Kambi ya Simba – Day 1

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Monday morning was the beginning of a four day stretch of mobile clinics. For those of you who have not read my previous emails or blogs, the mobile clinics we do are in the villages of the Karatu district in a region called Mbulumbulu. FAME had been doing a large funded mobile clinic every month to the Lake Eyasi region of Tanzania which was a five day long adventure and living in a very primitive conditions while providing general health care to areas that had none. I had gone on three of these clinics during my time at FAME and realized that we could do a smaller scale specialty clinic to villages not too far away so that we could return home each night. We started the neurology “mini mobile clinic” in April 2011 and have been doing them every six months since then. The larger mobile clinic ended when its three year grant was over sometime in late 2012 or early 2013. We have traveling to two villages in the Mbulumbulu regions, Kambi ya Simba and more distant, Upper Kitete. This region is out along the rift in an area that is not traveled to by any tourists and very few Westerners.

It takes about an hour to get to Kambi ya Simba so it is necessary to get a reasonably early start. Sometimes that is easier said than done, though, as there are many parts of this operation that are often difficult to sync. It’s also important that we have all our supplies packed as it is not possible to drive back during the clinic or have someone else come bring something that was forgotten. We finally rounded up all the troops and I think we were probably on the road out of the FAME compound around 10 a.m. Very little here is as simple as it seems, though, and after hitting town we had to first stop at the Mushroom Cafe to get our lunch that consisted of beef samosas, kitumbowa (spelled phonetically here but are little sweet, greasy rice cakes), and chapati with peanut butter and banana for Payal as she’s a vegetarian. Then we stopped at another shop for all our drinks and water for the day. I think we ended up making one or two other stops and were finally heading out of town after a little over 30 minutes.

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The road to Kambi ya Simba is incredibly bumpy and equally as dusty. This was supposed to be the rainy season, but as I explained earlier in the blog, the monsoon rains have yet to come. The land here is amazingly fertile and green everywhere. The soil is a rich volcanic mixture and most of the land is well utilized for farms. The requisite cattle and goats are being herded along the roads often by children who seem like they only recently began to walk. We arrived at Kambi ya Simba around 11:30 or so and began seeing patients shortly thereafter. The “crew” consists or William, our outreach coordinator, Dr. Anne, our clinical officer, Sokoine, our interpreter (along with Anne), Patricia, our nurse and pharmacist, and Ema, our driver and fundi (expert) in case anything goes wrong along the way. And then there are the three neurologists.

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Our mobile clinics, as well as our neurology clinics at FAME, are funded, meaning that we charge a very small flat fee that includes the neurology consultation, any labs and any medications prescribed. The charge is 5000 TSh (Tanzania shillings) and the equivalent of less than $3 USD. If someone can’t afford to be seen we reach in our pockets and pay for their visit or it is covered by a general patient fund that the volunteers here are constantly adding to. We keep track of any patients who are seen by the neuro team and the full cost of their care including testing and medication so that we are aware of how much the neuro program is costing. There is little question as to the impact we’ve had here over the last several years with treatment of epilepsy and stroke as well as assessing young cerebral palsy patients who require rehabilitation, but can’t go without a doctor’s referral.

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Our clinic at Kambi ya Simba is in a government health center which is a step above a dispensary. They have a clinical officer there and both a labor and delivery ward as well as a postpartum ward. Unfortunately neither of the wards have been used at least in the six months since we were last there, most likely due to a lack of supplies and staffing. Simply providing a building doesn’t insure that it will be used. In any event, we’ve held our clinics in the wards which are quite roomy, though devoid of chairs or desks and only have beds. We had to drag a desk from across in the nurses office along with some chairs. Despite these hardships, it has been a comfortable place to evaluate patients.

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There wasn’t much in the way of pediatrics for Payal that day and we only saw around 15 patients total. Clinic didn’t start until probably close to noon so we didn’t get out until after 4 p.m. which meant we arrived home after the clinic was closed.

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Christyn and Payal had decided to run and Leonard, my good friend, was up at Gibb’s Farm with a safari group so we were heading there later to say hi. He also hadn’t met Christyn and Payal yet and since they had met the rest of his family and we had stayed at his home I thought it only proper that they meet him as well. Before we left, though, Payal was asked to see a young leukemia patient on the ward who was complaining of a headache. When she was finished we were on our way to visit. We sat up at Gibb’s under an incredible sky full of stars until almost 9 p.m. and then said our goodbyes.

Lake Ndutu – final day

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WARNING – SOME GRAPHIC PHOTOS FOLLOW AND MAY NOT BE SUITABLE FOR FOR ALL READERS

We had decided to start our drive very early on our last day and leave just before sunrise. We would be eating breakfast out on the drive rather than in camp and planned to come back after noon for a hot lunch before our departure home. Everyone met at the mess tent at 6 a.m. in preparation for a 6:15 a.m. departure. There was definitely a chill in the air and it had rained slightly overnight which kept the dust down just a bit to be manageable. It was a gorgeous sunrise and the sky remained all pastels it seemed forever.

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We almost drove by our first sighting, but they were four bat-eared foxes sitting just outside of their den and alongside the road. They are nocturnal animals and the only time to really catch them is either right before sunrise or immediately after. They are extremely shy animals and incredibly cute.

imageWe drove back to the Big Marsh to look for the lion pride and ran across four females all lying together and just waking up from their naps. They didn’t look like they had eaten anything over night so we decided to watch them for a while to see what they were up to. Shortly thereafter, the four got up and looked as though they were on the prowl for something. As they traveled up and over a nearby ridge we followed them into another marshy area where they again decided to take a break and lounge a bit. We watched them from afar while several other vehicles came into the area to watch “our” lions as well. A lonely jackal was following them which is a good sign as they often scavenge off of lion kills.

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At one point we thought one of the baby cheetahs from the other night was near the jackal only to realize that it was an african wild cat. One of the other safari vehicles took off after the cat, but Isaac had spotted an adult cheetah up on the ridge and we decided to take a look. Though cheetahs are usually unfazed by vehicles, this one was on the move and most likely due to the presence of the lions as they are mortal enemies and the lions would jump at the opportunity to kill the cheetah without a thought. We followed her for a bit and then went back to the lions who were still just lying around. We decided to travel a ways onto one of the ridges in between the marshy areas so we could eat our breakfast that had been packed for us. It was so amazing sitting out of the vehicle (in a very safe area that Isaac made sure of) and drinking our coffee and chai with our breakfast. It was definitely a highlight. Hannah decided to climb one of the trees nearby even though she hadn’t done it since she was a child and luckily didn’t manage to hurt herself, though if she had there would have been plenty of help given all the nurses and doctors on site.

A wild land tree climbing creature

A wild land tree climbing creature

After our breakfast and checking the lions once more we decided to take a long drive to some distant areas from the marsh. We did run across another cheetah relaxing in the shade, but little else animal-wise. Cheetahs are always on the lookout, both from a standpoint of looking for prey as well as protection. They are very vulnerable to attacks by lions or leopards and so are always seen with their heads up and looking around as opposed to the lions who sleep without a worry on their minds as they are prey to no one.

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We eventually made it back to our four lionesses who were still relaxing in the shade, but seemed to be positioned expertly to keep an eye on the water hole below. A group of zebra were milling around up above and since it was getting to be around noon we thought there might be a chance they were thirsty and would come down regardless. We sat on the ridge watching the lions and it seemed the zebra had decided to avoid the watering hole. After almost two hours of watching little if any movement by the lions or the zebra we decided to wait another 15 minutes and if nothing happened by then we were going to head back to camp for lunch and call it a day.

We had now been watching these same four lions for the last several hours, or since 6:30 a.m. to be exact. It was one of those situations where none of us wanted to give up on the chance of seeing these lions hunting, but we also had a time limit as we had to be driving through the gate at Ngorongoro by 6:30 p.m. otherwise they lock the gate and we’d have to spend the night on the crater rim – not a good idea at all as we all had to be at work the following morning and there would be no place to stay on the rim.

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We were sitting on top of a rim overlooking the watering hole down below with four sleeping lions spread out at various locations and it was not looking as though there was going to be any action. We had given it our 15 more minutes and just about when we were going to give up we saw the zebra in the distance coming down to the watering hole totally unaware of the lions. As the zebra slowly worked their way down to the water it became readily apparent that the lions were strategically positioned so that they could cut off any escape by the zebra. The only problem was that only one of the lions was aware of the zebra and the other three were still dozing. The zebra moved into position and the lion waited for them to begin drinking before she made a move. It was a small group of perhaps eight adults and a baby. It was clear that she was getting ready to pounce and the zebra, though always wary and skittish, were oblivious to impending attack.

 

It seemed like forever, but then it happened. The one lion sprung up from her hiding place and shot down the hillside straight at the zebra who quickly realized what was happening. The zebra began to scatter and it was several moments before the other lions realized the attack was on, but once they did they were immediately involved. The zebra were running up the hillside in between the lions and it looked as though they might catch one of the adults when we suddenly realized that the lone baby was lagging behind the adults and stumbling as it tried to get up the hill. It happened so suddenly, but the baby was in the grasp of one of the lions who had it by the throat and the other three were there in a flash. Within a moment, the baby was dead and the four lions were devouring it with lots of growling and fighting.

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We were the only ones to have witnessed this event and we had watched these lions for almost six hours. We sat, perhaps only twenty feet from this scene as the lions finished off the baby zebra with lots of commotion and disagreement, as two other vehicles eventually came by to share. It was sad that the baby was the one to have been killed, but we were comforted in the knowledge that regardless of our presence, the baby would have been lost either way. All the other zebra sat up above us and were crying for the baby РI had seen this in the Serengeti last September after we arrived just following another baby zebra kill. It sounds so clich̩, but it truly is the circle of life and you quickly realize that this is nature in all its beauty and all its tragedy. Witnessing a lion kill is not a common event on safari and many people have come for several years without seeing one. I had also witnessed a cheetah kill in 2012 and these events are by far the most powerful thing one can can participate in here in Africa. They are intense and emotion filled and something that will never be forgotten by anyone who has witnessed them.

We watched the lions for some time afterwards as they finished off their prey and eventually drove back to camp for lunch. It was such an amazing morning for so many reasons and I think we were all still processing what we had witnessed. Lunch was delicious, of course, and we packed up and piled into our vehicle for the long drive home, back up over the crater rim and down into Karatu. We made it to the gate at 6 p.m. with only half an hour to spare. It would have been a cold and lonely night had we not made it. We were all exhausted and spent the evening relaxing. I didn’t eat dinner and got up starving the next morning. Our last day at Ndutu was a monumental one.

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.