I love the mornings here. It’s always cool, in contrast to the nights that are always warm or even hot, the roosters are crowing and the house is awake with ongoing chores. The roosters here begin to crow well before sunrise for some odd reason, though that’s fine for me as I am an early riser here. Lonnie, their askari, or guard, begins his sweeping outside my window well before sunrise so waking is not difficult. Overnight, there is the constant chatter of the dogs outside, some ours, and many others, as they roam their respective properties to keep out unwanted guests. Here, there is little violent crime, but theft is unfortunately common, as it is elsewhere in every third world country. I have never felt unsafe here, nor have I had anything taken from me, but I am constantly reminded of this fact by my hosts as we’re driving through town with our windows down not to have anything in my lap as it may be taken from me when we’re stopped at a stoplight. Interestingly, one of my very first experiences driving in Arushatown here was with Danielle Becker and someone on a bicycle told me that I had a flat tire and should pull over. I did, got out to check my tire, which wasn’t flat at all, all the while with Danielle still in the car. We drove on and when I got home and told Leonard about the experience, he informed me that these were very likely thieves who were planning to steal from me as I got out of the car to look at the tire, but hadn’t since Danielle remained in the vehicle. I felt rather stupid for having fallen for such a stunt, but it’s not really something that I’m accustomed to, nor have I been in similar situations in the past. It’s just a constant reminder, it seems, of the diversity of the world we live it and how we must adjust to it, but I am hopeful that it will never change me in any significant fashion.

I had planned this morning to visit a good friend and find a place for coffee. I met him at the gate of Arusha Lutheran Medical Center, or ALMC, that is the largest and busiest of the medical centers here in Arusha and where I have several friends who work there currently. This was a location close to where my friend who I was meeting lives and a hearty greeting since it had been six months since we’d seen each other, we drove a few blocks away to nice coffee shop where we had steamy cups of African coffee (milk mixed with coffee) and shared a few rather doughy donuts. We had a lot to catch up on for we hadn’t really spoken over the months I was away and I was so glad to hear that he was doing well as was his family. He is someone who I have shared much with in the past and whose friendship I have valued greatly over the years. As we left to say our goodbyes for the moment, I watched him head off and blend into the busy neighborhood foot traffic to make his way home. I think most everyone here feels more comfortable walking than driving if they can, and given the traffic in Arusha, that’s not very surprising for I think traveling on foot may often be more efficient than driving.

My next stop was to visit other friends who live in the hills behind the Arusha airport, which used to be pretty remote, but has more recently been the center of construction activity including a new government housing community. Since they had heavy rains over the last several days, the road was fairly rough and I was driving Pendo’s Suzuki rather the Land Cruiser, as it had needed to have it’s speedometer fixed. Given the voracity of the traffic police over the recent months, it was not at all very wise to drive without knowing your speed for you’d surely exceed the limit and be fined. There was plenty of mud and water on the road and several places passing over washes were the road seemed to be reduced to less than half a lane with the drop on the downstream side being something I didn’t want to experience any closer than necessary. The little Suzuki performed quite well and delivered me in a fine showing of performance to my friend’s home. Unfortunately, the plan had been for me to drop something off to them that I had brought from the US, but I had completely forgotten to put it in my car when I left this morning and didn’t realize that until I was well on my way. I’ll just have to make another trip there later this month to drop off their package.

I arrived home shortly after noon and was feed a hearty breakfast of pancakes and fruit and then left for the airport around 2:30pm to pick up the residents as their flight was arriving about an hour later. The traffic wasn’t bad, but I took my time considering the good luck I had had with the traffic police last visit, where I had received three fines in 24 hours for very offenses, at least in my mind. Thankfully, this trip was uneventful and I arrived to the airport just as the Qatar flight had landed as I heard from Susan, the only one of the residents with an international data plan, that they were getting into the line to get their visas and that it was quite long. Given the new, and much stricter, customs rules here, I have no longer asked the residents to bring supplies to FAME, though I did give Susanna a big box of rechargeable batteries that Frank had ordered and asked us to bring. It weighed a ton and was far to heavy to fit into my bags, which were already nearly overweight with other supplies. It used to be such a simple process to get through immigration as we had previously obtained our visas in advance from the embassy in Washington, DC, and were able to entirely skip the long line at the airport. They have change the designation for the visa that we need and, of course, the embassy in DC is entirely unaware of this fact so we are unable to get the new business visa from them and much now suffer through standing in line. I still had a valid visa from our last visit here in October and didn’t have to worry this trip. Not so for the residents which meant an incredibly long delay in getting through immigration and customs and it was nearly an hour before we had our bags loaded and were on our way back to Arusha. Of course, nothing is ever simple here, and the rear door of the Land Cruiser once again decided not to open for me such that we had to hoist every huge roller duffel inside and over the seats so everyone would have room to sit. This is the same back door that had nearly caused everyone to fly home without their bags last visit when it did the very same thing, finally deciding to open at the very last minute.

We drove home while it was daylight, thankfully, as nighttime driving here can be a real challenge in survival as every headlight seems to be directed right into your eyes and there are absolutely no streetlights anywhere. Pendo was still preparing dinner for everyone, so we took the opportunity to all take a walk and along the way decided to have a beer at one of the local pubs. Pendo had instructed Wesley, their nephew who I have known since he was 10, to accompany us and to make sure that nothing bad happened to us. It was a lovely evening and it was really great to all share drinks now that we were all together and their trip to FAME seemed to finally be real for each of them. We walked home in the dark on the side of the road with cars buzzing quickly by in the dim light and dust that makes up the African city night. Tomorrow, we will be leaving the urban sprawl of Arusha and traveling west across the vast expanse of Northern Tanzania to reach the Great Rift Valley and Karatu, a small jewel sitting in the Ngorongoro Highlands. We were all with huge expectations of the coming month, me knowing what these were while the others could only imagine, though I am confident that each of them will find this to be one of the most amazing experiences of their lives.

I always look forward to having a free day here in Arusha after my long flights from the US as it allows me some time to not only wind down, but also to reacquaint myself with the Temba family. Unfortunately, the boys are in school up in Nairobi and Leonard is on safari in the Serengeti, so it is me, Pendo, little Gabby and now, Gabriel, the latest to arrive last fall. Of course, there are many members of the extended family here as well, so staying overnight and others visiting for the day. After catching up on some busy work in the morning, along with some of the wonderful chai masala (an African tea made of many delicious spices that I’ve never been able to reproduce in the US), I enjoyed a hearty breakfast of some scrambled eggs, pancakes and freshly cut fruit.

I wasn’t entirely clear what I was going to be doing for the day, but I knew that Leonard’s brother, Jones, was coming by to get me before noon to go out and do a few errands that included picking up the Land Cruiser that I use while I here and which had been getting some work done on it. I’m never quite sure what the actual agenda is as that is part of the culture here. Information is really given on a need to know basis and what difference would it make if was told the entire itinerary anyways? I did know that we were going to check out a Land Rover that Leonard had spoken to me about so at least I had some idea of the plan. “Africa time” is a very real thing if you’ve heard me refer to it before or have heard others use the term. It is generally used when you’re trying to get something done and nothing seems to be on schedule. Once you spend time here, though, you find that it really refers to a general culture that is very much the antithesis of the west where we are driven by the clock. Here, things happen very slowly and most everything gets done, eventually. Their clock is in days and not in minutes and seconds, or even hours. There is actually something to be said for it, and definitely when you’re living in a place such as this where the weather trumps all, vehicles sometimes run and life generally moves at a completely different pace than we’re used to.

So, with that being said, after several stops to pick up friends and complete errands, we found ourselves on the northwest corner of Arusha, a place called Sakina, to visit the Land Rover. We turned off the main road and drove for a bit, at one point skirting around the edge of a large rock quarry where they were extracting large rocks that were then being worked on by women and children with small hammers. Yes, sitting on the opposite side of the little one lane road we were driving on, were piles of smaller stones along with larger ones, each pile with a person sitting, legs splayed, and using a very small, short handled sledge to pound the larger stones into gravel. No one wore safety glasses, of course, I would imagine that the children were as young as nine or ten while the older woman could have easily been in the upper years, perhaps in their 80’s. As we drove by them on our way to look at this vehicle, I could only help but think of how hard a job this must be, sitting in the brutal sun, day in and day out, smashing rocks. And more importantly, what could they possibly be paid to have made this a reasonable concern for them. What could possibly be the going rate for gravel to have made this possible? Or more importantly, how little could these individuals be paid to make this profitable for the owner of the quarry. It was really mindboggling to me and was such a stark contrast to the fact that we were going to look at a vehicle that might actually cost more than anyone here could possibly hope to make in their lifetime. I actually yearned for some explanation or perhaps a revelation that might make some sense of all this for me. Alas, none came.

Shortly after the quarry, we arrived to what could best be described as a Land Rover “boneyard,” a place where vehicles and parts of vehicles in every state of repair or disrepair existed over probably an acre or more of land. Coming as often as I do, we were looking at a vehicle that might serve me during my visits and perhaps be useful to rent when I’m back at home. It seems that prices on Land Rovers have dropped somewhat as they are no longer as desirable for safari companies to lease for their safaris. I have always had a place in my heart for Land Rovers over Land Cruisers for some odd reason that I can’t really explain. It is purely sentimental, I will admit, and should I ever have something here, it will be an internal struggle for me to overcome. The Land Rover I was looking at happened to be a 1999 model, relatively new for Tanzania as vehicles here are essentially driven forever. It is not at all uncommon to see a simple shell of a body being rebuilt into an entirely new vehicle as if being reborn into another life. I took the Land Rover that we were looking at out for test drive, traveling back by the quarry with the workers smashing their rocks into gravel with their little hammers and perhaps a kilometer further down the road. It drove like a tank, which is what they are known for, and it was everything I remember about them from having driven these in the past. There was a problem with the transmission, though, with a huge clunk when shifting and that was worrisome. After all was said and done, it was probably not the right vehicle, but at least it gave me some ideas for the future.

After several more errands with Jones and company, I was finally dropped off to get Leonard’s Land Cruiser and do some errands of my own. Traffic in Arusha has just become crazy over the last several years as the city has continued to grow with very little in the way of planning or infrastructure. From having a single traffic light when I first began to visit, there are now many more to be found, though I’m just not certain they are of much help. Motorcycles, or piki piki, pay absolutely no attention to the traffic lights, typically traveling through intersections with nary a thought of being hit or causing an accident. They are really distracting and if I had to compare to anywhere else I have driven before, it would be the Amalfi Coast in Italy where they zipped in and out of traffic on either side of you. The trick is to just drive and try to pay little attention to them.

I heard from the residents in Doha and, thankfully, they landed in time and were successful in getting the hotels they had booked that were far nearer the city market than where I had stayed. Everything apparently worked quite smoothly for them and they made it to their appointed lodging with plenty of time to spare and then gathered again for dinner. I was happy to hear that they had chosen to stay together as losing one of them in Doha certainly would have posed a significant issue for our work here not to mention having to break the news to their parents. I have previously promised Ray Price, our residency director, that I would not allow one of the residents to remain in Tanzania by choice as we would have to fill their remaining work responsibilities (he actually threatened that I would have to do them), so I would imagine that losing one in Doha would have had the very same effect.

So the residents enjoyed their night out in Doha and all met at a restaurant in the market area to enjoy the evening. Mindy texted me that she had a Jacuzzi in her room waiting for her when they returned, which I joked was really rubbing it in since I hadn’t been able to enjoy anything quite similar. In the end, though, the drain in her Jacuzzi didn’t work so I felt somewhat vindicated. All in all, they had a wonderful time in Doha for which I was quite happy and now I only had to worry about them getting back to the airport on time in the morning to make the final leg of their trek to Tanzania.

Despite all of my travels over the years, I had somehow never imagined myself traveling to the Middle East. Perhaps it was the fear of having a fairly obvious surname or my memories of past atrocities that have occurred in my lifetime. To be honest, I never chose to fly through the Middle East for that very reason which makes very little sense since I have a daughter who not only spent a summer in Cairo the year before the Arab Spring, but also loved every minute of it and never once mentioned to me any concern she had for her safety. She lived with an Egyptian family while participating in a Department of State sponsored language program for high school students and managed to travel through the city on her own and even once after her cell phone had died not knowing for certain which bus to take home. That’s being incredibly resourceful and something I will always remember about Anna. She loved it so much she was supposed to go back the following year, but alas the Arab Spring ruined those plans and she settled on Jordan and Turkey. Poor thing… 😉

Sadly, I didn’t get to see much of Doha, but will have other chances in the future. The new Qatar National Museum was being built just across the street from my hotel and I did have a reasonable view of the water and some of the traditional Dhows anchored just off shore. I would have to catch my shuttle at 7am to make my flight to Kilimanjaro, so I had very little time to explore. I managed to wrench the window open and stick my camera lens out of it in an attempt to get a few photos for my blog, and quickly discovered that there was something amiss with the focusing. This was the lens that I had dropped (along with my camera) while at FAME last October, shattering the filter that required a surgical procedure to remove all of the glass without scratching the front element of the lens as the filter ring had been bent badly and refused to unscrew. Scratching the front element would in essence turn the lens into a nice doorstop, and to be brutally honest, I have accumulated far to many doorstops in my career.

I had somehow never managed to deal with this until last week when I gave my good friend and fellow tinkerer, Clyde Markowitz, the lens to see if he could possibly extract the lens from the frozen and bent filter ring. Clyde never shies away from a challenge and this was no different. I received a text the following morning that the surgery was a success. I was so happy to have salvaged my lens, and saved a considerable about of money at the same time, that I threw it in my bag and brought it along, not fully tested due to time. Sadly, the lens focuses fine from about 18mm to 50mm, but after that, 50-200 mm, the focus ring does not move freely and the lens will not focus accurately making it essentially unusable. For all those photographers out there reading this, I know you feel my pain and can commiserate when I tell you that any camera equipment outside of a kit SLR (camera and lens purchased together) is unavailable here in Northern Tanzania. I will have to make do as I have no choice, but it’s still an unexpected blow that I’ll have to deal with in some manner at some point. I still have hopes that Clyde will manage to restore the lens once I have returned home (read, “Clyde, that’s a challenge”).

I rode back to the airport with another passenger who had been on “my much delayed, but definitely happy to be here” flight and was also scheduled to travel to Tanzania to meet up with some friends of hers. She hadn’t been to Tanzania (though just about everywhere else!) and I was more than happy to share my experiences and love of this wonderful country with her. I am such a fan of this place it is sometimes a wonder that I haven’t gone into the travel business. She will meet up with her friends and begin on a journey quite similar to the one I took with Daniel and Anna some nine years ago, now, and that changed my life forever, introducing me to a part of the world I had never explored, but had always dreamed of. It also introduced me to a part of myself that I had never known existed. I guess that may sound funny from someone who rides to work every day to spend his time helping others, but trust me when I say that this does not come with any sense of self-importance that one might think comes with the job. Rather, it is something that we do because we wish to and it’s something that makes us happy, or at least it should, otherwise we should find something else to be doing very quickly. I have always been quite fulfilled and thankful that I’ve gotten to do what I wish to do all of my life and I have never looked back for a moment, and I say that with all honesty.

The part of myself that I was introduced to eight years ago, though, wasn’t really a void or an emptiness that had been there. It was rather something that complemented all of my past experiences and was a perspective that I had never before taken advantage of. With the opportunity to come to East Africa and work with FAME, I feel that I have been exposed to the very best that humanity has to offer, and through that have been able to more acutely define what it is in life that really matters. Most importantly, though, I am content with the knowledge that I am now where I was always meant to be. Not geographically, of course, for that would be far too simple. But rather, a place in life that has become all fulfilling and where one feels the most comfortable that they could ever imagine. I started my professional career wanting to teach and though I decided to early on to take my chances with medicine, I never lost sight of my desire to be an educator. Throughout my medical career, I have always maintained that aspiration whether it was to educate my patient, a colleague, a medical student or resident, or even myself. Working at FAME twice a year has now also provided me the platform to further expand my role as an educator and has broadened my horizons on where to find these opportunities. Whether it is half-way around the world in East Africa or at home at Puentes de Salud on South Street, there are always these opportunities as long as one is open to them and always willing to take that step. It is worth it and you will never look back.

So sorry for getting sidetracked with that bit of a soliloquy, I will get on with the travelogue. I arrived with plenty of time to make the slight to Kilimanjaro that was another 6+ hours until I would arrive at my final destination. The flight was fine, except for the last few minutes as the weather here was a bit unsettled and had decided to bounce us around a bit like a cork before we reached the runway. The engines roared as the pilot made quick adjustments in our altitude from the strong up and downdrafts that were apparently standing between the tarmac and us. Thankfully, the turbulence was short lived and with a feathery soft landing, the pilot made contact with terra firma as if all was in a day’s work.

I zipped through immigration as I already had my visa in hand from last trip and my two huge duffels somehow appeared before anyone else’s. In very short order, I was through customs and on my way. Yusef, who I have used as a safari guide before was waiting for me outside along with all of the safari companies holding up signs to corral their clients before stray to far. Within minutes, we were on our way to Arusha on the Moshi Road, Mt. Kilimanjaro taking it’s normal position just to the north and completely hidden by the clouds of its very own weather system like a looming monster you cannot see. It was very windy, but the temperature was moderate and Yusef filled me in on the recent weather in the area. A hard rain a few days ago, but not since.

With the eight-hour difference, I was quite interested to hear how the residents were doing, as they would all be on the same flight out of Philly and certainly in much better weather than I had encountered only two days past. They were gathered together for their flight celebrating Mindy’s birthday with assorted brownies that that I only wish I could have shared in. Any thoughtful resident of mine should have realized that with sending me a picture of food comes the obligation to share with me, but somehow I have to believe that won’t be the case this time. Given their level of excitement at the moment of that photo, I will excuse them (auto spell almost put in “execute” there, I am not kidding. Could I have a Freudian computer perhaps?), but they will surely have to make it up to me after they arrive.

Six hours late and just a slight bit worse for the wear, I am finally in Doha, Qatar. Best laid schemes o’ mice an’ men….I had planned to spend the evening here following a comfortable trip and afternoon arrival, but such was not to be. At least I made it this far and considering the foul weather we had in Philly yesterday, it was something just less than a miracle that we actually took off at all. Our flight, scheduled for 8:15pm and having been delayed on several occasions, finally took off at around 1:30am after a full deicing on the tarmac that took some additional time. Most fellow passengers had much tighter connections than I did, having to rebook their connecting flights and missing a full day of travel. I really can’t complain at all and I am not. I am very happy to be here and I’ll have plenty of other opportunities to explore in Doha on upcoming trips.

With many travelers finding alternative arrangements out of Philadelphia on the following day, our flight was probably a bit less full than expected, and as such, I ended up with a full row to myself. I had planned to do some busy work on the flight and the combination of two empty seats next me along with the roomy economy class of Qatar Airways (the equivalent of economy plus on most other airlines) provided me with the perfect work space to spread all of my paperwork out. Of course, I did have to partake in at least some of the on flight entertainment (given the 12 hour flight time) and managed to watch two movies – Three Billboards Outside Ebbing, Missouri and Atomic Blonde. The former movie was wonderful with the only caveat being that to watch it on an all-Muslim airline where every line spoken in the movie contained a curse word that was spoken over with something similar was a bit annoying. Atomic Blonde was a so-so spy thriller with Charlize Theron and occupied some meal time.

I had mentioned in my last post that Qatar Airways has a program to put up passengers at hotels in Doha if they have long layovers here. You don’t even need to have a visa to leave the airport if you are from the US and the trip through immigration was quite a snap. I had originally tried to book a hotel in the city center near the market place with plans to explore and since that wasn’t going to happen, it really didn’t matter where I ended up tonight. Most of the hotels have complimentary shuttles and once I left immigration after having received my hotel voucher from Qatar, I just looked for someone holding a sign for the Century Hotel. I waited a few minutes for the shuttle, and then loaded onto a small bus with about twenty other weary travelers and we were off to the city to find our hotel. It was a short drive of about twenty minutes with the tall buildings of the city center off in the distance, sparkling in the clear night air like jewels in the desert. I would have loved to see this in the daylight, but alas that will have to wait for another visit.

The hotel lobby was quite small with three employees who readied themselves for the arrival of our busload of visitors and were incredibly efficient in getting everyone a room along with having to organize everyone’s departure back to the airport. Most of my fellow travelers ended up having to spend the day here tomorrow and were taking evening flights to India and the Far East, and thought would have been a enticing proposition, I was quite happy that my flight in the morning will get me down to Kilimanjaro at my expected arrival on Sunday so I would have two nights to spend with the Temba family. So tomorrow, it will be off on the final leg to Kilimanjaro and Tanzania with my residents arriving on Tuesday.

It’s March; so of course it’s that time again to be traveling halfway around the globe, back to the lush Ngorongoro Highlands and wonderful Tanzania. But first, the weather Gods, who weren’t quite satisfied to call it quits on winter, decided to play one last practical joke on the East Coast, and particularly Philadelphia. They had called for high winds today, so I knew it would be a bit of a struggle on my bike as I had planned to work the day and head home early to catch my 8:15pm flight out of Philadelphia International Airport to Doha. What I hadn’t planned on, though, were the particularly brutal hurricane force winds that swirled from every direction imaginable. Add to that the steady downfall of huge, wet snowflakes accumulating throughout the day and you have the perfect formula for a dreaded nor’easter pummeling the city, and of particular interest to me, the airport.

As I sat in our touch down space in the Perelman Center waiting for my patients to show and I looked out the huge picture windows at the incredible near white-out conditions with the snow blowing sideways at times only to give way to huge updrafts sending the flakes vertical as if trying aimlessly to reach back to the moisture laden clouds high above. The skyline of the city with its tall skyscrapers lost in a blanket of fluffy white sat in the distance.

I had finished seeing patients in clinic and had also finished most of my charts (one or two still to go) along with patient calls by around 3pm. With the storm still blowing like mad and blanketing the sidewalks and bike lanes with snow, I decided to put on my rain gear that I had ridden in with in the morning, and brave the elements. At about the same time, the University had decided to close, releasing all their employees onto the already crowded streets of University City and downtown. Riding in the snow is always a challenge, but adding to that the 80-mile-per-hour wind gusts that were coming from all directions and the ride home became one that was more about survival than anything else. Trees had come down in all the neighborhoods nearby, damaging cars and homes, and I was a bit concerned that I wouldn’t be able to get a ride to the airport as they wouldn’t be able to reach me. When my driver finally arrived, there was six inches of water at the curbside so he pulled around the corner. I opened the back door of his car and a sudden gust of wind ripped out the bottom hinge of the door so it wouldn’t close without some fancy finagling to line things up again, all the while with snow blowing in the car. Once closed, though, we were on our way and traffic was surprisingly light as anyone with an ounce of sense in their head was home safe watching the storm from the comfort of their sofa. Not me, of course.

The flight out of Philly that we had originally booked before the first of the year had been changed to now depart in the evening, 12 hours later, meaning that our layover in Doha, which had previously been a convenient several hours, was now an unwieldy 16 hours. Thankfully, Qatar Airways, in an attempt to increase tourism in their country, had offered to give us all hotels in the city for the night so we would have a free mini vacation in the city of Doha, albeit a very short one at that. Now, though, my flight will very likely be delayed by at least several hours cutting drastically into my time in the modern Kasbah of Qatar. So, much to the pleasure of my readers, if not to me, I have plenty of time to peck on my very first post of 2018, knowing that there will be plenty more to follow.

This will be the largest group of residents that have traveled to FAME with me alone. Though we did have a larger group from Penn in October 2015, when Danielle Becker had brought the EEG machine, along with a fellow and an EEG tech, they worked as a separate unit and were there for a shorter period of time. We have our usual schedule set up with our FAME Neurology Clinic for several days next week and then six days the following week when we will see the bulk of our patients. That will be followed by our Neurology Mobile Clinic where we travel to some of the local villages in the Karatu district where patients have a harder time getting to FAME or aren’t aware that they have something treatable. We’ll have our normal schedule of “Safari Sundays” so that everyone will have a chance to experience the diverse wildlife and topography of Northern Tanzania. And, of course, we’ll make sure to have a few scrumptious meals at Gibb’s Farm or one of the other local lodges where we are treated to five-star meals at some of the most spectacular locations imaginable for a reduced fare based on the work we are doing there. I can’t wait to share all of this with the new group accompanying me and always look forward to introducing them to the wonderful culture of Tanzania.