With our ordeal of last night now fully behind fully us, at least from the perspective of being stranded and needing rescue, we still needed to get back to Karatu and out of the Ngorongoro Conservation Area. Samwel, the driver/ranger/clinical officer (a man of many talents) who had been one of our rescuers last night, had told us that he wanted to leave the safari lodge by 8:00 am as he would be driving us back to FAME and then returning to Ndutu, a pretty hefty drive on some very rough roads.

I had been so exhausted last night, as I’m sure everyone was, that I had fallen immediately asleep, but wished that I had several more hours to spend in bed rather than having to get up early. At least it was for a good cause, though, as the breakfast bar at the Ndutu Safari Lodge was truly awesome, and I think most of us made excellent use of the omelette station. Once finished with breakfast, we all headed back to the rooms to grab our stuff and bring it out to the reception area where it was then carted to the parking lot to pack into the bed of Samwel’s truck. Vitalis would be staying as he would need to find someone with a tractor who could pull Turtle out of the muck, then get the clutch repaired and drive home.

I was once again put into the front seat of the truck, but this time Saidi sat in the back with Ashley, Laura, and Theandra, as it was too unsafe for anyone to ride in the bed of the truck on the main road past Oldupai and on to the crater. It was a pretty tight fit for them and I heard lots of strategizing being discussed as far as ways to fit everyone in, though I can’t confirm if any of these really did work since I had been sitting comfortably up front and feeling just a bit guilty (though not enough to have switched seats with anyone). Samwel once again sped along the roads at the very same pace as he had the night before, though we thankfully didn’t encounter any bull elephants this morning. The ride was most uneventful, including our passage through the Lodoare Gate that morning with papers indicating we had paid only through yesterday, and without the vehicle in which we had started. On any other occasion, this situation would have required hours of negotiation to have gotten through, but it was readily apparent that our arrival to the gate had been anticipated with instructions to let us through with little hassle.

We arrived at FAME by around 11:00 am with Samwell driving us directly to the Raynes House to unload all our baggage, and for everyone to breath a huge sigh of relief, and perhaps especially me given the ultimate responsibility I had to get everyone home safely. Though we were all now home and each in one piece, the episode wasn’t truly over as everyone would need to process the events that had taken place each in their own way, and that might take time. In our absence this morning, Dr. Anne had elected see any neurology patients that showed up for clinic along with our translators/clinical officers for they had now worked with us for over a month, so they would be able to put their training with the neurologic exam to practical use. Thankfully, it hadn’t been overly busy, and she was able to deal with all the patients which was certainly a testament to the fact that we have been working together for so many years. She is truly our boots on the ground in our absence.

I decided to change and head directly over to clinic to see what was going on, though had anticipated that the others would take some time to fully collect their thoughts before heading over, and besides, it would soon be time for lunch, and they could simply come over after eating. On my arrival to clinic, though, I was informed there was a 70-year-old gentleman with a history of hypertension and renal dysfunction who had presented the day before after developing a severe headache, vomiting, and then loosing consciousness. His history was most concerning for a hemorrhage and, sure enough, he had a very large right intraparenchymal hemorrhage with midline shift and developing hydrocephalus.

His CT scan from the night before (the one pictured) had been taken on admission and was, to say the least, very concerning. His GCS (Glasgow Coma Scale) was 7 at that time, and I was told that it was closer to 4 this morning. That’s about as low as you can get on that score, but his family was insisting that he be transferred to another medical facility for treatment – evacuating the hemorrhage would not be beneficial for the patient, and the only real consideration would be to put in an EVD (extra ventricular drain) that would help with the hydrocephalus to some degree, but would do nothing to alleviate the significant neurologic deficits that he had. In essence, we could perhaps prevent his death but would in no way prevent the fact that he would be entirely dependent on others for all his needs in the future even if he managed to survive.

The patient was Maasai from the Ngorongoro Conservation Area and his son had accompanied him to FAME, but there were also other family members who were involved in the decision-making including elders from his village who were pushing for him to be transferred to Arusha or Moshi. I had asked the residents to see the patient and their report was that he was unresponsive, and his pupils were sluggish and dilated, which told us that he was already in the process of dying and making it utterly hopeless to even consider transferring him for further treatment as there was a very strong likelihood that he would not have survived the transport.

It was now late afternoon/evening which would mean that any transfer would now take place in a good deal of darkness, making the trip risky as driving a night here is very dangerous and should only be undertaken if it’s absolutely necessary. In this case, making the drive to Moshi, or even Arusha, would put other’s lives in danger which was not a risk worth taking considering the horrible prognosis. I offered to speak with the son and another family member so that I could explain to them that any of our efforts to save him at this time were futile and that we should do our best to keep him comfortable and to allow him to pass away with dignity. We stepped out of the hustle and bustle of the ward into a utility closet close by where I offered to show him and another family member the images from the CT scan of his father that had been taken the night before.

I would have had the same discussion at home, and I was hopeful that I could get the point across to the son that his father had suffered a catastrophic injury from which he would not survive in any manner that his father would have wanted, and that it was really not up to any of us at that moment to decide otherwise. I let everything sink in with some long moments of silence and allowed Dr. Gabriel to speak to the son in Swahili as this was really not an exercise in convincing anyone, but rather a time to let the family come to their own conclusions. In the end, thankfully, the son realized what was best for his father, and agreed for us to keep him comfortable and not to escalate his care. They had already readied the ambulance to bring him to Moshi, a three-hour drive on treacherous roads made even more so in the dark, and I was relieved that no one would be placed in harm’s way for a journey that in the end would not change the inevitable.

Our afternoon of patients was otherwise very slow that day, a combination of the fact that the weather had been rainy overnight and everyone knowing that we had been delayed by our adventure in the Serengeti. We had actually been invited to have dinner last night (when we were instead hiking in the dark in the mud and water of Ndutu) at Asha’s home but had obviously been unable to attend. Asha had been the head of housekeeping at FAME since the very beginning, but perhaps more importantly, she is Abdulhamid’s aunt and had been incredibly grateful for everything I had done for her nephew in the past. Abdulhamid was a medical student at Muhimbili University when I first met him while on break from school, and he volunteered at FAME to help us in the neuro clinic over the next several years whenever he could. I had also arranged for Abdulhamid to come to Penn for a month observorship while he was in medical school given his keen interest in neurology and his burgeoning skills in medicine. It was an incredible opportunity for him, though as is always the case, the experience for the residents who had already worked with him in Tanzania, as well as those who hadn’t, along with the medical students, was perhaps even more rewarding to them. These bidirectional learning experiences provide far more than anyone could ever imagine.

Asha totally understood about having to delay our dinner, and even though we were all still exhausted from our ordeal the night before, she had prepared our dinner, and it was essential for us to get there to enjoy what she had made for us out of her appreciation for our coming to Tanzania. Visiting someone’s home for dinner such as this honors them with our presence, and though it has always felt odd to me as I’ve felt honored for them to have me, I’ve come to realize this distinction over the years and have always done my best to accept these invitations for what it means to our hosts. In essence, for them to be able to “pay back” for the fact that we have come to their country to volunteer our services is what honors them. It is these simple acts that are often overlooked and can mean so very much.

Though our dinner was very simple and very Tanzanian, it was delicious just the same, and we are thrilled to be there. I can’t remember how many of these dinners I’ve been to in the places I’ve gone to volunteer (Karatu, Dar es Salaam, Mali, and Vietnam), but I can say that each and everyone have had the same effect on me. I have been forever grateful to have had these opportunities, and they have meant the world to me.

We had planned for breakfast in camp this morning, which meant a more leisurely start to the day than our previous one, where we had been out on the trail in the dark and had enjoyed sunrise from well out on the Serengeti Plain rather than in the Sopa valley where our camp resided and the sun was blocked by the hill when it came up. The roads were still a bit muddy as even thought things dry up quickly with the rain, in areas of significant wetness, the water still sits just below the surface so that a several ton vehicle easily breaks through the dry crust.

Our stay at Dancing Duma had been absolutely incredible, which wasn’t at all surprising to me as I have stayed here a number of times in the recent past (the camp is only a few years old), but for the others, it was all their first time and a chance to lead a bit of a pampered life given the amenities. The food was absolutely delicious, and I think the chef tries to outdo himself every time we visit. The staff have always been super helpful and friendly and the accommodations in the tents are simply over the top and downright luxurious. Staying in a tented camp in the Serengeti is a must when one comes here to visit, but staying in Dancing Duma has always exceeded everyone’s expectations by a mile.

The entire camp staff came out after breakfast to bid us all farewell down by the vehicle, and as we began our game drive once again, they were still waving to us as we lost sight of them. We were once again heading to Seronera as we had to refuel for the drive home since we had run out of time last night. There are no fuel stations between the Central Serengeti and Njiapanda, just outside the Lodoare Gate, a drive of at least four hours and not one during which getting stranded out of fuel is a good option. After filling up, we drove directly to Naabi Hill and its gate to check out of the Serengeti and back into Ngorongoro Conservation Area that we would once again traverse on our way home.

But for today, as we had done on our last trip three weeks ago, we had planned on visiting Lake Ndutu with the hopes of seeing most of the migration there, and we were not disappointed. There were hundreds of thousands of wildebeests and a bit fewer zebras scattered throughout the Southern Serengeti and the Lake Ndutu region and were visible regardless of the direction you were looking. And the numbers of babies, especially the wildebeest, were truly remarkable as each cow has an incredibly high percentage of giving birth each season.

We drove to Lake Ndutu but then headed for the Big Marsh area and south where the number of animals only grew in number until we were certain that every single member of the migration had to be here, following the grasses and getting strong enough for the remainder of the trip to the Northern Serengeti and finally crossing the Mara River into Kenya and the Masai Mara. We took a brief break from our game viewing to eat lunch on a hill overlooking the Big Marsh, a place where I’ve seen the migration in past years, but most now were out on the open plain where the grasses were prime for them.

After lunch, we ran across three cheetahs who were brothers and had killed an adult wildebeest, a feat that a single cheetah would have a hard time with, but with the three hunting together, it was likely not an issue. The kill was hours old, and they were all taking turns feeding, their bellies looking like they were ready to burst. Two jackals were a short distance away and moving closer each time we looked at them, though they were keeping a very close eye on the cheetahs to be certain that they didn’t become their next meal. The wildebeest was not a particularly good sight as its very large stomach and intestines (which the cheetahs do not eat) were clearly visible while the three brothers focused on the more tender meat of the hind quarters and lower back. Cheetahs fill themselves as quickly as possible as they will often lose their prey to other predators such as lions, a leopard, or hyenas. These jackals were merely looking for scraps as they wouldn’t be able challenge these three brothers for the wildebeest.

We finally left the kill, looking for others we might find, and quickly ran across a wildebeest calf who had been killed recently, likely by a cheetah, so still had plenty of meat on the bone, but was being devoured by dozens of fighting vultures as well as an aggressive group of marabou storks. Each of these birds has a particular function at a kill such as this – some with smaller, surgically sharp beaks to open the abdomen, others with long necks and featherless heads who can stick their heads inside and pull out the organ meat. The marabou storks can devour the largest chunks of meat and store them in their neck pouches to eat and digest later.

It was finally time for us to begin making our way home as we needed to be through the Lodoare Gate by 6 pm, for that’s when the gates close and arriving after that time is not an option for it means spending the night in the conservation area and paying an extra day’s worth of fees. Three weeks ago, when we had come this way, we had taken the Endulen road that leaves from Ndutu and runs through some of the most gorgeous scenery in the conservation area with a great many Maasai bomas and herds of livestock. The only problem, though, is that it had been raining over the last days and the Ndutu area is notorious for becoming impassable during the wet season. Back in 2017, we had been stuck here in Ndutu for the better part of the morning along with at least half a dozen other vehicles until we were finally able to free ourselves and make it to the Lodoare gate just in the nick of time. I think I still have a bit of PTSD from that time being stranded with the possibility of not getting out of the mud.

We took our leave of the Ndutu Lake and marsh region and began our drive in the direction of the Endulen Road we had taken only three weeks ago. At that time, which was prior to some of the recent rains that we gotten, the road was reasonably wet, but passable, and other than one or two detours to make it around a washed-out area, we had done just fine. To be honest, in retrospect, I was a little bit surprised that Vitalis had decided to take this route home, for notwithstanding the beauty of this route, the recent rains gave me a bit of a pause as to what the condition of the road would be. When driving in water where the road beneath is mud, it is essential to keep one’s speed up to prevent sinking as there is no traction in the mud below. If the road is firm below, though, there’s no worry as there’s plenty of traction and the Land Rovers are made for river crossings, being able to submerge to the engine block.

We sped along what seemed like a very reasonable, albeit wet, road and Ashley and I were standing in the back of the vehicle as spray was continually flying up over Turtle’s hood and soaking us every several minutes. It was great fun and akin to riding on Splash Mountain over and over again for those of you who are familiar with this long time Disney “E-ticket” ride. There was a great deal of water not only on the road, but all across plain for as far as you could see – it was muddy everywhere and I was beginning to worry about our path going forward, though we were probably at least 45 minutes into traveling this route, and the possibility of going back to another way out of the area seemed to be slowly diminishing the further we traveled as we’d be late making the gate in time.

I recognized that we were nearing the end of this bad section of the road and approaching the river crossing where we had cheered three weeks ago when having successfully navigated it but then realized that there was a lake before us, and it was a long way to the other side. Vitalis decided to make a go of it, though it was clearly not the right choice for after having traveled 25 yards or so with reasonable speed, we began to slow and the car lost traction, causing us to slide to the left until we came to an abrupt stop in the middle of a what would have passed easily for a lake or a river as the water was flowing past us in a single direction. Standing in the back of the vehicle, I had the sudden, sickening feeling in the bottom of my stomach as we were clearly stuck in the middle of nowhere that was once the Endulen Road but was no longer. What was worse was that the good road was only a short distance in front of us if we only could have reached it.

I had brought my tall rubber work boots along in the car, which Saidi promptly “borrowed,” though to be honest, he was going to be of more use in getting us out of this muck than me given the differences in our ages. Both he and Vitalis hopped out of the car into the muck to see what they could do with our tall jack and the sand ladders (long rigid plastic devices that you put under your tires to gain traction or to cross a ditch and which I had just bought for this trip). I followed them out in my flip flops, which lasted only a short time for the mud would grab your feet with every step and the tops of them were eventually ripped off. I spent the rest of the time out of the car in my bare feet walking in the water and mud, the latter being at least six inches of gooey, gushy muck, and the former being a good foot in most places and deeper in others. We worked on freeing the car for at least several hours, finally getting it to move a little forward, but the clutch ended up going out and that was it for any hope of getting out on our own.

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It was probably 5:00 pm when the clutch went, which meant that we had about another 1 ½ hours of usable daylight. During this who time, Vitalis and Saidi were busily trying to call anyone they could reach, but the network service where we were was extremely poor and the majority of times, the call either dropped or didn’t go through. Meanwhile, in the back of the vehicle, Theandra had been calling anyone she could reach and apparently had a better signal than the rest and had contacted Dr. Annie to let her know of our dilemma. Annie had launched into action and somehow contacted the head of the Ngorongoro Conservation Area Administration (NCAA) to tell him that we were stuck and that we were important volunteers at FAME. With that having occurred, we now had the reassurance that they were sending NCAA rangers out to look for us and it seemed like the chances of us having to spend the night in the car were becoming less and less which was a good thing, at least we thought.

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It wasn’t as if we were lost for, we knew that we were on the Endulen Road, granted it didn’t look like much of a road and looked more like a lake, but at least it was a reasonable landmark, and we knew that we were just short of the river crossing. The problem, though, was that no one could really get close to where we were without the likelihood of becoming hopelessly stuck themselves, and there was no good way for us to give directions to the rescuers nor for them to give us directions to reach them. Despite this, it seemed in the conversations that Vitalis and Saidi were having with the rangers (all in Swahilli, of course) that they wanted us to leave the vehicle and hike in a direction where they thought that either we or they would be able to see the other’s lights as it was now dark.

Leaving the vehicle meant that we would have to bring everything from the car as anything left would be very likely stolen. We had all our bags, my camera backpack, Saidi’s camera backpack, and more that we had to strap on our bodies, front and back, and carry with us as we left the vehicle in the supposed direction of the rangers. The going was quite rough and there were holes along the way that couldn’t be seen and stepping into these was a real thriller as on one occasion, I went down on my knees in the muck. Now for full disclosure, I will concede that leaving the car may not seem like the smartest of ideas, and Ashley, Laura, and Theandra had clearly voiced their concern to me, though as I explained to them later, I felt that we had two Tanzanians who were directly speaking to the rangers who had instructed us to try to walk to them. Whether this was the right decision or not, I felt it appropriate to defer to Vitalis and Saidi. Jill summed it up pretty well later when she asked me in a text about my blog if I was posting the, “everything they tell you not to do (in a horror film) when your car gets stuck in the Serengeti surrounded by nocturnal animal piece???”

We walked for perhaps half to a full kilometer until we found a small hillock that was relatively above water and where we could stand without sinking while Vitalis and Saidi continued to communicate with the rangers. It was downright miserable out there as the termites had decided to swarm (yes, termites grow wings and swarm to find new locations to begin their colonies) just this night and were attracted by our lights, landing on each of us as we stood quite helpless. Meanwhile, we kept a watch for wild animals and when I spotted something running about 50 yards away and shined my light, illuminating a spotted hyena whose beady red eyes shone back at us while he watched, I think there was a definite sense that it was probably not the best place to be hanging out at the moment.

At that point, with the gentle, yet firm urging of my residents, I told Saidi that if we didn’t have a definite commitment from the rescuers that they knew were we were or they had seen our lights, then we really needed to go back to the vehicle and wait it out until they either found us or we’d just spend the night in the vehicle and figure things out in the morning. Thankfully, there was really no discussion after that and we began to make our way back to the vehicle, all the while carrying all of our belongings. The major concern by the residents was that we were in the middle of the Serengeti at night with wild animals all around which didn’t seem like a smart idea and was very dangerous.

Though in the end, trying to hike to where the rangers were didn’t help us in any way, I did reassure them the following day that I didn’t believe we were in any danger from the animals that were in the area as the predators would have never considered attacking a group of six humans with flashlights who were made even bigger by all the baggage we were carrying. They simply don’t register us as prey. Unfortunately, there had been the leopard attack on the young boy in the conservation area the week before, so that didn’t help bolster my argument, though that had really been a one-off event and exceedingly rare to have even occurred, given the fact that the Maasai live in this region of the Serengeti every day of the year and attacks just don’t occur. Nevertheless, being out there was clearly frightening whether or not there was a likelihood of being attacked by an animal and whether we were truly vulnerable or not just wasn’t the point.

We slogged our way back to Turtle and made it there without incident other than the fact that it was back through the muck that we had originally traveled and, thankfully, we spotted a good amount of our footprints on our way back such that the return trip was pretty much of a breeze. The three residents and I loaded back into Turtle, while Saidi and Vitalis stayed outside trying their best to reach our rescue party and make some sense of where they were in relation to where we were. Inside my first aid kit (which I recently learned was very out of date as far as any medications inside) was an old emergency strobe light that my son had left behind years ago and, amazingly, it still worked with the D cell battery inside that I later learned had expired in 2022! I had given it to Vitalis when we began our unproductive hike to nowhere and he carried it along with him but now had it up high on top of the vehicle where it could be seen from a good distance.

I know that I was totally drained from having tried to get the vehicle out and then walking a distance in the water, and I’m sure that Ashley, Laura, and Theandra had also had pretty much enough of this experience, so the four of us had mostly resolved ourselves to spending the night in the vehicle, which, given the alternatives at that moment, didn’t seem like such a bad idea. It was cozy, there were no animals inside, we had a few scraps of food with us, and it would soon be light enough to walk out. After about half an hour, though, the news came that the NCAA rangers had finally located us, and that they could see our lights as well as we could see theirs.

The only problem, though, was that their vehicle couldn’t get very close to us and was on the other side of the river of water that was flowing quite quickly at this point. This meant that we would have to once again leave the vehicle with all of our baggage and now cross what amounted to a nice little stretch of water whose depth was mostly unknown, though had to be shallow enough as Saidi had walked over to them, and they were now crossing to help us. Again, it was pitch black outside other than the beams of several flashlights. I remember someone remarking when one of the rangers showed up that they were thankful they had a rifle with them, though I think any predator would have cleared the area long before given the activity that was now going on.

I remember seeing Ashley walking unassisted across to where the ranger’s vehicle was, but one of them thankfully helped steady me as we crossed for I stepped into a huge hole that was totally hidden by the flowing water and nearly tumbled over. I had a backpack on my front and my heavy camera bag on my back plus was carrying one of my cameras with a long lens that wouldn’t fit into the camera bag. Had the camera dropped into the water, it would have been pretty much ruined, but thankfully it didn’t. When we reached their vehicle, it was a Land Cruiser pick-up truck with a crew cab and I started to climb into the back, but they insisted that I sit in the front seat with the three residents in the back seat, which I’m glad they did for if I had ridden in the back, I think I might not have made it. They were going to take us to Ndutu Safari Lodge at the request of the head of the NCAA, and we were going to spend the night there as it was unsafe to make the journey back to Karatu at night, so they were going to drive us back home in the morning. Vitalis would have to extract Turtle with the help of a tractor in the morning and make his way out of the conservation area without us. Thankfully, we were informed that we were spending the night and being returned to Karatu at the behest of the head of the conservation area and that we would not be paying for any of it!

Two of the rangers stood in the back with Vitalis and Saidi while Samwel, our driver who was also one of the rangers and who also turned out to be the clinical officer for the Ndutu region, drove at breakneck speed once we were clear of the watery muck that had stranded us in the first place. Samwel later clarified that he was only driving at his normal speed (twice what I would have been driving) given the amount of work they need to complete in the little time they have. Saidi later told me that he feared for his life in the back and eventually sat down so he wasn’t bounced out of the back of the truck. At one point, we came around a somewhat tight corner in the pitch black and there was a huge bull elephant that had just crossed the road right in front of us, and he wasn’t very thrilled that we had interrupted his nighttime stroll.

We finally reached Ndutu Safari Lodge, which is a very old and traditional establishment, and we must have all looked like total vagabonds as our clothes were wet and muddy as were most everyone’s shoes – I had been completely barefoot for the entire adventure, and I had a thick covering of now dry mud that completely caked my feet. The manager met us at registration and told us they were going to make us dinner even though it was already 10 pm, though we were all allowed to take showers first. We were led to our rooms with our bags and were all so incredibly thankful that we had beds to sleep in and that dinner was only minutes away.

I had realized that my right foot was killing me, though wasn’t quite sure why until after I had washed off the caked mud from my feet only to find that I had a large thorn in the sole of my foot. With the aid of my Leatherman, Saidi removed a ½ inch thorn and though my foot felt better, I was to later remove at least three additional thorns over the next two weeks and probably still have others to go. We had dinner and all made our way back to our rooms – the residents with a triple, Saidi and I sharing a room, and Vitalis staying alone. I don’t think I have every been so relieved in my entire life to have had a soft bed and clean linens to lie on after the ordeal we had all been through. We had survived, and though I’d like to say no worse for the wear, I did know that it would take everyone a bit of time to process the entire experience. It would be an incredible story that no one would actually wish they could tell, but if they had too, they’d at least be grateful that it had gone the way that it did. 

Waking to the sounds of the Serengeti is an experience that is not to be missed. It was difficult to tell what the day would be like since it was pitch black when my alarm went off, the others waking to their morning “Jambo” call with a tray of coffee for their room. There was a chill in the air, but on my walk to the main tent for my morning coffee, I could see that there was a layer of thin clouds overhead signaling that it was going to be a gorgeous day for us on the trail. We were planning to leave at 5:45 am, and we came very close as we were under way by 6:00. We left the valley heading for the best possible view as the sun broke the horizon, but before that event was to occur, there would be a kaleidoscope of colors bouncing off the clouds that were present.

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With the trees in the foreground, we stood in the car as the wonderful show before us unfolded as it has here for millions of years, and it was difficult for me not to think of our distant ancestors having stood on the very same ground, pausing to watch in amazement and were grateful that the new day was now reality. It is truly a remarkable thing, that the sun rises and sets each and every day, and without the knowledge we now possess, what must they have thought or was it just a recurring miracle to be seen on a daily basis.

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Our cameras clicked away, capturing the moments that were passing in time, as the air slowly warmed with the radiant heat of the sun, and within a flash, the Serengeti was bathed again in rays of light. We waited several minutes until the miracle was over and then moved on in the direction of the Seronera river. Up until now, things had been running smoothly, though as many of you know, driving a Land Rover in the bush is always an adventure and things can change in a very short time. There was a rhythmic noise that I could hear from my place standing up in the back of Turtle (my favorite spot), and by the time Saidi leaned over to take a look at was a front left wheel that was wiggling, we had lost three of our five lug nuts, and the wheel was loose.

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Now this might not seem like a huge problem for those of you who are adept at changing a flat, but the issue was that we were apparently missing our spanner (lug wrench) which must have been taken out of the car during its many repairs and had never been replaced. Changing a tire without a wrench is an impossible task and, given that we were in the low season and hadn’t seen a vehicle yet this morning, it appeared that we were in a tough position. Thankfully, within 10 or 15 minutes, another vehicle was spotted approaching us on the same road. The driver stopped, and though his lug wrench didn’t fit for Land Rovers and Land Cruisers use different sized lug nuts, he did have a set of wrenches that worked just fine to remove the remaining lug nuts, pull the wheel off the car, and place the new one with the help two lug nuts from our spare tire. The wheel that had been on the vehicle, had unfortunately been damaged running loose, but our spare was good, and we were back on the road in a very short time.

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It was time for breakfast, so we went to the visitor’s center, that is still under construction, but has numerous tables on which to eat, as well as small kiosks selling drinks and souvenirs. There were vervet monkeys hanging around the picnic area, and not matter how cute they look, they can become very aggressive when it comes to food. There were also tree hyrax that live here and though they do not harass you in any way for food, the small birds make up to it. Turtle was parked in the very same spot it had been three weeks ago, and after a short while, I once again heard a clicking sound coming from the passenger side of the vehicle. Sure enough, it had to have been the very same bird that was obsessed with our mirror, constantly chirping and hopping into the mirror as if it were attacking its reflection. This went on constantly.

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We had a hearty breakfast of hard-boiled eggs, toast, sweet rolls, cut up fruit, sausages, pancakes, coffee, tea, and juice, though shared what was left over with several men that were working at the picnic area. Vitalis took the Turtle to the “balloon camp,” which has a shop and could help with fixing things regarding the loose wheel that we had, though in the end, it worked best that we would borrow some parts from a Land Rover truck that was at Dancing Duma with a dead engine. Once Vitalis was back, we started our adventure for the day as we had planned to head far out to the eastern border of the park.

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The dominant geological feature of the Central Serengeti is the kopjes, which means “little head” in Dutch, and are granite outcroppings that occur in various sizes throughout this region. They may be single, or at times occur in a cluster. Pride Rock in the Lion King was an excellent example of a kopjes, and all life here revolves around these little islands of activity. Lion prides will occupy many of them, as well as leopards, and even an occasional cheetah. The roads throughout this area crisscross between the kopjes and when searching for cats, you drive from kopjes to kopjes in hopes of locating their resting spot.

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One of the biggest groupings of kopjes is Maasai Kopjes, named for the fact that prior to the formation of the park, there were several Maasai bomas here. They are located centrally and are quite distinct so they can be easily spotted from a distance. We began our game drive here, though the game were very sparse as we knew the migration was in Southern Serengeti and Lake Ndutu.

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We had really wanted to search for cheetahs and leopards today, though in listening to the short-wave radio, there were few spottings of leopards this weekend. We knew, though, that should be cheetahs out in the direction of the Gol Kopjes, as this is where we’d also find the bulk of the migration – the wildebeest and zebras with all their recently delivered babies who would be prey for the normally solitary cheetahs that would have difficulty taking down a full-grown animal other than the smaller Thompson or Grant’s gazelle.

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We kept on driving further and further out until we were nearing the eastern border of the park and eventually came upon two cheetah who were being observed by a cheetah research vehicle. As mentioned, cheetahs are solitary animals who typically live and hunt along except for mothers and their babies, or siblings of the same sex who live and hunt together for a time but will eventually go it alone and then find a mate. For the two cheetahs we were observing, it wasn’t initially clear, but they turned out to be a younger appearing male, who was very interested in mating, and an older female, who wasn’t.

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They sat in the grass for some time, but then moved closer to the road, with the female lying on one side of a bush, and the male on the other, though constantly moving around on either side and the female paying very close attention to his advances and snarling each time he got close. It didn’t appear there would be any action as the female was having none of it and, so, after some time, we drove on to look for other cats.

There were lions on several of the kopjes we drove by, but they were all sleeping which is what they do best when they’re not hunting. A large solitary male was under a try snoozing away and barely looked up as we passed by within several feet of him. These animals are very, very serious about their sleep and there is little they will allow to disturb it. The lions here are typically well fed, either by the animals that are migrating or by the resident animals who remain here in Central Serengeti year-round.

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It was getting late in the afternoon, but we continued to drive towards the east and eventually reaching the furthest most of the Gol Kopjes where we found two male lions who were brothers resting with an incredible view of the plains before them. There was another vehicle there who told us of a cheetah hunting that was yet further out, and it was off for the hunt. After a bit of time and scouring the area, we found the lone cheetah who was clearly on the hunt, though unfortunately, the prey it was seeking were a long way off and the shadows were getting longer and longer with a very long way to go to reach our camp. We followed the cheetah for some time but eventually decided not to call it off and head for home.

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The drive took us very close to Naabi Hill, the entrance gate we had originally come through, as we finally reached the main road, then left it again to transect the plain heading towards the valley where our camp stood. We typically fuel up on Saturday evening but had been out too far to drive all the way to Seronera and then back to camp, so decided that would happen tomorrow morning. It wasn’t a big deal, but did mean that we’d have to make the hour trek there in a direction opposite of where we were heading for the day, which was to be the Southern Serengeti and Lake Ndutu. We’d make do regardless, and besides, there are animals everywhere here, so any drive is a game drive.

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We made it back to camp with time for a shower, then dinner and, of course, a cold Safari beer. It was an African menu tonight that was delicious. We would be having breakfast here in the morning before departing camp.

The Rift Valley Children’s Village is a very special place for so many reasons, and I have been traveling there for the last 15 years as part of my work with FAME to provide neurologic care to the children living there as well as to those residents in the Oldeani district that surrounds the village. In fact, FAME’s location in Karatu has a great deal to do with its proximity to RVCV as the ability to provide medical care to the village and their community was something that Mama India, founder of RVCV and the Tanzanian Children’s Fund, recognized this and had suggested to Frank and Susan that it would be the perfect location for a medical center and hospital as the entire area was vastly underserved medically. As they say, and the rest is history, for the partnership has been integral to the success of both organizations.

Early on, FAME provided twice monthly medical clinics at RVCV, and we would typically tag along to see the neurology patients. For a number of reasons, though, it became more efficient to send patients to FAME for their care, but we have continued the neurology mobile clinics there twice a year when we are in Tanzania. Today (Wednesday) would be our first of those clinics for this season, and we would also be there tomorrow. Africanus, a wonderful clinical officer who began his career working with neurology at FAME as a translator and was then hired by FAME, moved over to take over the entire clinical operation at RVCV, and has developed an amazingly organized medical clinic including a new building that has truly upped the level of care that patients are receiving there. Early on, India recognized the need for better health care not only for her children, but also for the community as her children were going to school with the other children and having an unhealthy environment was not good for anyone. This philosophy has proved to be incredibly successful over the years based on the health of the community and how well all of the children have done with their education.

We left Karatu in the direction of the Lodoare Gate into the conservation area and turned off the tarmac after about 12 kilometers onto a road that is somewhat ominously named, “African Massage Road.” Besides being an incredibly bumpy road that during the rainy season can become nearly impassible, it also traverses some of the most gorgeous and idyllic farmland that one could ever imagine. The road initially travels along a ridgeline bordering the deep valleys that are common here and then descends to the bottom of the valley along a very steep and rocky road. On descending into the second valley and crossing a stream at the bottom, the road makes a very sharp hairpin turn and quickly ascends again up the opposite wall.

This turn is quite memorable for me as it is the very place I drove in East Africa and was on one of my very first trips here. We were in a small Toyota crew cab pickup, and neither the driver of the vehicle, nor anyone else in the car, could get it moving up the hill without stalling. After several unsuccessful attempts by the Tanzanians, I offered to jump in the driver’s seat and take us up the hill and on to the village. When it was time for us to depart, they asked if I was Ok driving home as well, at which I practically jumped into the cockpit for I could think of nothing more exciting than driving in East Africa and it fulfilled a childhood dream in doing so. Since then, I have driven thousands of miles in Tanzania, mostly on dirt roads and in Land Rovers, something I never thought would have been possible in my lifetime.

Though the African Massage Road isn’t the worst road here in Tanzania, it can become very treacherous in the rains and change at a moment’s notice when the rains come. Even the level stretches of the road will become a slip and slide with the rear end of the car swaying from side, but the most fun is going down the steep inclines as you can’t even think about tapping your brakes which will cause the vehicle to begin sliding down the hill with very little control. In this situation, it’s imperative that you use the engine as your brake by using lower gears and even shifting the transfer case into low range.

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The drive on Wednesday was perfectly dry, but then it rained heavily that night and made for a much more thrilling drive on Thursday. Going home the first day, I had taken a shortcut which is a favorite road of mine for its sheer beauty, but it is also a more exciting road to drive, and it has a very steep descent into the bottom of a valley, and then a correspondingly steep ascent that is very bumpy and requires maintaining your momentum throughout. I didn’t even try that road on our return trip the following day, for if I had, I was worried there might have actually been a mutiny aboard. Thankfully, no one drove stick shift to have taken over the wheel, so that was reassuring.

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We saw many interesting patients over the two days we spent there, though we have no access to labs or our CT scanner while we’re there and, if any studies are required, the patients are sent to FAME the following week and would be seen in follow up after those studies were completed. Ashley saw a young 6-year-old child with a year’s history of gradual onset of inability to ambulate, but without bowel or bladder dysfunction. On examination, she was clearly myelopathic making us most concerned for a tethered cord, a condition in which the spinal cord, which lengthens at a small amount than our spine such that the end of the cord is actually at the L1/2 level normally in adults, is tethered, or fixed, and becomes stretched and injured. The treatment for this condition, when it exists, is surgical. We recommended that she come to FAME the following week so that we could run some labs and discuss further evaluation.

Another child was seen, with a long history of epilepsy that had been well controlled but now presented with a right hemiparesis and left facial weakness. Having what are referred to as crossed motor signs with the body and face localizes to the brainstem after the corticobulbar motor fibers have crossed in the pons and the corticospinal fibers going to the body have yet to do so at the pyramidal decussation in the medulla. We had recommended an MRI scan which really would be the study of choice for any pathology of the brainstem, but it was unclear whether that was something that would be in the means of the clinic or the family. Having the child come to FAME for a CT scan would be worth a consideration, but we would wait until next week for more direction.

The ride home was uneventful, other than taking the shortcut I had described earlier, and it was a quiet evening at home for us, other than the fact that Denzel, Annie’s son, developed fevers and she had to bring him to FAME to be seen. He subsequently had some nausea and vomiting the next morning such that Annie had to miss our Thursday trip to RVCV. It had rained and rained overnight, making the African Massage Road more of a mud bath and causing a bit of silence in the car until we arrived safely, but we did and were ready to see patients. Unfortunately, with the rain and mud, clinic was a bit less well attended than the day prior.

One of the huge benefits of traveling to RVCV for our mobile clinics are the lunches we are served. They have a significant number of volunteers on a regular basis at RVCV, and they have a wonderful volunteer kitchen where the mamas bake fresh bread and serve incredible food. Wednesday’s main course was tuna salad and egg salad sandwiches with fresh fruit and a green salad. Freshly bakes cookies were there for dessert. On Thursday, we were served rice with either beef or chicken over it along with the fruit and green salad. The Tanzanians typically don’t eat with us for lunch, which bothered me early on until I was finally told that it was their choice as they didn’t like the food being served to us and would rather eat their traditional African food than ours.

We had planned to go out to the Sparrow on Thursday night for some dancing, but with Denzel sick, we couldn’t possibly have proceeded without Annie in tow, so it was postponed until next week.  We would be leaving for the Serengeti first thing in the morning, and I had to get Turtle to Vitalis so he could make sure that everything was shipshape. Leonard had offered to have us take their Land Cruiser, but with the recent rains having come, we all agreed that that Land Rover would be a better choice despite the fact that it had less creature comforts than the new Land Cruiser. Unfortunately, Vitalis’s Noah (van) that he was taking had a tire problem on its way and he had been stuck in Mto wa Mbu for two hours, ending up arriving very late in Karatu. We ended up deciding to have him come to our house at 6:00 am to pick up the vehicle and begin our trek once again to visit the Serengeti. Everyone was super excited, and we had our lunch prepared for the following day.

We had been on the road to Basodawish yesterday with a clinic that started slow but eventually gained steam and proved rewarding in the end for both the number and assorted diagnoses of the patients. It had been the first day of Eid al Fitr, and a national holiday, so we had expected that our patient load would be slower. Today was also a national holiday as the second day of Eid, though it would be the only day this week for us at FAME, so we had hoped for many more patients than we ended up seeing. We had several patients with epilepsy, but, in general, the volume never intensified throughout the day. We ended up seeing only several patients that came in early, so it was perfect timing for us to consider some other activities that we could do later in the early evening.

Also, Jill was heading back home today as she had only planned to spend a month here. She also had a Tanzanian colleague and friend from Karatu, Lightness, coming to visit her in the US right after returning. Lightness would be attending an international conference in Pittsburgh, but would be flying into Philadelphia first and spending several days, so Jill had her set up to visit a book repository (Lightness is building a library in Karatu, a novel idea here as there are no libraries) where she would look into acquiring books and also visiting some schools in Mt. Laurel, New Jersey, where she could meet with some other teachers and observe some classes. Jill would be departing FAME at around 11:00 am and departing from Kilimanjaro International Airport around 6:00 pm. It will be tough having Jill depart before me, but the opportunity to host Lightness even for a few days is huge and, besides, Black Rhino was going on break in April so she would have been stuck working with us for two weeks.

Meanwhile, we hadn’t visited Daniel Tewa yet, something I have done with each group now for 15 years, and each have found it incredibly informative and very rewarding. Daniel is a remarkable individual whose skills at storytelling and conveying historical facts about the Iraqw culture and Tanzania are simply amazing. There are few individuals who I have met in my life who could equal Daniel’s abilities, and the fact that he has lived through most of Tanzania’s history, from pre-colonial times to independence and now to its emergence in today’s world makes him quite a unique person and a treasure to the country.

I texted Daniel early in the day to ask if he would be available for us to visit sometime next week, but unfortunately, he texted me that he would be away tending his fields several hours away from Karatu. Given our slow day, I texted him again and asked if it would be possible for me to show the residents his underground Iraqw house, he said sure, but that he would let his wife, Elizabeth, know that we would be stopping by so she could assist, even though she doesn’t speak a word of English. Since I didn’t think Daniel was available today, which would mean our visit would be very short (Daniel really, really enjoys telling stories), I suggested that we visit Daniel’s house right after work and then run up the hill to see Phillipo and his family (our lovely coffee supplier) and have a coffee tour. I told Phillipo we would be up to their place around 6:00 pm which seemed to work well for them.

We loaded into Turtle (now fixed and running well) and made our way through town to the Gibb’s Farm Road and to Daniel’s property that was at the intersection of this road and the Ayalabe Road. I had first met Daniel in 2009 when we were volunteering at the Ayalabe Primary School for three days as part of our original visit with Thomson Safaris. As a prominent elder of the Ayalabe village, Daniel was there as our local liaison and helping us to paint the school windows. He was such an intriguing person, and I was immediately drawn to him for it was clear to me that he possessed exceptional qualities, and somehow, I must have known that we would stay in touch, though it wasn’t clear to me at the time just how that would occur.

Daniel was also drawn to my children, who were entertained by him while we were working, and thoroughly enjoyed our visits to his home nearby where he told them of the Iraqw culture, and we visited his underground house for the first time. When returning a year later to Karatu and FAME, Daniel was one of the first people I contacted to tell, and he amazingly remembered my children’s names, asking me how Daniel and Anna were doing without even skipping a beat. When I arrived, in September 2010, I went to visit Daniel and his family, and was immediately greeted with a warmth and closeness that I would have only expected from a family member, and a close one at that. Daniel insisted that I stay for dinner, which I did, and we have remained close friends and family since that time.

I pulled into the drive leading to Daniel’s home and was immediately greeted by Daniel, who I had not at all expected to see as I had thought he was away tending his fields. He greeted us with arms raised high and wide, as he does or each and every visit, meeting each resident as they exited our vehicle, vigorously shaking their hands and asking their names as he did, speaking both Swahili and Iraqw amidst his perfect English. It was a lovely evening, and we sat at a table and chairs outside his home, as we have been doing now since the pandemic, enjoying freshly picked avocado from his trees with soft drinks and beer (He always insists that I have a beer and not a soft drink for some reason). Elizabeth, his wife, was away at the moment, so he hadn’t been able to prepare his fabulous African coffee (coffee and fresh milk boiled together) for us which was unfortunate.

While it was still light, Daniel took everyone up to his underground Iraqw house and explained the background of why they had existed. As the Maasai believed that all cows were God’s gift to the Maasai and, therefore, their property, it wasn’t unreasonable for them to simply retrieve, not steal, cattle that was “rightfully” theirs. The Iraqw built their homes underground so that they could store their animals in their homes at night and prevent the Maasai from taking them. When Tanzania was young and trying to develop an infrastructure of roads, utilities, and public services, it was necessary for them to move all the 100+ tribes into multicultural villages rather than trying to continue supplying each tribe on it’s own. The underground Iraqw houses were outlawed in 1974, and everyone had to move into Bantu houses following that. Daniel built this house in 1993 to demonstrate to his children the type of house he grew up in as they had all thought him crazy when he had described it to them.

After touring his underground house, Daniel took everyone to see his methane (biogas) set up out behind his house where he produces enough gas to both heat and cook, though no longer uses it for lighting (which he did when we had first met). The excrement from only three dairy cows fed corn cobs and husks is enough to supply all of his needs and the byproducts from the methane tank flow into his fields to supply a significant component of his organic fertilizer. After that, we walked a short distance with him to pick avocados from his trees that were bursting with ripe fruit and were the largest we had ever seen. I think we left with probably ten large avocados that were not yet perfectly ripe but would be shortly.

At the end of our visit, Daniel had the residents all try on the Iraqw wedding skirts that Elizabeth has been making for some time – several years ago, one my residents received one from her husband (who had also volunteered at FAME) for her first wedding anniversary. The skirts are gorgeous, beaded goatskin affairs that wrap around, and each is obviously very unique. By this time, the sun had set, and it was pushing 7:00 pm – I had phoned Phillipo to let him know that were running late to which he simply replied, “Hamna shida. Karibuni,” meaning, “no problem. Welcome all.” We bid farewell to Daniel and began our trek uphill to the village of Tloma where Phillipo Bomba lives with his wife and children.

By the time we reached the village of Tloma and the Bomba residence, it was dark as the sun had set some time ago, but they still met us with open arms including his young daughter, Eliza, now 8 years old and who I have known for several years. I have photos taken every six months of her on my shoulders with the absolutely biggest smile, though she has been getting bigger and more difficult to lift with each visit. She continues to do well in school and Jill has been bringing books to her over the last two years.

Phillipo has a family business on which he grows several acres of coffee, and along with another family who also has several acres, their crop is harvested by hand and then completely processed in small batches on his property. Once the outer shell has been removed in a manual press, the beans are placed in a water bath to ferment and are then dried. After drying, they are pounded again to take off the second shell, winnowed to remove the chaff, and then placed in a small roasting cylinder that holds five kilograms. The coffee is roasted by hand crank for 40 minutes for a medium roast, then cooled and ready to be bagged in half kilo bags. Each plastic bag is placed in a cloth bag that Fausta, his wife, sews on site.

In addition to the coffee, Phillipo also has dozens of bee hives that are hanging all around his yard with colonies of small stingless bees that help to pollinate the coffee plants and also produce some amazingly delicious honey with floral accents. Each evening, you can watch the bees constantly coming in from the fields and somehow each locating their own hive to deliver the pollen. Each visit, Phillipo opens one of the hives and spoons out fresh honey for us to taste that never fails to impress. His honey is also for sale, though is sold out very quickly.

We left Phillipo’s home very late, and we so appreciated the fact that he was willing to have us visit so late. I have never considered buying my coffee from anyone else since visiting his family. It’s also special to see young Eliza doing so well in school and watching her grow.

We had a wonderful day yesterday in the Crater and, thankfully, the weather held out for the entire day. Not only that, we saw three rhinos at medium distance that was a real treat as it’s often that you visit the crater and don’t get to see a rhino. There are only approximately 30 endangered black rhinos in the crater, and each one is heavily monitored by the rangers to ensure that nothing nefarious could possibly happen to them. The black rhino has very poor eyesight and rely primarily on their hearing to detect any danger, so when it is windy in the crater, they won’t come into the open and can be missed entirely. Last time in the crater, we had seen one at a very far distance and it was lying down. We spotted three two weeks ago from the overlook, but it isn’t often you can do that.

It had rained heavily again overnight which didn’t bode well for our mobile clinic, though at least the road to Basodawish, the village we’d be visiting, would be passable as it is a major highway, albeit dirt, that leads to Mbulu (not to be confused with Mbulumbulu, the district to our east where Kambi ya Simba is located). The other issue regarding our clinic was that both today and tomorrow had been declared holidays for Eid al-Fitr, the ending of Ramadan and the breaking of the fast. Unfortunately, it’s a holiday that can easily move by a day or two depending on the phase of the moon, and it’s impossible for us to reschedule our mobile clinic in such an event.

Basodawish is a very small village that sits on a major thoroughfare heading south from Karatu to the town of Mbulu. There is plenty of traffic on this road, and though there are certainly crossings over streams, it typically does not completely wash out. Other areas such as Mto wa Mbu that sit at one end of Lake Manyara can be inundated with heavy rains to the tune of several feet of water for several miles making travel quite difficult. That happened to us last year and the drive to Arusha looked more and more sketchy the further we went, but luckily, we made it as we would have missed our flights had we not.

We arrived in Basodawish with the two vehicles and the clouds seemed to have parted as the sun was out and it was heating up. The ground, though, was still pretty mucky and I’m sure there were some who could just make the trip to see us. We have been here twice before, and the clinic is somewhat primitive. I had furniture delivered her as a donation from FAME as there were no pieces for us to use in the past and we had to make do with what we had. Two of the benches we donated were sitting out in front of the doctor’s office and, as there were few patients waiting for us, I took up residence on one of the benches with my computer and decided to do some other work while waiting. I had my camera out and ready for when the patients began to show up which they eventually did.

It took some time, though patients slowly filtered into clinic to see us. As with the other clinics we run at FAME, patients pay 5000 Tsh (less than $2 USD) to be seen and for a month, or sometimes more, of medications. In addition, any laboratory testing that was needed, even though we didn’t offer it in Basodawish, we would give patients prescriptions to obtain labs back at FAME when they could make it there. This area is extremely poor, even in relation to those patients we see at FAME, and many patients had trouble affording the 5000 shillings and it was also doubtful they could afford the 1000 to 2000 shillings it would cost for a boda boda (motorcycle) ride to Karatu. To put things in perspective, levetiracetam, one of the most widely prescribed antiseizure medications in the US, is priced at 1500 shillings per pill here and is taken twice a day.

Much of what the residents learn here, and especially in these more remote villages that we travel to for our mobile clinics, is about practicing medicine in a low resourced and extremely poor region of the world where you have to think about all aspects of care to truly make an impact on patient’s lives. Making a diagnosis and prescribing a medication that a patient is unable to afford long term makes little sense and all this needs to be put into the equation.

Eventually, more patients showed up and, in the end, we saw about 15 or so patients – not quite what I’d like, but decent enough that we were kept busy. Theandra and Annie saw a particularly depressing case of a patient who was facing several very challenging social issues with her family. We hear this so often, that husbands leave their family, often for prolonged periods of time, and then return home with their wives concerned for sexually transmitted diseases. It wasn’t an issue for us to place her on an antidepressant, which she clearly needed, but she didn’t have the money to get to FAME to get the blood tests that she needed (and which were included in the price of the visit). I’m not entirely sure what was worked out with this patient, but unfortunately, there were no simple solutions for how to manage her situation.

Ashley and Laura saw a very interesting last patient that left us with lots of questions and not a lot of answers. The patient was brought in by his older brother a number of complaints and a story that didn’t make a lot of sense as he had clear evidence of life-long developmental delay, despite having been moved up every year in school, short stature and very short stubby fingers, but also had numerous lesions on his skin that were concerning for neurofibromatosis. They took photos of his skin lesions and his hands to share with colleagues from CHOP to see if they had some idea of what we might be looking at. In the end, it sounded like NF-1 or one of its variants, or neurofibromatosis, type 1, which is what we had thought, was the most likely suspect, though without genetic testing it would be impossible to say for sure. In the end, it wouldn’t matter tremendously for our patient other than to counsel him or his family regarding risk of future generations having the same condition as this was clearly genetic.

Driving home from Basodawish along the Mbulu road on our way back the Karatu, the skies were blue, and the sun was bright and strong, quite a change from the overcast morning in which we had come. The plateau we were driving across was heavily agricultural and fields of maize, wheat, and other crops extended as far as the eye could see. The small towns that dot this route each have their own small dispensary, and we had just visited one of them. Our numbers for this clinic had likely been low due to the rain and the holiday, though we had seen some good cases, most we could help and a few with unanswered questions.

It was a quiet evening at home and would be Jill’s last night here for this trip. Vitalis would be picking her up tomorrow morning for her ride to the airport, and by Wednesday morning she would be back in Philadelphia. We’re half a world away here and yet can be home essentially overnight which seems so mind boggling. The cultural transition returning home, though, seems to take longer. Missing the multitude of bird songs in the morning, the cool, incredibly fresh air that greets you each day, and the simple walk to work are things that seem so natural here but will all be dearly missed. Our outdoor neurology clinic and lunch at the cantina could never possibly be replicated in the western world, yet each of us brings that home along with the knowledge that there are better ways to do things with far less, and the hope that each of us will continue to strive to make the world a better place. We all have made a difference here and, in doing so, has bettered the lives of everyone for, in the end, we are all interconnected.

With the entire week having been spent at FAME and now having Myrtle back, we were finally able to focus on getting the repairs done on Turtle that had been a long time coming. Prior to my arriving this trip, the entire body had been replaced and/or repaired, and a few other cosmetic things had been taken care of, but one thing that had never worked correctly from the time we purchased the vehicle was the instrumentation and the electronics in the dash. Turtle is a 2009 Puma Land Rover Defender, though the Puma engines were never as dependable as their predecessors, so when we purchased the vehicle from a safari company in 2018, its engine and transmission had already been retrofitted with 300 series components.

Though the 300 engine is tremendously more dependable and fits perfectly into the engine bay, its compatibility with the remaining electronics of the Puma was less than adequate. Despite this, the vehicle ran just fine, and with an auxiliary temperature gauge mounted into one of the dash vents, things had been perking along just fine. This week though, Saidi has supervised work on the car with one of the master Land Rover fundi here in Karatu, and the entire instrument cluster was changed over to match the engine and transmission while mostly bypassing the old ECU of the Puma. It took several days, but amazingly all of the gauges are now working – fuel, temperature, tachometer, and speedometer…all were working for the first time since we’ve owned the vehicle.

It had been raining very hard over the last several days, and worse, it seemed that we were in the clouds each morning that we got up. Thankfully, when it finally started to lighten outside (I had gotten up at 5:15 am to pack the car for an early departure), the sky was relatively clear, and I could actually see the slope of the crater rim from the house. I packed up all the water, my safari books for the others, both of my cameras as well as their long lenses, our first aid kit, our lunch, and watched as everyone in the house gradually appeared from their rooms, ready for an adventure. We were to leave at 6:20 am as we were picking up two others in town at 6:30, and then we’d be off for the crater gate.

Dr. Margareth, who had recently finished her pediatric residency at KCMC and was volunteering at FAME, had asked to come with us today as she would leaving shortly after spending several months here. Dr. David, one of FAME’s newer clinical officers had also asked to come along and, since we had room, I had told him yes. I had invited Saidi to come with us as well, so with the five of us, we’d have a full car with 8 people. The cost for a Tanzanian to get into Ngorongoro Conservation Area for the day is less than $5 USD (as opposed to the $70 USD it cost each of us), which is certainly appropriate, but the problem is that the reduced entrance fee does little good unless one owns or has access to a vehicle that can bring them. A safari vehicle here typically costs anywhere from $200 to $300 a day with a driver, which is entirely out of the reach for any Tanzanian.

Back in September 2020, I had come to FAME alone as none of the residents or medical students were allowed to travel because of the pandemic, and during that trip, I had the opportunity to bring a carful of Tanzanians to the local parks – Tarangire, Ngorongoro, and Lake Manyara. For many of them, it was their very first game drive, despite having grown up practically next door to the parks.  I remember bringing a car full of Tanzanians to the Ngorongoro Crater Lodge, probably one of the most exclusive and expensive lodges in the area, to have coffee and cookies as guests of a close friend of mine who works there. Here was a place that none of them would ever have the opportunity to visit on their own, yet they were able to be served in the main house and take selfies of themselves on the steps overlooking the crater. It has been opportunities such as this, and the ability to bring these Tanzanians to the crater today that are one of the reasons I return year after year.

Ngorongoro Crater, from the rim to the bottom, is, quite simply, one of the most breathtaking locations on earth that anyone could possibly visit. I have come here dozens and dozens of times, and it has never gotten old. I will continue to come to this remarkable place for as long as is humanly possible for me. We traveled down the descent road to reach the bottom of the crater and immediately made our way towards a group of vehicles that had clearly spotted something. This number of vehicles would usually correspond to something relatively common, but when we arrived, there were three adult rhinos in the near distance that you could see without binoculars – two were grazing together and were probably a couple, while a third was some distance away, munching vegetation on its own. They remained for an inordinate amount of time with us snapping as many photos as we could, for they are typically quite shy and skittish – surprising for an animal their size and with no natural predators.

There had been plenty of precipitation in the preceding days, so the crater was very, very wet, and many of the roads close to Lake Magadi (the large alkaline lake whose name comes from the Maasai word for salty) were flooded and impassable causing us to reverse course on several occasions. The best part of the day, though, is that the rain completely held off until nearly the last possible moment before we began our ascent out of the crater. There was no bright sun throughout the day, which made for perfect photography weather and Saidi nailed a few of them using both my extra Nikon camera that he was shooting as well as his own Sony ⍺7 mirrorless camera that he recently acquired. We drove around all morning and found lions, hyenas, wildebeest, Cape buffalo, Grant and Thompson gazelles, eland, hippos, elephants, warthogs, and innumerable species of birds that were far too numerous to list.

We had lunch at the usual spot, Ngoitokitok Picnic Area, where there is a lovely lake with hippos who don’t feel threatened and don’t bother anyone. The main problem at the picnic area, though, are the Black Kites. These medium sized birds with up to a five-foot wingspan sit in the trees and ply the skies just waiting for an unsuspecting guest to open their lunchbox on one of the many picnic tables and pull out a piece of chicken or a sandwich before they swoop in silently and snatch it right out of your hand. When there are many kites around, we have to eat in the car while we watch the show outside as these birds divebomb parties of visitors, stealing their lunches. I had one take a piece of chicken right out of my hand only inches from my face as I was about to take a bite. I felt only a quick breeze and it never even touched me. Jill had one steal a sandwich from her. So, as we all sat at the table today, I had eaten half of my peanut butter and jelly sandwich and was explaining to Theandra what to watch for as I hadn’t seen any of the kites around yet, when I suddenly felt my sandwich leave my hand. Thankfully, it only fell on the table and somehow the bird missed grabbing it. I calmly finished my sandwich at which point everyone had been forewarned.

After lunch, I looped back around the lake to head back to where we had started and then began our exit through the Lerai Forest where you can spot families of elephants on occasion. We didn’t see any today, but did see a troop of Black-faced Vervet monkeys with lots of little ones climbing in a tree just before departing. We had put our roof down before entering the forest as it had started to drizzle a bit harder, so as I left the forest, we turned up the ascent road to make our way slowly home. The ascent road is one of three roads into or out of the crater – there is also a descent road and a single two-way road. Both the one-way roads have been paved with cobblestones to help with traction on these incredibly steep grades. It was very treacherous in the past with many accidents going into and out of the crater with lots of accidents that have been reduced, but the rim road is still dirt and somewhat narrow so there are plenty of spots to get into trouble there.

I was so happy to have gotten to drive the crater this trip as I had missed it with the last group due to car troubles. It’s one of my favorite things to do in the world and I could never possibly get enough of it. Since the Ngorongoro Crater Lodge is closed for renovations (two years!) and we didn’t plan to stop there, we left through the gate with plenty of time to spare before they locked us in the Conservation Area at 6 pm as has almost happened numerous times in the past. We drove home, relaxed for a few minutes and we all went out to the Lilac Café downtown for dinner. Everyone, except Ashley, ordered cheeseburgers (she had their delicious chicken curry and rice) which were very, very good and certainly worth ordering again. We all went home tired and ready to start the new week. We were heading to Basodawish tomorrow and looking forward to more adventure.

I had scheduled today as a half day as the residents will have just completed working five days straight after a strenuous flight from the US which is rigorous enough for Africa. With the last group, we had planned for a dinner at Gibb’s Farm and an afternoon at the pool relaxing. With this group, I had decided to change things up a bit with a little encouragement from Nish Dodhia, who had suggested that we might want to try the Manor Lodge, which is another of the very fancy, and expensive, lodges in the Karatu region that caters to the wealthier clientele traveling on the Northern Safari Circuit.

Most of these lodges in Karatu are very accommodating to volunteers at FAME, giving us a discount for meals, but also allowing us to use their facilities for the afternoon prior to our dining. Similar to Gibb’s Farm, the Manor Lodge has a nice pool, as well as a stable and horses to ride, and our plan was to head there for the afternoon to relax around the pool and then enjoy an elegant dinner. Unfortunately, we hadn’t quite accounted for the possibility of heavy rains and lightning throughout the morning and, even as it seemed to clear up a bit over Karatu and towards the east, there remained dark and ominous clouds over the crater rim to our north exactly where the Manor Lodge sits. Though it seemed quite unlikely that we’d be going to the Manor to swim, we kept our options open as we began clinic for the morning.

Saturdays are typically a bit slow at FAME in general as well as for our neurology clinic and today proved to be no different. Between the rains and it being Saturday, patients were slow to show up. Our first patient of the day turned out to be a non-neurological case that had somehow slipped through, though I’ll have to admit that our triage procedures have been slacking a bit and could use some revamping. As the neurology clinic is subsidized, meaning that patients pay only 5000 TSh (less than $2 USD) for their visit, any labs and 1-3 months of their medication depending on the circumstances. But this flat fee is for neurology patients only and is not meant to be for the general population of patients. The reason for that has to do specifically with sustainability and funding. We are entirely unable to support providing this type of arrangement for the general population of patients.

Patients, though, have become aware of the how the visit is handled in the neurology clinic, and hoping to benefit from the flat fee will tell reception that they have a neurologic problem or complain of something that is close enough to neurology that they will be triaged to us and it is not until the patient sits down with us that their true complaints become evident. Our first patient of the day was just such a case, and their problem had nothing to do with anything neurologic, though they did have pain in their lower extremities.

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The patient had severe swelling and skin changes that were consistent with elephantiasis, or lymphatic filariasis, a mosquito borne parasite causing an infection of the lymphatic system and swelling typically of the lower extremities and genitals. Treatment here is with ivermectin, an antiparasitic medication first used for veterinary applications and subsequently approved for use in humans for the treatment of parasitic infections, though was also at the center of significant disinformation during the COVID-19 pandemic when it was reported to be useful for this treatment, though was never backed by any scientific evidence whatsoever, and finally fell out of favor. The patient that came to see us could only afford the cost of the visit, but not the medication, which would have been a problem in the OPD where patients are charged for their medications. The medication was not expensive at all, though, so I agreed for us to see the patient and not refer them to the general OPD, which seemed far simpler to achieve a positive outcome for the patient.

We finished up in clinic after a smattering of typical patients for us, though one patient, whom we had seen before, returned for additional labs. This was a young man who most likely suffers from Becker Muscular Dystrophy based on his clinical course and current level of disability. He did have a family history of an uncle being non-ambulatory in his middle age and both this and our patients deficits at his age seemed to correlate best with Becker MD as opposed to Duchenne MD which causes tremendously greater disability and death at a much younger age, though Becker also has a reduced life expectancy.

We checked the patient’s CPK (CK) which was still elevated similar to what it had been before, though we didn’t have any further diagnostic testing to provide here at FAME. Patients with muscular dystrophy also have other complications, most notably cardiac abnormalities, and they reported that the patient did have an echocardiogram performed previously, which was helpful.

We had already placed the patient on steroids previously, though had somehow been tapered down to a dose of 5 mg of prednisolone which is fairly homeopathic. Though there are no good randomized, controlled studies in Becker MD, there are in Duchenne MD where it has been shown that fairly high dose steroids can preserve ambulatory function for longer and can also reduce the risks of cardiac involvement over time. Though there are no studies in Becker, the general consensus has been to use steroids, and if there are no complications or significant side effects, to continue them for some time. We recommended this and gave them a prescription for higher dose prednisolone along with something to protect his stomach from the steroid use. He will come back to see us in follow up, though also plans to be seen shortly at KCMC by Dr. Dekker and we’ll do our best to collaborate on a plan of action going forward. Genetic testing would be very helpful to confirm his diagnosis, though this testing is very expensive.

We had planned to wrap up clinic sometime after noon and to have lunch at FAME as they serve rice and beans on the weekend, which, of course, we all know is my absolute favorite lunch. Jill had gone for a walk earlier, but then the rains came, and she decided to just eat lunch at home and wait for us. While we were at the cantina for lunch, a thunderous downpour began which pretty much made our decision of not going to the Manor Lodge for an afternoon at the pool given the dark clouds that continued to hang over the Conservation Area where the lodge sat. We had discussed alternative activities given that we had the entire afternoon to ourselves and decided on driving down to the African Galleria to do some shopping and visit with Nish.

As we drove out of Karatu, the skies seemed to open up and we actually had some blue above us, though the dark clouds remained to the west and north. Lake Manyara was fully visible in the distance looking down past Chem Chem into the Rift Valley below as we descended the sharp curves of the highway heading towns the village of Manyara where the Galleria sat. Coming home, we drove past a mangled tractor trailer that had lost its brakes on the descent with its rear trailer having overturned and the cab looking like it had been crushed by Godzilla. It had just occurred and there were lots of bystanders and other vehicles that had either stopped to help or to gawk, it was difficult to tell.

We spent well over an hour shopping at the African Galleria, now called SafariLand, though I much prefer the old name as the new one is just a bit too much “DisneyLandish” for my liking. Everyone found things including some jewelry, which is Nish’s expertise and what he likes best. Tanzanite, a rare gem that is mined just south of the Kilimanjaro International Airport in the Blue Hills is obviously a favorite here, as it should be, though I’m very particular to Tsavorite, or green garnet, a gorgeous sparkly stone that is just a bit harder than Tanzanite, and is significantly rarer, and consequently more expensive. It’s fun looking at their gems, even if the larger stones are way out of our price range.

We left the Galleria to return home, only to change our clothes for dinner at the Manor Lodge but seemed to loosing daylight as we went. The drive to the Manor ascends up through the Shangri La coffee plantation high up on the ridge behind FAME and there is actually an easement through part of the Conservation Area where an electric fence helps keep the elephants inside. As you arrive to the lodge, there are massive gates to let us in and we are immediately transported to the grounds of an estate that would have been what parts of Africa looked like in colonial times.

My plan had been to get there well before sunset, and though we missed that window, there was still plenty of daylight present that allowed everyone time and light enough to meander about their extensive grounds. The Manor Lodge is comprised of the main house where the dining room and lounge is, as well as a large downstairs media room where they can show football matches. There are 9 duplex cottages that are gigantic in size and there is a stable cottage that can also be used for a family. There is a lovely swimming pool for guests as well as others such as us who are volunteers visiting from Karatu.

The three residents spent some time walking the beautiful grounds of the Manor Lodge, though not until we had ordered our drinks. Once our order arrived, they brought appetizers to us outside that were so numerous it almost felt like this was our dinner – cheese samosas, small chicken bites, warmed cashews, potato chips, and taro chips. The staff built a fire for us outside as there was a bit of a chill to the air once the sun went down and it was so relaxing to sit with our drinks under the multitude of stars that were visible to us. It turned out that we were the only guests there that night, so we essentially had the entire place to ourselves.

As the only guests, they had set up a table facing the large fireplace in the lounge where in the past I had only eaten in dining room with other parties or once outside on the veranda. As in the past, there was more silverware than I’ve ever seen on a table, and it was set perfectly for us. It was an entirely spectacular setting for an incredible dinner – we all ordered the five-course tasting menu that was just delicious and were small portions of each course, so we were not stuffed at the end, but had been served a perfectly appropriate amount of food.

Driving home that night was a bit slippery, which is exactly why I drive a Land Rover as the low center of gravity is designed for these kinds of terrain. I’ve definitely driven worse, but the rain and mud here can certainly make driving conditions quite treacherous at moment’s notice. Driving on the FAME road, we followed a boda boda with something I’d never seen before – a driver and a passenger who was holding a calf on his lap. They were driving a bit slowly, but I was nervous to pass them for if the calf somehow wiggled loose and ended up on the road, I would have struck it, something that would clearly have ruined our evening. In the end, we did pass them, though it was sure a sight I wouldn’t forget.

The rains were again very heavy overnight, and continued into the morning making the roads a muddy mess and keeping patients from coming in. We had morning report, though, and reported to our neuro clinic space at 8:30 am to an empty “waiting room,” which are the benches sitting immediately adjacent to our outdoor clinic. The rains were so heavy at times that it was nearly impossible to hear when anyone was speaking, and the Tanzanians speak particularly soft on a regular basis, further increasing the difficulty communicating. And me, with hearing out of only one ear (due to a bout of labyrinthitis in 2017 that left me deaf in my left ear), it was virtually impossible for me to hear anyone when the rains were at their greatest.

The roof over our clinic area is fiberglass, greatly amplifying the sound of rain, though most of the roofs here in Tanzania do the same thing regardless as they are either metal or fiberglass and will make even the lightest of rains very audible. Overnight, the rains will awaken you with or without the loud thunder that will often accompany it.

The clinic was very slow today with only a total of 9 patients to be seen, and they were a mix of the typical diagnoses – headache, epilepsy, and numbness and tingling. Dr. Frank, though, did stop by to tell me that a tourist had been horseback riding in the conservation area and had fallen from their horse striking their head. They felt fine apparently, but couldn’t remember the fall specifically, so they were on their way here to FAME to get a CT scan. It would take about three hours for them to arrive and it was already well after noontime, so the question was when they would actually arrive.

We often talk of “mzungu time” (“mzungu” meaning stranger and includes anyone not born here in Tanzania and of any ethnicity) and “Africa time,” that refers to what one should expect. Mzungu time means on time as it would at home in the US or Europe. Africa time refers to the often more laid-back schedule here and could range to within several hours of when someone is supposed to arrive to half a day depending on how far someone is traveling and what encounters they may have on the way – rains, washed out bridges and roads, car trouble, etc. With this patient coming from fairly far in the conservation area, that could prove to be a problem given the heavy rains that we were having, and which were surely occurring there as well.

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Sure enough, we expected the patient to have arrived around 3 pm or so, but we were long finished with patients, and they were not here. As we were packing things up for the day the patient, of course, arrived and looked particularly well. We went back to clinic, and I had the residents quickly evaluate the patient, who spoke some spotty English, though wasn’t entirely fluent making the mental state exam a bit difficult. The patient spoke French, which Yombe spoke fluently, though unfortunately wasn’t here any longer. They exam looked very good and there was little worry of anything serious, though we were still going to obtain a CT scan as that had been decided before they even arrived here given the fact that they were a tourist and a safari company was responsible for their health. We walked home as it would take a few minutes to get the scanner up and running, but we would be called when it was finished. As expected, the scan was entirely normal with no signs of any significant injuries or otherwise.

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As we walked back to the reception area to speak with the patient’s tour guide as well as the patient, Theandra called Yombe in Philadelphia, who proceeded to speak to the patient in fluent French to give her our recommendations. She had had a mild concussion as she didn’t recall the accident itself but was otherwise entirely fine. She was scheduled for more horseback riding, and I suggested that she take it easy for a few days before returning to any galloping around on a horse, but mostly to rely on how she was feeling to direct her activity level. If she developed any additional symptoms, she should take it easy for a day or two and then resume. She didn’t require any additional treatment or medications.

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We had decided to have dinner at home tonight but would then head out to the Lilac Oasis for Karaoke (once again) given just how much fun everyone had there previously. Besides, Annie wanted to hear Jill belt out one her gritty delta blues songs again. It was still raining off and on during the afternoon and evening, and the rain continued to come down during our time there. One side of the bar opens onto a veranda that overlooks thick vegetation leading to a small river and the tree frogs were croaking boisterously as if they were serenading our group. Being inside during the rain while still being able to hear nature outdoors was very special, though once the music got going, the inside action certainly took front and center.

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The power went out several times early on, wreaking havoc on the internet, and putting our karaoke night in jeopardy, but things eventually came together, and a list was made of everyone’s preferred songs to perform. There were also other guests who were equally interested in participating in the karaoke, and given the number of open mikes, there were typically multiple people singing each song.

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When Jill’s first blues song, Women Be Wise, came up to sing, the lyrics were showing up at all, though the instrumental still played appropriately, so she just sang it from memory which I think blew everyone away, me included. That was just more than anyone expected. As time went on, everyone got into the action as well as some dancing, though I kept my record intact as I only filled in for the missing Yombe on one song, repeating the phrase, “it wasn’t me” whenever it came up in the lyrics. Sure wish I could remember the name of the song. Though it wasn’t entirely “Midnight at the Oasis,” we were there quite late and once again seemed to close the place down. We had clinic in the morning, but only a half day, and no one had really drunk extensively during the night.

We had also ordered a bunch of food (which took an inordinate amount of time to come out in classic Africa style) as the menu here includes most barbecued meat – chicken, beef, goat – as well as chips mayai (French fries and eggs cooked into a frittata). The grilled beef was some of the most tender I have tasted in Africa. We had plans tomorrow for dinner and the pool at the Manor Lodge, though it would really depend on the weather regarding the likelihood that we’d be spending time outdoors. The road to the Manor is a trip as you pass through an easement in the conservation area to reach the lodge.