Stories from the FAME Neurology Clinic
Jane, neurology clinic patient.
“The pain started in my right shoulder, but now the right side of my head and my whole right arm hurt constantly.” - JanE, Neurology CLinic Patient
Laura, fourth-year neurology resident, University of Pennsylvania.
Adapting Care: Child Neurology in Rural Tanzania
I’m Laura, a fourth-year child neurology resident at the University of Pennsylvania. I’ve spent three amazing weeks volunteering with the FAME Neurology Clinic, and the experience has really opened my eyes to how medicine is practiced in rural Tanzania compared to the U.S. In America, many conditions can be managed quickly with ready access to emergency care. But here, every decision must consider a range of factors that affect the child and the family’s ability to receive care including long distances to hospitals, limited resources and the cost of treatment.
I remember treating a child with prolonged febrile seizures, a condition that would normally go untreated in the U.S., as the seizures often stop within five minutes and kids usually outgrow them. The patient we were seeing here had been experiencing seizures lasting up to 30 minutes, which was particularly concerning since seizures of this length can increase the likelihood of brain injury. Because the patient lived hours away from a hospital or an emergency care facility, we had to take a holistic approach in managing their health.
We sat down with the family and proposed two medication options. The conversation was not just about the best medication but we had to discuss potential side effects as well as cost and availability of the medication so that the family could choose the best option for their child and for them.
At FAME, these kinds of conversations are common. Care goes beyond diagnosis and prescription, it involves understanding the full picture, including a patient’s home environment, their access to transportation, financial situation, family support and even the traditions of their community.
Laura and a FAME clinical officer observe how a patient walks.
Laura tests the reflex of a patient.
Theandra seeing a patient at the clinic in Man’gola.
How a Life-Changing Surgery Brings New Hope
I'm Theandra Madu, a third-year neurology resident at the University of Pennsylvania, and my ultimate goal is to specialize in headache and facial pain.
Today, I had a case that truly excited me and reaffirmed why I chose this path. This morning, a patient arrived with a mix of troubling symptoms. She had been suffering for months from cognitive issues, gastrointestinal (GI) distress and an acute decline in her overall health. Initially, her complaints led to a focus on severe GI concerns; however, as we dug deeper, we discovered a very large lesion in her brain. This lesion appeared to be the main cause of her neurological deficits, including her recent blindness.
It was disheartening to learn that she had potentially been misdiagnosed early on when she first sought care elsewhere. But I felt a renewed sense of purpose seeing her condition up close. The good news is, she may be able to receive surgery at a referral center. If the surgery is successful, it could be life-changing for her, as it would not only alleviate the symptoms she’s been experiencing but also improve her overall quality of life.
This case reminded me again why I chose neurology. Every day in the clinic brings new insights and the opportunity to make a real difference in someone's life.
Yombe, third-year neurology resident, University of Pennsylvania.
Shining a Light on Epilepsy Management
As a Resident Neurologist, I’m very interested in epilepsy, and I’ve seen many cases during my time here at FAME. I remember one case in particular, a young girl who came with her mother from a village three hours away because they knew there were neurologists here. She had been living with epilepsy since she was 5 years old. Initially, her epilepsy was well managed with one medication, but by the time she came to FAME, she was 14 years old and on her fourth medication. We had a long discussion about the characteristics of her seizures to help us understand her condition better, but nothing quite fit the picture.
One key piece of data we needed was an EEG, which measures the electrical activity of the brain. About two years ago, FAME introduced EEG services, and for patients like this young girl who had never had an EEG before, it was a breakthrough. With that additional data, we were able to better characterize her epilepsy and get her onto a better medication. It was deeply fulfilling to see her have access to that level of care. –Yombe, Resident Neurologist, University of Pennsylvania
Dr Michael Rubenstein (right), Saidi, FAME Volunteer Coordinator (left).
Teaching Resource‑Aware Patient-Centered Care at FAME
I’m Michael Rubenstein, Professor of Clinical Neurology at the University of Pennsylvania, and over the past six weeks I’ve had the pleasure of guiding a group of residents through the FAME Neurology Clinic. For the last 15 years, most of our cases at the Clinic were headaches; but more recently we’ve started seeing many more epilepsy cases. This is because epilepsy is a lifelong condition requiring regular follow ups and medication renewals, which brings patients back year after year in need of thoughtful, sustainable care.
What truly resonated with my residents wasn’t the difference in diseases, it was learning to practice neurology in a setting where families cover the costs*, hospitals may be hours away and resources are limited. Back in the U.S., it’s easy to order “million dollar workups.” Here, each test must be justified by how it will change a patient’s treatment. I watched my team learn to ask, “Will this test benefit my patient enough to outweigh its expense and travel burden?”
Seeing them embrace that mindset, prioritizing patient-centered, resource-aware decisions, has been deeply rewarding. My hope is that they carry these lessons home, because medicine as it’s practiced at FAME—with its commitment to compassionate, impactful care—is how medicine should be practiced everywhere.
*NB: At FAME, all of our care is subsidized so that it is accessible to all patients. This means that patients pay on average 27% of the actual cost. This includes lab tests, CT scans, etc.
Dr Rubenstein reviewing cases presented by the neurology team.
A Note on Our Partnership
For over a decade, Dr. Michael Rubenstein has brought neurology residents and fellows from the University of Pennsylvania and Children’s Hospital of Philadelphia to FAME to expand access to specialized neurological care for the communities in Northern Tanzania who need it most. Over a six-week period (twice a year), Dr. Michael, the visiting neurology team and FAME clinicians provide consultations at FAME and reach patients through outreach visits to dispensaries in Mang’ola, Mbuga Nyekundu and Rift Valley Children’s Village—all within a 40-mile radius of FAME Hospital.