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Remember the young woman with the severe burn covering her entire upper torso? She was badly in need of skin grafting but could not afford the travel and hospital costs involved in going to the nearest city for the procedure. Well, next came a two year old…

Elibariki’s mother brought him in with a terrible burn to the head, also in need of grafting. Frank and Dr. Gabriel, put the word out to Dr. Duane about both patients, sending photos and seeking medical advice. Having already donated the machine and certain that they were both good candidates for skin grafting, he immediately jumped on an airplane and flew from Nebraska to Tanzania to help. He did the procedures the very next day, teaching and  working closely with our team throughout. He also released a burn contracture on Elibariki’s leg — a surgical procedure that will allow him the mobility every two year old deserves. Both patients are recovering well, and Mama Elibariki is rejoicing. Needless to say, the word is out that Dr. Duane is here for a short stay. Surgical requests are coming in left and right. Not surprisingly, he’s also busy in the Clinic. Just yesterday, I noticed two Maasai elders, one a patient — the other a relative. Dr. Duane was standing outside in his unassuming, quiet way. They both grabbed his hands, and began thanking him for taking the time to help them. I went home smiling. 

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There are details and then there are DETAILS! Blood supply is a constant challenge in Tanzania. As a result, medical facilities, like ours, must have emergency plans in place for necessary transfusions. We’ve recently been given permission to collect, screen and store blood on campus for emergency surgical situations.  With a “scheduled” delivery on the calendar, we want to be ready for any and all eventualities. 

One of our Lab Technicians has the same blood type as the pregnant “mama” who wants to be the first to deliver her baby at FAME. Learning this, he volunteered to be our first donor. Lab Tech, Anthony, oversaw the process with Dr. Joyce and Fatuma looking on. Once complete, the blood was screened and put into the special fridge to be stored at the appropriate temperature. Hopefully, we won’t need it, but it’s comforting to know it is there if we do. We plan on typing volunteers and other staff so we have a ready blood supply when we need it for emergencies.

I always forget how many details go along with introducing a new service at FAME. As we prepare for Labor & Delivery, we need more sheets, slip covers, blankets, pillows, curtains for the ward…. Of course, here there is no Target or Costco or Bed, Bath & Beyond so this takes some serious planning. With the help of Nurse Siana and my dear friend Annie Birch, we managed to find the perfect fabric in Arusha. For the sheets, we got pink 100% cotton from Pakistan — a fabric that looks like it will withstand multiple washings and lots of boiling water. For the curtains, a lovely shade of turquoise. Next step? Arranging for Haji, the tailor, to come up to FAME and measure windows, gather up the fabric and begin working his magic on the sewing machine! We’ve got to get these stark rooms warmed up for all the pregnant women about to show up! We want our mamas and babies comfortable.

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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.

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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!

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Preparing second ward for maternal health services

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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. 

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Another injured tourist in the ward. This time with a probable broken back. We have been working on coordinating medivac since yesterday afternoon. Ema, a FAME driver, went to the Manyara airstrip to pick up the AMREF Flying Doctors team who brought with them a special transport unit upon which to secure the patient. Upon their arrival here, EVERYONE jumped into action — our doctors and nurses, the AMREF team, even our drivers. Once positioned on the transport unit, the team loaded the patient onto the FAME mobile unit (aka ambulance these days) and began the journey back to the airstrip where the plane was waiting to transport her to Nairobi for xray and further assessment. Here we are in the middle of nowhere, far removed from helicopter rescues and well-equipped ambulances, yet EVERYONE pulled together to help this scared and traumatized traveler get the help she needed. I must say, I am very proud of the FAME team today.