It is a gray and overcast Sunday morning here at FAME Medical. However, there was definitely some sunshine just outside the hospital as I walked up — not warm light radiating from the sun, but instead from these two women, mother and daughter. Two weeks ago the younger woman terribly burned on her arms and upper torso, was brought in for emergency care. Infection had set in and she was in excruciating pain. With many cooking outside by the light of a fire or charcoal and lots of walking to and fro with huge pots of boiling water or porridge, these types of injuries are not uncommon. This young woman has bravely endured regular dressing changes and debridements over the last two weeks. She will require skin grafting which is a challenge the FAME team is working to tackle just now. The family cannot afford to travel to Arusha or pay for the procedure there, nor can they endure the cost involved in staying away from home for this long, involved process. However, one of our former volunteers (Dr. Duane Koenig) may be able to travel back to Tanzania to resume teaching our team here how to perform skin grafting, which means this beautiful young woman may be able to receive the care she deserves right here in her home community. Just one week ago, it hurt to watch her try to walk, which is something she needs to be doing as part of her rehab. She grimaced with every step. Today, hand-in-hand with her Mama, she walked, albeit slowly, with new strength in her step and a hopeful smile on her face.
a very chilly morning in the ward
The day started early. I rose at 5:15. While historically NOT a morning person, Africa has taught me to cherish the quiet and beauty of dawn. Then at 8 am. it was off to the senior staff meeting. Lots of topics to cover today: accessing, screening and storing blood at FAME for elective surgeries and emergencies (blood supply across the country is a challenge); volunteer continuing medical education progress report — we have two volunteer American nurses who have conducted multiple early morning sessions with our nursing team, most recently one focused on how to deal with different degrees of “shock” in patients; updates and challenges we are facing on the construction projects underway (e.g,. two staff quadplexes) and necessary maintenance on some older staff houses; and strategizing on a broader plan for rainwater collection and storage as our campus continues to grow. Once senior staff meeting concluded, it was off to provide some key supporters with updates on our fundraising efforts for X-ray. And then over to the second ward to assess where we are in our preparation for Labor and Delivery Services. I was delighted to see we are very close, with the Nurses station and supply rooms coming together as well as the area where women will deliver their babies. We will not be fully equipped until the container arrives but we will do the best we can with what we have. The room we have designated for RCH (Reproductive Child Health) services is also coming along. We are in the process of building a partition in our last available area so we can begin the prenatal and vaccination program with dedicated RCH space. Of course, freeing this space up meant William (HR and Community Health) and Jackie (accountant) had to move to a temporary location until the admin building is complete. They have been such good sports….remaining flexible and cheerful despite this being their fourth relocation. I think that admin building will be greatly appreciated! We have Marshal Merriam, a major supporter and extraordinary human being, to thank for this. I know I will certainly like having an office again!
Preparing second ward for maternal health services
Finally, at the end of the day we had our maternal health/RCH planning session. There are so many small issues to work out. We are waiting on the “pharmacy fridge” in which to store vaccines. It is stuck at the port in Dar and the supplier is saying they need one more week to get it out and ship it our way. We are working on a brochure (in Swahili) that we will include with the RCH vaccination card that is more focused on prenatal care. We have to get new mattresses for some of the donated patient beds we will be using for pre/post-delivery, as the current one’s are used and dilapidated. I will make a trip to Tamfoam in Arusha next week to see about replacement options and costs. Finally, we discussed HR issues related to who among our nurses will be the RCH Coordinator and who will be Head of L&D. This will be challenging as we have a limited number of experienced senior nurses (7 to be exact) and RCH and leadership posts will most likely take some of them out of the night rotation in the ward. Many of our other nurses are very new to the profession and will require a great deal of mentoring and skill-building to deal with our most complicated ward patients. Lots of work ahead, not to mention recruiting for additional nurses as we roll out L&D and open the second ward. We are really looking forward to the ALSO (Advanced Life Support in Obstetrics) training that will be conducted at FAME in September. We want to equip our team with all the skills they need toward FAME being an example of “excellence in maternal health.”
When the day wrapped up and I wandered back to the house, Frank and I began comparing notes — his day was one of saving lives and stomping out disease;-) Just as clinic was closing, a little girl (the daughter of one of our groundsmen) fell unconscious on a bench outside the outpatient clinic while waiting for her Dad. Dr. Gabriel found her there appearing to be taking a nap. When he couldn’t rouse her, he carried her to the ward and admitted her. Needless to say, the team is investigating what appears to be a seizure. She definitely revealed her symptoms in the right place. We have a volunteer neurologist coming in a few weeks, so he will be able to follow-up with our team on the long-term treatment plan. Never a boring day in this neck of the woods;-) Off to bed.