March 26, 2017 – An Adventure, Part 2….

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CAUTION – PLEASE READ THE PRIOR POST (PART 1) FIRST!!

We were now free of the deep mud by the marsh and as we drove along it was clear that the trails were not improving. Yusef decided to drive up out of the marsh area to what he hoped might be firmer and drier ground which was an excellent plan, but, unfortunately, the high ground had also been completely inundated with all the rain so there was little safety there. We had to keep up our momentum at all times which meant that it was pretty much of a slip and slide with the vehicle continually fish-tailing from side to side and mud flinging in all directions including the vehicle as we now had the top back up as the rains had stopped. In the distance, we could see a grouping of four or five vehicles near a tree and as we approached, still maintaining our speed so as not to get mired down again, one of the other guides motioned for us to slow down, which wasn’t really possible as we would become hopelessly stuck again if we did so.

Mother and child cheetah scoping out the horizon

As we passed them, we first saw what they were looking at which was the cheetah with four babies that we had seen the day before. The second thing we saw was the horribly wet area just beyond where they were and which was directly in our path with no hope whatsoever of avoiding it. The vehicle slowed and in the short moment it took for us to realize what was happening, our momentum had slowed and we were again stuck in the mud. Considering that there was no immediate rush to do anything, we watched the cheetahs for a bit as the mother seemed to be interested in hunting as there was a Thompson gazelle fairly close that might be good prey for her. She had her babies wait for her in a group, but they eventually began to follow her, apparently not wanting to miss out on anything. The gazelle eventually moved on and so the mother cheetah and her babies began marching off towards a heard of wildebeest in the distance.

Vehicles stuck at the cheetah tree

All four wheels dug in deep

This was our signal to get out of our vehicle and assess the situation that we were in which was not very good. We also realized that at least two of the other vehicles that had stopped to look at the cheetahs were also stuck in the mud. As we were outside walking around, the driver who had helped us get out previously came driving up and managed to avoid the softer ground so as not to also get stuck. He had his four wheel drive working and, although that was helpful, it didn’t prevent one from getting stuck in this mess as several of the other stuck vehicles were also operational 4×4’s. We were very much dug in and this time it was going to be a bigger chore to get us out. We tried digging and pushing, digging and pushing, but to no avail. He finally got out his recovery tracks, which are three-foot long steel plates with holes for traction that you can put in front or behind your tires to gain traction.

Everyone working to free the vehicle

Unsuccessfully trying to push it out

Using the recovery tracks and the pull strap, we were eventually able to move the vehicle a few feet before getting stuck again and we did this again and again until we finally had it out onto firmer, though still quite slippery, ground. All the while, other vehicles kept coming upon us and thankfully weren’t getting stuck as the ground was slowing drying some, one advantage of being stuck here for so long. We now focused our attention on helping some of the other vehicles out of the muck. One of them had all four tires dug in and it was going to be a real chore to get it out. It had a winch on the front that wasn’t strong enough to pull the dead weight of the vehicle, so it was eventually up to using our tow strap and situating another vehicle in front to pull. This still wasn’t enough to do the trick and despite Chris and I trying to convince the drivers that it was necessary to jack up all the tires and get plates under them (we now had two others from another vehicle that had stopped) so we wouldn’t be trying to lift the vehicle in addition to pulling it, they continued to make failed attempts at getting it out.

Further discussion

During all of this, everyone was out of their vehicles and I met a nice young man from Santiago Chile who was here on his honeymoon with his new wife. They weren’t one of the stuck vehicles, thankfully, but were instead helping out as their vehicle was doing the pulling. We were eventually successful in our urging them to raise each tire and after many, many tries over several hours, we had the vehicle out and, now, the only thing left was for us to somehow get back to camp without getting stuck again. Our plan had been to get back for breakfast around 8:30, though now it was after noontime. All of the vehicles stuck together riding back in the direction of the camps which are near the marshes so that if someone got stuck again we’d have help. The going was still quite difficult, though it was an exciting ride as the vehicle had to keep its speed while constantly fish-tailing back and forth. We had finally made it down to the marshes where we were heading in a different direction than the other vehicles which meant that we now had to go it alone.

The final push (and pull) to successfully get it out

A herd of wildebeest crossing the newly formed river

We crossed several smaller areas of water and then had to tackle a slightly longer stretch and as we felt our momentum slow to a stop in the middle of the stream, our hearts sunk as it seemed we were stuck again, this time in the middle of a deep stream with rushing water. Getting out here to push would have been a big mess and very likely unsuccessful. Yusef expertly rocked the car backwards and forwards in a number of successions and after over a half a dozen tries and several minutes was able to free us from the clutches of mother nature and we were again on our way. At one point, Yusef had gotten disoriented as to the direction of camp, a very uncommon occurrence for him, and, thankfully, I had my iPad with my navigation application that allowed me to locate us, our camp, and the correct direction that we needed to travel.

Two Maasai giraffe

We had several more crossings before reaching camp that were much less eventful, though still quite exiting, and we arrived at around 1pm. We were exhausted after our ordeal and I’m sure that Yusef was worse off than the rest of us. They had prepared breakfast for us which was still available and so we all washed up before enjoying a much deserved meal of eggs, crepes, bacon, sausage, juice, and toast. They had made lunch boxes for us that we would bring back and eat later.

A nursing baby wildebeest

A Maasai giraffe

By the time we left camp it was well after 2pm and I don’t think Yusef was very interested in tackling any more of these roads considering we still had a long way to get home which entailed driving over a number of miles of open plains before reaching the Serengeti Road that we’d take back to the Ngorongoro Gate. We packed up all of our stuff and decided to head out slowly, doing some game viewing as we did, rather than exposing ourselves to the potential for another long extrication that would easily put us past the closing of the gate at 6pm in which case we wouldn’t be able to make it out of the Conservation Area and would have to spend the night here.

A selfie on the road

Nan enjoying the scenery

It was an amazingly beautiful day as we traversed the Serengeti plains with scattered wildebeest, antelope, zebra, ostriches, and eland as we traveling. We eventually made it to the main road and headed back in the direction of Ngorongoro Crater. The sky was ominous in front of us with huge rain storms, lightening and even some rainbows. Given the distances we were traveling, the rainstorms miraculously passed in front of us before our arrival and we encountered their wrath in the form of some flooding along the road, but nothing that wasn’t manageable. It became clear to me, though, that we were going to be very, very tight on time and Nan guessed this in the seriousness of my face when she asked me how we doing on time and I told her it was a 50-50 proposition. Since we had patients the following day at FAME, we couldn’t really afford to spend the night on the crater rim, either financially or timewise.

Chris and Mike enjoying the scenery

Yusef continued to drive at a very fast pace and we arrived at the gate at 5:55 pm, with just 5 minutes to spare. Given that we had driven hours and miles that day, it was a real feat. We sat in the car as Yusef went into the office to check out. We were all breathing a huge sigh of relief and congratulating ourselves on having survived such an epic day, when suddenly, Jamie let out a scream. Her windows was rolled down only about six inches or so, but somehow a huge baboon had jumped deftly through the opening, bouncing off the front seat and ending up in the driver’s seat next to our lunch boxes which was obviously his plan and previously calculated.

Needless to say, being in the cramped confines of a car with a wild baboon, whose canines are quite intimidating, can be just a bit anxiety provoking and it had just the effect you would imagine. I grabbed a Coke Zero bottle by the end and jumped forward swinging it towards the baboon in a perhaps lame attempt to protect my residents and had Chris quickly open his door so the beast would have an easy exit. With a sandwich in his mouth and a chicken wing in his hand, he quickly turned and, just as deftly as he had entered, he exited back through the small opening in Jamie’s window and was gone. The last we saw of him he was eating the chicken wing sitting on the small wall in front of us and Chris snapped a photo for documentation purposes. After a short while and after a chance to have settled down, we were able to get out of the car to see what was going on outside.

The dastardly baboon with the chicken leg

Yusef had been gone for some time and when I walked up to where he was, he told me that we had underpaid for our stay at Ndutu, which I was sure we hadn’t and went through our receipts again to show that everything had been paid for properly. We had indeed taken care of everything, except in the earlier turmoil of the day, Yusef had forgotten to check out at the Ndutu ranger station, an apparently necessary step when camping there. Therefore, they had already entered in the computer there that we had overstayed and we would have to pay another night’s camping fee. I told the supervisor that it was obvious we hadn’t overstayed as I was standing right in front of him and, also, that I was not willing to pay the additional fee ($286!) regardless. This went back and forth several times and when I told him of the ordeals of the day we had had, he was a bit more sympathetic and said that if we had photos of our car stuck in mud, then he would consider waiving the fee. Thankfully, we had plenty, and he was willing to make an exception as long as we would send him the photos at that moment so he would have the supportive documentation to justify it. Jamie sent him two of her photos and we were eventually on our way back to Karatu after a very, very long day.

I’ve been to Ndutu in the months of March and April, but have never seen it that wet before, though I’m sure it wasn’t that unusual of an occupancy. Perhaps we were just lucky. Coming around the crater before the gate, we saw our third rainbow of the day and though it was felt that that was perhaps too many, I think it was just the right amount as they allowed us to survive each and every ordeal, including the baboon, and make it home safely. We ate dinner that night at home and were all amazed at the adventures we had this weekend. We had seen quite a number of animals and had lots of stories to tell back home to our friends when we returned. These are the experiences we will remember forever and have to tell our children and grandchildren.

March 26, 2017 – An adventure we’ll not forget, Part 1…

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The rain fell solidly throughout the night in a steady chorus against the fabric of our tent, though seemed to let up slightly in the morning. I remember lying in my incredibly comfortable bed beneath the soft sheets and warm comforter wondering about what the day would hold for us. Certainly, if it had been still pouring, it would be very unlikely that we’d head out into the bush as early as planned, but since there was a reasonable break in the weather, I got out of bed before 5:30am along with Chris and we decided to head over to the mess tent for our morning coffee before loading into our vehicle. IT was still pitch black outside and we clicked our outside light off and on several time to call for an escort. When no one came, I began to whistle hoping that someone would hear us, but to no avail. Finally, with flashlight in hand and swinging it from side to side like Leonard had taught me, we made our way to coffee praying that we weren’t being watched by a hungry lion or hyena. All morning before getting out of bed we could hear the soft roar of two lions just outside of camp as they were heading somewhere near the lake. Thankfully, it was not our morning to serve as lion fodder and we promptly sent an escort for the girls.

A bat-eared fox in the rain

I vaguely recall the camp manager’s comment when I mentioned the nightlong rain and we should have taken more heed at the time. He said “too much rain” as nonchalantly as one can, but was clearly prescient in his wisdom. We piled into the Land Cruiser in the dark and popped the top so as to stand in the cool early morning air as Yusef navigated along the paths we had driven in on yesterday afternoon. It was immediately clear that the rain we had received through the night had swollen the previously shallow waterways so that they were all now swollen to several times their previous size. Paths we had previously taken were now underwater and even if you could find something familiar, it would very quickly lead into one of the bursting waterways.

One of our several rainbows of the day, this one with a giraffe at the end

We forded several deeper bodies of water and eventually made it back to the small Marsh which is always a good spot to find lions. Jamie immediately noticed the tracks in the mud that Yusef identified as hyena and they were noticeably fresh leaving no doubt that the beasts were very close by and likely directly in front of us. As we came around the corner of the marsh, we immediately spotted the same lioness we had watched yesterday and she was dragging a freshly killed wildebeest up towards the brush. Even more exciting, though, was the fact that there were three hyenas following her very closely and it was quite clear that their intention was not to settle for seconds. As we drove closer we could see the recent kill clearly whose abdomen had been opened completely with all its viscera exposed. The hyenas backed off as we entered the scene and maintained their distance for some time, though eventually skittering into the distance beyond our sight having chosen to make their battle another time. I’m sure the lioness was thankful for our intervention as it saved her from what would have been a formidable battle as she would have had at least three hungry hyenas to take on and possibly more had reinforcements showed likely shown up with the sounds of the fight.

We watched her eating for a fair amount of time until she became either full or tired and dragged the carcass further up the hill into a thicket of brush where it was partially hidden and she could lie down somewhat protected from the rain that had now begun to fall again. Two other vehicles had pulled up to watch the lioness and they had come and gone while we remained to watch. We were now heading in the direction of the big marsh to look for other lions or whatever we could find. The amount of rain that had fallen overnight had completely filled the basins that we had easily driven through yesterday and the water was actually flowing in the direction of the Lake so that what were previously very drivable trails traversing the dry river beds and wetlands were now flowing rivers. We crossed several smaller tributaries flowing into the river, but now had to get to the other side to continue on which would mean a full on fording of the waterway. One of the other vehicles that had been with us at the lion kill drove down to the river side with us where there were tire tracks entering and in the distance, one could see tire tracks exiting the flowing mass of water. It was a long way across, but we knew at least that there had previously been a road underneath somewhere and it most likely connected between these two points of entry that we could see.

Not a good sign

We began the crossing with water splashing in all directions, up over our hood and to the sides in all directions. The Land Cruiser did what it was supposed to do, thankfully, and we drove across the river with waves departing from each side of the vehicle in an amazing demonstration of the utility of these vehicles. The other vehicle followed behind us and we both drove off with the satisfaction of having conquered at least one major obstacle this morning. We were now on the other side of the river and driving off in the direction of the big marsh. The roads remained passable, but were becoming more and more treacherous and, finally, at one point while we were in a particularly wet area, the vehicle began to spin from side to side leaving us eventually perpendicular to the road and pointing uphill with our rear wheels completely dug into the mud, spinning with no traction whatsoever. It was then that we discovered that our four wheel drive wasn’t operational as the transfer case, which is a push button activation with automatic locking hubs on this vehicle, wouldn’t engage. Not a good situation in these conditions.

Trying to jack up the vehicle

Stuck in the muck

We were helplessly stuck at the side of the marsh with the vehicle pointing uphill, the rear tires buried, and pure muck behind us. I recalled that this was nearly the exact location where we had seen one of the lionesses yesterday so this was certainly not a good place to try and walk out of on foot. Once again, it ran through my mind, just how I would explain this to the program directors at home that one or more of their residents had been eaten by a lion while on safari. It would surely put a damper on the future of the program. We would have to get to work to get ourselves out of this predicament and thankfully, I had brought my rubber boots which I changed into rather quickly and got out of the vehicle to assess the situation along with Yusef. It didn’t look very good, but we got to work pulling out our Hi-Jack, a very tall jack stand that allows you to lift your tires completely out of holes if needed. Unfortunately, we had no rocks to pile under the rear tires, a strategy that often works to improve your traction, so instead tried to pile downed tree limbs under, but it was all to no avail as the tires wouldn’t grip and there was no way we were capable of pushing the vehicle out.

Attaching the tow strap

Nan enjoying the scenery

As we sat pondering our dire situation, another safari vehicle showed up on the scene and stopped to help extricate us. After numerous additional tries of jacking up the vehicle, it was eventually decided to try pulling us out which would be a real task considering the orientation we were in and the fact that ground in front of us was also a bit on the slippery side giving less than optimal traction for the other vehicle. We initially unsuccessfully with a chain they had from their vehicle until we realized that we had the tow strap which I had given to Leonard over a year ago in ours. The two strap was longer than the chain and had the benefit of some elasticity to provide additional pull on the vehicle. After several tries, our vehicle was eventually freed to the cheers of all of us and it now sat on somewhat more firm ground for us to continue, that is at least for the moment.

Free at last!

Walking back from the scene of the crime

March 25, 2017 – Off to the Southern Serengeti to see the Great Migration…

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March is the beginning of the low season for safaris as the longer rains are beginning to fall and with things more lush and green, the animals tend not to congregate as much near the water sources for easy viewing. This is true everywhere in Northern Tanzania, that is, except for the Southern Serengeti and Lake Ndutu, where one of the most amazing spectacles in nature occurs every year at this time. March and April are the high season for Lake Ndutu which is where you can find the largest concentrations of migrating wildebeest and zebra at any one time. Sure, the crossing of the Mara River into Kenya in the Northern Serengeti is pretty darn spectacular in August and September, but for different reasons and, in particular, watching the waiting Nile crocodiles pick off unsuspecting animals as they’re trying to reach the other shore. For shear numbers, though, seeing them in the south can’t be beat and this morning we’re heading down to one of the migration camps on the shore of Lake Ndutu where we’ll spend the night “glamping,” which is the new term for glamorous camping made famous at some music festivals on the east coast.

A Tawny Eagle

A vulture protecting its meal

We have plans for Yusef to arrive at our house at 5:45am for a departure of 6am that will put us at the Ngorongoro Gate at 6:30, right when they open. We have a several hour drive down to Ndutu and would like to get as much game viewing in as possible today before heading to camp later for dinner. We had packed our lunches along with a sandwich for Yusef, plenty of Coke Zero, cut up pineapple, a can of Jalapeño Pringles and some candy bars. Had we found ourselves lost in the Serengeti somewhere, we wouldn’t starve for at least three days with the supply of food we had.

A silverback jackal

Two strutting Marabou storks

Traveling around the rim of the crater once again was nothing less than spectacular as we first entered the clouds, but after a short while, the sun broke through and you could see down to the crater floor with it’s unique topography that is unequaled anywhere else on earth. We finally pass by the descent road as we leave the rim and begin dropping in elevation traveling by boma after boma in this very fertile and reasonably populace area. The views are just amazing and we are eventually down on what would be the Eastern Serengeti, passing by Oldupai Gorge, famous for the Leaky’s discover of oldest man here in the 1950’s, Oldupai George, otherwise known as Zinjanthropus. I am using the correct spelling of Oldupai, by the way, rather than the incorrect spelling of Olduvai that has been used every since the gorge was discovered back in the early part of the century before the Leaky’s. Oldupai, which is the Maasai word for a wild sisal plant that grows here, was what the gorge was originally named for. Oldupai is mecca or ground zero for anyone who has studied physical anthropology or the history of man. Interestingly, the river that runs through the gorge here dumps into Lake Masek and Lake Ndutu, our destination for today’s journey.

A migrating wildebeest

Homely, but graceful

The road we’re traveling is full of washboards and dust as we traverse the Serengeti plains here and make our way to the northwest until we reach a small turnoff that will take us southwest in the direction of Ndutu. All across the Eastern Serengeti there are herds of wildebeest and zebra spread out grazing as the rains have been generous in the recent weeks and there is plenty of grass to be had. After the turnoff we are essentially following tire tracks that make up the roads here through the open plains until we reach a region of taller shrubs and low trees through which we pick our route that presents the least amount of bumps to slow us down. We’re finally to the shores of Lake Ndutu where the going is mostly flat except for the occasional stream bed that empties into the lake and causes us to slow down briefly. There are flamingos on the lake that we stop to photograph as they squawk and mingle amongst themselves with some unknown agenda.

A small herd of wildebeest at a watering hole

An eagle in flight

We begin our game viewing by driving to the small marsh where we have seen so many things in the past including lion, cheetah and leopard, and in very short order we locate a sole lioness that looks a bit on the thin side and is making her way towards a large herd of wildebeest who clearly haven’t yet noticed her presence. She eventually moves into the tall grass that is situated on this end of the marsh where she begins to slowly move in the direction of the unexpecting herd. We situate ourselves up high above for a good vantage point to view any action and then break out our lunch while we sit and wait for her to make a move. We can see her head popping up occasionally in the tall grass along with a few hyenas who are obviously also hoping to benefit from a kill. Unfortunately, this wasn’t the time and as the wildebeest slowly move away, the lioness never makes a move and her opportunity vanishes as does ours and we eventually move on looking on for new sights.

Lioness in the high grass

On towards the big marsh, which is at the other end of the water way we’re following, where we find another lone lioness, this one resting atop a slope overlooking a watering hole, not far from where we witnessed four lionesses ambush a zebra herd seeking water two years ago. A young zebra was their victim then, but today, this lioness is not hunting which is probably a lucky thing considered there are two safari groups outside of their cars having lunch not far away.

Wildebeest looking for shade from the midday sun

We left the big marsh and headed out onto the plains in search of more cats considering the monstrous herds of wildebeest moving to and fro in long lines and occupying the horizon in every direction. Thousands upon thousands of them, many of the females with new calves that are typically born in Kenya and are older by now, but given the recent drought, many of the mothers have delayed their deliveries until the rains fell recently. The younger Wildebeest are much more attractive than their parents who have to be one of the homeliest looking animals I have every seen. I have called them “ugly” before, but have received grief from the others so have had to reconsider my critical assessment and finally settling on homely to be a bit more considerate.

Sisters

A more attentive lioness

In fairly short order, we were able to spot two groups of lions, one consisting of two lionesses and the other of two lionesses and one male lion, the latter who had a very coiffed ‘do with what appeared to be bangs. He was clearly no slouch, though, as he had his two women with him and I’m sure would have taken no slack from any of us had we decided to challenge him. After driving around for some time and marveling at the massive herds of “beesties,” we dropped back into the marshes where we were intercepted by two rangers who we had bumped into earlier when they were checking our permits and they now wanted to let us know about a cheetah that had been sighted not too far away. We sped over to the area where the cheetah was supposed to be and, although it took us awhile, we finally spotted it resting under a tree and not bothered at all by our presence. We watched for a bit as none of the others had ever seen a cheetah before and we were all by ourselves.

Our finely coiffed male lion

A very leary lioness

We eventually moved on to another wide open area where we spotted a cheetah in the distance under a tree which is usually how you find them resting in the daytime. Amazingly, as we got closer driving up we could see smaller cubs sleeping with their mother. They were the cutest little things, though much larger than some cubs I had seen here five years ago (that mom had five!) that still had their velvety coats of downy fur along their backs. They were all sleeping initially, but awakened intermittently to move around under the tree and interact in various states of consciousness, rolling over here and there, climbing on mom and grooming each other. We watched for sometime as they were all so adorable, but eventually moved on among the continuing herds of wildebeest while the sky began to darken with sheets of rain beginning to fall a short distance from us and moving in our direction. We were eventually caught by the grasp of the rain and were able to drop our roof in very short order so we wouldn’t be soaked, nor would our gear, as enough of the rain would have come in the vehicle to have taken care of each of those.

Our solitary cheetah

A simply gorgeous creature

It was only about 4pm and much earlier than we had planned to go in for the evening, but the rain was making it difficult to see much along the way so our game driving was done for the day. The drive to Mbugani Camp was uneventful and we pulled up in a pouring rain. I had stayed at this camp last year and it has a wonderful overlook of Lake Ndutu. The tents have running water, hot water with some advance notice, a shower, toilet and perhaps the most comfortable beds considering you’re in the middle of the Serengeti. We first sat inside the community tent with tables and couches while we waited to get our introduction to the camp and walked to our own tents. We were the only group in camp that night so we had the run of the place. The girls stayed in tent number one, while Chris and I were staying in tent number four, a few tents further away from the safety of the mess and community tents. Chris and I were definitely up for showers after the long day, so after a few minutes we got the go ahead from the staff that they were ready. Unfortunately, they were really “lukecool” showers, a new term we coined for a temperature that had little or no warmth, but less shocking than a straight on frigid shower that we’ve had on occasion here.

A young cheetah

We went back over the community tent after cleaning up as they did have WiFi there for us to check our emails and relax a bit. Jamie was napping, but Nan was there and, as the rain had stopped, she was walking around outside to check out our surroundings. I was typing away on my iPad when she said that she’d be back in bit, which just a funny ring to me and when I asked her where she was going, she calmly told me that she was going to walk down to the lake, perhaps a quarter-mile walk. Let me remind you that we’re sitting in the middle of the conservation area where we had just been watching lions stalking prey and hyenas stalking the lions. I quickly replied to her that she couldn’t walk to the lake for these quite salient reasons and the camp manager, who was also sitting in the tent at the time, suddenly took notice of our conversation as well. The beauty of this place often makes it easy to forget where we are at times and that around every corner lurks another part of the “real world” where we are no longer the top of the food chain.

Another young cheetah

Luckily, the rain had stopped for a long enough time for some of the firewood to dry so they were eventually able to get the fire pit going so we could watch the “bush TV” and relax a bit with the sun going down. Dinner wasn’t until 7:30, so we had plenty of time to enjoy the view and the wildlife between us and the lake, which at one point included a small herd of Coke’s hartebeest running, or really prancing, in front of us with their eyes reflecting in our torches, bouncing up and down, to and fro. They were apparently quite happy with the recent rain and were celebrating, or so we were told. When dinner was served, it was delicious butternut squash soup and then a buffet of amazing lamb, roasted vegetables and roasted potatoes. Jamie, being a vegetarian was served a stuffed roasted tomato that she said was quite delicious as well. I was quite happy with the lamb!

Mama cheetah with her four babies

A grooming session with mom and baby

We all relaxed a bit after dinner and then walked to our tents, with escorts, of course, considering the fact again of where we were and the constant danger of animals coming into camp during the night. There was a cool breeze after the earlier rains so a chill was in the air, but it was delightful, and sliding in under our thick comforters after a long day never felt better. We were planning for a pre-dawn start to our morning drive and were meeting in the mess tent at 5:45am for some coffee and chai and a 6am departure. We’d come back to camp for breakfast and then bring lunch boxes with us so as not to have to return to camp later during our game viewing. At least, that was the plan when we fell asleep, little knowing what adventures the next day would hold for us.

March 24, 2017 – Rift Valley Children’s Village and our last day of mobile clinic….

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It was Friday and our final mobile clinic of the Spring 2017 trip to FAME. I’ve written so many times about Rift Valley Children’s Village, but it’s very difficult to say too much about this amazing place. RVCV is not an orphanage, but rather a home to approximately 100 children of all ages were have been orphaned or unable to be cared for by their family and have been adopted by Mama India and her business parter, Peter. They grow up at RVCV which is their home and they go to school at the primary school that is next door. Eventually, they have the opportunity to go to collage and most do.

Tanzanian market weaver male weaving a new nest

The reason that FAME is in Karatu is that Frank and Susan met India when they first came here with the idea of opening up a facility and India convinced them that Karatu would be the perfect place and that would also allow them to provide care for her children and the surrounding community which she would subsidize as she realized that her children would be healthier if the local community were healthy. FAME continued to provide these regular medical clinics at RVCV until very recently and now patients are sent to FAME as it is about a 45 minute drive to the Children’s Village from FAME. We have been tagging along with the FAME clinic over the past, but today we would be going by ourselves, though we would have a clinical officer with us to help with medical decisions other than neurology.

Nan and Sokoine evaluating a young woman with cognitive delay

Nan examining her patient

The drive to RVCV is absolutely spectacular (as are all of our drives anywhere around here) as you leave the tarmac just below the Ngorongoro Gate and travel along a slight ridge in between fields of green that go on forever. There is no sign indicating that the road leads to our destination, though there is one for the Crater Forest Camp nearby along with a sign stating “rough road,” typically ominous here considering that other than the tarmac, all the roads are rough. There are several lodges visible along the way just before we begin descending into several valleys and eventually climb up into a coffee plantation that we travel through a short distance until we reach the primary school and, behind it, Rift Valley Children’s Village where we’ll spend our day. There are always patients waiting for us sitting in front of the offices, though today, since we are here by ourselves rather than with the FAME general medicine clinic, they are all for us. There have been times when it’s been a bit overwhelming, though today are list is manageable. We unpack the medications and supplies from the vehicle and immediately get to work creating a list and getting rooms set up.

Chris and Angel evaluating a patient

Jamie evaluating a young woman with epilepsy

Considering one room has a bunch of stuffed animals, that will be Nan’s as she has been seeing children whenever possible. I should have mentioned previously, that for all of our mobile clinics, we keep separate records from FAME as it’s impossible for us to know who will be coming so we don’t have access to the FAME charts. Even when we have some form of an EMR at FAME, there is no cell service at Upper Kitete and the bandwidth on the cells is not great. We keep notebooks of all of our mobile clinics with past records so when patients return we can find their previous clinic notes. Not ideal, but it works 90% percent of the time or more. RVCV, on the other hand, keeps meticulous charts for all their children in addition to the patients who come from the town, so it is very easy for us to find our notes, though we still make copies of all our handwritten notes that we bring back with us and keep them in a binding the same as the other clinics.

Nan evaluating another pediatric patient

RVCV also has a wonderful nurse, Gretchen, who has been there now for 18 months and is quite familiar with all of the patients including those from the local village next door, especially the children. She is able to fill us in on lots of back information that is not always readily available in the chart nor do the patients always offer it to us considering it is often very sensitive, dealing with all types of abuse. As such, we are often doing a fair amount of counseling here and, unfortunately, much with children who are quite commonly the victims of this abuse. Some of the stories are quite gut wrenching and, though there are authorities to deal with these instances, it is not always the most simple or effective. There is a social worker at RVCV who we are able to discuss these cases with and pass on the information we gather to her, but it still leaves us with a feeling of sadness often in not being able to rescue everyone, similar to how we feel with many medical cases that are not able to be treated here for lack of resources or otherwise.

Chris evaluating a patient with epilepsy with Angel’s help

Patricia counseling a patient on how to take his medications

Nan is in heaven considering the number of children we see at the this clinic and she wastes no time in getting started. We saw a number of epilepsy patients during the day and it so difficult at time as patients rarely know what they are taking, or how much or how often, when we ask them and we have to bring out tablets to confirm with them what they are taking. We were last here in October and many patients, as is commonly the case, have stopped they medication in the interim because they were “finished,” meaning that despite our constant education, most often in triplicate, they didn’t understand that they had to continue the medication for it to continue working as we are not “curing” their problem, but rather treating it.

Nan being Nan evaluating a pediatric patient with Sokoine’s help

One of the benefits we look most forward to at RVCV more than the other mobile clinics is lunch. This is extra important for Nan, who is always thinking about food and where will the next meal be served. When traveling to Empakai last Sunday, we all secretly place odds on when she would first mention lunch in the morning, but she fooled us all by lasting until 11am before asking about food. She was more than happy to discover that today we would be eating a delicious home made lunch in the volunteer dining room where the “mamas” always make an incredible meal for us. Today it was broccoli soup, salad, and cheesy pasta along with fresh fruit, including everyone’s favorite, mango. Lunch is always served at 12:30 so we didn’t have to worry about when to take a break.

Jamie providing a psychiatric assessment to Dr. Mike and Elmo

After lunch, we visited the gift shop while waiting for our Tanzanian counterparts, who eat a more traditional lunch along with the staff here, to come back ready for our afternoon session. Having three rooms seeing patients allowed us to plow through the patients rather quickly and we were done shortly after 3pm, which was good because some of the younger boys were kicking a soccer ball around nearby and I know Jamie had been mentioning wanting to play soccer here for sometime, but it was readily apparent that Chris was also more than ready to play. Even Nan pitched in guarding the goal for a bit and it was great to watch the three of them running around with the children who were all so happy here at the village. It is a place of miracles and you can’t but help know that everyone of these kids was rescued from a harsher life had it not been for the India and Peter, The Tanzanian Children’s Fund and Rift Valley Children’s Village. Saying goodbye and leaving this magical place to head home is always tough. I know that I’ll be back as I have so many times, but for residents, this is likely their only chance to experience this place.

Chris playing soccer with the RVCV kids

Jamie trying to steal the ball

Fancy footwork

Nan playing goalie

Chris playing defense

The weather today has been lovely and the drive home was so peaceful after having seen our patients, played soccer (the residents, not me, of course) and had a great lunch (Nan is very happy!). We arrived back to Karatu, our home for the last three weeks, early enough for Jamie to pick up the skirt she had made and then do some shopping as we’ll be heading into the bush tomorrow on safari. Yusef, our guide for this safari to Lake Ndutu in the Southern Serengeti, had called and was waiting up at FAME for me to give him the Land Cruiser so he could check it out before heading off to such a remote location. Nan and Abbey immediately went to the maternity and pediatric ward where they promptly assisted in finding a delivery going on so when we walked in a few minutes later, we found Nan holding a newborn and beaming from ear to ear.

Nan with a precious new baby

Meanwhile, I received a text from Frank shortly before getting back to FAME informing me that somehow, Dr. Lisso had told them about a patient still “waiting” for us despite the fact that we didn’t have clinic. It was a huge imposition after having nine days of clinic here, finishing five mobile clinics and preparing for four more clinics at FAME that we had to see a non-urgent patient after hours. After briefly venting (a single text) to Frank (who was also pretty frustrated by the event) Jamie and I saw the patient, who actually turned out to have psychosis and had just been treated at the local hospital days earlier, receiving some injectable medication that they didn’t know the name of and didn’t have their discharge papers from the hospital with them. Argh!!! We just kept repeating “TIA” (This is Africa) and explained to the patient, who, by the way, was doing better after the injection that we really couldn’t treat him as he had very likely been given a long acting medication that we didn’t know the name of, and, besides, it was helping him. They were happy with the visit, though we were a bit perplexed as to why they had come, not to mention being still bend out of shape as to why we had to see this patient at 6pm on a Friday evening.

Jamie’s birthday cake – it was delicious!

We eventually got home to eat our dinners, albeit a bit late, and got down to the work of preparing our lunches for the safari tomorrow as we wouldn’t be getting to our camp until dinner time. It was also Jamie’s birthday (sworn to secrecy on how many) and we had ordered a birthday cake from the Lilac Cafe which was running late, so Denis from the Lilac brought it to us during dinner. I had the desired effect either way as Jamie was quite surprised and we all sang happy birthday to her on Joyce’s veranda where we were eating. Later, I worked on my blogs while the Chris, Jamie and Nan made sandwiches, arguing about important things like the “appropriate” amount of peanut butter in a PB&J or PB and Nutella, the latter everyone’s favorite but mine preferring to stick instead with the more basic version of this American classic. Nan cut up a pineapple to eat with lunch and we each went off to pack for overnight in the Serengeti. We each slept with dreams of the wildlife we’d see the following day and the adventures we’d experience, having to awaken quite early for a 6am departure to head through the Ngorongoro Gate when it opened.

March 23, 2017 – Day two of our clinic at Qaru…

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The team rounding on a patient with severe burns – Dr. Elle managing

 

I completely forgot to mention that the night before, we had a ward consultation regarding a gentleman who had presented after the sudden onset of right-sided weakness and inability to speak or comprehend. Chris had gone to see him after we had returned from clinic and was happy to report that they had assessed him correctly after his lecture Tuesday morning which was very reassuring. He appeared to have a complete left MCA territory infarction on examination with a global aphasia, right visual field cut and right arm and face weakness with some sparing of his leg. He was also in atrial fibrillation which we had discussed at length at the lecture in regard to the fact that you should wait about two weeks before anticoagulating a patient due to the risk of hemorrhage. It was great for Chris to use as a teaching case, though not so great for the patient. He was a bit agitated when he was admitted, likely due to his global aphasia. So on morning report, we discussed his case and what his continued management would be going forward.

Chris examining his stroke patient with the team. Dr. Gabriel, Dr. Msuya and Siana looking on

Chris examining his stroke patient

Rounding on a pediatric patient with Nan discussing the case with Dr. Gabriel, Dr. Msuya, Siana and Dr. Brad

Nan, of course, was busy with her pediatric cases before and during rounds which she has been doing a great job with. This morning, the very tiny Maasai baby, whose name is Frank, had decent labs so he will go home today with his family. They live quite far and it will still be touch and go with him. The family agreed to come back next week to see us before we leave and we hope to reinforce the education that was given before he left when they return. He’s so small and without his mother, it will be touch and go. His family, though, was very motivated and seemed to want to provide excellent care for him.

Chris and Angel evaluating a patient

We picked up Sokoine in town as he was buying our food for lunch so we could get an earlier start. Stopping at the grocery store with everyone getting out of the vehicle and choosing what they would like to eat can be a bit cumbersome and time consuming to say the least. We’re often delayed in town for 45 minutes picking everyone up and shopping for each days lunch. I had tried lunch boxes (which are what is used when you’re traveling on game drives so are quite commonly sold here) before, but it didn’t go over well with the Tanzanians as it wasn’t what they were used to eating. Since then, we’ve typically bought the various pastries that are all full of carbohydrates and typically fried so they are the furthest from a healthy diet that you can imagine. Everyone seems happy with these, though, so that has been our practice for the last several years. At least having Sokoine buy everything in advance will save us time, if not calories, carbs and saturated fats.

Jamie evaluating her patient with epilepsy

Jamie examining her patient with epilepsy along with Dr. Mary. Moments later, the patient had a seizure

Discussing treatment options after the patient was back to his baseline

Clinic today was a bit interesting, considering Jamie’s first patient, which I had decided to sit in on today, wanted to demonstrate for us what his seizures looked like. This was a 21 year-old gentleman who was accompanied by his mother and spoke mainly Iraqw which is quite unusually for a young man. His mother described episodes that were fairly classic for seizures and, specifically, frontal lobe seizures that were reasonably frequent. As Jamie was examining him, he suddenly leaned forward and spit on the ground, then stood up with a very blank stare and was clearly having a seizure. We eased him onto the bed where she was examining him and his eyes were fixed to the right and he was not responding. This lasted only briefly and then he began trying to get up and was still quite confused. We put his coat under his head and he curled up for several minutes before he was finally able to speak and comprehend. He didn’t generalize, though his mother clearly described generalized convulsions in the past and this seizure was clearly a partial complex seizure without generalization and was quite consistent with a left frontal focus for his seizure. He had been put on phenobarbital sometime in the past, but the dose wasn’t clear and it hadn’t helped him at all. His mother had eventually stopped the medication due to it’s ineffectiveness and he just continued having seizures on a regular basis. How amazing it will be to possibly finally control his seizures after all these years. His mother was so appreciative and grateful that we were at least giving her son some hope that she was close to tears and couldn’t thank us enough even though we hadn’t even done anything yet.

Nan examining an adult

Nan happily keeping busy seeing patients.

Patricia in our “pharmacy”

Patricia talking with a patient in the “pharmacy”

Nan’s final patients of the day were also quite interesting. It was a mother and daughter who both suffered with epilepsy, though it wasn’t quite clear that it was genetic. Mom’s seizures hadn’t begun until her 30’s and her daughter’s seizure began at age 4 and she was now 7. The description of mom’s seizures by her husband, which very much embarrassed her, looked primarily generalized, but the description of the daughter’s seizures were less clear. While Nan was taking their histories, I gave the daughter my cellphone to play with for a bit and when I left with it after a while, she apparently burst out in tears so I had to give it her again. She was quite cute and thankfully seemed to be cognitively normal despite having had untreated seizures for several years which is so often not the case here. It was a struggle for us to decide what medication to use for each of them as we don’t have the full complement of medications to use that we have at home and some of the medications we have here are often in short supply and sometimes too expensive for the patients. We eventually came up with a plan that seemed reasonable, but it will require that they be followed up at FAME to make certain that they’re each doing well.

Lunchtime in the shade at the car

We were finished with patients and decided to have our lunch under the same tree, but try as I may, I couldn’t track down another chameleon and was very disappointed over that. After lunch, we discovered that we had more patients who had showed up in our brief absence, and since it was our last day at Qaru, it was only appropriate that we see them despite the fact that it was getting late.

Nan evluating a mother and daughter epilepsy case

Playing games on my cellphone

Happy with my cellphone

We traveled back to Karatu, arriving back to FAME sometime after 5pm and decided to relax for the evening. We were planning to go on Safari for the weekend and needed to do some shopping, but that would wait until tomorrow after work. So, for tonight, it was dinner and work and then to bed. Tomorrow we would be heading off to Rift Valley Children’s Village for our last day of mobile clinic and then next week we will be back at FAME for neuro clinic again.

Abbey’s new boot

March 22, 2017 – Our first visit to Qaru in the Endabash area….

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Today we were continuing our week of mobile clinics and after servicing the Mbulumbulu area to our northwest, we were now going to travel to the Endabash area and village of Qaru which is to the northeast. We had been looking for another site to have a mobile clinic and the district medical officer here had been supportive of it after having seen what we had been doing at Kambi ya Simba and Upper Kitete. We eventually settled on the village of Qaru, who were delighted to have us come to their dispensary and care for their residents. So it was set that we would spend two days in Qaru for our visit visit and see what came of it without knowing the volume of patients we were going to see, only that they were happy to have us there.

A typical wheelchair

Glen Gaulton, who had been visiting with us since last Thursday evening, was planning to leave this morning as he was departing from Kilimanjaro International Airport this afternoon. Glen and I met with Susan and Frank yesterday morning to discuss future plans for our involvement with Penn as far as neurology was concerned as well as other services that might work for both FAME and Penn. The big topic of conversation for us, though, was the laptop ban for carry on luggage from primarily Muslim countries that had been recently announced. Thankfully for Glen, it would not affect him as it wasn’t going to be enforced until several days from now, but for the rest of us flying through Doha, Qatar, it would mean that we won’t be able to bring our laptops, tablets, cameras or any other piece of electronic equipment larger than our cell phone with us on the flight. Yikes! Each of us had been planning to do work on our devices on the long flights home and will no longer be able to do that. It will mean that we have to read a book or watch non-stop movies on the 7-8 hour flight from Kili to Doha and the 13 hour flight from Doha to Philadelphia. Jamie will be heading to Namibia after we finish at FAME and she will have an even longer flight to Doha. I did read somewhere that Emirates (who is also affected by the ban) is planning to allow people to bring devices on the inbound flights to Dubai connecting to the US and then would pack anything there in locked cases for no charge. It is said that the ban was based on specific intel, but there is also a suggestion that this is an economic retaliation against middle east airlines that receive government subsidies and can therefore offer lower fares which the US airlines can’t compete with. Regardless of the reasons for the bans, it is going to pose a significant hardship for all of us, not to mention the fact that I am going to have to check all of my camera equipment and hope that it will arrive at home with me and not disappear. The fact that all of these electronic devices will now be stored in checked luggage surely won’t go unnoticed by unscrupulous baggage handlers along the way. The consequences of this ban in the long run remain to be seen, but for our flights home it will be a real hassle.

Angel screening patients wating to be seein

Sokoine screening patients

The drive to Qaru leaves from the tarmac immediately opposite of the FAME road and travels northeast through a somewhat different landscape than that of Mbulumbulu, but it is equally breathtaking with long vistas of green fields among low rolling hills and occasional kopjies (Dutch for “little heads” and referring to the large boulders poking above the ground, often the home of many animals in more remote places like the Serengeti) scattered across the countryside. This is an equally poor area of Tanzania where small villages along the road are made up of a few shacks that account for not only the homes of the inhabitants, but also the small places of business. We finally reached Qaru after perhaps 45 minutes to an hour and drove through town to reach the dispensary. They had a wonderful dispensary with two wings, a male and a female, along with a central office that were all for us to use during our visit there. The nurses were so happy to have us there that they directed moving desks to each of the wards along with extra chairs and, in very short order, we were set up for three lovely offices in which each resident could see patients along with their interpreters.

Chris seeing a patient in Qaru with Particia’s help

Nan evaluating a seizure patient with Sokoine

Jamie and Dr. Mary evaluating a patient

The patients were already there waiting for us as we arrived and the residents each jumped right in to see them so we were off and running quite early. One of the most important parts of these clinics is the pre-screening of patients before they are seen since we are there to see patients with neurological disease and not those with arthritic or orthopedic issues. Our role is not to do general medicine when we are there as they have clinical officers at the dispensaries for that and since we are charging only a small fee that doesn’t come close to covering the cost of the visit and medications, we cannot subsidize anything but neurology. Early during the clinic, Nan came out of her office at one point with a bit of a frustrated look saying that she couldn’t evaluate her 37 year-old patient who was complaining of chest pain. Clearly, that would not be considered a neurological problem on the face of it, but after reassuring her that it was unlikely that the patient had an acute cardiac condition, I sent her back into the room to ask a few more questions and after a some further assessment she not only found that that woman didn’t have a cardiac condition, but very likely had a neurological complaint that she could actually treat. Alls well that ends well.

Chris examining a patient with Angel’s help

Patricia and our pharmacy at Qaru

Jamie saw a woman with a clear psychosis who has been under the care of the government psychiatric nurse and receiving long acting antipsychotic medications, but we were unaware of the actual medication she was on and both she and her husband were asking if we had anything other medications to suggest as she had been having side effects. A call to the government dispensary to gather information didn’t go as planned as they were apparently unaware that we were in the area and wouldn’t provide us with any information. In the end, the patient was directed back to the dispensary since we were unable to treat her without knowing what she had been treated with previously and what she was currently receiving.

Jamie and Mary evaluating a patient

Chris examining a patient with Sokoine’s help

Lunchtime came and we put shukas down on the grass in the shade of a tree next to some boulders where our care was parked. This was a small kopjies and the trees were growing out of the rocks with their roots exposed. It was a lovely spot and while looking for lizards, I found a beautiful chameleon that was colored an amazing green and black at the moment. He threatened me with open jaws that were merely for show and puffed out his throat to make him look bigger. In the end, though, he settled down and we were able to handle him gently so that everyone got a chance to have him walk on their arm and marvel at his independently moving eyes, each moving in a 360° circle separately. Everyone other than Angel thought he was so cute as she went screaming around the car and wouldn’t return until he had been released back to the bushes near where we found him. As soon as we let him go, he immediately turn to color green that exactly matched the bushes as camouflage in the manner we’d expect of any respectable chameleon.

A nice close up of Mr. Chameleon

Jamie holding our chameleon

Taking photos of the chameleon

We had a few more patients after lunch and were able to get back to town in time to stop by the fabric store we had visited before and Jamie picked out some fabric for a skirt they were going to make for her. At the same time, I saw a Thomson Safari vehicle parked just up the road from where we were and decided to see who was driving it. When I asked whose vehicle it was, a familiar looking gentleman stepped forward and I realized it was Mohamed, who had picked me and my kids up at the Manyara Airport in 2009 after we had returned from the Norther Serengeti while on our original safari. I’m not sure if I’d seen him since then, but we clearly remembered each other so we sat and shared a drink to catch up on things. What a very small world this can be. I showed him pictures of my kids from our safari as well as where they are now and he was so happy to see them as well as knowing that I’ve been coming back every since to help out at FAME. It reminded me of my first visit to FAME that was the result of volunteering for a few days in Karatu, and what FAME was at the time. From a simple outpatient ward then to the complex of patient care facilities that it is today, we have grown together over the last seven years.

March 21, 2017 – Upper Kitete…..

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It rained pretty heavily overnight and once again we were heading out to Mbulumbulu for our mobile clinic, today visiting Upper Kitete, which is our furthest clinic and about an hour and a half drive along the rift. From Upper Kitete there is an overlook that we often visit that sits 2000 feet above the Great Rift Valley with a view down to Lake Manyara that is just spectacular when the weather is clear as it goes on forever. Today, though, I am more worried about the roads since we’re heading back towards Kambi ya Simba and beyond where it doesn’t take much rain to make it treacherous.

Chris doing his chalk talk on stroke

Thankfully, we’ve been able to recruit George Mila, a long time employee of FAME and someone who has helped me out in the past when I’ve needed it. George will drive us to Upper Kitete so if the roads are bad or if rains while we’re out there, we’ll be sure to make it home or at least we’ll have someone with more know how who can help us out of a bind. With Glen traveling with us today that will make ten for a Land Cruiser that only seats eight. We normally use the refrigerator in the back for an extra seat, which we did today as well, but to seat ten, I am sitting on a soft drink crate with a cushion, wedged between the third row that will serve as my seat for the drive today. It was remarkably comfortable, despite the bumpy road and long drive, though I’m not sure I’d recommend it to anyone if they had a choice.

Chris demonstrating how to do the NIH Stroke Scale using Jamie as his “patient”

Tuesday mornings are for education, so before our drive to Upper Kitete, Chris delivered a lecture on stroke for the doctors that he had been requested to give. Chris is a master educator and provided an interactive chalk talk on a propped up white board using markers to run through the vascular anatomy of the brain, the NIH Strok Scale, and finally treatment rationale. Chris did an excellent job and though the participation of the Tanzanian doctors wasn’t brisk at first, they eventually chimed in with some of the answers. Jamie served as Chris’ “patient” to demonstrate the NIHSS and how to rapidly assess a patient to determine the size of their stroke. There were many excellent questions after he was finished with his talk that clearly demonstrated not only how important this subject is, but also how much they had gained from the presentation that Chris had given. We have always given these talks since I’ve been coming here and now the residents give them as they are all incredibly educators which is one of their key roles back home for the medical students and they provide the same here for all the medical officers and nurses.

The Upper Kitete Dispensary. Rain water collection container and our parked vehicle

The drive to Upper Kitete was quite uneventful as to any incidents, though the beauty of this region would compare to any in the world. The fields are lush and green as far as the eye can see and we pass tractors and workers along the way going to and coming from their daily labors. It’s quiet and serene here that belies the difficulties of life here, given the remoteness and occasional struggles to make do. It is a much simpler life for certain. Upper Kitete is the second to the last village on the road we’re traveling that ends as the mountains meet the escarpment and it is no longer possible to travel further by vehicle.

Chris seeing a patient with Angel’s help

Nan evaluating a patient with Sokoine’s help

The dispensary at Upper Kitete is a bit more primitive than that of Kambi ya Simba. The two rooms we usually use are cramped and not ideal, but we’ve always made do. The one office has a square hole in the ceiling where there is a large colony of bats that can often be heard and there is always the aroma of bat urine, but I have never seen one fly out during the day so I am comfortable that everyone is safe. The other room we use is the labor and delivery room where there are two beds and a very small amount of space between them. As long as there are no patients in labor, we’re safe to use the room. Today, we were also given the dispensary’s clinical officer’s office to use which actually had a nice desk and bed in it on which to examine patients. Everyone got to work and Jamie drew the short straw meaning she would see patients in the “bat room,” though it took just a tad of convincing that she needn’t worry about the little creatures. Nan worked in the L&D room and Chris ended up in the office as this came available later and he was in the right place at the right time.

A young patient waiting to be seen

Nan and Angel evaluating a patient with hip pain

We had a smattering of the usual patients with headaches, neuropathy and seizures with none that stood out remarkably, though Chris’ last patient was one that took a bit more in the way of thought. He was a young boy of 5 whose grandmother was raising him and gave us a history of “drop attacks” that began at one year of age and had continued. When we hear the term “drop attacks” we usually think immediately of Lennox-Gastaut syndrome which is a devastating epileptic encephalopathy where children loose milestones and suffer injuries due to the multiple seizure types. We were also given a history that the child may have had spasms when younger, another worrisome feature suggesting infantile spasms. But he looked way too good to have either of these conditions and, in fact, his examination demonstrated normal cognition which went along with what his grandmother was telling us.

Our young child with seizures. Glen Gaulton, Sokoine and Dispensary Clinical Officer looking on

Glen Gaulton and Sokoine with patient

Getting a high five from our young patient once he’s more awake

He appeared initially to be a bit sedated which wasn’t surprising as he was on 90 mg of phenobarbital, but he later awakened to fully participate in his evaluation which was also very encouraging. We wanted to convert him to valproic acid, but before doing so, he needed to get labs to make sure there were no metabolic issues that can be seen in certain children and which would be a problem if we put him on this medication. In the end, we convinced them to come to FAME next week to have the lab work done at which point we’d decide whether to switch him to valproic acid or not.

Chris evaluating a patient with Sokoine’s help

At the end of the clinic day, the clouds were rolling in from the valley below and we could hear thunder in the distance. We packed up and hit the road, skipping the overlook as the weather was closing in fast on us. It began to rain and did so most of the way back to the tarmac. We had wanted to stop at a friend’s shop in the village of Manyara so took a different road back and made it there just in time before they closed. I had wanted to get some wall hangings and items for the new house and was successful in doing so, while the others were looking for gifts to bring home with them. We eventually got back on the road and made it to Karatu in time to watch the sunset with dinner. Glen made us a great tomato, cucumber, onion salad to go with our cheesy pasta that Samweli made us for dinner. We relaxed for the rest of the evening with Jamie, Nan and Glen watching Lost in Translation on Nan’s laptop. It was a good day at Upper Kitete and we made it back safely. Tomorrow would be a new clinic location at the village of Qaru in the Endabash area of the Karatu district. Glen would also be leaving tomorrow morning and it has been great having him here to see what we have been doing at FAME.