BY VOLUNTEER SURGEON, LOIE SAUER

Dr. Frank and Dr. Loie in outpatient clinic

In clinic one day, a woman presented with signs of appendicitis.  Dr. Msuya and Dr. Lisso recommended appendectomy, and we proceeded to the “operating theater”.  She was skillfully put under general anesthesia by one of FAME’s two nurse anesthesists. As we were halfway through the procedure, I could have closed my eyes and felt like I was in any operating room anywhere in the world, as it is an environment so consistent to those of us who spend much of our lives in them.  The familiarity of being in gown and glove. The sterile field. The friendly chatter.  The sound of the cautery machine. Sometimes the music or the jokes. But always the sense of teamwork and the intense focus when the procedure calls for it.

This really rang true when toward the end of the procedure, I felt a little something moving on my shoulder.  It was Siana, the scrub nurse, doing what all of us do when our nose itches and we can’t scratch it with our sterile gloves:  we rub our nose on the shoulder of the person next to us.  I laughed out loud because that same gesture occurs zillions of times per day in operating rooms around the globe.

FAME’s two operating rooms are beautiful.  Nice lights. Natural light through windows. Pristine clean. Cabinets housing supplies of all kinds.  What is remarkable is that it is revolutionary in the region.

You see, in places like East Africa, and other low or middle income countries, death rates are high for common, easily treatable conditions like appendicitis, hernia, obstructed labor, bowel obstruction, and burns, for lack of surgical capability. Last year, the global health attention was riveted on the report of the Lancet Commission on Global Surgery, which reported that 5 billion people worldwide do not have access to safe, affordable surgical and anesthesia care when needed.  In addition, the absence of a safe blood supply is a crucial problem globally in treating surgical conditions.

FAME, by virtue of offering primary surgical services, reliable anesthesia services, and a safe blood supply through its own collection, offers residents of the Karatu region what many in the world do not have. 

Our patient did well and went home in a day.  While at FAME I participated in procedures such as C-section, hernia, tonsillectomy, burn management, breast abscess, and appendectomy. Using teaching tools from UCSF that included videos, knot tying boards, suture practice materials, we had fun working on surgical skills. FAME, you all are awesome! 

By Angel Hertslet

Six-year old Allan came to FAME a few weeks ago with a serious medical issue: he could not swallow food.

Most of us count eating food as one of the great joys in life, and how easy it is to take it for granted. Although Allan greeted the medical team with smiles and laughter, his situation was grave: he weighed only 22 pounds (10 kilos), the weight of a healthy one-year old. To complicate things, his small malnourished body was suffering from chest rattling pneumonia.

FAME Medical treated Allan for his pneumonia and started him on nutritional support. After a few days of charming the doctors and nurses, he was stable enough to return home. Yet Allan’s esophagus was still constricted and only a complex surgery could address this congenital problem. FAME Medical began the search for someone who could operate on Allan, sending emails to the extended family of FAME supporters.

Luckily, a few people were well positioned to help him. The first was a doctor in Arusha who had seen Allan before and knew of his need for esophageal surgery. A specialized pediatric surgeon from Finland came to volunteer at her hospital, so she called FAME and invited Allan to return for surgery. The second was an anonymous donor, well aware of his situation, who committed to helping him get the best care possible. It would be remiss not to mention Brad, the nurse practitioner at FAME, and Angel, the social worker, both of whom took on the responsibility of traveling with Allan and his mother to Arusha to support and advocate for the family. I also traveled to Arusha, and serendipitously, had the same blood type (and arguably the same attitude) as Allan: B positive. His mother Mary and I both donated in case he needed a transfusion during the procedure due to complications.

In some cases, an esophagus can be dilated with a balloon or by other means (my grandmother recently had such a surgery), but after laparoscopically exploring Allan’s esophagus, it was clear it could be addressed only through removal of the strictureand resectioning the esophagus to the stomach. The FAME team reviewed possible outcomes with the specialist and guided the decision that it was too dangerous to perform the partial esophagectomy on his compromised body. He needed to build strength to endure the removal of the portion of his esophagus. Operating in his malnourished state could have lead to the worst outcome of all.

As a means to an end, the surgeon inserted a feeding tube, or G-tube, into his stomach, allowing for nutrients to bypass his uncooperative esophagus and enter his stomach directly. I spent some time with Allan and Mary post-surgery and felt such compassion for them. He was clearly in a lot of pain and his mother was doing all she could to soothe him. This feeding tube, while clearly an essential step to improving his nutrition, I knew would be a big adjustment for both of them.

A few days later, Brad and I joined up with the team at Rift Valley Children’s Village (RVCV) to check up on Allan. Another conspiring actor, RVCV, in addition to contracting FAME to provide medical care to the orphanage and community thru a mobile medical service, also provides daily health support, follow-up and education to the community, where Allan and Mary live.
The RVCV nurse, social worker, and nutritionist worked alongside Brad and I to educate Mary about how to feed Allan through the G-tube. You can imagine the joy on all our faces when with our help, Mary mixed together the ingredients to make F-100, a therapeutic milk designed to treat severe malnutrition, and fed it to Allan through the G-tube. “Nice job!” Allan exclaimed in Swahili, and offered his mom a high five.

The right to a healthy life may be universal, but the road to getting there certainly isn’t. Allan isn’t healthy yet, but his future is looking much brighter. He has a short-term solution that is allowing him to properly gain weight and build strength for the first time in six years. He has RVCV within walking distance, and FAME Medical a short drive away. Most of all, he has his dedicated mother who so demonstrably loves him.  She is doing everything in her power to nurture Allan to health.

At some point in the next year or two, Allan will be strong enough for a life changing surgery. He will wake up groggy in bed, free of his G-tube, with his mom nearby. He will take a few weeks to heal. And then, he will sit down to the first proper meal of his life. May the tears of joy – and not of hunger – flow that day.

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.

by Co-Founder Susan Gustafson

Photo by Ali Mendelson

Paulina arrived at FAME at 1:30 pm on a Friday, having already been in labor for 14 hours. Nawaso, only 33 weeks pregnant, arrived a few hours later. Having suffered a seizure two days prior, it didn’t take the doctors long to diagnose Nawaso with severe eclampsia and make the decision to perform an immediate C-section. Just as the team was prepping her for surgery, Paulina’s condition began to deteriorate. Still in labor but not progressing, she was wearing out and her baby was showing signs of fetal distress. This would soon be another “first” at FAME, with both Operating Rooms being put to use at the exact same time. Still understaffed, volunteers stepped up to the plate and our Tanzanian team rallied. In OR #1 the FAME team performed an emergency C- section on Nawaso, delivering a 4 pound baby boy. The baby was ventilated and warmed by one of our nurses and then transferred to the incubator where grandmother and father were anxiously awaiting news. In OR #2, a second FAME team was performing another C-section on Paulina, resulting in the birth of a healthy 6 pound baby girl. Soon thereafter, both mothers were recovering in the ward with their newborns, alive today because of the services YOU are enabling FAME Medical to provide.

In addition to these two women and their newborn babies, you are helping our doctors and nurses touch the lives of thousands more. We are thrilled to report that 159 women have delivered their babies at FAME Medical so far this year, and many more were treated for antenatal complications. Your generosity has enabled us to create, train and support our committed team of Tanzanian healthcare providers to provide emergency obstetrical care — a service women desperately need in rural Tanzania.

There have already been 20,433 outpatient visits this year as well and another 867 general hospital admissions. These patients are facing everything from life threatening emergencies to devastating diseases to long neglected common infections robbing them of their quality of life. They are doing so in an environment with extremely limited medical resources. Your giving enables us to provide them with the medical care they need. Join us in making this and more possible in 2016. Please consider making as generous a donation as you can. Regardless of the size, your gift will make a tangible difference in the lives of our patients. It will quite literally save lives and restore hope for a people and community we hold dear.

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.