"Do Unto Others" - Reflections of a Volunteer Pediatrician

By Volunteer, Dr. Margreete Johnston

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One morning, we walked into a patient room to find a Maasai mother in tears. Today was day three of a difficult recovery for her two year old, whom had been admitted with a severe burn.  Not fully understanding the seriousness of the toddler’s condition and vulnerability to infection, the mother wanted desperately to go home to her boma. Later that same day, there was another youngster admitted with a similar accidental burn. While this child was from a more educated and affluent family, their shared situation led both parents to reach out to one another instinctively. The Maasai mother consoled the new family, speaking from her experience. In turn, the young parents of the second child encouraged her not to leave until her child was ready.

Similarly, in the labor ward, a mother from Karatu delivered a tiny baby at about 8 months gestation. We were not surprised that this premature newborn needed our support for a few days to be well enough to nurse. However, the mother was disheartened. In an adjacent room, another mother from the Maasai community who had recently lost a baby due to an unexplained fetal death encouraged the new mother. In fact, when it was time for her discharge, even after having lost her own baby, she stopped by their room to wish them well. I am tearing up just remembering this.

An American colleague and I witnessed these scenes and although we did not understand the conversations in Swahili, we did understand the universal nature of what was unfolding before us – parents deeply empathizing with one another and feeling love and devotion for a vulnerable child.  I have expanded my definition of "do unto others" having seen the unconditional love at work at FAME Medical. There are many more stories that I will always remember from my time there. I am thankful for the opportunity to share in FAME’s vision in a small way.

 
Kathrine Kuhlmann
Sometimes We Can Only Offer Compassion …. And Maybe a Little Hope

By Volunteer, Dr. Apple

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The door opens and color fills the room as the Maasai family enter.  Seated in a wheelchair, the patient is rolled into Dr.  Jacob’s room by her son, also accompanied by her daughter and two-year-old grandson.  All are surprised and immediately put to ease as Dr. Jacob welcomes them in their own language.  Quietly the story is told of how over two months ago the patient fell while gathering wood for the fire.  She has not been able to walk since the fall and continues to have significant pain.  All too often, patients and their families seek care only after long delays and/or exhausting attempts at traditional medicine to heal. Dr. Jacob efficiently gathers further history and proceeds with his examination, all while addressing the patient and family with kindness and compassion.  Concerned the patient may have injured her hip, he explains the need for an x-ray, being mindful of how even the meager cost of this diagnostic test may overwhelm this family.  The x-ray is able to be quickly performed and a diagnosis is made.  This 57-year-old woman has a very serious hip fracture, suffering all these weeks since her injury.  To those of us in medically resource rich countries, this delay seems unbelievable. 

Though a diagnosis has been made, Dr. Jacob knows further challenges exist.  Though thousands of hip surgeries are performed daily in many well-off countries, surgeries like this are frequently not available or affordable to many of the patients served by FAME.  After consultation with several of the FAME doctors, Dr. Jacob returns to his patient to discuss options.  The best care for the patient would be referral for orthopedic surgical repair of her fracture.  However, Dr. Jacob knows this requires traveling more than four hours from their home and will be very costly, an expense this family may not have the resources to undertake.  He listens carefully as the patient and family begin to grapple with this information, deciding they will need to return home to discuss this information with the entire family.  Knowing there are occasions where charitable organizations visit Tanzania to perform such surgeries free of charge, Dr. Jacob gathers the patient’s contact information and pertinent physical exam features to pass on to Dr. Frank, in case he is notified of such a program coming nearby.  While the patient is still in the clinic, it is learned there currently is a low cost orthopedic program several hours away that might be available to the patient, so this information too is provided to the patient and family.  At least there may be hope the family and community could afford the surgery at reduced expense.  Realizing the patient and family will need time to reach a decision and that surgery may not be an option after all, Dr. Jacob proceeds with obtaining crutches for the patient, realizing that navigating with crutches on one leg will be almost impossible for this woman with a painful hip fracture who lives in the natural surroundings of a traditional Maasai boma.

As the patient is wheeled away to head home, we have a few minutes for reflection before the next patient arrives.  While the treatment options for this patient are very limited as compared with much of the world and it is discouraging to know successful treatment would likely return this patient to an active life as opposed to a life of virtual immobility, for today we have done the best we can for this patient.  Sometimes the best we can do is to provide compassionate care to the patient and family, mindful of the complexities of their lives ……… and maybe offer a little hope. 

Note – In the five weeks I was at FAME, I helped with the care of two patients who both arrived with hip fractures which were several weeks old.  To those of us in medically resource rich countries, this type of common occurrence seems incomprehensible, but is a daily reality at FAME.

 
Kathrine Kuhlmann
Reaching and Teaching

by Volunteer Nurse Practitioner and Diabetes Educator, Kim Hall

 Dr. Jackie and PA Volunteer, Joyce, meeting with a patient during Diabetes clinic

Dr. Jackie and PA Volunteer, Joyce, meeting with a patient during Diabetes clinic

 

Diabetes (mostly type 2) is on the rise in Africa with an estimated 15 million plus cases in 2017 (up from 14 million in 2015), and there are approximately one million documented cases in Tanzania according to the World Diabetes Federation.  Experts predict that only about 1/3 of cases have been identified, implying that as many as 3 million cases of type 2 diabetes exist in Tanzania.   The costs of the severe complications that can arise when type 2 diabetes goes untreated far outweigh the cost of treatment and efforts for prevention.

 
 Kim and members of "TEAM SISI"

Kim and members of "TEAM SISI"

Given these alarming statistics, I am happy to report that the FAME Diabetes/Chronic Disease Clinic continues to build steam! My favorite time at FAME is spent working with the fabulous staff, especially of “TEAM SISI,” the self-proclaimed name of the diabetes team formed during my March FAME visit.  SISI means “us” in Kiswahili and is a clear indicator of the spirit of teamwork, which continues to prevail in this dedicated multidisciplinary team.   The diabetes/chronic care clinic was launched by the TEAM with the help of Dr. Michael Zimmerman in April, 2018, with enthusiastic patient participation from the start.  The SISI team continues to assist patients with self-management of diabetes and hypertension at FAME.

Anecdotally there are several success stories and informal reports of high patient satisfaction and reported positive behavior changes.  A favorite is of a honey farmer who heavily used his own product, reporting marked thirst associated with his high blood sugars, which he quenched with a case of coke weekly.  Changing these two behaviors, and resuming medications which he had run out of, brought his sugars down from over 500 to under 100 in one week! FAME also intends to begin gathering more formal data by documenting improved outcomes and instituting patient exit surveys to continue to reach and teach this population.

I left a piece of my heart at FAME when I first visited it in 2015. When I came back to reclaim it in 2018, I left more of it there instead.  Thanks to all the great FAME staff for taking good care of it, until I return next time!

Kathrine Kuhlmann
Advancing Patient Monitoring
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In late 2017, we received an amazingly generous donation from a longtime FAME volunteer!  During her stay with us she noted FAME’s need for more robust monitoring equipment. With a growing number of emergencies finding their way to our ER, increasing numbers of high acuity patients in our general ward, and a rapidly expanding surgery program inspired her to do what she could to help us help our patients. Her gift enabled us to purchase additional and much needed state-of-the-art monitoring equipment. We received 4 bedside monitors to help with continuous monitoring of patients -- finally arriving this past July! The monitors are now up and running and strategically located in our Recovery Room, Small Procedure Room, Emergency Room, and Inpatient Ward.  These invaluable pieces of equipment are helping our doctors and nurses provide a superior level of health management for our patients who need close observation and continuous monitoring. When the equipment arrived on campus, a trainer arrived along with it, orienting our staff on how to properly use the machines for patient care. As soon as they were installed, our doctors and nurses were putting them to good use! We want to express our sincerest thanks to our volunteers for their continuous support and for embracing our mission to advance patient-centered care in rural Tanzania!

Kathrine Kuhlmann
It Takes A Team

By Volunteer Dr. Apple

 Dr. Apple and Dr. Badyana with their patient

Dr. Apple and Dr. Badyana with their patient

 

Afternoon clinic was winding down on the quiet Saturday afternoon, when a young woman was wheeled into Dr. Badyana’s office.  “Oh, this is not good,” was my immediate thought.  The patient before us had extreme swelling of her face, neck and upper chest and was not able to swallow anything, including her own saliva.  The patient’s mother quickly provided a history of her daughter starting with dental pain and some swelling three weeks prior.  She had received antibiotics from two other hospitals, but her condition progressively worsened.  The patient had a history of diabetes, controlled by her diet, but there had been no recent testing. 

Our examination and a bedside ultrasound performed by Dr. Badyana confirmed a diagnosis of an extensive oral infection spread to the tissues of the face, neck and upper chest, a rather rare condition called Ludwig’s Angina.  A very serious and potentially lethal condition, the patient needed immediate surgical drainage of the infected area, monitoring for swelling closing the airway producing inability to breath, intravenous antibiotics and treatment of her diabetes, which was found to be uncontrolled.  The young woman was seriously ill.

Our patient was immediately taken to the procedure area where a surgery to open the infected area was performed.  That afternoon began our FAME team’s long journey with this patient, with the team working tirelessly to treat her infection and manage several life-threatening complications that arose during her treatment. 

And yes, it took a team to bring this patient safely through her illness.  From the FAME staff doctors caring for the patient around the clock, to the volunteer doctors with expertise in diabetes care, infection treatment, surgical wound management and skin grafting, to Dr. Frank working with the anesthetists to find the best procedural sedation for this complicated patient, to our nurse/architect Nancy who suggested and acquired a high protein tube feeding supplement made from ground legumes used to improve wound healing, to the nurses who monitored and cared for the patient 24/7, to all the FAME support staffs, etc., etc.  

Five weeks after her arrival at FAME the young woman returned home, having survived an illness to which she likely would have succumbed had she not arrived at FAME on that Saturday afternoon and had the FAME team not been there with the facilities, equipment and expertise to save another life.

 
Kathrine Kuhlmann