Tuesday, September 21 – Another long and dusty drive to Mang’ola and a visit to Mbuga Nyekundu…

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The clinic at Mbuga Nyekundu

Our visit to Barazani yesterday had gone well, though we hadn’t seen the same numbers of patients as we had two years ago when we were still living in a pre-pandemic world. I heard later that there was some confusion in the Mang’ola region that patients couldn’t come to see us unless they were vaccinated which certainly wasn’t true, but that certainly would have been an explanation for why we saw about half the number of patients. Very few patients in this region, or in any region for that matter, of Tanzania have been vaccinated at present and it has to do with a number of factors that have occurred here over the last 18 months.

Joel getting the pharmacy ready to dispense medications
Kitashu taking a short breather

To begin, we were here in March 2020 when COVID-19 had hit the US in such a dramatic way with NYC being pretty much ground zero once again. We continued to do our work as it was actually much safer here than it was at home, but when the State Department said to “shelter in place” or return home, we scrambled to rebook flights and made it home to a country that was in the throes of a health disaster unlike any we’ve ever seen in our lifetime. Meanwhile, the pandemic never hit Tanzania in the numbers it did in our country. Remember, this is a country of over 60 million people, one-fifth the size of the US, and the hospitalizations and deaths that have accumulated have in no way approached the numbers that we have seen at home. Though people have attributed that to the fact that there was no testing here would not even come close to a logical explanation as even without testing, hospitals would have been swamped and there would have been bodies in the streets had it even been a small fraction of what we saw at home. And this is a country where you could not find a mask on the street if your life depended on it (and it was just that at home) other than at some health institutions and, even that, was a rarity.

Dr. Anne and Denise working together with a patient
Staffing a patient with Paul

This is not to say that there was no COVID here in Tanzania as there certainly was and it came in three waves that hit in small numbers, but when it did, there were deaths and, tragically, it was the gatherings for funerals that in the end were the downfall for a number of high profile political officials. Hospitals required isolation wards for those patients who presented with symptoms suspicious for COVID so that they wouldn’t infect other patients and caregivers. Since the very first moment of the pandemic, FAME became a leader in the health community of Karatu district, enacting protocols designed after those in the US to prevent the spread of the virus and they did this very successfully. Everyone is masked and all patients are screened for symptoms and fever just as we have been doing in the US since the very beginning. FAME served to educate all of the government health workers in the district and has continued to provide the same services including being the test site for tourists having to get their COVID PCR test prior to traveling back home.

Revo, Cat and Emily evaluating a patient
Akash, Phillip and Leeyan working with a patient

With the death of President Magufuli last March (during our visit, I might add), Tanzania’s vice-president, Samia Suluhu Hassan, succeeded him and quickly realized that she needed to move the country from denial of the virus to acceptance and even more quickly begin to adopt practices that would hopefully protect the country from future waves of the virus. One of her first steps was to accept a shipment of vaccine from COVAX, the international coalition led by the WHO to supply COVID vaccines in an equitable manner internationally and specifically to low-income countries in need of access. At the end of July, Tanzania received the first shipment of their one-million doses. This was certainly an incredible milestone, but unfortunately, this is a country of over sixty-million people and a nation that had denied the existence of COVID until only recently.

Joel discussing a prescription with a patient

The disastrous consequences of the latter of these two facts is that it is my understanding that less than half of those one million doses have even been put into patient’s arms at the present meaning that the percentage of the population that has been vaccinated here is less than 1% compared to the nearly 70% vaccination rate in the US. The difference here, though, is that those who are unvaccinated are not making a political statement, but rather doing it because of lack of knowledge or misunderstanding. I have heard from people here that say they’ve been told that young woman receiving the vaccine will no longer be able to become pregnant. It is on this background that the battle against the pandemic will be fought in Tanzania and many other nations of Africa and, as we have now learned in the most dramatic of fashions, there are no borders when it comes to disease, especially a global pandemic. If the need for increased global health efforts has not been evident to you before, it should be now.

Dr. Anne and Denise with a BPPV patient about to perform a Dix-Hallpike maneuver
The Dix-Hallpike

Our drive to Mang’ola was again an incredibly dusty and bumpy ride. Remember, I am driving a stretch Land Rover that can seat nine passengers meaning that there is a rear row of seats that sit well behind the rear wheels, having the added advantage, or disadvantage, of a tremendous amount of extra bounce when it comes to those extra big bumps. Though it is certainly not anyone’s intention to hit these bumps at high speed, just imagine driving at 80 kph in the dust and on the washboards and trying to slow the vehicle down when you see these at the last moment. I don’t use this as an excuse as much as an explanation for poor Philip who I think sat most often in the back of Turtle on our treks and probably hit his head on the room a time or two. There are certainly disadvantages to being tall.

Kelley gets into the trenches
Paul now confirming

The road to Mbuga Nyekundu leaves the main road to Barazani as you enter the region of Mang’ola and it sits in a valley that is more distant from Lake Eyasi. The district dispensary there is rather large and, though there was amble space for us, there were no desks or chairs in the building we had used in the past, which meant that they all had to be carried from the other building. Kitashu once again took care of the organization and with everyone’s help, we soon had three examination rooms set up to get through the patients that had already accumulated for us to see. Dr. Anne once did her announcements to the patients regarding what types of conditions that we see so as to triage out patients with non-neurologic conditions who would be better seen by the clinical officer stationed here and who delivers care to the community on a regular basis.

Kelley staffing a patient with Cat and Emily

The weather was incredibly dry and dusty and there was a strong wind that blew through the community reminding me of my days exploring through the inland deserts of California as the landscape was also quite similar. It was not hot at all, but the dry wind felt as though it sucked all of the moisture out of your body and for someone like me, who drinks very little water to begin with, it was a firm reminder to hydrate. It was decided that we would eat our lunch inside the building, not only to avoid the wind and dust, but also because we want to be sensitive to the patients and community by not eating out of lunchboxes in front of them. We’ve also done this from day one on our mobile clinics as it very often the case that we’re enjoying a meal when the patients and villages may get only one meal a day and are most frequently underfed and malnourished. The number of nutritional anemias here is quite large, but you must also remember about deworming younger patients at least one a year as it has been shown not only to help the anemia, but also to improve academic performance.

Emily, Revo and Cat staffing a patient with Kelley and Paul

Akash had both of the more interesting patients today. The first was a young man who came in with patchy sensory complaints that had been going on for some time and, though they were certainly neuropathic sounding, the patchy nature of them argued against the more typical length dependent process, such as what we seen commonly in Diabetes, and he had to give some more thought to this patient. His examination failed to yield any additional clues other than confirming the he indeed had something other than a common neuropathy. There were some additional clues that can’t recall at the moment, but with further questioning, it turned out that the man’s father actually had leprosy, but had passed away previously. After discussion with Paul, it was felt that this patient actually leprosy and would require further treatment in a center that deals with this diagnosis and does exist here in Tanzania for this and other diagnoses such as tuberculosis and anthrax due to their specialized nature of treatments.

Revo, Cat and Emily evaluating a patient

The other patient was a child with a much simpler diagnosis of cleft palate, something that is actually treated for free by the government and so there should be no barrier to the child getting surgical correction for this condition. Although the treatment is free, there is still a cost for the family as it requires that they travel to a government center that deals with this and that usually means the parents and other siblings would have to travel somewhere, find a place to live during the procedure and take care of whatever other expenses there might be other than just the surgery. Things are not always as simple as they sound here and “free” treatment may not always come without a cost. This is not unlike home in many ways and is why we have the Ronald McDonald house at CHOP so that families can have somewhere to stay for extended periods if necessary.

Staffing resident clinic

Our clinic wound down and it was eventually time for our departure from Mbuga Nyekundu. Thankfully, now knowing the way home, we would not have to drive with the other vehicle making the dust more manageable, though not entirely as there were certainly lots of trucks and other vehicles on the road that we would either overtake or were driving in the other direction to turn up enough dust to still make it miserable. We arrived home before sunset, though, and had time enough to run to Teddy’s as Kelley and Paul had wished to have some clothes made, as well, and the others needed to try on a few things. Amazingly, having never had anything made during a visit here, the group talked me into making a pair of shorts with some of Emily’s left over fabric. The cost to make the shorts was 10,000 TSh or slightly more than $4.00, so it wasn’t like I was taking a big risk regardless if I never ended up wearing them.

Trying on their new clothes

We finished at Teddy’s and drove home for the evening, having had a very full day of work and driving and it was now time for rest and relaxation. We still had two days of mobile clinic left in the week, though they were much shorter drives to the idyllic site of the Rift Valley Children’s Village, a place that is always wonderful to visit for so many reasons. Friday, we would be heading to the Serengeti for two nights and everyone was clearly looking forward to that, including me. We would have drivers and two vehicles and, even though driving on a game drive is one of my favorite things in the whole world, it is nice to be driven once in a while and I would be free to take photos as well.

Cat, Denise, Emily and Phillip in their new clothes with Teddy

Monday, September 20 – A long drive to Mang’ola and a surprise visit to the beach…

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The team at Barazani

Our day in the Crater and visit to the Crater Lodge had been incredibly memorable and now it was time to get back down to work. Mobile clinic has been a staple of our month of neurology here at FAME over the last ten plus years and began initially at the suggestion of Paula Gremley, an expat who had lived in Tanzania for over sixteen years when we first met, and had partnered with FAME during the early days. After one of our larger mobile clinics to the Lake Eyasi region where we spent a week in the bush, she had suggested that we travel to the Mbulumbulu region nearby Karatu to visit some smaller villages and provide neurology care for individuals who, even though travel to FAME was possible, were not aware that treatments possibly existed for their conditions. We had traveled originally as a very small group – me, Paula, a clinical officer and a nurse as well as Paula’s associate, Amiri, who did the driving. We visited several villages during each of my visits and continued doing so long after the Lake Eyasi clinics ended, thus maintaining the tradition of FAME’s work in communities remote from Karatu.

A huddle before seeing patients
Getting ready to see patients

These clinics have become an integral part of our work here and have typically occurred during the third week of our visit as this seemed to work the best in regard to the timing of visits and the ability to have some of our patients return at the end of our time here before we left. During the pandemic, though, we were unable to have the clinics due to safety concerns and so, it had been well over a year since we had traveled away from FAME other than to Rift Valley Children’s Village. Though we hadn’t originally planned to do any mobile clinics this visit, the opportunity presented itself for us to travel to the region of Mang’ola for one or two days to provide neurologic care in this community. When we had last traveled there in March 2020, we had seen our highest daily volume and it seemed to make sense for us to travel back to both the town of Barazani and the village of Mbuga Nyekundu, both near Lake Eyasi.

Joel taking vitals on a patient
The dream team

Lake Eyasi has to be one of the more remote regions that I have visited, or at least it has the feeling of being so. In the early days of FAME, we used to travel to the village of Gitamilanda which was much further along the shore of the lake and where the Hadzabe, the last hunter gatherers of Tanzania, lived alongside the Datoga. In comparison to Gitamilanda, Mang’ola and Barazani seem like a metropolis, but in reality, this is also a very remote region with little in the way of resources. The drive from Karatu is a tough 1-1/2 hours along one of the bumpiest and “wash-boarded” roads you could ever imagine. The trick to driving these roads is to do so at a fairly high speed to make the bumps less noticeable, or perhaps it’s just to get there quicker and suffer less. Regardless, it is a torturous drive and I suspect much better for the driver than for the passengers, considering we had two vehicles packed full with passengers.

Kitashu, Joel and Prosper with a patient
Anne and Emily reviewing a JAR Guide

I drove the entire neuro crew in Turtle since there now eight of us including myself, meaning that we had a single empty seat in the middle back that was vacant. We rented another vehicle and driver from Kudu Lodge for the support staff that included Dr. Anne, Dr. Revo, and Dr. Leeyan, all our interpreters, and then Joel, our nurse, Kitashu, our coordinator, and Prosper, our volunteer coordinator who would take photos for FAME. We brought with us all the medications that we might need to prescribe to the patients we would be seeing and all of the tools that we’d need for our work. We had picked up box lunches in town for everyone and had plenty of water to last for the day or a possible breakdown along the way. We drove in tandem with Turtle following as I wanted to make sure I remember the way, but this also meant that we would have to eat the dust of the other vehicle and given the dry gravel roads we were driving on, there was plenty of dust to spare.

Paul supervising a patient evaluation
Emily and Anne examining a patient

We had planned to leave at 7 AM, but by the time we picked everyone up in town, got the lunch boxes and other necessary supplies, it was more like 7:30 before we got onto the road. We had a bit of tarmac until the turn-off for Mang’ola and then it was gravel and washboards for the remainder of the drive until we reached our destination. Despite the condition of the road, the drive is absolutely gorgeous as it travels through spectacular countryside. We travel through numerous ravines that look as though they are completely washed out every year due to the torrential rains that must come down during the wet season. There are places where we are driving over long stretches of rock and others where you would have to avoid a complete lane having been washed out. Needless to say, you had to be on your toes every moment of the drive as you never knew what was coming next or whether a herd of cattle might be crossing the road around the next turn. Challenging is an understatement.

Emily and Anne examining a patient
Akash and Leeyan with a patient and their mother
Akash examining a patient with Leeyan. Denise scribing

As we came over the last hill, Lake Eyasi lay before us looking like a mirage in the middle of a vast desert, but, in fact, it is one of the very large lakes that populate the Great Rift Valley that runs diagonally through all of East Africa. It is the same Great Rift Valley that became the cradle of mankind several million years ago and populated the remainder of our planet with our species. We drove through the dusty streets of Barazani heading towards our destination which was the local dispensary where we had visited previously. Local dispensaries are the small government health clinics that provide the vast majority of care in Tanzania and are typically manned by a clinical officer (the equivalent of a nurse practitioner) who provides all of the necessary medical care that doesn’t require a trip to a major facility. They will even do minor surgical procedures in the local dispensaries and certainly all of the deliveries that do not require C-section.

Phillip scribing for Cat
Cat and Revo staffing patients with Kelley and Paul

The clinic had already anticipated our arrival though it still required that we organized the rooms with the necessary equipment for us to see the patients here. In the past, we have worked in rooms with only beds, labor and delivery rooms, desks in the middle of an open area in the forest and the likewise, but here we actually had decent rooms that in short order were equipped with at least a desk and several chairs or a bench to accommodate the patient and the caregivers. I had opened all of the windows to get some type of ventilation, but the large metal doors kept slamming in the breeze with a bang so I quickly whittled several door stops from the local foliage to keep the doors open. Necessity is the mother of invention they say.

Anne, Kitashu and Joel going through our patient charts at Barazani
Prosper and Akash discussing photography

Once everyone was settled in, we began seeing patients and there were a moderate number there as we’d been here several times before and the local population were aware of our coming today. Dr. Annie gave her standard talk to the patients who had gathered regarding the types of illnesses that we treated and that we were not here to treat general medical conditions or joint pain. This is often an issue for us as many patients come because of the flat fee that includes a month, or sometimes more, or medication. This screening is essential as we are not here to replace or compete with the local medical officer by doing general medical work and have always made sure to maintain that boundary. The day was a steady smattering of both new and return patients as well as patients with various neurologic conditions. One patient we saw had, in addition to her neurologic issues, which were minor, very significant medical issues with marked edema and hypertension. I believe that her neurologic treatment would have consisted of amitriptyline, though without knowing what her cardiac status was, we did not feel comfortable prescribing this her without an EKG or labs. We eventually recommended that she come to FAME for a medical evaluation and laboratory tests to confirm that she could tolerate the medication.

Finished for the day
The spit of land
A view of the beach at Barazani

We had finished seeing all of the patients within a reasonable amount of time meaning that we might be able to do a bit of site seeing prior to our departure from Mang’ola. Since the town is on the shore of Lake Eyasi, though, there had to be a beach somewhere close and the others offered to take us there. I had no idea of what to expect, but it certainly seemed like it would be something fun to do, or at least a great exploration. I had been to the lakeshore of Eyasi far southeast of Barazani a number of years ago on one of our visits, but the lake in that region was mostly dry at the time and we were able to walk far out into the lake on the mud flats. As we had come into town earlier in the day, the lake was clearly quite full and I was sure there must be a reasonable beach for us to find. We had the two vehicles and I had no idea where we were going, but we wound in and out of homes along the way, driving much further than I had anticipated, at times the road becoming much narrower than our vehicle, until after long last we could see the water.

Getting their feet wet

As we approached, there were tents that made me thing people were camping here, but, in fact, we had come upon an encampment of fisherman and their families who were clearly living on the beach during the fishing season. There were rather primitive boats pulled up onto shore and the lines for nets strewn across the beach. We drove out onto a spit of land where there were cattle and goats grazing and parked our vehicles at a high point on the land a bit away from the water, but close enough for us to keep our eyes on them. Everyone clambered out to enjoy the sand and the water and to watch the fisherman working their nets. What we later came to realize was that the nets were strung far out into the lake with glass globes as floats that you could barely see as it was directly looking into a very strong sun reflecting off of the water. It was a gorgeous scene, though, and there was absolutely no sense that we were intruding in any way. There were children running around who were appropriately shy upon our arrival, but eventually warmed up to us as I had no trouble at all entertaining them with my camera, which they thoroughly enjoyed and managed to take a few photos that were halfway decent.

Joel capturing a selfie
Turtle and our other vehicle on the beach

We all watched as the fisherman slowly dragged their nets onto shore, using old burlap sacks as slings around their bottoms while they creeped backwards in unison, tugging on the ropes. It was a long and arduous task to slowly haul in their nets, obviously heavily laden with the tiny sardines that are brought in and dried in the sun, then serving as a staple protein for many. At one point, Kitashu apparently asked one of the fisherman if he could take some of us out on the lake in one the boats, which he agreed to do and promptly found enough volunteers for at least two boats full even though it was clear that the boats were not completely watertight, thus leaking water and requiring them to be continuously bailed during their voyages. Someone did comment on the fact that everyone was voluntarily, and excitedly at that, getting into a boat that was knowingly sinking and somehow this didn’t seem like a very smart idea. Regardless of the poor seaworthiness of the boat, everyone did seem to have a wonderful time, though, paddling out onto the lake without the fear of sinking, or, if they did, they didn’t mention it nor did they seem to mind. There were enough fearless thrill seekers for two complete boat rides out onto the lake and, had the boat actually sunk along the way, I’m sure they probably could have swum or walked to shore without difficulty.

Getting ready for a voyage
Revo waving goodbye

At one point, we began helping the fisherman drag in their nets, but this didn’t last for long as it was clear that it was going to take some time to get it close into shore and, with a long drive home, the daylight was quickly waning. We did have enough time, though, for Denise to try out one of their butt slings and in doing so, she got some necessary instruction from one of the younger fisherman along the way. I joked that I thought being hooked up to the same line hauling in the fish meant that they were now married, but, that didn’t seem to be the case and we were allowed to leave with Denise and without a fight thankfully. Though we were clearly outnumbered by the many fisherman and their families, I am certain that it would have been an even battle in the end.

Taking off on their voyage

Our visit to the beach had been a truly unexpected and lovely experience, but that is so often how things happen here. It is perhaps this spontaneity and near expectation of the unexpected that makes everything so exciting on our visits. This is certainly the case when out on safari as you never know what you might along the way such as our caracal experience in the crater and our visit with Philippo whom I had never met before despite having traveled the Gibb’s road dozens and dozens of time before. Each day here brings a new adventure.

The happy crew returning from the sea
Be careful who you attach yourself to a fish net with…

We left the town of Barazani with great memories and the knowledge that we had left part of ourselves with the patients and the fisherman of this remote and dusty town. We would be heading back to another village in Mang’ola tomorrow and who knew what our next wonderful adventure would be along the way. The road home was long and dusty and bumpier than you could ever imagine, but no one complained for this is Africa and the experiences will last a lifetime.

Dragging the net in…
The full moon above

Sunday, September 19 – A day in the Crater…

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Driving Turtle in Ngorongoro

Ngorongoro Crater, or just The Crater, is perhaps one of the most unique sites in the world, let alone Africa, for a number of reasons. It is a World Heritage Site, along with the Serengeti, and between the two, are arguably the top game viewing locations in Africa for many reasons. Ngorongoro Crater is the world’s largest completely intact and unbroken dry caldera meaning that it was formed by the collapse of a massive mountain following its eruption and is believed to have occurred approximately 2.5 million years ago. It is a giant bowl that is between 10 and 12 miles in diameter and over 2000 feet deep with very steep walls that are accessed by three only three roads, one ascent, one descent and one two way. The crater is filled with animals that do not migrate with the others and it contains virtually every animal other than giraffe, as it is too steep for them to climb down, and crocodiles, as there are no flowing rivers in the crater. There is a very large alkaline lake in the center that changes in size throughout the year with the wet and dry seasons. Of the animals in the crater, the most notable is its population of the rare black rhino that remains endangered, but is growing in number with the strong protection of the Ngorongoro Conservation Area Authority and the Tanzanian government.

A bateleur – a small African eagle
Possibly an augur buzzard?

So, it is with this introduction that we all arose on a Sunday morning, with Paul and Kelley having finally arrived, to travel to this truly remarkable place. The weather was the best we had seen for a morning since we’d been here with totally clear skies and the sun just beginning to peak out from over the trees and surrounding mountains. We had our binoculars, our cameras and enough reference books to have done a research study had we chosen to do so. We had also packed a lunch of sandwiches and snacks and I suspect that the residents were already eyeing them anticipation as we pulled away from the volunteer house at around 6:15 AM as the gate would be opening at 6:30.

Caracal in Ngorongoro Crater
East African caracal

The drive to Lodoare Gate took only about 20 minutes and there were few vehicles and no baboons on are arrival. The baboon troop here are notoriously aggressive given the number of tourists that come through each day, all with lunch boxes in their vehicles that are ripe for a heist if one were to leave their window open even a crack. They can spot a lunch box from a mile away and be in and out of a car within seconds before anyone knew what happened. I recall one such occasion a number of years ago with Danielle Becker when we had left the window open enough for the baboon to squeeze through and suddenly we had a screaming monkey in the front seat with a lunch box in its hands. I threatened him with my camera that had been in my hands at the time and even though photographic evidence of the scene would have been wonderful, I chose instead to keep the of us from being mauled and left the thief to exit with his reward. We were both a bit shaken, though no worse for the wear and we continued on in our trip, minus one lunch box that was now being enjoyed greatly by a baboon family.

East African caracal
Caracal approaching the two jackals in search of it’s prey

Though the highway from Arusha that travels through Karatu is paved, that luxury ends here at the Lodoare Gate when entering the Ngorongoro Conservation Area. What many don’t realize, though, is that this is still the main, and only, highway that travels into the Serengeti and across Northern Tanzania on its way to Mwanza on the shores of Lake Victoria. Large trucks filled with cargo pass through this gate every day, making their way up to the crater rim and on to the Serengeti with destinations far to the west. The road up the rim, some 2000 feet above us, snakes up the mountainside as it hugs close to the slope with sharp turns and exposed walls frequented by elephants who carve out the dirt looking for iron and other minerals to ingest. It is a primordial forest that we’re traveling through with trees reaching for the sky from the depths far below us down the mountainside. Up and up we travel further until we finally level off and approach the edge of the crater at the overlook with its unobstructed view of one of the most amazing sights in the world – The Crater. It is a similar view as looking into the Grand Canyon, though here there are structures to interrupt the openness that has been created the massive caldera. All of the features of the crater floor can be easily identified and herds of animals can be seen with the naked eye.

The jackal with the caracal’s rabbit
East African caracal

As we leave the overlook and begin to head around the rim on the crater road with glimpses of the caldera through the overgrowth from time to time prior to our arrival of the ascent road. They are working on the descent road at the moment and it is closed, so the ascent road is open in the mornings instead for one way traffic down to the crater floor. There is certainly a sense of traveling back in time as you descend and the anticipation of reaching the floor with all its wildlife grows with every switchback we take. It was a bit confusing for me as I have never come approached the crater floor from this direction, having always arrived on the descent road during my dozens of visits having driven here before. We first entered the Lerai Forest where there are frequently many elephants and, I have been told, a leopard or two, but I have yet to spot one here.

Phillip on safari
Binocular shot of zebra

We eventually wound our way around to where the descent road first reaches the floor, enabling me to get back on track with my normal routine as I began to drive around the periphery of the crater where there were huge herds of wildebeest, Cape buffalo, Thomson and Grant gazelle and zebra. I looped back towards the lake road that had been blocked by some rocks indicating that it must have been flooded up ahead, but there were several vehicles that had already gone through and were in front of us so it was clearly safe. We quickly spotted a jackal running with something in its mouth that turned out to be a rabbit on closer inspection and it was closely followed by another jackal that was hoping to share in their prize. As we sat watching the two jackals dancing across the landscape with their prey, we saw what we initially thought to be a third jackal when we suddenly realized, much to our surprise, that it was actually a caracal!

The tree at the lunch spot
The gang at the lunch spot

The caracal is a fairly rare cat that is typically never seen because it is primarily nocturnal in its activities. It is described as a either a big small cat or a small big cat (or perhaps a medium cat), but it fits in somewhere between the cheetah and the serval with its prey consisting of small mammals, birds and rodents. In my many dozens of trips to the crater and the Serengeti, I have seen only one. Here was a caracal in the morning hours chasing after two jackal with a rabbit. What didn’t make real sense was seeing the caracal chasing after the jackals, as it should have been the other way around, until I realized that the jackal had most likely stolen the rabbit from the caracal who was now trying to recover what was rightfully his to begin with. We had an amazing and lengthy view of the caracal during this struggle, never having recovered its meal, and it eventually gave up, but continued walking parallel to the road and in plain sight for us. It is a beautiful cat with its tufted ears and sleek coat of light tan and watching it run across the shore of the lakebed was truly an experience to remember. I made certain to let everyone know just how lucky they were to have seen such a rare animal on their first visit to the crater.

The tree at the lunch spot
The residents at the lunch spot in the Crater

We next made our way across the floor of the crater to one of the highest points in the crater itself, Engitati Hill, where the view from high up is spectacular and looking down at the marshy area in from of us, where scores of animals including many elephants, though we were mostly wishing to see a rhino. It was unfortunately, rather breezy on the floor of the crater today and, because of that, the rhinos were in hiding as their eyesight is so extremely poor and they are totally reliant on hearing for their protection and defense. So, we made our way down off the hilltop and slowly proceeded to the lunch spot by way of the Munge River, looking all the way for lions, which in the absence of the rhino, was what everyone wanted to see despite my reminding everyone of just how lucky they were to have seen the caracal.

Hippos in the lake at the lunch spot

We reached the lunch spot at Ngoitokitok Springs just in time to get a good spot as it does get pretty crowded here at lunchtime. There is a small lake with a number of hippos and, most importantly, bathroom facilities. The setting is absolutely gorgeous and everyone is free to get out of the vehicle and walk around, though there are times that lions like to visit the lunch spot which does create a bit of a commotion. They typically don’t approach any of the vehicles, though when Sean was here several weeks ago, there was a single lion who was wondering a bit close to those eating their lunches necessitating a ranger to lure him away with chunks of meat. Likewise, the hippos all remain in the water without any interest in the tourists along the lakeside or frequenting the large and beautiful tree that serves as a great photo spot.

Me having a juice outside at the Crater Lodge

The most threatening animal in the crater, at least for humans, is the black-shouldered kite, a small raptor bird that inhabits the crater and with a wingspan of up to a meter, soars on the high thermals in search of their prey. Their prey consists of rodents, large insects and reptiles, unless, of course, they reside in the crater where they have adapted their behavior to prey upon unsuspecting tourists whose guides have failed to caution them against eating outside in full view of these incredibly accurate dive bombers. It almost never fails that at least one tour party will fall prey to these hunters and today was no different than other times I’ve been here. Towards the end of our stay, sure enough, a couple with their guide sat comfortably on the rocks overlooking the lake and the big tree with their lunch boxes and once they were fully engrossed in this idyllic setting with their lunches in hand, the kites struck. There were three of them who swooped down in succession, stealing everything possible in almost no time at all while the guests scattered over the rocks trying to evade the diving birds.

Having drinks in the main house at the Crater Lodge

Perhaps the strangest thing I saw at the lunch spot, though, was the zebra-covered ice cream truck that I’d never seen there before serving ice cream popsicles. I’ll have to admit that it did detract somewhat from the rugged image of being on safari in the crater, but it was also fantastic to be eating a salted caramel chocolate-covered ice cream popsicle after a long morning of driving. They had to be eaten quickly, though, as they seemed to begin melting almost immediately and even before you unwrapped them.

A panorama from the Crater Lodge
Ladislaus and the gang with a view of the crater beyond

After lunch, we drove to the hippo pool which had unfortunately changed drastically changed its topography and we were unable to get close to the hippos, though there plenty of water birds to watch that were pretty close. We did see one small group of lions very far off in the distance who were sleeping which is the typical state that lions are found in during the day. We drove back through the Lerai forest one last time before turning around and heading up the ascent road on our way out of the crater. The visit had been wonderful and given it was everyone’s first visit to the crater, it was an incredibly successful day.

Walking down to the main house of the tree village at the Crater Lodge
Dining table at the Crater Lodge

We had one last visit to make along the crater rim and that was to the Ngorongoro Crater Lodge, perhaps the most expense and fanciest lodge in all of Northern Tanzania. The Crater Lodge first existed years ago as a hunting camp and was eventually converted into a high end resort that caters to the most elite visitors who are quite often very famous. I have a very good friend there who I have known for several years and is now one of the managers, and he usually has us visit for coffee or a drink to show his thanks for the work we do here. Last year, I brought a carful of Tanzanians from FAME for a visit and it was really wonderful for them to have the opportunity to see such place as none of them had ever done so, nor would it be something they could have ever imagined. We all sat together in one of the large main houses where the guests would normally eat, but because of the pandemic, they were still closed. Our neuro team felt the same way perhaps about visiting such a resort, as few of us would ever have the opportunity to stay there, though, it was still very special to visit and enjoy a beer, a glass of wine, or simply a Stoney Tangawizi.

Paul and Kelley at the Crater Lodge overlooking Ngorongoro Craater
Paul and Kelley at the Crater Lodge

We left the Crater Lodge with just enough time to get through the Lodoare Gate, as it closes at 6 PM and, if you do not make it in time, you are stuck in the Conservation Area for the night. We arrived to the gate with about 10 minutes to spare, far more time than we’ve had in the past on several occasions. It had been a wonderful day in the crater and a total success. We drove into town after sunset and, as we’re on our own for dinners over the weekend, needed to find some food. Meals here take a minimum of an hour once you order, so you can usually plan to spend nearly two hours when you head out for dinner and we were all absolutely worn out from the day considering we had been on the go for the last twelve hours. We ended up at Patamu once again after the first place we went to seemed deserted including the staff, which wasn’t a good sign. The cold beer did hit the spot, but we were all starving so the hour or more wait for food was torture. We were finally served and the food was delicious so at least that was a consolation. It was back to the Raynes House and a bit of relaxation before bed. We were all excited as tomorrow we would be leaving at 7 AM on our first mobile clinic to Mang’ola.

A heavy lift

Saturday, September 18 – A half-day in the clinic, Paul and Kelley arrive as Sean and Kerry depart…

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A spoonful of honey…

Today had been planned for a half-day in clinic, which was good given the issues with getting Paul and Kelley here on time. For the last several years, we have inserted two “wellness” afternoons for the residents during their time here that would essentially mimic the procedure back used at home, though the wellness days are normally to take care of personal matters such as doctor’s appointments and the such, none of which occurs here. I have never argued with the request, of course, as it keeps the moral up for the residents, who are typically working six days a week and could use a break. My only argument to this plan has been that the entire month working here is really just like one big continuous wellness day given what we are doing here and the pleasure that comes from it. Regardless, I was instructed to insert tow half days for the residents which means it’s a half day for me as well.

Anne and Akash about to check head circumference with Cat’s moral support

There is no morning report on Saturday and it was Sean and Kerry’s last morning with us, so we all elected to go to the Lilac Café for breakfast and coffee. The Lilac Café opened around the same time as the inpatient hospital did as it became readily apparent that there needed to be a kitchen not only to serve the inpatients, but also to provide meals to the families who were here to visit their loved ones. Thankfully, it also serves as a place for a good meal, coffee, or even a cappuccino when one is needed. It has also served as home base for the medical students who have come us as a good portion of their work is data entry which can easily be accomplished with a good cappuccino and a cookie. Our breakfast there was incredibly relaxing and Anne, Revo, Leeyan and Kitashu eventually joined us, though none but Anne were tempted by the available options on the menu. I suspect that they all ate at home prior to coming.

Akash and Anne trying to get a head circumference on a squirming young girl

During our breakfast, I heard from Kelley and Paul who had arrived on time in Dar es Salaam on schedule and now it was a matter of figuring out what the airline was going to do to help us. I had purchased tickets with FlightLink, a local Tanzanian airline, to fly them to Arusha with an arrival time of noon, rather than the 8:30 PM that their original Precision Air flight had slowly morphed into which would have meant that they wouldn’t be here in the morning to leave for the Crater, something Kelley had never done, nor had Paul. They had arrived too late to have even conceivably made a morning flight that the airline had later suggested, so I was on the phone all morning with Penn’s travel agency to see what we could do.

Success!

After multiple calls to the agency, who were very helpful, and numerous calls by them to Qatar, it had finally been determined that if they did not board the final leg of their originating flights, then their return trip home would be forfeited with no hope for a refund. Meanwhile, during these conversations, the two of them had boarded the FlightLink flight to Arusha which meant that they were absolutely not going to board the Precision Air flight they had originally been booked on. Qatar chose to take absolutely no responsibility for the repeatedly delayed code share flight with Precision, a flight whose time was no longer acceptable to them. To make matters worse, Qatar suddenly offered an earlier flight on Precision that had not been offered earlier, but since they were already in the air, that was an impossibility.

Revo, Denise and Emily evaluating a patient

We were told by Qatar that the only option we had was to cancel their remaining flights and then rebook the return flights, but this had to be done prior to their previously booked, and massively delayed, flight took off, otherwise everything would forfeited and the property of Qatar Airways. The cost to rebook would be around $400 for each passenger. It was complete highway robbery in my mind and we were being held hostage to their technicalities without any chance for recourse or someone with common sense looking at the situation. World Travel was totally sympathetic, but Qatar Airways was completely unwilling to listen to reason. So, in the end, I made an executive decision to cancel their existing flights and rebook the returns for the additional fee, all while they were in the air, as there appeared to be no other choice in the matter. World Travel did offer to have their Qatar rep pursue the issue on our behalf, but I think it is very doubtful that anything will change after the fact. The important thing from my standpoint, is that the two of them arrive to FAME safely and the fact that they’ll be able to make the trip to Ngorongoro Crater was certainly an additional factor as we had already paid for that with the Conservation Authority who manages the Crater.

The MRI of our patient with probably spinal AV fisula

Meanwhile, we had to finish up our morning clinic to be free in the afternoon and perhaps the most interesting patient that we had wasn’t here at all, but his MRI was. The young boy who we had seen last week with back pain and unilateral leg weakness had undergone an MRI of the thoracic spine that was quite abnormal, but not in any typical manner that one would normally see. Unfortunately, Kerry had left this morning for the Serengeti as she would have been the perfect person to have reviewed the scan given the fact that she is a pediatric neurosurgeon. Thankfully, Sean was still here to review the study and we were all in agreement that there was a significant posterior extramedullary, intradural process that appeared to represent either flow voids representing spinal arteriovenous fistulas or a spinal subdural hematoma. Never the less, what we saw was compressing his spinal cord and undoubtedly causing his pain and neurologic deficits.

Paul and Kelley moments after their arrival to FAME

Now, the question was what to do about it. There is no place in Northern Tanzania that could deal with this type of a problem as he was going to need advanced imaging such as a spinal angiogram or spinal MRA, both studies that would require the proper center to administer them and then the surgeon to fully evaluate him clinically along with the studies. Quite atypical of the normal situation here, though, the boy’s family did have the resources to take him wherever the best center would be in Africa, Europe or Canada. Due to their insurance, they could not travel to the US to be evaluated or have surgery. We made the necessary inquires regarding various centers around the world and made the necessary recommendations to his family, who will hopefully be able to take him to a center that will be able to deal with his problem.

Akash and Denise on their walk to Gibb’s Farm

Clinic was finished by lunchtime (typically 1-2 PM here) and we all made our way home for the afternoon. Kelley and Paul had landed in Arusha by now and were making the trek to Karatu, typically about 2 hours, which was better than the three hours needed to make it all the way to Kilimanjaro. I choose to stay at the house, while most of the others decided to make the hike again to Gibb’s Farm as Akash had not done it before and Denise wanted to check if they had her sunglasses she thought she may have left the last visit. While at Gibb’s, they did take the opportunity for cold drinks and Akash was introduced to Stony Tangawizi, a strong ginger flavored soft drink made here in Tanzania by the Coca Cola Company. Meanwhile, Kelley and Paul arrive to FAME after their lengthy flights and detour in Dar. They were no worse for the wear, but were certainly exhausted. I sat and caught them up on recent events here at FAME and how things were going and what the plans were for the following day going to Ngorongoro. I had planned to pick up the residents (other than Emily who had stayed behind) at the carver’s shop or our new coffee supplier and was going to take Paul and Kelley, but seeing how exhausted they were, suggested that they both take naps and we’d wake them up for dinner later in the evening.

Akash discovers the wonders of Stoney Tangawizi

We drove up the Gibb’s Farm Road, back to Philippo’s farm to meet the others who had been shopping there and next door at the wood carver’s where Denise was determined to get a large painting that she liked. I had asked Philippo to save us some honey the next time that he was harvesting some, and he promptly brought out five small jars of the golden brown liquid that was like treasure to us. I quickly bought all five jars, figuring that we could work out who would be taking some of this amazing product later. Others bought more coffee and there was a huge crowd of Tanzanian guests visiting to sample his coffee. Denise did manage to get her painting for a relative steal. I drove everyone home after their hike and shopping spree and we hung out at the house until it was eventually time to wake up Paul and Kelley and to head out for dinner.

Ngorongoro Highlands coffee
Bottles of honey

We ended up returning to the Golden Sparrow, but this time our mission was only for dinner and no dancing as we would be leaving early in the morning and needed to get home to make our safari lunches of peanut butter and jelly sandwiches for the following day. Though its precursor, Carnivore, had served only chicken and chips, the Sparrow has a full menu with many other items. Cat, as a pescatarian, had ordered fish and Akash, a devout vegetarian, had ordered lots of carbohydrates and a few vegetables, while the rest of us chose various versions of chicken with sides of chips (fries) or ugali and vegetables. Every restaurant here takes around 45 minutes to an hour to bring your food, so it was not at all unexpected that we enjoyed a drink before dinner was even close to having been served. We all traveled home with the same thought in mind as we’d be heading to the Crater early tomorrow morning with the anticipation of seeing the incredible sights of animals at the bottom of a caldera that is over ten miles in diameter and 2000 feet deep.

Emily and a bottle of Konyagi outside at the Sparrow (of course she wasn’t drinking it 😉

Friday, September 17 – A few difficult cases, stopping by Teddy’s duka and a visit with Daniel Tewa…

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The FAME team of doctors with Dr. Kerry and Dr. Sean

There was no educational lecture this morning so that meant a half hour more of sleep for most everyone. I’m usually the earliest one up in the morning as I like to get some things done, but Emily has also been up very early (though at least she’s in bed early as opposed to me) so there’s always been hot water ready to go for my tea. The mornings here are usually quite gorgeous, but the weather pattern has been dense clouds and very cool in the morning, perhaps another sign of the ongoing climate change that so many in Washington have chosen to ignore despite all the science to the contrary. Thankfully, for the moment, though, the skies have typically cleared by noon and the afternoons have been quite pleasant and occasionally warm. This is not the coldest month of the year here for that is in July, but it can still be very brisk in the highlands where we are located, and even colder on the rim of the crater several thousand feet above us.

Our lunch table behind the cantina – rice, beans, mchicha, pilipili, and banana. A definite favorite

Kelley Humbert and Paul Novello, two colleagues from Penn, would be arriving tomorrow to join us and we were having some issues with their travel. Kelley had been here in October 2016 as a resident and is now a neurohospitalist at Penn, while Paul, also a neurohospitalist, had never been to Africa. They had left Philadelphia yesterday on Qatar Airways and because we would be heading to Ngorongoro Crater on Sunday and they wanted to join us, the connections were through Dar es Salaam on a Precision Air flight. That leg kept getting bumped later and later on Saturday such that it meant they would arrive to Kilimanjaro too late to make the drive to Karatu – night driving is incredibly dangerous here due to both animals wondering into the road and crazy commercial drivers who pass when it’s unsafe.

A difficult discussion

Kelley spoke with our travel agent prior to leaving Philadelphia to inquire about just not using the last leg of their flight and booking on a different airline arriving in Kilimanjaro earlier. Unfortunately, they were told that doing that would void their return flights. They arrived into Doha at around 5 pm today and, thankfully, the airport had excellent WiFi so we could stay in touch about their trip. I had to make an executive decision, though, and booked them flights from Dar to Arusha that would depart shortly after they arrived there and would get them to Karatu early in the day meaning they would come to the Crater with us. I would have to speak with them once they arrived in Dar and that would be tomorrow morning.

Dr. Anne and Emily delivering difficult news to a family

Meanwhile, we did have a clinic to run today and had plans to visit my good friend, Daniel Tewa, in the late afternoon for coffee. More about Daniel later. The two patients that stood out during today’s clinic were both difficult, but in very different way. The first patient was a young woman who had been involved in a very bad motor vehicle accident earlier in the year, not only suffering multiple traumatic fractures of her limbs, but also a very serious head injury that left her non-communicative and bedridden. Her family had brought her to us to see what we had to offer in the form of rehabilitation or anything that could help her get better. Unfortunately, her injuries were devastating and irreversible, but it was unclear whether her family had ever been told that or not. Emily had done her best to obtain a detailed history from the family, though in the end, it really didn’t change what we had to tell them. Ultimately, it required a discussion that was very difficult and involved both Emily and Anne that took not only quite a bit of time, but also their energy as it was very draining. The patient did have a very large sacral decubitus ulcer (bed sore) that was originally concerning, though in the end, it turned out that it was being dressed at home by one of FAME’s nurses so we were reassured that it was clean. How long the patient would survive in this condition was something that no one could really tell, but in the end, she would probably succumb to a systemic infection or something similar and there was very little that could be done to prevent it.

Dr. Anne and Emily speaking with the family of the neurologically devastated young woman

The second patient that stood out to me appeared at the very end of the day and was actually someone who arrived after I had told Kitashu that we were finished with patients. It’s essential that we have a time after which we stop seeing patients, otherwise, we would be stuck in clinic all evening long as patients would continue straggling in to see us and it would never end. Most of the patients we see are from the Karatu region and though it is certainly not the most convenient to return the next morning if we ask them to do so, sometimes that is necessary given our volume. This patient was brought over to us and I agree that we could see her before realizing that she had a bag full of records and prior imaging.

Revo, Cat, Anne and Emily all contributing to our final patient with a bag of records and radiology studies

Her complaints were varied and numerous and very little of her story made a lot of sense to us outside of her having fairly simple radicular symptoms in the lower extremity that didn’t require our involvement necessarily. What made matters even more difficult was that she had undergone a multitude of testing at a number of different sites and though she had the results of all of the testing, it didn’t make much sense to us. It seemed that she had been evaluated at some point for demyelinating disease, or multiple sclerosis, which really doesn’t exist much here given that we are on the equator and when we reviewed her MRI scan of the brain that had been read as possible MS, it was much more consistent with small vessel ischemic disease, a common problem, especially in those with hypertension, a condition from which she also suffered. In the end, all that we really had to offer her was to treat her hypertension better, take a baby aspirin and put her on a statin medication to keep her lipids low. Anne did her best to explain everything to her in detail, though she continued to want more explanations of everything until even Anne, the most thoughtful and concerned clinician I know, had become completely exasperated.

Teddy in her new shop sorting through clothing
Dr. Sean tying his bow tie with Akash’s help

As we had planned a visit to Teddy’s late this afternoon prior to heading to Daniel Tewa’s home, everyone abandoned Anne and her patient so we could change and get Turtle for the drive. Anne was coming with us, of course, to help at Teddy’s as it always helpful to have her along since Teddy’s English, is about as good as my Swahili, meaning that we both need a translator, hence Anne’s participation in the venture. By the time we had returned to the pick-up Anne, she had finally finished with her patient and was ready to head out. Teddy, had also moved her shop since the last time I was here which meant that we had arranged to meet her at Happy Days with her boda boda (motorcycle) driver so she could then show us the way. Kerry, who had a number of clothes made, would be leaving town in the morning which meant that her orders were the priority for this visit, while Sean, who would also be leaving tomorrow, did have a bowtie made that he would pick up. All of the other clothes could wait if necessary.

Philip, Akash, Denise and Emily watching an Indian soap opera in Swahili. Talk about lost in translation
Sean checking out his bow tie in the mirror

At Teddy’s shop, Kerry immediately went to work modeling her clothes for us (they were all great and fit perfectly which was amazing how given the little time she had been given to create them) and Sean modeled his bowtie, which, I will have to admit, was just a bit much with his scrub shirt and in the middle of East Africa. The effect was there, though, and everyone was tickled with her work and looking forward to our subsequent visit for everyone else’s clothes to be presented. I had met Teddy through a previous long-term volunteer here and she has continued to do wonderful work for all the residents and others who have wanted pieces made from the colorful and bold kitenge cloth that is worn here. Her new shop (and home) is also very nice as it is not only her workshop for making clothing, but also a neighborhood duka (shop) where the local residents come to buy sundries, many of them stopping by while we were there. It is so important that we support the local merchants like Teddy while we are here, though most of her work is for the local population and I am certain that we are the only outsiders that visit her.

Dr. Sean over the top with his bow tie
Teddy at work

Once finished with our fitting session, we hightailed over to Daniel Tewa’s home for the daylight was quickly waning and I wanted to make sure we had plenty of time to spend with him. I have spoken of Daniel many times in this blog, but he is an incredibly special person not only to me, but to his Iraqw community. I had first visited Daniel in 2009 when I was here on safari with my two children and we had chosen to do some volunteering at the end of our trip. Not knowing where we would be volunteering in advance, Thomson Safari had paired us with the village of Ayalebe here in Karatu and we spent three days painting the local primary school during which time Daniel joined us. This was also the time I was introduced to FAME by our guide, Leonard, forever changing my life and cementing life-long friendships not only with Leonard, and eventually his family, but also with Daniel and his family.

Daniel Tewa and me on my very first visit back in 2010

When I had decided to come back a year later to work at FAME, I contacted Daniel and he not only remembered me, but also immediately asked me how Daniel and Anna, my two children, were doing. When I visited him for dinner that very first trip back to Karatu in 2010, he told me that of all the hundreds of foreigners (for he gives cultural visits for the tour companies at his home) who had visited him during their safaris, I was the only one who had reached back out to him and the only one who had come to his home for dinner. He told me of how incredibly honored he was to have me visit his family and home, but it was I who was the one that most honored. Since that time, Daniel and I have become attached by that special bond of friendship and family and despite the fact that we see each other only twice a year when I am here, we are both keenly aware of each other’s existence in the universe. Each time that I am here, Daniel has had the entire group of residents and others with us over to his family’s home for dinner and it has always been one of the most remarkable and memorable experiences for each of them.

Entering Daniel Tewa’s Iraqw house

Daniel is a truly unique individual. He is someone who grew up during the time of Tanzania’s independence and has seen the country grow into what it is today. Having only a seventh grade education, he is one of the most informed people that I know, always telling us more about U.S. politics and history than most of us know and being the one to inform us of current events back home when we visit him as we do not pay attention to any new back home when we are here, either intentionally or unintentionally. He has twelve children, most of whom have been to college and are working in various parts of the country as accountants, court advocates, or in tourism. He continues to farm his property that is on the Gibb’s Farm road here in Karatu as well as land that he has near Haydom, several hours away. He is an authority on everything Iraqw and Tanzanian and every time we visit, I learn something new about him and this amazing country. As we all sat outside in the fading sunlight of this remarkable land, he tells us stories about our homes that most of us had never heard and stories about Tanzania. He serves us African coffee that is boiled with milk and water and is to die for. I had decided that it probably wasn’t totally appropriate for us to have dinner indoor given the pandemic, so we were just visiting for coffee today, but the experience was the same.

Daniel and his house in March 2020 demonstrating throwing spears under a rainbow

One of the highlights of going to Daniel’s home is a visit to the Iraqw house that he built in 1992 and continues to be visited by students and scholars of Tanzania history. After the Maasai had come to this region several hundred years ago, they began to cause trouble with the Iraqw over their cattle, which the Maasai believe were all given to them by God. I have heard this story from enough individuals of many of the tribes here over my years of visiting that I do believe it to be at least reasonably accurate. The Iraqw home was built underground so that it would protect the family and their animals, all of which would be in the house at night for protection. You could hear whether anyone was walking on top of the house at night and then protect against an attack.

Daniel Tewa’s goats including the little young one bouncing on the right

Before the Maasai had come to this region of East Africa, the Iraqw had lived in a Bantu style of house that is now quite common here. When Tanganyika, and then Tanzania, became an independent country in 1961, and then 1964, respectively, with its union with Zanzibar, there were over 120 individual tribes, all of which had their own villages and cultures. Julius Nyerere, the father of the country and their first president, quickly realized that it would be impossible to build a country of such distinct cultures in regard to the infrastructures, so he required that villages become multi-cultural and outlawed such unique features as the Iraqw house. Daniel’s home was built as a historical reminder and he and his family live in a Bantu style home currently. The Iraqw and the Maasai eventually signed a peace treaty, but that was not until 1986. If you search the blog for “Tewa,” you will find numerous photos and references to prior visits with Daniel and his family. For today, everyone was thrilled to sit outside in the gorgeous Tanzanian evening light with the sun setting in the distance, sipping Daniel’s African coffee and hearing stories of the past, present and future.