Sunday, March 24 – Leaving the Serengeti and an incredible visit to a friend’s boma….

Standard

Sunrise at camp in the Serengeti

It was our last day in the Serengeti as we’d be heading back to Karatu today, but we still had at least half a day of exploring before we left. We were up early for breakfast which was a delightful affair and made even all the more so by the presence of everyone’s favorite, pumba bacon (no longer an oxymoron, by the way, given all of the healthier versions of bacon we have in the markets) much to our appreciation. Though we had wanted to be on the road early, I think we all enjoyed sitting just a little longer for the meal today as it would be our last in camp. The camp, Tanzania Bush Camp, has exceeded everyone’s expectations, I believe, and have been here several times before, they have never let me down. The staff are incredibly friendly and have a willingness to help to goes well beyond. I’d highly recommend them to anyone setting up their own itinerary here or making suggestions to someone else. There’s little question that you feel fully pampered here at camp, but this is one of those times where it truly makes a difference and is more a part of the culture than anything else.

A group shot with our camp crew

Lilac-breasted roller

We headed off once again in the direction of the Maasai Kopjes, but looped around towards the village of Seronera before reaching them. Some of the sights included a hippo pool with virtually, and literally, tons of hippos basking in the morning sun, constantly flicking mud and water onto their backs and occasionally rolling completely over (a real feat for an animal this size) to prevent from becoming sun burned which they can easily do if they’re not too careful. The most striking thing, as you might imagine, is having all of those hippos in a pool and the accumulation of their feces and urine, which makes for a pretty ripe concoction and something that you will smell long before you hear or see them. Not that you would ever consider having lunch next to such a pool for the sole reason that the hippo is the deadliest animal in Africa and can run far faster than you would every imagine, but the stench would cause you to so quickly lose your appetite that it could be marketed as an incredibly successful, though not popular, weight loss program.

“You looking at me?”

Marabou storks

We came upon a huge heard of wildebeest and zebra at one point that were making their way to a small river crossing to drink, but looked very, very nervous and it became readily apparent why when we spotted four lionesses moving in their direction and clearly on the hunt. They were positioning themselves for a kill and very quickly things became very tense and exciting, but somehow, they let the bulk of the herd through, leaving some stranded zebra by the water. We were super excited as it really looked as though they were serious and we were going to see a kill, but they became disinterested, letting the stragglers through and then making their way across their way across the river towards some other animals. It was decided that they were not serious enough at the moment and, so, we moved on in the direction of Moru Kopjes.

Lionesses hunting

Lionesses hunting

Vitalis had taken Kathy and me to the Moru Kopjes last year and they were some of the most beautiful landscape I had seen here so it was decided that we would go there again. There are black rhinos in this area as well, though we didn’t see them last year and struck out again this year, unfortunately. There was less wildlife there at the moment as the grasses were not optimal for the migration despite being very green and lush. The topography, though, made up for the lack of animals that were present here. We did see some elephants very up close that were crossing the plain, much to Dan and Marin’s approval as they had missed our elephant escapades at Manyara several weeks ago and we could only see them from the distance in the Crater. The elephants that we did see were three huge ones crossing the road around us so both of them had a great experience of seeing these amazing and huge animals up close and in person.

Why did the lion cross the road?

A Montagu’s or pallid harrier in flight

In the far reaches of Moru Kopjes, we visited the Maasai drawings and Ngong rock, two vastly different sites. The Maasai drawings are not ancient, but are drawings made by the Maasai who come to this spiritual site as part of their rituals of manhood that include the circumcision ritual (held every seven years for late adolescents and young men who come of age) and also when the men go into the wilderness alone for months to prove their manhood that previously included killing a lion, but no longer does. Ngong rock is a large boulder that sits atop the kopjes and when stuck with another rock makes a “singing” sound of hollowness that is different than any of the other boulders around. It is also in a lovely spot and we took every advantage of our time here to relax and explore the rock outcroppings. Jon clearly made the most of it, though, scrambling to the top of a large boulder and then finding it a bit more difficult to get down. Perhaps he had been inspired by the movie on free soloing we had watch last week or maybe he just had the urge “because it was there,” but either way, it was an impressive feat that no one else chose to undertake for good reason.

A blacked headed heron

A secretary bird

From Moru Kopjes, we made our way slowly back to Naabi Hill to leave the park. We would have lunch there which is a popular place for trips heading into the park from Ngorongoro as the distance is just right. There’s a small store there that sells cold soft drinks and, in the past, Pringles had been a big hit, but not so with this group. I took care of the payment to transit the Ngorongoro Conservation Area heading back to Karatu and after we had all rested up we were back on our way passing Oldupai Gorge and heading to the rim of the crater. Kitashu, one of the two social workers at FAME, along with Angel, and someone who is exceedingly responsible for our neuro clinic to run smooth, is Maasai and his boma is just off the rim road at the turn off to Endulen, where there is a small hospital and dispensary. Kitashu had asked us to visit his boma if we had time and with this invitation, we had all agreed that it would be great to see him there.

At Moru Kopjes on visiting Ngong rock

Marin, Adys and Jon at Ngong rock

We called as we were close and he met us on the main road outside of his boma, which is actually a grouping of a number of bomas for his father and his brothers. Kitashu has one wife and now has a baby that is about a month old. We drove along a winding trail between structures until we pulled into a small area outside his hut. He was dressed in his traditional Maasai clothing that he wears at home on the weekends and greeted us all very warmly as it was clear he was very happy to see us. What we had thought was going to be a short visit to say, though, was actually a formal visit with his entire family as I’ve been greeted in the past when visiting friend’s bomas. We were so honored to be there with his family, yet they were equally honored by our visit and, as I later discovered, we were the first of anyone from FAME who had visited him since he had been working there. In all fairness, it’s a trek to get there from Karatu unless you’re also visiting the Serengeti or the Crater, but over this month, our group had developed a special closeness with Kitashu and, in the end, we were all so happy to have come.

Jon beginning his epic climb

Success

Kitashu invited us into his wife’s hut (huts are only built by the woman and belong to them) where we met her and their new baby. What I hadn’t known before, though, is that it’s tradition for the new mother to remain indoors after childbirth for a full six months and she is brought meals by other family members. A Maasai hut is comprised of a center room of approximately eight to ten feet in diameter around which are found two other rooms, one for the husband and male children and one for the wife and female children. The beds are raised a few feet off the ground and are made of cowhide stretched over wood slats. There is also a room for kitchen goods and a small cooking fire nearby. The last parts of the hut are made up of the entrance way that leads to the outside and a large room for the goats to be kept inside at night (cows remain outside in a small corral that is surrounded by brush and wood.

Lesser flamingo with a smoky backround

After visiting with Kitashu and his wife, his sisters-in-law lead Sheena, Adys and Marin off to one of their huts while Kitashu helped Jon, Dan and me dress in their shukas (the plaid cloth the men wear) in a proper Maasai manner. The woman later came out dressed in a bright blue cloth wearing lots of Maasai jewelry including the beaded collars that the Maasai women wear when dancing. The entire village was out to share in our visit and it became very clear to us that this was a big event for them. Kitashu’s brothers wanted to show us how they make fire using rod of hard wood that they place in a depression of a softer wood and then spin between their palms, handing the chore off to each other when they tire. They use their knives to make slits in the softer wood next to the little depression that collects the embers and then they are cut away and placed into some dry grasses that they’ve collected. They weren’t successful today in creating a big blaze, but I’m confident that if it had been a necessity, they would have continued until we had a nice little fire going.

Kitashu greeting all of us

Adys, Sheena and Marin greeting Kitashu’s wife

Kitashu’s wife and new baby

After the fire making demonstration, we all gathered in front of one of the cattle kraals where both the men and women lined up to demonstrate their dancing and singing. Sheena, Adys and Marin participated since they were in the appropriate dress, but of the men, only Jon was brave enough to participate in the traditional men’s dance that consists of repetitive jumping and stomping. I remember when I was here ten years ago with my children and visited one of the cultural bomas where they had also danced for us and my son, Daniel, had participated and had done quite well. Jon did great and though he didn’t reach the same altitude as Kitashu’s family members, he performance was quite respectable. I’m sure had I attempted in any way to join in the fun, I probably would have left the boma with some type of injury.

In front of Kitashu’s wife’s hut

Me, Jon and Dan with our Maasai paraphernalia

Once the dancing was finished, we all made our way back in the direction of Kitashu’s wife’s hut and were led to one of the smaller kraals next to the hut that was full of tall stinging nettle, but there was enough of a path for us to make it to the center without injury. There in the center of the kraal was a small clearing in which they had prepared a goat roast for us which was totally unexpected. A goat roast is event that is offered typically to an honored guest or guests and is not something that is done routinely. Goats are not eaten on a regular basis by the Maasai, nor are their cattle as they are a measure of their wealth so it wouldn’t make much sense to be eating your assets as that wouldn’t be very sustainable. It was a great honor for us to be presented this goat by Kitashu and his family and as we all stood in the clearing while he sliced off piece after piece for us to eat, there was a clear sense of mutual respect and community that was shared by all who were present. The goat was amazingly delicious and tender and though it is cooked by the Maasai without any spices, there is a smokiness to the meat that comes from the open fire. We all ate piece after piece of the juicy slices and Kitashu kept going around the circle handing us more of more until there was little left and we were now enjoying the ribs. Though his brothers did share in some of the meal with us, I’m sure we devoured the majority of the goat meat that had been cooked.

Jon joining the dance

Jon jumping high

It was now getting very late as we hadn’t anticipated the incredible reception that we received and we were once again under the gun to get to the gate before it closed at 6 pm which would have meant finding someplace to sleep in the conservation area or otherwise trying somehow to talk ourselves out in some manner. We packed up the Land Rover with Kitashu planning to come back to Karatu with us. It had been a wonderful visit to the Serengeti over the weekend and it had been the last game drive for everyone today. They had all seen four of the Big Five animals of Africa (elephant, rhino, Cape buffalo, lion and leopard), missing only the last. We left the boma and raced along the rim road heading toward the gate as fast as we dare, when suddenly, on the side of the road, there appeared a leopard walking. It was like magic, as if someone had decided that everyone couldn’t leave without seeing the Big Five. Regardless of how, the leopard remained on the road long enough for everyone to sure they had seen it and then it disappeared into the underbrush as mysteriously as it had appeared.

Kitashu serving us all goat

We made the gate with no time spare and waited while Kitashu took the paperwork to the office to check us out of the conservation area while baboons fought among themselves outside our vehicle, making a huge racket. The leopard, the baboons and the race to the gate was a parting ending to our game drives for this trip to Tanzania. We dropped Vitalis off in Karatu to spend the night before heading home to Arusha in the morning (he actually planned to hitch a ride with Dan and Marin tomorrow morning as would be traveling early to the airport to fly to Dar es Salaam) and then ordered dinner from the Lilac Café as everyone was far too tired to cook. Dan and Marin would be leaving in the morning, but the rest of us still had four days left of clinic at FAME and were looking forward to it.

A picture taken several days later by Kitashu of the same leopard we had spotted on the road

Saturday, March 23 – A very long day in the Serengeti…..

Standard

Predawn on the Serengeti

We had decided the night before that we would leave before sunrise on our game drive and have the camp pack us both breakfast and lunch so that we wouldn’t have to return until late in the day and quite possibly after sunset. Thankfully, though, and more so for the others than for me, we were able to make some coffee or tea and drink it down before we left. Having been a coffee addict my entire life, I certainly understood the need for this morning cup of Joe, but over the last couple of years, I have broken myself of that habit and no longer require that morning “fix.” I will have to admit, though, that Adys’ mixture of AfraCafe (Tanzania’s wonderful version of instant coffee that tastes amazing) and Cadbury powdered chocolate was particularly appealing and really hit the spot on our way out.

Dawn on the Serengeti

Dan looking for birds

We all readied our camera equipment, Dan and I each with our large “safari lenses” on our Nikon cameras that bring the action tremendously closer. On earlier safaris (game drives) during this trip, I was obviously not taking photos as I was driving so handed my camera off to others to use and have the same experience that I have had over the years. It really is amazing what a long lens does for wildlife photography and especially in a place such as the Serengeti or Africa in general. With the top up and standing in the cool air of pre-dawn it can become quite chilly at times and reminds you of just home much radiant energy the sun pours down on us here on the equator. I always advise bringing a light fleece to wear on these trips for the early morning and after sunset as it can become quite cool. The altitude of the Crater rim is 8000 feet, making for very chilly nights requiring lots of layers, while here on the Serengeti plains we’re probably at 4000 feet, which is still nothing to sneeze at.

Breakfast on the drive

A trio of rock hyrax

Part of the Great Migration

A friendly croc

Our drive took us in the direction of the Maasai Kopjes this morning and right by the launch site for one of the balloon companies who a good friend of mine pilots. We watched the balloon inflating and not yet airborne prompting a number of comments from the group regarding some type of dysfunction for which a certain medication could help, but alas it turned out that Jones (my friend and balloon pilot) had been delaying take off due to high winds at the launch site that were over the limit of safe flight. The balloon eventually launched with tremendous relief by all and we watched as it floated slowly away. Danielle Becker and I flew with Jones several years ago after he invited us to come and I will have to say that it was one of the more amazing experiences that I’ve ever had. Though I’ve never been in a balloon before , there was certainly something about floating effortlessly above the vast Serengeti plains in all of their splendor at sunrise, the animals moving about below you and universe above, the complete silence broken only by the occasional sound of a blast of hot air into the balloon to keep you aloft. We finished our flight with a champagne breakfast on tables set on the open grass and freshly made while we toasted the pilots of the two balloons that had flown in what we were told was a ballooning tradition. Whether that was true or not was of little consequence considering what we had just experienced. We had gone as guests on the flight, but if I were ever considering the experience again and asked by someone whether I would recommend it to them, I would answer with a strong affirmative.

Jon gazing over a large herd of wildebeest

Dan ready to photograph

Buddies….

The vastness of the Serengeti is something that you can only experience and is impossible to fully describe, though I am sure there are great writers who have done so successfully. I’ve mentioned before of Hemingway’s The Green Hills of Africa, which doesn’t take place in the Serengeti, but rather Lake Manyara, and is a non-fictional account of a hunting trip that he and his wife had taken back in the days of wild Africa, when rhinos filled the park in what seemed like an over-abundance, though, unfortunately, we have learned all too late that that wasn’t the case such that the black rhino were hunted to the brink of extinction of Tanzania and elsewhere. The Serengeti’s vastness isn’t really about standing on a tall mountain and seeing endless plains that reach to the horizon. It is about being there, with your heads often barely above the tall grasses, and looking out to see plains that stretch to what you see as the horizon is, only to reach that horizon and have the same scene repeat itself, over and over and over again, in a never-ending fashion that suddenly makes you aware of not necessarily your insignificance, but more so the importance of the universe of which you make up only a very small fraction of its entirety. It is humbling to say the least.

A mother cheetah and four nearly grown siblings

We explored the Kopjes during the morning, catching glimpse of occasional male lions doing what they do best, sleeping, as well as rock hyraxes, supposedly the closest living relative to the elephant, though recently debated. In between the Kopjes we saw every version of antelope, including the massive herds of wildebeest with their partners in the long migration, the zebra. The wildebeest and the zebra work well together in that they eat different lengths of grass and protect each other, the zebra acting as sentinels with their keen eye sight, watching for predators and warning the vastly larger number of “beesties.” The other antelope, which include the topi, eland, Grant’s gazelle, Thompson gazelle, and Cook’s hartebeest, occupy the grasslands along with the zebra and wildebeest while the woodlands are occupied by the impala and the dik dik. It is a cacophony of antelope here where they all live harmony together and in constant fear of the predators. Large lion prides roam throughout, often hunting in small groups while the leopard is a solitary killer. Cheetah are most often solo hunters, though you will often see two or three siblings or a mother and her older cubs hunting together.

A pair of lionesses on a termite mound

We stopped for a lovely breakfast under some trees where we were able to get out of the Land Rover and had chapati, hard boiled eggs, sausages, bacon, coffee, tea and juice, just to name a few of the things that were prepared for us. The bacon was the real hit of the day for everyone, I think, and it became known for the rest of the trip as “pumba bacon,” in honor of the warthog that is certainly related to the pig and is often hunted by the lion for this very reason I am sure. Later in the day, we also stopped for lunch that was a mixture of more delicious items that the kitchen had put together for us.

A giraffe having a drink

Grant’s gazelle

A typical Serengeti scene

Everyone had a wonderful day of game viewing, but probably most of all, Dan, who is a passionate birder which is a breed all its own. I will have to admit, that when I was living in the suburbs, one of my greatest passions was my bird feeders and bird houses that I had located through our back yard that was heavily wooded. Having probably spent years selecting just the perfect locations for the feeders to completely foil the significant squirrel population that made their homes in our trees. I had cables strung between the trees from which the feeders hung with discs over eat feeder that protected them from the squirrels who would artfully perform their high wire acts with the thought of stealing some of birds precious seeds. I had also built my own version of woodpecker feeders from PVC tubes and galvanized wire strong enough to deter the squirrels who can eat through just about anything including wire that isn’t up to snuff. After twenty-five years living in the house, I had finally perfected squirrel-proof placement for the feeders, only to have moved on to downtown Philly where I now have no feeders. I do miss the birds and my feeders and nesting boxes, but I will have to admit that I also enjoyed the sport of out foxing the squirrels which probably doesn’t speak very highly of my goal in life in that regard if being smarter than a rodent becomes a pleasure in life. What can I say.

Dan’s interest in birds was far more academic than mine and it didn’t involve outsmarting rodents. He had an incredible knowledge of the birds here even though this was his first time to East Africa, having previously visited southern African on safari. For one with this interest, there is so much more to our game drives as the number of birds species far outnumber the species of mammals that we will see in any given days. Birding here is actually quite spectacular and the bible, Birds of East Africa, has so much information on so many species that it dwarfs anything related to the mammals. Spending the time with Dan, I found myself becoming so much more acutely aware of the birds despite having seen them numerous times before on the dozens and dozens of game drives that I’ve not only been on, but have also guided myself. Because of his acute interest in the birds, I had actually requested a particular guide and friend of mine, Vitalis, who drove me to the Serengeti last year and had impressed me incredibly with his knowledge of the feathered component of our game drives. At the end of our safari last year, we had given Vitalis my Nikon binoculars as a present and in appreciation of his keen guiding skills. Any guide with his knowledge and skill deserves a pair of wonderful birding binoculars.

A lilac-breasted roller

A lilac-breasted roller in flight

Some of the sights that we saw on this day included a lone cheetah on top of a termite mound who was nonplused with our presence, but didn’t seem to be on the hunting mood at the moment. Later in the day we had seen the amazing sight of a mother cheetah and her four adolescent cubs who were almost the same size as she was, all resting under a tree, but clearly checking out the terrain. It would have been amazing to see this group hunt as they most likely would have been able to tackle even a wildebeest adult, but it was in the midday heat and they didn’t look necessarily enthusiastic about using the energy. One of the funnier moments was when we were looking at a few lions sleeping and were parked alongside another vehicle. It contained an American couple and when we said hello and asked what they had seen, the woman promptly told us that they had seen a group of leopards a bit further back. What she was referring to was undoubtedly the group of cheetah we had seen and her husband promptly corrected her. The mere thought of a group of leopards, which are solitary animals other than a mother and her little cubs was a bit ridiculous on its own. Shortly after, we pulled up to a massive line of vehicles jockeying for position to see what was reported to be a leopard in the grass under a tree that no one could see or even confirm. We waited a few minutes and then decided that it was quite unlikely that the leopard would surface, but before we left, the woman we bumped into earlier pulled up alongside us and after we pulled away we all had a good laugh regarding what she must have said about shy leopard in the grass.

A morning yawn…

On the way back to camp that evening, we needed to find fuel to get us back Karatu as we had driven two full days on the current tank. Turtle has a 70 liter tank and her powerplant is a four-cylinder turbodiesel that is very fuel efficient and great for these excursions to the Serengeti and beyond. The station in the village of Seronera where most of the visitor information is for the Central Serengeti was closed or didn’t have fuel when we arrived, so we drove up to another station (there are only two here) that was thankfully open and had fuel and we were now in good shape for the trek home tomorrow. We made our way back to camp before sunset and all took showers as were dusty and grimy from our day on the trail. Jones was going to stop by before dinner to say hello so it was good that we had time to freshen up. In the end, he brought a group of young people with him, all of him were friends working at the Seronera Wildlife Lodge and who he had arranged to have dinner at the camp. We sat inside the lounge tent and caught up on things. I have been inexorably linked to the entire Temba family since I first came to Tanzania with my children in 2009, and I will continue to be throughout my life as I plan to continue coming as long as I am physically capable of doing so.

A black-shouldered kite

Surveying the landscape

We enjoyed another relaxing dinner in the mess tent with all the wildlife abounding just outside our camp and ready for the sounds of the hyenas once again as we sleep. Walking back to the tents, as I shine my flashlight away from camp, you can see the many eyes of the animals that tend to surround camp as they feel safer around us for some reason. We were told that a small herd of Cape buffalo had been coming every night for the protection and I surely didn’t look forward to running into one of them walking back to my tent. We had planned to have breakfast at camp tomorrow, but would bring lunchboxes with us since we would be heading home and wouldn’t be coming back to camp.

Mom and three cubs

 

Friday, March 22 – A morning in clinic and then off to the Serengeti….

Standard

Over the last several years, it has been become somewhat of a given that we go on an overnight safari for our last full weekend before wrapping things up. At that point in our time here, we’ve had plenty of days of clinic and would have only taken off the Sundays to go on a day safari. We have various options for the overnight trips and I have taken the residents to the Serengeti as well as to Tarangire National Park. This month, we’ve received lots of reports of that the tsetse flies have been overly obnoxious at Tarangire which was enough to have everyone unanimously voting for the Serengeti. Not that the tsetse aren’t there as well, but they are much more limited in the areas they infest, which is usually the wet woodland areas. I’ve written numerous times about these nasty creatures and they have become no less nasty over time. There is very little in the way of trypanosomiasis, or sleeping sickness, here, but that does not lessen the sting of this blood sucking nemesis. If you ever have the gumption to watch a very short horror flick with a very small leading character, just go to YouTube and search for tsetse and you’ll quickly run across videos of tsetse flies engorging themselves with blood until it looks like they are going to burst. Their bite is very painful and typically leaves a significant welt that may take some time to recover. I have several scars on one hand from blisters that formed after a tsetse bite.

Dan and Marin discussing a case on Friday morning

So, when offered the choice, there was very little question that everyone was interested in seeing the Serengeti, which, to be honest, is a real shame to miss coming all this way. We had been to Ngorongoro Crater last weekend which is quite impressive, but it doesn’t compare in the shear magnitude to the Serengeti in all its diversity. Throw in the Great Migration, and the Serengeti becomes a spectacle that can rival just about anything else in nature. We had all packed the night before or in the morning, that is, everyone but Daniel. As he would be extending his visit by a week to go on safari with his fiancé and most of being in the Serengeti, he elected to stay back at FAME and spend a relaxing weekend. Our plan was to be in clinic until about noon at which point our guide, Vitalis, would pick us up and we’d be on our way. At least that was our intention. Vitalis had taken Turtle the night prior so that he could check her out and make any last minute repairs that might be necessary before heading off into the bush where the chance for rescue after a breakdown becomes exceedingly slim. The flow of patients in the morning was steady, but we were able to head out by around noontime, though it did take some persistence on my part to prevent the OPD from continuing to send patients our way even after I had told them we would be leaving.

Mother and child

An agama lizard

We had time to eat some of the mac and cheese we had saved from yesterday’s dinner so we’d have so food in our stomachs as we departed. Again, Daniel was staying behind to man the fort, the rest of us got our bags together and waited for Vitalis to show up so we could get packed. Since we were going for only two nights, there wasn’t an excessive amount of baggage for us to load and once it was done, we were on our way down the FAME road in the direction of town. Despite our intention of getting an early start on the drive, we discovered that we had to go to the bank to pay for our entrance fees to the Serengeti. Last year, I had been able to pay with a credit card at the gate, but as is typical here, the gate and park protocols change on a regular basis and there is little in the way of any notice. The problem was that none of us had anticipated needing this type of cash and all of our money was back in the safe at FAME. Thankfully, Dan and Marin had taken their money and passports out of the safe since they would be leaving the morning after we return, but it was touch and go as to whether we would have enough. Also, we didn’t know the exact amount that was needed until we went into the bank and had them process the quotation that had been entered into the system. What should have been a relatively simple affair turned into well over an hour of frustration trying to get our papers processed and then, trying to get all of the money together that we needed. Everyone contributed, including Vitalis, leaving us with just enough between everyone to cover the necessary tip at the camp and nothing whatsoever to spare.

Vultures out on a limb at Naabi Hill

We stopped at the market on our way out of town to stock up on waters and we were finally on our way. To get to the Serengeti, you must pass through the Ngorongoro Conservation Area which requires you to pay for transit. This is the same drive we took last Sunday on our way to the Crater and luckily, the necessary transactions at the gate were a snap and I was able to put everything on my credit card. Plastic is wonderful. In no time at all, we were climbing up towards the crater rim and through the primordial forest that makes up what is left of this massive mountain that has left for eternity its enormous caldera. Given the time, we drove by the overlook and continued on our way, past the descent road we had taken down to the bottom of the crater and turned in the direction of the Southern Serengeti, past Olduvai Gorge, the site of Mary and Louis Leakey’s famous discoveries, and on to Naabi Hill, the official entrance to the Serengeti from the Conservation Area. The drive from the Crater Gate to Naabi Hill usually takes several hours and is a very long and very dusty ride. As vehicles pass by in the other direction, there is the immediate sound of everyone sliding their windows shut to avoid the pounds of dust that will be immediately sucked into our vehicle. The dust here is ubiquitous and permeates essentially everything.

Looking for prey…

Early in the drive we begin to see small groups of wildebeest, the tail end of the migration, with many babies and the always present Thompson and Grants gazelle that cover the open plains. Occasional groups of Eland, the largest of all the antelope in Africa, show up from time to time. The closer we get to Naabi Hill, the more animals we begin to see along with the many birds, particularly the Corey Bustard, the largest flying bird in Africa. Naabi Hill serves as the entrance to the Serengeti and, most importantly for the government, where one must pay their fees to enter the park. With our luck today, nothing was going perfectly smoothly and Vitalis found out that the bank had made a mistake when we paid our fees there and had forgotten to charge us an additional small amount for the vehicle and guide that had to be paid in TShillings. What would have taken us a minute at the bank ended up taking about 30 minutes for Vitalis to pay them the money using his phone (M-Pesa is similar to Apple pay except you have to put the money on your phone in advance – no credit and no debit cards). We all took the time to climb up on top of Naabi Hill which offers an amazing view of the surrounding plains that clearly have given Serengeti its name which means endless plains in Maa, the language of the Maasai.

Hitching a ride….

A White-backed vulture

We were finally on our way to camp once we were able to take care of everything at the gate and we were way behind schedule. We stayed on the main road for a bit, but then veered off somewhat to the east in the general direction of the Maasai Kopjes and to our camp. The Central Serengeti topography is dominated by a unique feature called Kopjes, which are essentially large boulder islands, some of which can be quite large, and are arranged all throughout the endless plains, some that are in a line like a mountain range, but separated by flat plains in between, and others that are quite random. Rough roads, or really trails, connect the Kopjes to each other so that you drive from island to island and it is here that all life is centered in the Serengeti. True, the wildebeest and zebra are out in the grasses, but it is the lions and leopards that live in the Kopjes who prey upon them. The other “big cat” is the cheetah that likes to lay on one of the many termite hills so that it can scan the distance for its prey. Cheetah have to sneak up on their prey and for this, they require grass that is high enough for them to hide as they move close enough to unleash an attack, which is sudden and powerful. Cheetah have the highest “kill rate” of all of the big cats here at nearly 60%, while lions have a meager 25%, and leopards are in between (African hunting dogs, very difficult to find in the Serengeti, have the highest success rate of all of the predators here).

Two adolescent male lions at a watering hole

…And a third joins in

Driving along, Vitalis spots a lion off in the very far distance and as we come closer, it turns out to be a group of five younger males traveling together on their way to a watering hole. It’s hard to tell if when they’ve eaten last, but they don’t look like they’re hunting at the moment and besides, there are no prey as far as the eye can see at the moment. We’ve had the opportunity to watch them for a bit, but really have to get on our way as the sun is beginning to set and we’re still a long way off from our camp. Sunset in the Serengeti has to be one of the most amazing sights and tonight’s event does not seem to be disappointing us in any way. Once you think it’s at its maximum, it continues to impress you even further and never seems to end. We had noticed some fires in the distance, and some of the color may be enhanced by the smoke, but regardless, it was spectacular. Red and orange and yellow hues of every imaginable combination seems to add to each other as if they are competing for dominance. It just seems to be never ending.

And a lovely reflection

I can recognize most of the roads we’re taking, having driven here on numerous occasions, but the light is now really disappearing and the world slowly shrinks to whatever we can see illuminated by our headlights. It is difficult to explain darkness here as there are few external lights and the moon has yet to rise. I know we’re heading in the direction of camp and can vaguely make out some landmarks in front of us as we are approaching the area where our camp should be. As we get closer, it becomes readily apparent to all of us that one of the fires we had seen from the distance is actually burning right in the vicinity of our camp and we can see the line of flames on the hillside. At that moment, there were plenty of nervous jokes about the good price we had gotten on our lodging being a part of a “fire sale,” but in the end, it turned out to be a further away than we had originally thought. We turned on the road to get to camp and in the incredible darkness of the night, everything was a bit disorienting so that we ended up initially pulling into the wrong camp, but ours was only a short distance away. They had cool washcloths and fresh juice for us to drink and though we all would have loved to have taken showers with all of the dust, it was getting late and we needed to get to dinner.

A tawny eagle with an adolescent

I had stayed at this camp previously and it is really luxurious. There are two main tents, one that serves as a dinning tent and the other that serves as a lounge while doubling as the charging station for the entire camp. The table is a jumbled pile of cables and chargers for every device known to man. On each side of the main tents are seven individual, though quite large, tents that each have two double beds and a separate bathroom area with a shower, toilet and dressing area with sink. The beds and linens are nicer than anything that I’ve ever had at home. Since we were running late, dinner was served to us rather than the normal buffet and the food was delicious. Soups here are especially tasty and fresh and have always been my absolute favorite part of the meal at any camp that I’ve stayed at as they are clearly made daily and every flavor imaginable.

A gorgeous sunset

The unique feature of staying in “tented camps” as opposed to lodges is the absolute closeness of nature. Though the tents are fabulously comfortable and certainly nothing like backpacking on the Pacific Crest Trail (I will have to admit, though, that the little pup tent I started out camping in years ago has vastly changed and has morphed into an ultra-comfortable, lightweight, aluminum tubed structure that bears no resemblance whatsoever) nor what people refer to as “glamping” on the East Coast, they do all have one thing in common. And that is a very thin layer of fabric between you and the external world. Admittedly, there are bears in the High Sierra and wild concertgoers at many of the glamping sites, but neither of those compare to the nearby sounds of hyenas or of lions that sound as though they are sitting right outside of your tent and wanting to join you inside for a little nighttime snack. At all times during the night and in the early morning darkness, you are never allowed to walk outside of your  tent as you must be escorted by a guide who is often armed with a spear, though sometimes not, in which case your only hope is that you can outrun him (and in my case, that would be wishful thinking). There is really never any fear of being attacked in your tent and I’ve been doing this long enough to be very familiar with the sounds of the bush, but for anyone doing it for their first time, it is definitely an experience. I think everyone tonight must have had these thoughts in their minds at some point or another (read Marin), though I was quite confident that all would be present in the morning for breakfast unscathed.

 

 

Thursday, March 21 – A visit to Rift Valley Children’s Village…. 

Standard

 

Note: Thanks to Katherine Kuhlmann, FAME’s Communications and Marketing Director, for sharing her photographs with me.

Dan and Adys presenting in the morning

Well, I must admit that everyone was just a bit slower getting started this morning after our night at The Golden Sparrow. Everyone had a great time, though, so it was well worth it and it was an excellent release for everyone. It was also Thursday, so it was another morning of teaching and Adys and Daniel had volunteered for this one to discuss altered mental status. As expected, even with the hurdle imposed the by Sparrow, they did an excellent job of discussing this topic which can often be very difficult for the non-neurologist. Correctly identifying a patient with an encephalopathy as opposed to an aphasia will completely change one’s differential and what evaluations and treatment are recommended for the patient. It is not always as straight forward as it may seem and the differences can sometimes be very subtle, even for a neurologist. Adys and Daniel covered the topic perfectly and alluded to a number of the specific features that we use to differentiate them.

Adys and Ann evaluating a patient

Compassionate care

After our talk, it was matter of getting everything together for our trip to RVCV. We were planning to take only one vehicle today as Chris and Michael, our interpreters are both from there and therefore would not require a ride in the morning. Still, this meant that we would have twelve people needing transportation there and back as both Katherine and Phoebe were also planning to come. My Land Rover has seating for nine passengers, but if we put four across the back instead of three and also used empty plastic soda crates between the second and third row of seats, we could reasonably and safely fit the additional passengers in for the 45 minute trip to the children’s village. We wouldn’t need lunch today as we are served a wonderful midday meal by the cooks here who also serve the other volunteers at the village.

Jon and Daniel acting out their exam

The drive to RVCV is as spectacular as just about anything we’ve seen here. Heading from Karatu in the direction of Ngorongoro gate, we leave the tarmac just before the final hill and begin to head in a westerly direction along a ridgetop that overlooks wonderfully fertile farmland in all directions. We drop down into several ravines, only to rise again on the other side of each when we finally come upon acres and acres of coffee bushes that surround the entire area including the village. For the full story of Rift Valley Children’s Village, you’ll have to go to their website, but it was founded by India Howell, who is originally from Boston, and fell in love with Tanzania while on safari here (sound familiar?) She worked for bit in the tourist industry, but quickly discovered all the needy children, some of who lived on the street and others whose families could no longer care for them. India partnered with a Tanzanian to develop the concept of a children’s village rather than an orphanage, where all the children are adopted and raised here as their home with no fear of having to leave until they are over 18, and even then, they have their own housing just outside the village. There are children from all ages here, all living in their own homes separated by age and gender, each house being run by separate house mothers who are from the outside village.

Marin and Dan conferring on a patient

Daniel and Jon present a patient to me

There is a primary school situated just beside the children’s village and this is where all of the children attend school every day. Early on, India realized that sending her children to a school where the other children were constantly sick due to the poor access to healthcare and the poor personal hygiene. She offered to partner with the local community to bring in more teachers that she would help pay for and also developed a regular clinic that would be staffed by FAME and would occur every other week and would see patients from a catchment area that included the surrounding villages along with the children’s village. When I started the neurology mobile clinics here, it was an obvious choice to also accompany the FAME doctors when they came, but about two years, it was decided that FAME would no longer have a regular clinic there in which case, we decided to continue with it as part of our mobile clinic week. It is now only a neurology clinic and any patients needing general medical care will be sent to FAME by vehicle.

Dan evaluating a young child with severe bilateral esophoria

Dan enjoying his exam

Who’s checking out who?

We see a wide array of patients here and much of them are obviously pediatric, but the bulk of the patients seen by us here are epilepsy patients for various reasons. Having Dan and Marin here was a huge plus for us this visit as was the fact that the clinic area had been extensively rearranged since last October. We now had four examination rooms that were all set up for us in advance along with a room that we could use as our pharmacy. All of the patients to be seen that day had already been organized into adult and pediatric cases and had also been fully triaged so that we were only seeing patients with neurological complaints.

Marin and Christopher evaluating one of our long term patients

Adys’s very first patient of the day was a young man with poorly controlled epilepsy accompanied by his mother. The episodes were primarily causing loss of consciousness and some abnormal behavior and we discussed the need to continue him on seizure medication because of the nature of his seizures, but after we were finished discussing his case, we heard a very loud commotion coming from the room only to find him on the floor trying to crawl into the corner of the room with a frightened expression on his face. The seizure lasted only a minute or so and I was able to get him situated on the floor so he wouldn’t injure himself nor would he injure me. As he settled down, I was finally able to help him up onto the bed in the room where he remained until he came around and his post-ictal lethargy had improved to some degree. This was a very classic focal seizure, probably of frontal or temporal origin and it was the same as those that he had been having at home which was very important regarding the diagnosis and the fact that seizures are, by definition, very stereotyped. His medication was adjusted to place him on a more therapeutic dose.

Marin and one of her young patients

Adys and Dr. Annie presenting a patient to me

Marin saw a fascinating patient that became a real dilemma and something that we’re still working on. The baby was reported to be about 15 months old and had failure to thrive due to inability to take food adequately, having already been to a feeding program in Arusha, but failed to gain any weight there. The problem was that the baby examined more like a normal three-month-old from a cognitive and stature standpoint and just seemed to have a bit of diminished tone. No matter how hard she tried to clarify the history with the mom, the story remained the same which was completely perplexing. In the end, we referred the baby to FAME to obtain x-rays of her hands and long bones as well as an abdominal ultrasound to rule out some organomegaly consistent with some metabolic storage disease. The ultrasound turned out to be normal and the films will have to be read by someone at CHOP, which I will take care after my return.

Sheena and William evaluating a patient

Sheena catching up on her documentation

We always look very much forward to the lunches here as the house mothers cook amazing food. Today, it was fresh baked bread rolls with hamburgers, French fries, fresh salad and for dessert, chocolate oatmeal balls that were delicious. It was a wonderful meal that was well appreciated. After lunch, it was back to work to see the remainder of the patients and, eventually, a trip to the duka (store) run by Arturo and has a great selection of objects created by the Rift Valley Women’s Group. Everyone came back with a back of items and seemed quite happy with the selections they’d made. Sheena missed out on the group shopping spree and went over later and when she’d been gone for some time, we decided to call over to make sure she was still alive. She was, of course, and was also extremely happy with her purchases.

Daniel closing his charts so they don’t autoclose 😉

Phoebe and Dan during a break in the action

We left Rift Valley Children’s Village after a very successful and efficient day of seeing patients and a real sense of accomplishment. The cases that we’d seen were solid neurology and all of which we had something to offer, whether it was immediate treatment or at least some direction to head in regard to further investigations if appropriate. I took the more scenic drive home that turned out to be tremendously smoother than the primary road much to everyone’s joy as we were still loaded with the twelve occupants in Turtle and the less jostling meant happier passengers. This route does have a very, very steep downhill section driving to the bottom of a ravine and then a very, very steep uphill section coming out, but everyone held on tightly and Turtle took the hills like the pro that she is and in full Land Rover tradition.

Our clinic hallway

The waiting room at Rift Valley

We were scheduled to go to Susan and Frank’s house for the evening as this was the last night at FAME for both Dan and Marin for we are all heading to the Serengeti tomorrow, except for Daniel who decided to forgo the trip (despite just bit of FOMO) as he would be going there the following week with his fiancé after our time at FAME. Before going over to their house, though, we had to make what I thought would be a quick stop at the tailor’s shop to pick up all of the clothes that everyone (except me) had made from the wonder kitenge cloth ubiquitous here in Tanzania. It ended up being just a bit longer of stop than I had anticipated as there was a bit more shopping going on than I had been led to believe would occur, though I was finally able to rest everyone out of the shop and we were on our way. We had one more stop scheduled for next week, though, to pick up the additional orders made.

Daniel and Jon evaluating a patient with the assistance of Katie, the nurse at RVCV

Susan and Frank’s get together was a very nice affair as it always is at their home and we dined on wonderful local Camembert cheese from the Shangri La farm and both beef and vegetable samosas from the Lilac Café. Mixed with Safari beers, wine and Stoney Tangawizi, we were all quite happy and there was little need for the dinners that had been prepared for us that night, so we all saved our mac and cheese to eat the following day for lunch before our departure on safari.

Visiting the tailor’s shop at the end of the day

 

Wednesday, March 20 – It’s off to Kambi ya Simba and a night at the Sparrow….

Standard

Evaluating a patient in 2011 with Dr. RIngo

Kambi ya Simba is another village in the Mbulumbulu region and about half the distance of Upper Kitete. When I had first come here in 2011, there was literally nothing to speak of in regard to their medical facilities with only a very small dispensary that wasn’t sufficient for us to work out of so we held our clinic in a small field in front of the church. Patients would sit on a bench made out of a log and wait their turn to be seen. Quite often, the patients waiting would slowly encroach upon my open air office out of their interest in what was going on and I’d have to repeatedly ask them to sit back on the bench so as to maintain some semblance of privacy. I would frequently remark to friends that I had the nicest office here that anyone could ever imagine.

Paula Gremley, Pastor Temba and Dr. Ringo discussing things with a patients mother in 2011

One of my favorite photos – evaluating a Trisomy 21 patient in 2011

Over time, though, Kambi ya Simba has acquired an ever increasing number of buildings here for medical care and my outside office has vanished and has now been replaced by a state of the art dispensary, wards, offices and other equipment that have now developed into a lovely facility. A few years ago, I had arrived for mobile clinic only days after the prime minister had been here with lots of fanfare including a small monument, plaque and flagpole in the center of the grounds. Pulling into Kambi ya Simba that time, I commented to everyone that I was just a bit surprised to what lengths they had gone to welcome us. As the commitment by the government has continued to improve the facilities here, our clinic has become that much closer to what we have at FAME, though we are still working as a mobile clinic meaning that we do not have access to labs or X-rays without sending patients back to FAME for those.

Kambi ya Simba dispensary. Note the not uncommon occurrence of pushing cars here

One of our clinic rooms at Kambi ya Simba

Adys, Jon and Dr. Caren evaluating a patient

With the shorter drive to Kambi ya Simba it means we get an earlier start with our patients. We weren’t sure how many patients would show up, but in the end, there were quite a few and there were some fascinating pediatric cases so that it was extra nice having Dan and Marin here to sort them out. One very interesting patient we saw was an infant that had reportedly been developing normally until about three months of age when, following their Tdap vaccinations, the child began to become very weak and floppy and their motor development screeched to a halt. The baby was now seven months old and have very reduced axial tone, but reasonable strength, normal reflexes, and seemed cognitively intact. It was a very puzzling story, but the mother was quite clear that the child had been fine before their vaccinations that also included a polio vaccination, raising the question of whether this could possibly have been an issue with the polio vaccine having reverted since it was a live attenuated oral vaccine and in very rare circumstances can cause cases of polio. After many emails, text messages and a phone call to one of the neuromuscular folks at CHOP, it was decided that this was very unlikely to be polio, but was rather more likely a progressive muscle disease and that without further testing it would be impossible to determine what it was. Furthermore, regardless of the diagnosis, it was exceedingly unlikely that it would be a treatable process. In the end, it was decided that we would try to get an echocardiogram on the baby to determine whether there was any involvement of the heart.

Sheena examining a patient with Daniel scribing

Dan and Marin discussing a baby

Dan and Marin continued to have very interesting patients throughout the day and any thought of leaving here early to try for the African Galleria was pointless. We continued to have two adult rooms and one pediatric room throughout the day which seemed to work very well with Marin seeing the children on her own and Dan staffing her along with some of the adult cases. Our lunch today turned out to be the boxed lunches again, even though I think all of us would have been much happier with the Tanzanian food we had eaten yesterday. We ate again in the vehicles which is usually the case so as to avoid eating our meals in front of the residents here. These are the smaller things you have to think about here that wouldn’t even enter your mind at home.

Marin consulting on a patient with Chris translating

Dan and Marin discussing a pediatric case

It was a steady day of patients that kept everyone quite busy and though we had hoped once again to make another attempt at getting to the African Galleria, it was not to be as our window of opportunity closed quickly. Having learned the hard way with all of the dust we ingested on the first day, the two vehicles were now driving separately and it was much better experience for everyone. We arrived back to FAME in time to relax for the evening and catch another of the beautiful sunsets here as we had plans to go to Happy Day after dinner and then to The Golden Sparrow for some dancing. The Golden Sparrow is a restaurant and dance club that opened about two years ago and is the reincarnation of Carnivore, which was the previous iteration of this establishment. Carnivore was a dirt floored restaurant that served only roasted chicken, chips (fries), and fried plantains as well as lots of beer and wine. They also had a very small bar with a smaller dance floor that could accommodate only a handful of people. A night at Carnivore for dinner and dancing had been a regular highlight of our trips in the past.

Sheena taking a quick break from seeing patients

Kambi ya Simba dispensary. Note the not uncommon occurrence of pushing cars here

Two years ago, the owner of Carnivore closed its doors or, more accurately, it’s gate, and opened The Golden Sparrow. The Sparrow is a much more upscale version of Carnivore, and, to be honest, has much less of the charm and character than the original. There is a huge outdoor area for eating that does serve the same delicious roast chicken that was served at Carnivore along with a much larger menu than the original. There’s also an outdoor bar that serves whatever drink one could imagine. What really differentiates the Sparrow from Carnivore, though, is the dance club. It’s a very large and very dark room with tables and chairs and, most impressively, a disc jockey playing songs and taking requests. There are many locals here and far few fewer ex-pats, but everyone is enjoying themselves just the same and this has now been one of the social highlights of our trips here. Tonight, it was our entire neuro crew plus Katherine, and absent Dan, who claimed to be tired and not up to it, though I have no independent confirmation of this claim. We all had a wonderful night of dancing and had set a midnight curfew (which I had later regretted as it should have been a more conservative 11 pm considering we had a 7:30 am talk in the morning to deliver). Tomorrow we would also be heading to Rift Valley Children’s Village.

Ady, Jon and Marin at Happy Day

Most of the gang at Happy Day

Tuesday, March 19 – Day two at Upper Kitete….

Standard

Our mobile clinic week was now underway and we were returning to Upper Kitete today for our second clinic day there. We had had another site selected, but things had fallen through as far as scheduling was concerned and there really wasn’t enough time to find a new location given the amount of planning and announcements that have to take place for this. Up the road from Upper Kitete is the village of Lostete, which is the last village on the plateau and the end of the road literally, though we were hopeful that patients from that village would come visit us just down the road. Also, the road to Lostete is very often a horrific mess once the rains begin to fall and then it’s a very iffy proposition to make it up there. So, we’ve settled this year on making advance announcements there that we’ll be in Upper Kitete for a second day with the hope that patients will come there to be seen.

Marin delivering her talk on Hypoxic-Ishcemic encephalopathy to a very interested bodyd

Tuesday mornings are education day and we’ve been asked to give lectures for all the days that we’re here save for the two previously given by Ann and Vic. With our pediatric neurologists here, it certainly made sense to have them give some of the talks and today’s was going to be on hypoxic-ischemic encephalopathy, or HIE, which is something seen at birth and not infrequently seen here. Marin filled the whiteboard with lots of information regarding the causes of HIE, both maternal and fetal, how to evaluate the children and, then, what to do for them. In the United States, it is now standard to immediately begin cooling the children which improves their prognosis as it reduces the amount of injury to the brain. What is really most important, though, as emphasized by both Dan and Marin, is that the child is not allowed to be too warm, such as a fever. It isn’t necessarily the most important to have expensive cooling beds or blankets, but rather to aggressively treat fevers and to not cover the baby or use the incubators warming system as readily. Allowing the baby to remain cool and treating any fever will probably capture a significant amount of the benefit seen with cooling such as they do at home. It was a great talk and very, very relevant considering the number of babies now being born at FAME along with those who are brought here immediately after birth. Even a small benefit and improvement in prognosis of these children will be immensely helpful to their quality of life and that of their family who must care for them for many years.

Yesterday, we had followed the other vehicle and had essentially eaten their dust for the entire drive to Upper Kitete, or an hour and a half. Since I’ve driven this route now for several years and know it well, there was really no reason in regard to directions, but there is some security in knowing that if we had any mechanical problems along the way, there would be a seasoned driver/mechanic there to help. Last October, we had just such a problem with Turtle and were without a driver when our alternator died leaving us about an hour out of Karatu essentially dead in the water. Thankfully, we had some semblance of a cell signal and were able to call Soja, who is FAME’s mechanic, to come rescue us with a new alternator and install it just as darkness was falling. There is no AAA here and for readers of my blog, you are well aware of some of the sticky situations that we’ve gotten into in the past, some due to mechanical failures and some due to pilot error (getting stuck in the mud in Tarangire several years ago).

FAME doctors focused on Marin’s talk while a Maasai woman does her laundry outside.

So today, we took off well ahead of the FAME Land Rover as that way if we did have a breakdown, they’d find us easily and, perhaps more importantly, we wouldn’t have to suffer the clouds of dust that we did yesterday and which left the right hand side of my face with enough dirt on it to pot a plant. The drive went smoothly enough without incident and was tremendously more pleasant, though with each passing car, everyone still had to quickly slide their windows closed so as to avoid filling the car with pounds of dirt. Needless to say, the necessity of taking a shower as soon as we arrived back home was a given, even if it was typically cold as the kuni boilers (a wood fired hot water heater that is used here) are only fired in the morning and by the end of the day, the hot water and fire have been exhausted.

We arrived to Upper Kitete a bit earlier than yesterday as we were hoping to get to the African Galleria this afternoon to do some shopping. It also turned out that our patient volume today was fairly light making us even more hopeful of the possibility of our shopping spree. For lunch yesterday, Angel had purchased lunch boxes for everyone from one of the local restaurants. Lunch boxes are a staple here with everything revolving around the safari business as they are carried with you into the parks to sites that are good for lunch – i.e. no dangerous animals roaming around or those that are designated picnic sites. At certain places, you have to eat in your vehicle, such as Ngorongoro Crater, where the kites drop out of the sky to steal your food right out of your hand and in front of you face. Today, we decided to pick up a more traditional Tanzanian travel lunch that included a number of primarily deep fried items such as beef samosas, vitumbua ( a fried rice cake),  egg chops (a battered and deep-fried hard-boiled egg), sambusa (deep-fried, battered vegetable bites) and donati (yes, just as you might have imagined, donuts). All of this with a side of bananas and for drinks, various Coca-Cola products including Fanta passion and Stoney Tangawizi (both of my favorites). On our last visit, we discovered that they had actually released a sugar-free version of the latter called Stoney Zero, but I will have to admit (after many trials) that the sugar-free version is not nearly as tasty as the regular.

The patient flow was not overwhelming or the day, allowing us to finish up shortly after lunch and begin to pack up our things. As we were doing so, of course, a piki piki drove up with three men on it and as they dismounted it became readily apparent that the man sandwiched in between was actually unconscious and had to be carried to the grassy area in front of the dispensary. There are few things that get our attention more than an unconscious patient, so everyone quickly went over to assess the patient who was breathing just fine and had a good pulse, so that was quite reassuring. When it was eventually learned that he was merely inebriated, we were all a bit relieved as he was a very young patient and had that not been the case, the differential would have been quite large and nothing that we would have been able to handle here so he would have had to come back to FAME with us. We departed Upper Kitete that afternoon with the drunk patient having been carried into the nurse’s office with the plan to manage him there and quite confident that they could handle the situation on their own.

Hopelessly stuck in the mud

The plan was to take an alternate route to the tarmac as we were planning to go to the African Galleria just outside the village of Manyara. This road takes off about half-way home and used the be the road we used for every trip to Upper Kitete, but the other road we now use was found to be quicker and more reliable. Immediately after starting down this road, it became readily apparent that this had been a wise decision as the road was in horrible shape and this was without any rain. Had it been raining, this would have been an incredible mess for certain and would have brought back memories, actually nightmares, of the time my Land Rover slid off the horribly muddy and slick road into the muck, hopelessly miring us in a sea of slimy mud that even the local farmer refused to help us for fear of getting his tractor stuck. It took the help of another vehicle from FAME, lifting and digging out each wheel at a time and then supporting them with rocks. The other vehicle couldn’t even get close for fear of becoming stuck itself, so it eventually pulled from afar and we were freed after several hours. Not one of my finer moments driving in Africa as the clinic we were heading to had to be cancelled. It was very disappointing for everyone.

Meanwhile, we were finally able to navigate this bouncy road and make it to Manyara and the gallery, only to learn that it had closed for the afternoon as all the employees were attending the funeral of a prior employee. How disappointed everyone was after having left Upper Kitete early only to find the shop closed, but it was clearly for a good cause as funerals here are a very big affair as they a time for all those to show respect to the departed and to the family. As we drove home from the gallery, we came upon many, many cars parked on the roadside at one spot with markers in the road warning drivers to slow down. There were many hundreds of people there and this was clearly the funeral that had closed the gallery. The funeral typically goes on for three days and is a huge and important affair with the host family arranging to feed all of the guests during that time.

Monday, March 18 – A drive to Upper Kitete and the Overlook…. 

Standard

 

It was the beginning of our mobile clinic week and I think everyone was very much looking forward to heading out into the bush to explore more of the Tanzania they had now come to know. Adys, Jon, Sheena and Daniel had been here now for a full two weeks, while Marin and Dan had now been here for a week. Everyone was half way through their visit here and it’s always sad to reach that milestone. We had had a wonderful safari to Ngorongoro Crater yesterday with a wonderful sighting of two rhinos for a long stretch of time and very close, so everyone was still on a bit of a high from that standpoint.

Walking to work on Monday morning

Our neurology mobile clinics were an offshoot of the larger mobile clinic that FAME used to do when I first came in the Lake Eyasi region where we would take the bus, a few Land Rovers, about 25 doctors, nurses, and other workers, as well as a ton of medical supplies and would spend a full week in the bush running clinics for the Datogo and the Hadzabe. These clinics were funded by a grant that lasted three years, but early on, Paula Gremley and her business partner, Amiri Mwinjuma, who worked in the area mostly helping disabled patients, suggested that I accompany them to the Mbulumbulu region of Karatu to provide neurological care to two villages there. This was in 2011, and I have continued to visit both Upper Kitete and Kambi ya Simba twice annually since that time. The Mbulumbulu region sits on a plateau bordered by the mountains of the highlands on one side and the escarpment of the rift valley on the other until in the distance, these two borders meet as the mountains descend directly to the valley floor below.

Our two Land Rovers parked adjacent to the dispensary

This region was settled by the Iraqw and the fields here are incredibly lush and fertile with maize and other crops growing and being harvested. The soil is a gorgeous red-orange and motely tilled either planted or readied for crops. Most of the work here is done by hand or with teams of oxen and the fields are full of workers. It’s an incredibly different and tranquil world here and life is dictated not by the hands of a clock, but rather by the seasons and the angle of the sun. Life is changing here, though, even in the short time that I have been coming as at Kambi ya Simba there is now a beautiful dispensary and multiple buildings for all aspects of healthcare there. In 2011, I was in a field under the midday sun with a desk and chairs for my office and a waiting room that consisted of a log on which my patients sat. Upper Kitete, though, remains much the same as it was in 2011 when I started, save for a small building next door to the dispensary that we used on one occasion but haven’t since. Oh yes, there are new outhouses at Upper Kitete and a flushable, though squatty, toilet at Upper Kitete.

A field adjacent to the dispensary

It’s always a chore to get out of FAME on time for these clinics as somehow patients show up for us to see and that was the case this morning as they as Onealy, our radiology technician had contacted me on Saturday afternoon that the CT scanner was finally running and they had scanned a patient of ours who clinically had a thoracic myelopathy (spinal cord injury). Since we were at Gibb’s Farm in the afternoon on Saturday, I told him to have the patient return on Monday and we would also look at the scan, so I guess in some way, the patient there on Monday was partly my fault. In any event, her scan was normal meaning that we didn’t have a clear explanation as to what was causing her myelopathy. In going through the same exercise that we do here repeatedly, it was not merely a matter of sending her off for an MRI scan, as we would have to find something that we could treat here and that is a very “if” in East Africa. Rather than sending her for an MRI scan that would be very costly for her, we elected to do a lumbar puncture as this information would help us immensely. Sehewa, who is an amazing anesthetist here at FAME agreed to do the procedure for us and we gave him the labs we needed and asked him to contact me once they came back. What we hadn’t realized, though, was that we were heading to Upper Kitete for the day, where there is no cell service whatsoever. I finally received the information once we were heading home and conveyed our instructions to Sehewa later in the day and he contacted the patient.

Usually, we take one vehicle with us on mobile clinic, but since we had such a large contingent of neurologists (four adult neurology residents and two pediatric neurologists plus me) it meant that we would have to drive two vehicles. After finishing with our myelopathy patient and a pediatric patient that Marin saw as someone handed her the chart, we were finally on our way into the Mbulumbulu district. I drove our vehicle, which was perfectly fine since it wasn’t raining and the roads were clear, albeit a bit dusty. We didn’t arrive in Upper Kitete until almost 11 am which was certainly much later than we had intended, but we were perfectly fine working as late as necessary.

The Upper Kitete dispensary

Our turnout was a bit lighter than normal due once again to the planting season and the fact that most people were out in their fields rather than coming to see us. We had two rooms to work in, which was fine, and there were babies coming for their well-baby visits needing to be weighed, which is always such an enjoyable event. Each baby has their very own personalized harness that their mother has sewn for them and they are then attached to a “meat scale” where they swing in the breeze while their mother checks their weight. Some of the babies are completely unfazed, while others will scream bloody murder, but the most part, it all goes well and no one is worse for the wear.

One patient today is a young adolescent girl whose mother reports that she had not been to school in a number of months and has lost a tremendous amount of weight due to nausea and vomiting. Not really a neurological problem, but worrisome just the same, so we decided to bring her back to FAME with us to check her blood work and have her seen by one of the general folks. It took some doing, but we finally convinced her mother that it would be the best for her. We loaded them in the other Land Rover as ours was full and started our trip home at the end of the day. Leaving town, though, I remembered that I had wanted to show everyone the “Overlook,” which is this amazing view from on top of the escarpment down to the valley below. Our patient and her mother decided to wait at their home briefly while we drove the short distance to the incredibly scenic sight and then returned to town to pick them up. Paula had first taken me to this place in 2011, and since then I have brought every group here so that they could also enjoy it.

Our mobile clinic contingent at the Overlook

The drive home was uneventful except for the fact that the young girl had become very nauseated and was vomiting in the other vehicle. Thankfully, Sheena had brought enough Zofran with her to supply an army and quickly came to the rescue, running the medicine over to her. All seemed well, until we had arrived in Karatu and while the other car stopped to let out some of the FAME people, the girl and her mom also got out and were apparently planning to hop on a piki piki (motorcycle) to head back home for some reason which was never entirely explained to us. They were convinced to get back in and we eventually made it back to FAME where Marin escorted the young girl to the ward to be admitted and evaluated.

We spent a relaxing evening at home taking care of busy work and devouring our dinner of roasted chicken, mashed potatoes and vegetables and prepared for the next day’s mobile clinic which was going to be back out to Upper Kitete. We had taken care of the Overlook today and tomorrow we were hoping to stop by the African Galleria on our way home so that everyone could look at gifts to bring home.