Beating the Odds - Hope and Survival in Rural Tanzania
 Namunyaki and her son, Julius, on discharge day

Namunyaki and her son, Julius, on discharge day

 

When tetanus develops, mortality rates are extremely high, especially when appropriate medical care is not available. Maternal and Neonatal Tetanus (MNT) has been among the most common life threatening consequences of unclean deliveries and umbilical cord care practices, and are indicators of inequity in access to immunization and other maternal, newborn, and child health services. "With no cure, MNT is responsible for an average 110,000 deaths a year in the African Region. Once contracted, the newborn usually dies within seven days." (World Health Organization).

Julius's survival was a miracle made possible by the FAME team.

Eight-day-old Julius arrived at FAME in late September with severe tetanus, his fists clenched and back arched. Even minimal stimulus caused him to become more rigid. Like his three siblings, Julius had been born at home in his mother’s Maasai village. His mother, Namunyaki, had not experienced prenatal care – a vital component of maternal care that would have included a tetanus immunization to protect her and her newborn. It was a very challenging case, yet our medical team was determined to do their best to save Julius. They began by administering tetanus immunoglobulin and multiple drugs to alleviate his muscle spasms. As Julius was unable to breastfeed in his current condition, the nursing staff gave him Namunyaki’s expressed breast milk by nasogastric tube. For two and a half weeks Julius remained in critical condition, requiring large doses of medication to keep his spasms under control. Yet, Namunyaki, buoyed by the advice and encouragement of our doctors, stayed hopeful.

Little by little Julius showed signs of improvement and was slowly and carefully weaned off the medications. After nearly a month of care, Julius was finally able to breastfeed. This was a huge save for our team. As Namunyaki and Julius were being discharged, they received their first tetanus shots and will return to FAME to complete their immunizations. Namunyaki and her family were so grateful to our staff for the care they received. On parting, Namunyaki remarked: “I will be a good ambassador for FAME. I am so happy to see my baby doing well that I will tell my village that FAME is the hospital to go to.” Julius is alive and healthy because of the incredible work done at FAME through our staff and a network of global supporters.

 
Kathrine Kuhlmann
Filled With Thanks and Giving
 Dr. Badyana and a healthy and grateful Paulo

Dr. Badyana and a healthy and grateful Paulo

 

It was 11:30 at night when Paulo, a young male in his 20s, arrived at FAME with severe abdominal pain. Dr. Badyana and Dr. Julius, the clinical team on night duty, immediately jumped into action, performing his work-up, putting him on IV fluids and performing X-rays to try to determine a diagnosis. Following his x-ray, they called in Dr. Kelly, our global surgery fellow from Creighton University for guidance and support. When Dr. Kelly arrived, there still wasn’t a clear diagnosis. They did know, however, that Paulo had an acute abdomen, and that there was something emergent going on inside. Dr. Kelly and Dr. Badyana called the OR team, explaining that they needed the OR opened as fast as possible. Despite the late hour, the team rallied. Thank goodness the OR supervisor lives on campus and a driver is “on call” to pick up others for just such situations. In no time at all, the OR team was in place and ready to go. When the surgeons opened Paulo’s abdomen, they found what is called small bowel volvulus, a situation in which the small bowel twists on the mesentery, the tissue that fans out to the small bowel. When this happens, all blood flow to the small intestine is cut off, leaving only a finite amount of time before all of the bowel dies.  

As Dr. Kelly and Dr. Badyana worked to save Paulo’s life, they noticed that his intestine was already showing signs of injury. They untwisted his small intestine and placed warm saline over it. They waited a few minutes and much to their relief, the color of the bowel improved. Fortunately, none of the intestine needed to be removed and the surgery was a success. Following the operation, Dr. Kelly expressed that if FAME didn’t exist, considering how time sensitive his condition was, this young man would have died.

Young and strong, Paulo recovered remarkably fast over the next few days. He’s been back in clinic twice since surgery, asking the doctors when he’ll be well enough to be back playing soccer. He is also exceedingly thankful: “I appreciated how they received my father and I. Immediately, I was taken to the doctor’s office and they began treating me.” Paulo’s story illustrates what a proactive and patient-centered team can accomplish at a small hospital on a hill in rural Tanzania. His life saved, hopefully Paulo will be back on the soccer pitch soon! 

We are deeply grateful for you, our friends and supporters. Your generosity and support are enabling us to save lives, like Paulo’s, every single day in Karatu, Tanzania. Be blessed this Thanksgiving and always.

 
Kathrine Kuhlmann
Inspiring the Next Generation of Healthcare Providers
 

This past month, three Tanzanian young people training to become healthcare professionals chose to spend their annual school holiday volunteering at FAME. We welcomed Lucy, studying Laboratory Sciences at Mvumi in Dodoma, Christina, studying to receive her diploma as a Pharmacy Tech at Muhimbili in Dar Es Salaam, and Abdul, studying to receive his degree as a Medical Doctor also at Muhimbili.

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Lucy, soon to be Laboratory Tech

Lucy found FAME Medical after having grown up in Karatu. When she left to begin her training in laboratory sciences, she knew she would be spending her holiday home with her family and wanted the opportunity to get hands on experience in a laboratory for the first time. She had never been to FAME before, but she heard that our campus had one of the most advanced labs in the area. With only one year remaining in lab tech school, she wanted to gain practical knowledge to contribute to her studies. She spoke on how much she had learned in such a short time – learning how blood is tested and about parasitology. She was thankful for our staff – for taking the time to teach her, for their patience and for giving her a chance to really learn from the experience. As she heads into her final year of school, she’s excited about applying the knowledge she gained over her holiday at FAME!

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Christina, soon to be Pharmacy Tech

Christina spent her time at FAME assisting in our pharmacy. She chose our hospital because it was close to her family home in Karatu and had the proper resources. She knew to get the best experience, she would need to be in a hospital that had a lot of medicine present in the clinic and FAME’s pharmacy was well stocked. As she finishes up her final year in school, she looks forward to finding a stable job to earn some money to support her future. After a few years working, she plans to return to school to upgrade from her diploma to a degree. She found FAME to be an ideal place to get practice before entering the workforce. She really enjoyed the staff she was working with, saying that they were incredibly friendly and willing to share information. They were always ready to teach her and provided explanations when she needed them. She said she learned a lot during her time in the pharmacy about medicine and about the lifestyles of people who pass through our clinic. Spending most of her time around students of her own age in school, she found it interesting to learn from adults and their experiences as her peers. She was very grateful for the opportunity to work with a knowledgeable staff in a pharmacy that had an adequate supply of medicine for her to learn about.

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Abdul, soon to be Medical Doctor

Abdul also hails from Karatu and is the nephew of our Head Housekeeper. While growing up in Karatu, he saw the work FAME was doing and had dreamt of being a doctor in a hospital similar to ours. He’s currently heading into his fourth year of medical school, with two years of schooling and one year of internship to go before he receives his degree. He chose to use this holiday as an opportunity to learn. The hospital at Muhimbili, where he attends medical school, is a referral hospital where students see very complicated patients and many emergencies. Abdul was grateful for the opportunity to gain exposure to other aspects of medicine at FAME, particularly in the outpatient clinic, where he’s shadowing FAME doctors and learning how to interact with patients. Abdul had an added bonus during this time at FAME. He was chosen to be a translator for our biannual neurology clinic, getting to work with and learn from neurology residents and their attending. He spent two weeks assisting them in clinic, traveling with them on outreach, and learning how to examine a neuro patient. In clinic, he also got to see a patient with Parkinson’s for the very first time. He’s enjoyed working with the neurology team because he’s learning how this specialty can save lives and improve quality of life. As someone who loves to help people, Abdul admires the work FAME is doing and hopes to work in a hospital with a similar culture of philanthropy. He spoke very highly of FAME saying, “I’ve never seen a hospital like this. Regardless of one’s position (doctor, nurse, housekeeper or groundskeeper), they are all working hard to support the organization.” Additionally, Abdul said that upon arriving at FAME, he immediately felt like a part of the family. Like the other students, he found the hospitality and kindness of the staff to be one of the biggest takeaways from his time volunteering at FAME. He believes the work being done at FAME is very good for Tanzania and is excited to share what he’s learned here with his peers.

Thanks to our generous supporters, we have been able to build a medical facility and entire team of Tanzanian healthcare providers that are now serving to inspire the next generation of healthcare professionals in this country. If we’re lucky, maybe we’ll even see these young people back on the FAME campus one day.

 
Kathrine Kuhlmann
Back to School - Meet Yona!
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As someone who likes to take care of people and wanted to pursue a career that allowed him to do so, Yona chose to go to college to study nursing. In Nursing School in Dar es Salaam, Yona had a few classmates who were from the Karatu district and spoke very highly of a certain hospital in the hills of Karatu called FAME hospital. We’re grateful that our reputation was so far reaching because Yona has been with us as a Nurse Assistant ever since he graduated in 2015. Currently, Yona works in the pharmacy for FAME, assisting our pharmacist with the critical task of always having medication in stock and readily available, as well as making certain patients are receiving the correct prescriptions and understand how to safely take their medicine.

When asked about his experience at FAME thus far, he says he appreciates the way the doctors have fostered a culture of service here on campus, which he’s really gotten to see in the way the doctors treat each patient and handle each case. On a more applied level, he’s been able to learn a lot about treatment for patients during his time in the pharmacy, the place he enjoys working the most. All of this led up to his decision to pursue his certification as a Pharmacy Technician at Spring Institute of Business and Sciences in Moshi.

 Having started on October 15, Yona will be attending school in Moshi to receive his certificate. He believes that this certificate is just the beginning for him, a “first step” to his future. Following his certificate, he would eventually like to continue his studies for a master’s degree, but he recognizes this as the best place to start and understands that hands-on experience back at FAME will be important to his overall professional development. His plan is to return to FAME after his certification and apply his new knowledge in our pharmacy. He believes his education will enhance his abilities and allow him to develop his skills as he employs all he has learned in Moshi.

Yona is able to attend higher education due to the generosity of FAME supporters who are helping sponsor him. He wanted to extend his appreciation to all of those who have supported his goals, as well as those who already have, and will in the future, support other FAME staff in pursuing their educational goals!

Kathrine Kuhlmann
A Day in the Life of a Consulting Radiologist at FAME Medical

By Dr. Barbara Sharp

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When I arrived at FAME, I found two very capable and industrious X-ray technologists, Onaely and Japhar, who introduced me to the equipment:  a sixteen slice GE CT scanner, a PACS system, and two ultrasound machines, one for body work and one for vascular studies. It is quite special to find such sophisticated equipment in rural Africa. I found the African doctors to be compassionate, inquisitive, and interested in providing the highest possible care with the available resources.

In case it is interesting to you, here is what a Monday as a radiologist at FAME is like.

I began the day by getting up to make breakfast of French toast, local honey and wonderful coffee from Arusha, Tanzania, brewed with a French press. There is a kitchenette in our quarters, which we used frequently, and is quite serviceable.

I then proceeded to morning report to learn about the interesting cases admitted the day before and to learn about progress of the inpatients.

Many interesting cases were admitted and we learned more about each patient in ward rounds. I have found the clinical correlation with X-ray findings really great, which doesn’t happen in typical Radiology practice in the US.   

My radiology skills were needed for four inpatients on this particular day:

One was a 66 yr old male admitted for alcoholic hepatitis.  His family said he drinks a lot of moonshine. I did a kidney and abdominal sonogram and found his real problem was an enlarged prostate with bladder outlet obstruction, bilateral hydronephrosis and shrunken kidneys due to chronic bladder distention due to prostate enlargement causing obstruction to the flow of urine.  He had other findings such as fluid in his abdomen (ascites), fluid in his lungs (large pleural effusions) and cardiomyopathy (large heart).

Next patient was a three-year-old boy with loss of consciousness and seizures. His Maasai family brought him to FAME after two weeks of trying to eliminate his symptoms with traditional remedies. Many people from the Maasai community live traditionally, herding cattle and living in houses made of dried cow dung. They drink cows milk and eat goat meat. A non-contrast Head CT revealed a bleed in the brain on the left. Contrast was administered which revealed TB meningitis (for you radiologists, meningeal enhancement, left basal ganglia bleed due to involvement of the lentriculistriate arteries, irregular, thickened tentorium and falx enhancement.  Diffuse ventricular enlargement and transependymal periventricular edema).


My next case was a 23 yr old woman who is 3 feet and 6 inches, weighing 32 kilograms, and is 26 weeks pregnant. I did an obstetric ultrasound and found an active baby with somewhat delayed fetal growth.

Last inpatient was an infant, also from the Maasai community, with seizures due to tetanus infection. One traditional practice within the Maasai community is to cover the infant with mud poultices at birth. This happened when the umbilical cord had not yet healed, and is the likely route for infection with tetanus. The nurses had to remove caked dirt off the baby on admission. I helped ascertain nasogastric tube position with X-ray.

From the outpatient center I had many normal chest X-rays and an elbow fracture.  

On my way home I encountered Kelly in the hallway. She is an American surgeon who is working at FAME for one year. She said my patient with the large bladder needed a catheter placed through the skin of the pelvis as his large prostate would not permit the placement of a normal drainage catheter. I detoured into the procedure room with Dr. Kelly. I found my services once again useful when the patient’s heart stopped and my free hands could check for a femoral pulse and pass syringes. After 5 minutes of CPR, I did a transxyphoid ultrasound and found a nice heartbeat.

Voila! A nice day. I then proceeded home to enjoy a delicious dinner on our back porch, looking out over the beautiful trees, ridges, and farmlands of Karatu.

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Kathrine Kuhlmann