Four Part Med/Surg Mission to Tanzania

10-JUN-B-1
LAUNCH THE TANZANIAN MARATHON, SAFARI AND TANGA
MISSION
10-JUN-B-1 Index of 10-JUN-B-series of the Tanzanian marathon, safari, and Tanga mission
2 Takeoff for Tanzania: the longest day of the year at the Summer Solstice, a tour of
Derwood and the Game Room for the Simmons family, followed by Clyde’s Tower Oaks lunch,
a last Needwood run, hosting Denny Steinauer who is shooting pre-wedding photos of Julie
Whitis before our dawn takeoff to Dulles for Air Ethiopia
3 Day one in Moshi and tour the town stopping for a first pass through the Post Office
where the faithful Tanzanian government servant overcharges me for postcard stamps which he
immediately acknowledges upon return, a visit to the Police Academy, and then lunch with the
elite male and female Tanzanian marathoners—(2:24 and 2:13!) and 8nterviews with press and
FM radio before return to the empty MT Inn awaiting the returning Kilimanjaro climbers for
dinner together
4 The Grand Ceremonial Colonial proclamation and processional in dedicating the Marie
Frances Boulevard in Moshi Tanzania as a way of honoring a source of foreign currency in the
tourism trade and a plea to refurbish and maintain the first street named after a white American
woman and keep the dollars flowing into the Kilimanjaro District’s economy, before a return for
lunch and an afternoon at leisure getting to know a few of the other participants
5 The day before the Kilimanjaro Marathon and the driving of the course, a luncheon at
the Lutheran Uhuru House and the visit to the handicapped handicrafts center and the pasta party
for the night before, in which Marie Frances announces she would like everyone’s support for
her nomination of me for the CNN Heroes Award
6 The events of the Kilimanjaro Marathon
10-JUN-B-2
TAKEOFF FOR TANZANIA:
THE LONGEST DAY OF THE YEAR AT THE SUMMER SOLSTICE, A
TOUR OF DERWOOD AND THE GAME ROOM FOR THE SIMMONDS
FAMILY, FOLLOWED BY CLYDE’S TOWER OAKS LUNCH, A LAST
NEEDWOOD RUN, HOSTING DENNY STEINAUER WHO IS SHOOTING
PRE-WEDDING PHOTOS OF JULIE WHITIS BEFORE OUR DAWN
TAKEOFF TO DULLES FOR AIR ETHIOPIA
June 21--22, 2010
I took full advantage of the long (now it can be said) summer evening to enjoy the
Derwood ambience and to take a final run down Needwood Trail. I am packed, and had gone in
to GW early to send out the mailings I had put together on the weekend, including the reference
letter for Julie Cavallo‟s medical school applications, the audiotapes and printouts to Shirl up
through 10-JUN-A-Series, and pay the bills that will be due I my absence. I then came home to
meet Hall Simmons who had brought his wife Ann and two grandkids, Wesley and Clara who
are visiting. He had been eager to sign me up to go hunt with him for geese and ducks in Alberta
since he insists I am the most phenomenal wingshooter scoring series of triples on waterfowl,
and he is eager to use his dog Tom, since he is not sure he can continue to train him at the point
he is now in which he competes nationally on field trials and something else like them called a
French term which is the equivalent of “dressage” to barrel racing.
I cannot convince him to try for the Midwestern flyway in Arkansas with Sarge I had
met in follow-on to Katrina in New Orleans, but he wants to go back to GooseMasters by flying
up to Calgary and driving a rental car up to Peace River. Carrying no firearms, but using the
shotguns they have up there. It would just be the two of us and it would largely be me shooting
and he dog handling. That would be the first days of September the first moment the season
opens up there, and then I might fly from Calgary down to San Antonio to visit over Labor Day
with Michael and the twins. He tried to convince me of this as we had looked over the Game
Room for the inspiration of his grandkids as his granddaughter had once lived on a thousand acre
farm in Alabama with her father Philipp with whom we had once gone pheasant shooting in
Virginia, but she now lives with her mother in near Orlando. She has gone deer hunting often
shooting a .270, and she was knowledgeable about the difference between horns and antlers, and
twisthorns and other antelope, recognizing a Greater Kudu which she said she had always
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wanted to hunt since she had seen a picture of one when she was about Wesley‟s age. They had
a good time in the “museum-quality Game Room” and then although Hal had been eager to get
home before any traffic, I reminded them that I had made a reservation at a special place they
would like to see, since they had enjoyed the Game Room. So, we went to Clyde‟s at Tower
Oaks. Once we were there and I had taken them around on a tour of the “barns” and shown them
the bronze Labrador retrievers and the punt gun from the era of the market gunners, I had them
hooked, We had gone into my gun safe and produced the Parker Double, and had the grandkids
as well as Hal handle the double twenty and the other prize pieces and even strapped the big
Ruger Super Redhawk .44 mag around small sized Wesley to furnish him with photos of the
event, I had them excited about coming up here on the week before Thanksgiving Day.
We will then return to the place in Virginia where I had once gone with Hal as he was
handling the dogs and his “son” Philipp from Alabama, and we had harvested a bunch of
pheasants. We made plans to try to repeat that process this year coming up so that I can shoot
birds as Hal manages the dog for retrieving. He is looking forward to this since most all of his
time is spent looking after Ann who is getting more forgetful in a spiral of Altzheimer‟s Disease,
and he has arranged for a relative to come to stay with her if and when we might go to Alberta
Canada for a waterfowl shooting, We have had repeated invitation s to come on down to
Alabama to hunt deer and turkeys and the destructive feral hogs, as Philipp had tried to convince
us to do, but Hal describes that as “more like „hunting‟ and less like „shooting‟ in which he
prefers a more predictable fast action to get the maximum number of dog retrievals.
I returned to zip up most of the remaining items into the already packed bags in
preparation for the three main events coming up: 1) the Kilimanjaro Marathon and the events
around it including the re-naming of the main street in Moshi; 2) the Serengeti Safari, a
photoextravaganza during the great wildebeest migration; 3) The Tanga Province
Medical/Surgical Mission concluding in an outing to Zanzibar/Pemba.
I have also made arrangements for another “Derwood tour” in my absence: Patty is
writing the last chapter of the book and that chapter is on Derwood as a “main character”—the
home base homestead in the woods. She said that there were further elements in the story she
needed to fact-check and that would involve another visit, which could not be done before I left
for Africa, so I have had to make arrangements for her entry and accessible records, such as the
photo albums of the remodeling in stages. Then she will have to depart, locking up the house
and re-alarming it, even as I have notified the MCPD that I will be out of the country and they
will swing by on occasional patrols. I received a notice that they have not yet found any of the
gold fenced, and that the principal suspect is laying low since he is on probation. Sarge
“Hammer” Hamburg had written me that they were getting his junior accomplice alone to see if
the story held up after isolation. I had dashed back to the house when I had received an ADT
call last week that there was movement sensed in the foyer, which turned out to be a large spider
crossing the eye of the motion sensor, and although they called off the police to say that the
owner had returned home, the police car entered the driveway, and turned around, but that was
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good enough to receive the warning letter that this was my one free alarm call, and after this one
there is a heavy penalty fee for any future “false alarms.”
I had heard that the very tall Sudanese known as the Dinka Dunker Minut Bol, one of the
more famous Dinka since he had played for a number of teams including what were then the
Washington Bullets, died yesterday of kidney failure at age 47. He may have been one of the
tallest basketball players ever at seven foot six inches and was a master of the blocked shot. He
was a prominent figure in several of the books (like “What is the What?”) as he was a refugee
from the Dinka wars, and often was a figurehead in the political and public relations struggles.
I had been awaiting arrival of Denny Steinauer to come down so he would not have to get
up before dawn in Gettysburg in order to try to get to Dulles on time. It turns out that he would
be a bit late. He is shooting photos of Julie WHitis‟s “Engagement Party. Then that led to a
dinner at Bertucci‟s in White Flint Mall, and then he discovered that he had packed the wrong
photo card in order to get it to them before departure, he called his wife Dora, and she had to
drive down to Fredrick as he drove u so that they could exchange this half way and he then
returned to upload those photos. He said even after that he would have to go through and do his
usual re-packing—which meant he did not reach Derwood until after midnight. I just left the
outdoor lights on and the front door open and went to bed. He is always hard to get moving from
the inertia of a stop along the way since his paraphernalia must weigh more than all the rest of
ours combined, and on the last trip, he had said “If I go on the next trip with more than one bag,
just shoot me.” HE would be riddled with holes in that case, since he will never carry less as a
bundle of carry-0ons than I have for the entire baggage.
AIR ETHIOPIA #503, TAKEOFF: THE FIRST TWO FLIGHTS
WITH A REFUELING STOP IN ROME ARE 4,498 MILES (7,239 kms0
AND SIX HOJURS LATER THAN OUR EASTERN DAYLIGHT TIME
IAD TO ROME TO NAIROBI TO KILIMANJARO
Sure enough, after re-packing last night and again this morning he is down to only six
carryon bags of equipment. At check-in, the agent asked to see my carryon bag which he said
could number only one and could weigh only fifteen pounds. Dennis does not have one of them
down that small and even needs a wheelie to haul his carryon collections through the security. It
is a bit like a “Sea Anchor” being towed which even with a lead time of a couple hours cushion
leads to cliff-hanger connections.
I went on ahead through the brand new terminal underground, but since I am headed to
Terminal D I still got on the mobile lounges which were to have been discontinued with the new
"Air Tran” train which is now used for the domestic flights. We re-connected an hour later as he
was still re-consolidating his bag and baggage having checked in only one of the bags, and it was
fifty one pounds, with his carryon baggage totaling much more than that. I am in the Boeing
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767—Air Ethiopia was supposed to be the first carrier to fly the dreamliner , and since Bowing is
a couple of years late on their sales delivery, they are paying penalties to them for not having that
new aircraft on this route—as far west as they travel. They now are getting the first Boeing 777
200 series, the longest range carrier in the world of commercial aircraft which will carry 800
passengers non-stop from IAD to ADD or to Asia without the Rome stop or other refueling. I am
getting settled in for this first limb of over 8 hours and will write a few cards and read a bit
before checking on the videos or taking a nap in the daylight hours of our crossing to arrive in a
foreshortened night.
Here is the total transmitted time in each of my Air Ethiopia sites: IAD to Rome 8 ½
hours, Rome 1 hour, Rome to Addis 5 ½ hours. Addis 1 hour; Addis to Nairobi 1 hour 45
minutes; NBO ½ hour; NBO to Kilimanjaro 44 minutes; then taxi to Arusha 2 ½ hours; Arusha
to Moshi 2 hours; check in at MT Inn for the night/ Meet Marie Frances for dinner as the only
customers in the restaurant and watch a bit of the World Cup.
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10-JUN-B-3
DAY ONE IN MOSHI AND TOUR THE TOWN STOPPING FOR A FIRST
PASS THROUGH THE POST OFFICE WHERE THE FAITHFUL
TANZANIAN GOVERNMENT SERVANT OVERCHARGES ME FOR
POSTCARD STAMPS WHICH HE IMMEDIATELY ACKNOWLEDGES
UPON RETURRN, A VISIT TO THE POLICE ACADEMY, AND THEN
LUNCH WITH THE ELITE MALE AND FEMALE TANZANIAN
MARATHONERS—(2:24 AND 2:13!) MD MTERVIEWS WITH PRESS
AND FM RADIO BEFORE RETURN TO THE EMPTY MT INN
AWAITING THE RETURNING KILIMANJARO CLIMBERS
June 24, 2010
Off—but not yet running~ In fact, anything but, I am crawling around stiffly with a
creaky back from having sat scrunched up in a coach seat for a collective 20 hours of aircraft seat
time that has made my back feel like it will not be moving anytime soon. I have just taken a
shower to hurtle me through the jet lag hours and also try to relax the spasmed muscles of the
deep back after popping a couple of Motrin—and all of this is BEFORE I have run a single step!
But, today, under an overcast cloud cover, I did get a small tour of Moshi town doing
errands in preparation for the big events and parades tomorrow and did have lunch with a special
pair of twenty six year olds as well as an interview with the local press. I also accomplished one
of my chores, and purchased my postage stamps for the postcards I had written while in the
aircraft—the OLY constructive us of the time since the AC system was out—as it always seems
to be for whatever seat I have for whatever airline—not just on the first pair of flights on the 767
from Dulles, but also on the 737 from Addis to Kilimanjaro. That story is worth the repeating. I
gave my addressed postcards to Castro, the fellow at the desk of the MT Inn of Shah Tours. He
told me that the postage required was 1,000 Tanzanian Shillings for each card, and at the airport
I had purchased $100 in shillings at 1,44o per US Dollar. But I went with our guide and the next
Race Director an ex heavy weight champion discovered and brought to America by Floyd
Patterson and Archie Moore, Onesro, and he and I went to the post office where they sold me
fifty stamps in the 700 shilling denomination, and charged 50,000 Tz shillings. As we were
leaving to go to the Police Academy where most of our TZ runners will be coming from, I
pointed out the error in math of 15,000 TS and he said we would go right back. We went right to
the same agent at the window and Onesro said “Why are you setting such an example for a
distinguished visitor from another country that all Tanzanians are thieves and cheat you?”
Without ever looking up, and without acknowledging anything at all, the agent simply slapped
15,000 TZ on the counter—his usual “commission having fallen through in this case as
contrasted with most others which are whatever the market will bear, no questions asked.
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We went to the Lutheran Guest House set up to service the KCMC which I had visited
twice in the past, once when I had first come to visit KCMC (Kilimanjaro Christian Medical
Center) over thirty years ago when I met the Director and his small son—the fellow named Greg
Mortenson who has just written the Preface to my biography after making a name for himself in
the Himalayas (Three Cups of Tea.) The last time was in 1996 when I came up during my
Fulbright year in Southern Africa to climb Kilimanjaro by the Marangu Route. I stayed there
before and after the climb, and noted in the book by Michael Crichton that he had also. I have
been gathering supporting materials for a dream which may not come to be—I am considering
repeating that climb by another route, perhaps the Machembe Route with Grandkids this time—
perhaps on the twentieth anniversary of my first ascent to the Roof of Africa—and [possibly do
the Kilimanjaro Marathon with one of their parents or take them on the Safari form here as I go
to continue the missions here.
That will be determined by whether I can still move freely, which today I am not thanks
to the frozen back in the position of a coach class seat. I felt that way as I had lunch with two
twenty six year olds. . Bonweli Katesingwe, who has won both the Milan and the Barcelona
Marathon and who has run in 2:24, and her age-mate the male Jumanne Milathuwax Baki who
ran a course record of 2:15:37. If I dived my age by theirs, I should be allowed a course record
for my age group of just two and a half times their speed!
I was interviews as a celebrity runner if not an elite runner, presumably because of some
other things that I may have done that are of benefit to Tanzania by a print journalist who will be
here to attend the pasta dinner the night before the run as well as the street-naming ceremony and
the marathon itself, which I understand is a loop course of four times around. So, I should see
these elite runners several times at least, including one other, a woman from Ethiopia who has
run a marathon in 2:20, so that the entry of Tanzanians this year is limited so as not to crowd the
course which a few of these elites may “lap” several times. I presume I will be a “lapee” rather
than a “lapper” so, I will be happy if by then I am unaware of my back being stiff.
LOCATION OF THE MOSHI MARATHON COURSE, TEN
THOUSAND FEET BELOW THE STARTING GATES OF THE
MARUNGU AND MACHEMBE ROUTES UP KILIMANJARO, WITH THE
SUMMIT TEN THOUSAND FEET HIGHER THAN THOSE GATES
I m in Moshi within very easy range of Kilimanjaro which I took photos of from the
topside as it was wreathed in clouds yesterday upon approach to Kilimanjaro Airport, which I
have marked:
AIRP= 03* 25.41 S and 037* 03.79 E
MTIN= 03* 20.56 S AND 037* 23.01 E at Alt= 817 meters at MT Inn Moshi.
It was a good thing we are actually here a day ahead of when we were expected, since we
met the people Marie Frances wanted me to meet, including the Catholic church and school
officials and a number of the officials of Moshi and the media. I had come back to the room in
time to get ready for when the team arrived from those who had summitted Kilimanjaro explain
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as they did that they were glad to have done it but that it was really hard. I agree. At the
reception and dinner in which we all talked, I met a few Brits, a really neat young family from
Austin Texas, consisting of a couple with their two sons, one at Auburn and one starting
Colorado State after graduating high school all celebrating this last hurrah on the combined
climb, run, and Serengeti Safari just as I would have wanted so it is a source of envy.
A young man named Kyle is an optometrist in the US Army in Germany going to Iraq
next month. They had been classmates at Wheaton College near Chicago, and I told them that
the woman who had just dropped off me and Dennis in Dulles had been a Wheaton College grad.
How did you know about this Wheaton College as opposed to the one in Massachusetts? She
asked. I told her that we had often beaten Wheaton in basketball when we were in college.
Where was that? She asked. I said I had graduated from Calvin College. She said: “Oh my
goodness; I grew up Christian Reformed and visited both Calvin and Wheaton before I had to
choose where to go to school.”
I asked where she had grown up. She replied “Alaska!” So, within minutes we had
exchanged the names of the Heynens, the Sharpes, the Veltkamps and the DJonges. Except that
the ones I mentioned were the grandparents of all those she knew! That is a quite revealing thing
about the two fellow Kilimanjaro Marathon runners! She had already done a marathon in Africa
she said, and that was the Marrakesh Marathon—a place I have not yet been—a source of
wonderment to each of us. Most all of the people here are trying hard to get into the Seven
Continents Club and are booked with Thom Gilligan to run Antarctica to get that continent out of
the way, which was my “Last Marathon” in the continents. I had heard of one person here who
has done twelve and another is rumored to have done twenty but I suspect I am the winner by a
long distance in the total number, since on the mountain a group had pooled together and figured
they had forty marathons among them. But, I am sure that they will be out there in good form
this weekend. A second fellow named Kyle had his father come along to do another father and
son, another point of encouragement for my goal here as well. They were all looking forward to
it saying that they wanted to run this marathon but if they could not finish it they had the perfect
excuse, having just done the Kilimanjaro Climb!
So, it seems a good group. And tomorrow we will start into the morning celebration of
the dedication of Moshi’s Street as Marie Frances Boulevard, the first African Street to be named
after an American woman. Our afternoon will be at leisure for touring the town. All day
Saturday Is booked for driving the course which is being painted tomorrow afternoon. Then the
following morning is the marathon with the start at 8:00 and the awards ceremony at 1:30 when I
should be plodding in. The pasta party is on Saturday night and the bibs will be handed out then.
I have a night to rest up and a surprising number are then going off with us to the Serengeti
Safari, including quite a number who could not afford to come in from the airport and had asked
for a free ride.
So, I will have a chance to get to know a few of these a bit better over the course of the
next week, and they seem genuinely buzzed at having done the climb-possibly more excited at
“”Having done” it than doing it. Twenty one went up, and fourteen summitted, several of these
had made it to Gilman’s Point, and despite nausea and headaches from the altitude, many went
on to the Uhuru Point, the Roof of Africa. A guide is coming to sign their certificates tomorrow
morning and one of the British women asked if they could get a certificate for almost climbing
Kilimanjaro. Sue, the wife of the Austin Texas quartet had been taken down on the second day,
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but is glad she made the try and is part of the cheering squad. A pair of women had done three
safari parks Lake Manyara, Tangeera and had returned to day from Ngorongoro Crater arranged
by a tour group other than the Shah tours that have made the arrangements for us. One of them
is going to run the marathon and then they will depart. Otherwise, I have seen the Americans
and Brits—I believe thirty plus who are running the marathon along with about a hundred
Tanzanians, a number restricted to avoid crowding the Ethiopian woman whose last marathon
was in the 2:20’s. So, we have two days of preliminary celebratory events before we get to get
out and do it. It seems like a good mix of folk and the right time to be here to run it—any time is
better than “later” to do anything after one passes a certain age, after all! I mentioned this since I
had received the Calvin Spark the night before departure, as I just related to the young lady Erika
tonight. I always look in the back at the “Sixties” which is the alumni column I belong to, which
is now reporting the great achievements of the classes in the “Aughts.” I looked to see what
were the newest achievements in the classmates of mine in the Sixties, and was disappointed to
see that not many of them were listed, except, of course, in a rapidly growing “Obituary List” of
college classmates!
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10-JUN-B-4
THE GRAND CEREMONIAL COLONIAL PROCLAMATION AND
PROCESSIONAL IN DEDICATING THE MARIE FRANCES
BOULEVARD IN MOSHI TANZANIA AS A WAY OF HONORING A
SOURCE OF FOREIGN CURRENCY IN THE TOURISM TRADE AND A
PLEA TO REFURBISH AND MAINTAIN THE FIRST STREET NAMED
AFTER A WHITE AMERICAN WOMAN AND KEEP THE DOLLARS
FLOWING INTO THE KILIMANJARO DISTRICT’S ECONOMY,
BEFORE A RETURN FOR LUNCH AND AN AFTERNOON AT LEISURE
GETTING TO KNOW A FEW OF THE OTHER PARTICIPANTS
June 25, 2010
Nobody can strut to Pomp and Circumstance, Trumpet Voluntaire, and—would you
believe?—“Guantanamero!” quite as much as an ex-colonial power in indigenous hands. We got
the full panoply of pageantry at the Moshi City Council’s office in which a brass band
accompanied us, as we lean and mean runners in shorts and running shoes with marathon shirts
were mingled with burgundy and scarlet robes, and cockade hats with plumes and sashes and
medals and biscuits paraded into chambers and heard accolades read in stilted English, with a
processional following as we went between rows of uniformed school children from the Catholic
School waving alternate red white and blue and Tanzanian flags behind the big banner of a
Tanzanian flag of a nation independent since Sabba Sabba Day July 7, 1961. And Marie Frances,
a 73-year-old white woman with artificial hips staggered along the rough unpaved 759 meters of
potholed road with a sign she had printed in Bethesda Maryland proclaiming this the Marie
Frances Boulevard. It is said to be the first street named after a white American woman in
Africa, and Councilwoman Bernadette gave a very candid reason for this. First, for twenty on
years Marie Frances has been bringing American runners and their American dollars in great
quantities to Moshi, which is totally dependent as no other province is on the dwindling tourist
economy in a world-wide recession as the seat of Kilimanjaro District. Second, there are two
hundred twenty eight kilometers of roads in Moshi Town, only seventy paved, and if you will see
how bad this road is, you will feel an obligation to refurbish, maintain, and perhaps pave it to
keep it in better shape that all others into perpetuity.
Before long, this income generating asset will find duplicates springing up all over Africa
since the Almighty knows there are roads aplenty kin Africa that need improvement and
maintenance for which there are no monies here! The reason many (in fact, most!) roads are
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unnamed is that few are worthy of naming since they are ashamed to call attention to themselves.
If we must get these “unthoroughfares” adopted out to someone, anyone, anywhere, we should
get them assigned to someone to oblige them to care for their namesakes! Clever!
So, father Gregory blessed us and the road and sprinkled Holy Water upon us, and the
band played on. They are very happy that the Marathon and the Mountain Climb and the Safaris
cost so much since that is the single lifeline infusion into their economy, and since there are far
fewer tourists now, we must get more out of each, and who would those best candidates be but
American tourists? The glacier on the top of Mount Kilimanjaro is diminishing and that is due to
Global Warming—and what it is that is due to—it is due to you, so you must do something to
enhance what we have since by 2019 there may be no more glacier up there! [The glacier as I
viewed it coming in and saw it last year is about a quarter of the size I had seen it on my first
visit to this area in 1977.]
I audiotaped, and videotaped, and still photographed the events in all the colorful African
colonial pageantry.
SOME OF THE PARTICIPANTS ON THIS TRIP
We have some interesting folk on this trip. Mike and Sue Bexter, and their high school
graduate son Chase heading to Colorado State next fall and the older son who will be a senior at
Auburn are on a family vacation as he is taking off from a high tech firm in Austin Texas now
named Convergys, after having been with several other tech firms now bought by Oracle, and
they are planning their Kid-free years. They did the Kili Climb, will do the marathon, and are
doing the Serengeti Safari with us. They invited me to come to Austin when Greenleaf publishes
the book Patty is finishing now, as they know the Greenleaf of the title
A Guajarati-born Indian neonatologist from Chicago is here with his wife. A second
young man named Kyle was the winner of the Americans last year and came back to better his
time but he is young and he has brought this father this time since it is expensive. Christina
Harding is the on again/off again senior GWU medical student who was going to do the medical
mission with me but needed to have here expenses paid for all details, despite having done the
Antarctic Marathon and the Kili Climb and the Serengeti Safari, and is eager to stop at KCMC
while here to put in for some kind of clinical credit for a holiday trip. This Kyle is different from
Kyle Smith who is married to Erika the CRC blonde from Alaska, but he had an MBA and has
started a foundation in honor of two significant women in his life who died of breast cancer.
Suzanne was born in Addis Ababa living in Santa Fe NM, trains at 12,000 feet at home.
The team of runners from the USA includes a Brit from BP in Houston, who is weathering out
the oil spill on holiday,
As I was typing these words, I got summoned by His Worship, the Honorable Lord
Mayor of Moshi who is due for an election campaign and also has a son who graduated from
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KCMC has a wife and is living in Nairobi where he is working for an Indian East African born
eyeglass manufacturer and he would like him to get a masters degree in the US—and my card
with GWU pasted on his consciousness means he can do an end run around the visa requirements
and be relieved of the forty thousand dollar tuitions for his son to become an optician or
optometrist. Fortunately I spotted Kyle Smith who is in the US Army as an optometrist (the one
married to the CRC young blonde Erika from Alaska so we connected him with the optician
schools for him to make application. His Honor and I then played a cell phone game for an
African geography quiz, the winner of which is going to be announced tonight on TV—and I got
all the answers correctly to contribute remarkably to his point spread for a chance to win the trip.
The equinox has got to me and I can no longer see the keyboard, as the lighting in this
MMT Inn does not allow reading or typing, and the Mayor took up almost all of my afternoon
daylight hours, so we will adjourn until dinner and then get up early for the seeing the course
tomorrow morning and the pasta party tomorrow night
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10-JUN-B-5
THE DAY BEFORE THE KILIMANJARO MARATHON AND THE
DRIVING OF THE COURSE, A LUNCHEON AT THE LUTHERAN
UHURU HOULSE AND THE VIST TO THE HANDICAPPED
HANDICRAFTS CENTER AND THE PASTA PARTY FOR THE NIGHT
BEFORE, IN WHICH MARIE FRANCES ANNOUNCES SHE WOULD
LIKE EVERYONE’S SUPPORT FOR HER NOMINATION OF ME FOR
THE CNN HEROES AWARD
JUNE 26, 2010
This is the Penultimate Day after a lot of ceremonies and creaking backs and sore
muscles in Moshi Town, with those who had climbed the mountain recovering from the climb,
and my own aching back from sitting in cramped seating around the globe—I would a whole lot
prefer to have this sensation after the aircraft ride and BEFORE the run than knowing as I often
do that I am going directly from the long run to sit in the cramped seats AFTER the long run!
We are on our way to drive the course, which is a four times around ten kilometer course over a
sturdy German made bridge, and two narrow and potted spots in the roadways, and at each stop
the water boys from the Catholic school will be manning the water stops—ten boys with
balloons tied to their stand each kilometer on a road painted with the markings of the course.
Anything else that has been hung up for marking the course, like balloons, ribbons, markers,
signs or cone barriers have been stolen before the runners get to the next turn, so it is necessary
to paint the course and also to drive it, since we will often be alone on the run. What just occurs
to me is that these are “Water stops” and not Gatorade stops, and any race over ten miles requires
salt containing energy drinks. Anything less than ten miles the adrenal glands can shut off the
loss of salt, but the distance run is in danger of water intoxication if not salt and carb containing
solution is used. We will figure all of that out by race time, I hope.
There are a couple of “first-time marathoners” in this group. There are at least four who
aspire to the Seven continents club, and three that have done the Antarctic Run, although only I
am the member of Seven Continents Club, and I have done more than half the number of
marathons that the total of the group has collected. One of the half marathoners, the Gujarati
Indian neonatologist has done fifty marathons, most of them in Chicago, and got in as a standby
into the Antarctic marathon but had figured he would be too worn-out from the climb to
complete a marathon so signed up for the half. He is over twice the next highest total of the
marathons. There are multiple father and son teams and a couple of similar teams with a
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supporting family member, One whole family , the Bexters are running—four in all. We are all
lying about at the MT Inn, some getting massages, some reading books and we have swapped
quite a few titles of recent books to be read
STARTING OUT ON OUR ORIENTATION TO THE COURSE
Creaking forward feeling more like the “morning after” than the “morning before” I am
aligned now to try to get my back to bending after a creaky start. We will take a tour of the
painted course, and we will try to see what the vi42w of the course we will see once—for the few
who are doing 10.5 k, or twice for those booked for the half marathon, or three times, for those
who drop out, or four times for those doing the full marathon.
It is a back and forth repetitive course on traffic filled roads passing the Lutheran Uhuru
Hotel and Conference Center where I had stayed in 1996 when I flew up here to climb
Kilimanjaro by the Marangu Route, and where later I had read a travel book by Michael Crichton
who had published a book about his climb up Kilimanjaro doing exactly what I had and staying
here also. He then threw in a couple of patients’' stories from his Harvard Medical Student days
since he never practiced not ever matched for a residency. His experience in the Lutheran Uhuru
Hotel and climb rather identically matched mine. Here is where the MSD South African
Afrikaans speaking woman named Magdalena had walked in to the Hotel and asked to borrow
my Nikon camera and dropped it, shattering it. I then went into my backlog of a spare Nikon I
carried still in the box, and she took that up the mountain instead never seeing either camera
again. Meaning that I did the whole of my Fulbright year without the primary camera or its
backup system, back when film cameras were all I had. It was a place where I might have been
triumphant upon return, but mostly I was tired and hollow, hungry and hypothermic and
hypoglycemic, the sensation I got from summiting Kilimanjaro at 5,575 meters.
So in the morning after breakfast many of the men had gone golfing and had actually got
rained upon. Them the rest of us went to the center of the town to do the shopping that only two
wanted to do. I walked the others around since I had been to the Post Office, and we went to a
church bookstore where we could buy stamps and post cards and I wrote two of them while
sitting at the café I had pointed out to them, and mailed my two postcards one to Michael and
one to Donald telling them how everyone had got so excited about my doing a three generation
climb and run as part of the safari I have been trying to arrange for the grandkids before it is too
late to add an exertion as the coming race would represent.
We went to drive the course, which was a monotonous back and forth with the km
markers corresponding to where the water boys will be out to signify turns. I then went to the
Shah Industries, a relative of the Shah Tours which has arranged the safari for us and the owner
of this hotel the MT Inn—all related Asian Tanzanians. Just learned that the safari goes first to
Lake Manyara and an overnight at the lake Manyara Hotel---where I had been last year guiding
the tour through that rather rich game park. Next we go to the Serengeti and spend two nights up
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there and then return to go to the Ngorongoro Crater, again where I had been last year, so more
than half of this will be very familiar to me, in fact, I was the naturalist guide for the two of the
three tours last time. No matter, both were magnificent.
Now we are gathering for the pasta party and the hoped for early to bed, since I am
drowsy and achy and cannot believe I am here to run a marathon which feels much more like the
day after than the day before. But, then, especially as I remember Boston and all such stand
around days before the run on Patriots’ Day, it always seems to feel like this and go this way, so
why not keep that consistency as well and just get out and do whatever can be done!
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10-JUN-B-6
THE EVENTS OF THE KILIMANJARO MARATHON
June 27, 2010
I did it! And I did it without any major glitches, injuries, and I did have to slow down
at the last quarter to an uphill walk quarters with most of the fast younger runners doing the same
and a couple of quarters earlier than I. I had slowed down after leading the pack of Europeans
through the first quarter of 10.5 of the kms, as we were passed by many Tanzanian runners at
the end of the first quarter of two hairpin 180* turns on each end where they recorded the bib
number and time of arrival. I slowed to the point where it could be less uncomfortable, with a
number of young folk really suffering and some experienced runners saying this was the worst
experience of their marathoning life. I got to the end of the third quarter at 4:1- and might have
done it in five hours if I had run at the same speed, but walked the uphills of the last quarter
arriving last of the marathoners in six hours.
But I finished the race, and was the oldest runner to do so which got me a trophy, as
well as the finisher’s medal and certificate so I can count it as one officially successfully
completed. The Tanzanian runners clustered around me including the first and second place
finishers, like most Africans—“Ah, I need your runner’s watch to train with” said the winner;
and “I could run even faster I your shoes,” said the runner up. On the run several kids came to
me to say the forbidden opening words “Gimme Money!” for lunches. I asked them if a runner
in shorts and tee shirt looked like someone packing along a lot of currency—a bit as stupid as
asking a distance runner for a cigarette, and all of it preceded with the magic words that shut
down any further conversation of a charitable intent, the demand “Gimme….”
It would be an ideal family run since the person can choose to do one lap—a 10 K, two
laps—a half marathon, or four laps for, the full 42 km marathon.
There was an award ceremony at the end when I came through the line for the low fives
from the gauntlet and then I took photos of the ceremony in which the first place Tanzanians
runners won one hundred dollars from the Oryx Gas company and also a “Gas Grille running on
compressed gas, they each got a certificate, a medal and could pick a set of running shoes from
the fifty pairs that were brought over by the women with a running club that had gathered them
and carried them at the expense of an extra bag. I received my medal, certificate and trophy for
the oldest runner here, and I said all the rest of them were just running against the clock whereas
I was running against the calendar as well. The certificates says that this qualifies as an African
marathon for those who are attempting to run all Seven Continents, something that is already a
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decade late for me. A number of runners are here especially for this purpose and a number had
done the Antarctic as a way of getting the most difficult continent to get out of the way
accomplished and then are just trying to do the easier ones. I have talked a couple of them into
doing the Easter Island Marathon as a way of scoring their South American marathon. The
whole Bixler family is asking that I be their guide on the safari and we may re-rendezvous in
Austin TX when the Greenleaf Book Group in Austin releases my book later in the year.
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10-JUN-C-1
SERENGETI SAFARI IN A DELUXE SHAH TOURS GAME DRIVE FOR
A FIVE DAY SAFARI THROUGH LAKE MANYARA, SERENGETI, AND
NGORONGORO CRATER BEFORE RETURN THROUGH ARUSHA TO
MOSHI FOR THE LATER START OF THE MEDICAL MISSION OF 10JUL-A-SERIES
June 28-July 2, 2010
10-JUN-C-1 Index to the Serengeti Safari including Lake Manyara and Ngorongoro Crater
2 Launch the Serengeti Safari in deluxe tour from Shah Tours from Moshi through
Arusha and beginning in Lake Manyara National Park before ending the evening in the Lake
Manyara Hotel on the Western Scarp of the Great Rift Valley
3 A superb day begins with breakfast in the elegant Lake Manyara Hotel with Dennis
leaving veranda door open and a baboon stealing his Microsoft wireless mouse; then a long dusty
drive through Ngorongoro Crater entrance to the flat dry plain entering Serengeti for views of
gazelles, birds, elephants, Nyati, giraffes, and then cheetah, leopard and lion before settling in at
the Serengeti Game Hotel for dinner and a two night stay
4 A full day in the Serengeti, with an early morning game drive as the Bixler family goes
off on a hot air balloon ride at dawn, and Dennis and I see a variety of lionesses stalking gazelles
and zebras, then a pick up at the interpretive trail around the Frankfurt Zoo’s Conservations
Center for their return from their champagne brunch, and a continuation, seeing crocodile and
again watching unsuccessful stalking by lionesses, a cheetah surveying a nervous gazelle herd,
and a return for a sumptuous lunch; the evening game drive seeing an African Fish Eagle, a huge
hippo “cesspool” hyenas and sunset before dinner with our group
5 The drive out of Serengeti into the Ngorongoro Conservation area for the Massai
Village visit and hustle before we descend the scarp from the volcano rim into Ngorongoro
Caldera to spot a pair of cheetahs, several lions, including a pride drowsy from gorging at a kill,
huge bull tuskers, and after many sightings of birds, a myriad of wildebeests we finally spot a
black rhino and calf to round out the Big Five and ascend the rim wall through euphorbia and
groundsels to check in at the elegant Ngorongoro Wildlife Lodge for the night to begin July 1
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10-JUN-C-2
LAUNCH THE SERENGETI SAFARI IN DELUXE TOUR FROM SHAH
TOURS FROM MOSHI THROUGH ARUSHA AND BEGINNING IN LAKE
MANYARA NATIONAL PARK BEFORE ENDING THE EVENING IN
THE LAKE MANYARA HOTEL ON THE WESTERN SCARP OF THE
GREAT RIFT VALLEY
June 28, 2010
LAKE MANYARA HOTEL= 03* 23.56 S, AND 035* 59.04 E at 1193
meters, on the Western Scarp of the Great Rift Valley, overlooking the Great Rift with its Lake
Manyara filled with pelicans, flamingoes and filter feeding birds, as we have returned from the
good Game Drive through Lake Manyara National Park
LAUNCH SERENGETI SAFARI PART B ON DEPARTING MOSHI
THROUGH ARUSHA AND ARRIVAL AT LAKE MANYARA
We each left a bag checked in at the MT Inn where we will be returning to Moshi for an
overnight on Friday to launch our Part C of the Medical Mission in Tanga Province, shifting
outfitters from Shah Tours to Ilya Tours for the transfer to Tanga about as many hours east as we
have now come west to begin our safari where I had ended the last year‘s Tanzanian Safaris in
Lake Manyara.
It was almost as good on arrival this time as the last. Again, I was the big game guide,
the naturalist bird watcher, and our driver Bete only stopped the vehicle and muttered something
after I had said what I had uttered, repeating in an incomprehensible language to agree Yah, Yah.
We took off from the MT Inn saying goodbye to a few of our group which included
Marie Frances and others who would be leaving tonight, Dr. Vasa is going to a one day trip to
the Arusha National Park for a day trip. Our vehicles are heading off through Arusha where we
see the big hotel and conference center for the UN type East Africa Union meetings and the even
bigger Permanent War Crimes Council for the Rwanda Atrocities. This is where the atrocities
are being heard also for the Congo and also where the CPA (Comprehensive Peace Agreement)
ending the civil war between GOS and GOSS six years ago that did NOT bring peace to
Southern Sudan because of the cattle cultures inter-tribal wars over grazing rights and women
and rustling of each.
The whole of Arusha was hopping. Everyone was been whipped into a frenzy by a
mobile truck we got behind in its slow crawl through dense traffic as a media hype campaign
was going on at a higher pitch than a political campaign. The message was projected by the fast
talking screaming young salesmen and more saleswomen in tight chartreuse shirts labeled with
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the name of the media company. There were block long queues at every Vodacom shop and
tables set out on sidewalks completely mobbed by pedestrians all of whom seemed intent on
getting the cell phones that were being hawked. The message was clear and in an increasing
frenzy: ―All that stands between you and complete happiness is to purchase our product and
deliver us a residual income from as many as possible, and without this you are simply not
connected to the mainstream of life and are cast out from this society of those in the know.‖ For
the majority of the citizens on the street shoving push carts laden with either vegetables or
bananas or ―found parts ― for entropy industries, (reducing some other societies‘ cast off
products into smaller usable fragments for new purposes in ―bricollage‖) it is not likely that they
would have what little cash economy they could muster committed to the serving of a cell phone
contract so that they might get narcotized into dependence on the same texting mania as the
average American teenager.
We did a very slow crawl though the teaming pedestrian traffic of Arusha, where big
buildings of UN and international agencies shadowed hawkers on the street serviced by streams
of people pushing carts or carrying babies. A noticeable number of young women WITHOUT a
―bump on their back‖ meant that the fertility rate among urban African women has to be reduced
from that seen in the countryside, since the ―cost of living index‖ is much higher where they
have to service cell phones and breathe in diesel smoke and fight traffic and watch as trucks
collide. That is what we saw as we stopped to purchase several cases of water by the advice of
Bete our driver, so that we would have water in the vehicle, as an inexperienced driver in a large
lorry mistook reverse for forward low and rammed another large truck with the rending of glass
and bending of metal. He then tried to get out of that situation by again flooring it, ramming
again. As in casualties of most African environments, this turned in to an ―event‖ and a crowd of
young men began running from everywhere to kibbutz and offer observations and advice, none
of which seemed to make the situation any better.
I am adopted into the Betzer family from near Austin Texas, a coincidence from the
proximity to San Antonio, as I reported I may be visiting soon. They are celebrating at a unique
time in their life—younger son Drew just graduated from high school and is hoping to go to
Colorado State, as older son is going to Auburn and working briefly this summer in his Dad‘s
software company Covergys, which has been bought and sold several times since started. I envy
their all family adventure which included the climb of Kilimanjaro (although the wife got ill and
had to be returned to base, and Drew persevered despite having the worst headache of his life at
altitude) and then the Marathon—which would be the first race of their lives for either son. She
did the half marathon, and all but Mike got a trophy for placing in their division, such as Drew,
the ‗youngest runner.‖
The ―Double B Ranch in Blanco Texas is a place they have fifty miles from home and
about between San Antonio and Austin. Their 116 acres is named Double B since he is Bixler
and she was Buchanan ―or because we have two boys.‖ Chase is the one from Auburn and
Drew just graduated from high school going to Colorado State. They are all being here on what
2
is likely to be their last all-family vacation and the market has been good enough in this high tech
world to support a big ticket trip which has included each of them having both climbed the Kili
mountain and run their first ever marathon now on their first ever safari. At their request, the
safari Toyota Land Cruiser from Shah Tours has the family of four and Dennis and me, since it
turns out that this way they have a better private guided tour, as we are the only vehicle in which
some natural history is being explained as everyone else is also on their first safari, and the other
driver named Frank is the silent type. Our group has a good grasp of the basics from their
donkey at home (a Jerusalem donkey) and thirteen long horn Texas cattle which they will have to
sell off about half of them. They have limited pasture and a big pond and a seasonal lake on the
Double B. They are a pleasure to be with since every sighting is a first.
OUR GAME SIGHTING LOG AS I SPOT AND IDENTIFY IT
Just like last year, the first big game sightings occurred BEFORE we got into Lake
Manyara National Park, and the very first animal I had seen—possibly the same one!—was a
Bataleur Eagle on a post along the road as I was explaining the vegetation along the way. There
were coffee bushes planted in the shade of trees, and I showed the difference among the various
acacia trees, including the yellow bark acacia which grows by rivers and is said to be the ―Fever
Tree‖ since its bark has been used for elevated temperatures—for which there are a myriad of
causes here in the ―White Man‘s Grave.‖ It is also the case that the acacia is the favorite, if not
the sole source of food for the giraffes, which use that long prehensile tongue to lick the leaves
off among the thorns of the ―umbrella‖ acacia. The best of all species of tree, of course, is the
―Upside Down‖ ―Tree Where Man Was Born‖= the Baobab. There are some really magnificent
specimens as we get closer in to the Park and drive among them.
I pointed out among a number of the baobabs there were hanging hollowed logs. These
are arboreal beehives. The stylized patterns are distinctive enough that the postage stamps from
Ethiopia are a series of different indigenous beehive constructions. I could tell them about the
African hunger for sweet carbs and the co-evolution of a similar bird that has brought men to
honey for millennia for its own sake—the honey guide.
Before we get to the park, there are some other birds to be seen—the long-tailed Whydah,
the fork-tailed Durango, the Golden Weaver with its typical nest, and the red-headed weaver
with white shoulders, the Buffalo Weaver. But the sky was soon filed with vortices of yellowbilled storks riding thermals, making them the full time baby deliverers down here, before flying
off to Europe in the Lowlands nesting on summertime chimneys in the Netherlands. They have
been slacking off in their work habits, since the Netherlands is well below ZPG, but African
growth continues to explode among these populations.
And, now, the piece de resistance—we are not yet within ten kilometers of the park, and
at the road side is a pair of male elephants tearing out the bushes. I could show them the pattern
of learned behavior in which the elephants pull up the grass or bush and swat it to shake the sand
3
off from it so it does not get excessive wear on its molars. The ―loxodontia‖ are named for those
molars which define them. They grow two sets in a lifetime, and have to be careful not to wear
them down too early or they are dead from inability to eat enough to keep them alive. So, the
young learn from the old, to shake and raise the dust off their fodder. They put on quite a show
for us of just this feeding behavior, then both flapped their ears and crab-walked around us to
cross the open road, seemingly aware that they were outside the park in a territory they were
borrowing from human habitation rather than the pre-historic reversal of that pattern as it is now
artificially maintained in National Parks. I had told everyone they would get lots of photos of
elephants at close range so that they should NOT shoot all their exposures of the first elephants
they see—and then I took quite a few only because these two were close by and exhibiting the
behaviors I had described for the group in advance of actually seeing it put to practice.
We were driving along a very populated stretch under trees filled with yellow-billed stork
nests, and an occasional Marabou Stork. There were souvenir and carving shops along the way,
as could happen only along the main entrance to the Park‘s front door. As we were watching the
birds, a big commotion began in the crowds of people running along the way. Apparently one of
the other Land Cruisers had struck a pedestrian and the man was down, as the Cruiser drove off,
either unaware that he had struck the pedestrian or overly aware of that fact which could be a big
problem for an African driver in a full load of Warungu which would raise the price of the
encounter considerably. We did not see the victim, only the commotion. It was not a member of
our tour which was limited to only two vehicles, driven by Frank for them and Bete for us.
LAKE MANYARA NATIONAL PARK ENTRY AT 3:00 PM AMID
THE USUAL THIEVING BABOONS AND GREEN MONKEYS
We finally got to the park entrance where it is traditional to use the flush toilet facilities
as we are getting the permits to enter, but there is the inevitability of the souvenir shop which has
a fatal attraction for many who find it irresistible when all of Africa awaits just beyond the gate.
But it is 3:00 PM when we enter, and in most places under the African sun, you might consider
that to be the doldrums when not much happens; but as proven last year, this time of day is also
teaming with big game, at least animals big enough to have a mass to surface ratio allowing them
to shed excess heat from overhead sunlight. This is true for all but the young of the species such
as smaller giraffes, or baby elephants.
Olive baboons were everywhere in troops of alpha males staked out and yawing their
warning in display of their dentition while rapidly blinking. Females with callosities on their
buttocks were advertising their estrus, and others were giving small fry rumble seat rides or
underslung sloth-like postures. We were still under a cloud of yellow-billed storks in a large
tree-top rookery.
We saw a few more groups of elephants and a lot of impala, both in breeding herds and in
bachelor groupings, most hiding out under vegetation. We were on a drive toward the hippo
4
pools where I had last seen such a variety and number of birdlife. This time we saw zebra, lots
of hippos, a lone cape buffalo (Nyati) and a score of wildebeest which did not migrate. But,
there were a lot of bird species: pelicans, flamingoes, yellow-billed, open-billed and Marabou
storks; there were roseate spoonbills, Egyptian geese, Hammerkopf, white fronted cormorants,
and a large number of each of these species. I did NOT see as many species as I had last year, at
a more favorable time of day back then. But still it is wonderful to be here, standing next to
grunting hippos, looking over at flocks of uncounted birds and using my small binoculars to
check out cantankerous ostracized Nyati in the distance. It makes me want to get out and hunt
the Selous in the South of Tanzania on my next mission trip here.
I will simply list a series of sightings and show and tell with photography later, although
the important part is not just the seeing the game but in the behaviors I pattern in each, and
seeing relationships between species and within the species groups—such as bachelor herds of
impala rams, all with aspirations to take over the overtime job of the breeding ram in the
breeding herds who is such a busy boy keeping the ladies in line and fending off challenges that
he has no time to eat and weakens after only a short few weeks on the job and is bumped off by
the successor, who in turn notices that life is short at the top.
Roseate Spoonbill
Giraffe family grouping of eight, with necks intertwined like the carving in Derwood
Red-billed hornbill
Yellow-billed hornbill
Giant Ground hornbill—always found in lifelong mated pairs which can celebrate a
fortieth anniversary! But, although I heard the mate scratching through the bush, I only saw the
one of them in this instance.
Vervet monkeys
Big Nyati seated in grass—now there‘s trouble!
Dik-Dik—a few of the pygmy antelope in pairs
Bush buck—the furtive Tragelaphus scriptus
Elephant with babies under foot cared for by a series of aunties and grandma‘s—a crèche
of babysitters!
Impala breeding herd with the perpetually breeding spectrum of ages, and several
newborns toddling along in ungainly fashion to keep up
5
And, one brief shining instant—CHUI! I yelled as I saw the cat drop from a ―bait tree‖
along a watercourse, but it was gone by the time we stopped. The leopard is a rare diurnal
sighting, so the others were not sure I was not just making this up.
THE ELEGANT LUXURY OF THE LAKE MANYARA SAFARI
HOTEL PERCHED ON THE WESTERN RIM OF THE GREAT RIFT
We drove up the western scarp of the Great Rift Valley—a cleavage plane in the earth- to
get to our elegant hotel driving through a slummy collection of subsistence huts, and a few
souvenir shacks to enter a gate beyond which is a manicured lawn, a swimming pool and
flowering Frangy Pany and Bougainvillea –is this still on the same planet as the rutted road just
left where the majority of the planet‘s people happen to be? Oh, that‘s right! I forgot! Hey are
not paying $2500 for a five day safari, so we are the ones to expect this and the souvenir
salesmen back there just have to sell a lot more carvings before they can enter the gate and
purchase a few minutes of our pre-paid days.
Here is where we are: Lake Manyara Safari Hotel= 03* 23.56 S, 035* 49.04 E at 1193
meters at the rim of the Western Scarp of the Great Rift
It is elegant, and might easily be able to convince those who did not just drive down that
rutted road that we are no longer in Africa, or at least any REAL Africa. Personal robes and hair
dryers and flowers with graceful mosquito netted canopy beds are the tenor of the day. And we
will be immediately seated among the oriental and African antiques for a sumptuous dinner.
You are not in Kansas anymore. Where you are is in a place where no destitute people are
allowed to enter, but worse thieving life is. As a warning, with baboons frisking all over the
place, I had made the pause on the deck to take the GPS mark, and closed the door behind me.
Dennis forgot, of course, and left the door open as he went to dinner. As I came back, I spotted
two baboons in our room, one tearing off the packets of coffee creamer from our complimentary
coffee bar. I shouted and shooed one of them out, but did not notice anything unusual with him
and only the mess left behind.
What Dennis discovered in the morning is that he had been robbed. Part of his large
quantity of gear which he unpacks and repacks at each stop had been gone through and a shiny
radio-frequency remote controlled Microsoft cordless mouse had been snatched away. But the
baboon (the dull primate!) had not taken the wireless antenna from the computer, so the cordless
mouse will be useless to him to carry home to his inamorata as a trophy!
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10-JUN-C-3
A SUPERB DAY BEGINS WITH BREAKFAST IN THE ELEGANT LAKE
MANYARA HOTEL WITH DENNIS LEAVING VERANDA DOOR OPEN
AND A BABOON STEALING HIS MICROSOFT WIRELESS MOUSE;
THEN A LONG DUSTY DRIVE THROUGH NGORONGORO CRATER
ENTRANCE TO THE FLAT DRY PLAIN ENTERING SERENGETI FOR
VIEWS OF GAZELLES, BIRDS, ELEPHANTS, NYATI, GIRAFFES, AND
THEN CHEETAH, LEOPARD AND LION BEFORE SETTLING IN AT
THE SERENGETI GAME HOTEL FOR DINNER AND A TWO NIGHT
STAY
June 29, 2010
I am now checked into the Serengeti Lodge at a series of rocky outcrops ―Kopjes‖ to
borrow the Afrikaans name as I mark it at the following location:
SEREN= 02* 26.93 S and 039& 58.37 E at 1503 meters altitude.
It is in the dry season here as the rains have already begun in Kenya so that the majority
of the three migratory groups of hoofed stock have already left to go north to cross the Mara
River and its waiting phalanxes of crocodiles and run the gauntlet of the lions and other
carnivores awaiting their turn at this movable feast. They migrate with the three principle
grazers numbering in the combined millions—wildebeest, zebras, and Grant’s gazelles.
We had left the Lake Manyara Safari Lodge as I had described, with Dennis looking for
his cordless mouse for his computer, stolen by the baboons that had come in through the open
door he had left for them as opportunists. We had an elegant breakfast at which I sat with a
couple from the other vehicle and had learned that they were appropriately uncomfortable in
luxuriating in the elegance of our hotel after having just come down the rutted road and seen how
the ―Majority half‖ of the world lives. Never having been in Africa or anywhere really
impoverished, the man had asked me repeated questions about how such economic disparity
could exist in an open world? He wanted to hear some hope for Africa that was emerging from
some further back starting point, but we are all on the same trajectory in forward progress. Alas,
I have been in Africa far too long to give anyone that Pollyanna prescription that it is getting
better every day in every way, and some is in entropic collapse. The trip into the hotel was even
more eye-opening for them than was the Game Drive though the Big Game, which could
1
presumably be done in San Diego’s drive through Zoo or in a stocked park of wildlife—but how
do these people out there subsist? I turned from naturalist to anthropologic economist again, and
talked about the constraints of these poor people and the limits on what they can hope for from
any trickling down—our drivers don’t even stay in this compound!
I was up and out before dawn having stopped only to identify my Mallarone pills by feel
for the malaria prophylaxis. We were led as gullible lambs into a carving shop to be shown the
wares of the locals with one of them assigned to dog the steps of the prospective purchaser as
each carried a basket to make for a ―Good Price‖ in a quantity deal. I rather dislike someone
insisting that I purchase something I definitely do not want so they lower the price to see if that
of course will make me suddenly start wanting it. There is but one answer and that is the one I
am pre-programmed to accept since it is to my advantage. The dedicated shoppers of the tour
were in heaven as they reviewed the large number of oh-so wonderful mass produced items,
many of which have come from China
We are going to go through the same Gate at Ngorongoro Crater entry that we had used
last year where the baboons had become so invasive of our prior vehicles, at this site I again
punched in the mark= NGORO= 03* 16.41 S and 035* 35.16 E at 2,125 meters. We stood at
the crater overlook site where we had been before last year, and as last year, we could see herds
of wildebeest and a few cape buffalos at a long distance below on the Crater floor through the
binoculars. Then there were herds of wildebeest and zebras on the run as Masai had actually
penetrated down to the crater to water their stock, a special dispensation due to drought
circumstances, I was told.
We drove on past the Crater to enter a valley you may recognize by name. It is ―Olduvai
Gorge‖. This is the early hominid site where fossils of the earliest of a large number of primates
were scavenged at this site on the Rift. This is the place where ―Lucy‖ and other several million
year old specimens have started their influence on the thought of human origins.
We came by a Masaai Village (remember this is the Masaai Conservation Area, not the
Park where they allegedly are not allowed to run their cattle to graze and water to avoid the
rinderpest epidemic repeat and the starving of the wild game by the over grazing of the
domesticated stock. We looked over and saw a group of seated giraffes in the tall grass. They
looked like an image of the Loch Ness Monster or a Joshua Tree forest, with ungainly heads
sticking up on long necks as they ruminated—that is a long round trip for their rumen in their
abdomen passing all the way up and back down again.--still only seven cervical vertebrae.
THE LISTING OF THE SIGHTINGS AS WE ENTER OUR
SERENGETI HIGHLIGHT OF THE SAFARI AS THE BEXTERS MAKE
PLANS FOR A PRE-DAWN BALLOON RIDE ACROSS THE SERENGETI
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The simple listing of our sightings will be used again for economy sake in the words of
the habitat and relationship being left for those requested. We spotted secretary birds and
watched as they stalked away in search of lizards and other morsels.
Secretary birds.
Grant’s gazelles—larger than Tommies, and they are the ones which should be the
second largest number of migrating herbivores to be going north to the Masaai Mara to seek out
the fresh grass in pursuit of the rains.
Masaai Ostriches, males and females.
Thompson’s gazelles—the tommies have the black side stripes, and do NOT migrate.
Lord Derby’s eland, the largest of the antelope in Africa, domesticatable, often primed
with hormones to get into estrus to implant a fertilized in vitro endangered species like the
Okapi—used therefore as a ―host uterus‖ –a useful big beast!
The Serengeti itself is an 18,000 km2 plain with lots of outcroppings of rocks—the
Kopjes. Right now it is a dry dessert, but it is raining in Kenya across the Mara River in the
contiguous National Park I had visited several items before the Masai Mara—where the 1 ½
million hoofed stock have wandered in search of new grass—but not too much grass to give
cover to the carnivores which stalk them in tall grass.
We spotted several Cori Bustards a running ground bird, often in pairs.
Glossy starlings by the score around water gleaning tourists’ droppings from lunch boxes.
A pair of cheetahs; they were seated and scanning the horizon, but then walked up wind
toward a group of Tommies and we lost track of them as they were on their way to try to feed
their young. I showed anyone who asked the brief video clip I have of a cheetah in pursuit of
and catching an impala in the Masai Mara.
We passed Simba Kopje, a place where lion prides frequently hang out, but today they
are on the prowl northern in direction having followed the prey species as it wanders towards the
rains.
We are on the prowl ourselves, as the land cruisers spread out to follow leads; our
afternoon Game Drive picks up the trails and makes the following spotting:
Buffalo weaver birds
Small mongoose, possibly a meerkat in the mongoose family
Rock Hyrax, an improbable colony forming relative of the elephant
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Cheetah
Then—a must see for everyone—a leopard in a tree crotch drowsing away the afternoon
heat in a ―bait tree.‖ Everyone came to a screeching halt and a lot of photos were taken of this
cat. We tried different angle on it, As everyone was shooting photos, almost unnoticed,
A collared lioness came stalking though the grass. She was obviously hungry and was
making a daylight scouting trip to see if she could get close to the zebra herd approaching from
the other side of the Leopard in the tree. At one point I could shoot them both in the same
frame. I then did not further follow the lioness, As our other Shah Tours cruiser went to stare at
her in an uneventful wait, she suddenly sp[rang form the grass and brought down a zebra, out of
our sight! This is a rare day time successful stalk.
Wattled Plover
Large euphorbia, known as the candelabra tree.
Hartebeest, ―Kongoni‖ in Ki-Swahili
Zebras, Burchell’s
Wart hogs
Baboons—no friend to the leopard. The leopard nearly always solo and stealthy, the
baboons almost always in large mobs not afraid to attack the arch enemy leopard.
SERENGETI LODGE: OUR ELEGANT HOME BASE AMONG THE
ROCKY KOPJES FOR TWO NIGHTS
Our stop at the elegant hotel lodge built into the rocky kopje and blended with it is the
Serengeti Lodge; Serengeti lodge= 02* 26.93 S and 034* 48.37 E and 1503 meters altitude
On the porch railing of my room I look out as a vervet monkey is trying to get in having
seen me emerge for long enough to mark the GPS setting. I uploaded all the photos I could after
orienting them to right side up, and re-charged the batters and went to the dinner at the elegant
bar and dining room overlooking the Serengeti from the elevated Kopje. It is good to be here, as
I always knew I would be, and I am glad to be doing a non-stop tutorial on the natural history of
the Serengeti even if I envy that fact that I am doing it to other people’s kids when I would be
happy to be doing it to my own.
Dennis went in search of an email source and despite the wireless signal seen on the
laptop, there have been NO internet accesses wherever I have traveled so far through Parts I and
II of this wonderful Tanzanian expedition. In a way, that is quite liberating. I watched the
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sunset over the dry grass lands, and plan to watch the same sun rise over the large hippo lake
nearby as a few yips and howls are starting to come from hyenas around my room.
5
10-JUN-C-4
A FULL DAY IN THE SERENGETI, WITH AN EARLY MORNING GAME
DRIVE AS THE BETZER FAMILY GOES OFF ON A HOT AIR
BALLOON RIDE AT DAWN, AND DENNIS AND I SEE A VARIETY OF
LIONESSES STALKING GAZELLES AND ZEBRAS, THEN A PICK UP
AT THE INTERPRETIVE TRAIL AROUND THE FRANKFURT ZOO’S
CONSERVATION CENTER FOR THEIR RETURN FROM THEIR
CHAMPAGNE BRUNCH, AND A CONTINUATION, SEEING
CROCODILE AND AGAIN WATCHING UNSUCCESSFUL STALKING
BY LIONESSES, A CHEETAH SURVEYING A NERVOUS GAZELLE
HERD, AND A RETURN FOR A SUMPTUOUS LUNCH; THE EVENING
GAME DRIVE SEEING AN AFRICAN FISH EAGLE, A HUGE HIPPO
“CESS POOL” HYENAS AND SUNSET BEFORE DINNER WITH OUR
GROUP
June 30, 2010
Just superb! I am where I have always wanted to be and doing what it is that I have
wanted to do. Of course, I have been on safaris past counting and even have led most of them.
Moreover, I have gone with some very real experts, not in being driven through an open air zoo
in a pop-up minivan or safari 4WD, but on foot through swamps and armed in pursuit of
creatures that are very well equipped and disposed to turn the tables and hunt down the hunters.
These expert guides of mine were not necessarily licensed by the local ―Tourism and
Wildlife Board‖ ( I have always enjoyed the names of the majority of such agencies in official
governmental bureaucracies in most African nations with any number of wildlife not yet eaten—
as though the entire purpose and reason for being of the wild life scenes and environments is to
attract foreign currency in the form of aluminum packages of first worlders to come and shoot
photos through bus windows of the fauna in a checklist of required sightings, now abbreviated
down to the names of the ―Big Five.‖) My experts lived by their wits and carried a spear and
knew more about the ecology of the species they hunted and its interactions with them, the
environment and other animals out there than most PhD zoologists. We often spent several days
and nights together exchanging up to about ten words in a vocabulary three steps removed from
the languages we each felt most comfortable in, but a lot of information came from the knowing
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nod or the simultaneous recognition of the situation we were in shared with the beasts and habitat
around us, in which we were frequently the one species at greatest disadvantage.
We were each to this manor born. And now I can explain what I have known through the
help of people who have never been in school to first world others who can buy and sell whole
villages here of the locals for less than they have spent on entertainment in the past month. So, I
am a naturalist ―interpreter‖ reversing the information flow from those who have seen it only live
and those who got the edited or simulated versions through documentaries on Discovery Channel
or NGS.
INTO AFRICA
I am up on top of the kopjes in the cold morning fog, listening to hippos grunt and hyenas
cackling at dawn. I have my jacket zipped up in the same place where the equatorial sun will
burn us all into scrub tops before another two hours exposure, ―under the African sun.‖ The
Betzers had left at 5:00 AM, all four of the family members eagerly going for their first balloon
ride, and these are not small. The gondola is a divided basket of sixteen seats or more, so that
cold air I was enjoying on top of the desert kopjes makes for a powerful lift as the burning of
propane sends them aloft in a large group. My motto taken from a bumper sticker when I had
gone with my son Michael on ―Serenity‖ a neighbor’s balloon over the bucolic countryside of
rural Maryland, soaring over owls’ nests and deer which scattered when they heard the propane
whoosh, but never looked up since they have no natural predators form above—until ―the sun
went down‖ as the balloon shadow crossed them—―Propane and Champagne—Breakfast of
Balloonists!‖
And they would have it all, including the soaring over herds of animals and seeing dawn
predators from above----expensive, but worth it, right through the luxury deluxe breakfast that
made them tipsy with the champagne brunch. This is like the luxury brunch I had in the
Zambian Bush along the South Luangwa River after a Malawi Mission three Malawi trips ago,
where a table is set out for you in the shaded bush with liveried servants and linen and a braai
and an always full glass---after all, this is no more than we European Colonialists should expect.
If I had a son and at least one grandchild here, I, too, would have sprung for this ―once-in-alifetime‖ experience in a highly appropriate place—the Serengeti---where else?
I had seen the first balloon take off, and it is huge. It is so big, it is hard to believe it can
lift than much weight, but then it is soaring very low, over the acacia tree tops, scraping a few to
slow itself down. As I had photographed them at dawn while the second one was launched doing
a ―hare and hounds‖ chase, I saw a group of giraffe galloping in their simple harmonic motion
pattern, fleeing not the balloon, but the schwooshing of the fired propane as the pilot skillfully
tried to keep from touchdown right behind them. As these pilots are flying these everyday in the
low wind conditions, they are skilled navigators, and can select the altitude at which the air
currents are going in opposite directions. They targeted the Serengeti Safari lodge on its Kopje
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to soar right by the dining room windows so that they could see and be seen by those at breakfast
with a buffet selection in one hand a camera I the other. Great scene! We heard later about there
lion sightings and their other reactions to the thrill of balloon flight over such a setting, and I said
I would do it too—as a very special occasion—since there is no honeymoon eminent, perhaps a
grandchild’s graduation present.
But that left me and Dennis, with Bête our driver, and he asked what we would like. I
said as early as possible, I was eager to be out after dawn in the bewitching hour of prowling
predators and we would catch the Betzers as they came later to the center where we had stopped
yesterday (an exhibit sponsored by the Frankfurt Zoo on the Serengeti—once again, remember
that Tanzania was once German East Africa’s prize colony!) for them to pre-pay the hefty
charges for the experience, that they would report was well worth it. So, with proper precautions
to Dennis to secure the room and its windows so we did not lose any more shiny equipment to
primate predators, we walked through the clusters of lazy fat rock hyrax which were already
spreading out on the walkways to thermoregulate by soaking in as much as possible of the rising
sun.
DAWN GAME DRIVE FOR JUST TWO OF US PHOTOGRAPHERS
AMID PROWLING LIONESSES
Our early Game Drive was rich with lionesses on the prowl. We had good parting shots
of the balloon chase as we left the lodge and could frame the rising sun between the large
Montgolfier envelopes---the parachute-plugged hot air cylinder that gives the gondola its lift.
(The champagne is a tradition, since any descent is a breaking and entering of the ―close‖ and the
Montgolfier brothers were set upon by French peasant famers who attacked them worth
pitchforks as aliens from outer space—to convince them they were one of them, they protested
―No, we are Frenchmen, like you, here is proof!‖ and they popped a champagne cork, beginning
the tradition of the balloon always carrying a champagne vintage to gift to the landowner upon
whom it has intruded in descent.)
I looked out to see a large herd of cape buffalo, and saw a scattering of Tommies which
seemed to be the principal foodstock for the carnivores just now with the majority of the 1)
wildebeest, (brindled), 2) zebras (Burchell’s) and gazelles (Grant’s)—in that order of the
frequency distribution of the migrating hoofed stock now heading into Masai Mara searching for
the new grass as the rains have already started up there. That number is not small—it totals well
over 1 ½ million migrating herbivores. Along with them would go the big carnivores—
especially large lion prides and the big lion males, hyenas, Cape Hunting Dogs. Those that
would remain are the carnivores that can take on and be satisfied with the non-migrating
antelope of the size of Thompson’s gazelles, and the odd herd of zebra and lost-in-transit
wildebeest---which are too young or old or weakened—which means they are dead meat and
easy pickings for the smaller cats like Cheetah, serval cats and lion cubs.
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Almost on command, after having expressed this ―non survival of the non fittest‖
I spotted lion cubs. One of our other parties had seen a lion cub and had said how sad it was to
spot an ―orphan‖ and that she wanted to pick it up and care for it. Right! Like she was going to
hop out of the Land Cruiser and run down a zebra herd at the water hole and haul a 4oo kg
carcass back to be dismembered by the snarling grateful cub! If a lion cub is out here, I know
well it is not alone, and that there is a very capable and also extremely motivated hungry lioness
somewhere closer than I can see, and a very lot closer than I can smell or hear!
And, sure enough, there she was. She was stalking through the grass. She was
occasionally making a low growling sound, which meant she was not so much on the stalk as she
was re-assuring her cubs out of sight where it is that she was, and that she would be back after
she had business to attend to to get them breakfast about which they had been mewing before she
left them. I spotted a cluster of kits in the upturned roots of a tree that had been bulldozed over
by elephants. They were frolicking with few cares in the world, since they would telescope their
heads above the grass and swivel to follow the low purring sounds of the lioness as she was
slipping through the grass with only the tops of her ears being seen. There were two of them,
sisters, likely, and they seemed to know of a third. We had swiveled all around the grassy area
looking first at the cubs and then following the slowly moving pair through the long grass, and
returning to the cubs, before we spotted what the ―third‖ presence was.
As regal as possible, there, spread out on a dead fallen tree turning to a smooth barkless
log, perched a lioness with head up. In alert pose, she was looking in the direction the two
lionesses had gone, as they had stopped in the shade of a lone tree adjacent to a dried up stream
bed, which would probably fill to a meter wide in the later rains. Those rains should be moving
down here (at 2* S ) next month as the earth tilts back from the summer solstice in reversing the
migration of the hoofed stock from Masai Mara in Kenya 375 km north. In reality, of course, the
rains do not move. The ―Inter-Tropic Depression‖ stays steady in the earth’s atmosphere, and it
is we, on the earth, that are moving under it in the wobble of the globe that creates four seasons
where you live and only two here—wet and dry, long and short.
Now those rains and those grasses are important—a ―necessary evil.‖ How necessary
they are is apparent when they aren’t here; how evil they are when the exuberant growth fueled
by the torrential downpours that will be coming to the Serengeti next month cause the grass to
grow ―as high as an elephant’s eye.‖ The tall elephant grass might be abundant for grazers, but
this is too much of a good thing, since if it can swallow an elephant from view, just imagine
what other more dangerous game is slinking along in the cover of the tall grass? [―Death in the
Tall Grass‖ by Capstack, Peter.]
So, that explains what we are seeing this morning. The lionesses are using the tall grass
as cover to stalk the Tommies. The Tommies would not be the normal bill of fare for a cat the
size of a lioness—which is going to kill and eat and gorge about every five days, so it would
require something to satisfy more than an individual, and they hunt in prides which grudgingly
4
share the kill almost every time, so the kill should be of zebra, wildebeest, or even Cap Buffalo
size for a lion’s group satisfaction, with leftovers galore for the hangers on—hyenas, jackals, and
vultures, in that order before the dung beetles come in lower on the food chain to roll away what
is left.
The tommies seem to know this too. They are not the preferred lion bill of fare,
although they are on top of the list for cheetahs. A cheetah Mama must hunt often for several
reasons. She is a daytime killer, and as a sprinter is unexcelled. But she is almost always
hunting to supply a pack of kits. So she must kill frequently. Every day is a close call. She
must get very close without being seen or scented, and then does her blinding speed rush with the
traction provided by the little factoid that she is the ONLY cat in the world with non-retractable
claws. The long supple spine coils and releases elastic energy, and the ―Cheetah Leg‖ is now a
patented aid for amputee sprinters—giving a long springy ―lever arm‖ for high acceleration—
like the atl-atl throwing stick.
That item of mechanical advantage is on display even more prominently in the ―spearing
birds‖ like the Great Blue Heron in my Rock Creek back yard A close photo is my laptop screen
saver) or the grey-necked heron here which occupies the same ecologic niche. They have a C2
on C3 dislocation of the cervical spine which serves as the ―atl atl throwing stick‖ for rapid
trajectory in the thrust of the beak.
Now, another odd factoid. She cannot kill a standing antelope that is perfectly composed
and unalarmed. She has a body mass not larger than the prey she seeks, so she needs help. The
best help comes from the very prey she is attacking. Her blinding speed is a rush designed to
induce panic and a headlong rush from the prey put into maxim mum flight with the intent being
to have the antelope help kill itself by its own headlong plunge into Vmax, and a tumble that
might kill or injure itself by a broken neck or leg that she will certainly try to help along by a
swipe of the non-retractable claws to trip up and tumble. Then as soon as the prey is ―off its
feet‖ lunge for the neck and clench the teeth on the airway while the cheetah’s own nostrils are
flared, sucking in the air hunger from the short sprint.
She has incomparable acceleration speed, but she is a light bodied cat, and must stop to
breathe hard after the chase, and clamping down on the trachea of the prey while breathing,
guard herself. She is a target of opportunity for almost all other predators who hunt as a pack—
mostly hyenas and hunting dogs and vultures, so she is very often stripped of her kill. The video
I have got of a cheetah catching and killing an impala on the second try of a bounding wind
sprint shows her clamped on the airway as the impala kicks its last gasp. But that brief interval
also alerted every other easy pickings hunter or scavenger n the area and the alert brought in a
pair of hyenas which easily snatched the kill from the defenseless cheetah. A high-speed killer
is not the ideal design against a combined team of long distance marathoners. I’m still here!
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So, the Thompson’s gazelles (remember, they are residents and did NOT migrate to
follow the rains unlike their slightly bigger cousins, the Grant’s gazelles) are healthy on the
shorter dry grasses, and prefer the vegetation to be ―just about knee high‖ since any other length
gives cover to the approaching high speed predators they had evolved against to survive as a
species. So since they grew up under the adaptation pressure of cheetahood, they are rather well
adapted to keep to grasses that do not cover a cheetah’s approach—and here are three lionesses
looking to disappear in the same grasses.
The smaller creek bottom had produced grasses almost a meter high when the rainy
season was here a few months back, and the gazelles had shunned this apparent luxurious feast to
move into a large open park-like space with sparse grasses which they nibbled, as the herd was
spread out in a way such that nervous eyes and noses were covering the 360* perimeter outside
the rushing range. But, since the grass was sparse, they had to drift along to keep feeding and
still be in transparent grassland. As they drifted, the lionesses were stalking along the dry stream
bed bottom, hoping for a siesta break within the rushing range. The lone lioness on the log in her
regal perch figured this drill as well, and hopped on down, to get ahead of her sisters as they
were moving down the dry creek bed, hoping she might hunker in the edges of the sparse grass
as the drift of the two lionesses of which the tommies were well aware as they were downwind
would push the outer edge of the herd over her stakeout.
We had spent time watching the play develop, as we had also gone back and forth to the
mewing cubs, which had turned silent when the lionesses were out of sight. No sense in calling
for trouble since other predators are out there for which a lion cub is a morsel of about the right
size, and one of those I had seen in a vengeful status last evening as we came in to the Lodge, a
hyena loping sideways with a left rear leg shattered by getting too close to a lion not quite
drowsy enough to steal from. Turnaround is everywhere fair play out here.
Lions do not eat hyenas, but kill them regularly to decrease the competition from other
carnivores. Hyenas have no such dietary scruples and eat hungrily any thing they can clamp
their powerful jaws on—such as lion cubs or leftover skulls which they can crush to get marrow.
This is one way I identify hyena scat; it is frequently white from the ground-up bones that have
passed through as they are trying to suck out the fatty marrow and whatever other sustenance
they can derive from the scavenged kills. Life is good for the second order scavenger close to
those who kill—just check to see how many lawyers are out here as they can afford the hot air
balloon rides on a safari I am postponing!
CRUISING AROUND AFTER CLOSE OBSERVATION OF A
SCATTERED LION PRIDE, TO PICK UP THE BETZERS ON THEIR
LATE RETURN FROM THE BALLOON RIDE AS I LOOK OVER THE
EXHIBIT BY THE FRANKFURT ZOO
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I spotted Topi! The last time I saw topi was in the early morning runs at Werkok when I
was running through the dawn and encountered a large herd I had photographed in the dim light.
I figured I could get one, and was told it would be an ideal hunt; but just now, the biggest
predator population out there at that moment were packing AK-47’s, both Murle and Dinka; so
we gave the Topi hunt a miss, even though I was in easy (photographic) range of a large herd
with excellent specimens in it in Sudan. Here I got close to the beautifully colored topi for the
first time since I had done so with Michael who had accompanied me on the Masai Mara safari.
I saw hippos already submerged in their pool as we came around a third time to follow
the lionesses, and spotted the lion cubs, now hunkered down low in the upturned roots since they
had no longer heard the growling signals of the parental honing mechanism. As we had watched,
other vehicles saw that we were on to something and came around to see the crouching lions and
await some action. The only action we saw was the pair of lionesses walking right across the
road between vehicles, apparently having given up on the stalk of the tommies too open to be
rushed and therefore the ambush strategy of the third lioness was not going to be successful
either. It seemed to me the lionesses on the road were using the ―diesel scent cover‖ of the long
queue of Land Cruisers to shield their downwind approach.
We were pulling out of our little lion haven to start towards the site where the Betzers
would be brought back after their balloon ride, but unknown to us, they were late since they had
had a late start and an incident at takeoff in which the gondola tipped and was on its side shaking
up a grandmother and granddaughter on a false start; so they had re-grouped and started again. I
recalled from last night Peter Barbera from Rhode island and his wife Betsy who had come here
to run the marathon to get into the Seven Continents Club and was asking me about the Antarctic
and other marathons when I suggested we do Easter island as our ―South American entry‖ for
him; the Betzers had agree to consider this as well.
Peter is an interesting fellow runner since I discovered that he is a commercial fisherman
off the Atlantic Georges Banks and closer in, and has had some difficult times due to fishing
regulations and the price of diesel fuel in his aging boats which are under regulatory pressure to
upgrade or replace. We talked of the politics of fish and also his running club in a small town, in
which he said he is a middle of the pack of the fifty year olds, and nearly all have done Boston
and continue to qualify for it. Betsy’s sister—if you can believe this coincidence,-- is a volunteer
in St. Mary’s Court feeding homeless people in DC and they had received a gift of a large
custom Viking Refrigerator/Freezer that had fallen over in a Maryland home!—Once again,
there can be no ―coincidences‖ in life!
I had walked back from the dinner and nearly tripped over the rock hyrax which are
lounging all over the decks, and then spotted a large scarab beetle which I had tried to take a
macro photo of—there will be some interesting fauna and flora on the small side as well as the
―big game‖ end of the spectrum. One was a ―squirrel‖ scampering away before I had realized
that it was one of the mongoose species here. There had been a project here run by someone,
7
presumably the Frankfurt zoo, in which ten lionesses were collared, and just by coincidence, I
have seen and photographed two of the ten. The others may be presumably up north following
the herd, picking off those injured in the journey; but those wildebeest, Grant’s gazelles, and
zebras who have stayed behind have presumably done so for a reason, possibly bloody
independent-mindedness, or else they had lost their way and had not been able to keep up with
the social pressures of the ―Joneses going North for the season‖ and are left behind. They will be
either the easiest of the pickings or the tough mavericks that are taking their chances on lesser
fodder with lesser competition and a separate strategy to beat the odds of survival, stacked
against any single individual in this crucible of the selection of factors for an advantage—
perhaps our own additive pressures will mean that a new breed of carnivore may exude the odor
of diesel exhaust.
A “LIST” OF THE KIND THAT I URGE MY FELLOW SAFARI
MEMEBERS OF THE “WE WANNA SEE THE BIG FIVE” PERSUASION
NOT TO MAKE!
My route over to the pick up point spotted along the way:
Francolin (called ―pheasant‖ here, and are a tasty game bird, to which I can attest in my
South African hunts.)
Wattled Plovers, nearly always in pairs along watercourses
Egyptian geese
Grey-necked herons, posing magnificently in the same niche as occupied by the Great
Blue heron in Derwood as is evident in Rock Creek park behind my house and is preserved as
my screensaver on my laptop.
There are bush hyrax here as well as rock hyrax. They are NOT rodents although they
resemble them, and live in the clefts of the kopjes and can scramble in and around trees. If you
can believe—perhaps from staring at their stubby little prehensile noses—they are the elephants’
closest relative! They are very social and have very little man fear—instead, they have to worry
about snake eagles and marsh harriers which pluck them of the kopjes without apparent effort.
They have ―latrines‖ which they use as designated ―middens‖ rather like the impala herds do, to
concentrate the spoor and make it harder to follow the individuals. The pellets that have passed
in latrines have been collected, and for reasons certainly unknown to me, have been used as pills
that are said to be anti-epileptic. Yeah, Right!
I went around a labeled tour of a kopje at the balloon passenger pick-up site with exhibits
supplied by the Frankfurt Zoological Society and a number of the early German zoologists were
featured as they did animal counts from a zebra-striped single engine aircraft. It seems there was
a low point when the million plus wildebeest herd went down to a count of 85,000 due to a
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rinderpest epidemic, but the wildlife have evolved to tolerate it now, along with vaccine
development for domesticated stock, with wariness about the transfer between them. There were
excellent videos at a projector in the exhibit which I discovered only after an hour and a half wait
for the Betzers who had finally come in, and we joined to drive out after they all had a happy
buzz on return—half from the balloon ride and half from the champagne brunch!
As we drove back the same direction we had been in our lion chase alone, we saw that
the gazelles had again moved as a mass to a still thinner patch of grass, and a majority of them
were lying down as the heat of the day rose but there were sentries on each corner of the herd
with the lionesses’ scent still in the direction that they had retreated. It was just after that we
stopped by a tree and looked hard into the crotch of the tree to discover a leopard. The Chui was
not on alert, and actually seemed to be drowsing, which I have usually seen them do by swaying
back and forth in still higher branches, using the ―bait tree’s‖ lower boughs for ambush lookouts
on passing herbivores.
Next was a cheetah sitting in the long grass and looking over the top of the grass ripples,
at distant gazelles which—no fools they—were crouched in an area that looked like they had
first taken a lawn mower to it.
As we drove further, we saw we had indeed missed some action this morning. The
Betzers had yet to see a Male Lion—of the MGM special variety. There under a tree was the
monarch sitting up and blinking slowly against the flies buzzing his eyes, no doubt attracted by
the juices still rivuleting his face from a gory kill somewhere nearby. It was soon joined by a
second male which was slowly lolling its way along, passing gazelles which were no more
alarmed about his presence than I, since, after all, we could both see its full and bulging belly.
This King of Beasts was only looking for the Queen sized TempurPedic mattress that I had just
put on order to give him a comfortable spot to veg out in a food coma.
I saw a nearly comical ―Pile of Wart Hogs‖ looking like the melted ring of hairy flesh
encircling the base of the tree in what was (only in my youth) called ―Little Black Sambo.‖ They
were in the open sun-scorched Serengeti with a single tree and a bit of shade, so they sought it
out and took advantage of it several layers deep, to drowse away the overhead sun in the
scorching part of the day. The Polish journalist who had written the classic ―Under the African
Sun‖ had de-romanticized this sun, which most animals and Africans view as an overhead curse
to be avoided. Only ―mad dogs and Englishmen‖ come rushing out when anything with any
sense has retreated from the scorching radiation.
That included us. We were on a retreat from the sun, with the Betzers eager to sleep off
their early rising, and the champagne brunch as well as the noonday sun, so we went back to the
Lodge to soak in A/C and a big lunch. I determined from each of the quotes I heard from all
those who have never been to Africa nor ever been on safari, that I should see the Lion King with
the grandkids, and another named ―Where the Wild Things Are.‖ I need to go to movies to see
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the real Africa and not spend so much time in the bush tracking the big game and immersed in
the tropical African ecosystem!
THE EVENING GAME DRIVE AND IMMERSION IN THE SMELLS IF
NOT THE MURKY WATERS OF THE BODY-CLOGGED ―HIPPO CESS
POOL‖
I did NOT nap, since I had all I could do to recharge camera batteries and quickly upload
all the re-oriented photos (turning them correct side up before storing them on my laptop.) But,
still, I was ready before all others were, and primed for the 3:00 PM departure of the ―Land
Crusher‖ as Drew had called his vehicle back home in Blanco Texas.
We packed off and almost immediately came upon still stalking lions. It is a full time job
for hungry lions, whereas they can take the rest of the next few days off if and when they kill and
get a nourishing bellyful so they can lie around in ungainly poses—the kinds usually captured by
tourists from the poptop of the vehicle, as the comatose lions have nothing to do but digest for a
few days before they prowl again.
The success rate of a lion charge is high at night, which is why most animals are NOT
on the move, nor do they water at night in a likely ambuscade by night, except under unusual
meteorologic conditions, like a full moon. Their wide angle low light intensity, rods-only eyes
are adapted to the dim light of dawn and dusk, while the predators have a central cone of light
perception which included (in the case of the cats) a ―slit‖ of cones distributed for added depth
perception by color variation from shadow. One does not hunt lions in ―blaze orange camo‖ as
we do all the time in dealing with the herbivores like browsing deer. The carnivores have frontal
eyes for binocular vision again for depth perception, and they can ―yoke‖ in conjugate gaze for
accurate targeting.
To neutralize this ocular predator advantage, the herbivore has wide set eyes with a very
large field of view except right over their rump, and they do not need to know depth perception
but only to bolt for cover under the recognition of two items: threat outline, or motion. Added to
their early warning senses given by hearing and scent out of sight range, they also have the added
advantage of scent signals from tarsal glands or lower leg secretions which, like the ones that are
peri-anal in those animals that ―Flag‖ with the tail upright, squirts out a scent marker ―hatari‖ (in
Ki-Swahili) or ―Quidado‖ (in Espanol) or ―Danger- Look Out!‖ for a signal for others to seek
cover.
These lions are still hunting after a scoreless morning, but they have cubs to feed.
Daylight lion charges are successful less than ten percent of the time. If a lion connects with
you, you have very little chance of escaping the encounter—but you are forewarned since he
comes after you with a roar and you can make evasive efforts. A leopard is not so: it is silent and
stealthy and may just drop on you from a ―bait tree‖ ambush and it has a high percentage of
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connecting with you. But, it may still be possible to survive that hit, since the leopard is a
smaller cat than the lion and the hit is not instantly lethal as it often is with one swipe of a lion’s
paw. A fight with a lion is not very useful, but there is some chance that one can get away from
a contest with a leopard. But for its size, the leopard’s power is evident in that it jumps up trees
carrying its prey, which might outweigh it several fold. But it does this only if there are any
other predators around which might compete with it. That is why leopards are no friend to
baboons which are in packs, or hyenas, often the same. With competing predators nearby, the
leopard’s prey will be hanging in a tree before it stops kicking or dripping.
We saw where one of the lionesses had passed through the tall grass even though we
never saw the cat. There were a group of zebras standing stock still and alert at a waterhole they
had not entered. Abruptly they bolted---all at once, but hardly in unison. That is the point!
Their striped coats are a defense against that binocular color vision I had just said gave the big
carnivore such an advantage in determining just when and at what point to leap and pin the pinpointed target. Now, the ―TV Vertical Adjustment‖ has gone haywire, and scattering zig zag
lines lose all depth perception.
The zebra has one more final agonal defense if the lion DOES make contact despite the
fuzzy targeting diversion—one backward kick, savage as a mule’s. If the lioness is kicked in the
jaw—that does not mean a toothache. That is lethal. A cracked canine means that lion never
hunts again and starves. For that reason the lioness cannot just get up topside and take a ride, but
has to lunge up through and grab the throat with her jaws—another pin-point target objective
confused by the mad stampeding in all directions on a ―tachystoscope‖ of aberrant linear vectors,
and then with all four legs off the ground—a most vulnerable posture for the lioness, which is
trying to bring the heavy prey off its feet down –on top of her—rip the underbelly with the
backleg claws to disembowel the zebra and have it come stumbling down off its feet. This is
another of the moments when I might ask you to forget the sentimental—this bucolic Currier and
Ives Africa is as specious as most of that which I work in human misery. To say it in the not so
pleasant vernacular, the lion attempts to get the zebra off its feet by tripping it entangled in its
own guts. [Impedimenta is a wonderful Latin word, which is the name for luggage; ―that which
tangles up the feet!‖]
All this, and the lions still preferentially go for zebra---perhaps it is for the sporting free
chase of it. But this charge, like 90% + daylight charges was futile in bringing one down. Not
that it is wasted energy, however. The lion never stops observing and learning, even from
―failures‖ to bring down meat. That older stallion favors its left hind leg. The young colt runs
sideways to its left—perhaps a clue to vision impairment. That far side of the herd zebra is
wheezing hard after not much of a chase—we can cull that sick one easily on the next go at it.
BONZAI! A GREAT SPOTTING OF A NOBLE APPEARING
RAPTOR
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My prize spotting of the day! We were driving too fast on a rutted road to get to the
corner of a low bush where we are headed toward a hippo pool. We are surrounded by herds of
bewildered wildebeest (those who got lost in the migration and separated from the main route)
and failed guides they were following—the allegedly smarter zebra I had just been describing,
which are now bobbing and weaving on near-daily lion charges which will cut down on their
feeding time remarkably since the usual surrounding herd of wildebeest (lion fodder) is much
less, with which they associated to lower the odds that they will be the ―hit‖ from the lion in the
stampede. So the MUCH smaller herd of herbivores left behind by the great migration is preyed
on by the only slightly less numerous carnivores, which means the odds of their making it all the
way through this dry season have been lessened by just a bit –and each and every marginal
advantage must be used here to get through even the random day, since this is where life
flourishes on the margin.
Bete our driver was watching the road, and our group was looking left where clusters of
wildebeest and zebras were milling around in the low bush. I looked right along the course of
the small stream that had given rise to the bush—and which would flow eventually into the pool
where we were headed. I sang out at the instant I had spotted it perched high and regal on a dead
branch----―African Fish Eagle‖!
We backed up quite a ways to confirm the sighting and then all cameras clicked away.
Looking like our American Bald Eagle that somehow stuck its head too far into the peroxide
bottle, the white headed black raptor has a white shoulder mantle as well and a fierce mien of
hooked beak and forward binocular raptor vision. He is the emblem of several nation states in
Africa, Zimbabwe among them, much as the graceful African Crowned Crane we had seen
earlier around watercourses is the national bird of Uganda.
We drove on closer to the stream bed and there in the usual spot one would expect a
hippo to be wallowing, we saw not just the hippos but a very large croc. I had seen a group of
big nyati coming down to the water and standing in lush grass, but they, too, were alert, possibly
smelling the lions we had NOT seen but knew they were there from the bolting of the zebras. A
couple of giraffe looked on, above it all. They were ―smacking their lips‖ wetting them with that
28 inch prehensile tongue that emerges like a brown black snake from this improbably narrow
bumped-nosed, small head at such an elevation you would think they should have nosebleed
from the altitude.
STICKING OUT OUR NECK—A LONG ONE
I explained the giraffe’s neck to our group: the same seven cervical vertebrae as we share.
But its very great height puts it at such a great hydrostatic disadvantage for blood to be pumped
all the way up to course through its brain. Arterial pressure can get it up there so that it does not
get ―light headed dizzy‖ when it is standing for a period upright. But it has to get down, low and
slow, to drink. The venous side of the circulation in the neck now poses a big problem for it, and
12
it has to do the lowering and rising in stages to prevent blackouts. Vulnerability with a capital
―V‖. So, it makes a behavioral adjustment to a physiological one.
Giraffes come to water in groups, but not all drink at the same time. A sentry or two
must stand guard since their normal circulation allows them to be alert and on the lookout. Then
they take their turn after their buddies slowly get up from their splayed knees’ awkward slump to
get their heads down low enough—often below their feet if the steep bank is undercut by water
current—and trade places on lookout. But, any one of them just needs to lower its head from
that elevation of twenty two feet, and immediate venous hypertension would result with a backup
blowout of the cerebral circulation—and a giraffe with a subdural hematoma is lion bait without
the necessity of a charge to climb up that high.
So, a physiologic solution requires some extra anatomy. We all have ―check valves‖ in
the big veins of the body below groins, axillae, and neck—or else the blood would pool out there
in the extremities and never make it back to the core for the pumping action of the lungs
(primarily—for a high flow, low pressure system such as the venous circulation) and heart (for
the higher pressures and thicker muscular walls of arteries.) Our venous valves are closed in the
direction favoring blood flow toward the heart with the muscular exertion against fascia that is
the ―peripheral pump‖ that propels venous return to the core away from the extremities. The
giraffe has these valves too. But, additionally, it had valves facing the other direction (toward
the heart) as well in its cervical arteries—the carotid system. This means that when it starts
moving its head lower, these valves protect the head from a gravitational influx of blood as well
as the propulsion of the heart to power the blood up that long distance uphill.
So, in making adjustments by stages, the giraffe does not blow out its brains as it slowly
starts lowering its head between its widely splayed knobby knees to get that remarkable tongue
to work lapping water into its long pipeline; and then it gets up still more slowly so that it does
not fall over in a dead faint from an ischemic brain not perfused, since the arteries were checking
the blood flow as downhill runoff when it was bent over. That means for all its ―altitude
advantaged‖ unique adaptation to feeding in the canopy of umbrella acacia trees, it has to pay the
price in rapid transitions in vital maneuvers such as watering that involve the hydraulics of a
heavy fluid column acting unchecked over a six meter pressure head.
―Behold, (it is not just I who) am fearfully and wonderfully made!‖
And here we get to watch that marvelous plumbing in action, as though it is a design the
giraffe need not even think about! And, of course, it doesn’t, nor do most people, until now, in
this ―Land Crusher‖ just for this minute if never before or after.
― Flower in a crannied wall…‖
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AND, NOW, PIECE D’ RESISTANCE! WHAT? WE WAITED IN
ANTICIPATION FOR THIS?
“Not since the Wall Street meltdown have I seen such despicable lazy
bloated overindulgence as this pod of kindred spirits laying around in the filth
of their own excrement, grunting puerile challenges at each other that “mine
is bigger than yours!”
We spotted several dik-dik always paired as they scrambled at the feet of the
bush—the smallest of the pygmy antelopes, too small a morsel to be of interest to the big
carnivores, and only an opportunistic snack for the starving, but a staple for big raptors, like the
African Crowned Eagle or the Tawny Eagle I had seen taking a ―bird bath‖ in the water course at
Lake Manyara.
I saw a tree branch with a line-up of the magnificent sunbirds that are the spectacular
nectivores of Africa, occupying the niche that hummingbirds fill in the new world. They have an
intriguing and quite photogenic habit of all lining up in a unison chorus line, with heads
swiveling to ―stage left‖ awaiting some next cue which does not seem to come their way.
And then it hit us: the stench—a romantic evening dinner spread out as a candlelight feast
in a pig stye abattoir. And we heard it—the low grunting demands and shoving contests of
hippos claiming contact-inhibition rights in territory in a crowded pool with each submerged in--well, how to say this less indelicately—shit.
Possibly as many as fifty hippos were lying in, on and over each other like bloated rubber
life rafts upended in a semisolid state sewage non-treatment center. Periodically, one would
―blow‖ as the nostril flaps shreaked open and a geyser of liquid stool would erupt as a new gasp
would inflate the corpulent slob. Its eyes would stare briefly in my direction until the sewage
glop rolled off its large flat head into the eyes giving it a somewhat shitty outlook on life, and it
would re-submerge.
The images and the video that I had shot will be missing one important feature—I cannot
quite capture the smell, but if you have a septic tank that is overflowing you might get the same
ambience without the airfare.
I scurried downstream around the bushes to be out of the slipstream, and was going to
give a dissertation on hippo feces (honest, I was, and I still will if you are still going to keep on
reading!) when I stopped.
[OK, you deserve this!
―A Concise Disquisition on Hippo Excrement‖ (GWG, all rights reserved.)
Ahem! Let us begin:
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Hippos do not leave behind them large clumps of dung unlike elephants
and to a lesser extent Cape Buffalo. So ―tracking hippos‖ would not be done by
sticking one’s naked toe into a dung pile and sensing the temperature to tell how
fresh it is, as one of my favorite fellow trackers in Assa Congo was fond of doing--perhaps as a little joke on the Wazungu. ―Mizori Wazungu‖, you know, the
―White Man’s Madness.‖ [He has told us enough tall tales about owning a metal
machine that allows him to run as fast as a cheetah, and getting off the ground and
flying here like a bird, or talking into his hand and being heard on the other side
of the world, or showing us where we are by this little dial that collected rays
from stars that the crazy Wazungu have hung in the sky—so it is time for us to
pass along a few of our own ―That’s incredible‖ quotes he will elicit and receive
guffaws a world away when he repeats what we have told him.]
No, no such luck for hippo scat. Instead, we look into the trees. Hippos
may dance gracefully in a tutu, but they do not, so far as I know, climb trees with
any regularity. But, crawling along a tunnel from the watercourse forward into a
grassy plain beyond the fringe of riverine bush, my unwitting guide looks up and I
see with him discolored leaves, and in some cases dripping mucoid –well, I will
call it what I see it to be—diarrhea, slipping off the ends of branches. The older
encrusted stuff does not seem to bother him, but the gooey fresh stuff, means we
are on a hippo path and we may be suddenly barging in through the low bush on
the cantankerous tank as broad as two barrels as he bulldozes his way back to the
watercourse, through or over us.
That is how I learned that hippos, who are lounging lazily in water most
all their days and part of each night, have very high fluid intact and liquid stool.
They also have a short stubby wisp of a tail, which spins around when their anal
sphincters relax, and this ―swizzling action‖ is a spin propeller that scatters fecal
liquid in an arc behind and above them. Hippo spoor, therefore, is airborne, and
drips from branches overhead. It is a little like the ―space toilet‖ designed by
NASA, which for reasons of weight restriction could not carry a septic tank into
space nor the chemical toilets of aircraft. Behind the speaker in the news
broadcast feeds of astronauts in space, one can sometimes hear the high pitched
momentary spin of a rotary propeller which vents the Astronaut ―Waste into
Space‖. Yes, and I alone am here to tell you that hippos were way ahead of us in
spreading this good cheer all around, behind and above them.
OK, did I fulfill my promise on the quick and dirty dissertation on Hippo
Doo Doo Number Two?]
The ―canyon‖ below the bend in the filthy river looks a lot like the geology of the
Mather Gorge on the Potomac, with steep rapids and slippery rocks, but here the rocks are
15
slippery for quite another reason. I had absolutely NO intent of hopping from rock to rock as I
might on the Billy Goat Trail along the Potomac flood plain. The biggest reason you may have
already ascertained.
The next biggest reason was lying along the filthy bank, its head facing away from the
river, presumably for ―fresher‖ air. A croc was enjoying the ambience of the downstream
outflow of the Hippo Cess Pool. I would presume from its normal eating habits—pulling any
fresh kills under water and storing the decaying body under rocks and logs for a few weeks
before consuming the ripened flesh—had accustomed the croc to lying in the whirlpool eddy
below the hippo pod awaiting the fecal suffocation of any one of the congregants above, which,
it would seem, would already be pre-ripened by the croc’s cuisine standards.
―Ah….it don’t get no better than this!‖
BEAUTY IN AFRICA—WHERE YOU FIND IT—AT EVERY TURN
It is beautiful—even down to and through Hippo Cess Pool entropic levels—this
Serengeti. ―The Serengeti will never die‖ was once a documentary I may have seen or just
wanted to, but I have seen even the parts that are dead and decaying, and, as in Hindu rituals of
birth life, destruction, degradation and rebirth—it is all a tapestry hear for those who can read the
code. That code is written in the genes I carry, so I feel very much at home in the Great Rift and
in its precious pieces—another Derwood, and as familiar.
As I had once explained: ―I have been an American for four generations, a European for
twenty thousand years, but for three and a half million years before that, I have been a wandering
hunter-gather along the Great Rift Valley, so each return to Africa is my Homecoming.‖
There is nothing trivial about this experience of origins—it is the best of times and the
worst of times; the most beautiful and the most squalid; the most hopeful and the most
despondent.
And the hyena with the lion fractured leg is limping along again as I return to the
Serengeti lodge: it glowers in my direction. It does not express a pride in its past or a gloating
satisfaction in having stolen prize chunks of a lion’s kill. It is not begging for mercy and
sympathy now that this near random event has made it a scrap of transient Serengeti burnt toast.
It does not threaten me, but would take advantage, if it saw one in a greater weakness on my part
than it happens to have now tipping the balance in my favor, so it lopes away, unwilling to
engage in a contest which would not benefit it, knowing its handicap is terminal.
The hyena is not hoping to be better than it is, feeling sorry for itself, cursing all
lionhood nor whining that it never had a decent break. It was not the ―Big Man on the Serengeti‖
nor was it the lowest outcast, nor did it care, nor is there any future for it now, possibly only a
16
contingent one for whatever offspring it may have sired that are still out there. There is NO
sentiment to all this. It is unapologetic and just IS.
AH…AFRICA!
Africa is real—the brief, the bad and the ugly; reality can be beautiful, or one can make it
so in whatever opportunity one has to modify any circumstances over the short run. One can
extract beauty from some of the circumstances, but from each of them one can learn truth.
The African Fish Eagle poised on its raptor’s perch, the sunbirds aligned on the
branch polarized toward the glow of the African sunset over the kopje; the lioness on the
log in the morning glow as she searches out the tall grass closest to the alerted gazelle
herd with her cubs mewing to her from the elephant pushover tree roots
The hippo cesspool with the wallowing in aromatic overflow; the croc lying amid
the rotting leftovers of its haphazard table manners; the dung beetles following the
elephant herd in a backward scramble rolling their precious cache.
It is all here, and the perspective changes from different points on the food chain
or the hierarchy of value added. Africa is not at all like life. It is.
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10-JUN-C-5
THE DRIVE OUT OF SERENGETI INTO THE NGORONGORO
CONSERVATION AREA FOR THE MASSAI VILLAGE VISIT AND
HUSTLE BEFORE WE DESCEND THE SCARP FROM THE VOLCANO
RIM INTO NGORONGORO CALDERA TO SPOT A PAIR OF
CHEETAHS, SEVERAL LIONS, INCLUDING A PRIDE DROWSY FROM
GORGING AT A KILL, HUGE BULL TUSKERS, AND AFTER MANY
SIGHTINGS OF BIRDS, A MYRIAD OF WILDEBEESTS WE FINALLY
SPOT A BLACK RHINO AND CALF TO ROUND OUT THE BIG FIVE
AND ASCEND THE RIM WALL THROUGH EUPHORBIA AND
GROUNDSELS TO CHECK IN AT THE ELEGANT NGORONGORO
WILDLIFE LODGE FOR THE NIGHT TO BEGIN JULY 1
July 1, 2010
LEAVING SERONERO LODGE AT 02* 26.93 S, 37* 48.37 E 1503 m
TO CRATER FLOOR AT CALDERA AT 03* 09.15 S, 35* 30.24 E, 2,047 m
TO NGORONGORO WILDLIFE LODGE AT 03* 14.91 S, 035* 31.20 E,
2,198 m for our final luxury stop in our five day four night safari tour
And here you thought after my Jun-C-4 dissertation from the Serengeti, I was through?
Never! I am decamping now from the Serengeti, through a place you have heard of often—
Olduvai Gorge—to go back to a site I am familiar with from just last year—Ngorongoro Crater.
Like Lake Manyara, I can give a rather good guided tour of the ecosystem of the Crater, a
wonderful natural laboratory.
Just as I had last year, however, I had to stop first in the Masai Manayatta—their
―concession‖ to show off the Masai culture, to sell trinkets and to ask support for everything
from their ―school‖ –more on that in a minute—to their traditional grazing rights in following
cattle and the Moron culture system.
We pulled in to another Masai village than the one we had stopped at last year for the identical
program—a chance to do the jump dance with the Masai, wearing their beads and paying US
1
dollars into this small migrant tribes’ treasury , whereas they are the largest in media savvy for
soliciting support. This are of the ―Masai Conservation area‖ is a large ecosystem around the
Ngorongoro Park—in which they are specifically excluded from grazing their cattle or passing
their initiation rites that makes them pass from boy to Moron and eligible to marry after a five
cow bride price—that turns out to be only 2% of the final asking price of the Dinka Bor clan of
Tabitha for gouging out of Ajak! We should all be so lucky and come on over here and barter
for brides at a discount!
THE MASAI:
AN “INVADING SPECIES” THAT HAS BECOME “MOST FAVORED
NATION” IN ENTITLEMENT RIGHTS AROUND AND IN THE
NGORONGORO CRATER
In creating this Masai Conservation area, the locals had been moved out, but only Masai
were allowed to move back in. That the majority of the locals excluded form their own turf,
then, the Chaggas were displaced by Masai. The Masai have a colorful culture that they are
more than happy to tell us about, and they have groomed several red-robed spokesmen to explain
to us in small isolated groups small enough to bring inside the squat tiny huts to see the lifestyle
they lead of cramped poverty, to feel moved by the pitch of support. The women have all lined
up for photos and the opportunity to sell you any and everything they are wearing. And the pitch
is, that they, the Masai, are a special cultural treasure and are entitled to free roaming without
passport or taxes or any other obligation of theirs to any state, since they follow the cattle to
grass and rains, and not to citizenry, but they need help for their transitions.
My higher pressure guide was surprised that I knew the moran traditions and had once
marched with the moran through the Rift in Kenya, and had seen the ceremonies. They would
take a small bow and arrow and after a rope had been strung around the neck of a cow, the
distended jugular vein was punctured and the red cascade from the venopuncture was collected
in a red decorated gourd, and the blood mixed with milk was drunk as their staple diet. At least
it is a staple when tourons are looking on or filming the event. Right now no such cows were
available and the gourds had a more important use, being sold as souvenirs to tourists where they
might presumably take them home to use on their family pet cat for the same purposes.
The Moran applicant is sent outside the village—no Moran lives in the protected
manyatta, with its thick thorn scrub fence around the boma, but they are outside in the broad
world of the rift, trekking long distances in the sandals cut from tire casings known as Morani.
These presumably protect against punctures by thorns. The Moran is dressed in a single wool
red robe, and wears beaded anklets and gauntlets, with red ochre colored plaited hair plastered
with cattle dung—with which their lives are surrounded. He carries an assegai (happy to sell you
one of these take down models since I hear it is difficult to pack them on aircraft these days) with
2
which he must spear a lion to be initiated. In the other hand he carries a knobkerrie—a knobbed
wooden stick that can be sued to crush skulls in the event that the attacker is not a lion.
The lion is an arch enemy of any cattle culture, so that to prove oneself a man, after the
two year wandering in the rift with face painted with white clay looking for all the world like
trick or treaters, a moran initiate must corner a lion with his fellow initiates all closing in with a
ring around a lion in cover. As the lion bursts out, the brave young wannabe jumps forward and
thrusts the spear into it, and if the lion is killed by the pincushion they all make of him, then the
newly initiated may wear the lion mane as a ruff around his head as well as be entitled to select a
bride, if he can give the FOB five cattle—a K-Mart bargain basement deal for most of my
Sudanese cattle culture pricing.
When I had been in Masai Mara with three others (besides son Michael) we were with a
Kikuyu, a Chagga and a Masai. It was not a case of white or black, as we approached a pride of
lions, I got really good photos of the lions, since they ignored me completely. They never lost
eye contact with just one of us—the Masai. They ignored not only me, but also the Chagga and
the Kikuyu. The lions have grown up under the pressure of few predators, but here is one that
they recognize as a traditional threat to them. In the millennium since the Masai have come down
from the Middle East in following their cattle, the lions have been aware that there was one ritual
component of their coming of age and it involved them—not the others of us.
And what is with this cattle obsession of Nilotic peoples? They came down with cattle
from Asia Minor and are walking through the greatest collection of edible hoofed stock on planet
Earth, and they import cattle to further denude the landscape and compete for the water and
grazing (equivalent) for an imported meat source they do not often use, skirting around herds
numbering in the hundreds of thousands? Instead of spearing a lion, go spear a wildebeest,
which for the rest of its time on earth will largely take care of itself and you do not have to
constantly find it water and grassland and protect it form carnivores as well as greedy gouging
from others who are keen to rustle! If only the early migrants could have had the benefit of my
advice, I would have told them to come on down, but leave the cattle back around the Dead Sea.
There are a lot better pickings here and a ―free range‖ alternative to animal husbandry among
competing carnivores!
Now, a population explosion for the Masai might mean a reciprocal precipitous drop in
the lion population which might lead to more cattle with which to purchase more brides—I sense
a lack of a check and balance system here. But they are trying to get other skills and we are
going to be shown them right now. We are brought over to a small enclosure and groups of
grubby looking near naked kids are sat in a small pen, smeared liberally with cattle dung as their
best form of insect protection. This is the ideal community in which to study the exposure to a
very large antigen load from living in the fecal debris of cattle—which is used for the fuel for the
fires, the plaster for the walls, the floor of the hut, the mousse for ones plaited hair, etc—would
3
make one’s immune system stronger and more resilient, such ht annoying diseases of civilization
like asthma would be kept in check.
The teacher is calling upon them to recite, with a stick used to pint to the numbers, letters
and multiplication tables on the chalked up portable board, which does not look like it has been
replaced for a long time—at least twenty bus loads of tourons worth of demos. The little kids are
called upon or that over-eager ones volunteer to sing a song, or recite the abc’s---I insisted that
any ―EEE‖ sound did not somehow rhyme with ―ZED!‖ A donations box is displayed at the exit
and each were encouraged to contribute to this open air school room in the hot sun and caked
dung around the single ―teaching aid‖ the green used chalk board and the stick. The kids sang
the ABC’s in English and Ki-Swahili. They were way over-rehearsed, but quite telegenic in a
filthy sort of way that PigPen is attractive. The usual ―Flies in the Eyes‖ I experience all the time
in Sudan is present but not with the same intensity as near the Nile. When asked if there were
any ―higher ed‖ in town, the moran explained that he had never been to town, although others
had; he had been trekking through the rift valley with white face paint caked on his cheeks as
were the trio I had seen on the road both coming and going through here on our way to and from
Serengeti.
It was a conflicting view for the anthropologist in me—since they made their case that
they would like to have it the way they had designed it—free and open spirits wandering
unfettered thorough the Rift Valley—a bit like the same argument between the cattlemen and
settled farmers out West in the USA which led to land use wars until a simple invention called
―Barbed Wire‖ separated the two cultures of agronomy and foraging.
Here there is a major super presence also of a Nation State Government funded by both
NGO’s and UN world wide sponsorship to create a ―National Park‖---even a UNESCO ―World
Heritage site,‖ not to be molested but to be preserved. Preserved for whom and at what level?
Before man entered the valley, or before White man entered, or before the Internal Combustion
Engine did? The Masai had agreed to be excluded from the Crater, to get exclusive right s to the
Masai Conservation area surrounding it (there is no comparable ―Chagga Village equivalent ― of
the more numerous ethnic clan in TZ)—but then, as we entered the Crater down the steep crater
rim one way road, we were passing Masai herders going up or down the road since they had been
granted an exception because of the drought to water their cattle in the Crater—and the goats and
cattle , of course, will not sneak a mouthful of UNESCO grass while they are done there, will
they? And no Masai at dusk will decide he cannot take it with his herd up the steep crater road
and will just overnight etc, etc, The Masai have hostaged their colorful popularity to blackmail
their way to take advantage of both the modern and traditional, making the ―Bumi Putra‖ claim
of Malaysians or any other ―we got here first‖ peoples—we are sons of the soil and have rights
of first priority to the resources here—the grazing, the lions for our killing to keep our culture
going, and, oh yes, those nice tasty packages of First Worlders which we will stop and frisk on
all visits to the World Heritage Site crater. The Masai have learned US Entitlement politics with
their Mother’s Milk (and Blood Mixture) feedings.
4
RETURN TO NGORONGORO CRATER WILDLIFE, FROM
CONSIDERATION OF ITS MANIPULATION FOR ONE GROUP’S
ADVANTAGE AS “INDIGENOUS”
And now on to Natural History in place of political and economic advantaging of one
group over all others. We packed out from the elegant Serengeti Lodge perched high on the
gathering of rocks that make the Kopje a perch for many predators with far ranging vision. I was
one such predator in the early morning, looking all over the fog shrouded valley where the
hippos could be heard grunting challenges at each other. I tripped over hyrax as we packed up
the Land Cruiser following our breakfast buffet, and started on our way out the dusty road. We
saw a family of five cheetah in the tall grass, looking hungrily over the flat basin where most of
the gazelles had ―yarded up‖, their own vision not being much of a slouch either as they looked
around in the taller grass for a margin of safety in the ―pass receiver rush.‖ Another kopje had a
pride of lions hanging out on it, greeting the dawn lazily. Hartebeest were present in small herds
and a lone Tommie was seen—a very deadly isolation that makes for a short life expectancy.
I felt reluctant to leave this part of real life. The part I refer to as real is that which is
going on every moment on the dry grass plains and under and around the kopjes—not the
synthetic luxury of the elegant Serengeti Safari lodge. It is comfortable and sumptuous, which
both I and the animal wildlife around me know is not to be an expected given in any day to day
struggle for survival, which is so real as to hardly need either proving or stating. There is no
entitlement here—not one of us is even entitled to so much as the next breath drawn, a gift of
incomparable improbability!
We came back through the stone arch that constitutes a fortified gate—a bit of a joke,
since the arch is over a road on the plain and there is no fence and as many tracks around the
arch as through it. But having left the Serengeti national park we are in the Masai Conservation
area, a halo around both Serengeti and Ngorongoro Crater, where ―public use‖ is allowed, so
long as that public is that of the well-favored Masai. One of our group members had been
shocked when we went through the Masai village since he said he had never encountered such
abject poverty so close up in the filth of the cattle dung. One man’s poop is another man’s
pleasure, one might summarize, since the filth he referred to is an expression of their wealth
since they are swimming in the excrement of their sacred cows—much as are the ―American
impoverished‖ who worship other gods of tin and tinsel, which may have the single advantage
that they produce less unrefined excreta.
I had a goal upon stopping where we were possibly going to have our box lunches, right
where we had on the entry to the Serengeti two days before. I was on a mission, and stalked a
bird so common that it has the name of a ―trash bird‖ in America—the starling. So common a
name should not prepare one for the dazzling colors of the resplendent ―Glossy Starling‖ that
hangs around human habitation in great numbers, even greater should those humans be dripping
5
morsels of excess foodstuffs as the Europeans seem always to do. But, I knew where they would
be, clustered in bunches around the picnic tables, and I had seen a small bird bath water hole
where they also congregated. A bird bath! And my instincts paid off in what could be dazzling
morning sun videos of the glossy starlings by the twos and fours splashing and bathing and
shedding silvery droplets of water after submerging and shaking like a dog to flick the water off
their flight control surfaces---beauty in the common!
We crawled slowly up and over the rim of the crater to 2,840 meters and then took the
one way crater ―In‖ road which did not ―switchback‖ as often as the Crater ―Out‖ road for
reasons that would be obvious as we left the Crater in late afternoon. We came down to the level
of the Crater floor at 2,047 meters, and I marked it as I had before only last year at this time, but
this time as we were watching dust devils, little funnel shaped clouds as ―mini-Twisters‖ spun
across the dusty crater floor. Our vehicles threw towering plumes of dust behind them like jet
skis or the ―rooster tails‖ of unlimited class ocean speedboats.
CRATER= 03* 09.15 S and 35* 30.24 E at 2,047 meters
We drove around through series of scooting warthogs, and a few gazelles, and came to a
grassy corner where a few of the vehicles had stopped so that we could tell there was an ―item of
interest‖ since the vehicles could be seen without their rooster tails denoting transit. There was a
pair of adult cheetahs in the grass. They were parked side by side, and had stared over the tops
of the grasses. When the vehicles closed in, they could not see quite so well over to a group of
gazelle, so they stood up languidly and stretched. They then did the ―Strike a Pose‖ as a pair of
bookends might, mimicking each other in mirror image. This was very kind of them since the
only purpose for which I could see them doing it was for digital photography as a professional
model might stretch and preen for the runway , in this case a quite literal cat walk.
They were, of course, beautiful, and they seemed to know that, too, so that just being was
good enough right now, since all their speed and agility would not do them much good unless
projected a long way all of it in sight of savvy prey. If I had my way, I would take them both
home with me as a brace—a matched pair, which would be so good to have around the house in
place of the ADT alarm which can get spooked just by the passage of a spider—thanks to which
I owe the Montgomery Police for false alarm calls. If I had cheetahs at home I would likely have
to be a little faster and more alert, and they might also be considered an ―attractive nuisance‖
around the household. But, if these two follow me home… Hey, I am into ―rescue!‖
As we drove along a higher part of the crater floor the grass was a little greener but not
much longer and there were herds of wildebeest stomping around in circles, like they had just
fallen off the bus that had ticketed them, one way Masai Mara or Bust! There was a fresh water
stream leading down to the salt water lake with flamingoes and pelicans filter feeding in the lake
for the brine shrimp found in natron lakes in the rift valley, but that cooler clearer fresh water
stream had attracted a lot of wildlife large and small: biggest was a hippo which was rolling
6
around in the water, eschewing the deeper lake and relishing the fresh water stream, which could
only cover inches of him at a time, hardly a buoyancy factor. A big group of wildebeest started
moving across the marshy grass following in the footsteps of the one ahead and the one behind
repeating all the same stumbles of its prior mate in the train. There was a deep part of the
stream, so the ―dumb as an ox‖ wildebeests would proink along to get up a good head of steam
then jump with all four feet, trying to do a Masai jump dance and go ―Plunk‖—right into the
deep part of the creek. They would proink forward and shake like a dog, then the next one ,
having learned nothing at all from close observation of its fellow, would repeat the same
maneuver and get pushed into the jump and splash down. This was repeated for the entire
caravan of mini-migrating wildebeesties—each one dumb as a gnu. It was almost comical.
Perhaps it is a good thing that the wildebeest are not deep dish thinkers, since every day they see
one of their comrades close to them get pulled down and taken apart, and one should not be
overly contemplative about such a fate. Since virtually everything with sharp teeth out here is
making plans for their inevitable fate, they have a reason to be a touch on the, shall we say
―quirky side,‖ and they take refuge in the only thing they do better than anyone else on the
planet—produce more and more redundant little wildebeest.
We drove on as it became almost cool and overcast—a harbinger of the rains coming
soon to this end of the migratory route which would get the mass of similar like minded
wildebeest to reverse their course, with scores to hundreds of newly dropped little homely
wildebeest calves toddling along in the southward direction, again protected only by the
abundant numbers of them that can almost satiate the carnivores to allow a few to get away with
the transit. So the mass transit will bring them back again to dilute down the number of targets
of opportunity, and that should give them comfort, even though there will be many more jaws
cropping the same grasses—maybe they are not so dumb after all.
We saw still more of the herds of wildebeest, this time with zebras nearby, as we turned a
curve into thicker grass. Only a few animals were deep in the grass, and two of them looked like
they did not have to care a fig what might be lurking in the tall lush grasses—up to even their
shudders—two huge old bull elephants, one a one tusker, and the other a ―Hundred Pounder‖ as
they were once called by PH’s (―Professional Hunters‖)—a hundred pound tusk to a side. The
massive bulls might be older than I. In this environment, they are safe, even wearing all that
high priced jewelry... I only got to be as old as I am by not wearing any jewelry at all.
An odd congregation of small bodies was spread out on a duty pan right in the middle of
the grasses. I looked at first without being able to use the binoculars in the bumpy ride, but then
when we stopped I realized I was staring at a whole gaggle of hyenas. They were doing the
―Lion Thing.‖ They had apparently had a group feast, and old ―Fisi‖ (the Ki-Swahili name for
the homely beast) was sleeping it off. One stood guard, however, and it looked like there was a
spare part or two of some prey animal lying in the middle of the pack. As still intact owners of
similar spare parts were standing all around at the margin of the tallest grasses between the big
7
bull elephants and me, they looked on with apathetic interest, and no alarm as the hyenas were
burping and snoring.
As graceful as the hyenas are ungainly, African crowned cranes were wading in the wet
grass, and down the middle of the road, even between vehicles, a black-backed jackal was
cruising along targeted on a mission. I could see what had attracted him; a fresh wildebeest
carcass was lying on a small berm of the grasses. Now, you can be sure, the beast did not fall
over in a faint, or catch his death of cold, or swoon in the vapors. We searched the grasses, and
there with only ear tips visible was a lioness, licking her chops, having had her first feed on the
carcass, and taking a break awaiting the sorbet to cleanse the pallet, before falling to again.
When we later returned, she was lying drunkenly upside down with one paw caressing
the carcass, announcing to the rest of the world, or more particularly, the circling jackal—―this
baby is mine, all mine, and this refrigerator door is shut and guarded.‖
We came to the area where last year we had all assembled at the lakeside and posed
under the big bait tree at the site where we might have eaten our box lunches—and only I did so,
since it was not up to the standards of the others, it would seem. As soon as we pulled up, the
helmeted guinea fowl that had been all around here last time were here again, scooting along the
ground and snatching at whatever was dropped form the unwanted lunches. But, much more
attractive, a herd of zebra were standing close to the lake and one after another of the group
hopped out to pose with them in the middle of the zebra pack—like Japanese tourists. The
young 16-year-old Ellen, daughter of one of our runners, Joe, was a high school student, and
very sweet. She put down her backpack which contained her journal which she was continually
writing in, as this ―trip of a lifetime‖ with her Dad had progressed. She was very excited about
the zebras and being IN the picture with them, so pursued them around a bit, and when she
returned her backpack was gone.
Now, this is a crater. This is a controlled entry national park, and the only people here (in
the absence of marauding baboons) are all in the vehicles, and I asked each one at a series what
had happened to her backpack. She was in tears. Only much later did it turn out that an Italian
in one of the vehicles (who did not understand what I was asking) had brought the backpack to
the public restroom at the big tree and left it there, to great relief by our whole group. After all,
what horrors might result from anyone else reading a teenage girl’s diary?
Two big males and two big female lions were right at the roadside, sleeping off a feast.
They looked like I might in attempting to record something of my observations in a balky laptop
after a forty-eight hour day with jet lag. They could hardly stand, and slumped down heavily;
making some effort to hold up their heads, but not succeeding in keeping open their eyes. This
means that we were close and got close-ups—the lordly lion looks better on the MGM movie
trailer, or in a distant photo under a shady tree. Up close it is a bit different. These were having
a bad hair day. They had flies cluttering the gore around their muzzles which were also scarred
8
form past encounters with prey and with each other. They had certainly become individualized
personalities in close up, but that was branded upon them by irregularities, not beauty marks.
The King of Beasts would probably not enjoy being laughed at, but nobody admires a slovenly
drunk, which is almost all dead wait and overflow incontinence. We waited until one and then
the other of the females got up to stroll to a more comfortable clump of grasses and then not sit
down, but literally to fall over. The one male opened his eyes and expressed all the enthusiasm it
could muster for the closest female, by sniffing at her. And, so it goes, in Life at the top, among
the rich and famous and powerful. Ennui is the order of the day!
Well, we had seen the big four. I had promised that Ngorongoro crater was the place to
see a rhino, but that these were black rhino –and they are more difficult to spot. White rhinos are
Southern African—although I was there when the importation of several white rhino for Kruger
was let loose in both Nairobi National Park and the bird-rich Rift Valley Park visited again
second to last trip top Kenya I March 2008. White Rhinos are NOT ―White‖—that would have
to be ―Wit‖ in Afrikaans, as in the University of the Witwatersrand. Weit = ―Wide‖—and the
―Wide-lipped Rhino‖ (I like the German name the ―Nashorn‖) is, by definition a grazer. It crops
grass with its wide flat snout, and is in the open grasslands, and is often in groups with babies in
front of them. (Like the ―White‖ women, pushing their babies in a pram, Get It?) It is docile,
approachable, and can even be domesticated in farms.
The black rhino is not so amenable to ease of displaying. It is solitary and forested as it
has a prehensile snout, so, again by a quick and easy understanding, its little trunk is used fro
Browsing, not grazing. It is often alone, except when a female has a calf, and the calf is at its
back (as African women also carry their babies---―Blacks,‖ Get it?) They are cantankerous and
have very little sense of humor and when stumbled into in a forested environment they have the
unpleasant habit of wheeling, charging, and ―mowing the man down.‖ They are not
domesticatable. So, here we are with a couple of Land Cruisers full of ―I wanna Rhino‖ chants.
As we wheel around Bete stops the car and looks long and hard at something I cannot
even see when it is pointed to. As it develops, it is a black rhino mother and calf sitting down
with head down and facing away in deep grass bordering a copse of wooded thickets. Only the
best binoculars can see it over a kilometer away and then even the heavy duty turreted telephoto
lens of Dennis can barely make it out. And, then, wonder of wonders, it stands up. Baby at its
back, prehensile snout sniffing the air and confirming all my ―Rhino 101‖ within a few seconds,
it plops down again disappearing into the tall grass.
BIG FIVE---MISSION ACCOMPLISHED!
What more is there to say? We came, we saw, we kicked butt!
But, wait! It ain’t over til it’s over! I never turn it off in the wilderness, since looking for
something you know will be there and quitting when you find it, means you will only find what
you look for, and you look for only what you know. How can you learn anything, if you pack
9
away the binocs and cameras and fold up the ―tick off list‖ and put up your feet, and say ―OK, I
have heard about the Big Five (only recently) but I have now been there and done that!‖
As the rest of the gang chortled about first world items such as movies to be seen and hit
songs to listen for and iPod downloads, they effectively had left Africa abruptly by the last tick
on their pre-formed list. That was easy!
I was still swiveling around, especially since now is the approach of the bewitching hour,
when wildlife is prowling and fleeing and when the emergence of all creatures big and small to
take advantage of the last of the light but not of the blazing heat. To see as much as possible and
to be as little seen as possible. The Cori Bustards are running in pairs coursing down the
grasslands at roadside. This is when I saw so many serval cats right here in this same place at
this very time last year. This is when the big bull elephants were locked in their heavy duty slug
fest until one was pushed over at the crushing of several good size trees. But, we have been out
here ins this crucible all day and it is time to retreat to more customary and agreeable luxurious
accommodations—it is Miller time—except here the names are Safari, Serengeti, or Kilimanjaro
(Go Figure) if you are not interested in an import of Kenya’s largest single product—Tusker.
I see giraffes emerging from the acacia trees in groups now including small giraffes,
which we absent in the overhead sun time of day. Why? Since the big giraffes at twenty two feet
and three and a half tons, have a mass to surface ratio appropriate for not overheating, whereas
the small giraffes are at an advantage. They don not have mass enough to keep the blood cool
with all that spread out solar absorbing surface to become overheated, so they must be in tree
cover, or even stand beneath an adult in mid-day. Cape buffalo, rhinos, and elephants have
heavy mass each of which can thermoregulate just on the considerable heat sink of all that
tonnage. Even dark colored elephants can hold heat, although they do two things to mitigate the
mid-day. They blow dust over their back sides to reflect some sunlight, and fan their ears, the
equivalent of panting. The very well vascularized ears can radiate and fan the heat away. OK, I
have all this good stuff crammed inside—is anyone interested? Does anyone want to know? I
once did, and am willingly here to dispense these data as a freebie! What? No takers? Who
played the vampire in First Blood? Argh!!!
THE HOTEL HIGH POINT—THE NGORONGORO LODGE ON THE
CRATER RIM, FOLLOWING A ROLICKING JUNGLE ASCENT UP THE
CRATER ROAD TO EXIT THE PARK AND COMMENCE THE RETURN
It is the piece de resistance for our luxury lodging! I had said to our team—just you wait!
And this spectacular hotel clinging on to the rim of the crater with all Ngorongoro spread out
before us is the final flourish of our luxury Serengeti Safari Tour.
NGOR= 03* 14.91 S AND 035* 31.20 E at 2,198 meters
10
The hotel may be spectacular, but the getting here was better still! As we left the crater
floor, and made a run at the switchback climb up the exit road, we crossed into about a half
dozen eco-zones, with the vegetations going from desert to alpine to heavy duty rainforest all in
this Equatorial latitude. I saw big lianas across the switchbacks and giant euphorbia and ficus
and heavy duty hard woods. I turned on the video and rocked and rolled around the inside of the
rover as we pushed up the steep gutted road. As we clambered up the steep valley, the backdrop
of the crater floor and the scenery as we go should be spectacular if you are not seasick from the
vertiginous perch a bit like seeing the world from the ―crow’s nest‖ while ―rounding the Horn.‖
Our final evening was spent strolling the vast porch in front overlooking the crater. A
mounted heavy duty binocular telescope is fixed on a gambit here, and the guide that dropped us
off casually turned it to the forested edge of the crater and said, ah, there are a couple of rhinos
there now! So, we are seated in luxury as our last breaking of bread together from the group that
has climbed, run, and toured together—and overeaten as well. One of the younger certainly
more naive women of the trip said to me—―Can I see your pictures?‖ I asked ―What?‖ She
motioned to my camera to play back a few of the shots—―You know, the pictures of this trip‖—
she herself had taken almost a hundred of them! There is no heavy duty battery available to play
back the images and videos on this 8 Gig card alone, and there are three of them filled. I
suggested she wait until the upload to Flickr, and I will put the unedited ones up on York.
EXIT LAUGHING, IN AWE ON THE CRATER RIM:
NGORONGORO CLIMAX OF OUR SERENGETI SAFARI
And, so, the sun is setting over the crater—and on this safari, and on Part II of the
Tanzanian Expedition of 2010. You have heard my commentary as we go. I am still eager to be
a safari guide for my grandkids or possibly even a three-generation immersion in the great
natural history of this Cradle of Mankind. Each part thus far has been superb, and getting better
as we go. Just wait until you get the full photojournalism later!
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10-JUL-A-1
THE TANZANIAN MEDICAL MISSION IN TANGA PROVINCE AFTER
CONCLUSION OF THE SERENGETI SAFARI
10-JUL-A-1: Index to the Tanzanian Medical Mission in Tanga Province
2 Return from the Ngorongoro Wildlife Lodge on a Cloud Forest morning as we make
our way back from the Serengeti region via bumpy roads and souvenir shops and part with our
driver Bedu, as the Betzers are making plans to leave via KLM through AMS as we search for
our Ilya Tours connection and our joiners Holly Pierce and Jay Miller for our transit to Tanga
Province
3 After a four o’clock rising for a five o’clock departure from MT Inn at Moshi, we drive
through the Sisal plantations down a one thousand meter altitude drop to get to Korugwe to
begin our screening clinic with cases being reviewed and the afternoon at the St Raphael’s
Hospital doing a couple of cases, a large hydrocele and a hernia repair under Ketamine with a
following drive to Tanga Province to hold our tutorial despite bone weariness at the Seaside
Resort and a prep for a new day in Tonga Province in repeating a big clinical day.
4 A full clinical day in a school room as I rotated around clinical teams helping make
patients diagnoses and dispositions of 112 medical patients and selecting thirteen surgical
candidates scheduling them for operation at Pongwe Regional Hospital over the next several
days, as a group of primary health team trainees are brought around to follow us and be taught at
an entry level; then we go to seaside Indian Ocean Restaurant for prolonged tutorial as we await
dinner service before an exhausted turn in.
5 Monday morning, a celebration in the USA of the “5th of July” as we split into
medical/surgical teams for a clinical half day before return to clinic for further screening
6 A second day in the Pongwe hospital in operating on several good cases selected from
the population of patients in our newly renovated theatre for our USAID inaugural of its
operating suite further enthusiasm for our presence is shown by their opening the theatre
for a holiday tomorrow to do still more double digit cases on “saba saba” day
7 The third consecutive day in operating at the newly inaugurated Pongwe hospital
theatre on our final medical mission day in Tonga for the grande finale of the mission and part
IV of the TZ trek
1
10-JUL-A-2
RETURN FROM THE NGORONGORO WILDLIFE LODGE ON A
CLOUD FOREST MORNING AS WE MAKE OUR WAY BACK FROM
THE SERENGETI REGION VIA BUMPY ROADS AND SOUVENIR
SHOPS AND PART WITH OUR DRIVER BEDU, AS THE BETZERS ARE
MAKING PLANS TO LEAVE VIA KLM THROUGH AMS AS WE
SEARCH FOR OUR ILYA TOURS CONNECTION AND OUR JOINERS
HOLLY PIERCE AND JAY MILLER FOR OUR TRANSIT TO TANGA
PROVINCE
JULY 2, 2010
I am now back in familiar territory, but for how long I do not know. We have returned to
MT Inn in Moshi where we began ten days ago, and where we stayed through the Marathon five
days ago after our luxury accommodations and overeating of the Safari through the Serengeti.
We have come back as each of the others have tried to make new arrangements to leave early
and spend the extra day they are booked to spend just simply ―vegging out‖ around Moshi and
they thought they might get KLM and its earlier flight to carry them to Amsterdam tonight and
take my advice on getting the train to ride into the city and take the Heineken tour or simply
stroll the Netherlands capital. Right now they are watching the Netherlands team take on Brazil
in our return to the World Cup. But, there had been a mechanical failure a couple of days ago,
and the flight they had hoped to take is overfilled, so the Betzer‘s will remain here, as it is
presumed that we will be going on ahead, even though we have booked a room of the night here
at the MT Inn.
Two students of mine, Jay Miller and Holly Pierce are arriving about now on the same
Air Ethiopia flight that brought us in on Tuesday last, and Ilya Tours was booked to pick them
up and carry them to Tonga Province which means they would be passing through here to pick
us up, but we have no word on that tonight, so we will wait to hear. It is likely we may still be
here tonight awaiting either the two of them or the Ilya Tours that was so confused about us and
had planned to pick us up on the arrival of Air Ethiopia July 2, when it was us arriving ten days
before that, awaiting transfer on the July 2nd when the other two of our team arrived here. SO,
we will wait to see what is happening.
I hope that I have finally got a text message off to the twins in San Antonio on their
birthday today, which might have reached them about the time they were getting up for breakfast
1
on their birthday at about 7:30 AM. I tried sending it earlier through Mike Betzer‘s phone, but I
am not a regular texter, and had sent the message to the home phone number which has no
capacity to take text messages so the system kept sending it back with an error message that I
had the wrong number, Finally, I sent one as an alternative to the second phone number which
might be Michael‘s cell phone which CAN take text messages—so they may be aware that
Grandpa Glenn is thinking of them as I was staring out over the Ngorongoro Crater which I had
been eager to show to them,
We had a day of essentially just driving from the Ngorongoro Wildlife Lodge, a
spectacular hotel perched on the rim of the crater looking down through the mixed vegetation of
the tropical cloud forest down the differing ecologic zones to the Crater floor and distant herds of
hoofed stock. The clouds had welled up from the dense collection of ―fever trees‖ (a streamside
yellow barked Acacia tree whose bark—like that of birch bark in American Indian lore allayed
fevers do to its high salicylate content) is used in Africa for the same purpose. [It gave rise to the
Kipling line: ―By the green, grey, greasy Limpopo all set about with fever trees‖ which had
always been a favorite of mine, and became even more so when I DROVE the Limpopo, which
only has water in its sandy bottom about three months of the year! ]
So, from the cloud forest of groundsels and euphorbia being swallowed in the rising
moist fog from the crater, I stand between ―Fever Trees‖—the yellow bark acacias---and send
out from this exotic spot a message ‗round the world---―HAPPY BIRTHDAY DEVIN
MICHAEL AND JORDAN LEE GEELHOED!” I hope that some day you can join me
here!
I believe the sending of this text through Michael Betzer‘s phone to Michael Geelhoed‘s
cell phone may finally have worked. The prior attempts were to the home phone which does not
take text messages. I would like to get the two Michael‘s together at some point in the near
future on a Texas visit. I can describe Michael Betzer in two words given to me by the others in
a first glance: Woody Harrelson.
We drove out of the fog-shrouded Ngorongoro Lodge as we made our way through the
exotic cloud forest (groundsels I had not seen since the third ecologic level on Mount
Kilimanjaro make this look like another planet.) As we pulled closer to a dirt road better
traveled to get to the paved road leading out of the area, I spotted again the ghostly faces of three
Masai Moran initiates, the white clay past giving them a cadaveric mien, as they tugged their red
wool robes around them and their red ochre plaited hair bobbed behind them in their loping walk
to nowhere in particular---ghosts of the past emerging from and being swallowed by the fog as
they seek their Moranhood.
As soon as we got to the paved road, of course, we had to stop at the wood carving shop
with all the paintings and spears and other kitsch piled so high as to be a thicket of its own
design. I remember this shop well since this marks my fourth visit to it and it seems to be the
2
last chance to separate tourists from their currency, and wouldn‘t you like to take home some
rare Tanzanite jewelry? I keep asking of my colleagues, that for all the natural history narrative I
have supplied them in explanation of what they have been seeing in the Serengeti Safari, the
least they could do is to carry back home for me a carving I am rather keen on getting—then
point to the four ton $25,000 stump carved into a throng of figures polished to an ebony sheen. I
have had no takers this time, either, even though I am sure someone in this group could afford it
as a Game Room centerpiece for me.
They have a couple of bruiser Nyati mounts on the wall which look like the only things
close to a bargain I have found here, since I am well aware of taxidermy prices. A hawker wants
to sell me a ―Lion‘s tooth necklace.‖ I have had enough such offers to make a full set of
dentures for most of the cats in Africa, since they are usually made of polished fragments of cow
bones. I peeled off my photojournalist vest as it is getting warmer as we are coming down from
the altitude of the crater, and have taken photos of the same bougainvillea bushes that I have now
seen in several stages of their blooming. I used the gazebo here as a good place to eat our
standard box lunch. The only further event of note in the course of our drive back to Moshe is
that we made a brief fueling stop during which we all hopped out to find the ―facilities.‖ They
were not as good as the grass behind the station so each of the males went through the low gate
to make the grass greener behind the station, and on a hurry up return, I forgot how low the lentil
of the gate was and bonged my forehead with a resounding metallic clang. I had a Kleenex in
my packet for just such emergencies and stuffed it in the scalp laceration among lots of
comments in the Land Cruiser that it is a nasty thing to have the one person with a laceration
being the only one who is capable of suturing it on up. It made for a decorative addition for the
rest of the medical mission, since it made me look like I shared something of incisions with my
surgical patients.
Our drive back was overcast, so we did not get the dead ahead shots of Mount Meru that I
usually see I driving toward Arusha—my next target for a climb with grandkids. We did get a
minimal glimpse of Kilimanjaro, unlike the spectacular foreground of sunflowers in bloom and
backdrop of snow-capped glistening cone photographed last year from these same vantage
points. We returned to the MT Inn and checked in again, in order that we might be a fixed target
for the two students who would be looking for us here and which we used as the rendezvous
address for takeoff into Phase III –the Med/Surg Mission. As it turned out, after some
uncertainty through the evening dinner, the address was a good homing signal, since as I was
typing this on the porch of the MT Inn room, Holly Pierce arrived to tell me she thought she
would recognize that explorer sitting looking up at where Mount Kilimanjaro would be! I was
glad to see here and got two bits of news, one being possibly the only ―downer‖ of the trip thus
far. I introduced her all around to the climbing/running/safari teams and then later Jay Miller
came over from a hotel he had got down town in Moshi, so we could repeat the process as we
watched the improbable win of Netherlands over powerhouse Brazil in the World Cup to
advance to the finals.
3
The one and only bummer, is the bag of meds and supplies including spinal anesthesia
kits I had packed and transferred to Holly‘s father in Derwood. He is a US State Department
representative on the Crisis team and had met his wife as both were Peace Corps Volunteers.
Holly spent some tem n Khartoum where they were posted, and they also got to know the present
US Ambassador to Ethiopia. For that reason Holly had picked up the bag all inventoried and repacked in the SCI blue bag, and then stayed o in Addis Ababa for a couple of days on her flight
form IAD on Air Ethiopia, following our flight pattern a week later. As a guest of the
Ambassador, she was taken around Addis, and enjoyed that, but then she had to report that on
arrival in Kilimanjaro Airport, the bag was confiscated since it did not have a Mission Letter
clearing its importation. I had all of my licenses and credentials in the bag, and the Mission
Letter accompanied all the other medicines which were coming through Dar on the same day.
We used her SIM card in the cell phone to call Dr. David Mwenge, the WHO rep who has met
me on several of these missions, and told him that the bag had been sequestered in Kili, and
asked it to be forwarded with his push for its clearance. We all agreed that is what should be
done, and I alone was convinced that it would never happen, but that my SCI Blue Bag and all its
contents were already distributed through the black market. That was sure thing—and quite
possibly, the ONLY glitch of this entire trip thus far as things keep going from good to even
better!
Later that night during the further fervor of World Cup televised play at the bar in MT
Inn, I got calls from David from Ilya Tours and an associate who had met me on our arrival and
had taken us first to Arusha and then forward to Moshi, and a private land cruiser was arranged,
for $400 with the drive getting up at 2:00 AM to leave Arusha and pick us up at 5:00 AM for the
four hour trip from Moshi to Korogwe where the first day‘s clinic is being held with the Toledo
team driving up toward Korogwe from Dar as we are coming down from the highlands toward
the coastal area of Tonga Province. We will arrive at around the same time and start the clinic
immediately in Korogwe, for our one-day stand there. We will be ready here with a room we
arranged for Holly and Denis and I in another and then go downtown Moshi pre-dawn to pick up
Jay Miller from his hotel there.
So, HERE COMES PHASE THREE! It had the two precedents of successful outcomes
of the first two component parts, so we are starting up the mission with enthusiasm and a lot of
forward momentum. And Away We Go!
4
10-JUL-A-3
AFTER A FOUR O’CLOCK RISING FOR A FIVE O’CLOCK
DEPARTURE FROM MT INN AT MOSHI, WE DRIVE THROUGH THE
SISAL PLANTATIONS DOWN A ONE THOUSAND METER ALTITUDE
DROP TO GET TO KORUGWE TO BEGIN OUR SCREENING CLINIC
WITH CASES BEING REVIEWED AND THE AFTERNOON AT THE ST
RAPHAEL’S HOSPITAL DOING A COUPLE OF CASES, A LARGE
HYDROCELE AND A HERNIA REPAIR UNDER KETAMINE WITH A
FOLLOWING DRIVE TO TANGA PROVINCE TO HOLD OUR
TUTORIAL DESPITE BONE WEARINESS AT THE SEASIDE RESORT
AND A PREP FOR A NEW DAY IN TONGA PROVINCE IN REPEATING
A BIG CLINICAL DAY.
July, 3, 2010
Here we are! TANGA= 05* 14.37 S, 037* 06.37 E, at s meters altitude, smack
on the Indian Ocean coast at Sea View Hotel in Tonga City
Our day started before dawn in Moshi, in the highlands of Kilimanjaro Province, then
after a four hour drive down the scarp to the coastal plain we arrived in Korogwe where I had
worked last year in both clinics and the District hospital, and at 3:00 PM we packed up the busy
clinic and got in a bus to go to Tonga City on the coast up further north n Tonga Province to
settle in at the Seaside Hotel to start up our main venue for the clinical missions in both medicine
and surgery here. It was a very long day, in three very distant venues, and still at the end of it we
had the usual tutorial in which each of us could present patients and discuss them so all could
learn from each.
It began well before dawn, since we had to be on the road to start a clinic at nine o’clock
four hours away in Korogwe. We picked up Jay Miller at a downtown Moshe hotel he had
somehow found on his own, and we went toward the coast, dropping through the higher
elevations along a mountain range. We could see well-outfitted hunters who were hauling
trailers with Olive Drab tarps stretched over them. I had asked about hunting opportunities in
Tanzania as a chaser to the next trip. I am referred to David of our Ilya tours and he will see
someone else about it.
We drove through the sisal plantations that grow along here and in a few instances—
passed too fast for me to unlimber the camera—I saw the long ―blonde‖ sisal fibers laid out
across a bar to be combed and dried. They make a lot of hardy textiles out of this plant, which
looks like Yucca the Century plant, but it is a market that had once boomed and has since busted,
making Tonga Province one of greater prosperity in the past than the present. It is the same with
the fibers that make the ―t’nalak" in Mindanao an art form. The fibers were once made into rope
which made for a lot of market in the days of sailing, and navigation depended on these tough
products. Since the fibers from Mindanao became finished commercial products in the
Philippine capital it was called Manila Rope by the time it was shipped out, even though it had
come form a distant part of the islands. It is like that with the Panama Hats, which are not made
in Panama, and as far as I know never were. Their epicenter for collecting what the Andean
peasant women do as a cottage industry in their homes in the mountains was Cuenca in Ecuador
and we visited the single most prominent of these Panama hat centers in Cuenca, seeing the story
and I actually now own a genuine Panama Hat form the source—a long way from panama which
was inlay the export port.
The sun took a long time to rise, since it was hidden behind the mountain ridge along the
left side of the vehicle since we were driving the road along the south edge of these mountains
with the vast sisal plantations guarded by the spiky yucca-like plant that is both their fence and
their product. We watched the passing scene from our vehicle as we headed down from a
successive series of altitude readings to where it made no difference, since we would be in sight
of the Indian Ocean. At every new change of a couple hundred meters, it got several degrees
hotter. The driver had told me of the hunting convoys we had passed, and as we dropped out
from the altiplano along the mountains, we were no longer in hunt country, but in the urban
littoral along the coast. Our first stop would be where I had been before, in Korogwe—a stop we
were making since we had promised to do so, but we would only spend a day n the clinical
missions here and then move up the coast another two hours to get to the Tonga Town where the
major part of our mission would be held.
THE CLINICAL MISSION BEGINS WITH A MEDICAL MISSION AND
SCREENING CLINIC WITH A PHARMACY AND TEETH-PULLING
DENTISTRY IN KORUGWE SCHOOL, BEFORE A SURGICAL
ADJORNMENT TO SAINT RAPHAEL HOSPITAL
Our set up is in a school, but a different one than we had been in last year. We arrived at
the nine o’clock starting time, as our vehicle pulled in just as the teams were set up for screening
patients, and the pharmacy had been organized next to an open hallway that was going to be the
tooth pulling dental clinic. I off loaded Holly Pierce and Jay Miller into their stations and set up
as the coverage of Audrey Roberts who had been the Students for medical Missions president at
University of Toledo last year, as I met Shweta Pai a rising sophomore who would be the
president in the coming year. I would cover Audrey and also float to answer the questions of the
junior clinicians, none of whom had been in Africa before and all of whom were interested in
learning the unique tropical pathology of the area but were stumbling over the ordinary western
kinds of illnesses that were also unfamiliar to them, such as a series of venous stasis ulcers on the
lower extremities.
I greeted Richard Paat who was already seeing patients he wanted opinions on that might
have correctable surgical conditions, such as an elderly man with a large hydrocele, and a couple
of potential hernias for evaluations. I saw a woman with a large right breast mass which had
been present for several years, and was smooth and mobile. Given the epidemiology of breast
cancer and the non-tender rubbery consistency, I knew it was neither inflammatory (she had
nursed a couple of babies through its presence, and had never had a fever of pain in the area) nor
was it malignant. She has a large adenofibroma of the breast, and, lucky her, she can just watch
it to see if there is any reason later to do something about it. It would be removed anywhere else
in the world, but only because of its presence, not because of its immediate threat to her, and
since that does not exist, she can keep it—advice she was more than happy to carry along with
the lump.
Several of the team members have been on missions, usually in Central America, and
most of those limited to screening outpatients or puling teeth. A couple of the students are very
eager to be with me since two of them are seniors already committed to going into surgery
residencies but have never had any hands-on surgical experience. They are eager to see if I can
use the adjacent schoolroom for an ―O T‖ and operate in these circumstances, on such cases as
the hernias or hydroceles. But I have also heard that there is a Hospital nearby set up by the
Catholic Church and in considerable disrepair, but it is the facility that would be pushed to serve
in the emergencies such as C-sections or trauma. It is called Saint Raphael, and I have not seen
it before, but apparently it has the name ―hospital‖ and such a setting is preferable to operation in
the janitor’s closet in a schoolhouse, so we will gather the cases we may need to operate and
carry them over there for later afternoon.
Another patient with breast mass comes in with a contrast to the one just demonstrated.
This one is nursing and this one is tender and has a fever—so she is treated for the mastitis she
has, and encouraged to resume nursing from that breast—the classic situation in which the
woman so afflicted immediately stops doing the one thing that would encourage drainage of the
collections of infected milk which should be no harm to the baby which would do her the favor
of the ―D‖ without the ―I‖ of ―I & D‖. I gave a short course in Apothecary script in all its
antique shorthand for the writing of prescriptions so that a long lyrical narrative would not be
necessary to translate at the Pharmacy. As in most missions, it doe s not matter what is written
since they will get what we have in substitution for equivalent medicines, and the patient will get
a translation in their own language of how to take the medicines. There is a rising sun, a full and
sunset, and then a moon to show the intervals. And the best use of our nursing students from the
same school as we had with us last year are going to be in the pharmacy as well as at each
station. It is always disconcerting to hear about ten minutes of dialog between translator and
patient reduced to ―No‖ or ―She has pain.‖ But the nursing students at least are not eager to get
in and treat the patients themselves rather than letting that function fall to the clinicians. And the
big difference so immediately apparent to everyone, most of all the students themselves, is the
huge gap between freshmen medical students and the juniors who by that time have got the drill
down on how to assess and present patient histories to their supervisor for the decision process.
As in America, most people are coming in with either functional complaints, or with a classic
pathology so obvious, it is ―res ipsa loquitor‖—speaking for itself –but only to those with enough
experience to tell at a glance what is going on and the reasons for it.
The nursing students are very good as translators, and are eager to be with us. They are
gong to get a certificate at the end of our stay in ―graduation‖ in which they also receive a
stethoscope and a few decals and other mementoes from University of Toledo. The nursing
students are uniformly better than ―Dr. Grayson‖ who remembers me from last year and is eager
to please and be treated as a colleague. He has not learned anything notable since last year, and
most of my pearls dispensed to him are heartily agreed with and forgotten immediately. He is
very unreliable, and if I send a patient over to him for, for example, a gynecology exam, he is
most eager that it be done but cannot do it, nor any other rudimentary medical procedure. So, he
is largely there to make it seem like the community is part of the practice we are carrying out, but
he is less effective than our nursing students and knows less medicine than our freshmen medical
students. I do not rely on anything relayed through him as being done. Such as the referral of
the two patients we selected for operation to be sent over to Saint Raphael’s Hospital where we
would catch up with them and operate on them in later afternoon. I kept seeing them over and
over again, as Grayson sent them back to me, as, after all, I am a surgeon and they needed
surgery, so it would no doubt get done if they were in proximity to me rather than over where it
was supposed to be done. On the fourth such pass, we went over to Saint Raphael’s hospital and
carried the patients there ourselves.
Given the instructions and the plans made clear to all in several languages, we still must
stand drowsily as the whole process is re-explained and not much happens as the weakest link in
each chain finally gets the understanding that we are actually going to DO something not just
talk about it. After a PBJ lunch we are going to Saint Raphael’s with Kannan Samy, a senior
med student Tamil-Nadu ancestry Ohio-born who is a friend of John Lazarus, my U T Gujaratiborn friend and Calvin grad and twice traveled to Sudan and once to Ecuador with me, and a
rising senor going into surgery and with holly Pierce. Kannan is wearing the five-toed black
rubber socks ―Vibram Five Fingers‖ alleged to be the choice of runners but which also makes
him look like the Swamp Creature for the Black Lagoon emerging on dry land to treat patients.
He has heard a lot about me from John Lazarus and is convinced that I can operate under almost
any circumstances, and we are about to test the limits of that hypothesis as we enter the
somewhat ―Spartan‖ OT of Saint Raphael’s Hospital.
The Hospital is on a hill and ha s a beautiful setting amid bougainvillea intertwined
around the cistern that collects rainwater runoff. It looks good, but has not functioned for some
time, at least not the OT, and the last and only patients treated here as far as I can understand it,
were C-Sections—a testimony to the resiliency of pregnant women near term. I get dressed in
scrubs and bring in the first patient, the elderly patient with a hydrocele for Holly Pierce to be the
primary surgeon in her first-ever operation. That is the case also with Kannan who will be the
one to do his first operation on a man of substance—he is wearing a sport coat—who has a direct
hernia which he is eager to have repaired before the US Surgery Professor vanishes later this
afternoon. He has a motorbike, and after Grayson has sent him around to me for the fourth time
after the first several sets of instructions on getting him to Saint Raphael’s Hospital, he loads the
elderly fellow with the hydrocele behind him on the bike and drives over behind us. I ask for
anesthesia, and as in almost all African OT’s, they know only one kind of anesthetic and that is
to dose the patient with a neuroleptic shot of Ketamine. So, we have a patient not hurting form
the operation but moaning in hallucination from the drug effect and at the conclusion of a swift
hydrocelectomy—selecting from among the huge ―horse scissors‖ and other gross tools in the
OT--, make a minimum fuss of it, and show the two students how the inversion of the sac in the
―water bottle repair‖ is done. I discuss why it is that hydroceles are so common in this area,
since they are a virtual proxy for the frequency of filariasis. I learned that Holly’s grandfather
was a WW I General and a hero of some renown. Her parents met in the Peace Corps and they
were stationed in several State Dept posts which is how she happens to be a family friend of the
US Ambassador to Ethiopia with whom she stayed for a few days before she caught u with me in
Moshi, her first return to Africa as an adult having been a child during a posting to Khartoum.
Now, it is Kannan’s turn and we fix the Right Inguinal Direct Hernia—swift and
smoothly before kannan even knows what has happened as we imbricate the bulge without
dissecting out or entering the sac. Once again, the distinguished patient is reduced to a drunken
grinning sot blowing bubbles after Ketamine anesthesia and we have to put him in an otherwise
unattended room in the hospital and wait until he recovers—not from his operation but his
anesthetic agent. Despite this delay, and the caution that we must leave by three o’clock in order
to get to Tonga Town before dark (it will never happen—since every one of these missions has
people loitering afterwards, slowly packing up and as long as our presence is seen, new patients
keep coming since they see the ―Clinic is still open‖ and the allure of free medical and surgical
treatment overcomes any inhibitions they might have and they certainly have no sense of
―closing time‖ or time at all! So, we are not only not in Tonga by dark, we are not even started
on our journey, since on the Equator there is a perpetual Equinox, and at 6:00 AM it is dawn
abruptly, and at 6:00 PM it is black dark even more quickly. As the group loiters and says
goodbye to the staff and thanks them, we have our ceremony of presentations of certificates and
the individual photos and group photos as each are given their rewards.
For someone (and there are each of the four of us from Moshi) Whose day began at 4:00
AM though the long venues, it is dark and in the bus we should have boarded at 3:00 PM, finally
getting got it after packing in the medical bags (mine notably absent since it is still –and
forever—impounded in Kilimanjaro airport) we are treated to a cold air shower form the
overhead A/C and a drive though the dark to arrive in Tonga Town at the Seaview Resort—
without even seeing the sea in front of us and a weary group dragging their stuff up to their
rooms, reluctantly returning to the long porch of the hotel for dinner and a bottle of Serengeti
beer (or the alternative –as David’s tee shirt says—―Kilimanjaro—If you Can’t Climb it, Drink
It!‖) Despite that late hour and the buzz about having got started in the medical mission after
long travels or other activities along the way, we are in our third major distant venue for the day
(see GPS marking at the opening of this chapter) we hold a good tutorial with me giving an
introduction to the Tonga Province coast telling them they are following in the footsteps of
David Livingstone on his arrivals, but also the sacred spots where his body was carried out, first
to Bagamayo, the slave export place to be carried to Zanzibar to be shipped back to Westminster
Abbey for enshrinement for having done something definitively good for Africa and humanity –
and we might aspire to do the same.
10-JUL-A-4
A FULL CLINICAL DAY IN A SCHOOL ROOM AS I ROTATED AROUND CLINICAL
TEAMS HELPING MAKE PATIENTS’ DIAGNOSES AND DISPOSITIONS OF 112
MEDICAL PATIENTS AND SELECTING THIRTEEN SURGICAL CANDIDATES
SCHEDULING THEM FOR OPERATION AT PONGWE HOSPITAL OVER THE NEXT
SEVERAL DAYS, AS A GROUP OF PRIMARY HEALTH TEAM TRAINEES ARE
BROUGHT AROUND TO FOLLOW US AND BE TAUGHT AT AN ENTRY LEVEL; THEN
WE GO TO SEASIDE INDIAN OCEAN RESTAURANT FOR PROLONGED TUTORIAL
AS WE AWAIT DINNER SERVICE BEFORE AN EXHAUSTED TURN IN:
A CLINICAL DAY OF AFRICAN “HORSES” AND “ZEBRAS”!
JULY 4, 2010
HAPPY USA INDEPENDENCE DAY! (WE WILL GET TO TANZANIAN INDEPENDENCE
DAY CELEBRATION IN ONLY A FEW MORE DAYS—WORKING BOTH HOLIDAYS!)
Here I am on the Indian Ocean taking a stroll along the waterfront where Arabic dhows
are raising their lateen sails just after dawn as they have for as long as recorded history, riding
the twice a year trade winds that give the rainy seasons here, reversing as the dry seasons‟ winds
carry them back. The commodities that they carried have in more recent times contributed to a
problem in African deforestation, since large sacks of charcoal are stacked all along the
roadsides for pick up to be carried to the charcoal braziers of Oman from the sand-smothered
wood fires hacked from the Tanzanian interior. In only somewhat less recent times, the
problems may have been even greater in the commodities carried in those same dhows on those
same tradewinds—human beings, exported in large numbers in the slave trade. That will be the
principle focus on a number of my final observations in Phase IV of this trip, having just got well
started in Phase III—when I re-trace the final pathway of my hero David Livingstone in his
mummified remains (minus his heart, buried under a Mobolo Tree in Zambia where I stood in
1989) being shipped from Bagamayo where I commemorated his passage last year by dhow to
Zanzibar. It is in Stone Town at the British Consul that he left by steamer to Victorian England
in mourning for him, as he was confirmed by the Royal Hunterian College of Surgeons (another
of my addresses in my “European Home Town”—London) to have him enshrined in
Westminster Abbey as the great Liberator.
1
I am here on that Indian Ocean at INDI= 05* 04.32 S and 039* 06.34 E at O meters
elevation. It is the fourth of July, and I am high as a kite—as I also have a small American flag
packed along with me. It is crossed with the Green Black Tanzanian flag since their holiday is
coming later this week. Neither of these will be observed as a “holiday off” since we are
working hard both days.
I only now saw where we are in relationship to the Indian Ocean as the Sea View resort
hotel in Tonga Town. I had a rather nice surprise by opening a balcony door and finding that I
was overlooking the front street, and on the far side of the street was an open park with a steep
bank dropping off to the Indian Ocean. I looked out at it and used the Dictaphone as well as the
GPS to record that position we now occupy and will for the next four days, and then scurried to
get out before our morning breakfast will be served on the hotel porch where we had our dinner
last night and our tutorial to follow it. I ran across the street and went out under a large
spreading neme tree next to a mango tree in the park where there were even cement benches,
somewhat worse for wear and tear. I had heard the muezzin make the second prayer call since
the one I had heard pre-dawn, and am glad to be up early after a long prior day, delighting in the
“resurrection” form bone weariness that can be induced by long distances and activities in each
of the three major venues of our long day yesterday. Today promises to be something on a
bigger scale since we are setting up in a more definitive position, and I will also have a big
surprise in that the nearby district hospital is going to be made available to me to begin operating
on an expanding list I am sure will be filling up the schedule, with both the medical students and
the “Clinical Officers” eager to get involved in some real curative care—in which they view
surgery as a much more capable therapy than the screening clinics of pediatrics and medicine.
I walked the sea front in front of our rather ordinary Sea View Resort, but am glad that
we are situated to look over an open bay which leads directly out to the Indian Ocean with
nothing but Zanzibar (which we will tour as our reward for a hard-working week) and Pemba
between us and Australia. A world of water is either a barrier or a highway, as it was for the
early seafarers here, whose descendents are pulling up their lateen rigged sails right now in front
of me as the graceful dhows move slowly out into the bay from being virtually beached in front
of me. With hardly any perceptible breeze in the mango leaves overhead, the calm seas still has
this ancient design watercraft moving gracefully and smoothly propelled by only zephyrs, as
their ancestors had mastered in a sailing craft so good that they could make it from here to the
Oman, Yemen, Dubai Creek each of which I had explored and marveled at the number of East
Africans from nearby in these “Spice Islands” and how they could make it twice per year on the
trade winds that are the atmospheric equivalents of what the interior peoples live off from called
the alternating Rainy and Dry Seasons, as the globe tilts along this Equatorial line under the
atmosphere, that moves one way, picking up moisture content off the Indian Ocean surface, and
as it rises up the Eastern Scarp or the Great Rift, cools and drops its water load in the torrential
rainy season, but in the reverse of that season, the same air column slips downhill desiccating the
landscape as it drops and heats up pulling water from the soil and dropping it later out in the
2
Indian Ocean to keep the “Hydrologic Cycle going indefinitely. “Springtime and Harvest” as we
know it, or "Outbound” and "Homeward Bound" as the dhow-seafarers knew it.
The Europeans also had words for it, since they had to sail from England or later under
steam to round the Horn at the Cape of Good Hope and beat up the Indian Ocean toward the
Raj‟s Empire of Inja—of which Victoria became the direct regent, the Imperatriz, after the Black
Hole of Calcutta incident in which British citizens suffered at the hands of the Indians in the far
away colonies settled by the British East India Company. She was not amused, and would have
none of this violence directed at her citizens even if they were in a non-state private company, so
she took over the direct rule and sent in the Royal Navy to access “Inja” in her Empire as the
Crown Jewel. POSH as the Europeans knew it, described the Upper Crust who might come out
to Inja in Her Majesty‟s service. They deserved the cooler side of the ship as the pre-A/C days
were under the miseries of an Equatorial sun in a floating tin can. So, those who could afford to
be choosy, chose the “Port Out” meaning they were on the “left” hand side of the boat on their
way toward India, but reversed that so as to be berthed on the “Starboard Home”—like the
bullfights in Spain and its colonies—the high price seats were in the “Sombre” and not in the
“Sol.” As only mad dogs and Englishmen went out in the NoonDay Sun, the Imperial
bureaucrats had to protect themselves by being choosy as to where they would sit in the course
of moving through Empire. The dhow captains out in front of me this morning were always
under the merciless Equatorial Sun, and they oriented themselves instead to the direction that
wind was blowing—prevailing out bound in the dry season and homeward during the rainy
season here---all of this propelled by the mighty “Wind Engine” atop the Jewel In the Crown—
the Himalaya—the “Home of the Gods”—a place I have known well and often.
My musings were confined to the tape recorder and a chance to shift gears as a new and
intensive part of the medical mission would be launched today. A business man named Julius
has been very active in getting us here and joined us on the veranda of the Sea View Resort
Hotel. He is on the town council of Tonga City Central and is part of the Sister City campaign
with Toledo. He is s civic booster, and has a business which involves a private company with
products for veterinarians‟ care of livestock. But that does not mean he is not interested for
personal and family reasons to get to know the visitors from America. Just like the Mayor of
Moshi who was distant and regal in his robes and gold-colored chains of office until he saw my
card and titles, he came to call upon me later to say he has a son who very much needs to be in
the USA to get a degree and title to help him finish off his education and must be supported to do
this to return and benefit his people. Julius comes to make a request that his niece come to work
with us, since she is a graduate of the KCMC program in pre-medical studies. I met his niece
Meena, and she is a graceful and beautiful young lady, whom I tried to involve in our tutorials
and the workings of the clinic. She is very reticent, and when I ask a question she speaks in a
voice so soft that I cannot hear it let alone the others who are supposed to be exchanging and
learning from each other. She is going to be applying to higher education, most likely through
the KCMC, and will no doubt use her brief period of observation with us as a credential to do so,
3
with a later request, most likely, that now she is ready to come to America and must be supported
to continue her studies there.
Our quite satisfactory accommodations overlooking the Indian Ocean complete with a
balcony has a toilet, which, of course, does not flush and there does not seem to be any hot
water. Therefore it is fully up to standards for my expectations and I have adapted to it easily.
Others have expressed their complaints for a different standard of expectations and the Hindu
owner of the Sea View Resort has switched a few of them around in rooms to see if any of them
are more to their liking. We have a new joiner who is a great asset to our team. Donald Miralle
is son-in-law of Linda and at least half Philippino as would give him further points with Richard
Paat and our Nurse/Pharmacist Josie, Richard‟s “favorite Auntie.” Don is a professional sports
photographer, and has come along to take pictures of us, sort of the way Dennis has been
doing—but Dennis saw a few of the photographs Don had taken on his earlier side trip to the
Great Selou Game Reserve and quickly said to me “You ought to get yourself a professional
photographer.” Dennis‟s pictures are good, but Don‟s are stunning.
I have been eager to get into the Selou for a long time. It is named for the greatest of the
African Big Game hunters, the one who is incongruously looking down in the British Natural
History museum over the last Quagga ever before its extinction from hunting pressures by the
British Royals who used to shoot the Topi and Quaggas herded toward them by “beaters up” and
would shoot double barrel Rigby and Holland and Holland custom made rifles reloaded for them
by bearers, very much as they might have popped “beaten grouse” on a shoot in Scotland. The
bag limits were astounding, like Argentine dove shooting. Selou had reformed a bit over time
and had gone from being one of the great elephant killers to one who advocated retaining a few
fro seed stock. He was also acclimatized to the African climate as a “PH” (Professional Hunter)
and had a resistance to much of the illness that felled most Brits coming in fresh. As an
acclimatized savvy PH guide, he became a leader of British Expeditions into the formerly
German territory. He had guided Teddy Roosevelt in the last great Safari for shooting out whole
herds of animals, many of which are still stuffed in packing crates in the Smithsonian for
taxidermied exhibits in our own Natural History Museum. There is a group of the African
Crowned Cranes in a diorama in Washington labeled “Shot by Theodore Roosevelt on East
African Safari.” Teddy himself was a shoot „em all dead hunter, until he too mellowed out and
tried to preserve the game as well as the habitat in the great national parks system of USA that
spawned a whole genre around the world. The Selou is a game hunter‟s concession and is a
paradise of big game, abounding in buffalo and elephant and most big game species. I want to
get in there and hut, but also to explore one of the great intact ecosytems of Africa.
Don Miralle has just done that. He is fresh back from the Selou—twice the size of the
Serengeti ecosystem. It supports a lot of the Tanzanian government objectives by the exorbitant
rates charged to hunters. Don took photos, which are not just good, they are STUNNING. See
www.donaldmiralle.com and click on Selou. I want to return next year and tag on an extra week
to do a hunt in the Selou largely just for the experience of being there.
4
I got my TIMU tee shirt, to add to my Kilimanjaro Marathon tee shirt, and carried all the
newest surgical and medical journals I had carried with me, regretting that all of my meds and
especially the spinal anesthesia kits were locked in the Kilimanjaro Airport so that I could not
use them here in this straight ahead surgical clinic to follow up on the patients selected form the
screening medical clinics. We adjourned from the veranda breakfast of our Sea View Resort
Hotel run by the Tanzanian Hindu of East Indian origin whose whole team is part of the family
and got in the bus to go to Pongwe to set up our clink there. As we drove in there were about
three hundred potential patients awaiting us. I told the team to remember this since they are here
under the promise of a medical team coming to help. However, I said contrast this with the
crowd you will see on your last day here, since the rumor will go around that not only did a team
come along as promised, but we saw with our own eyes people coming back with free medicines
and even some have had free operations. That means the last day the crowd is usually ten times
the size of the first day, as each are desperate to get whatever we have before we take it all away
with us. We will see how accurate that predication is since we are already off to a roaring good
start.
We are setting up in a school in Tonga City in several classrooms, with multiple teams in
one building separated by screens of a separate room for a gyn examining table. The dentist will
have a separate room and a separate building will house the pharmacy. We will triage at a front
table where civil engineer Denny is being invaluable in policing the patients who come with the
slip of paper recording their names and BP and chief complaint making some order out of the
chaos that would result, especially near closing each day or particularly on the last day.
On one classroom wall I saw a poster advocating for the rights of albinos. It seems that
the life of an albino in Africa would already be tough enough, since they are victims of the
overhead merciless sun without a pigment protection from the rays that would lead to skin
cancers which are normally rare among Africans. But, there is a darker side for these unnaturally
“white” people; the sorcerers and local witch doctors consider them a special breed with powers
to cure diseases. That is not to say they are empowered to go out and cure the sick, but that
“parts of them” are sold as medicines, as Juju to put into various concoctions to alleviate bad
mojo. So the life expectancy of an albino in Africa was first limited by their susceptibility to
disease against which the others were relatively protected; but, second, is that tradition of their
having a special power to fix what ails people if only they can get their hands on some of the
body parts which a few of the darker practitioners are all too happy to disassemble.
I saw a half meter chunk of rail from the narrow gauge railway hung from a tree which is
the school bell when struck by a pipe tucked into a crotch of the tree. As we waited through the
always long slow process of getting started in a new place, I gave the requested dissertation on
the geographic medical consideration of Vitamin D and its requirement to prevent rickets, and to
allow childbirth through a non-deformed pelvis, and the evolution of hunting and fresh kills of
spoilable meat which was eviscerated in lion-like preference for the fatty high calorie fat-soluble
vitamin rich food preferences in going up the food chain, the reason with lighter skin covered up
5
in the winter in shorter period days, grandmothers did the same thing by making their children
take a teaspoon of cod-liver oil in my youth, before nearly ubiquitous addition of irradiated
ergosterol to all milk supplies to prevent rickets by spiking the single food source required by
those at highest risk.
We were still protracting the process into late morning before the patient flow was
established that allowed us to show to the Clinical Officers what we would suggest as a
“differential diagnosis” as they acted as translators. A special group of village folk who will be
inducted as very low level “Health Promoters” are going to be observers in this process of the
clinics functioning primarily as the translators of the patients‟ complaints. The Clinical Officers
are already the “go to” team for the day to day relief of what it is that trouble most people, so we
hope to elevate their skills in the resolution of some common complaints. There is a chief
medical officer here, also named Julius, who is primarily an administrator. He said he is eager
that I teach him surgery which he has never done, but he is often confronted by problems which
should be treated surgically and he does his best to divert them away to somewhere where
someone else might take care of them. I gave him all my surgical journals for which he
expresses great gratitude saying he will be reading them each night, but my principle focus will
be on the Clinical Officers who are the ones who will have to handle almost all the emergencies
and the acute surgical needs.
Quite a number of blind people were admitted being led on a stick by the small boy who
is their seeing eye. Almost all had the corneal opacity of trachoma. None had glaucoma or
cataract as their principle reason for blindness. One had trauma to the only seeing eye they had. I
believe that all of the patients I saw had easily medically preventable blindness. There were also
quite a few of the kids with “squint” meaning that they would have cortical blindness after a few
years of diplopia to prevent their going nuts on the dual images portrayed to them, they would
simply extinguish all signals from the divergent non-dominant eye. These kids should have been
found earlier and patched so that the non-dominant eye gets a chance to become yoked in
conjugate gaze. One of the blind patients has a cerumen impaction—wax buldup pluggin his ear.
I do not want to go around irrigating the ears of everyone who has this problem, but for the blind
patina that is a necessity since he is going to be navigating on his ears and must have binaural
hearing. So we irrigated out the ears on this blind patient and I advised that they take down the
setup before we would be overwhelmed with everyone who demanded the same service, even if
they had one or two eyes which made their hearing a special luxury of an added sense.
We had a whole series of US-type illness patterns: the "horses". [I use the term from
the old adage "When you hear hoof beats, you look for horses, and not zebras." I often add,
"Unless you are in an area where zebras outnumber horses!"] The curse, and staple, patient of
outpatient US family medicine practices is the sofa spud with the “metabolic syndrome.” The
patients were obese, hypertensive, asthmatic, with degenerative joint disease and diabetes. Hey,
wait a minute! This is why I am here, to get away from first world self-inflicted disease patterns
6
of over-indulgence! So, inhalers were dispensed and breathing treatments were given almost as
though this were the USA emergency room
Julius brought in his son with an unusual problem already worked up to get my opinion.
He has “macro-digit.” In an otherwise perfectly normal hand he has one digit about five-fold
oversize. It does not seem to get into the way, and had not been injured. There is no evidence of
neoplasm or hemangioma. He is not troubled by any circulation problem like an AVM
(Arteriovenous malformation) He has brought in an X-Ray to show a normal bone structure. HE
has a good grip. I advised them to stay away from any medical intervention. Other than possible
teasing from other kids at school, he has no loss of function in any other way, and EVERY
treatment suggested will lead to some form of disability since they all involve some degree of
amputation. He has a good grip and fist and should not lose that and any intervention will make
him worse, not better. It makes for good photos in my collection of congenital hand and foot
anomalies, but he does not have a functional problem and should avoid getting treatment that
would give him one.
I saw a woman with a recurrent ganglion cyst in the brachioradialis tendon. I told them
that she might be injected or have it re-removed, but either means she might have a recurrence as
she would already be in a position to know. Despite all this information, she still insisted she had
come to have it removed, and is added to our OT list. A man with a large hydrocele was added
to our list and then one after another I saw multiple hernias and hydroceles. I was sent several
people referred to me with the diagnosis “Hydrocele”—each of which, on exam, turns out to be
hernias. After a half dozen of these, word must have got back, and now a whole sequence of
men with “Hernia” were sent to me, each of which, as it turns out, had hydroceles. We made a
list of those I would operate on in the order in which they would be fixed at the local hospital
which I understand I am to open.
I saw multiple skin rashes, a few skin tags, several post-pregnancy problems, a lipoma of
the right groin sent to me as a hernia, a 2 year old child with cerebral palsy, for which she needs
social services which are likely to be in short supply in Tanzania, especially distant from the
capital city. I was sent a dozen patients with “Hernia” and ten of these were not hernias. One of
them was bilateral hernias, but he came with a bag since he had been incontinent of urine for
several years. “Fix his hernias” said the note.
This is the classic snookering into a doomed situation. Yes, he has two acquired direct
inguinal hernias. Why did he acquire them? There are three reasons of acquiring a direct hernia
at an advanced age, unlike the indirect inguinal hernias which are largely congenital defects.
Increases in intra-abdominal pressure from 1) Chronic coughing, 2) bowel obstruction/
constipation, 3) bladder outlet obstruction. He clearly has prostatic urinary obstruction, and has
overflow incontinence from a distended bladder.
7
I explain all this to his brother who speaks good English. Yes, he responds, that is what
they told him already and they suggested he go to KCMC to get his prostate fixed. But that
means money since he has to get moved to KCMC which is several hundred dollars away (I
know, I just paid two hundred dollars for each of four of us as we drove down the day before
form Moshi to Korugwe!) We cannot afford this. So, since your services are free why can‟t you
fix him here? We do not have three way irrigating catheters nor an inpatient service for the
aftercare which is nursing intensive. Ok, then just fix his hernias. How, did he acquire these
hernias? If fixed, without removing their cause, they would recur immediately and he would be
worse off.
You understand all this don‟t you? Right. So, get him to KCMC where they can fix his
BPH and do his prostatectomy and only after that can his hernias be repaired after this cause is
removed. Got it? Yes. Nonetheless, when we get to the Pongwe Hospital for our next phase of
the operative list, who is the very first person shown to us to be the first on our list to fix both his
hernias? You guessed it. Going through the explanation yet again, brings forth his brother who
says “yes, but we do not have any money to get him to KCMC so you will fix his hernias here
free.” It all makes perfectly good sense to them, and why we should be so dense as to not
understand that they can appreciate that he needs his prostate fixed somewhere else but all we are
required to do is fix his hernias free here and now. And get a guaranteed complication and
immediate recurrence. Yes, I know, but you have to do something! Each subsequent day, this
patient is the first one presented to be the first one operated each day, with each day a repeated
explanation and agreement by all concerned, and the following day we will see him again as
operative patient number one.
By afternoon PBJ lunch break I have listed fourteen patients who are operative
candidates. I know we will accrue more patients for operation and faster than we can get them
done, especially since we are here and collecting patients for operations which we are not doing
as yet. I have another patient with a pilonidal infected cyst in the midline cleft, a half dozen
more hydroceles; a woman comes to me with a renal cyst shown on ultrasound. They had
enough money and resources to get to a center where an ultrasound was done, and now they are
coming to a schoolroom with a pile of supplies in duffel bags asking that it be operated here,
since the diagnosis is already made and the therapy is free. I saw several supraspinatus
tendonitis, a lot of DJD (degenerative joint disease) several more venous stasis ulcers we treated
with graduated pressure stockings, and a half dozen filariasis elephantiasis lower limbs. Once I
had demonstrated these, then a dozen of them were removed from the queue and brought all of
them alleged to have the classic misnomer “Elephantitis” (which would mean an “inflammation
of an elephant”!!) I explained, that, no, these are NOT elephantiasis—look to see that the puffy
ankles are bilateral and that the patient also has distended neck veins and shortness of breath.
This is a “horse” and not a “zebra”; this is a common USA disease known as congestive heart
failure, and it is bilateral pitting edema of the lower extremities which your ancestors in Britain
(who did NOT have filariasis to mis-name “Elephantitis” mis-named this instead as “Dropsy”)
8
recognized as “Hydrops” from the hydrostatic component of the venous stasis from heart failure,
so the treatment is going to involve diuresis and support to a failing heart.
Horses and Zebras—they have come to Africa to see Zebras, so they are stumbling over
“horses” which are much more common in the USA and are proliferating throughout the world
under the same growth influences in disease patterns of degenerative disorders as affluence
allows those who survive the exotic communicable diseases develop those which are common
“horses” in both pastures.
For demonstration purposes, I pointed out the “Acanthosis nigricans” seen in several
patients. I had the odd sensation of disorientation, as I see women veiled in burkas as they bring
in their children and I am carrying a camera from which they turn their heads and masked faces.
Then, as they see me in clinic, they immediately pull their face coverings aside and point to
something in their jaw, and then raise their robes and show me where else they hurt, which is all
over. If I am not allowed to see a public visage, why am I treated to this grotesque showing of
private parts?
I went through the foot and ankle ulcers of 1) arteriosclerotic disease (rare as hen‟s teeth
in Africa—a “horse” and not a “zebra”, 2) neurotrophic (such as the anesthetic limb of leprosy (
a “zebra” and not a “horse” but increasingly common in Africa the imported “horse” of diabetes;
and 3) venous stasis (a “horse” not to be confused with a “zebra” here of “Mycobacterium
ulcerans”—the “Buruli Ulcer.”
I distinguished the “horse” of rheumatoid arthritis (small distal joints, morning stiffness,
gets better with exercise, younger individuals) from the DJD of osteoarthritis (large joints, gets
worse as the day wears on, in older individuals) one treated by steroids and one made worse by
them.
A large hemangioma of the right thumb and left hypothenar eminence made for another
unusual phenomenon, and a subject of the evening tutorial as another “hand deformation” that
made for spectacular photos. This one was large enough that it can cause clotting inside it and
actually calcified thrombi, which may give a “”consumption coagulopathy Type IIIa” described
by my PBBH hematology colleague Rodriguez-Erdman. This, I just happen to know from a
collection of almost never called upon stock of miscellaneous information not yet forgotten is
VonHippel Trelauny Syndrome.
I wandered around each station picking up signals that whatever was being seen was a
clueless puzzle or a slam-dunk diagnosis that still needed double checking—like the myriad of
non-hernia hernias. We were going to have to make a very early start on the long process of
getting the operations under way and I pulled out Katrina and Shweta to be the first operative
team for our introduction to what was described as quite a surprise forthcoming in our
succeeding surgical days at the refurbished Pongwe Hospital I had not yet seen. I would rotate
the students who are all eager to operate, but will focus primarily on the Clinical Officers who
9
will have to continue the operations that they have never yet done, after we are gone and the
demand for surgical services that our very presence has set will be continuing after our departure
with some capacity left behind along with our equipment and encouragement.
As, always, the “Stand Around” after the clinic should have been closed down as dark
had fallen led to still more patients coming for attention, since, after all, we were still here, and
quite apparently “open for business”. So, this loitering delay which is never able to be explained
to people new to a mission, means there is always “just one more patient” to be seen. That is
NEVER true. What IS true is that "You will never be able to see the LAST patient!"
There IS no “last patient”! At least you should hope not. And everyone is convinced
that you are waiting there just to see them, since they would rather have the European hand
treating them and giving out the free care. This undermines the training imitative we try to
bring, since we will have a lot of people we will see, but our primary goal is to enable the local
care to handle them better. We are not here to deliver care to the insatiable masses of Africa.
We are here to encourage and train indigenous care, which is why I am focusing on the clinical
officers and we have a cadre of “health promoters‟—NOT so that we can definitively see and
treat the last of the patients that come to each clinic, but that we prepare those who will be left in
charge of the continuing operations to handle them effectively.
We are late and exhausted once again on return to the Seaview Resort to come down to
the bus to be carried to a Seaside Swimming Club for a late night dinner. The process of
ordering food and its actual delivery took forever with very slow service, so we were both
exhausted and hungry and weary. But to give full credit to our team, they were still eager to
learn and share the stories of the day in an extended tutorial with the addition of a story form my
won first time mission in Africa.
We DO make a complete two-round tutorial in discussing the patients and now with
digital photography meaning we can pass around the camera to show the particular lesions not all
may have seen, we have a real “CPC.” (Clinico-Pathologic-Conference.) I end with a story by
request. I tell the story of my flight into a small village I Nigeria on my first-ever trip to Africa
forty three years ago and my attempts to revive a man with an immeasurably high fever. I tell of
my Comanche aircraft radio call back to Bingham Hospital at Jos to report that I did not know
what he had, but he died in high fever in opisthotonous, and the young woman MD whose rosegardens were attended by her and her two nurses replied that I should try to come in as soon as I
could to get started on an anti-rabies vaccine. I never did. The pilot Ray Browneye later
returned to that same village to pull out another similar patient with an immeasurably high fever
and got to Jos to Bingham Hospital where the patient died and a limited autopsy was conducted
by the young MD and her two nurses each of whom came down with the same illness, probably
from the rose thorn pricks each had in abundance. Two of them died and the recovering nurse‟s
serum was used to identify the organism and to treat it in the subsequent patients. I had seen this
disease in all its full and lethal fury before it had been described, named and understood by the
10
consulting physicians of Columbia P & S in New York who analyzed the samples from the last
patient ever treated by the young woman who is buried in Jos Nigeria.
What is the name of this village?
LASSA!
11
10-JUL-A-5
MONDAY MORNING, A CELEBRATION IN THE USA OF THE “5TH OF
JULY” AS WE SPLIT INTO MEDICAL/SURGICAL TEAMS FOR A
CLINICAL HALF DAY BEFORE RETURN TO CLINIC FOR FURTHER
SCREENING—OUR INAUGURATION OF A NEWLY USAIDREFURBISHED PONGWE HOSPITAL THEATRE
JULY 5, 2010
Wonderful! Now we are ―on a roll!‖
I have been dilating on the subjects of the differences between the patients and illness
patterns depending on the setting in the tropics or temperate zones, the first or the third worlds,
the affluent or the destitute, the ―horses‖ and the ―zebras‖ and how with the fluid world
flattening out barriers, the horses and zebras are now often found in the same pastures. Now I
have both first and third world trainees being brought through their first operative treatments in
an African Hospital which has almost-first-world facilities!
INAUGURATION DAY!
WE OPEN UP A BRAND NEW USAID-REFURBISHED OPERATING
THEATRE IN PONGWE HOSPITAL AND DO THE FIRST OPERATIONS,
NOT JUST TREATING THE FIRST PATIENTS, BUT ALSO TEACHNG
THE FIRST-TIME EVER OPERATING STUDENTS AND CLINCIAL
OFFICERS TO KEEP OPERATIONS GOING IN TONGA PROVINCE!
Inauguration day on the USA day of celebration of the Fourth of July Independence
Day—and only two days before the Tanzanian Independence Day= ―Saba Saba.‖
As I again walked along the Indian Ocean sea front in front of our Sea View Hotel, I
watched the dhows put out to sea before going back to the veranda for breakfast. Our tem might
have been as excited as I about the new facilities and the new skills they were about to put into
practice if a number of them were not on their way toward being patients themselves. Audrey
for one was slipping down fast and Richard was also getting the same GI Distress that had
foundered a couple of the others. Audrey is not typically a wilting wallflower, so she was
annoyed that the illness troubling her was knocking her out just as the treatment of patients was
about to jump to a new plateau in opening a full out surgical list from the score of surgical
candidates I had listed from our screening yesterday. I always overbook, since the same
1
obligatory drag in getting a new process started in setting up clinic is even more so in the
surgical suite. Most often the patients who are told to be first on the list are the no shows, or eat
breakfast despite three separate admonitions to come to theater fasting and with someone to look
after them post-op. Very often the first people cluttering my theatre door are the very ones I had
told are NOT operative candidates, or who need some extensive preparation before they have
any operation. True to form, the patient with overflow incontinence form BPH obstructive
uropathy is at the door awaiting the repair of his hernias despite the repeated explanations to one
and all, that he needs his prostate fixed, and only then will his hernias be both safe and
effectively repaired. Right. So here we are, and the others did not come anyway, so let’s get on
with it. Let me define for you a term ―CONTRAINDICATED.‖ This does not mean that we
cannot do an operation. It does not even mean we do not want to do it. It means that if we do it,
the patient will wind up far worse than he or she was coming in, and it is not only just NOT
indicated that we proceed, it is definitely indicated that we, and no others as well, NOT
OPERATE on this patient with this condition.
While we are at it, let me give you two other terms: Resectable/non-resectable; Operable
/non-operable. Resectability is defined by the lesion; operability is defined by the patient.
Neither operability of the patient and resectability of the lesion yet determines that an operation
OUGHT to be performed. If that were the case and we could get around any human judgment,
we might computerize this on a nomogram and be done with the long years of residency and the
added graduation of responsibility, since it would be built-in by the engineering of the ―surgical
program of indicators,‖ off the shelf and fits all circumstances, including these, way out on the
margin of what can possibly be done in benefit to the patients
So, there are lots of resectable lesions in Inoperable patients. For example, a small coin
lesion of the lung ought, to, by most means, be resectable. How about if that small lesion is in a
patient who has chronic lung disease and is a pulmonary cripple at rest? Surely, I can take that
little tumor out—and the patient will just as surely die, since he is inoperable, despite the
presence of a resectable lesion. How do we determine operability? I use the old fashioned way
despite pulmonary function studies and hysterixus loops and about three thousand dollars in preop blood gases and work of breathing studies along with pulse oximetry. If in fact, all such
studies are done and made available, they still are supplanted by this old fashioned rule; forget
the values on the studies and take the patient to the nearest staircase. If they can walk up one
flight of stairs, they can tolerate a thoracotomy; if they can walk up two flights of stairs they can
tolerate a lobectomy; if they can walk up three flights of stairs they can tolerate a
pneumonectomy. If they can’t, it does not matter what those fancy expensive studies showed,
since if operated on and the patient could not perform that simple proof of marginal reserve, the
patient will simply never ever get off the ventilator and is a pulmonary cripple who will die.
Simple enough? So, our first fellow has resectable hernias in an inoperable patient.
Next?
2
We had taken the bus over to Pongwe to the school and the three of us selected for the
surgical team stayed with the bus, as we pulled up to almost twice the number of patients queued
up outside the school classrooms. So far, my prediction is about exactly on target. Now wait to
see what happens when patients come back without the hydroceles or hernias or other conditions
diagnosed yesterday and put on a list of the next few days of operating!
Katrina and Meghan are the student team (Meghan having swapped out with Shweta) as
we pull in to the Pongwe Hospital. We wait in the courtyard and see a few of our pre-op patients
we had selected sitting under the huge mango tree in front. There is a sign on the hospital that a
Korean ―Save the Children‖ fund is operating here and there is some kind of well baby clinic for
which there is a queue already awaiting but no apparent function going on in the clinic itself. I
walk around to the OT block. There is a new sign: a hand shake with the stars and stripes on a
bronze plaque. ―This facility is refurbished by USAID as a gift to the Peoples of Tanzania.‖
I open the door and see a big red line across the floor, marking the usual fetish about
maintaining a clean zone with all footwear and outside clothing changed to keep a semblance of
sterile environment on the other side of this ―Lock‖ to cross. I have seen other white elephants
before, notably in Rwanda where a big and beautiful hospital was built by the Japanese with a
huge sign denoting that fact in front and behind it, a brand new mothballed facility, since there
was no one who could use the hospital, Without any skills, it was safer not to open it, so in this
magnificent building with spectacular rooms, one patient sat forlornly on a bed, with her baby
which had been delivered at home in a hut, and she had come by to get the midwife to talk to her
about breast feeding.
I peeked inside. I was startled. It was clean. It was simple, with a good light and a real
OR table. It was simple but it had what was needed, and it did not have a lot of extras that were
not. It was—hold on, now---A/C! When the switch was flipped, it became cooler!
Bring them on!
Now I regret especially that the SCI Blue bag is sequestered in Kilimanjaro airport, since
I could surely use some of my instruments, but above all, my spinal anesthesia kits. But I
checked around and found that injectable diazepam, lots of local anesthetic which I had carried
over from our own pharmacy as 1% Lidocaine with 1:100,000 Epi, with which I could do almost
anything—including injecting it as a spinal since I had brought separately a few spinal needles.
The Clinical Officers were three in number and were curious about me. When they
figured out that I was s surgeon they gathered like kids in a candy store, since they had always
wanted to see an operation, but never had. When I tried to communicate that they were going to
see quite a few of them rather close up since they were going to be doing them, they thought:
―Yeah, we have heard that before!‖
3
Only then do three things become apparent to me. 1) This spotless ready to use and
equipped theatre has not yet ever been used. 2) These clinical officers have never operated but
are eager to SEE operations done that they may one day have to do. 3) I have a dozen patients
out of the score of them I had preselected sitting out under the mango tree and could conceivably
get a real team operating here in real time and teach them how to do multiple operations safely
and effectively. Let’s roll!
The first patient is the older man with a big hydrocele. I had lined up three females and
one male Clinical Officers, one of whom would be my anesthetist and the other three operating:
Orotta, (curiously, this is the name of a major battle for Eritrean Independence from Ethiopia,
and is the name of the principle –only—medical school in Eritrea which we are supporting from
GWU after my visit there), Rose, June, and the very big and affable man Regis. It took me a
while to know who was functioning in what role, and for that interval I had introduced ourselves,
with Katrina, who will be a Surgery Resident next year being my ―Chief Resident.‖ We
staggered though the language barrier enough to get the first patients in to theatre with the
requisite gown and the fetish of having an ―inside gurney‖ (―Clean‖) and an ―Outside Gurney‖
(Contaminated) and exchanging the patient from one to the other over the magic tape on the floor
that demarcates the inside world from the outside.
AN HISTORIC FIRST CASE; ALL NEW ALL AROUND, THE
OPERATION GOES VERY SMOOTHLY AND THE TRANSITION TO
THE NEXT ON THE LIST IS EFFICIENT
The first operation ever done in the newly refurbished OT, Katrina’s first operation of her
life, the first case overseen by anesthetist Rose and the first hydrocele repair I was teaching to
Regis---all could not have gone more smoothly. With a local and Epi infiltration and then a
double hit of diazepam and intravenous Ketamine, the patient felt fine. The procedure was
conducted swiftly and smoothly, since Katrina had seen how it was to be done from the one and
only operation of this kind she had ever seen and that was the one we had done two days before
in the Saint Raphael’s OT in Korugwe. She was eager to perform and not too aggressive since
she confessed even as she was suturing, that this was the first time she had ever been allowed to
assume this much responsibility in any surgical case and she was pumped since this is what she
wants to be doing the rest of her clinical life.
As we got to the subcutaneous skin closure, I said to Katrina that now she could help
Meghan close up and they did so as I very deliberately took off the gloves to show everyone that
they were going to have to go a good job even with supervision at an oversight level. I wrote the
orders and operative note and recorded the cases in a brand new operative log, which had been
brought in and hand-drawn lines were scored for our use. Before we finished the day we had
filled in the first page of the first log book in Pongwe Hospital.
4
While we prepped the next hernia patient, we re-excised the recurrent ganglion cyst from
the brachioradialis. If I had had triamcinolone, I would have injected it, but since I did not, the
incidence of recurrence may be just a little higher, but not as high as it already had demonstrated
by recurring.
As if we had been doing this for years in this very room, the transition to the next patient
was smooth and the next ones were faster yet, so that by the time we had got on a roll after the
usual stutter start in the beginning, we had completed five cases by late morning, three
hydroceles and a right inguinal hernia. I did successively less and less of each procedure and
tried to entice the clinical officers deeper into the action with each case. As I was in between
cases after recording the paper work, there were more and more of my usual ―OR Door
Consults‖—and I saw a patient referred over for a ―hard testicular mass‖ and two more
―hydroceles‖ found I clinic only a few hundred meters from our OT door—and ONE of these
actually WAS a hydrocele, added to a later schedule. The hard testicular mass was NOT,
however, and appeared to be an irreducible scrotal hernia, but not tender as an incarcerated
hernia would be—leading to the suspicion that in addition to a garden variety hydrocele, the
patient might have a ―Sliding inguinal hernia‖—an obvious subject for the tutorial later.
As things were rolling along with me pushing on the wheels with a fair amount of
prompting and pushing, but a light hearted teasing as well, the wheels got well greased. The
team got noticeably more excited with each patient successfully passing through the door. By
the end of the day we had added several others and the output was piling up in the male ward
along with a couple of pre-ops being prepped for the following day. I had two spinal kits and
reserved one to demonstrate on the patient with the alleged testicular mass, which I believe to be
a sliding hernia so that Regis or Rose will understand how to do the following spinal anesthetics.
I reserved four of my spinal needles which I passed along to them and gave them one that had
been used to practice on in manipulating it.
When we got dressed back out of our scrubs and into street clothes, we made a quick
post-op rounds and all the patients were doing well, the hydroceles up on scrotal bridges, but
without ice we could not decrease a little swelling. Katrina had got deeply ―into it‖ and
functioned just like the chief resident she was designated. The Clinical Officers now, instead of
standing and waiting for me to do something, are in forward progress mode. Rose had told me
that she had once seen operating, but never an ―assembly line‖ of multiple cases. [A "List" in
Briticism terms in the "OT" which is an OR in Americanism.]I told them that we may have done
rather well today for a slow and late start, but we would at least double our output tomorrow, and
be prepared to move them through to get still more unusual illness patterns seen. I had promised
that I was going to pair some of the patients, with like conditions, and then I would help them do
the complicated ones or more difficult, but that the simpler ones would be done by the clinical
officers after we were gone. So, I had left with them the list of the patients still to be done with a
red mark by those which we would do while we were all together, but the others with the
5
designated names adjacent to them—this one will be done by Regis, Orotta, etc. They have
already got ―Ownership‖ of these patients and their problems pre-operatively.
As we parted to go back over by bus to the schoolroom clinic, High Fives were slapped
by the exhilarated team, including the clinical officers and Katrina and Meghan. We got over to
clinic which was bogged down in its daily extraction from the continuing overtime, and then
pulled out by bus to get back to the SeaView Hotel. Rather than going out to eat as we had last
night for an endless waiting for service, we had elected to pre-order from a menu of chicken and
fish for all of our group which would be prepared for us even before we arrived, so that we could
go directly to the veranda and get served without the wait. We had our dinner simultaneous with
our tutorials and the patients were presented form the clinic and the dental extractions and then
from the OT—and there was a buzz from the students who had been directly involved in the
procedures of the day, ―no longer just observers‖ one had said. The puling of teeth and most
parts of the OT experience are NOT rocket science, and should be performed as low down the
health care chain of command as safely possible, and there is an obligation to make sure we are
not just here performing for our own gratification, but are leaving a sustainable legacy behind us.
The team in the OT has figured that out, and is pumped about conditioning with us, eager to see
a few new things, since now they have hydroceles down, and simple hernias a bit less so. Now
they are eager to discuss the more complicated owns and to see the difference, since they are
eager to fix an incarcerated hernia which they will be coerced by the emergency into doing, but
do not want to stumble into the sliding hernia instead, and need to know the distinction.
We have a distinction also. We are here to teach, but not just the first world trainees on
third world patients. But collaboratively, we are here to see that a functioning capacity is built
up and encouraged so that the health care that is left behind us is superior to any that had been
here before we arrived. That is certainly true of the new structure of the USAID gift to the
peoples of Tanzania. I certainly looked nice, when I opened the package. But now it looks a lot
better since it is useful and well used already—on it day of its Grand Opening!
6
10-JUL-A-6
A SECOND DAY IN THE PONGWE HOSPITAL IN OPERATING ON
SEVERAL GOOD CASES SELECTED FROM THE POPULATION OF
PATIENTS IN OUR NEWLY RENOVATED THEATRE FOR OUR USAID
INAUGURAL OF ITS OPERATING SUITE FURTHER ENTHUSIASM
FOR OUR PRESENCE IS SHOWN BY THEIR OPENING THE THEATRE
FOR A HOLIDAY TOMORROW TO DO STILL MORE DOUBLE DIGIT
CASES ON “SABA SABA” DAY
JULY 6 2010
Shuffling the medical student teams to have a senior and freshman present with the
former acting as my “”chief resident” once again, we went directly over to Pongwe Hospital after
first stopping at the clinic, which, predictably, had still more people standing in the queue
awaiting registration. We will try to re-shuffle student teams at mid-day, so as not to short the
clinic staff, but we are also planning to double our patient flow rate through the OT so we are
going to put in a full day in our refurbished OT.
When I arrived at Pongwe Hospital, we had Dennis as a photographer taking pictures but
we preceded him as we went through the wards getting the patients seen and the dressings
changed. To do so, we are now an official surgical hospital;, the staff had decided, so they had
to first assemble a “rounds trolley” ala British work rounds where the “ward sister, follows the
houseman, and the dresser and the dressings are changed with a set of tongs dipped in antiseptic
which will then drop new dressings for reapplication. Drains are pulled if they are used (none
employed in yesterday’s cases” and the patient is encouraged to ambulate to being the discharge
process. It took longer for the “”Rounds Trolley” to get assembled than it did to complete our
rounds, but the patients were all doing well and were very happy. Of course, with one exception,
and that is our fellow with incontinence and bilateral acquired direct hernias since he is sure that
we will be doing him first to get rid of at least one of his secondary problems, and ignore the first
which he cannot afford to travel to the center to get it fixed. It is not something I will explain
again, but he is moved out of the OT List as patient number one.
As always happens when it is discovered that there is a professor from America on site,
the local big men come for private consultation. In Africa that is a proper name “Big Man.” I
am often called that as I am walking through the markets, since they seem to recognize that
either I am the one in charge and leading the groups or the one with the deepest pockets or any of
a number of criteria that they put in a hierarchy toward their own advantage and they salute me
with “Big Man!” I usually respond, “I am rather glad that I am only a rather average size man
1
and have no aspiration to become any bigger.” But this Big Man is the headmaster of the local
school, the one we are displacing to hold our clinic. SO he must come to see me in a private
room to have a complete workover, as a favor to me, he seems to say. He has a pleuritic chest
pain and a probable PPLO (Pleural Pneumonia Like Organism) or Mycoplasma Pneumonia. That
we can fix, but it is not a surgical problem and I write the script and direct him back to the clinic
in the school with which he should be
quite familiar. I always carry a student and local
practitioner with me on any of these private consultations, to show them that this is s medical
education enterprise, and not one in which we are coming for the private directed care of those
who are able to talk their way into it, Besides, it inflates the prestige of the indigenous
practitioners to have me consult them, even over such Big Men patients saying what I think the
problem may be but only after first asking their opinions and agreeing very positively with the
often small points they get right, and telling them they will have to follow-up to see that the
outcome is appropriate.
I have to guard against a series of similar patients Dr. B, the local administrator of this
hospital has lined up to have me see, essentially running his up market practice for him
consulting on a couple of them saying that we will be late for OT if we continue to see further
medical outpatients in this hospital setting when we have the school set up for the diagnosis and
treatment of most of these other conditions. Before I can get away, one more high profile patient
comes to be evaluated, and she is carrying a folder from the Bombo Regional Hospital with
various studies and she expects me to do a complete gynecologic exam and then produces a
small slip of paper which informs me to “do hysterectomy.” Right. She has been already
worked up in the Bombo Regional Hospital where they were at least equipped to come up with
the determination that she should have a particular treatment appropriate in their regional
hospital, yet, once again, she is sent over to me to do the hysterectomy “under a tree,” since I am
here, I am fast and most of all, I am free.
I said it seemed she was already under the care of a physician who was making her plans
for her and she should continue under that treatment in following his advice. Elective
hysterectomies were not a priority for my clinic plans for the day, and I can use again the reason
that the majority of my spinal anesthesia kits were not allowed to join me from the health care
impoundment officials that intercepted them in the Kilimanjaro Airport, which I advise them to
follow up on to see if they might be released, if not in time for our use of them, at least to see
that they are brought into this system here and used eventually.
I briefly met a Korean girl who said she was here to do a study on the Save the Children
fund the Korean government had granted to this hospital as advertised on the poster out in front,
yet I could not learn what she was measuring as outcome data.
I quickly got to the OT for our “early start” which all had agreed to, and Regis and the
others were eager to get going, with Kannan Samy, and Shweta Pai coming on over from clinic
to be the students who would be managing their first rapid pass through of the cases, and then,
2
once again, we waited. It was as if we had to go through the introductions all over again. To
while away the time I had answered questions from a historical perspective, about Burton and
Speke and their early travels through here, and then about my hero David Livingstone, and
following that, the era of Henry Moreton Stanly and then the big game hunters such as Selou.
Then the German colony which is why we have the relics of a German influence in the Lutheran
church founding the first private medical school in all Africa where I had first worked long ago,
the KCMC (Kilimanjaro Christian Medical Center) which was well run; then the socialist
government under the founder of the country Julius Nyere had made a planned economy for
everything including the pittance on health care and nationalized the KCMC which immediately
deteriorated to uselessness, and was used only as a source of jobs incomes. The socialist
government was a colossal failure, and the World Bank and other sources came in to restructure
the economy and the wisdom of asking the Lutherans to come back and take over KCMC again,
just not to use the Lutheran name when they did so! The British had got Tanganyika as a prize
from the loss of German colonies after WW I defeat, and had amalgamated it into British East
Africa, along with Kenya and Uganda in the East African Union which fell apart about the time
everyone here became independent—July 7, 1961 for the amalgam of Tanganyika and Zanzibar
which became Tanganyika on the day celebrated tomorrow as the Saba Saba day anniversary of
that event. I talked about these things long enough to see if we could get started and eventually
said I would stop since we really had to get to work. “Oh, OK, we were just waiting for you to
begin!”
We begin with the complex case I had seen yesterday that was sent over as a hard
testicular mass, but is really a non-reducible hernia and an opposite side hydrocele. The
hydrocele we can fix. Under local with supplementation by IV analgesia we do a swift
hydrocele repair, which Kannan had seen one previously when we did the Saint Raphael
operations, but then I tried to reduce the left incarcerated hernia and could not get more than one
third of the bowel back inside. This means it is likely a sliding hernia and we will use that point
in discussion at the tutorial, and postponed him until tomorrow and start with him under spinal
anesthesia and do a laparotomy pulling the bowel back into the abdomen so as not to risk the half
the bowel wall which is the sac. It is easier to explain with a drawing which was done when we
had completed the operation and all the Clinical Officers had a chance to see what it involved
and not to get into trouble by trying to stuff the bowel back into a sac when half the sac was the
bowel.
Now came a favorite patient who identified with me and was a very grateful happy
“drunk” on just a little diazepam and Ketamine. He wanted to call out to me “Babu!” We are
both grandfathers of about the same age, and he wanted to say how very grateful he was for this
operation. It makes one eager to have a little of that analgesia to make it as happy as that patient
seemed to be. Here was the first chance for Regis to operate. I helped Regis and Shweta
together do this large but uncomplicated hydrocele, and Kannan took over in the teaching role to
get the closure completed.
3
I had been sent a woman with nasal polyps, which I had told them cold ideally be
managed by Afrin nasal spray but we had none in the pharmacy. Unfortunately, I have quite a bit
of it in my SCI bag being held in the Kilimanjaro airport so that might have avoided an operation
for her. Given that we could not treat her optimally with the medicines their own government
had confiscated, we were next confronted with her in the OT. I told them that the biggest part of
this operation was done by the epinephrine injection with the local which causes the redundant
nasal mucosa to blanch and become much less vascular. SO I injected the patient's turbinate’s
with the Lidocaine with 1:100,000 Epi and that did most of the operation for me, tearing out the
polyp as a ragged piece of mucosa which did not even bleed much. IT was not like the one I had
done in Chad when I pulled the polyp out that had blanched, the ostium of the maxillary sinus
exploded with all the pent up mucus shooting all over the room and the patient whose eye had
swollen shut under that back pressure, could suddenly see form both eyes and talk normally
immediately after the polypectomy.
Now we are on a roll. Everyone gets the idea that we are going to do as many of these
operations as are listed and with all the patients fasting and waiting outside the theatre door, we
start up immediately doing a large direct right inguinal hernia imbricating the sac without
opening it—the same operation that Kannan had seen before. He pointed out to Shweta that I did
not stand on ceremony requesting and requiring special instruments, but used what was
available. For example, we had no knife handle, so I grasped the blade in the needle driver
handle and used it like the knife. Kannan had heard many of these procedures described to him
by his good friend John Lazarus and said he really thought that John had been making them up—
especially about the part of “Dr. G operating under a tree”—until John showed him the pictures
he had taken of that event which was swiftly and successfully done, since it had not been
encumbered by any excessive redundancy in formality or in paperwork.
Nest, Kennan did his first large scrotal INDIRECT inguinal hernia, We mobilized the sac
and trimmed it to its base and performed high ligation and then a modified Bassini repair—I call
the “”Schuldini” since it starts off as a Bassini repair and ends up as Schuldeiss (Toronto) hernia
repair.
A patient was sent over from clinic with a very large mass in his thigh. It was said to be a
tumor or a hemangioma. It had not disturbed the function of his extremity other than by it size
and mass, but no connections with the nerve or vessels seems to have been affected. He had it
for over ten years and it was not tender. It was not inflammatory and was soft and supple. He
would like to be operated on tomorrow but had been told that it is a holiday “Sabba Sabba” and
that was confirmed by each of the staff. It seems like he has a large lipoma and it will no doubt
be easy but extensive, and another ideal spinal anesthesia operation,
I discussed the burgeoning number of pre-op patients till being accrued with Orotta,
Regis, Rose and June. They agreed that Sabba Sabba was an official holiday and we were
entitled to take the day off when no procedures would ordinarily have been scheduled. But, they
4
added, we cannot pass by the opportunity that your visit gives to all of us, so we will be willing
to come in to work, and we will stay open and do as many of these patients as possible to
complete. They added, “Besides, you operated overtime on your holiday—the fourth of July!”
So, we continued booking more patients. And the discussions I had led earlier about the
complications of filariasis besides the by now evident to everyone higher incidence of
hydroceles? I had showed them a photograph of the “hanging groin.” I had discussed with them
the “Watering Pot Perineum” and these conditions sounded disgusting, being the male equivalent
of an always wet perineum seen in women with a VVF. Katrina particularly had said she had
never even heard of such a thing and would have an easier time understanding it if she had once
seen it. On cue, stage right, enter a patient sent over form clinic for my evaluation since he
smelled like he was leaking urine. Voila! A “”Watering Pot Perineum!”
He had a foul smelling series of scrotal fistulae. This had followed a filariasis in which
the bladder overflowed and he had sought out some kind of medical or local practitioner to help.
He had some kind of instrumentations and it seems that he has disrupted the urethra so now he
had a fistula leaking from over a dozen sites in the scrotum which were giving maceration to the
skin. He needs serous diversion and a VCU “Voiding Cysto Urethrogram” I know that they do
these to get a chance to evaluate and repair the obstructed urethra that is strictured since I had
seen them performed at KCMC. So, we advised that he get to Moshi and perhaps take our
colleague from the ward with the obstructive uropathy and overflow incontinence with him.
I had two visitors as I was in full speed ahead mode. Two very American fellows came
in and introduced themselves as from AFRICOM the new US military Africa command center.
They are in Djibouti and have an East African territory that they supervise. It was they who had
contracted for the refurbishment of the theatre in this Pongwe Hospital and they wanted to come
by and check a few things to see if the contractor had come back to set right a couple of items
they had noted before sign off on the project. They checked on it, and then got my card as they
asked a question: “Do you think that the newly refurbished facility is ready for use?” I replied
“It had better be since we have just operated on the first dozen patients and have twice that
number queued up to go!”
They were pleased and surprised to see that the new facility was being put to use already
and by an American Professor of Surgery supervising it at that. They shook hands all around and
went on their way after completing their report to return to Djibouti.
Don Miralle came over to take pictures with his special rigs which can take photos from
straight down over the operating site. He did some really expert shots just as we began an
operation on Patrick. Patrick was effusively grateful calling down God’s blessings upon us for
our service. He got even more vocal after a bit of Intravenous Ketamine. He announced that he
was a pastor with “Youth with a Mission” and as a missionary himself, he could appreciate the
selfless sacrifice we were carrying out, and was very grateful that he was the recipient of the
5
blessings of our services. Our services included striping out a long indirect hernia sac and its
high ligation caught on Don Miralle’s expert photography, a “sporting event “ a little different
from his usual such as Ironman, or Tour de France, or the Olympics, but an ever faster, higher
and further effort as we proceeded. He also asked for a brief video clip, which he set up a
camera and I simply did a “”one take monolog interview” on what we were doing here and why,
expressing my own appreciation for the newly refurbished facility which we were happy to be
inaugurating on behalf of the people of Tanzania to whom it was dedicated and for whom it
would be continuing in service by the trainees we were here to help.
A couple of other interviewees were asked to express themselves, as I went back in to
start up the next case The case I had seen on the first day at the clinic over at the school. It was
a soft and supple mass that was nontender and non inflammatory right in the superficial lobe of
the right parotid gland in a woman who had had it for a number of years and wanted it removed.
I suggested it might be a “Warthin’s Tumor of the Parotid” a benign but frequently recurring
mixed pleomorphic tumor of the parotid named by and for a University of Michigan Pathologist
who had first described it. Raising the flap to get at the superficial parotid, we realized that it
was a lipoma in the same position, so it was resected completely and easily without injury to the
facial nerve.
We were still operating when Don went back to clinic and I had promised to get over
there when we had run through the cases we had assigned for today, willing now to do so earlier
since we might be operating tomorrow on a day they had originally described as a holiday off.
We finished several more cases and then made our post-op rounds. We had finished up and
called the bus to collect us and got over to clinic which was bogged down with a still more
crowded clinic of patients who were now getting restless since they could see we were running
out of both time and medicines and they wanted to be sure that they got theirs.
I had told Don Miralle that I had done the last several missions with photographers, but
was eager to see his “take” on it. I mentioned that Stephen Katz had joined me on the Rwanda
missions which had resulted in the stunning DVD I would try to copy and send to him. He knows
Steve Katz, and I told him he had subsequently gone with me to Eritrea and other missions
before he had gone on to Cleveland clinic to have his aortic valve re-replaced, I am familiar with
this since Donald has had that operation as well. I mentioned that I was eager to have a stunning
visual centerpiece for a special lecture I will be giving in Michigan in January 2011. I will see if
I can get Don to Derwood and also make the rounds among the folk who have worked with me
such as Michael Skinner and the Pendragwn team and a number of other leads, then we might all
rendezvous once again in Toledo for a Homecoming “Show and Tell.” I will be in touch with
Don as we get back to doing our thing closer to home.
With over 215 patients treated in clinic today and Saba Saba Day coming up tomorrow
when the last desperate crowds will be coming to push their claim on the last patients to be seen
before we depart on Friday I will also have to wrap up the operations I will be assisting them
6
doing, and lay out the operations that the clinical officers will now be left with to do as they
model their care after what we had done with the “matched pair” patients we had teamed up with
them. Today I had done one hydrocele by “Remote Control” getting Regis to launch in on the
operation and standing over his shoulder as if about to come on in and take over, but prompting
him at each step before I did so. As it turned out, I never even put on the gloves; so that before
he knew it he was finished, startling most of all himself. So, after tomorrow they should be
ready to carry on the operations we have booked with them. They may not do nearly the volume
at the rate we are doing them now, but they at least are off the launch pad and the community
now knows that operations can and are being done in the new refurbished Pongwe Hospital
Theatre.
Or tutorial tonight was a rush of quick presentations of cases and no prolonged
discussions of any of them, with only questions and answers for a follow on. We have worked
hard. After our final full day and the celebration with the Town Council tomorrow night, we will
be ready and well-deserving of our Zanzibar weekend holiday!
7
10-JUL-A-7
THE THIRD CONSECUTIVE DAY IN OPERATING AT THE NEWLY
INAUGURATED PONGWE HOSPITAL THEATRE ON OUR FINAL
MEDICAL MISSION DAY IN TONGA FOR THE GRANDE FINALE OF
THE MISSION AND PART IV OF THE TZ TREK
A SUMMARY CELEBRATION OF THE MISSION WITH THE TONGA
TOWN COUNCIL AND A WRAPPING UP SCORECARD OF A
REMARKABLY SUCCESSFUL MISSION ON ALL COUNTS
JULY 7, 2010
It gets no better than this! If I were to make a list of objectives at the outset, and count
them off---like a “checklist” of the “Big Five” to “tick off” my expectations on a game-viewing
safari, I would never have got half way into the list of those items that in retrospect were nearly
ideally fulfilled on this Mission! The crescendo has continued from the successful completion of
the Kilimanjaro Marathon (Part I—now complete with “Trophy!); the Serengeti Safari (Part II to
include Lake Manyara and Ngorongoro Crater and the “Big Five”); and now the Tonga Province
Medical Mission and the successful Inauguration of a newly refurbished Pongwe Hospital
Theatre with over a thousand patients treated medically, and hundreds of teeth pulled, and fifty
one of the selected patients treated surgically (Part III); just wait for whatever can top this in our
Zanzibari holiday retreat across the Indian Ocean! (Part IV)
To begin as a contrarian, the only “bummer” I can list, and it was virtually optional, was
the failure to get the SCI Blue Bag (additional to the ones I had carried with me) cleared through
the Kilimanjaro Airport that had been transferred to Holly Pierce through her father and had been
checked in through her stopover in Addis Ababa as guest of the US Ambassador to Ethiopia, a
family friend from their State Department ties. Even that I was able to circumvent, since I had
packed along with me a few spinal needles and I was able to both do and teach spinal anesthetic
technique by cobbling together a few “found parts” from our pharmacy stock to carry out more
operations than I had thought possible, until the medical student team and the Clinical Officers
“caught fire” in our inaugural dedication of the new theatre to move into high gear on our
climactic surgical flourish, ending the mission on a high note as we rounded on the dozen postop patients from just today’s “List” with several “add ons” included.
WE PUSH THORUGH THE HUGE WAITING QUEUE OF EAGER ―LAST
MINUTE‖ WANNABE PATIENTS AND GET A RUNNING START ON
OUR ―THEATRE LIST‖ FOR OUR CLIMACTIC OT DAY –OPERATING
1
FULL TIME ON WHAT WOULD HAVE BEEN A HOLIDAY ―OFF‖=
SABA SABA DAY—TANZANIA’S INDEPENDENCE DAY
The day began, just exactly as predicted. It may have been a Tanzanian holiday, but
because, more than in spite of, that reason, the crowds had swelled to HUGE and colorful
proportions as we pulled up I the bus to drop off the clinic personnel who were planning on
being overwhelmed in this final clinic day. As we pushed slowly through the crowd of veiled
women, who were apparently veiled to avoid my attentions, but then would push themselves or
their babies at me to attract the very same attention they were supposed to be avoiding. I was
particularly interested in one old woman in a colorful robe that was flowing all around her, but
not voluminous enough to obscure the huge right limb that protruded from it. My first impulse
was to get a picture of this grotesquely enlarged limb, which, still, had not kept her form
hobbling forward in all due speed to be near the head of the queue. She had the classic
“Elephantiasis” from filarial, and would be the ideal patient to treat first with tetracycline to
eliminate the Wolbachia organisms that cause much of the lymphatic scarring, and then with
ivermectin to control the filarial, then most important to rehabilitate her with one of the oversize
compression full-length stockings that I had reserved out to treat just such a patient—and here
she was, right on schedule!
We had better not get caught up in the clinic outside the school which was already
pushing and shoving even before these patients were registered for intake, since we would have
our own “Mango Tree Shade Overflow” of waiting pre-op patients on this Saba Saba Holiday
morning at Pongwe Hospital. So we rocked back and forth in the bus to clear the way through
the crowd to carry the three of us who would be going forward to the surgical part of our mission
today, with a bit of contention among a couple of candidate medical students who were tussling
over who would “get to do the operating today.” Everyone will get equal opportunity, I had
assured them, and we would switch at mid day half way through the list to get a swap from the
clinic, so that there would always be a senior and junior US medical personnel so everyone was
exposed to, but still not impeding, the flow of patients through our OT List. I had to
reemphasize that our job is NOT to bring forth Tanzanian patients for subjects to be operated on
by inexperienced first-worlders, but to encourage local care which is the target of the majority of
my teaching, and that all would be floated to a higher level by the same rising tide, but without
making any of the care inferior or slowing the process, for example, of skin closure by having
each such process performed by a novice clinician whose prior experience had been seeing it
done on store-bought chicken skin. We agreed to carrying over a senior student and swapping
juniors at the half. And we rolled through the colorful crowd, with a new one that greeted us as
we approached the mango tree in front of Pongwe Hospital. A number of them were calling out
a word that is finally translated for me: “Bushe!” This is translated with a smile---“Big
Scrotum!” And “Mabushe!”= “Very Big Scrotum!”
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This time, they were ready for me. They figured out that these American Surgery
Professors may like to chat a bit but only on the run, and we got through a brisk ward rounds
with the “Rounds Trolley” clattering along behind us. I explained that we would be going
directly to theatre after the rounds and dressing changes in which the students were involved and
the Clinical officers would supervise the “Ward Sisters” but that we would not have any “Down
Time” before beginning our first case, which would be---“No, not the fellow with incontinence
and bilateral direct hernias, but the fellow from yesterday who had a hydrocele repair under local
and today would have a spinal anesthetic for the laparotomy to reduce his large sliding hernia.”
And so it was. They even had the first patient transferred from the “Outside” (“Dirty”)
Gurney to the “Inside” (“Clean”) Gurney when I walked in and changed from shoes to my
operating sandals as they unpacked the USAID case of white rubber boots for use in theatre only.
For demonstration purposes, I opened the one of two spinal kits I had packed along promising
that if ever the SCI Blue Bag was released to them as promised, they would have dozens more.
In typical first world redundancy, the spinal anesthesia kits, designed as disposable, have several
spinal needles and each is sterile and salvaged for use in the later cases. I then did the first one
as a demonstration. It might be discouraging to them, since I put in the introducer, then followed
with a single pass of the small needle and popped it into the dura as CSF slowly dripped back.
“That is just SO COOOL!” gushed Audrey, who was really pumped about being back form her
own “down time” since she had been knocked out by a GI problem and was eager to make up for
the lost time and had not yet been in OR’s. Whatever was next to be done, she would say “I’ll
do it!—Now, what is it I am supposed to do?” The spinal anesthetic took less than the thirty
seconds that the patient remained seated for the “heavy spinal" Specific Gravity to settle for the
lower extremities to avoid a “high spinal” that might give great anesthesia, but interfere with
breathing if it rolled up to cervical levels. The patient was spun around and had perfect
anesthesia for the laparotomy, which we proceeded to do without any Intravenous analgesics.
I pulled the extensive scrotal component of the hernia up form the groin into the
abdomen, and tried to demonstrate that we were “re-peritonealizing” the part of the bowel that
had formed half the sac. This concept is difficult to explain in words alone, but her it was
obvious as they could see it—and they will never need a repeat explanation of a concept that was
only a murky image before. The “pre-peritoneal” part of the repair was run with the abundant
suture I had packed along, and everyone could see that this judgment call which had involved
NOT mucking around yesterday and trying to get the bowel returned to the abdomen form
below, had worked out smoothly and swiftly today by postponing the second procedure to an
abdominal one under spinal anesthesia. The lesson was directed at the clinical officers as the
students closed up and I did paperwork as Don Miralle made both images and a video.
Our next patient was a Hoot! He had a three times recurrent hernia that extended into the
scrotum, and we did the repair under local anesthesia supplemented by Intravenous Ketamine
which he seemed to enjoy more than anything in his previous life, including the three attempts at
fixing this before. It is obvious why the prior operations had failed, since the large inguinal
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indirect hernia sac was clean missed, never having been approached. It was all virgin tissue
planes without any evidence of scar, and it was dissected out as a long and narrow sac, which we
could demonstrate, open and twist around to be sure that there was no bowel content in it as it
was suture transfixed in the internal inguinal ring. It was a good repair, made even more light
hearted by his crooning tunes and thanking us all profusely. It made good images on Don
Miralle’s super camera shots, but it should have added a sound track!
Next we took on “Bushe” in fact “Mabushe”---bilateral hydroceles. Bilaterality is “made
to order” as a teaching case, so the “See One, Do One, Teach One” in this instance was truncated
to only two basic steps---“Do the first side” (Come on now, you know the drill already!) and
“Teach the second side” (You will not always be on call, so you need to train a cadre of others to
join you!) So, Regis has graduated. He is not just a freshly minted operating surgeon, but he is
now also an instructor, and taught the second side to another clinical officer with whom he
shares call. By the end of the day, this step will also have been taken further with Orotta.
I had salvaged one of the spinal needles from the tray that was designed for a pediatric
patient. Well, we can improvise and make do! So, I drew up our own 1% Lidocaine in
1:100,000 Epi and used the leftover spinal needle to help them pop in the next spinal
anesthetic—it was useful that this one took two passes, so they wild not be discouraged that all
of them do not just fall in as if by magic. This patient also had a long sac into the scrotum, and
this time it was reduced easily given the additional abdominal wall relaxation form the spinal
anesthesia and I could simply watch as this was carried out just as competently as if it were they
watching me instead of the reverse. They were all taught the technique of “purse string” closure
and then the “Houguet Maneuver” tucking the ligated sac under the transversalis fascia to get it
out of the way of the repair, which was a “Schuldini” technique simply watched and cheered on
by me.
As I filled in the order sheet and wrote the post-op note in exquisite detail, leaving it as a
model for them to use, since I told them that this was my last note, and all the rest were theirs, a
patient was sent to the theatre door, with a “Solid testicular mass, probable cancer” from the
clinic. With Regis and a transluminating light, we could demonstrate that this was a “balottable”
tense fluid filled sac of a hydrocele, and could be fixed as easily as the one he had just done—
tomorrow, when we are no longer here but the Clinical Officers are. I explained to the patient,
that he would stay here in the hospital since we were on a Saba Saba Holiday schedule today, but
let me introduce you to your surgeon who will take good care of you tomorrow—and Regis
beamed possessively and followed the patient to the ward. Today is all about shifting
“ownership” of responsibility for this new and now well-functioning theatre, “Under New
Management!”
I had got one quick glance at Don Miralle’s spectacular safari photos form the great
Selou, where I have been hoping to get to hunt and trek in the next follow-on to next year’s
missions. I would gladly leave the photography to him having seen the photos that made Dennis
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green with envy acknowledging the complete mastery of the art. I showed him a few of mine,
and he did me the favor of not chuckling over the techniques of my pocket camera technology,
noting that the important part of this photojournalism, was simply being there in the thick of the
action to get access to such images.
At the middle of the OT List there was a student swap out, and a bit of contention since it
seems everyone wants to be where they can actually get in and DO things that they can see have
a direct and immediate result I patient treatment for better or worse. But it got resolved as I had
insisted it would, by the single consideration that counts. “Who is the most important person in
this O T?” Until and unless we all recognize it is the one lying down and how they might best be
served, by my presence or absence, then it is best to step aside. A re-shuffling of the students
and re-assignment of the clinical officers brought a new team in different capacities for the
afternoon shift in the List. Holly, Meghan and Todd came over for the next cases and Orotta and
Rahima moved up to operators from assistants. Holly read her missions well and did a good job
of teaching Rahima, a Clinical Officer who had held back until today but was particularly gifted
in how she moved deliberately and effectively. Rahima will be a good second shift Clinical
Officer with Regis on the first.
As we sat up the next patient for a spinal anesthetic, one could see at a glance the step-off
of his left shoulder—a classic A-C Separation (Acromioclavicular Separation). When asked
about it, he remembers well the fall in which he had injured his shoulder. If he were a basketball
player in the USA, we would fix that, but he is a Tanzanian farmer so we just diagnosed it, and
he will accommodate the instability of his left shoulder.
Jay Miller’s father works in Georgetown Hospital in supplies. He had brought a blue
suitcase stuffed with useful items such as sterile gloves, and caps and masks. Holly had brought
a large bag of scrub clothes. I had brought suture and spinal needles and other items. Saba
Saba---a working holiday—turned into Christmas—with all the presents delivered here in
theatre. We have done lots of cases using up lots of material in our inauguration of the OT.
However, now they are better equipped than when we first arrived, and with judicious handling,
they might be able to function fully for a full year until our next mission without experiencing
critical shortages of vital equipment.
TOUCHING CEREMONIES OF GRATITUDE AND REGIS’ LITTLE
SPEECH—―AND NOW WE FEEL WE CAN CARRY ON!‖
We were getting close to the end of the List for those I had suggested I would help them
do, and for each of those still awaiting operation, I went over each of them with Regis, Rahima
and Orotta and assigned a schedule, tomorrow and Friday for those ready now to have hernia
repairs and hydroceles excised. I got them my on-line surgical text for consultation in other
problems that they might confront. We swapped emails and toted up the cases in the brand new
OT Log. Each came forward to say thank you for the time and effort invested in teaching them.
5
Especially touching was a tribute from Regis who had prepared a small formal presentation and
got started in it, when he broke down. He had said how much he appreciated our help and our
efforts toward assisting the people of Tanzania and how this would go a long way toward making
them a confident and competent full service surgical team. He then stopped, choked up and gave
me this enormous bear hug, and said simply, “and now we feel we can carry on!”
We got on the bus and drove over in silence and weariness to the clinic still working in
the dark. They had closed out the patient intake, but still kept on for those in process not yet
cleared through the pharmacy. Apparently there were officials who were expecting us all to
come to a meeting, and discuss future collaboration, but that was overwhelmed by the press of
immediate patients. As rapidly as we cold clear the patients and pack up the pharmacy to leave
with them all the items still here, we were to go directly over to the Indian Ocean side Swimming
Club where we had waited for hours for service three nights earlier. There we joined the entire
Town Council and friends of the Sister City project, including Dr. Mwenge from WHO and a
number of the persons prominent in either side of the exchange. We tried to stagger us out to
have an American between each of the Tanzanians as we went through a buffet line for faster
service. We each gave a small speech identifying where ewe had come form, what we had done
here and what we felt about it.
OUR FAREWELL VALEDICTORY CEREMONY AMONG THE
OFFICIALS OF THE TONGA CITY COUNCIL, AND THE ―FIGS AND
NUMBS‖ OF THIS WEEK’S OPERATIONS WITH THE PROMISE OF A
CONTINUING SUSTAINABLE ONGOING CLINICAL CARE
The numbers are significant, but like the “check list” on safari, they certainly do not
define the experience. On our clinic days we had a number of patients come through the
pharmacy (here in Tonga—in addition to the 112 treated medically in Korogwe and three treated
surgically in Saint Raphael’s Hospital on our first day there) to complete their treatment as
follows: Day #1: 115, #2: 189, #3: 225, #4: 365; for dental patients: 3, 11, 13, 17, 15 with 350+
teeth extracted. For Surgery patients, a total of 51 operated here in Pongwe in inaugurating the
new OT, but more importantly, full operating lists are booked for operations encouraged and
instructed by the Clinical Officers for the following week trebling our output.
It would be hard to improve on the performance of this successful medical/surgical
mission over the duration of our visit, but we will try, and plan to schedule a return next year to
push them up to a newer plateau of clinical care. Given this remarkably successful mission, what
can be expected to top this in my own Phase IV of my Tanzanian Expedition, after the I
Kilimanjaro Marathon, II Serengeti Safari, III Tonga Med/Surg Mission comes IV—Zanzibar—
and my final re-tracing of the route of David Livingstone through “Darkest Africa” as he left in
mummified form from Stone Town British Consulate in Zanzibar. Stay tuned to see if I avoid
the same fate in our final chapters of 10-TZ-Excursions!
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7
10-JUL-B-1
THE PART IV OF THE TANZANIA TREK FROM TONGA TO DAR TO A
HOLIDAY IN ZANXIBAR, THEN THE LONG RETURN VIA ETHIOPIAN
AIR FROM DAR, VIA NVO, ROME, IAD
1-JUL-B-1 Index to Part IV of the Tanzanian trek through Zanzibar
2 Departing Tonga leaving all clinic supplies, and the bus ride to Dar to board the ferry to
Zanzibar for our holiday overnight in the “Spice Islands”
2 Exploring Zanzibar on a full day of Stone City, walking the narrow streets and carved
wooden doorways in old Zanzibar, then the Slave Market and Anglican Church for the
fulfillment of my last stops in the re-tracing of the footsteps of David Livingstone as I watch
contemporary African schoolchildren confront their ancestors in chains at their slave pit models
and then Island touring and Kenwa Rocks beach combing and Indian Ocean swimming among
sailing dhows while beach going while enjoining the culinary seafood delights in the public
square
4 Final pre-departure day in Zanzibar touring the spice markets and souvenir purchasing before
boarding the ferry to Dar es Salaam to begin the long return flights through three continents—
and after a late return from the ferry, we check in as the Air Ethiopian flight is already
boarding—I produce my Sheba card and find we are assigned to “Cloud Nine”—a luxurious
departure in first class as we leave a near=perfect trip in style, heading for Addis enroute to a
further sixteen hours to Washington return
10-JUL-B-2
DEPARTING TONGA LEAVING ALL CLINIC SUPPLIES, AND THE BUS
RIDE TO DAR TO BOARD THE FERRY TO ZANZIBAR FOR OUR
HOLIDAY OVERNIGHT IN THE “SPICE ISLANDS”
July 8, 2010
I am “On the Bus “as the “Beat Generation” classic by Bob Perzig would have it—as we
are doing serious road time on our way down south to Dar to make it there by our four o’clock
ferry call for a further ride to Zanzibar. We have been seen off by the folk who were gathered
with us last night at the Indian Ocean front outdoor buffet at the swimming club where we had
waited over two hours to be served on Monday night after a full clinic day. The food came late,
and the team got a chance to make a twice around tutorial, and it was possible that this may have
been good for the teaching parts of the session, before everyone knew of the "intensive lecture
hall” that the theatre represents.
We were surrounded by the officials of the Tango city council as well as the boosters of
the projects that have us coming back here. That included Dr. William Mwenge, who was the
UN representative to WHO and is the technical advisor on the extended program in
immunization in Tanzania. He is trying to add Hemafluous influenza, and diplococcal
pneumonia to the list of the seven immunizations already in place, like hepatitis, M, M, P, T and
others as needed depending on the Tb prevalence, adding BCG.
Each of the officials got a chance to thank the group for their efforts and each of the team
got a brief self-introduction. The buffet dinner was served to us in a line up and then we sat in a
Safari beer haze after a full time day at work. I collapsed in bed and decided to pack up for the
trip in the morning. That is what we did before dragging home our weary bodies to the Sea View
Resort and I was downstairs when I heard that the rest of the younger components of the team
had gone out drinking at the La Vida Loca, a bar within crawling distance of the Sea View
Resort in which we are staying. We had breakfast on the porch, and then left by bus. We went
through the sisal and cassava plantations along the coast as we went south seeing large groups of
women sitting in the sun behind big pyramids of oranges and all other vendors seeming to subsist
on homemade charcoal. They chop wood and start a fire and bury it with sand to make the
charcoal and this is stuffed in a big synthetic burlap bag to overfilling which is sewn in for the
overload of charcoal which represents East African deforestation for the benefit of the Yemeni
and Omani braziers to perform their cardamom flavored coffee ceremonies in a tree less Arabia
peninsula. I am told a big bag of charcoal costs ten thousand shillings, the same as our lunch.
1
Our lunch was eaten n the same place as our last year’s stop where everyone had stopped
to watch the Michael Jackson funeral ceremonies and flashbacks of his life of dubious
achievements as they were mixed with some unusual child molestation charges for which he paid
his way out, and as he was about to set out on tour to pay back twenty five million dollars in
debts, he had hired a sleaze of a “live-in physician" who had “helped him sleep" with a
Propothol injection, the same drug we use in the Mindanao Philippine missions to induce
anesthesia and apnea—so he was assassinated.
Outside the open air restaurant, there are lots of hawkers peddling souvenirs, and there
are folk out on the same kinds of charcoal fires roasting corn. A carving salesman was standing
in his aggressive pose to sell the carvings when I spotted a large green female praying mantis,
which is the green leafy immitant that looks indistinguishable from a tree leaf. It was staring
straight at me as it moved around on its ungainly widespread legs, with each joint festooned with
a green “leaflet.:" I took some video as well as Macro photos of her, a similar species as I had
photographed in South Sudan at Duk Payuel—as remarkable a piece of Darwinism as I have
seen. It is a pleasure to have done this “big game photography.”
I showed a lot of photos to Don Miralle who had joined us from his photo safari to the
Selous preserve, and his photos are nothing short of stunning. The composition is spectacular
which means some of it is carefully prepared for—and a lot more is due to luck. He was careful
and lucky. Both of these commodities are easier to capture if one carries extensive equipment,
and I am packing a simple pocket digital camera which seems to do the job just fine. In
swapping photos shows, I told him of what we have not swapped, which is a couple of videos
like the one on Rwanda and he is eager to make up a U-Tube program from his excellent photos
on this trip and consider going on a next excursion. I told him of Pendragwn, and the other
media outlets I have had. We will get together. I am getting sleepy in the mid-day transit and
we are pushing forward to reach the ferry to Zanzibar by four o’clock so I will re-tune later in the
“Spice Islands.”
To feel right at home here, we had Ugali as one of our lunchtime staples, which is the
pounded cassava root flour and water paste. It is Tuo di Mia in Nigeria or Fon in the
Francophone West Africa, and it is everywhere “what’s for dinner.” It is said to be distinctly
African all along the Equator since they cannot grow grains with the exception of finger millet in
Sudan or “tef” in Ethiopia, and in Southern Africa the importation of “Mealies” has made the
corn product of a porridge called Nsima in Malawi. But these are all new world products of the
Columbian exchange, and the Ugali we has is if not tasty, at least satisfying as a belly filling
paste.
After a wearisome bus ride through the now urban traffic jams which still contain the
clutter of pedestrians of multiple species, we crawled through the crowds down toward the docks
in Dar’s harbor, under the tower of the harbormaster’s elevated “ATC-like” control tower. In
2
Australia, with their droll sense of humor, this tower over the harbor is called “The Pill” since it
“Controls Berth.”
ARRIVAL AT DAR ES SALAAM AND BOARD THE “KILIMANJARO”
FAST FERRY FROM DAR TO ZANZIBAR ACROSS THE INDIAN
OCEAN FOR A TWO AND A HALF HOUR RIDE TO STONE TOWN
We are on the docks at Dar: DARS= 06* 49.41 S and 039* 17.36 E and at O meters
elevation.
AIRP=290 miles @ 329*
ARUS= 247 miles @ 326*
BAGA= 367 miles @ 318*
These data tell you I am over a long day’s drive from Kilimanjaro Airport where I had
entered the country part way between Arusha and Moshi where I did the Marathon and launched
the safari respectively. I am also south of the town of Bagamayo which I had visited last year at
this time to see the Livingstone Tower where his mummified body lay in state overnight before it
was carried over the beach at that point he had entered (as had also Burton and Speke and
Stanley) at the very same point that most of the slaves had left the African continent forever,
which is why that site has its name “Here, Throw Down My Heart” This “”Bagamayo” was my
penultimate stop in Africa on my re-tracing of all the steps of David Livingstone before he was
taken by Royal Navy Steamer to London to be interred in the Hall of Kings in Westminster,
where I have his grave site illegally photographed. I had explored much of Zambia and stopped
under the Mobolo Tree where his name was carved and under which his hear was buried, (but
true to form, the Africans then chopped down the tree—a resource they could hardly conserve
because “don’t they grow everywhere in abundance?”) David Livingstone died at his prayers
under that tree where his heart remained, but his faithful African attendants carried his
mummified body all the way from what is now Zambia to Bagamayo to have the remains put on
a dhow here to be transshipped to the British consul's residence in Stone Town Zanzibar under
the sultan near the Slave Market. I will now be able to make the last exit point of Livingstone’s
body from Africa to return to the ceremonies the London Missionary Society had planned for his
royal reception as the one person who had done more than any other to “Wipe the scourge of
slavery off the face of the earth.”
But, first I have to get to Zanzibar, and before that I have to get to the ferry. That was a
close call. I was carrying a small bag, a bottle of water and the GPS and camera in hand as I
hopped off the bus, leaving most of my stuff to be stay in the locked bus. I had to fight my way
through a crowd holding on to the ferry ticket as we boarded on the gangway in a crowd that
looked like the Noah’s Ark boarding party. Our bags were taken to be lashed to the bow deck
and covered with a plastic tarp. There were deck chairs up front and outback, but mostly people
3
stood or leaned or crawled to where ever they could eke out a space. I am sure that there must be
some international maritime limit to the number of people that can be squeezed on to a ferry, but
I am also sure that here, as in the Philippines or in any other major ferry passage area on earth,
no one has any idea how many people are on any given ferry or who they are as long as their
ticket has been bought with cash—the sole limiting factor I could see on boarding the
Kilimanjaro.
Almost as soon as we were on board the hawsers were slipped and the Kilimanjaro
rumbled out with the Noah’s Ark of hangers on clinging to whatever rail or space that could be
found. It came out along dhows which were making the same passage but they looked more
graceful under the “claw” of their lateen-rigged sail. We pumped our way out of the protected
harbor of Dar and its Bay and out into the Indian Ocean under the shelter of a barrier Island
whose name I was given and have forgotten.
As I was in the bus as it was crawling forward to the harbor, I saw two Masai Moran
walking in their tire casing sandals toward the pier. When I was in the melee of the boarding
group, I saw them again and realized they were going to get on the same ferry. Later, after I had
stood at the taff rail and watched Dar and its “Pill Tower” retreat behind us, I went up to the
foredeck. The two Masaai were seated in the area right behind the tarp covered bags. I greeted
them with a bit of the Ki Swahili I still know and we got to talking. The eldest spoke a little
English. His name was Daniel Longnka, 26, and he spoke for his younger brother Tomas Paulo
age 22. We hit it off and posed for photos together to which they responded in the only KiSwahili phrase uttered world-wide “Hakuna Matata”---“Ain’t no big ting”, “No Worries.”
I introduced my new Rafikis to the others in our group and told them a few things about
the Moran ritual of initiation. Each of the two Daniel, first and then Tomas had gone through the
ritual and had wandered for two years in the “Morani” (“tire-casing sandals”) through the thorn
scrub, looking just like the trio of Masaai I had seen both coming and going into the Ngorongoro
Crater Conservation Area in which they have exclusive jurisdiction rights to follow their cattle.
They only get out of this status when they are formally initiated as a Moran and that involves
their killing a lion with their assegai spear, a rite of passage. That is why I had once been in the
Masaai Mara with two Africans and Michael, and one of those was a Kikuyu Kenyan and the
other a Masaai. I could always tell where the Masaai was, since the lions we encountered never
took their eyes away from the Masaai. For millennia the Masaai and the lions have both grown
up in the same “Cattle Culture” and are rivals for the same food stock.
Since Daniel’s English was limited he encouraged me to tell them the stories about life in
the Rift and exclusion from the Manyata where women and children are kept. I deferred to him
but he kept nodding his head in agreement as the stories I have long heard about the Masaai
priests, the witch doctors, the drinking of blood mixed with milk ritually obtained by a small bow
and arrow puncture of the cow’s jugular vein, all were agreed to in his confirmation. They were
going to a resort on Zanzibar where they were the colorful Masaai Act which was a common
4
tourist attraction at nearly all the resorts where they did the peculiar Masaai slouching dance and
the jump dance to get vertical clearance of up to a meter form a standing start. We were
swapping pictures and names and I gave them the water bottle I had hoped to carry me into
Zanzibar.
We motored into the Stone Town Harbor in its ornate white buildings festooned with
Bougainvillea, and watched as the sun set behind Dhows lowering their sails in the harbor. We
had to fill out an immigration form to get a “visa” for Zanzibar—an “internal visa” apparently to
support Zanzibar’s claim to be an autonomous part of Tanzania with a strong separatist
movement to re-establish it as a sultanate and secede from the former union with Tanganyika.
We were picking up our bags from off the quay and lugging them to a bus to make only a short
trip over to the Garden Lodge, our accommodation for the next two nights here on the island.
We could walk through the narrow winding streets designed a long time before the internal
combustion engine, but even in the darkening evening we could see the signature of Zanzibar,
elaborately carved and ornately festooned wooden doors. The influences of India (steel spikes to
discourage elephants pushing them in) or Arabic (non-representational art) and Christian (gothiclike castle moat gates) made each of them distinctive.
SEAFOOD MIXED GRILLING IN THE CENTRAL SQAURE OF STONE
TOWN BEFORE A SPECIAL PLACE TO RETREAT FOR A LATE
EVENING DRINK—THE LIVINGSTONE BEACH HOTEL AND ITS
SPECIAL HISTORIC SITE OF THE OLD BRITSH CONSUL
We went out almost immediately to a central square in town where there were many
merchants sitting around charcoal and gas-light tables with fresh seafood which one could select
in an array of squid, octopus, barracuda, swordfish, tuna, prawns, lobster, etc and then it was
shish-kebabed for us on the grill and a fellow came around to beg to buy me a drinkable item in a
bottle that he was very attached to since it has a deposit he needs to collect on returning it. We
sat around in the rather popular central square at night in the cooling sea breezes and ate our
seafood grille, which was about the same price as a Washington DC restaurant which meant that
it was enormously over-charged here. But, the ambience was good, and I thought we were about
out of activities for the evening. Not yet, and not with this gang.
We went to the Livingstone Beach Hotel which had tables on the beach sand right behind
the bar of the first floor and it was a temptation not to be passed by for several of our younger
females who went right to the water’s edge to dip into the Indian Ocean. We all gathered at the
tables to order some drinks and after-dinner snacks as the team assembled for a rolling toast to a
successful mission. The shots that followed kept the younger members busy far into the night, as
if they needed a second night after closing down the La Vida Loca Bar in Tonga Town last night,
but that they did.
5
For me it was a different thrill. I was sitting in the house of the British Consul at the time
of the slave trade and the negotiations that were done to outfit the major expeditions inland, for
Burton and Speke and for Livingstone, and later for Henry Morton Stanley on the trail of
Livingstone after he had vanished—with no trace by GPS, emailing or satellite phone card at the
time of Victoria. I was in the room where David Livingstone’s mummified remains had been
delivered by dhow from Bagamayo on the Tanzanian Coast and from which it was take n with
full honors aboard the Royal Navy steamship to be transported home to London.
The menus were marked with this historic record and the room itself, now turned in to a
bar, was showing the last of the world cup matches.
6
10-JUL-B-3
EXPLORING ZANZIBAR ON A FULL DAY OF STONE TOWN TOUR,
WALKING THE NARROW STREETS AND CARVED WOODEN
DOORWAYS IN OLD ZANZIBAR, THEN THE SLAVE MARKET AND
ANGLICAN CHURCH FOR THE FULFILLMENT OF MY LAST STOPS
IN THE RE-TRACING OF THE FOOTSTEPS OF DAVID LIVINGSTONE
AS I WATCH CONTEMPORARY AFRICAN SCHOOLCHILDREN
CONFRONT THEIR ANCESTORS IN CHAINS AT THEIR SLAVE PIT
MODELS; AND THEN ISLAND TOURING AND KENDWA ROCKS
BEACH COMBING AND INDIAN OCEAN SWIMMING AMONG
SAILING DHOWS; AFTER BEACH GOING REPEAT ENJOYING THE
CULINARY SEAFOOD DELIGHTS IN THE PUBLIC SQUARE
JULY 9, 2010
I always knew I would be here! I had been once when I took the “Kilimanjaro” the
ubiquitous name of anything good in Tanzania, and the one 737 Boeing that Air Tanzania had at
the 1996 time when I was Senior Fulbright for Africa. I had made the longest trip possible on
that airline, leaving from Johannesburg to Kilimanjaro at Arusha/Moshe, and then to Dar, and
then to arrive across the sea in heavy cumulous clouds of the tropics to land on the island even
before I could see it. I saw the “Spice Islands” from this landing and took pictures in my film era
shooting a number of scenes of this exotic place on my map I needed to fill in. I then went on to
land in Aden, Yemen, Muscat Oman, and finally Dubai—the entire routing of the dhows that
could make this trip twice each year on the trade winds as the rainy seasons switched the
prevailing air currents to have the traders from Oman come and go to Zanzibar.
Even the name sound like a faraway place! I had read a lot about it after that, especially
about the Sultan who had ruled it and who had been here when the British came through with the
Royal Navy when Britannia ruled the waves. That era had each of my heroes and models of
early African exploration using exotic Zanzibar as East met West here. That meant explorers
outfitting with porters and supplies here and trekking inland, even as Arabic slave traders were
coming in the opposite direction, using the major slave market in Stone Town as it single biggest
source of commerce, with the "Spice Islands" trade in spices coming in a distant second.
ZANZ= 06* 09.89 S and 039* 11.37 E at 4 meters altitude
AIRP= 239 miles @ 325*
1
BAGA= 271 miles @ 227*
DARS= 46 miles @ 177*
HOME= 7,885 miles @ 313*
BREAKFAST AT THE ROOFTOP RESTAURANT OF THE GARDEN
LODGE WITH THE LARCENY OF “JACK DAWS”; AFTERE A SLOW
START FROM OUR “PARTY ANIMALS” WE SET OUT FOR A
WALKING TOUR OF STONE TOWN TO SIGHTSEE AND VISIT THE
SLAVE MARKET AND ANGLICAN CHURCH
I had gone up to breakfast and found myself alone. After using the GPS to make the
marks and associations of the site I am relating to much of Africa, I was seen by a waitress who
brought me coffee and a small passion juice. I sat and drank the coffee while looking over the
bougainvillea at the Government House across the street. There is a bit of turmoil in the local
politics of Zanzibar with a newly elected president (an odd office to have inside a sovereign state
called Tanzania) who has not yet been seated but who is supposed to assume office today—the
subject of the headlines on both Zanzibar and the mainland at Dar.
I was making notes to myself since I was alone for well over an hour, eager to get started
on my walking tour of Stone Town; but the “party all night” team has been at it again last night
and stayed in the Livingstone Beach Hotel bar doing shots until they had closed it down also, so
they are in no condition to get an early start on our tour this morning, In fact, no matter how
historically interesting, the Zanzibar tour is proabaly not as high a priority as the chance to go to
the beach and lie in the sand and sleep off the night they had missed, before getting started all
over again on a repeat performance. Ah, the majesty of the mission and the folly of we, the
youth who have to carry it out!
I was musing on these thoughts and writing a few “postcards” I had made up myself and
carried along for this occasion at this site. The cards are of a familiar place in an unfamiliar
scene—Derwood under the heavy inundation of Snowmageddon in February. It could not look
less similar to my present surroundings as the tropical breezes are stirring palm fronds over the
veranda on the rooftop as my waitress brings me an omelet and puts it on my plate as she puts
the coffee carafe on and adjacent table. I had been shooting photos of the rooftop scene over
Stone Town, as large “corbids” circled over head. These crow-like big birds would be called
crows by Americans, ravens by others and in “Briticism” they are “jack daws.” The generic term
is that of the crows = “corbids,” or "Corbin" in French. There is an antique surgical instrument
named the "Beck du Corbin"= "The Crow's Beak."And I got very much more familiar on how
intelligent these larcenous birds can be.
2
I watched carefully to guard my toast and juice then leaned over to pick up the coffee
carafe from the adjacent table without getting up to leave my seat. In a flash, a pair of the jack
daws came swooping in, brushing my arm as one was chased off by the other. Before I could
swing the carafe around in one hand, the more aggressive jack had snatched the omelet, and then
he tossed it into the air to catch it again by the mid-section to make it more aerodynamic to make
off with it by an air raid.
“Arrgh!” I yelled at the dirty bird and sat down with my reduced breakfast to guard the
toast and coffee at least. The waitress who had heard me came around and without any exchange
of words she looked at my empty plate and at a glance and a sweep of her hands upwards into the
air, she laughed and came back about five minutes later with a second omelet. “Asante Sana!”
I finished my breakfast while keeping guard over what was left. I had filled out several of
my Derwood “Winter Wonderland” cards and had seen the post office as we walked back on the
street last night after we had been in the central square for our seafood grille. I thought I would
not want to miss the gathering which was already past due, so I sat down in the garden at the
front behind the gate. No one showed up. So, I sat to write a couple more cards to finish the
stamps I had bought in Moshi, and then when no one had still appeared for our tour now an hour
later, I made a brisk walk to the Post Office and dropped the cards in the international mail slot.
I scurried back since I certainly did not want to miss the tour that should have already left. When
I got back to the garden, I saw David, and he said we were going to start our walking tour as
soon as everyone was ready and no one else was up as yet. So, I sat and waited in the garden as
a few of the red-eyed team mates came out to look for coffee and start a very leisurely crawl
toward the rooftop veranda or to skip that and wait as they were still groggy.
I told those that were going up to the breakfast on the rooftop veranda to “Beware!”
“Quothe the raven, Nevermore!”
WALKING TOUR OF STONE TOWN
We walked along the narrow street passing the walled houses with ornate wooden carved
doors. We had a tour guide who was walking with us as the stragglers caught up. He had told us
that there were over 520 carved doors in Zanzibar, and they showed the Indian, Arabic and
African origins of those who had lived here over centuries. There are a million Zanzabari with
700,000 on Zanzibar and 300,000 on Pemba. The British Protectorate status lasted one month
after the Sultan gave up the rule in 1964 before it was combined with Tanganyika which had
become independent in 1961. There are 15,000 population in Stone Town. There is full freedom
of religion even though 95% of the population is Islamic. There are Shia and Sunni here as well
as a sizable Hindu population and a large Anglican church.
The integration of the society was done abruptly since the Arabian influence kept
segregation in the baths, and the result was the baths were closed in the bloody revolution that
led to independence. We were walking slowly along as several of our stragglers were less
3
interested in getting more ground covered and were eager to sit. As we passed a shop which had
gone around the island and salvaged old wood, and were making small wooden chests of this
historic wood with brass fixtures pounded into them. The team sat as a few of the group went
into the shops and commenced a long process of bargaining which got protracted to over an
hour. As I stood in the street lots of kids came along with the head covers of one of the nearby
Madrassas. They would pose while waggling a finger in the air “No Photo!” and then continue
mugging and posing. Women were riding on bicycles while flowing burkas trailed the gowns
that served as blinders, Despite the obvious impediment of the clothing custom and the
mechanized travel on bicycle or motorbike, several out of control near collisions occurred as the
pedestrians were standing around us as we waited for the bargainers for small wooden chests
kept us in one location. We had seen the customs of the early days of the sultan’s rule in which
the graves were above ground often in the front courtyard of the houses. This allowed ghosts to
cohabit with their successors. We had seen several madrassas as well as a number of both Shia
and Sunni mosques.
At almost all points in which a shopkeeper is either making a sale or being frustrated in
his coming to closure, the phrase “Hakuna Matata” is used as a farewell. The same phrase is
found on the tee shirts or beer sales posters. I had seen a lot of people in the streets scurrying
ahead to go to market or bring back food stuffs. Even the veiled women were not outraged if
they seemed by accident to get included in the view frame of the photos I was shooting. This
might even be considered a capital offense in some places I had done photographs in which
veiled women were in the shot, such as several conservative Shia towns in Saudi Arabia, such as
el Hofuf.
We walked around several small shops but did not enter the main Spice Markets which
we were reserving for shopping tour tomorrow. Despite the shopping tour the following day and
a cultural information tour today, we were a bit bogged down as several of the group were
interested in stopping to shop and others were eager not to press too vigorously forward after a
very late night, and this made us drag a bit of a sea anchor along our slow route. I was eager to
see the slave market and get to the Anglican Church where I had heard the Livingstone window
was a central feature besides the cutoff of the marble pillar to which miscreant slaves were
brought for whipping.
The Anglican Church had a large group of schoolchildren in it when we arrived. We
could see the spire of the church’s bell tower adjacent to the minaret’s of the mosque. When we
came to the old brick church with some interesting architectural aberrations, we saw flying
buttresses like a medieval cathedral and the inside of the church had a nave and choirs like
European ancient churches, but there was something unusual about the carved marble pillars. I
stared at them before realizing that the capitals were on the bottom; the pillars had been installed
4
upside down! This is a hazard of the slave trade. One can coerce labor, but not necessarily that
they would do it right or have much incentive to know which way was right!
I saw the schoolchildren who were coming along with a local TV news camera and they
were being filmed as these children in school uniform of the Islamic variety and all Tanzanian
black were on a day trip form Dar to see some parts of their country’s heritag3e. They were
shown the church and what it meant in all its features, including the Bishop who had once been
here in the “Chair” (= “Cathedra” of the “Cathedral”) who is now buried behind the altar. But he
is NOT the “unspoken presence” here. Although other influential people of the time may be
mentioned, such as Wilburforce and others interested in Emancipation, one person is an almost
palpable presence. The church is clearly a memorial to probably the most illustrious citizen of
Scotland and by extension UK to come through these parts—David Livingstone. It was he who
had returned from Africa and given a lecture at Oxford and at Cambridge detailing the slave
trade he had witnessed and stirring the citizenry of the UK to take all necessary steps to rid this
scourge from the planet. He had returned again through Zanzibar and had got outfitted here and
stayed at the British Consul’s house in which the group had stayed too long last night.
The pillar is cut off flush with the floor which was the whipping post for the miscreant
slaves. The choir behind it has carved figures of important saints and figures in the movement.
But the central window is the Livingstone window, detailing important events in his life, and
finally of his death, before he was transported back here to his “home church” and transshipped
home to a hero’s welcome in London and entombment in Westminster. He had certainly
cemented the British claim on a large and unknown part of the Dark Continent. But he also had
done more than any other to eliminate the trade in human beings, which was abolished by the
sultan under the pressures of the crown.
We had been escorted down into the catacomb-like holding areas in the underground
adjacent to the church. This was the site of the slave market and this is where the “merchandise
was chained in the fetid and crowded conditions in which it was almost impossible to stand up
straight or lie down. As we came above ground we came to the side of the church’s flying
buttress where the women of our team all lined up to have their picture taken on the steps of the
buttress. There was a slave pit in the original position and the original shackles and chains were
there with model figures being held by the neck and limbs. It was an imposing sight even before
the next “live action” occurred for which I had turned my camera to video. As I stood there
adjacent to the slave pit with the manikins in chains, the whole contingent of the schoolchildren
from the African mainland came out in their school uniforms and carrying note books and
looking around as kids would anywhere until they approached the slave pit. Then they got very
quiet. They stared in wide-eyed wonder, as they looked at the manikins which represented their
own ancestors not more than three or four human lifetimes ago, which accounted for the greatest
emigration from Africa which they had missed because of the actions of a few principled folk
fighting an economic system of enormous commercial profit pressure. It was an impressive sight
largely because of the time warp of the observers and the stark facts observed.
5
We had backed up to “Creek Road” to which we will return tomorrow at the Spice
Market tour. Creek Road used to be the edge of the sea and Stone Town had been expanded by
reclaiming this “Creek” (named as the quay the same way that “Dubai Creek” is so named) by
landfill to make the Stone Town one street wider and the harbor by just so much closed in. As
we had been inside the church our guide Muhammad repeated these two stories I had given to
this team at least twice in exactly the same detail: about the life and lessons of David
Livingstone and then the epic adventures of Henry Morton Stanly who had come out in search of
him along with other explorers and would-be rescuers of Livingstone each of whom had passed
through Stone Town Zanzibar as their base of exploration. I also remember from Riczard
Kapucinski’s book that he had tried very hard to reach Stone Town during the bloody uprising
that preceded the independence of this the earliest of the East African Independent states, and
finally had to get into a small boat with an outboard motor and risk the passage we had just made
by big ferryboat over from Dar to get here to witness and report as a journalist the events that
were reshaping African political history.
BEACH BUNNIES BUS ON OVER TO KENDWA ROCKS RESORT
BEACH TO SWIM THE INDIAN OCEAN, PLAY BEACH VOLLEYBALL
AND “VEG OUT” ON THE WHITE SAND OF A TROPICAL ISLAND
BEACH IN ZANZIBAR
We pulled out in the special bus we had reserved for this purpose at 12:40 eating only a
nut bar for lunch as we made it two hours across the island. Dennis stayed behind since he
wanted to edit pictures and also seek out an internet access to send a message home to his wife
Dora. The other members of the team were eager to get over to the other side of the island, to
swim in the Indian Ocean and to “veg out.” This beach scene was proabaly the high point of the
Zanzibar visit for most of the others than me, since they had been dreaming of a summer on the
beach foregone by the mission, and they were eager to catch up.
On the bus, I had outlined a plan of action that we would try to make a composite report
of our mission and Holly and Jay would assemble it for GW and EVMS and then with the
program put together for this venue, we would put it on the road for a rendezvous in Toledo at
the Students for Medical Missions in March of 2011. At that time I may try to host Don Miralle
to come to DC and Derwood to meet a few of the documentary teams and he could join us on the
trip to Toledo. He will also be looking in to the possibility of a clip of the kind of expertise he
works so professionally to be shown as the “kicker” to the Calvin January Series lecture for
January 13, 2011 which can then be shown again in Toledo for the MMHOF.
I looked around as we passed many makeshift mosques along the roadsides, as this was
the noon Friday prayers. Each small mosque seemed to be overflowing, with men scattered in
linear order outside the buildings by directing themselves in the same orientation as the mullah
6
who led them facing Mecca—which, it must be remembered, is less East from this GPS location
than principally north.
I had been told earlier that it is OK to take pictures of nearly everything we encounter
except the police, since the latter are almost always involved in some kind of extra-legal
shakedown activities that they are not at all happy to have photographed. It was a long and
drowsy drive out to Kendwa Beach, but not as long and drowsy as the return after an afternoon
of fun and sun and swimming in the Indian Ocean. I had done a fair amount of beachcombing
and had come upon a large puffer fish and a big dead parrotfish as well as a collection of Indian
Ocean seashells. I was fascinated by the log canoes on the beach with their primitive rigs and
netting used for fishing in the sunset coast of Zanzibar. The long white sand beaches were
idyllic, and had a strange combination of Islamic veiled women and bikinied European sun
bathers There were also a large number of high pressure salesmen trying to sell paintings or
beads or scarves or tours and a few who desperately wanted to have me take a boat cruise all day
to an adjacent island did not seem to stop when I told them that we would all be leaving before
their boat cruse got back. A number of the team got into a vigorous beach volleyball match and
then would swim to get the sand washed off.
I took photos of the dhow cruises heading off into the sunset with thief sails hoisted to
take advantage of the light winds. They made a good foreground against the sunset background.
We then crawled back to the bus and got started on the much longer return trip. I heard Katrina
and Holly comparing their amazingly similar life stories and forward plans as they were both
seniors I medical school and trying to make decisions regarding personal and professional lives.
I heard the others reflecting back on the trip and the ideas of how they could repeat this kind of
experience in some parts of their training later as they enter another tunnel. It was like the Labor
Day holiday in Michigan coming back from the beach and facing a “back to school” reality,
recognizing that there might not be too many of these lazy and carefree summer days up ahead!
When we got back to the Garden Hotel, I got showered quickly to rid myself of the
Indian Ocean salt and gathered with the team downstairs in the Garden as two repeat
performances were about to take place;
First, we returned to the Central Square and had a repeat seafood grille of calamari, squid,
octopus, lobster and all other good things and a Serengeti beer. After that, I was ready to go
back to upload films and go to bed; Denis had a day of that already and had discovered an Indian
Restaurant he wanted to try.
The second part of the “Repeat Experiences?” You will have either guessed it or cannot
believe it. The team went back to the Livingstone Beach bar and spent the night doing “shots”
and crawled back after closing it down!
Gaudeamus igatur, juvenatus summum!
7
10-JUL-B-4
FINAL PRE-DEPARTURE DAY IN ZANZIBAR TOURING THE SPICE
MARKETS AND SOUVENIR PURCHASING BEFORE BOARDING THE
FERRY TO DAR ES SALAAM TO BEGIN THE LONG RETURN
FLIGHTS THROUGH THREE CONTINENTS—AND AFTER A LATE
RETURN FROM THE FERRY, WE CHECK IN AS THE AIR ETHIOPIAN
FLIGHT IS ALREADY BOARDING—I PRODUCE MY SHEBA CARD
AND FIND WE ARE ASSIGNED TO “CLOUD NINE”—A LUXURIOUS
DEPARTURE IN FIRST CLASS AS WE LEAVE A NEAR=PERFECT TRIP
IN STYLE, HEADING FOR ADDIS ENROUTE TO A FURTHER SIXTEEN
HOURS TO WASHINGTON RETURN
JULY 10-11, 201
A near-perfect Tanzanian trip has just concluded as I lift off from Dar es Salaam after a
last minute return from the fourth phase of our excursion, the Zanzibar weekend holiday, capping
the fourth consecutive remarkably successful phase of our expedition—and we are leaving in
style!
As close to the liftoff as safe, because of our somewhat hammered sea crossing on the
―Kilimanjaro‖ fast ferry, we got involve3d with the melee in which we tried to retrieve our bags
as they were tossed over from the bow deck where they had been covered with a plastic tarp, and
now were tossed into a sea of competing porters at the floating quay among passengers, most of
whom had been shaken up by the pounding from the seas in brad daylight’s crossing., rougher
than our outbound cruise to Zanzibar at sunset previously. Among the items on the foredeck was
a woven wicker basket containing a frightened little dik-dik, the smallest of the pygmy antelopes.
I asked the man who brought it aboard what was the Ki-Swahili name and he said ―‖Pah.‖ We
did finally get our bags, none of which have gone missing by error and no thievery has occurred
during the entire trip except for my breakfast omelets yesterday morning as I had breakfast on
the Garden Hotel’s rooftop dining area and jack daws stole it as I reached to the other table to
retrieve the hot water to make instant coffee. Only one bag has been missing and that was not by
accident—that is the SCI bag full of medicines especially the spinal anesthesia kits which I had
made available to Dave Pierce, Holly’s father as he came over from his US State Department
post to pick it up for her and re-packed it with an inventory. Since it had no letter of
authorization in Holly’s carryon bag, only the inventory inside the bag along with all my licenses
and plans for it as a donation to the mission, it was officially impounded and never was released
1
in time for us to use it in the course of the mission. I certainly could have used it, especially the
spinal anesthesia kits. But, it is gone and that perhaps is the only single instance of a downer in
this remarkably consistently successful trip in all four phases, doing precisely what we had
hoped and more besides in each phase!
And, now, we are on ―Cloud Nine!‖ We got to the check in desk late enough that the
aircraft was boarding already. I handed the agent my Sheba Club card for Ethiopian Air. I got a
momentary pause by the agent then a rush of folk around and we were issued boarding passes—
mine was seat 1J—the first seat in first class. Holly also got the opposite side of the aircraft, so I
could swing my camera over to her so that she could shoot both the overflight of Mt Kilimanjaro
as well as the African sunset from above as I looked down on the Indian Ocean coast as we flew
north and west toward Addis, sipping fine wines, ordering a Nile Perch dinner and special
dessert, with a ―Cloud Nine‖ folder given to us as a souvenir to carry along with us—flying high
at the conclusion of a trip in which the students were all riding higher still!
At the last tutorial I had asked who had performed their first operation and all hands went
up; then I asked who had just performed their last operation, and no hands went up. Several are
making plans for their next trip with me since they are now convinced that what they had heard
is true—they really DO get the entire medical school and residency experience compressed into
one fast-forward experience on the mission with me! Further, they got a chance to be ―Squirrely
girlies‖ and party it up after a full day on the white sand beaches of Kenwa Rocks and still stay
up all night drinking at the clubs on Zanzibar as a chaser. And, now, they can ride out in style as
well!
THE ABBREVIATED SPICE MARKET TOUR AND SOUVENIR
SHOPPING FROM THE HUNG OVER CONDITIONS AND LATE START
OF MOST OF THE PARTICIPANTS
I started out this morning early—the only one of our group to do so, since I had taken the
correct turn at 11:30 PM as the whole group peeled off from our return from the main square in
Stone Town and had gone back to the Garden Resort Hotel. They all went out for another all
nighter, as they had the night before which made so many walking zombies for our prior
morning of the walking tour of the old town interrupted by an hour and a half shopping stop as a
series of those who were still hung over went through a shop to buy souvenir boxes made of
salvaged old wood. We had a second night at the open air seafood grilles in the central park, in
which I had gone through a rather large series of choices that included calamari, octopus, squid,
tuna, scallops, garlic bread and some grilled veggies with it. This gave me a supply of "traders‖
to swap off, among those eating lobster, piri piri chicken, and a few other items along with my
favorite, the jumbo prawns. A fellow had identified me as from Washington DC, Obama’s
neighbor, so he extended me credit and knew I would be good for it as I had been the night
before, so he could add to the collection of good things I had ordered so as to increase the
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charges, already too high for the Island standard of living. As always, there were a whole string
of hangers on who begged to be included into this standard of living, and who offered ―services‖
to merit their coming to attention—such as ―conversation partners‖ for their own attempt to learn
more English, or to carry away the paper plate when it was finished –all of which were reckoned
to be worth ten dollars or an ―extra‖ 20,000 Tanzanian Shillings (= $17.00) which they were
exclusively entitled to keeping all others at bay form the ―mark‖ they had identified as theirs. It
was a repeat of the performances the night before, but it was also tinged with a bit of worry sent
through David who had pointed out a text he received saying that this Saturday night there would
be demonstrations against a political rally, as the newly appointed Zanzibari president was
declared. This was a reason to stay close together and sequester inside a bar and drink along far
into the night, as interpreted by a few. But there was no redeeming feature about hit outing as
the first one was, when at least we were in the Livingstone Beach Hotel, the classic British
Consulate from the Victorian Era of which I had read a fair amount as the final resting place of
David Livingstone’s mummified body on its return to London to be interred in Westminster after
proof of its authenticity.
We walked around to the teaming spice market on a big market morning, starting off after
breakfast which I had enjoyed alone, two hours before any of the others actually materialized. I
was accompanied by only a few jack daws which I had to guard my breakfast from as the others
came up one at a time long after I had already finished. We took off with only one hour total to
allow us to tour the market, get around to another souvenir place and still make it to our ferry
departure at 12:30 which would be a close call for our 5:30 departure of the first three of us,
myself included on Air Ethiopia.
The market is going to be seen in my photos and video, but will not be smelled, which is
a major sense for its appreciation. It has a lot of contrasts, as European holiday makers are
strolling in short shorts and tank tops through crowds of fully burka-shrouded women whose
direction of travel is not apparent until one sees an outline of their eyeglasses in the distorted
shape of what must be there ―en face‖ direction. Unlike the same status in Saudi Arabian or
some of the stricter spots in the Emirates or Gulf States, the women do not seem to mind if they
wander into the view frame of the camera. I had shot pictures of the spice racks and the colorful
cloths, and if I could capture it, would have carried home the smells of the fish market and dried
meats or the live chicken market of chickens sticking their heads up through the interstices of the
wicker baskets in which they had been transported on the back of a bicycle of o top of someone’s
head to get to this big market day. As I wandered I had periodic hangers on attach themselves to
me despite my indifference to their calls of ―hey, Big Man!‖ who essentially wanted to escort me
through the market and bargain for me on things I had an interest in buying. Several of them I
could not shake, as I tried to keep them away from our first timers particularly the pretty young
women who attract attention as more like them but clearly better off. I had several of the women
in traditional dress suggest that first I buy something, and after I showed no interest in that, that I
marry them and carry them back home with me. Yeah, in only one of our dreams!
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I shot a video complete with the hawking of ―Chai Chai Chai!‖ and the packets of mixed
spices—from which the name comes of the ―spice islands.‖ There were whole nutmegs and
coriander and brightly colored spices in separate sleeves of plastic sealed wrap. There was also
jack fruit and durian, and the kinds of fruit I see in the Philippines, like Lonzoni’s and Rambotan,
and a lot of folk selling cloth, with many that feature Barak Obama as a centerpiece for the only
tourists that can comfortably be assumed to have money. I even bought a couple of filmy
scarves since they were the first I had seen of the Big Five, but I bargained for both me and Don
Mirales, the photographer.
We left from the spice market to get to ―One Way‖ a rather tony upmarket shop
―complete with A/C) where special tee shirts cost up to forty eight dollars, while outside there
are aggressive independent marketers pushing knock off products of a tenth of the price. It
seems that much of the stock comes from the same place—all China made, of course. China has
been very big as the wholesaler to Africa and they are the second marketers back to the
Europeans looking for something that is ―typically African.‖
Now it was past time for the scramble to the ferry amid the same teaming scene of
pushing and hauling the bags and baggage, and all of it starting up at about two hours past the
agreed upon times. We managed to make it, but only by scrambling unnecessarily, and it might
have been more instructive earlier to simply abandon anyone not ready within fifteen minutes of
the time set for departure to anywhere but David, our laid back Rasta Man is frequently late
himself, and that becomes the standard, and only after his late appearance does the start up of
long processes such as Dennis packing all his carryon equipment which comes aboard in two
additional suitcases on the bus, so we are often dragging a sea anchor. Somehow we had
managed to barely make each of these last minute connections and today’s boarding both the
ferry Kilimanjaro and Air Ethiopia were last minute catches. But all has gone at jet speed since,
but the three continent day still takes sixteen hours even after we reached Addis with our drowsy
stopover for refueling in Rome and a crew change. I have abandoned the movies except for the
old classic of James Bond in Diamonds are Forever, and tried to nap a bit, since my laptop does
not have a chance of staying energized as long as I need it after I begin the orientation of the
images and storing the images right side up.
This trip has been a superb four phase undertaking, with each one getting even better than
the spectacular preceding stage. Somehow, with the exception of the sequestration of the SCI
bag of medicines in the Kilimanjaro Airport and the loss of the medicines and surgery stock,
particularly the spinal anesthesia kits; everything else is an ever-better sequence of superb
Tanzanian excursion experience. Superb! And now, making plans for next year’s return, we
may even add a post-mission hunt in the great Selou Game Reserve!
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