leukemia or an opportunistic infection. Either way, she has some intracranial process that needs urgent attention. She has previously been doing very well and has responded to her chemo.

We can’t send her to Dar by bus as she is neutropenic from her chemo and trying to fly her commercially will take at least two days to arrange. We contacted a flying medical service here who is picking her up in several hours and flying her to Dar to be taken by ambulance to Muhimbili. The cost for this trip will be 1.2 million Tanzanian shillings which converts to $1275 USD. FAME doesn’t have this budgeted and we’ve raised some of it here from volunteers, but I am also hoping that a few of my readers may also be able to help out with this. I know I have old photos of Grace somewhere, but none handy to post at the moment.

Any donations can be made directly through the FAME website at http://www.fameafrica.com and just make a note or send an email to them that it for Grace Joel. If you’d like to email me you can as well and I will let them know of your generosity – michael@rubensteins.net. Life is so difficult here, but to have an illness like this would be difficult anywhere.

Thank you.

The Central Serengeti

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As the rains had not come as expected and the migration had moved on to the Central and Western Serengeti, we planned to leave the NCA and drive into Serengeti National Park on the second day of our trip. This meant taking a very long and dusty drive far to the south of Naabi Hill which is where most safaris enter the park coming from Ngorongoro Crater.

We had a wonderful breakfast at camp and then left for our long drive at around 7:15 a.m. A short way from our camp we ran across a small group of bat-eared foxes sitting just outside of their underground den. They are a very nocturnal animal and the only time to see them is just at dawn as night drives are not allowed.

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We had to leave in the direction of the marshes so we first checked on the lion pride we had seen the evening before and found it very close to our previous sighting. After that we ran across a female cheetah that looked very pregnant and probably due any day. Having Kelley, a women’s health NP, and Hannah, soon to be starting an NP program in women’s health at Penn, along meant that they were both hoping to watch a birth and secretly desiring to somehow assist with it – probably a very bad idea as imagine a mother cheetah even during birth wouldn’t appreciate the fact that they were only trying to help. We left the mother to her own devices and Mother Nature which I am confident would suffice even without the assistance of either Kelley or Hannah.

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We arrived to the Central Serengeti by way of the Morro Kopjes (pronounced Copies with a long “o” sound). It is a dutch word that means “little heads” and is one of the main geographic features of the Central Serengeti landscape. They are also very important to the wildlife as much of life there centers around these rock outcroppings. We drove around the Morro Kopjes area with sightings of small wildebeest and zebra herds and then ended up closer to the Seronera area which is where the airstrip and most of the camps and lodges are in the central region. On our way in we found a leopard sitting some distance away in a tree and lounging. It did have some prey hanging on another branch but it was hard to tell the age of the kill. Along the way we had also seen several old leopard kills hanging in the trees and abandoned after all but the limbs and hooves were left. We’re pretty certain that they were all baby wildebeest carcasses.

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We drove along the Seronera River north and ran into a number of zebra – and also discovered that a zebra “herd” is actually referred to as a dazzle. So we ran across a number of large zebra dazzles that were acting very strange with lots of zebra calls to one another and running around in a state of anxiety it seemed. It was as if a predator was close, but the behavior was the same in all of the groups we saw. At one watering hole, the zebra kept running down into the water to drink and then suddenly all charging out of the water and then back again. None of us had ever seen anything quite like it. I will also tell you that all of us were secretly hoping (perhaps even praying) that a crocodle would suddenly jump up out of the water and snatch one of the zebra. We all saw bubles several times and swore that it was a croc sneaking up on them, but nothing ever materialized. And no, we never felt a bit of guilt for our wishes.

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We found a few smaller lion prides during the day, but all were sleeping during the midday heat and none were worth watching for any length of time. One female was lying in the shade next to a muddy spot where a dead zebra was also lying and it wasn’t entirely clear whether she had killed it, but either way what she intended to do with it was pretty clear. Lions sleep most of the middle of the day and hunt either at night or in the early morning or twilight hours. It takes them quite a bit of energy to mount a hunt and doing that in the midday sun is something they would rather skip and probably opt in for a nice nap in the shade instead.

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After driving up and down the river we started our long journey back to Lake Ndutu via Naabi Hill. Naabi Hill is the southern entrance to Serengeti National Park and the border between it and the Ngorongoro Conservation Area. We arrived to the gate and were there for almost an hour. It’s hard to imagine what could be happening in the gate office for that long, but somehow it always does and having been in that position before I can tell you that it’s mostly waiting for the internet to connect along with some chit chat amongst everyone in the office about anything. I think it’s considered a rite of passage or something, but it is certainly the antithesis of passing through a toll gate, especially with an EasyPass!

We arrived back to Ndutu near sunset and went looking for cats, but only found a single relaxing cheetah. We made our way back to camp in time to sit around the campfire before dinner and then had a wonderful dinner of soup, a beef dish with vegetables and desert. We shared stories of the day with the other guests at camp and everyone wished for a successful safari the following day.

Dreams again of lions, cheetah, zebra and wildebeest and hoping they would be in the same location for at least some of the time.

Our Drive to Lake Ndutu and Day 1 of our safari

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I have made it a practice of providing the full Tanzania experience to everyone who accompanies me here and that means at least several safaris to visit the national parks. Tanzania is the number one destination for animal viewing in Africa and the premier locations here are Ngorongoro Crater and the Serengeti. Kelley, who was here with me last fall, had contacted us about taking a safari to the Lake Ndutu region of the Southern Serengeti. Lake Ndutu is known as the prime location to view the Great Migration in March and April which is when all the wildebeest and zebra travel there during the rains to calve. I’ve been here before and it is spectacular.

Unfortunately, this year has been an anomaly with the rains that haven’t yet come in full force which has caused the migration to move on to the central and now western portions of the Serengeti. Rather than being incredibly lush and green, the Lake Ndutu region is dry and very dusty. We had booked well in advance to visit there in a tented camp for two nights and so began our journey early on Friday morning at about 8 a.m. when we were picked up by our driver, Isaac, from Duma Explorer which is the safari company Kelley booked us with. Along on the trip are Kelley, Natalie and Hannah in addition to Christyn, Payal and myself.

We left FAME a few minutes after 8 a.m. and drove up to the entrance gate of Ngorongoro Conservation Area which is a very large area that borders Serengeti National Park to the east and contains some of the Serengeti ecosystem. The NCA is a multi-use area meaning that many Maasai live there and graze their cattle while also sharing the land with the natural fauna. It is very regulated and well maintained with an entrance fee to just pass through the gate. Ngorongoro Crater is also within the NCA, but requires separate entrance fees and is more heavily restricted due to the often high level of traffic into the crater.

The tarmac (paved road) ends at the NCA gate and there is no paved road any further traveling west over the crater rim, through the NCA or across the Serengeti. There has been much controversy over this issue and whether to allow a paved road for commerce such as trucking, but at the present time that has been blocked and will not likely occur – for now.

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So our trip began with a very long drive up to the crater rim and then around it and down into the Oldupai Gorge region which I’ve mentioned before. Dropping down the backside of the crater we immediately encountered a massive group of giraffe (probably more than 50 in all) with lots of babies and adolescents. It was amazing to see so many together as that is not often the case and much smaller groups are more typically seen. They are just so amazingly graceful to watch and seeing so many in one place was an incredible sight

On we drove past Oldupai Gorge with Maasai children herding huge groups of cattle and goats that represents their family’s entire wealth. Also past long lines of donkeys carrying water to their boma with the women and children also tending to these chores. A sort of “clean up crew” made up of mostly women followed to pick up any loose water containers that had fallen off their respective transport. It is an existence that seems very harsh, but having visited many a boma on my trips I can say that the Maasai are all a very proud and happy people. It is a constant reminder that happiness is not merely a two-car garage and a large home.

The turnoff for the Lake Ndutu region is barely marked and the first thing one notices is that the “road” is really just multiple cross-country tire tracks heading essentially in the same direction. As opposed to the parks where you are unable to drive off-road (“roads” in the park though are often only several tire tracks), the NCA allows you to drive entirely off-road. This totally changes the perspective of game driving as you can drive however to reach any sightings. You must still respect the animals by not interfering with any of their activities to alter their behavior – sometimes this rule isn’t followed as well as it should be unfortunately.

We arrived at our camp for a hot lunch (as opposed to a box lunch often prepared for full day game viewing when you don’t return to camp) and dropped off our bags. Chaka camp, where we booked two nights and three days of game drives, was simply amazing. It is owned by Duma Explorer who Kelley had booked our trip with and I can’t say enough good things about them. Our tents were incredibly comfortable and some of the nicest I’ve stayed in.

After a lunch and a brief nap we took off at 4 p.m. for an afternoon game drive and immediately ran across a lion pride in one of the marshes that make up the landscape here and they had just killed a warthog. There were two males and at least four females, but the males had the kill and were hidden in the reeds. We spent a short while watching them and then decided to do some more driving. In a very short time we found a mother cheetah and two cubs about 4 months old. The sun was getting low and the lighting was excellent for nice photographs. They were so majestic to just observe and with the sun setting it was an amazing time.

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We arrived back to camp with barely any light remaining in the sky and just in time to spend some relaxing moments around a fire and chat amongst ourselves and some of the other guests at the camp. One was a friend a Natalie’s who was there just by chance and is a professional photographer and guides some photo safaris. It was great speaking with him about safari photography and sharing some similar experiences. I hope some day to be able to go out with him on a short trip.

Dinner was marvelous – homemade soup for the first course and then fish with potatoes and vegetables. All the food is very fresh and prepared on site. We went to bed all very satisfied with the day and our experiences. The travel to Ndutu was very tiring and being on safari is also a bit draining. It had been a long day and we were all looking forward to the next two days. Dreams of big cats and wildebeest and zebra.

FAME Neurology Clinic – Day 4

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I will have to admit to you that I am typing this blog about yesterday while lounging in a safari camp in the Southern Serengeti after eating a wonderfully fresh lunch. Yes, we left the security of FAME and Karatu and are now on a three day safari in the Lake Ndutu region. You will have to check back, though, to hear more about that.

Day 4 (Thursday) of our neurology clinics began with Payal’s last nursing lecture on seizure management and, yes, Christyn again performed her magnificent seizure simulation for them. We hadn’t much hope for attendance, but there were plenty of folks including Hannah and Kelley, two longterm volunteer nurses here. Talk about a small world, but Hannah will be starting a masters program in midwifery at Penn beginning in the fall.

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Our started off fast with them bringing a young woman who was unresponsive and had been that way at school earlier in the day. It was readily apparent to both Payal and myself that this did not appear to be a seizure or a syncopal episode and was more than likely a conversion reaction – “swooning” would be a good way to refer to it. After a bit she began to wake up slowly and very shortly she could shake her head yes or no, but still appeared quite somnolent. We brought her back into our office to keep an eye on her and had one of the nurses talk with her. It was very clear that she was extremely depressed and that was confirmed with the information she subsequently gave regarding her parents’ divorce when she was five and that her mother had remarried. I decided to put her a small dose of amitriptyline (“Vitamin A” here) as she was not surprisingly having difficulty with sleep as part of her depression. I spoke with the volunteer who had brought her and she will be seeing one of our long term workers here for counseling in a few weeks.

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Christyn started her day with a young 22 year-old woman with terrible back pain that had started the day before and probably had a radiculopathy based on her story. As Christyn was examining her she suddenly began to vomit. After further questioning she hadn’t been having fevers or abdominal pain recently, but then gave the history that she hadn’t had her period since January. Yes, she was pregnant and with severe back pain. Isaac did an ultrasound on her and found that she had an early pregnancy that was very low in the uterus so we brought Kelley over to look. It didn’t appear to be a viable pregnancy due to its location, but since it didn’t appear viable we decided to treat her with a course of steroids given the intensity of her back pain.

The day continued to pile up with patients and we had to stop taking new patients around lunchtime as we didn’t feel that we could get to everyone and we didn’t want people waiting around all afternoon to be told we couldn’t see them. I didn’t get the final count, but will tell you that we averaged about 30 patients a day for the four days at FAME which is a huge number of neurology patients to see and all of that done by two residents who worked tirelessly and refused to compromise on the care they were providing which is often tough here.

In addition to the outpatients we saw on the last day, Payal also saw two patients on the wards – one was an 18 year-old with the worse case of osteogenesis imperfecta that I have ever seen and who had come in with a fractured right arm. Payal assessed him and then contacted an ortho resident at CHOP to ask him for some advice and then reviewed some YouTube videos about splinting and proceeded to apply an excellent immobilization splint to his arm. A little know-how and a ton of resourcefulness is often what it takes to practice here.

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I also met with Susan (FAME’s co-founder), Brad (FAME’s nursing education coordinator) and Will (FAME’s current volunteer coordinator) to discuss future plans for the neurology program here and implementing some of that during our upcoming October visit. I am bringing residents next time as well as several epileptologists to begin work on our epilepsy project here. The trick is to make sure that we are not overtaxing FAME both as far as housing is concerned (further emphasizing the need to build a “Penn House” here for our use) as well as the staff required for us to see neurology patients. I will begin working on looking for funding for the Penn House and will also try to look at funding to cover the cost of the staff that we utilize for neurology while we are here. Both of these needs are significant now that the program has grown and is very successful. What was once me coming alone and seeing neurology patients as they showed up has now turned into an organized visit with patients coming from far away to be seen by the neurology “fundis” (experts) and many returning again and again.

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Roza Andrea

Roza Andrea, Sokoine (our intepreter) and Payal

We also saw Roza Andrea with Payal today. She is the young women (now fifteen) who we first interacted with by video email in December 2012. She had Sydenham’s chorea – a movement disorder triggered by Strep infection related to bacterial endocarditis and which can cause serious heart problems and even death. This was my fifth time seeing her and she is now symptom free as far as the movements are concerned, but she requires.prophylactic penicillin until the age of 40 and had not been returning to get it since her last visit in September. Luckily she’s still fine, but it may not have been so good. We impressed upon both she and her mother that she is really a miracle and it would be terrible for something to happen at this point. Hopefully she will continue to come back to get her antibiotics going forward. These are often the challenges here. Patients may not return due to lack of understanding or the inability to afford the treatment which may be as little as several dollars.

After running some errands in town and dinner on Joyce’s veranda, we all began packing for our trip the next day to Lake Ndutu.

FAME Neurology Clinic – Day 3 (hump day)

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Having recovered from our incredible dinner the night before at Gibb’s Farm, I arose early to finish my blog regarding the prior days. Posting my blogs has become part obsession and part therapy, but either way it’s an important way for me to share these experiences that would otherwise be so hard to convey after returning to “civilization.” I’ve mastered the transition between cultures without a problem, but the real issue for is trying to relate experiences from one culture to the other. Trying to describe a patient encounter here to someone at home is just very difficult when the other person hasn’t experienced what it’s like here and vice versa. Because of that, it’s much easier for me to describe those events while I’m still here rather than when I return. Hence, my blog.

We began our clinic day with Payal’s nursing lecture on seizure management that was reasonably well attended, but either way we were there to support her. In fact, Christyn served as her epilepsy patient during her patient simulation. There were lots of great questions from the nurses and it’s always tough to tailor recommendations to what’s available here, but she did a great job of it.

Payal giving her seizure management lecture to the nurses

Payal giving her seizure management lecture to the nurses

Christyn doing a seizure patient simulation helping out Payal

Christyn doing a seizure patient simulation helping out Payal

We had another totally swamped day with the same number of patients being seen as Monday. We’ve seen 91 patients in the three days that we’ve been at FAME which is amazing both from the standpoint of what Christyn and Payal have done as well as the fact that all of the patients have been genuine neurology patients so the message was clearly conveyed to the community by William, our outreach coordinator. Payal was working with Dr. Isaac again and Christyn with Sokoine as an interpreter. They were both subjected today to the experience of multiple translators as we had several patients who only spoke Iraqw and needed a family member to translate from Swahili and Payal had a young Maasai woman whose husband didn’t speak Swahili either and they brought a translator with them.

Payal’s Maasai woman presented other obstacles that are often encountered here with the Maasai specifically. The Maasai have traditionally practiced polygamy and the women often do not leave the boma while the men regularly attend the local markets so speak Swahili out of necessity. The patient was having episodes of unresponsiveness that were just about to be interpreted as possible seizures though the history to that point was supplied exclusively by the husband and not until the men were asked to leave the room and a female Maasai interpreter was enlisted was the true story apparent. She was sixteen and had been married at nine. She had been pregnant three times with three children. Her episodes were limited to when she was pregnant and were clearly syncopal and not epileptic. Thankfully the more accurate history was obtained and she avoided a trial of unnecessary medication.

Payal after evaluating two syndromic siblings

Payal after evaluating two syndromic siblings

I sat down for lunch and was immediately summoned to meet with a surgeon that we had met the night before at Gibb’s Farm and I had invited to have a look around FAME. In fact, he brought the entire safari group he was with so I spent about 30 minutes showing off the facilities here at FAME and totally impressing the group. It is hard not to marvel at the medical facility here and what can be accomplished with an idea and lots and lots of energy.

In the afternoon I worked with Christyn and the interesting patients continued. We saw an elderly gentleman with a one year history of generalized weakness and muscle wasting and symptoms of neuropathy. He denied coughing or fever and we decided to check for all the likely suspects including HIV, syphilis, and finally TB. Of course everything was negative other than his sputum for AFB – he had active pulmonary tuberculosis as an explanation for his gradual decline over the last year. Even neurologists can diagnose pulmonary disease.

We also saw a depressed woman who was also complaining of memory loss and decided to check her for syphilis along with thyroid function only to find that she had the former so we had to counseled her on STDs and had to have her come back to be tested for others by the women’s health nurse practitioner.

We again ended up seeing 34 patients today and finished a bit late. We were heading to Daniel Tewa’s home for dinner and wanted to get over there in the daylight, but on arriving home to get the vehicle found that I had a flat tire. It took probably 20 minutes to figure out the jack for the Land Rover as it is one of those hijack models given the height of the vehicle. I finally got the tire changed and we were off to Daniel’s. He is just the amazing individual and always a pleasure to visit. I have visited with him every time I’ve been here and have brought all the residents accompanying me to visit with him as well. We went up to his daughter, Isabella’s home for dinner that was all local Iraqw dishes and were amazing. They are so gracious and remind us over and over again how we honor them by visiting and sharing a meal with them. We fell quite the same, that it is such an honor to spend time with them for despite the struggles often encountered here just to provide for their own family that they bring us into their home and share their evening meal with us. It is a relationship of mutual respect and love and Daniel constantly reminds us that they are our Tanzanian family.

We returned home at 10pm and after such an amazing meal I don’t think we lasted that long before bed.

One more thing. I’ve linked Payal’s blog to mine, but just in case, you should all visit it as well. It’s wonderful and another perspective of this amazing trip:

http://www.lionsdontbite.blogspot.com

FAME Neurology Clinic – Days 1 and 2

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It’s an early day leaving the house as Payal has her first of three lectures to give to the nursing staff today. Brad, our new education coordinator told us yesterday that there was a significant chance that no one would show up for today’s lecture as the nurses would have to be picked up early from town to make a lecture that early and in all likelihood they will have forgotten over the weekend. He was right. Sahawa, our nurse anesthetist, was the only one to show for the lecture, but that was fine since it gave Payal a good chance to practice her lecture as she will be giving it on two other occasions so all the nurses have a chance to hear it.

After lecture it was off to our neurology clinic here at FAME. As they have outgrown the outpatient clinic even without our specialty clinic our plan was to see patients across the courtyard in the emergency room and night doctor’s office. That would allow us to have two rooms working at a time and we had one clinical officer to work with a resident and an interpreter with the other. I would hang out mostly with the interpreter/resident pair as that would require a bit more supervision.

Busy day at FAME

Busy day at FAME

Karatu Ambulance Service

Karatu Ambulance Service

Busy day at FAME

Busy day at FAME

 

 

I will begin by telling you that Monday turned out to be a record setting day at FAME due to the numbers of patients and our Monday neurology clinic ended up being the greatest number of neurology patients we’ve seen in a day here – thirty-four. It is really a testament to the work by our outreach coordinator, William Mhapa, who is a real powerhouse. Every patient we saw was an appropriate neurology patient which is so important so as not to waste our time trying to triage during the day with so limited an amount of time to do everything. Payal was seeing all the pediatrics and Christyn was seeing all of the adults.

Christyn examining a patient

Christyn examining a patient

Payal evaluating a young girl with hemiplegia and epilepsy who I have followed for four years

Payal evaluating a young girl with hemiplegia and epilepsy who I have followed for four years

I will have to say that a great majority of the adult patients were headache patients, but otherwise we had a great diversity of diagnoses in both the adult and pediatric patients seen. We worked until rather late and I drove Sokoine, our interpreter, back to town since we had made him miss the vehicle heading down having worked so late. We also drove two bebes (older women) who were at the clinic late down to town. We had dinner on Joyce’s large veranda with everyone including two surgeons who are visiting for just the week deciding if they would like to commit to a longer term relationship. They would be a great asset to FAME as there are many surgical cases that come through but most of all wound care for all the burns they see here many of whom are children.

Christyn giving her stroke lecture

Christyn giving her stroke lecture

Tuesday mornings begin with the doctor’s education lecture at 7:30 and Christyn did an amazing job covering hemorrhagic and ischemic stroke using two case studies that were interactive. It was very well attended with all the doctors, visiting nurse practitioners, and clinical officers and there were lots of questions. We’ve given the lecture numerous times before, but since it’s something they don’t do on a regular basis it very hard to change how people practice. The same problem exists back home, though, and is not unique to East Africa. We are going to begin writing protocols for them to use here for management of neurologic problems like stroke and status epilepticus that should help greatly going forward.

Christyn evaluating a young Maasai women with epilepsy

Christyn evaluating a young Maasai women with epilepsy

Christyn and I saw a gentleman with a history of atrial fibrillation that came in with a complaint of headache. His headache had been present for several years, but a year ago he had had onset of focal neurologic symptoms including a complaint of some language difficulty and had gone to Arusha to have a CT scan at Aga Khan which they hadn’t brought with them. They told us that nothing was found on the CT scan which didn’t make sense so they went home (luckily they lived very close) and brought in the scan. Of course it wasn’t normal, but showed an acute left posterior MCA infarct as well as at least one other subcortical infarct. It was obvious that he needed to be on Coumadin to prevent any further events and that was taken care of.

Payal evaluating a young man with delay and previous surgery - no history available

Payal evaluating a young man with delay and previous surgery – no history available

At noon, Payal had gone to lunch at the Lilac Cafe (the little restaurant on campus) since lunch for the workers was Ugali and meat and Christyn had already gone up to the canteen. I was just walking up when one of the nurses brought a young boy over from the clinic who had just seized and was post-ictal. He was on a gurney and quite stable at the time so I put him in Payal’s room with his mom and went to grab a quick bite. Payal returned to find the boy in her exam room, but I got to her quickly to explain the situation and it turned out that he had been refusing his medications and it was unclear how much he had been getting. His mother was excellent and described how they were crushing the medication and putting it in his mouth while holding his nose so he would have to swallow, but it was still unclear if he was getting the full dose. We wheeled him into the hallway as Payal wanted him to stay until he was awake and functioning, but he later had another brief seizure that she was able to witness and she wanted him to come in at least overnight to observe him. Mom didn’t have the money needed to pay for the night in the hospital (20,000 TSh or less then $12) so we told her we would take care of the cost for the visit. I had been given some money by a generous friend to help with situations, but either way, we would have merely reached in our own pockets if necessary and that is how it happens here so often.

Patients are put on medications that cost a pittance in our minds, but are out of the question for them so they are stopped and their problem returns and that’s very often seizures. We now have a grant from LinkedIn to work on epilepsy here that will hopefully allow us to subsidize the cost of lifelong medications for these epilepsy patients and allow them to remain seizure free.We are also hoping to bring an EEG machine here in October to allow us to more accurately diagnose our patients rather than doing it by trial and error and seeing whether a medication works or makes them worse to know that it’s the right one. Danielle Becker will be working on that project and given the impact that uncontrolled epilepsy has on one’s life it should make a tremendous difference to overall health of the region here. Epilepsy is incredibly prevalent in Sub-Saharan Africa and the overall impact on disability and health is tremendous. Though this will be a huge undertaking it will clearly make a difference for the residents here on many levels. I am looking forward to watching that happen during my tenure here.

Since it was my birthday on Monday and though I had managed to keep it quiet, it somehow leaked out (thanks to Facebook with Kim and Susan) and we had a get together at the Lilac after work. A bunch of us had also made plans to go to Gibb’s Farm for dinner (having nothing to do with my birthday) so we headed up there after a quick visit at the Lilac. Gibb’s Farm is the true Shangi La and they offer a local’s rate of $25 for a four course dinner that would rival anything and is probably one of the finer dinners one can eat in Africa. The view from Gibb’s is also spectacular and we sit on the veranda there for at least an hour before dinner is served so it is a whole evening affair. Of course, Joyce wouldn’t allow me to pay for anything since it was my birthday the day before and it was such an enjoyable evening that I didn’t fight her on it (she reminded me to respect my elders!). We drove down the long road back from Gibb’s at 10PM and there were so many stars in the sky that is was absolutely crazy. The Milky Way rode over our heads in total brilliance. I was looking forward to a restful night in the cool air of the Ngorongoro Highlands with all the relaxing sounds of the wild here. I closed my eyes to the distant howl of a lonely hyena disturbing the local dogs and wondered what tomorrow would bring.

Lake Manyara National Park

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I’ve written several times before about Lake Manyara as it is always a regular on my safari circuit, but not only due to its close proximity to Karatu. True, it’s only thirty minutes down the rift and is a bit smaller than Tarangire and doesn’t have the reputation of Ngorongoro Crater, but it is a park that is very unique with much to offer. It is almost a hidden jewel as it is often overlooked and left off many a safari itinerary. Lake Manyara was formed millions of years ago with the Great Rift Valley and for that reason the geography is unlike any other park here.

We awakened early and packed our safari consisting mainly of our camera equipment and lunches, but somehow managed to forget the fantastic peanut butter and jelly sandwiches I made in the fridge – we were left with bananas and Cliff Bars for the journey but knew we’d survive. Arriving at the gate a bit before 7:30 we were the very first group to enter the park that morning. Amazingly we practically had the who park to ourselves for most of the day. It was probably two hours before we saw another vehicle.

Christyn and Payal - Safari photographers at large

Christyn and Payal – Safari photographers at large

We saw everything to see there during the day much to Christyn’s and Payal’s delight. It’s always so exciting for me to take friends on their very first safari here in Tanzania and to share the beauty and wildlife of the area with them. I had brought several camera bodies and lenses for them to use while here and with the very first baboon troop we ran across their shutters were furiously clicking away. There was no reason for me to tell them that we’d see dozens more baboon troops during the day and by the end they would be merely saying “look, more baboons.” We drove to the first hippo pool, but after the sun comes up most of the hippos are wallowing in the mud and water so their hard to see. Driving away from the pool, though, Christyn spotted a hippo right next to the road ambling along in the mud, sinking up to it’s knees with every step under its massive weight. We sat watching for several minutes as it mostly ignored us and then disappeared into the brush and reeds.

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We saw lots and lots of giraffes and a few elephants and had our meager lunch at Maji Moto (hot water) sitting under the trees at the mouth of one of the hot springs. Hearing the trickling water and the quiet sounds of Africa were amazingly relaxing and had it not been for the fact that we would have either been attacked by one of the nearby Cape buffalos or eaten alive by the bugs we would have all taken a nap in the tall grass leading out to the lake. Thankfully we all had our wits about us and chose to head back to civilization in the form of our Land Rover.

A baby dik dik

A baby dik dik

After lunch we headed further south along the road in search of a lion pride. I had seen a very nice pride last September and had them marked on my iPad’s GPS. As we turned off the main road towards the lakeshore and the prior pride sighting on my GPS we saw two vehicles off to the side near the hippo pools. One rule of safari driving is that if you don’t find it yourself (which is often the case) then you look for someone who did find it and head in their direction. As we drove up alongside one of the vehicles and were looking over at the hippos, one of the guests in the vehicle asked us if we had seen the lion pride. When someone asks you this it is usually attached to a long dissertation on how to get to wherever the sighting was and then only to find out that whatever you might be looking for has moved on. This was not the case as he merely pointed in the opposite direction of the hippos towards some trees and there under a tree were ten plus lions led by two very healthy males.

Our pride of lions in Manyara

Our pride of lions in Manyara

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The lions were all sleeping as they do most of the day, but almost immediately several of the lions got up and started to walk away or move around. The other vehicles which had driven away towards the hippos quickly reversed course and came back in our direction. We drove a tad bit closer to the lions on the trail of the other vehicles and then sat and watched them for a good bit of time. They are just so very majestic and grand. Payal and Christyn really wanted to see the lions so it was great to have found them.

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We spent the rest of the time in the park looking for more elephants after a return visit to the lions and the hippos. We ended up spending almost eight hours driving in the park which is a good amount of time.

Having essentially skipped lunch (Cliff Bars and bananas just don’t cut it for hungry explorers I’ve found) we were definitely willing to accept Kelley’s suggestion of pizza for dinner at a small club down the road. Payal wanted to call it a night so ate one of our forgotten PB&Js while Christyn and I (the more food oriented members of this party) decided to go for the pizza. You might wonder whether it’s really possible to get good pizza in East Africa or not. Leaving all suspense aside I will answer the question for you in advance. It is not possible. We sat down outside and the weather was gorgeous so we definitely had that going for us. The beer was fairly cold (another plus), but unfortunately they weren’t making pizza that night. Not a problem as they had other things on their menu that sounded very appetizing. Problem was that none of them were available either – not any of the pastas and not the local version of beef barbecue. I ordered pepper steak, Christyn the fish and Kelley (who was now with us) the chicken. The waitress came back ten or fifteen minutes later to tell me that there was no pepper steak so I went with the fish. An hour and a half later, she came out with our food. The fist was a whole local fish deep fried and served with fries. Kelley’s chicken was too touch and gamey for her to even bite into.

We arrived home so late and tired from the safari and our dinner experience that I fell asleep trying to type my blog while Christyn hiked up to use the internet at the clinic. We have our first day at FAME tomorrow for our dedicated neurology clinic and are all very much looking forward to it.