Monday, October 12 – Exploring Ushongo Beach and the town of Pangani….

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Our Ushongo Beach Bandas – mine in the foreground

Given the incredible day we had yesterday, our plans for Monday were somewhat less ambitious as we had decided to spend most of the day at the resort and around Ushongo Beach with no plans for any further ocean adventures. Despite my still very painful ribs, I had managed to sleep, albeit with the assistance of some hefty doses of naproxen, and chose to spend a few extra minutes in bed rather than get up for the sunrise again. Leonard had wanted to scout around for property in the morning with the idea of perhaps someday building a small resort similar to the one we were staying in as he has been quite familiar with this beach for many years and always felt that it would be a perfect place to end up someday.

A deserted lodge reception

A street in the village outside of our lodge

So, after another fantastically scrumptious breakfast in our little restaurant where it seemed like we were the only guests there most of the time, the four of us began our tour of the beach area both to the north and south of Ushongo Beach Bandas along with the help of a friend of Leonard’s who knew the area well. As we walked along the beach, there were several smaller resorts that were close by, as well as the Emayani Beach Lodge, a larger and more luxurious resort, though all of them were closed due to the lack of tourists given the ongoing pandemic. As I had mentioned earlier, though, the presence of COVID had been essentially non-existent during my time here and though we certainly weren’t hugging and kissing as is the usual custom here, there were no masks or social distancing being practiced either.

The view outside of our restaurant

A typical ngalawa (outrigger fishing boat) of the Tanzania coast

The Emayani Beach Lodge is a lovely resort that is owned by ex-pats Annette and Peter who also own the Tarangire Safari Lodge, and they have known both Frank and Susan for some time as Frank has been providing their workers with annual physicals since the beginning and they also send anyone ill to FAME for medical care. The main building of their lodge is a beautiful open structure that is used primarily for lounging and drinks and, I suppose, also for meals when the guests are there. Their rooms surround the main building on either side. We spent time walking through many of the properties, both waterfront and inland, and I, all the while keeping my eye out for any poisonous snakes crawling in the brush or in the trees, such as the deadly boomslang, one of the deadliest snakes in the world, whose venom is usually deadly in a very short time. Having now visited the Indian Ocean and seemingly paradise, it was not my intention to finally discover one of these creatures the hard way. Being a snake lover from a very young age, I have always looked for them wherever I’ve traveled in Africa, but have thankfully seen very few up close for there are some very deadly species here including many types of cobra, green and black mambas, numerous species of viper and then the boomslang.

A scene of Ushongo Beach

We ventured back to our bandas around lunchtime and discovered that Enock and Amina had made us a huge plate of prawns in addition to our fresh fish and chips that were being served. The prawns had been cooked in garlic and lime juice and were just so incredibly tasty, but once again, it was left to Jones and me to share almost the entire pile of prawns as Leonard and Simon, though they did try them, were just not big fans of eating shellfish once again. We all had times for naps after lunch, having tired from all the walking up and down the beach in the morning, and later spent time with one of the fisherman who had brought his fresh catches to us once again both for dinner and to bring home. As he would sell the fish by the kilogram, Enock had to bring out his fancy balance scale to weigh everything. We chose what we would have for dinner and also what the other three would be bringing home with them, which did end up being quite a bit.

Lunch awaits us

Lunchtime on Ushongo Beach

After the naps and all of the fish purchases, we decided to drive to Pangani for the day as I had really wanted to walk around the town a bit and explore. As we drove up along the opposite side of the river to the ferry landing, there were lots of locals on foot as well as several smaller trucks and vehicles already waiting for the ferry, which I suspect is on its own schedule, plying back and forth across the river the dawn to dusk. The fare is very little, for both passengers and vehicles, and all passengers have to pay separately from their vehicle regardless. Only the driver is allowed to ride within the vehicle for safety reasons according to my travel companions. On this occasion, we had decided to leave our Land Rover behind as we hardly needed it to walk around the town, which was only several blocks long, and we would save perhaps a dollar on the fare. We did have to find a willing shopkeeper, though, to keep an eye on the vehicle for us, as breaking into vehicles here, mostly to steal car parts is not too uncommon.

The Pangani ferry ready to dock

The Pangani waterfront

The initial look and feel of this town is one that seems to mostly reflect its earlier prominence in the region with many waterfront buildings that I am sure were once the center of activity, but are either no longer occupied or have been converted into other uses. Close to the ferry landing, there is a modern bank, but beyond that and the waterfront buildings that are ghosts of their former selves, there is very little to separate Pangani from any number of the other little villages you encounter while traveling. We initially walked down the street that paralleled the waterfront and was one block away as it seemed to have the most commercial activity with little street side shops selling just about everything. I remember that we had needed a cooler for all the fish and, sure enough, we found one quite quickly at one of the shops and decided to pick it up on our way back through town. We walked all the way to the east end of the town where the river fanned out into a very large area and the beach at the mouth seemed to go on forever.

The Pangani ferry ready to dock

Scene aboard the ferry

We had been hoping to find someplace to have a beer, but had really seen none up until now, but heard the faint sound of music in the distance and eventually followed our ears. Sure enough, there was something that was certainly local club at the end of the road and adjacent to the beach that looked like a hangout for sailors and fishermen from town. We each ordered a beer and sat out back in these really funky benches that had fishing nets for backs, but were surprisingly comfortable, and watched locals walking across the incredibly wide beach down to the water. As we sat, the small outrigger fishing boats, called ngalawas, were all making their way home, with only their sails visible at first behind the small dunes of the beach until finally their hulls and passengers revealed themselves as they entered the river to our right. The lighting was lovely and their day, as was ours, was coming to close and it was time to head back to the ferry. We picked up our cooler at the shop as we walked and turned the corner to the ferry dock to wait for the next boat to dock and board.

The mouth of Pangani River

Waiting to head back on the ferry at Pangani

The drive back to Ushongo Beach, through the small towns we had now seen several times, seemed to be quicker than the other night and we had much more light with which to see. I had bought more lobsters from the fisherman and was looking forward to another incredible dinner. We were planning to leave tomorrow morning after breakfast and I knew that I was going to miss the food here. After dinner, I spent the evening on the beach with the crabs and an incredibly clear sky chock full of more stars and planets than you could ever imagine. For many, many miles there was no artificial light to spoil this amazing view of the heavens above and it seemed as though I was there alone to witness this miraculous sight, save for the crabs. They were there, sharing this near religious experience with me, scurrying across the sand by the many thousands, feeding on what the rippling shallows would bring them, just as they have done for millions of years before. It was surely another day in paradise.

Bring us his catch of the day

Weighing our fish

Buying fresh fish off the scale

Sunday, October 11 – Awakening to paradise….

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Fisherman at sunrise

I had truly left Moshi and the Kilimanjaro region with little in the way of expectations and our drive to the shore had been a real adventure for me, traversing regions of this wonderful country that I had never seen before. Our journey the evening before had also been a wonderful drive through an increasingly more tropical landscape that provided an excellent clue of our final destination for the sun had long since set by the time of our arrival. I had been given my own bungalow, or banda (not to be confused with the form of Mexican music but rather a thatched hut in Africa), for the night and had slept quite soundly with the gentle sound of the ocean and thankful lack of mosquitos that were fended off by the netting that hung over me. I had planned an early rising to check out the sunrise here and, given that I hadn’t even seen my surroundings yet, I arose with the anticipation of actually seeing where we had been deposited after our six plus hour trip the day prior.

Sunrise

A gorgeous sky

My banda sat on the beach only yards from the water and though there was still plenty of time before sunrise, there was more than enough light for me to see and verify that we were actually on the Indian Ocean, with its broad expanse of bright blue water stretching far to the east. I had pictured this moment in my mind during the night, but stepping out onto the sand and having it right there in front of me was a sight to behold. I was on a lovely tropical beach with nary a soul to be seen and the soft sand felt quite cool between my toes in the waning hours of dawn. I was certain now that that we had truly arrived in paradise and the following days would only serve to further that conviction. I wandered down to the water with my camera (which took all of about 10 seconds or less) and watched as the soft glow of the rising sun first lit the horizon and the clouds above in wonderful muted hues of orange and yellow, while still not fully declaring itself to the world at hand. Almost reluctantly taking a peek from the distant lands it had brightened only moments earlier, it then began to slowly rise with a concert of colors and then an explosion of light in only a matter of minutes. It was a sight to behold.

Sunrise

With the gradual parade of daylight, I began to notice all of the small boats that were slowly coming home after their night at sea. These were the lights I had seen the night before that were far off in the distance scattered across the dark horizon that was only marked by their presence. I came to discover that these were the sardine fisherman who spend the entire night on the water in their rickety boats, illuminated by large lights hung over the sides to attract the tiny fish soon gathered up by their nets. I grabbed my camera and decided to stroll up the beach to where they were all coming ashore and the residents of the tiny town were meeting them to offload their silvery cargo. It seemed as though absolutely everyone was out on the beach that morning to claim their portion of the catch (which I later learned was purchased by the women who would cook and package the sardines for sale at the market) and numerous cooking pots were set up for them to cook the tiny fish after sorting the gigantic piles into the sardines and any other unfortunate critters that may have accidently been swept up in all the commotion. It was a family affair as children were there pitching in with the duties, that is, when they were not running around and playing with each other. I strolled amongst the groups, with mostly woman doing the work, all dressed in the marvelously colorful patterns that I have so come to love about Africa, for it almost defines a great part of the culture here.

Our beach at sunrise

Heading out to sea

I spent a good hour there just taking in all the sights of this incredible village and it’s lovely people, not once feeling as though I was an outsider, though knowing full well that I was. Thankfully, this is not a touristy place as there are few resorts here and most of them cater to the ex-pats living in Arusha or Moshi. This is not an easy place to find or to get too, so I was very comfortable knowing that we were well off the beaten track and that those who come here do so very intentionally just for that reason. I had Leonard to thank for introducing me to such a magical place and I looked forward to exploring more of it over the next several days for we had only just arrived.

All hands on deck to unload

The night fisherman coming in with their sardine catch

The sun had now fully engaged with the coming day and its intensity was something to behold as it began its steady climb in the sky. As much as this natural clock had let me know that the day was now upon us, my own internal clock began to chime with hunger pangs and I was definitely ready for some breakfast, or at the very least, a good cup of coffee. The sun was now well into the sky, but the temperature remained incredibly delightful as I wondered over to the little restaurant/bar that would serve as our dining area for the next several days. It was a small, thatched roof building that was open on the ocean side (again, only yards away) and, in addition to the six or so small tables and accompanying chairs, there was a bar and a cooler packed with beers. As we had discovered the night before, the locals from the nearby village and homes would suddenly appear from the surrounding dark to enjoy the evening together and even some dancing. They also dropped in throughout the day to socialize and catch up on any local gossip or news.

Bringing home her portion of sardines to cook

Sorting sardines

I sat down at one of the tables with my book in hand and no real expectation of any service until the others had awakened, but as soon as I sat, both Enoch and Amina, our hosts, seemed to appear out of the shadows (in reality, they were in the little kitchen building next door) and ask me if I’d like some breakfast. As all who know me, that is not a question that needs to be asked of me more than once (as Jon Rosenberg will gladly attest too, I am certain). They took my order for eggs, brought me some coffee in a big thermos (the standard here) and went back to the kitchen to begin working on breakfast for me. What appeared after a short time was, in reality, a feast fit for a king that included eggs, toast, fresh juice, hot peppers (very hot!), and more fresh fruit than you can possibly imagine. It was all incredible and, after I had finished, I just sat and relaxed with my book (King Leopold’s Ghost – highly recommended book on the atrocities committed in the Congo by the King of Belgium at the turn of the century) and continued to work on the thermos of coffee that seemed to be calling my name. Pure, unadulterated bliss in paradise.

Portions of cooked sardines to package

Departing for Maziwe

As we were on absolutely no timetable here, it mattered not when the others finally appeared, but they eventually did and made their way to breakfast for an equally filling feast as I had enjoyed while I continued to relax with my book. Not far off our beach was Maziwe Island Marine Preserve that is a popular snorkeling site as there is a reef that surrounds the island and no scuba diving is allowed to further protect the reef from becoming a popular dive site and risking damage. I had wanted to visit the preserve, so we had spoken the night prior with one of the local guides who had offered to take me snorkeling at the island and I was pretty certain he would be looking for me in the late morning once the temperature had climbed from pleasant to warm. As expected, he arrived sometime around 11 am looking for me so we could head out to the island with plenty of time to snorkel in the afternoon. I had anticipated that I would be going out on my own and was surprised when Leonard, Simon and Jones told me that they would be joining us for the trip to Maziwe as I knew that none of them could swim so they certainly wouldn’t be joining us in the water. The journey to the island was about 45 minutes and was delightful given the incredible panorama that lay before us heading out to sea. At one point, there was nice sized group of dolphin that cruising along behind us in the distance and as we swung around to follow them, they quickly disappeared and resurfaced some distance away. None of the others had ever seen anything like it, so it was surely a thrill for them to see these amazing creatures leaping out of the water even if it was not right in front of us.

A motley crew! Leonard, Jones and Simon from left to right

Approaching Mawize

Maziwe Island, a small speck of sand that barely peeked above the surface of the ocean, has been devoid of vegetation for many years, but could still be spotted many miles away and served as a beacon by which we could easily navigate. The closer we came, the more brilliant the color of the water surrounding the island became until we were upon it and in the middle of a turquoise sea all around. We beached our little boat and unloaded the water for the others along with a tarp that we set up for them to sit under while we were out snorkeling. By now, the sun was dead overhead and quite hot so it would only be safe for them to wait for us in this manner with plenty of fluids to drink. I loaded back into the boat with the guide and his assistant and we left to head to the reef which was only a short distance and surrounded us completely. The water was crystal clear with the bottom easily visible below us as I put on my fins and mask and dropped into the water rolling backwards while holding onto my mask as I had learned so many years ago. As I cleared my snorkel and took my first look down towards the reef, I could hardly believe my eyes at the hundreds and thousands of colorful fish that inhabited this reserve, many by themselves, some in pairs and some in larger schools, but all with the single mission of scouring the reef in search of food. The only regret that I had was that I didn’t have my underwater camera (that I had bought for the Galapagos Islands several years ago) so that I have no way of sharing with you the immense beauty of this place.

Approaching Maziwe Island

Maziwe Island

Arriving on the island of Mawize

In addition to the fish, there were giant sea slugs lumbering along the bottom and giant clams that were nearly a foot across with the most iridescent of blue frills that guarded their rippled opening and would quickly close as I waved my hand above them. They were spectacular. I dove and dove, constantly looking for more unique specimens and finding them every time. On one dive, I found a very large stingray half buried in the sand and half hidden by some rocks, though his easily identifiable tail was more than enough to give him away. The countless species of fish were more than enough to overwhelm anyone for I had never seen so many in one place before even with many dives in the Caribbean. It was tiring to be out for so long bobbing on the surface, constantly dropping below the surface to every nook and cranny, and after more than an hour of doing so, I was pretty pooped and out and ready for a break. While lifting myself into the boat, though, as there was no ladder or steps for entry (this was a very rustic fishing boat and not a dive boat, mind you), I unfortunately slammed my ribs onto the gunwale. Not wanting to say anything as it was pretty darn embarrassing, I simply rode back to the island not entirely sure whether I had merely bruised my ribs or broken them, but when it came time to go out for more snorkeling, I politely said that I had seen enough (not true), was actually exhausted from the first dive (which was true), and didn’t want the others to have to wait any longer for me on the island (partly true). We packed up the tarp that the others had been sitting under and loaded all of the water back on the boat to start our journey home. I must admit that I wasn’t feeling quite as spry as I had been on our way out given even the subtle bouncing of the boat and the subsequent nights were a literal pain to get comfortable in bed as those of you who have injured your ribs in the past will recognize (I have done so skiing in the past), but it was still a great adventure to Maziwe, all the same, and a visit I won’t forget.

Ushongo Beach, Tanzania

Leonard picking out our dinner

It was time to relax after we returned, but first it was time for a quick lunch of fresh fish cooked by our favorite cook, Enock. Later in the afternoon, the fisherman began to come by with their catches of the day and for us to pick out what we wanted to eat for dinner that night. One of the fish, which we all seemed to agree was a cobia, though I’m not entirely certain any of us knew for sure, was quite large, and Leonard decided to purchase the fish to bring home with us when we left which meant that we’d have to find an ice chest and then some ice before heading home in a few days. Then, to my heart’s desire, a fisherman came by with a number of spiny lobsters for sale. Needless to say, I absolutely love lobster! Leonard and Simon weren’t quite so sure they were willing to eat it as they had never tried it in the past and were quite suspicious of these strange looking creatures. Jones had tried it before and knew how good it was, so I purchased four of them to add to our fish and Enock agreed to cook them for us. For those who are familiar with spiny lobsters, they are missing the huge front claws we know so well on the Atlantic lobsters, but are what are found in the Pacific and Indian oceans. Their tails, though, are just as tasty as their relatives.

A large cobia

Our little restaurant and bar

Leonard relaxing

My lobster dinner

Dinner was another feast of fish and lobster and Enock has outdone himself with the meal. The lobsters had been steamed perfectly and I think I ate 2 ½ of the tails to Jones’s 1 ½  while we did convince Leonard and Simon, who were quite happy with their fish, to try several bites, but neither would attack an entire tail on their own. It was a great end to an incredible day and we all looked forward to Monday.

My office on the porch of my banda.

 

 

Saturday, October 10 – And we’re off for Tanga…at least I thought so

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Having the opportunity to spend two nights in a fully legit hotel in Tanzania was a unique experience for me as prior to this the only nights spent away from FAME were either in the tented camps (which, by way of reference, are quite luxurious and beyond “glamping”) or a single night while on the road. Lounging the day before here at the Keys Hotel forced me to remember what it was like to simply enjoy myself with no schedule to keep and only my thoughts. I can’t recall having done anything similar in some time, or perhaps ever.

I awakened early and headed downstairs to enjoy some of the wonderful Kilimanjaro coffee and order some breakfast while waiting for Leonard, Pendo and Lenox to join me at some point as it wasn’t entirely clear to me when the others would be arriving from Arusha to begin our journey to the coast. Jones, who is Leonard’s brother, and Simon, a longtime friend, would be driving into town at some point with Simon’s Land Rover that we were taking on sort of a test drive as it had been newly rebuilt. Why we would be taking a six hour “test drive” was a bit beyond me, but I had learned long ago to put my trust in these friends and it had served me well so far. Jones would be driving Pendo’s car so that she could drive back to Arusha with Lenox and we would leave Turtle at the Keys Hotel, where they would keep a close eye on it for us until we returned.

My final memory of a wonderful surprise of a hotel

Lenox looked surprisingly well in the morning having just had his tonsillectomy a little over 24 hours earlier and managed to drink some fruit juice for breakfast while the rest of us enjoyed fresh fruit, French Toast and eggs cooked to order. I’ll have to admit that I felt a bit guilty enjoying such good food in front of Lenox, but by no means guilty enough to skip the meal. The day was once again spectacularly clear and bright and the air quite crisp and almost cool until near noon time. We hadn’t heard from Simon and Jones, but knew they would be arriving sometime mid-morning.  When they finally did show up it was almost noon and with the time it took to get everything checked out and loaded, it was well after lunch before we were finally on the road. The traffic heading east out of Moshi was heavy given the single lane on either side of the only highway heading in the direction of Dar es Salaam, but we managed to make it to the outskirts of town in a decent time and begin our trek to the shore.

The Pare Mountains

The road out of Moshi heads near due east towards the Kenya border until you reach the junction of the B1 highway that then travels south along several incredible mountain ranges prior to once again heading east towards the shore. The road is reasonably paved, heading through numerous small towns along the way where the speed limit drops to 50 kph (31 mph) and it’s important to closely as there are traffic police who would like nothing more than to ticket you as I have proven numerous times in the past. Our speed out of the towns is typically in the 80-100 kph range (50-62 mph!) which means that driving these very long distances feels like your traveling at a snail’s pace at times.

A view of the distant Pare mountains

The highway we’re traveling skirts along immediately to the west of the North and South Pare mountain ranges with the Kenyan border just on the other side of them. The geography here is very flat other than the mountains and reminds me of the drive from LA to Las Vegas with it’s beautiful vistas and incredibly long stretches of long flat terrain. That highway in the southwest, though, had always been known for its insane speed limit which was essentially “safe and prudent,” which more simply meant there was none. It was the stuff of legend and where car enthusiasts first went with their newly purchased Corvettes and Porsches to “see what they could do.” We had no such luck in our classic Land Rover defender and were relegated to a meager 60 mph, unless, of course, we were traveling through a town when it was only half as fast, for the incredibly long stretches of highway. Thankfully, it was all new to me and I was now getting my change to take in this part of the country that I had long hoped to do. For those who know me and my passion for wanderlust and the open road, it was heaven for me just to be cruising across east Africa in a Land Rover and the many hours in the car was a small price to pay for another incredible journey that has become such a part of my life here.

The North and South Pare Mountains with sisal farms dominating the horizon

We were heading into a region of Tanzania that is known for growing sisal and its massive plantations that stretch for as far as the eye can see. It is used primarily for making rope and baskets and it was hard for me to imagine how anyone could use all the sisal growing here for it stretched for miles and miles and many hours of our drive. The plants are a member of the agave family, best known to us for tequila, though these plants are only used for their fibrous leaves and the strands of sisal that go into making the ropes and baskets seen throughout the country in the markets, industry and in people’s homes. From the moment we made the turn onto Highway B1, the sisal plants became our closest friends and remained with us for the rest of the day until we reached the shore. Rows and rows of sisal plants fanning out to the horizon dominated the countryside and were broken up only by the small towns that housed the families who supplied the work force needed for such an industry.

Rows of sisal by the side of the road

The North and South Pare mountains to our left were absolutely spectacular ranges as their peaks sought the sky and small pockets of level ground within them contained tiny enclaves of houses that formed hamlets high on the mountain tops where only foot trails or an occasional small road dared to reach. But these mountains were only an introduction to the mighty Usumbara ranges that were still to the south and would soon be upon us. Before the Usumbara, though, we needed sustenance and as my stomach began to growl, for breakfast had been hours before, we somewhat miraculously came upon two rest stops that could have been right out of the Northeast corridor and I-95. I had never seen one here in Tanzania, but admittedly, this was first experience on one of the country’s long stretches of highway that sits between major centers of the population. These rest stops were here to service the routine travel by bus of the majority of individuals who make this trek and are run by the larger of these bus companies. There were several counters for various types of food, but I followed Simon and Jones to a buffet where woman doled out helpings of rice, Chagga stew (bananas and meat), roasted chicken and various vegetables. You pay by the plate and Leonard had gone to buy our tickets for the food while we headed to some outside tables where large speakers blared out music broken only by the occasional announcement of one of the buses leaving for its destination.

A view from the patio of the service area

Happy to have had lunch for I had no idea when or where our next meal was to come from, nor for that matter how far we had to travel to reach our final destination for the day, we loaded back into the Land Rover and were on our way again, now heading a bit more southeast in direction as the shore lay directly to the east. As we passed close along the edge of the Usumbaras it was easy to see why they were such a popular attraction for outdoor activities such as camping and climbing. They appeared quite unique with large undulating cliff faces and numerous flat areas on top that once again housed small villages that were easily visible to the naked eye and had to be truly miraculous places to live with their expansive views of the land below. There are roads that lead into the mountains and, quite likely, to the villages on top and I thought how amazing it would be to one day return here to further explore the area.

Three master Land Rover mechanics working on our vehicle with sisal in the background

We passed through the larger town of Korogwe and, several kilometers further, reached an intersection where, had we planned to head to Dar es Salaam, would have continued further south, but instead turned to the northeast toward the city of Tanga and the coast. Tanga is one of the larger cities in the country and is primarily an industrial town that was headquarters for much of the shipping during the German colonial period for the country. Up to this point, I will have to admit, I had absolutely no idea of where we were heading or what our actual plans were for the next several days. All that I had known was that we were heading for the coast and “Tanga,” but that is both the name of the town and the region here, and I wasn’t even sure where we would be spending the night. I Tanzania, I have never asked too many questions regarding plans when traveling with Leonard as I have never needed too. As the person who has typically made all the travel plans in our family (which, by the way, I had always chosen to do and no one else), it seemed to be a welcome rest from those duties and, besides, he knew tremendously more than I did about the country and seemed to know exactly what I’d enjoy in the process.

The mighty Usumbara Mountains

After entering the town of Muheza and stopping to refuel, we left the tarmac and headed east along what was about a 40 km “shortcut” to the shore. At this point, since we were diverting from what I had thought was our destination, the city of Tanga, I chose to ask exactly where we were heading for I was still studying the maps in the remaining daylight that existed. It was easy to see on the map that this road led to the town of Pangani that was at the mouth of the river by the same name as it entered the Indian Ocean. The shortcut was entertaining enough as Simon drove like a banshee, hoping to get to Pangani before sunset, and was little deterred by the Land Cruiser that seemed to manage staying just ahead of us on the road and kicking up loads of dust. It was clear that the passenger in the Land Cruiser was a nun and each time we pulled up close to the vehicle with the intention of passing it (mind you, this was a narrow dirt road with nary the space for the two vehicles side by side), they would spurt ahead clearly not wishing us to pass. There was something less literal about this process and at times seemed like there was divine intervention, but thankfully, their destination was only about half way and we all breathed a huge sigh of relief as they pulled into one of the larger parochial schools that sit here quite isolated and remote.

This is a photograph and not a painting of one of the mountain ranges from inside our vehicle

We eventually came to the crest of our route and far in the distance was the Indian Ocean. It was bluer than blue and gorgeous to behold after having spent years in the country without seeing it except for in air while traveling through Zanzibar or Dar es Salaam as merely a short layover on my way to and from Doha. We began our descent to the shore and reached it soon after, intersecting the coast road (also dirt) just north of Pangani. As we drove into town around sunset, there plenty of souls on the street who were either coming or going and, as we turned a corner, I could see a ferry stop sitting in the distance. I love ferries and had no idea that we’d be on one to get to our destination, so it was certainly a pleasant surprise for me and, as we pulled up the gate the ferry was there and being loaded so it was perfect timing. Though it was a short distance across the river, it was still exciting for me and, as the sun was slowly setting up river to the west, it made it quite a scene. As Simon drove the Rover onto the ferry, the rest of us walked on, for only the driver can remain in the vehicle for safety reasons, and we sat along with all the other passengers as the ambient light very quickly drifted to dark as it does here close to the equator.

The Usumbara Mountains

Arriving on the far side of the river, we all climbed back into the Rover to continue our journey to exactly where, I wasn’t quite certain, but it was becoming more and more evident that we would not be staying with family for I knew of none that lived in this region. It became quickly very dark as we left the ferry landing and all that was visible to me was what I could see directly in front of us, illuminated by our headlights, as we traveled at a rather high rate of speed initially along a somewhat wide dirt road, but it quickly turned into a path wide enough only for a single vehicle with dense vegetation and trees occupying either side. We traveled in this fashion for perhaps half an hour, making various turns that I would have hard pressed to recreate if had ever needed to return on my own.

The ferry landing in Pangani

Our ferry before boarding

Eventually, we happened upon some signs at a fork in the road that seemed to be important for we exited the vehicle to be certain of which direction we needed to head. Thankfully, the others knew exactly where we needed to go as I had absolutely no idea where we were, and soon we were pulling into a small village crowded with townspeople along a short and very narrow road with structures lining both sides of it tightly. I could see in our headlights that the roofs were thatched and the low eaves seemed to leave little clearance for us to drive under given the narrowness of the roadway. As we passed through and seemingly reached the end of the road, both literally and figuratively, we pulled up to a shack that was marked “reception” We were greeted by our host who helped us with our bags and showed us to our rooms, though in the complete darkness, it was very difficult to tell anything about where I was. It was clear that we were on the beach for the small waves crashing a short distance away were telltale sign as was the sand we walking on. My room was a small banda, or little hut, that had its own bathroom and shower in the back, though I was told no hot water in my hut which was just fine with me.

Looking west up the Pangani River at sunset

Our road illuminated only by our headlights

We were then let to a small structure with a thatched roof that was otherwise open to the night air and served as the bar and restaurant with several tables for us to sit at and eat. In short order, we were served an incredibly delicious grilled fish dinner with rice and vegies and, as we ate, I watched the thousands of crabs who came out each night and were scurrying along the wet sand by the water’s edge. I had no idea where we were nor what it looked like, but somehow, I knew that we were in paradise and, the following morning, I was to discover just how right I was.

Leonard, behind the bar, and Simon relaxing after dinner in our little restaurant

Thursday and Friday, October 8 and 9 – Moshi and the Keys Hotel….

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It was another glorious day in Ngorongoro Highlands with the sun shining very early as I awakened readying myself for another last day at FAME, having had so many of these over the last ten years. It has become a more routine and simpler task for me these days as it’s really not saying goodbye any longer, but more a “see you five months,” and something to which everyone here has become accustomed. There are other volunteers, like me, who have found a home here and return on a regular basis, but I had realized quite early on that for this project to really work, it would require that not only the patients here knew that I was coming back, but also the staff at FAME. For as much as it means to come here and provide care to the patients, it is really about supporting the medical staff and for them to feel comfortable in that fact.

I still had at least a third of the charts to go through this morning before returning them all to Kitashu and so I sat down at our kitchen table with a cup of tea and began plugging away on my laptop with the new EMR and the stack of cardboard charts, that will soon become obsolete even here in remote East Africa. I had discovered last night that we were missing a few charts and, though, thankfully I had a record of their visit in the EMR, there was some missing information for our database that had been overlooked during the installation of the new system. I had been able to obtain this information as long as I had the paper chart in hand as the information still existed there, but for those missing charts, which was typically because the patient had received care elsewhere at FAME following their visit with us, I would have to locate the charts. Knowing that I was leaving, I met with Kitashu to give him a list of the approximately twenty missing charts so he could find them later and email me the missing data. Of course, he did this within a day.

I made certain to hang around late enough that morning for tea time to come along as it would be several months before I would again have the pleasure of drinking Samwell’s remarkable Chai Masala that is so lovingly brewed each and every morning at FAME so that everyone can continue to partake in that remnant of colonialism that still exists in much of East Africa. I enjoyed my tea, stopped by Jackie’s office to give her some of my nice clean American dollars in exchange for some beat up bills that she had accumulated and would not be acceptable here at the bank so that I could bring them back to the US for her. They are very particular about the need for US dollars here to be pristine and recent, lessening the likelihood of them being counterfeit, or at least that’s in principle. Regardless, that was fine with me as I did have left over cash that was perfectly suitable and no worries about exchanging the beat up bills on my return to the States. I walked through the administration building to say goodbye to everyone and then down to the outpatient clinic. I met with Kitashu to hand over the huge stack of charts we had, though not nearly as huge as that on other visits where there are nearly three times as many patients seen.

A delicious plate of kuku choma

I was on the road and heading out of Karatu surprisingly on time, which is a rare occasion for me, not because of the inability to manage my time, but rather due to the unexpected things that pop up at the last minute and need to be completed. Amazingly, everything had been finished early and it was now just a matter of taking my time with Turtle, listening to The Gipsy Kings, and enjoying the sights down the escarpment, of Lake Manyara, Mto wa Mbu, Makuyuni, and on towards Arusha and the towering Mt. Meru. It is certainly helpful that I now know this route like the back of hand, having driven it dozens of times over the years and it has become my familiar commute, though has lost none of its shear magnificence as a result.

The pool at the Keys Hotel

Our plan on my arrival was that I would be departing the next day with Leonard, his brother and a friend for the coast region of Tanga and the Indian Ocean, though, to be honest, I knew little more than that. On my arrival, I discovered that one of their children had been scheduled at the last minute for a tonsillectomy that was to be performed that night in Moshi, about 2 hours away. I wasn’t certain as to what our plans were for the coast, but went along with the family to the care center where they were to have surgery as I was part of the family and I knew that they would value my support through the process. I met the surgeon, whom I was very much impressed with, and sat around as we waiting for all of the admission procedures to be finished. Leonard and Pendo would be staying at the care center with their son after his surgery, but we would need to find a place for me and, thankfully, right down the road was a wonderful, old hotel, The Keys Hotel, that turned out to be one of those incredibly pleasant surprises. It turned out to be one of the nicest and most relaxing places I’ve stayed here in Tanzania.

By the time we had taken care of everything at the care center, which also meant going to the market for cartons of ice cream, it was well after 9 pm and none of us had eaten dinner. Luckily, the kitchen at the hotel was open until 10 pm, so Leonard and Pendo order food that sent to the care center for them, and I finally sat down to enjoy a nice meal after having been traveling the entire day it seemed. I relaxed on the back deck that overlooked the pool (yes, they actually had a pool) and ordered my favorite soft drink, Stoney Tangawizi, which is the tastiest ginger ale you can imagine and available mainly in East Africa. Deciding on what to eat, I went with the “kuku choma,” or barbecued chicken and was so happy that I did since it turned out to be one of the most delicious dishes I had had in some time. I ordered only a half chicken and can’t imagine having tried to eat an entire one by myself.

The back deck of the Keys Hotel

Exhausted from the day and all of the excitement with the surgery, I went up to my air conditioned room (a rarity in Northern Tanzania) and read a bit before bed, knowing that I’d be awakened at some point by a message from Pendo as I had asked her to let me know when the surgery was over and all was well. The next morning, I went downstairs only to discover that breakfast was included with the room and proceeded to relax with a wonderful pot of Kilimanjaro coffee that was later accompanied by perfect French toast and fruit. All had gone well with the surgery, but it wouldn’t be until the evening that they would be discharged, so it was decided that we would just stay in Moshi for another night and I would get a room for Leonard, Pendo and their son to stay. We would just delay our trip to the coast by a day to be certain that all was well.

Out in front of the Keys Hotel, a beautiful view of Mt. Kilimanjaro

Having the day to spend at the Keys Hotel was just so incredibly relaxing as I was able to catch up on work and reading and, in the afternoon, walked over to the care center to spend time with some of their immediate family who had come to visit. Sitting with everyone out in front of the building in the plastic chairs, it was very special for me as I was there not as a visitor or a guest, but rather as a part of their extended family. We all sat sharing stories for a long time, until it was getting dark and time for me to walk back to the hotel and begin to think about dinner. I had had a delicious pizza, perhaps the best I had tasted in Tanzania, from their wood fired oven for lunch, so decided to have kuku choma again for dinner, though with a salad instead of chips tonight. The evening was lovely with a slight chill to the air that was much appreciated. Leonard, Pendo and their son would be coming over later this evening after they were discharged and we had decided that we would leave for the shore in the morning. The others would be heading back to Arusha as long as all was well following surgery.

 

 

 

Wednesday, October 7 – A day to finish charts and documentation…

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The primary role of our work here at FAME from my very first visit and including the present has been to work with the doctors and nurses to provide them with all the necessary skills to evaluate and treat neurological illnesses in the residents of Northern Tanzania. By doing so, we would be fulfilling one the main missions of FAME and improving the health of the community relying on them for their medical care. Early on, though, we also realized the need to keep internal documentation of the types of patients that we were seeing and where they were coming from, to what tribes they belong, the diseases that we were treating, and what medications we were using to be certain that we were addressing their needs and would have the necessary resources available for each of their visits. Beginning in 2015, that internal documentation became an organized database that now contains well over 2500 patient-visits and provides an incredible cross-section of the neurological health of a large community in Northern Tanzania and a wealth of information that will enable us to not only continue to provide this care, but to do so in a more efficient and effective manner over time. Furthermore, the knowledge that is gained from this record may well translate to other similar communities in Tanzania, and even throughout Africa, as well as to other specialties beyond neurology.

This database has been continually maintained by the residents who have accompanied me here and, more recently, by a select group of medical students from the University of Pennsylvania who have not only demonstrated a keen interest in neurology, but have also shown their desire to pursue it as a career. Though it has never been the intention of FAME to provide medical students with a global health experience, the volume of data that we have been collecting has made this role very helpful, if not essential. Despite the fact that I saw far fewer patients than we do on a normal visit (140 as opposed to 400), I would still be responsible for making sure that we have all the necessary documentation to input each patient into our database, both new patients and return, as well as additional information for all of our epilepsy patients concerning their seizure control. My plan for today, of course, was to spend as much time as would be necessary to complete that task which was slightly more complex given the new EMR (electronic medical record) that we had just started using the first day I began seeing patients this trip.

Thankfully, FAME had seen fit to actually hire their own IT person who would be managing the EMR internally and that made my life tremendously easier. The EMR that FAME selected would have to be one that would be usable in Tanzania for Tanzanians and was not being developed for the volunteers who are coming, most of whom are very familiar with systems such as Epic that cost millions of dollars to install and would have been total overkill. The main problem that I encountered with the new EMR actually had to do with the report feature as I wanted to be able to pull up all of the neurology patients we had seen for the month and that feature just didn’t exist when I began to play with it. Thankfully, though, Valence, FAME’s new IT specialist, was able to go into the system and find the report that I was looking for which saved me an incredible amount of time. As with every new system, though, there are often oversights that weren’t anticipated and a glaring one that I discovered, at least from neurology’s perspective, was that the data regarding tribe and village was not being recorded in the patient demographics in searchable field. Some of the questions that we had been looking over the last several years had to do with whether there were differences in neurological disease, rates of return, and demographics between the various tribal affiliations and locations throughout the region that we draw from. This information, which had been included in FAME’s older demographic database and on the paper charts, would now require that I go back through all of the paper charts to update our records and make certain that we would have the necessary information to input into the neurology database, otherwise, it would be incomplete.

I came up to clinic around 8:30 am as I knew that Kitashu was going to be there to help me gather all the charts together. Then, I was able to create a list of all the patients we had seen in the EMR which allowed me to tell if one of the paper charts was missing as often happens if someone comes and takes it for various reasons. I sat down to start the process of going through about 120 charts (quite a big stack) when Kitashu came in to ask me if it was possible for me to see a young man whose father had brought him to clinic today as he could not find the boy yesterday. This was somewhat of an interesting excuse and I wasn’t quite sure whether to take it totally seriously, but in the end, it turned out to be very legitimate.

I invited the young man, who was about 24-years-old, and his father to come into the exam room where I had all of the charts strewn across the desk and table after finally getting them chronologically organized. Dr. Adam was there with me to translate, though it turned out that both the son and the father spoke very good English. Despite this, I typically want to have a Swahili speaking person in the room as certain things can be lost in translation and just to be careful, I have always stuck with this practice. When I asked what I could do for them, there was an initial bit of a silence, and then began a very long and saga that involve the son being away at college several years ago, becoming mixed up with other youths smoking marijuana, being sent home from school and the father taking him to the hospital not once, but several times for what sounded mostly like psychiatric admissions rather than just for drug rehab (which is really hard to find in Tanzania for the most part).

Over the last several years, though, the son had been following with district mental health officer and had been on a fairly strong antipsychotic medication, chlorpromazine, that had actually worked very well for him and it was only when he went off of the medication that he would become agitated or aggressive with others. The father was blaming the marijuana for his son’s issues, and even though this might be partly true, after I had clarified that the son did indeed have auditory hallucinations and paranoia, I was completely confidence that this young man, whose issues began initially when he was 18-year-old, had a pretty run of the mill case of schizophrenia that had been well controlled on the chlorpromazine. Though the marijuana may have temporarily made him acutely psychotic, or, should I say, more psychotic, it was not the underlying problem and marijuana or no marijuana, the boy would have had the same issues and needed to be on medications.

The father, meanwhile, had done a remarkable job of not only keeping his son safe, but also doing what was clearly the best for this boy by taking him to the hospital on several occasions to try to find help for him. Unfortunately, there are no psychiatrists around to manage these case, which is why we are often seeing them in our clinic, but I did know of a psychologist in Arusha who Frank has referred patients to in the past, and I promised the father that we would reach out to get that information for him as he was willing to do whatever was necessary for his son. Hopefully, we can make that connection for them and find some relief for this very caring father. In the US, the son would undoubtedly be in a group home as he was very well dressed and appeared to be functional on his medications.

I was finally able to get back to my charts, and other than meeting with Susan and Kitashu for a debriefing meeting, I spent the rest of the afternoon working on them and was able to complete perhaps just over half. I had wanted to get in my last bike ride of the visit and was determined to do so as this would be my last opportunity. I hopped on my bike and pedaled down the FAME road into town, paralleling the tarmac along the Tumaini School Road and then connected up with the main road out of town towards Rhotia. It was actually a bit cooler than I had expected, even with the late afternoon sun bearing down on me, and it was great last day for a ride. I returned home, showered and met Abdulhamid in town for my last nyamachoma dinner, one of my favorites here. I took care of a few more charts before bed and knew that I still had a few hours of work to do in the morning.