by Volunteer Nurse Practitioner Barb Dehn

Nurse Evelyn, Volunteer Nurse Barb and newborn

On my 2nd day, here at FAME, I saw something, extraordinary. I was privileged to be at the right place at the right time and witnessed a jaw dropping display of talent and knowledge in a most unexpected place. Pauline Diaz, the volunteer coordinator was giving me a tour and suggested that we bring the new donated baby hats from the US and the brand new Tanita baby scale to the maternity ward. Sure! Why not?

Here in Africa, many people come to see the Big 5 animals on safari. Yes, I know there are birders out there and plenty of people who love the cheetahs, warthogs, jackals, hyenas, antelopes, giraffes and zebras. Thousands of dollars are spent, and thousands of miles traveled to catch a glimpse, or perhaps get close enough to see the elephant, cape buffalo, lion, rhino, leopard, all of whom belong to the exclusive group of the Big 5.

However on that 2nd day at FAME, within seconds of arriving in the maternity ward and setting up the new baby scale, what I saw was Nurse Evelyn, a 62 year-old experienced midwife, who delivered a baby, kept traction on the cord, and then resuscitated the new infant.

She then moved calmly back and forth between mother and baby to deliver the placenta, examine it carefully, give the mother the medications that prevent hemorrhage, check on baby and then administer glucose via the umbilical cord. Her assistant nurse, Moinan, helped throughout, while they both very graciously invited me to watch, learn and help out.

There’s no rest for the weary here at FAME, and truth be told, it’s energizing to be here. As soon as the new mom and baby were stable and settled, it was time to go check on the other moms and babies, because the Maternity ward here was full with 7 new mothers and their babies, plus a room where 2 growing premies and their moms are staying.

This safe delivery is also a direct result of a very generous donation from Every Mother Counts (http://www.everymothercounts.org/pages/ourwork-grants/#Tanzania) and Christy Turlington Burns’ vision that together, we can make pregnancy and childbirth safe for every mother, everywhere.

Thanks to Every Mother Counts, many of the moms here in the maternity ward, received regular prenatal care, ultrasounds, vitamins and malaria prevention from Mama Joyce, who oversees the RCH (Reproductive maternal, Child Health) program here. We call here Mama Nurse Doctor Joyce because like Evelyn, she wears many hats and does whatever it takes to educate, dispel myths and reassure pregnant women who previously would have opted to deliver in a hut on a dirt floor without any clean blankets or even a clean clamp for the umbilical cord.

Nurse Moinan, Volunteer Nurse Barb and newborn

Before I can really consider how many lives are saved here, it’s time to tuck the newborn baby’s head into a brand new baby hat to keep him warm and join Nurse Evelyn and Nurse Moinan in the ward to check on the other moms, babies and premies.

I walked behind Evelyn and kept looking at her back, convinced that there would be a small sign of her superhero cape. I asked her where it was and whether she preferred red or blue, she even let me peek under her scrubs to show me that it was just an ordinary day for her and she didn’t have any special super powers. She just laughed and laughed and then started charting, but I’m not convinced.

I didn’t see any of the Big 5 that day, but I did see a hero in action, one that had what she needed to provide the kind of care that most of us in the other parts of the world take for granted. Here at FAME, the level of care is exceptional, and it’s all provided by a dedicated team of Tanzanian nurses and doctors.

I’m learning so much here and am so grateful to all of the staff who have very patiently taken me under their wings and invisible capes.

Dr. Michael with a little patient, Photo by Ali Mendelson

By Neurologist, Dr. Michael Rubenstein

I am taking today's blog title from an amazing book by Tracy Kidder about a young medical student who survives the genocide in Burundi to find himself in the United States. It's a true story and so as not to give away too much I will suggest that you find a copy and read it. The inspiration for today's blog, though, is another amazing story of strength and hope here in Northern Tanzania.

Our very first patient of the day was a young woman who had recently been diagnosed with epilepsy and was on a medication that she was not taking on a regular basis. Thus, she was continuing to have seizures. After taking our history and examining her, though, we had some concern for the type of epilepsy she had and felt that an EEG would help to sort it out as the medication one uses is often dictated by the type of underlying epilepsy the patient has. We brought her over to the ER which is serving as our makeshift EEG lab for the time being and the epilepsy team hooked her up for a study. She was patient No. 1 for this groundbreaking technology at FAME. Amazingly, she had exactly the type of epilepsy that IS NOT well treated by the medication she was taking and she was converted over to a medication more effective for her condition. In fact, the medication she was on can sometimes worsen seizures for patients with her condition. This could certainly make the difference between well controlled and poorly controlled epilepsy which would make all the difference in the world for this young woman.

We saw an early tremor dominant Parkinson's patient who we had not seen before - Dr. Thu was incredibly excited since she will be going into a movement disorder fellowship next year and this was right up her alley. We saw another stroke patient who I first saw in 2011 and continue to follow up with on a regular basis even though he has continued to do well. The hardest thing here is to get patients to remain on their long term medications, though, as it is just something they aren't used to doing. We had wanted him to remain on aspirin but he had unfortunately stopped it several months ago after his prescription ran out. It is not due to non-compliance, or lack of adherence as they now refer to it, but rather that it's just something that isn't build into their culture at the present time. We'll continue to work on that.

So now for the story that inspired the title for today. A woman was brought to FAME today by her friend and eldest son. She is 47-years-old and the single mother of five children and the primary caregiver for her elderly mother. One year ago, during the night and for no apparent reason, people came into her home and threw acid onto her face. Those responsible have never been caught and there was no clear motive to suggest why it may have happened in the first place. She spent two days in a local dispensary (about three hours from FAME) before they realized that she needed more extensive care. She was then transferred to another hospital where she spent only three days. Antibiotics and bandages were applied and she was sent home. When she arrived home she found that many of her possessions there had been stolen. The acid has disfigured her face to such a degree that she has lost both of her eyes and is now blind and all that remains of her nose are two small holes for nostrils.

Despite this horrendous injury and disfigurement, she has persevered and has a remarkable attitude. When asked about any sad thoughts, she does admit to some concerns as to how she will continue to care for her children and her elderly mother, but says that she has accepted what has happened to her and is ready to move on. Her only complaint to us was a minor headache. She was an incredibly lovely woman and when she spoke it was quite easy to forget her disfigurement or the ordeal that she had been through. At the end of our visit, she asked if she could have a photo of her with Thu and myself. I think all of us wondered if we would have that amount of strength had we been put through a similar situation. And, almost to add insult to injury, we found today that she also has diabetes as her blood sugar was extremely elevated and that this will also need to be dealt with. As I walked beside her to the lab for her blood work, I could feel the strength and livelihood emanating from this woman who made me realize that in the depth of our struggle for survival, there are always those unlikely individuals who have demonstrated an even superior strength to have risen from further depths and will always give us eternal hope that we may do the same. It is these unlikely encounters that remind of us of our internal strengths. 

by Volunteer Nurse Chana Schaffer

At the end of February a seemingly delicate, extremely premature baby boy was brought to FAME. He was hanging on to life by a thread when he arrived, and we weren’t sure if he would make it through the night. We supported him with warmth, oxygen, intravenous sugar water and love.

With the help of his amazing mother, our nurses and doctors helped Godbless Joseph (GBJ) to grow and thrive. After he survived that challenging first night, we all recognized that this little one had a lot of fight in him. He may have appeared physically weak, but he was drawing strength from somewhere.

Initially GBJ required an incubator to maintain his body temperature. We gave him sugar water through an IV, and then progressed to using a feeding tube that went into his nose and down to his stomach. His mother was by his side always. Even when she couldn’t hold him, she talked to him, touched him in the incubator, and played him music. Maybe it was her strength and continuous love and support that kept him fighting to live.

FAME Volunteer Pediatrician Dr. Verena Moreno with Godbless Joseph and his mother

Our not so delicate miracle baby boy went home with his mama just over a week ago! He was cared for at FAME for four weeks.  When he arrived he weighed less than 2 pounds (800 grams), mostly skin and bones. On discharge day he weighed almost 4.4 pounds! Godbless Joseph astounded us all. On the day he went home he was wrapped in a colorful kanga and breastfeeding in his mother’s arms. All the tubes and supportive devices were gone, leaving a tiny, yet incredibly resilient babe.

Volunteer Nurse Chana Schaffer with new mother and her healthy twins

By Volunteer Nurse Chana Schaffer

Days at FAME are long. About a week and a half ago I had an especially long day. It started at 7:30AM and ended at 3AM. Our labor ward was full. We admitted a very sick mom and preterm baby who arrived after the mom delivered on her way to FAME. She tried to make it to the hospital for the delivery, but had to stop along the way to give birth.

The baby looked to be about 30 weeks gestation and was cold, blue and barely breathing when he arrived. We put him under the warmer immediately and helped him breathe with oxygen and a resuscitation mask. We put in a nasogastric tube and an IV to give him dextrose. He was struggling. We were able to warm him up to normal body temperature and keep his blood sugar up.

In the meantime we also admitted his mama. We discovered that she had severe pre-eclampsia, explaining her pre-term delivery. It took the teamwork of three nurses and one nurse practitioner to stabilize her. We treated her pre-eclampsia and controlled her blood pressure with a combination of intravenous and oral medications.

The other patients on our labor ward included a woman in active labor, a woman with postpartum sepsis and a blood clot in her leg, a woman with a suspected intra-abdominal pregnancy in severe abdominal pain, and another woman with postpartum sepsis who had a C-section at another hospital and had to have a lifesaving hysterectomy at FAME due to severe infection. A very heavy patient load indeed!

We were short-staffed on the night shift; Mama Mshana was by herself in the labor ward. The level of care that this group of women required was far too much for one nurse. Safi (our Ward Supervisor) came in to help, and so did I. We rose to the challenge and worked as a cohesive team.

At 11 PM we got an admission. Our on call doctor came into the ward with another preterm baby. The mother of the baby had delivered a month earlier at another hospital. The baby looked to be about 28 weeks gestation. They kept the baby in an incubator at the other hospital for a week, and then the incubator broke so they sent mom and baby home. For 3 weeks, the mother did her best to keep her baby alive, finally recognizing she could not do it alone.

This little baby boy was skin and bones. He was barely breathing and gray. We all thought that the chances for survival were low. We warmed him and supplied oxygen, and then we waited. To all of our surprise, he made it through the night! What a resilient little one. The next day we started intravenous dextrose to maintain his blood sugar and continued our supportive care. He was fighting to survive and we would give him every chance possible.

The first preterm baby boy mentioned was in severe respiratory distress throughout the night. Mama Mshana knew that he and his mother would need one nurse assigned to care for them both. She was already caring for the young woman in active labor, so she asked me to stay in their room to provide 1:1 care. I held the baby’s hand and stroked his head when he cried. It was painful on every level to watch him struggle so vigorously to breathe. I wished I could breathe for him to relieve his suffering. He passed away the following night. We supported him physically and with love until he took his last labored breath.

Another nurse, Julieth, had come to our aid at 11 30 PM and so did Kelley, our Women’s Health NP. Between the four of us we were able to provide safe and quality care to all of the patients on the labor ward. In addition to caring for our two preterm infants, we welcomed a healthy baby boy into the world when our laboring mama gave birth at 2 30 AM. This night was another amazing example of the teamwork that happens at FAME.

As exponential growth continues, more nurses are being hired to safely staff the two inpatient wards at FAME. Finding experienced nurses is no easy task. According to WHO statistics, Tanzania has 24 nurses/midwives for every 100,000 people. By comparison, the United States has 981 nurses/midwives for every 100,000 people.

The miracle of this very busy night is our 28-week baby who is defying all odds. He is gaining weight, eating expressed breast milk by mouth, crying loudly, and spending time out of the incubator on his mama’s chest for kangaroo care. He has astonished us all, and I feel blessed to be part of the team caring for him. We may not have all of the advanced technology available in the more developed world, but the nurses and doctors at FAME are moving small mountains in the care they are providing.

Chana with little patient on discharge day, after a very long healing process

by Chana Schaffer

It had just rained.  My morning walk was weighted with layers of thick red mud stuck like glue to the bottoms of my sneakers.  I had been at FAME for just over a month and I could feel my inner pace of life slowing with every sunrise and walking meditation each morning. The heaviness of my life in the U.S. seemed to lift with each layer of mud shed.  It would build, one, two, three inches thick on my heels, and I would excitedly wait for the step when it would all fall off and I would feel 10 pounds lighter.  What a relief.

Every day at FAME was different than the last.  The anticipation and unknown was similar to that which I experienced working in the Coronary Care Unit (CCU) at home.  Added cultural and language differences made it even more interesting and challenging.  I had already learned so much in such a short period of time; yet I had only scratched a miniscule area of the surface.

It was my last day and I was working in the ward with Safi, one of the many amazing nurses employed at FAME.  We admitted a young woman who was very lethargic with a blood pressure that is considered “incompatible with life”.  Dr. Luigi informed me that she had a large pericardial effusion- fluid accumulates in the sac surrounding the heart, putting pressure on the muscle and making it difficult for the heart to beat properly.  Dr. Luigi asked me if I knew how to do a pericardiocentesis- a needle is used to puncture the sac surrounding the heart and a catheter is thread over the needle so that the fluid can drain into a bag.  This procedure relieves the pressure and is often lifesaving.  In addition to the dangerously low blood pressure, the woman’s heart started to show signs that it was giving up.  Her heart rate would “brady down” (become very slow) and then speed up again.  Her heart was threatening to stop.  I knew that if we didn’t do something heroic and fast, the woman would die. 

Dr. Luigi and I found Dr. Frank and told him that we had a patient that needed a pericardiocentesis.  Dr. Frank heard the urgency in our voices, took one look at the worry on our faces, and came immediately to our aid. I have watched and assisted with this procedure many times in the CCU, so I thought setting up would be easy.  The nurses and I brought the crash cart into the room, gathered the sterile supplies and the ultrasound machine…but where was the pericardiocentesis tray?  It was time to get creative.  FAME has a lot of medical supplies available and at hand, but some specialty items are not readily available.  Everyone mobilized.  When something unfamiliar is happening at FAME, everyone (both nurses and doctors) is ready to step up to the challenge, learn quickly, and contribute any skills and expertise he or she has to offer.  The teamwork and sense of community never ceased to amaze me.  I felt so blessed to work side by side with such intelligent, resourceful, and caring individuals.  I always felt like I was learning far more than I was contributing.

With many hands at the bedside to help, Dr. Frank successfully performed a pericardiocentesis and drained almost 1200 ml of fluid that was compressing our patient’s heart.  The patient’s heart rate was still intermittently dropping, and the blood pressure remained dangerously low.  We began administering life saving medications, and I taught the nurses how to mix and titrate them to support the patient’s blood pressure and heart function.  It was a long night.

The nurses rose to the occasion and provided a high level of ICU care that was new to them.  Everyone worked together and supported each other to keep this woman alive, and we succeeded.  I was in partial disbelief when I walked into her room 3 days later (I came back to visit with my dad during our safari travels) and she was sitting up at the side of the bed talking to her husband.  The cardiac supportive medications had been weaned off, and the drain was removed.  The joy that I experienced after witnessing her recovery was unparalleled.  I knew that my knowledge and skillset, paired with unending support from my FAME colleagues, helped to save her life that first night. 

My time at FAME was profound.  The environment demanded self-reflection and growth in a beautiful way.  I was outside my comfort zone of fancy cardiac ICU monitoring and toys, immersed in a new culture, and trying to understand an unfamiliar language.  I was helping to care for patient populations very unfamiliar to me (i.e. burn victims, children, pregnant woman etc.).  I could feel the layers of self-doubt and hesitation shed with each passing day.  I realized that everyone was doing his or her best to provide excellent healthcare to an amazingly resilient community in need.