Having spent nearly every birthday now for the last 15 years in Tanzania, it’s not too difficult for me to remember (and yes, my birthdays have been adding up) that come March, I have already spent the last month in vigorous preparation for another trip to FAME. The last two years have become a bit more complex with two groups of residents now accompanying me, each for three weeks, and this trip will include two additional attendings – Joe Berger, coming for his very first time at the end of a career that included lots of global work, and Marissa Anto, who was here in the fall 2019 as a resident, and is now a headache attending at Children’s Hospital of Philadelphia. Adding the mix of residents and attendings will be Joe’s wife, Sandy, and my partner, Jill, an ESL and early childhood education specialist, respectively, planning to do some work at the Black Rhino International Academy in Karatu.
The adult residents who will be coming for the first shift include Leah Zuroff, Jenn Morganroth, and Evan Rosenberg, all three of whom are seniors and making the trip with little time to spare. Leah was here in fall 2019, on the same trip as Marissa, but as a medical student and who will be lucky enough to return a second time, now as a resident. Gina Chang will round out the first group and is our much-needed child neurologist, given the fact that nearly a third of our patients are children or adolescent. The second group will include Holly Elser, Christina Boada, and Michael Perez as our adult neurologists, and Maya Silver as our child neurologist. They will be arriving as the first group is leaving on that very busy changeover weekend where we say goodbye to one group on a Saturday and greet the second group at the airport the following morning as they arrive. We also have a medical student from the Perelman School of Medicine at Penn, Megan Shen, who is planning to go into child neurology and will be finding out where she matches in about two weeks. She will be accompanying us over the next month and helping with our database of patients that we’ve continued to build for the last 9 years and is a wealth of information.
“The Mridha Spirit of Neurology Award is a humanitarian award that recognizes the work of a neurologist or neuroscientist who has demonstrated altruism, compassion, integrity, and leadership while providing quality neurological health care to a destitute, distressed, or marginalized population or in impoverished communities of the world. Also referred to as a humanitarian award, this non-scientific award is open to current AAN members in practice, academics, or retired that have demonstrated these attributes while serving a distressed population or impoverished community in the world.“
Several weeks ago, I was totally blown away to learn that I was selected as the recipient of the 2024 Mridha Spirit of Neurology Award sponsored by the American Brain Foundation and funded through the philanthropy of Dr. and Mrs. Mridha. The following is a description of the award:
I was graciously nominated by my good friend and colleague, Brach Coslett, who has spent time at FAME on his own on two separate occasions and has been a global neurology powerhouse in his own right, having worked also in Botswana with the Botswana- Penn Partnership.
Of course, I share this award with all those who have worked tirelessly in the field before me and who have paved the way. I also share the award with all those who have made this project possible over the last 15 years – Frances Jensen, Chair of the Department of Neurology at Penn, and Ray Price, Residency Program Director at Penn, both of whom have shared in the vision of making this unique experience for our residents possible, and Glen Gaulton and Megan Doherty, of the Penn Center for Global Health, for without their behind the scenes assistance, much of this would never have occurred. And how could I not acknowledge Frank and Susan, co-founders of FAME, and all those who have worked tirelessly over the years to make FAME a reality, who, had it not been for my chance encounter with them in 2009, I would have never started on this incredible journey. Lastly, how could I not thank the most important part of this equation and, for that matter, any equation that involves global health work, and that is the people of Tanzania, who have created the most amazing and loving country of well over 100 tribes, all who have worked together over the years to create what they are today – a country of absolute beauty and populated by individuals who would do anything for anyone ever in need. Their love is boundless.
So, it is with this amazing group of clinicians and others that the spring 2024 global neurology rotation would begin in earnest. Though I had initially flown on Virgin Atlantic in 2009 with my children (thank God for frequent flyer miles), having to brave the Nairobi airport, and after that, flew with KLM through Amsterdam for several years as they were the only airline off the continent flying into Kilimanjaro International Airport at the time, it was simply amazing when Qatar announced some years ago that they would then be flying non-stop flights out of Philadelphia to Doha, Qatar. How wonderful to have a five-star airline at our home base without the necessity to travel to Newark or, even worse, JFK, which is where KLM/Delta had departed from. Well, as they say, all good things must come to an end and, with that, it was last fall that Qatar announced they would no longer be flying out of Philadelphia and were turning that route over to their One World Partner, American Airlines.
It was truly the end of an era for me as I had so looked forward to my traveling on Qatar Airways every six months. Yes, much of it had to do with racking up the miles and becoming a gold member on Qatar, allowing me lots of extras like priority boarding, lounge access, and an extra piece of baggage to schlepp all the supplies I bring to FAME. Yes, I’ll still get miles as I insist to book through Qatar regardless of the fact that the route is operated by American, but it will never be the same. I had hoped the change would not be as drastic as I had anticipated, but reality quickly sank in the minute I saddled up to the ticket counter at the international terminal in Philly. Handing over my passport to the ticket agent as she asked me, “where are you heading today,” I quickly and excitedly replied, “Kilimanjaro” much as I had over the last ten years of Qatar’s run out of PHL. Whether she was unfamiliar with Kilimanjaro as an American Airlines agent or not, her reply was abrupt and fairly rude. “No,” she said, “what is your next stop?” Her unfriendly manner seemed to be a harbinger of things to come, and, in no time at all, I was wishing for those days of old or that I could somehow turn back the clock.
The agent’s demeanor never once softened throughout our exchange, and it wasn’t long before we were off to go through security with TSA. What is typically the most dreaded portion of the airport experience actually turned out to be a pleasure as the TSA agents could not have been more friendly and helpful, and even though some of that may have been in comparison to the cold welcome we had gotten at the American counter, it wasn’t lost on us how smoothly the security line went. The best, though, was yet to come.
Boarding a flight is a pretty standard affair and, thankfully, there’s very little that can go wrong when it comes to being herded like cattle onto the plane and into our seats. We had bumped into Megan at the gate and Joe had been with us at the ticket counter, so it was a relief to see Leah and Jenn boarding the plane and getting to their seats. Gina would be departing from another city and meeting up with us in Doha. The flight to Doha is quite a long one as we’re essentially flying to the other side of the Middle East and then must backtrack ever so slightly to get down to Kilimanjaro. All in all, the flight can run anywhere from 11-13 hours or even longer at times and a flight that long can only be tolerated with excellent amenities. Even in economy, having good food and a robust entertainment system makes the time go by quickly and that is exactly where Qatar Airways had always excelled. Unfortunately, I had been entirely spoiled and was now at the mercy of American Airlines.
With priority boarding, we got to our seats early and my strategy is always to make my list of movies to watch during the flight and to then get started watching as there was usually at least 30 minutes before we were in the air and having that head start on a movie was always a good thing. Having a list of movies on a behemoth flight such as this one was absolutely essential to maintain one’s sanity. Several movies that were new releases and still needed to be purchased at home – Oppenheimer, The Holdovers, and Ferrari – were available and we had already scoped everything out. Unfortunately, it was all just a tease, for when you clicked on any of the movies to watch them, it would just revert to the selection screen, and you were back to square one.
Eventually, Jill got up (men never ask for directions, do they?) to check with the flight attendant what the situation was with the movies and was told that she had to reset the system for it to work for us. Well, when that hadn’t after some time, she quietly, or so she thought, checked with someone else as they were serving our meal, only to be snapped at by the original attendant who’d apparently overheard her question – “I told you that I would check on it and it would take some time.” Well, of course, that time never arrived during the entirely of our trip and it was eventually suggested by the second attendant, who was actually quite nice, that we should send a complaint to American when we reached our destination. With 10+ hours still remaining on our marathon flight, the realization that we would not have movies to watch was a bit crushing, to be honest, though we dealt with the situation like the adults that we were. It later became apparent that the movies were out for most of the passengers on the plane, but not all nor was it all the movies, just the good ones. I won’t even go into the fact that the food on the flight was inedible for the most part but save it to say that I was definitely looking forward to visiting one of Qatar Airways incredible airport lounges with their award wining food.
Once we were all off that memorable outbound flight to Doha, arriving at approximately 5:00 pm, we now had about an eight-hour layover until our next flight that was departing at 1:55 am for Kilimanjaro. For those of you who have not experienced the International Airport in Doha, Qatar, it is truly one of the most amazing airports in the world for its amenities and size, though this is not at all surprising considering that the airline and airport are both run by the country of Qatar. As incredible as the airport was when I first began flying here over eight years ago, it has more than doubled in size in anticipation of the country hosting the World Cup in 2023 and has only continued to grow since. Given the long layovers, though, the most important amenity is their airport lounges, of which there are many. With Joe, Jill, and myself having access to the lounges, we were able to bring everyone else in with us, other than Gina, as she was arriving much later in the evening and, having run out of free passes, it wasn’t worth paying for entry for only two hours. Relaxing in the lounge with its food and drink and, even more so, its showers, was a lifesaver to be sure.
It was eventually time for us to head to the gate for our next flight, but before that, we had to make a quick stop at the Duty-Free Shop to pick up a few things for my Tanzanian friends, though this took only a few minutes. We walked through the newer part of the airport where they’ve built an arboretum that is as impressive as any I’ve seen elsewhere. Some of the palm trees are at least three stories tall and, though I don’t believe they intended for it, any birds who have found their way into the airport, have made their new home here. Thankfully, our next flight had a fully operational entertainment system, the one that I’ve become accustomed to on my Qatar flights, with all the movies that we hadn’t been able to watch on our last flight. Unfortunately, the flight was less than half as long as the prior one, meaning that between doing some writing and other things, I came up ten minutes short on finishing Oppenheimer and will have to wait to watch the ending for when we return in six weeks.
We arrived at Kilimanjaro with two vehicles waiting for us given the size of our group and all the luggage we had to transport. It would have been a completely smooth arrival had it not been for the medications that I was traveling with for FAME, the only issue having been that I did not have a letter from the TDA, or Tanzanian Drug Authority, authorizing me to import the medications. I will have to make sure to do this in the future. With a quick call to Egbert, FAME’s pharmacist, who was able to confirm with the TDA representative at the airport that I was indeed bringing these medications to FAME, I was finally released from what Jill had begun to refer to as a hostage situation as that is what it was beginning to feel like. After this short delay, we were on our way for a short stop in Arusha to reorganize our baggage, drop some supplies off to Pendo, and then make our way to FAME.
The drive was uneventful, again in two vehicles, this time with me driving Myrtle, or the short Land Rover, and Victor, our mechanic driving Turtle, the long Land Rover. Just past the Makuyuni junction, I spotted a group of three elephants out of the corner of my eye, and we made a short stop to watch these magnificent creatures grazing just off the highway. Animals here roam the countryside and the parks do not have fences but are rather merely located at the places where the animals are most likely to congregate for most of the year. This is the reason for it not being wise to drive after dark for you might run into an elephant or gazelle crossing the road and making for a very unpleasant meeting. With everyone being totally exhausted after about 36 hours of travel time and little sleep, we finally arrive to FAME and moved into the Raynes House. Since we fend for ourselves for dinner on the weekend, we went into town to the Lilac Café, and all had delicious meals to tide us over until tomorrow when our work would finally begin in earnest.
