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.

By FAME Clinician, Dr. Anne Ghati

Sunday mornings at FAME Medical are usually much quieter than other days of the week. But not always. During one of my last night duty rotations, a young pregnant woman arrived very early in the morning, having traveled over rough roads while in full labor. With two of our esteemed nurses at my side, we rushed her into the labour ward hoping for a normal labour and delivery.

In talking with her, it became quickly clear that she had a very complicated obstetrical history, with two previous C-sections, including one during which the baby did not survive. But then she never lost hope.

My heart began to race, as I knew this woman needed an emergency C-section. Just then, while one of our nurses was examining her, the membranes ruptured and there was meconium staining. We had to act very fast. Dr. Mshana was my back up and he arrived quickly, along with Mama Mshana, one of our lead nurses in the Operating Room. With the mobile phone network down in the area, I had to run to get our Anesthetist on call. Because he lives on campus, we were able to race right back.

The nurses were preparing the patient to go to the OR. Dr. Mshana and I scrubbed and the emergency C/S commenced under General Anesthesia. With many adhesions from the two previous C-sections, evidence of a ruptured uterus, and meconium staining, the surgery was complicated. The baby was extracted, but he did not cry and was not breathing. We quickly cut the cord and our Clinical Education Coordinator received the baby and began resuscitation. I believe prayers do wonders so I quickly said one. As we were busy removing the placenta, finally the baby cried! What a nice feeling. Everyone felt happy. The baby's Apgar shot up to 10. He was fine. Two of our nurses took the baby out of the OR and the team finished the surgery. The mother and the baby were saved and we rejoiced.

by Annie Birch

When my neighbour, Pascalina, became pregnant last year it coincided with the imminent opening of the RCH (Reproductive & Child Health) programme at FAME Medical.  To me, as a long time childbirth educator and doula, the prospect of comprehensive pre and postnatal care plus the possibility of a safe and caring delivery with emergency back-up for necessary C-sections right in our neighbourhood was exciting news indeed.

 Pascalina already had one uncomplicated pregnancy and delivery followed up by over a year of breastfeeding so she was a great candidate for the new anti-natal (pre-natal) clinics held weekly. The nurse in charge of the clinic welcomed us with a big smile and carried out the necessary tests—which all came back with great results. Pre-natal vitamins were dispatched and a due date of January 1, 2015 was established.

 As the end of the year and the holiday rush approached, Pascalina kept up her monthy then bi-monthly and finally weekly visits to the clinic. She continued working and kept up her good nutrition, which is pivotal for a healthy pregnancy and baby, and is also an essential component of the FAME programme. Christmas was upon us and still no baby…. Maybe this would be a 2015 arrival?

 Then, late at night on the 28th December my phone rang. Pascalina was at the gate; it was time!  I roused myself from sleep and we loaded into the car and headed up the hill to FAME, a short drive away but a long walk in the middle of the night. Dr. Isaac who was on duty, backed up by Dr Ivan and the wonderful nursing team, received us. Although contractions were minimal she was already 5cm dilated. Based on her previous birth, which was fast and easy, it seemed likely that the baby would arrive in a few hours and I left her with the capable team.

 As anyone who’s had a baby knows, every labor is different. When I came back at mid-day I was surprised to find that the baby had been born only a few hours before. Unlike her first birth, this one was longer and harder. We chatted in Swahili, comparing birth stories with the new baby’s Bibi (grandmother). Some experiences cross cultures with no translation. It turned out this baby was quite big, (something I’d attribute to Pascalina’s attention to nutrition) and she is quite tiny so the nursing team really stepped up at the end with extra encouragement to get this new little boy into the world.

 At the time of this writing the new arrival has not been named, and his brother Herrick is delighted to be a big brother. There’s nothing like the miracle of birth and life to open our hearts. Both Pascalina and I are grateful for the professional and compassionate care provided by the team at FAME.

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. 

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.