By Women's Health Nurse Practitioner Kelley Brennan

I'm not talking about the near blinding lights and deafening cheers that signal Friday night high school football in the USA but rather the spot-lights in the Operating Room at FAME. Lights that bring just as much adrenaline and excitement, along with possibly even greater significance and life changing results. You see, we've spent three of the past four Friday nights performing life-saving cesarean deliveries. FAME opened its doors for Reproductive and Child Health, including a Labor and Delivery ward on the first of October. Since then we have saved six lives with the ability to perform emergency cesarean sections; something far too many women do not have access to in rural Tanzania.

On Friday, October 10, a woman arrived to see me in clinic, 15 days overdue with her first baby. At first, she simply said she wanted an ultrasound to see when her baby was due. But as I have learned while providing medical care in Tanzania for the past two months, you rarely get the full story upfront. The patients are strong and resilient and they don't want to worry or burden their doctors. It often takes quite a bit of questioning to get down to the real problem. In this case, the baby initially appeared active and full term on ultrasound, but there was virtually no fluid surrounding him. This young mother-to-be also had high blood pressure and protein in her urine, indicating pre-eclampsia, a potentially dangerous condition for mom and baby that can only be cured by delivering the infant and removing the placenta.

The patient was admitted and soon the baby was showing signs of distress. FAME's head doctor/surgeon, Dr. Mshana, and I made the decision to go for a cesarean section. This would be the first cesarean section ever performed at FAME. The patient was frightened, and rightfully so as surgery can be risky business in Tanzania. As Mama Mshana, one of FAME's extremely talented nurse midwives, consoled her, the patient revealed the full story as to why she had travelled several hours from her home in Ngorogoro to be seen at FAME. Shortly after sunrise that morning, she was walking near her home and was charged by a Cape Buffalo. These massive animals can be quite dangerous and aggressive. As this terrified young woman ran for her life and the life of her baby, she fell twice, landing on her swollen pregnant belly. This trauma provided even more of a reason for an overdue baby, lacking enough amniotic fluid, to be in distress.

At this point, the patient was rushed into FAME's operating room, which is remarkably well equipped. You'd almost believe that outside of those OR doors you'd find a large, well funded, stocked and supplied hospital in California or New York or Boston, and not a small, rural hospital in Tanzania. Dr. Mshana, an amazing doctor and surgeon with decades of experience, performed the operation with my assistance and the assistance of his wife, Mama Mshana, who acted as our scrub nurse. We were tremendously fortunate to have both FAME anesthesiologists, Sehewa and Doctor Frank, at our disposal along with Siana, the head nurse, Chana, a nurse volunteer from Washington DC, and Dr. Doug, a volunteer pediatrician from Philadelphia. Under the glowing OR lights, on a beautiful Friday evening, this young woman had the very first cesarean section at FAME. Dr. Mshana and Mama Mshana worked as a well oiled machine; you'd never know it had been a few years since they'd last performed a cesarean section.

This patient was complicated. She'd suffered a trauma on top of being pre-eclamptic; her baby was 15 days overdue and surrounded by almost no fluid, covered in meconium and clearly in distress. After delivering the infant, a baby boy, we noted that the placenta had abrupted, starting to separate from the wall of the uterus and soon the patient was hemorrhaging. Due to the talented and dedicated staff at FAME, along with the availability of necessary supplies and equipment, this young mother and her baby boy survived. FAME is an amazingly special place, that provides tremendous care to all of its patients and saves lives on a daily basis. I can't think of a place I'd rather spend my Friday nights than under the OR lights in the operating room at FAME. It was such an amazing experience to take part in that I've decided to repeat it twice more on the past two Friday nights. I think if I keep this up, attracting the high risk Obstetric patients for cesarean sections every Friday night the staff here just might kick me out.

By Pediatric Neurologist Volunteer,

Doug Smith

Remember the days when you didn’t need an alarm to wake up?  When you woke with the sun rise, and your body was so anxious to rid itself of sleep that it was insufferable to stay in bed?  The song in your head is not one you heard on the radio and can’t shed, rather it’s the background music of your life.  You knew that the day ahead was one to remember.  One where you will experience the payoff of weeks, months, or perhaps even years of planning and anticipation.  Possibly one in which you will meet challenges or opportunities you have never had before, ones you feel prepared to overcome, with meaningful experiences as your reward.

That’s what this morning was like.  That’s what nearly every morning has been like during my time in Africa.  At night, the darkness is absolute, an almost palpable heaviness to the air.  The lack of sensory input gently and slowly turns the brain off.  It is disarmingly relaxing, and I find myself in bed and asleep well before I had intended to rest.  Come morning, the energy of the world changes with the sun rise.  The light calls to action dozens of songbirds and crowing roosters.  You can nearly feel the world waking up, and the call is hard to deny.  Then you remember what you’re here to do, and it really is impossible to stay asleep.

This is my view while I eat breakfast. I can literally see where my morning coffee was grown.

The medical experience thus far dwarfs my time in Botswana.  Morning starts with 8:30AM rounds.  FAME Medical has just 6 general inpatient medical rooms, each with 2 beds.  Despite the low numbers, the acuity and complexity of patients is impressive.  Currently, over half of the admitted patients are children.  We spend a particularly long amount of time with one child who became neurologically devastated over the past three months; I come up with some answers, but without significant testing abilities, I’ll never know if I’m actually right.  The father, a proud warrior whose stretched earlobes and traditional garb could just as easily grace the cover of National Geographic, tears up at my explanation.  He will not be the last person to receive bad news today.

5 kids from a nearby orphanage, awaiting their turnto see me.

The rest of the medical load, while significant, is African-casual paced.  Today, two orphanages delivered half their children to our doors, having heard that for the first time ever, a pediatrician has come to town.  I see five of them today.  The experience is exactly what I have come for.  

For two of the boys, I can make a diagnosis: muscular dystrophy.  They will never walk again. It is not all bad news, though.  A large percentage of families here do get the answers they've been seeking for a long time.  Down syndrome, Ohtahara syndrome; in these cases, I can offer a somewhat clear picture of the future, even if it is not the one they had hoped.  For others, they get confirmation of what they had suspected: that their severely weak, "disabled" child in fact has a full mind, capable of learning.

This is no small reward.  You see, schools here are very limited in their resources.  Any child with any somewhat significant problem is refused entry to school.  As an example, one 10 year-old boy was refused entrance to school his whole life because of a very subtle tremor, and they came to meet me to get a note saying he was medically cleared for school.  After TEN years!  In a more heartbreaking example, a boy with severely dystonic cerebral palsy, where he has basically lost control over all of his muscles (including his mouth and face), has a very full cognition, as far as I can tell.  When I asked his caretaker what I can help with, the boy replied, "I am a cripple."

Where schools have failed, the generosity of others have succeeded.  He was taken in by a Norwegian man, whose name I can't pronounce, let alone spell (it sounds like Skroli, but I'm sure there's an umlaut or two in there).  He has spent every cent he owns and has raised money from Norway to build an orphanage of sorts for children like him, children with significant physical handicaps but a lesser extent of cognitive impairment.  He takes them in and teaches them, not just basic schooling but also life skills, with the hopes of one day reintroducing them to their families.  So far, I have seen 7 of his sickest, and have given him half the money in my wallet to continue doing what he's doing.

Were it not for the FAME clinic here in Karatu and for Dr. Mike Rubenstein, the Penn neurologist who introduced me to the facility and is here with me now, none of these neurologically impaired children would have ever found the care they need.  Thanks to their charity, they are on appropriate medications now, and being cared for by people with the right mentality towards disability.

Skroli will have many more children for me in the coming days.  I hope I have the emotional wherewithal to handle them, and that I brought enough money to leave with a clear conscience.

Volunteering at the FAME clinic in Tanzania was an incredible experience. Having worked with other international medical missions in the past, I always look forward to experiencing a new place, new friends, new food, new culture, and the new lessons that I will learn. One thing that I learned while working at the FAME clinic was the importance of teamwork when providing exceptional patient care. All of us had our own jobs from sweeping the floors, checking in patients, diagnosing and treating, running the lab, filling prescriptions, organizing finances, getting more donations, recruiting volunteers, etc. Each task was essential and required great thought and care given that money and resources were limited. When there was a challenging patient case, we would all work together to come up with the best possible solution for the patient. This is how medicine should be— individuals bringing their knowledge and talents together to create something better then anyone could have done on their own. One specific patient comes to mind—a 5 year old girl that was severely malnourished with little family to take care of her. We all played a part in trying to help her: the doctors examined her and discussed possible diagnoses, the nurse was able to start an IV, the cooks made her rice to eat, the lab was able to draw blood and run rests, one of the assistants was able to translate for her tribe's dialect, the pharmacy organized her medications, and a local social worker researched possible hospitals for her to go for further care. We all depended on each other. It's sometime easy to forget at FAME that we were lacking in some resources, as the hearts of the people made up for it. Now that I'm back home, I hope to continue to practice what FAME taught me: be grateful for what you have, work as a team, and love what you do.

Moving Day – May 4th – it really happened. At first it looked like we would have to wait for the furniture people to come and assemble the furniture. As an interim measure, I asked if I could pilfer some furniture from the shipment that had come the day before that was to be used in the various bungalows and the hospital. They said yes and we put an interior design scheme together that is unique in all the world. Eclectic doesn't begin to describe it. We have wicker stands that would probably be used to store bath towels and others that are probably flower pot stands. We have some stackable plastic bins that look like those things you put your cat in and others whose original function I can't begin to imagine. But of course, beauty is in the eye of the beholder and it is sheer beauty to these eyes. The front two-thirds of the building were totally functional throughout the entire day of moving. We timed each move between patients so we didn't miss a beat with regard to patient service. The day after the big move the furniture assembly team came. When I came in on OD3 (Operational Day 3), the new furniture had been assembled. The lab guys had completely cleaned and organized the new lab. All of the boxes of miscellaneous stuff has been emptied and properly (or at least neatly) shelved. I spent all day either doing blood chemistries using the new machine coupled with some more old-fashioned tests or sitting at the lab bench next to the window that overlooks the cornfields with the mountains in the distance. The masked weavers are just outside that same window. It was better than I could ever have imagined. And when I look around the lab with its state of the art equipment and stainless steel counters juxtaposed with the wicker bookcase and the plastic cat bins, I think it is quite perfect. And when I further reflect on my impatience while waiting for a full year for the lab to be completed, I also think of the residents of this area who have been waiting for generations for this kind of access to quality health care. Somehow my vision seems pretty myopic. Yet another lesson learned.

For as long as I can remember, I have dreamed of traveling to Africa to do something that would benefit those less fortunate than myself. And for the longest time, I was unsure what I could possibly do to help. After finishing grad school, receiving my degree in Occupational Therapy, I decided it was the perfect time to make the long awaited journey to Africa to see what I could do to help out.

Originally, a friend and I arranged to spend 4 weeks volunteering at the Rift Valley Children’s Village. We thought that we would only be able to visit the FAME clinic due to our busy schedules at the Children’s Village. We were very fortunate that things worked out and we were both able to join the remarkable FAME team. We accompanied 18 other FAME staff and volunteers as we traveled to Laghangareri for the first of 24 mobile clinics. I was unsure what to expect, but extremely excited and curious about the mission.

I was stunned on the second day of clinic when what seemed like hundreds of people were lined up seeking medical treatment when we arrived early that morning, and even more showed up on each of the following days. I was astonished by the stories I heard of how far and for how long many of these sick individuals had traveled to obtain medical care. One elderly woman asked us if she could sit down to rest for a little while, she had traveled for 2 days to get to the mobile clinic. It amazed me how these individuals who in many cases are very frail and sick are able to travel such extreme distances to get the medical care they needed. In many cases it was not only a sick parent, but also one or several sick children that made the treacherous journey.

On this same day, an older man was brought in by a community leader, by truck because he was unable to walk. The man suffered from paralysis below the waist following a sickness approximately 2 years ago that continues to persist and now also suffers with severe decubitus ulcers on his buttock and opposite hip. They were some of the worst ulcers I have seen. His wounds were treated at the clinic and he was started on antibiotics. Things were then set up to check on him at the end of the week, and arranged for him to be seen at the FAME clinic. I was able to help transport him back to his boma (mud hut). I was stunned by the condition this man was living in; he had to lay on a piece of cardboard on the dirt floor with a thin blanket covering it, and his blankets were filthy and soiled. We provided him with a foam cushion to help with comfort and positioning. I helped to educate the family through a translator, instructing them on proper positioning, wound care, and hygiene. They were also provided with the materials for dressing changes until he was seen at the clinic. With very few resources and limited knowledge of the language, this intervention and patient/family education was lot different than it would have been done in different circumstances. Despite the limited resources, it amazed me how resourceful all the medical professionals were and the incredible things that could be done in “the bush” to help these individuals.

As I begin my career as an Occupational Therapist I will now take with me something very special, something that will stay with me forever. Dr. Frank and his team are incredible; they make such a huge impact on so many lives. Joining the FAME mobile clinic was such a life changing experience that I am so glad I was able to be part of and I hope that I am able to be part of something so special again someday soon.