Back to School - Meet Hosiana!
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After working at FAME for two years as an Enrolled Nurse, Hosiana will be leaving us for a year to continue her studies and become a Registered Nurse! She is very excited to travel to Moshi to attend school, but is already missing her home at FAME. With two years experience at FAME under her belt, her favorite thing about working here is how free she feels, in her work and interpersonally. She’s able to connect with administration, voice her opinions, and feel heard. She says the way administration handles their staff makes her feel appreciated and understood. “It feels like home.”

Aside from feeling connected, the culture of learning she’s experienced during her time at FAME has made her really excited to go back to school. She knows she’ll return more advanced after her year of studies and is looking forward to bringing her new skills back to Karatu. She believes she’ll return more capable, improving how she works and relates with patients. She also has hopes that her advancement will allow her to begin helping our doctors in the operating theaters. Hosiana definitely wasn’t shy about her goals for her future at FAME.

“I already miss FAME,” she responded when asked if one year would feel like a long time away. However, she knows going back to school will help her in the long run, allowing her to set realistic, tangible goals. She was so appreciative of the opportunity to return to school and make her dreams achievable. When she first applied for the scholarship, she was unsure if she would be chosen or not, but she felt that FAME knew her position and how motivated she was. When she told her father she had been accepted to return to school, she said he was in complete shock and couldn’t believe the opportunity she had been given.

She ended our conversation with immense gratitude. She wanted to thank FAME’s staff; all of her coworkers, leaders, and administration. She is deeply appreciative of this opportunity and is already looking forward to her return to Karatu. Thank you to our donors who have made our Scholarship program possible and giving us the opportunity to support bright healthcare providers like Hosiana!

 
Kathrine Kuhlmann
"You Might Just See a Miracle"
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By Volunteer Pediatrician, Margreete Johnston

Today, a half a world and a year away from my last volunteer visit, while in an expert group of pediatricians in the US, I was reminded of how remarkable the care is at FAME Medical.

In my comfortable surroundings with coffee and brunch, we were given a few clues to solve our “study case”. Our study patient was a 14-year-old girl with eye hemorrhages, fatigue, and anemia. My peers are well-respected clinicians and specialists and I have been a practicing pediatrician since 1982, having volunteered at FAME on two month long visits. Cases similar to our “study case”, which took my colleagues and I over an hour to figure out, are every day occurrences at FAME. Here in the USA, differential diagnosis is pared down after doing multiple tests, finding results, performing more tests, procedures, and finally moving on. Very little today was said of a bedside patient exam, and a detailed, complete, history and physical.

It was an Ngorongoro Crater safari guide who mentioned casually to me on my first trip that you might just see a miracle at FAME. He was right.

It was just another September day in rural Tanzania when a hunter found a lost, unconscious boy who was about 14 years old and dressed as a student in the bush. The hunter somehow got him to FAME’s outpatient clinic. Word of mouth brought his father, who assured us the boy had been a well, healthy child just the day before. The boy could not be awakened, had a stiff neck, and difficulty swallowing. He could not seem to hear and responded slowly to pain. Our differential diagnosis included everything from trauma, to rabies, to meningitis. The FAME team supported the boy with intravenous fluids and antibiotics. Spinal fluid results returned suggesting encephalitis like illness. He was monitored as potentially a critical case and examined frequently.

 

Encephalitis is an inflammatory form of meningitis that can be catastrophic. Complications of encephalitis may include permanent brain injury, seizures, loss of language and purposeful movements. Some patients may even have brain swelling. After 36 hours with minimal improvement, our FAME team reached for the next line of therapy, including steroids and anti-viral medications. There was a global shortage of intravenous anti-virals, so we began to question if we should risk giving the medicine orally through a tube? It was risky giving liquids to a person in and out of consciousness. However, the answer became clear when we saw the pleading look on his father’s face.

Less than 24 hours later the lost boy was able to sit with help, swallow food, and ask his dad for his favorite music. Protocol requires treating encephalitis for a minimum of 21 days. By hospital day four, our patient got up from his wheel chair and told his father he would prefer to walk. What made this case a miracle for this experienced pediatrician was the confidence he had. To make my complete surprise even better, he stood up in front of American tourists visiting FAME to “find out what goes on here”. I smiled and said “miracles”.

Kathrine Kuhlmann
A Committed Team and a Child's Smile
Dr, Kelly, Paulini, and his grandmother

Dr, Kelly, Paulini, and his grandmother

Based on interviews with Dr. Kelly Shine, Creighton University Global Surgery Fellow

Seven-year-old Paulini arrived at FAME with stomach issues. His mother was able to tell us that he was born full term and was a healthy baby. But then, at around age five, something changed and he was suddenly unable to eat.  She took him to a hospital near where they lived and a surgery was performed that seemingly fixed his problem. Much to her relief, Paulini was able to eat normally for the next two years. But then the problem resurfaced. He could still eat, but was unable to keep the food down, vomiting it up almost immediately after taking it in.  Recognizing the seriousness of the situation, Paulini’s mother brought him to FAME for help. She knew that without intervention, he would certainly starve to death. And despite how chronically hungry he must have felt, Paulini arrived with an infectious smile and child-like joyfulness that simply melted the hearts of everyone in his midst.

It can be quite a challenge, in this environment, to get an accurate and complete history on a patient, and Paulini’s case was no exception. For Dr. Ken, Dr. Badyana, and Dr. Kelly, our visiting surgeon from the US, it was clear that Paulini’s stomach was blocked and he needed another operation.  But it was also clear they would be going into surgery with many questions still unanswered. In the Western world, surgeons generally have many more tools at their disposal – effective communication systems with other healthcare providers, detailed medical reports,  and tools that enable them to do extensive preoperative work-ups that can inform how they prepare themselves for the task at hand.

 

In a setting like ours, however, the situation is different.  In the absence of information, the challenge becomes one of thinking ahead and preparing for multiple outcomes.  And with Dr. Kelly’s coaching, our team engaged in just such an exercise --thinking through and preparing for multiple possible scenarios they may encounter in the operating room.  Unable to know precisely what they would find, they had to be prepared for one of a few different operations, and it paid off.  Once in the OR, Dr. Ken, Dr. Badyana, and Dr. Kelly were able to determine what operation had been performed when Paulini was five years old, as well as identify the current underlying problem. While the previous operation had been done well, there was scarring that was now causing Paulini’s new symptoms. The surgery required a fair amount of suturing of the intestine and Dr. Kelly took great pleasure in watching how well Dr. Ken and Dr. Badyana tackled the challenge.  With the problem fixed and the surgery complete, it wouldn’t be long before little Paulini would eat again and be able to return to school, which he could hardly wait to do.

The technicalities of this case made it a very significant one for our surgical team and certainly satisfying in terms of FAME’s commitment to building local surgical capacity. Watching FAME doctors applying new knowledge and expertise that would save a life was more than gratifying for everyone.But that’s not the only thing that will leave an indelible impression on those who participated in giving this little boy his life back. In Dr. Kelly’s words, “the most significant thing about this case is how joyful a kid he is. He made us all smile.” There is nothing quite like making a difference in the life of a child and restoring hope to a family so devoted to their little one. In fact, it captures the spirit of what life is truly all about.

Kathrine Kuhlmann
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