Why is everyone building?

Walking around Karatu, I've noticed a lot of people are building houses. A lot of houses. Last week, I counted the construction projects on my walk to work. I live about a mile from the hospital, and my commute passes through a fairly rural setting. There are 18 houses under construction, eight new houses (finished in the last six months) and 12 extensions being added to existing homes, all along one mile of unpaved, country road. That seems like a lot to me, and it's not bounded by economic status. Everything from one-room mud huts to (what pass for) mansions are sprouting like crocuses on the first day of spring.

The construction along my morning commute represents a small example of a larger phenomenon visible in most parts of Karatu. There's a brick-laying bonanza going on, and it's making me wonder: why is everyone building right now?

I've thought about it over the past week and came up with a few possible answers. Please note that what follows is pure speculation, based on my personal experience from living here over the past two years. No effort was made to consult expert opinion, quantify information or conduct rigorous analysis of any sort whatsoever. With that caveat, here are my explanations:

1. High fertility rate
People are popping out babies like crazy. Children are everywhere. We are suffering an acute staffing shortage at the hospital because one third of the housekeeping staff managed to get pregnant at the same time. That's no exaggeration; their due dates are within one week of each other. Tanzania's census service estimated the total fertility rate of 5.4 children per woman in 2010. Compare that to 1.9 in the USA, and keep in mind that the true rate in Karatu is probably higher than the nationwide statistic because fertility rates tend to be higher in rural areas. The fact is there are more and more people living here, and people need houses to live in.

2. Improved transportation
Karatu is like the American railroad boom towns of the nineteenth century. Last year they finished the paved road from Arusha—the only paved road in the district—which makes it worlds cheaper to move people and goods back and forth to the third largest city in the country. The paved road cut the travel time to Arusha from seven hours to two. It's also funneling ever-growing caravans of tourists to visit Ngorongoro and the Serengeti and bringing their dollars and euros to the lodges and lodge employees. It also brings driver-guides and their shillings to the guest houses, bars and brothels—not an inconsequential economic boost either. Not only are there more people to house but there's more money to do it with.

3. Lengthy construction times
Building a house can take a very long time here. Some of the sites I tallied in my informal survey have been under construction since I first arrived. A big reason why you see so much building going on is that you are seeing the overlap of many years' worth of projects. Nobody waits until they have enough money to build the whole house before they start. When you have enough money for a foundation, you build the foundation. When you get money for bricks—maybe a few years down the road—you buy bricks. When you find money for mortar—a few more years—you build the bricks into walls. There's a very practical reason for doing it this way, and it has a lot to do with the my final factor...

4. Houses are illiquid
Nobody is going to ask to borrow your half-built house to help pay their water bill. If you kept the money in cash, someone would ask for it. In individualistic, Western countries, it's hard to say no when a family member asks for financial help. In a society where social support is built entirely on family and community ties, it's impossible. When Cousin Emanuel comes knocking because the crop failed again and the cow died and he can't afford water and think of the children... you had better pay up or ostracism awaits. If there's two things we have no shortage of in East Africa, it's relatives and problems. The only way to hang on to your money is by turning it into something illiquid as quickly as possible. When payday comes, you go straight from the bank to the brickmaker. Even if half your bricks get destroyed by rain waiting for roofing tin, that's better than losing all of your construction budget to Aunt Balbina's medical bills while you wait.

I'm sure there are some other factors at work. I have no idea how important each of the factors above are, though I suspect the last one is the biggie. It's interesting for me to experience the process of getting to know a place. First you might not even notice details, then you see them but not the reasons for them—at this stage, it's tempting to conclude that there are no reasons and people are being senseless—then you begin to put the pieces together and understand the underlying forces shaping people's behavior. Or maybe you just think you do, and there are still more layers to peel back. This is all just wild speculation after all.

Long overdue

Well it turns out that, to nobody's surprise, I'm terrible at keeping up with blog posts.

I guess I was in the middle of our trip to Lake Natron when it got away from me last october.

We made it to Natron. Here's Ben dipping his toe in its caustic waters:

We had passed Oldonyo Lengai (the sacred volcano of the Maasai) that morning, and the scenery was beautiful. Hard to believe it hasn't been turned into a national park yet.

After that the excellent road that we were on met up with the main tourist road, which was also unpaved but much worse in every way. We started seeing landrovers again, the whole road was covered in washboard bumps, and we also started running into tourist gates.

There is a law in Tanzania stating that communities can charge tourists for visiting sites of cultural or natural beauty in their jurisdiction. What various villages have interpreted this as is that they can put up toll gates across public highways and charge anyone who looks foreign driving past. The fees shouldn't have applied to us, since we are legal residents of Tanzania and not tourists and because we were just trying to get to the other side of these villages and were not interested in any nature or culture in their jurisdiction anyway. But the guards at the gate weren't having any of it, even when we showed them our papers and explained at length the situation. They insisted on charging us an outrageous sum to pass. So we ended up giving them 5,000/- as a bribe instead of paying $15 each, and they let us through. They also told us there was another gate on the way to Natron that would charge us again. Instead of going through that rigamarole again, we instead turned off at the closest dry riverbed and drove down that to the edge of Lake Natron.

It was alright, kind of pretty but left me wondering why people make such a big fuss about it. We did get to see some flamingos up close in a sort of tide pool though.

On the way back we realized it was going to be hard to retrace our steps. The dry riverbed had flattened into the larger mud flat on our way down, and we didn't know exactly where we had come from. Fortunately we were able to just make out our tire tracks from earlier. Unfortunately a herd of giraffes and zebras had wandered right across our path, and we looked like terrible people for driving right at them. We didn't want to disturb them; we just didn't want to get lost since we were already kind of low on water and fuel.

Anyway, we did find our way back to the road. Right before we turned onto it, we were met by a very angry man coming the other way on a little Indian motorcycle. He was gesturing wildly for me to stop. I looked back for Ben, but didn't see him behind me around the bend. I saw that the man on the little motorcycle had a machete, and I thought "no way I'm going to stop for some stranger in the middle of nowhere with a weapon." I pinned the throttle, and relied on the power and suspension advantage of the Honda to quickly leave him behind. After a while, I stopped and waited for Ben to catch up. He had also seen the man and did the exact same thing as I had. We both opened the throttle and didn't look back again. We've heard stories about bandits waylaying travelers in this part of the country.

On the way back we got an even closer look at Oldonyo Lengai, but the top was still covered in clouds.

From there we headed straight South through Engaruka to Mto wa Mbu. I don't have much to say about that part of the drive except that the road was terrible, it was very hot, and there was not much to see until we hit Mto wa Mbu. Just butt-pounding driving on the washboard bumps and unending hassle from the tourist gates. I highly recommend anyone going to or from Natron do so through Monduli. It's longer but an infinitely better drive.

We made it back to Mto wa Mbu for a cold beer (the first in days) and a hot meal. Then we zipped up the escarpment to Karatu. Just like that the trip was over. Back to work the next morning. I'm infinitely obliged to Ben for going with me. It was quite a bit of fun and definitely not the sort of thing you want to do alone.

We even forgot to do an end of trip picture, so instead here's a selfie we took upon reaching Lake Natron.

Addendum:

I lost my raincoat on this trip. I don't remember precisely where, but I suspect that Ben left it at the guest house in Kitumbeine after I lent it to him during that terrible storm. I even have photographic evidence of him wearing it there. I liked that jacket; it was a Christmas present from my sister. I hope that Ben is properly ashamed of himself.

Break Time

It's been an incredibly busy month at FAME: lots of patients, lots of volunteers, the first birth in the new labor ward, the first Caesarean section, many ambulance transports, and grant deadlines all piled on top of each other.


Then last weekend, I took my first days off in a month or so to do a one-last-trip with a friend who is leaving Tanzania to go back to England.

We decided to do a motorcycle trip to Lake Natron via Monduli.

The first challenge was getting the motorcycles in good shape. I recently traded my newish Toyo 150cc and a bundle of cash for a Honda XLR 250 that's long on character and mileage. It's the same model year as I am: 1990. I've spent the past month in and out of different motorcycle shops trying to get it ready for the trip. I had the carburetor cleaned and adjusted, the valves adjusted, the fork seals replaced, the turn signals and horn replaced and rewired, the choke and speedometer cables replaced, I adjusted and lubricated the clutch and throttle cables, replaced the clutch lever, replaced the oil seal on the shift lever, and had passenger footpegs and a skidplate custom made. Then she just needed a wash to look as good as she probably has in decades.

I used to feel like I needed a hunchback assistant and a bolt of lightning to start the thing in the morning, but now it fires up every morning on the first kick.

The night before our trip, we loaded everything up so that we would be completely ready to leave early in the morning. Here is everything loaded in the garage/living room.

At this point, the sharp-eyed reader may note that the front tire looks low on the XLR. This is because the tube had a puncture that we didn't notice until we got back at 10:00 that night. Fortunately I had purchased a spare tube the day before. Unfortunately neither of us had replaced a tube on a motorcycle before, and it took a long time to figure it out, and of course we put a hole in the new tube in the process. The second time took much less time, but still by the time we finished patching it was already 1:00 in the morning, which did not bode well for our crack of dawn start.

We finally got out the door at 8:00ish,  and stopped for a pre-trip portrait at the Lake Manyara overlook.

From there is was a two hour zip on pavement to Monduli. We had to stop and wait for the presidential motorcade. The presidents of Tanzania and the Congo were coincidentally also traveling to Monduli that day for the opening of a new military academy. We were first in line to go after the motorcade so we had the highway to ourselves going into Monduli. We had a brief stop there to fuel up and eat some chips mayai (a sort of potato omelet), then we were off the paved road for the rest of the trip.

We had a lovely winding journey through the mountains behind Monduli that dropped through a very steep, switch-back laden road down to the basin behind Mount Kitumbeine. I think we saw three cars (in one caravan) the whole way. Then we had a rocky, twisty road through mixed savanna and forest. Not many animals to be seen aside from innumerable antelope, just a few ostriches, giraffes and the occasional zebra.

We were chased for most of the day by a huge thunderstorm coming up from the Southeast and a dust storm from the Southwest. We finally sloughed into the dust storm right by a Maasai village where they were having some sort of gathering-- thousands of brightly dressed Maasai with their shukas being whipped by wind and dust in a strange half light. The temperature dropped by twenty degrees, and we started hitting mud pits in the road from recent rainfall. I drove through one, and the bottom dropped out. I was halfway submerged, but the bike kept running and motored out the other side.

We began to worry about running out of fuel about midday. We knew we had enough to get to Natron, but not back, and we hadn't seen anything like village where they might have gas. We had seen a village on the satellite imagery, but we weren't sure that the road we were on would take us through it.

We finally found the village about 3:30 in the afternoon and sure enough there was someone to sell us gas out of old water bottles. That was when the storm finally caught up to us. We pulled the bikes onto someone's covered porch and hunkered down with some Maasai kids to wait it out.

What a storm. You couldn't see five feet through the rain. It was like being under the ocean but louder. We worried a few times that the tin roof would blow off. But there was nothing to be done except share out some of our precious peanuts with the other people sharing the shelter.

After if finally blew itself out, we took a walking tour of the village of Kitumbeine. A stroll through the village quickly showed the damage: downed trees, mud slides, and roofs blown off houses. 

The road had turned into a raging torrent of water, so we decided to spend the night in Kitumbeine and press on the next morning. I'll try to get the rest of the trip posted soon, but here's a preview:

Telling Stories to Save Lives

My sister, Hannah, is raising money to make a new video for FAME. She has been working as a film maker in LA, and now she is planning to take a few months off to make the trip out to Karatu.

We have a lovely video about FAME, but it's sadly outdated. It was made before we had our laboratory, our hospital, our surgical center, or our maternity ward (which had it's first birth last week by the way), all of which we want people to know about.

If you want to learn more about the film she's planning or make a contribution to the crowdfunding push, check out her page on Indigogo (link below):

https://www.indiegogo.com/projects/sharing-stories-to-save-lives

Catching Up

Apologies for the delay between posting. It's been a bit busy around here.

In September I spent two weeks in Arusha attending a Swahili course, which was enormously helpful. The truth is, my language skills had plateaued for a period of about three months after I moved out of the place I was living with the Tanzanian family and finished the introductory textbook I was studying from. Still I felt inordinately proud of my ability to carry on a basic conversation, so long as the subject matter didn't deviate far from travel logistics, soccer, and motorcycles.

Ah, how little I knew about how little I knew. The first day in the classroom was a real eye-opener for how clueless I was when it came to advanced grammar. Someone once told me that Swahili was an easy language to learn because the grammar was so simple. I don't think I've ever been so thoroughly misinformed in my life. Perhaps people have that impression in the US because so few people from the US progress farther than learning the basic tenses, which are fairly straightforward. But underneath that superficial impression lies a complex set of verb-based structures that allow an extreme precision of meaning and subtlety of expression using a startlingly concise vocabulary. And all of it had gone straight over my head for the past year.

I enjoyed the course immensely and feel that I gained a much better foundation to move forward. The school, MS-TCDC, also had a lovely campus and a very talented teaching staff. The accommodations were very nice too, but the room and board fees were just shy of highway robbery, so I stayed with the parents of a friend of a friend in Arusha and commuted by Dala Dala every day. The last part of the commute was a nice walk with a view of the volcano, Mount Meru.

I also found another chameleon. I was surprised again by how terrified people are of the little critters. Still not entirely sure why.

Also, I saw something interesting while taking a walk around the perimeter of the school. Someone was growing some sort of edible greens on farms right in the middle of the river. They had built stone walkways all across the river to tend to the crop. I don't think I've ever seen that sort of riverine aquaculture before. It made for a nice place to take a stroll, so long as someone wasn't trying to go the opposite way on the same set of rocks.

A Social Activity

Right before I left the States, Grandma gave me a crash course in knitting. She keeps a few starter kits in her bag to ensnare the unsuspecting visitor at knitting group meetings.

I've started in on a scarf, which I have accidentally made twice as wide as intended. This has proven frustrating since it takes eons to finish a row. It may yet end it's life as a potholder.

Knitting, as a productive activity, runs somewhat counter to my normal mindset. When I'm working on the scarf by myself, I spend most of the time plotting ways to mechanize and automate the process. When I mentioned this to Dr. Joyce, one of our volunteers and herself a veteran knitter, she explained that, like quilting, it's supposed to be a primarily social activity rather than just manufacturing.

So I've started joining the Maasai ladies who do beadwork next door to my cottage. We all speak a little Swahili and shoot the breeze about what sort of livestock is kept in our respective homelands, and they never tire of asking what time of day it is in the USA right now.




Also, thanks to Heba for sharing some photos she took at our recent visit to Coleman's boma.

Here is a closer shot of the house:

 The decorations inside:

And our hostess with the corn-water gourd:

First Blood, First Boma, First Phonebook

Our blood refrigerator has it's first parcel. Sizya, a lab tech, got poked today so that we can be ready for a possible delivery. I'm next up on the donor list apparently.

Last week, Heba, a volunteer nurse practitioner, asked if it would be possible to visit a traditional Maasai village. She said she had seen a lot of interesting pathologies in our Maasai patients, and she was hoping a better idea of their home life would shed some light as to why.

The problem is that all of my Maasai friends live in Ngorongoro, which is a horrifically expensive place to visit if you aren't an East African citizen, which I'm not. It comes out to the tune of $300 per person per day. So I asked around a bit and in the end, Coleman, a member of the FAME staff invited us to visit his village close to Monduli, which is outside of Ngorongoro. The date was set for the next Tuesday.

We briefly considered delaying when I was hospitalized Sunday night for a suspected kidney stone, but I felt fine the next day, so we decided to go anyway.

Coleman's village was about an hour and a half drive from FAME. We started out on the paved highway, turned off onto a partially paved road, transitioned to a gravel road then a two track dirt road, then a one track dirt road, then no road at all, driving cross-country. Fortunately, our Toyota RAV4 is made of sterner stuff, and tackled the rocky terrain like a champ.

A Maasai village is generally called a boma, which refers to the thorny enclosure that surrounds it to keep the cattle in and the predators out. Coleman's boma had four houses, all made of mud and dung over woven sticks with thatched roofs. One house for his head wife her children, one for the second wife and her children, one for cooking, and one for storage. There were also two internal enclosures: one for cattle and one for goats. The RAV4 looked a little out of place, like a spaceship that had just landed there.

The houses were quite beautiful up close. The mud walls were smooth like driftwood. It was very dark inside because the only opening is the door, which serves as entrance, light source and chimney all at once. Coleman's first wife offered us tea. The Maasai idea of tea is fresh boiled milk with lots of sugar, waved in the general direction of a tea plantation and then drunk as is. Conversation stopped as everyone sat around slurping. Then Heba brought out one of the gifts she brought: two big jars of colorful gumballs. They turned out to tremendously popular. Coleman officiously took on the role of gumball distributer, and soon the sounds of slurping tea were replaced with smacking lips as the gum made the rounds.

Then we had a tour of the whole place. The second wife's house in particular was interesting because she had decorated it with all sorts of things, from medication packaging to Christmas tree tinsel. Anything bright, shiny or colorful had been saved and carefully tied to the rafters to liven up the decor.

We also walked around to visit some neighboring bomas, where they apologized for not having tea because there was no water.

Walking back to Coleman's house, we heard a rumbling sound, and it became apparent why he had wanted to come on Tuesday. It was the one day of the month that the four-wheel-drive lorry came around to sell corn, and he wanted to be there to personally oversee the negotiations, which took about half an hour.

Then we had a sumptuous meal of roast goat. I think the Maasai recipe is the best. There are only two ingredients: meat and fire. I also tried a kind of mashed corn floating in water that you drink out of a gourd. I may regret that particular decision in a few days, since I doubt the water was boiled beforehand.

We exchanged more gifts. We had brought shukas (a sort of plaid blanket) for the elders, and we received jewelry for Heba and a decorated club for me. Finally, we took some pictures together and then said goodbye. It seemed like everyone from a four mile radius came to see us off. It turned out we were the first foreign visitors to that particular community, or at least the first that anyone could remember.

Hopefully I will be able to steal some pictures from Heba's phone, since I didn't take very many.

BONUS FUN FIND

I was at a school office today, and I saw a phonebook, the first I'd seen in Tanzania. It turns out it wasn't a Karatu phonebook, but rather the directory for the entire country of Tanzania. Not a whole lot of landlines here. It was less than two inches thick.

South to Haydom!

Last week a couple of Norwegians (a pediatrician and a community health expert) came by FAME, and I showed them around. It turned out they were visiting from Haydom Lutheran Hospital, which is about 100 miles to our Southwest. After the tour, they invited me to come visit Haydom. I always enjoy learning more about healthcare in the area, so I said I would love to.

On my next day off, I saddled up the piki piki, and headed out before dawn toward Haydom. The road is all dirt and rock, winding through the hill country around Mbulu. It would have been a miserable drive in the car, but the dirt bike is built for that sort of thing.

Six hours later, I pulled into the gate of a major referral hospital in the middle of the wilderness. Haydom was opened in the 1960s on a previously uninhabited hilltop to serve an extremely rural population, mostly Iraqw and Datoga, spread out to the South of Lake Eyasi.

Now it serves as the primary hospital for 400,000 people and as a referral hospital for more than 2,000,000. With 450 beds (and I'm told up to 600 admitted patients at a time), it's a bit busier than our little clinic in Karatu. Each year, they perform 2,000  major surgeries and deliver 6,000 babies.

At first glance it doesn't look much different from other hospitals in Tanzania-- stuffy, poorly-lit hallways with beds packed into the wards and patients overflowing into the hallways. But going through department after department, you quickly realize just how many capabilities this facility has in comparison to other institutions in the area. Surgery, optometry, dentistry, inpatient, outpatient, HIV clinic, radiology, pediatrics, maternal and child health, labor and delivery, ICU, neonatal ICU, CT scanner... even a detox center.

Here's a view of their outpatient clinic, named for Ole Olsen, the Norwegian doctor who was the driving force behind the hospital until his death in 2005.

They also host a small contingent of international volunteers, and I had a very illuminating chat with their volunteer coordinator, who faces a lot of the same challenges we have at FAME.

The biggest issue for Haydom, not unlike many hospitals, is funding. Only Haydom's situation is especially acute since right now the Norwegian government is underwriting 66% of their budget, to the tune of three million dollars per year, and they are pulling the plug in 2015. It seems like nobody is quite sure how the hospital is going to deal with two thirds of their budget disappearing next year. They've known about the Norwegian government's plan to end funding for the past five years, but it's as if nobody thought they would actually go through with it.

It will be interesting to see how this situation plays out. The hospital is so important for so many people, and if they raise fees and cut services to cover the shortfall, the vast majority of their patient base will no longer be able to afford care there.

Back to work

I got back to Karatu after a month in the US.

It took me a week to catch up on sleep and email, but now we're back in business.

In the clinic, we have three new volunteers: a husband and wife team of globe-trotting nurses and a thoracic surgery nurse practitioner from California. I think they are all past the wide-eyed, slack-jawed stage of taking in how things work around here, and now they are getting into the swing of things too.

Ryaan, an ER nurse, has been digging around in our store rooms and is putting some useful stuff back in order. Here's a picture of Ryaan (left) working with Anthony, our lab director, to get some optometry equipment up and running.

We are also working on getting ready to start our Reproductive/Child Health (RCH) program. I saw some of the crew working on putting the new RCH office together today. If you were wondering how many men it takes to put together an IKEA style cabinet, the answer apparently is four: our physical plant director to supervise, a groundsman for consultation, the laboratory manager for quality assurance, and one carpenter to actually put in the screws.

We hope to have the RCH office, maternity ward, and prenatal health program in service and ready to go by the end of this year.

In other news, old habits can prove useful. Ever since living in New Mexico, I've always shaken out my shoes each morning to dislodge any scorpions that may have taken up residence during the night. I do this even when I'm staying in places with no scorpions. Yesterday when I was shaking them out before walking to work, I evicted this guy:

I think of shoe shaking like knocking before opening the door of a portable toilet. I'd rather do it all my life and never need to, than not do it once when I need to.

I also went on a trip this week to a big referral hospital to the south. It was quite an experience. I'll try to do another post when I get a chance to look through the pictures I took. Apologies for the photo quality. My camera did not survive my trip to the US, so everything is taken on my museum-piece original iPhone.

New Place

Today we had the first sunny morning in a long time. Maybe the long rains are finally ending.

I've been asked to post pictures of my new house, so here you go:

It's about a fifteen minute walk to the clinic along a lovely path. It has electricity (usually) and hot water when I can be bothered to fire up the wood burning boiler. I have the kitchen all to myself, so I can cook whenever I want.

It's also out in the country instead of in the middle of town like my last place. That means no call to prayer being blasted out at 5:30 in the morning. Instead just more roosters, but they don't usually cut in until 6:30am.

Since it's a bit of a walk to town, sometimes it can be harder to get to the store to pick up this or that. Necessity is the mother of invention, and hunger is the mother of strange dishes. The grocery situation has led to some kitchen experimentation. One product is the Egg-Guac sandwich: fried eggs, guacamole and melted cheddar on toast.

Next time, I'll try adding some lettuce or sliced cucumbers for more crunchiness.













Here's another look at the house to give you an idea of how compact it is:

It's perfectly sized for one person though, and very roomy by Tanzanian standards. In any case, I can't complain since my next-door neighbors live in a one-room house made out of mud.

I'm looking forward to the World Cup, though it's getting surprisingly little attention in such a soccer-loving country. It seems like most people around here only care about the Premier League. When I asked a friend which team he favored for the World Cup, he answered Manchester United. When I informed him that, since they weren't a national team, they wouldn't be playing, he just said, "Huh."

I read on the Internet that smart watches are starting to be a thing in the US. Well, here in Tanzania we are way ahead of the game.

Dog-throat-scopy

I got to witness an interesting procedure.

One of Dr. Frank and Susan's dogs, Safi, had been feeling poorly, and an online veterinary consult suggested she might have throat worms. This is a potentially life-threatening condition since they can migrate to the heart and cause cardiac failure. The nearest vet is in Arusha, and charges an arm and a leg, so Dr. Frank got his longest laparoscope and went to take a look himself.

I happened to wander by at the right time, and got a chance to help out by holding the dog in place and switching the scope on and off to keep it from overheating.

Here's the patient before the procedure.

Our nurse had no problem finding a vein on her, and she was very calm when they put the IV in.


She did get very confused though, when her hind legs stopped working.




We used a big vacuum splint to hold the anesthetized dog upside down during the procedure.











It was interesting to watch Dr. Frank intubate the dog. I had done intubation on dummies because, contrary to all good sense, it used to be part of the Ohio EMT-Basic scope of practice. I had never had the chance to actually visualize the glottic opening on a living, breathing creature before, and Dr. Frank let me take a look with the laryngoscope. It turns out that big dogs are easy to tube because they have great big vocal chords, and they don't have the 90 degree bend between mouth and trachea.

The problem was that big dogs also make a lot of slobber, and they had to suction out about a liter of spit before Dr. Frank could see anything in the esophagus.

Our nurses are used to Dr. Frank's devotion to his dogs, but we got some funny looks from everyone else. There are lots of dogs around Karatu, but they have a very different relationship with people here than in the US. They aren't pets so much as part of the scenery, like litter. Some people keep them in their compounds, but they typically lock them up in little boxes during the day, and nobody pets a dog. I suppose it's a reasonable attitude to have where there are so many stray dogs, and none of them have rabies vaccinations.

In other news, we are starting into the long rains. Our big, 5000 liter tank was almost full yesterday, and this morning the iron stand it sits on collapsed. The tank fell on its side, demolishing a section of the security wall behind it. I took a closer look at the welds on the broken stand, and none of them were worth a nickel. It was a good thing nobody was standing next to tank this morning.

Piki Piki Trip

When I get a chance to take a day off, I usually jump on the dirtbike and head off into the bush. My first trip was to Lake Eyasi, a big salt flat and soda lake about three hours away.

Last Tuesday, I went to Mbulu Mbulu, an area right on the edge of the escarpment of the central African rift. My friend Sokoine, who also works at FAME, wanted to come along too, so we had the experience of traveling with two guys on one little motorcycle on some very steep, rough tracks. We spent a lot of time in first gear at full throttle and just had to push the bike over a few of the rockier or muddier sections of trail.

The countryside was beautiful though: little farms squeezed between the Ngorongoro wilderness and the 1,500 foot drop off of the escarpment with the empty Maasai steppe beyond. We also caught a glimpse of the Oldonyo Langai volcano in the distance.

I had been in the area before when I tagged along on a mobile neurology clinic. I didn't pack a lunch because I knew a place where you could get peanuts and cookies in a little town along the way. However, Sokoine was confident that we could find peanuts at our destination, a little town at the very end of the inhabited zone along the cliff top. So we drove right by the first shop, giving a bird-in-the-hand to the wind.

We also stopped to help a man who had gotten his motorcycle stuck. It was weighed down with bags of grain, and there was no way he could get it out of the rocks by himself. After we heaved his bike back onto the path, he confirmed the presence of a store in the next community, so off we went.

There was indeed a store (read mud hut with a sign), but all they could offer us was one, dust-covered bottle of Coca-Cola. So we gave up on the peanuts, left the motorcycle at the house of a Maasai lady (Sokoine is also Maasai, and he assured me that any property we left with another Maasai would be safer than in a bank vault) and climbed the tallest hill in the area on foot to get a good look around. It was a steep, 30 minute climb, but there we found company on top because it's the only place in the area where you can get cell phone reception.

Sokoine took pictures, but he couldn't get the hang of holding the camera straight.

When we went back down, it turned out that the house we left the bike and helmets at belonged to the same guy we helped with the motorcycle earlier and he had come home for lunch. So he invited us to eat with him, corn-chowder and fresh milk, so it turned out we didn't need peanuts after all. I might have also agreed to buy 10 kilos of dried beans from him, but I'm not sure.

Sokoine's son, Ibra, also shows great promise as a future motorcycle adventurer. He will be turning one next month, but he already knows how to make motorcycle noises, and he loves to wear my helmet.

















BONUS EMERGENCY MEDICINE PHOTO

We had someone show up at the clinic today in a motorcycle ambulance, generously donated to the local government hospital by the government of Saudi Arabia.