“If you build it, they will come”

Dr. Mark and Dr. Monica with one of the triplets

Although that quote was most famously related to a baseball field in “Field of Dreams”, it applies to the Obstetric unit at FAME Medical as well. We first came to volunteer at FAME in December 2014, just a few months after the opening of the new unit. During our 2 week visit, we assisted in 2 deliveries and 2 hysterectomies. We also saw patients with the FAME doctors in the outpatient clinic. Although we didn’t have as many operative teaching opportunities as we had hoped, we both were overwhelmed by the enthusiasm of the doctors and staff and their genuine desire to gain as much clinical information as we could provide. We planned to be back for another visit as soon as we could arrange it.

In the same way that this blog was going to be sent to Susan within 2 weeks (it’s now been 6!), our next opportunity had to be delayed until we could schedule it in December 2016. Oh, how things have changed!

Whereas we had only 2 deliveries in 2 weeks in 2014, there are now more than 40 per month. The reputation of the staff and facility have spread so quickly that new facilities are being built for maternal and child health, and plans are being developed for a maternity wing that would include space for antepartum admissions as well as postpartum care. In this two week visit, we assisted the FAME doctors with several Cesarean deliveries, including for the mother who had the first Cesarean delivery at FAME returning for her repeat Cesarean. Another was for a mother with spontaneous triplets diagnosed only three weeks before she presented to FAME at 32 weeks with leaking fluid. (One week later, all three babies were gaining weight and were able to go home, thanks to a donor who funded formula to supplement her breast milk primary feedings.) We had the opportunity to participate in several other surgeries as well, tubal ligations, cervical cerclage, myomectomies: we began to wonder what we had wished for in 2014!

The donations that allow FAME to continue to expand have also funded an infant warmer, without which many babies might not have survived. The most astounding example is the infant born at least 12 weeks early (may have been more like 15 weeks early, as gestational age is sometimes difficult to document in Tanzania) who weighed <500 grams (1 lb 1.5 oz) at birth. We were blessed to be there the day the little one surpassed the 1 kg milestone! That is a miracle anywhere in the world, even more so in rural Tanzania. There isn’t a way to describe the joy in the mother’s smile as the nurse showed her the baby’s weight on the scale.

Which brings us to the best part of our visit – the staff! We knew the doctors we had met two years before had been enthusiastic to learn, but we didn’t have the opportunity to work then with the nursing staff as much. The staff in the “Operating Theater” wanted to review proper scrub procedures, the maternity staff sought information on post-partum hemorrhage, the staff in the outpatient clinic asked about cervical cancer screening, the doctors questioned surgical techniques…. We have never met a group of people so dedicated to the work they have chosen and so intent on improving their own abilities so that the care they provide is the best it can be. The new doctors and nurses added to the staff are just as enthusiastic as the “veterans” from our first visit.

It is truly humbling to help take care of more exceptionally high risk patients in 2 weeks than we would see in months, if not years, in the U.S. Two women presented with eclamptic seizures and several more with severe hypertension in pregnancy, one with a severe shoulder dystocia at delivery, another with post-partum bleeding, a case of infection after a miscarriage…. And the doctors at FAME take it in stride. Cases like these can intimidate anyone, even when the best facilities in the world are available. Watching the staff at FAME provide excellent care in creative ways, using the available equipment, is amazing.

We can’t wait to see what they are able to accomplish by the time we return next! Best wishes to the entire FAME family in 2017, with profound thanks to all of the friends and donors who have helped make FAME possible.

Dr. Monica Norwick
Dr. Mark LaRose
Waconia MN, USA

Beatrice, her father and FAME's Social Worker Angel Obeid

“In Africa, it may take a village to raise a child, but I am increasingly convinced it takes a global village to keep one alive. From the Tanzanian staff, to the volunteers, to the neighboring facilities, to the circle of consultants around the world, and the ever-expanding network of donors and supporters, the work of FAME really is a global collaboration…. the contributions of so many around the world focused on a small facility in rural Africa bringing health, hope and love to so many people in need of all of these.”

— Volunteer Dr. Joyce Cuff

Dr Gabriel Kissima and volunteer cardiologist Dr Reed Shnider performing a heart echo on Beatrice

No story better illustrates the power of a “global village” to keep a child alive than the story of Beatrice. Having already been diagnosed with congenital heart disease, she first came to FAME on Sept. 1, 2008, at age five. After confirming a leaky heart valve on a cardiac echo, the FAME team began providing her with the long-term care she needed to buy time, continue in school, and live a reasonably normal life. Finally, in 2016 she was bumped up on the government waiting list and scheduled for surgery at the new heart institute in Dar es Salaam, 488 miles away.

Beatrice and her father came by FAME earlier this year to say THANK YOU to FAME and those who support our work. Their words were translated from Kiswahili to English by Angel, the FAME social worker…

“My name is Alfred Dafi, and this is my daughter Beatrice. We are here today because we wanted to thank you and FAME Medical very much for taking care of us. Beatrice was diagnosed at seven months with a heart problem. We went through a lot trying to figure out a solution, and visited many hospitals in the region to find a treatment for her, unfortunately, nobody was able to help us.

In 2008, I heard about a new hospital called FAME in Karatu where there was a doctor named Doctor Frank. We decided to come to FAME and consult Doctor Frank. He received us, listened to us and gave us some different tests. They confirmed Beatrice’s diagnosis, and told us that she should keep attending the clinic regularly.

Doctor Frank told me that he would do his best to help Beatrice with support from other expatriates and foreign doctors. In 2016, we received a call from Muhimbili hospital telling us there will be a heart surgeon specialist coming to Tanzania to operate on people with the same diagnosis as Beatrice.

I really thank God because we started the process with a huge assistance from FAME Medical and on the 26th of April 2016 Beatrice underwent a very successful surgery.
I have no way to thank almighty Jesus, Doctor Frank, sponsors, and everybody who participated in making this happen. May God bless you abundantly. Thanks again. ”

— Alfred Dafi, Beatrice's father

Beatrice in 2008

“My name is Beatrice and I would love to say thank you very much to Doctor Frank and his team for making this happen. It was not an easy journey for my family and myself. I have nothing to pay back, but God Himself will. Today, I am healthy and back at school. I wish to keep on growing healthy and get a good education so that later I can help those who are undergoing the same problem I had before. Thank you very much Doctor Frank for bringing FAME Medical in Karatu. and for helping me get the surgery I needed at Muhimbili Hospital. God bless you all.”

— Beatrice

Beatrice after her successful surgery

We at FAME would like to thank all our international donors and the Rotary Club of Arusha, for financing Beatrice’s long-term care and finally her surgery in Dar es Salaam. We would like to thank our own Dr. Gabriel for providing such conscientious medical care for Beatrice and for helping her father navigate the complex system that would ultimately get her the surgery she needed in her home country. And we would like to thank the many volunteers, especially Dr. Reed Shnider and Marjorie Boor, for keeping a close eye on her condition over the years, providing expert advice from near and far and never ever giving up.  

Six-year-old Allen before surgery

By Co-Founder, Susan Gustafson

“At some point in the next year or two, Allen 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. An then he will sit down to the first proper meal of his life...”

— Volunteer, Angel Hertslet

Some of you may remember this excerpt from the FAME Blog. If not, you can read the FIRST part of the story here. Six-year-old Allen came to FAME suffering from severe malnutrition and pneumonia. The malnutrition was the result of a congenital problem, a stricture in his esophagus, that prevented him from swallowing food. Well, life took a dramatic turn for Allen 18 days ago today. He and his Mother traveled to Switzerland with volunteer pediatrician, Dr. Verena Moreno on November 5th, and on November 11th he had the surgery he’s been waiting for his whole life: A resection of the narrowed part of his esophagus and an end-to-end anastomosis reconnecting his esophagus to the stomach. Of course, this journey did not materialize overnight.

The complex surgery Allen needed is not yet performed in Tanzania. We had to find a surgeon and a hospital willing to do the surgery AND we had to keep Allen alive long enough to make it happen. For 10 long months, Dr. Verena and the FAME team have been caring for Allan, treating him when he got sick, providing the nutritional supplements he needed to build strength, and teaching his mother how to mix the F-100 nutritional formula and give it to him thru his feeding tube on a daily basis. Mind you, Allen and his mother have no running water in the poor, rural village where they live. Nothing is easy to keep clean, let alone a feeding tube inserted in the stomach.  While only a short-term solution, it was a successful one – one in which Allen’s mother played a central role. She made absolutely sure he received the nutritional formula thru his feeding tube on schedule. She was religious about keeping it clean, and she arranged to bring him in to FAME whenever she had a concern or felt something was amiss. Slowly, Allen began to gain the weight and strength necessary to stay alive while waiting for a miracle.  And the miracle finally came.  Dr. Verena received word that a surgeon and hospital in her home town of Bern were willing to donate their time, expertise and facility to perform the surgery that would save Allen’s life.

The lastest update from Dr. Verena on November 19th was very encouraging, “Allen is recovering well. He is still in the hospital because he has some drainages, nasogastric tube and IV ailmentation. On Monday they will do an X-ray (Barium meal) to see if the anastomosis they did is functioning well. Afterward the drains and the NGT can be removed and I think mid-week he will leave the hospital. The convalescence will be at my home.” 

Allen is only one of many, many children cared for by the FAME team. Fortunately, the vast majority can be treated right here at FAME Medical.  We have been able to maintain and grow our “in-house” programs and services thanks to the generosity and ongoing commitment of our supporters and friends.  Thank you for helping us care for the most vulnerable among us – in a place where the usual safety nets simply do not exist. You are their heroes and ours.

Martina presents Dr. Duane with a Shuka

By Nancy Allard

Thanksgiving came a little early this year at FAME. One of our former patients paid us a visit. Some of you may remember Martina, a patient who came to FAME in 2014 with second and third degree burns over 35% of her body, some already infected. She ended up spending the next 342 days in FAME’s inpatient ward fighting for her life and being cared for by our team. Well, Martina got word that visiting surgeon, Dr. Duane Koenig, had returned to FAME Medical for another volunteer stint and she wanted to personally thank him for the central role he played in saving her life. You see, Dr. Duane is the one who brought skin grafting to FAME Medical, donating the equipment and training his Tanzanian colleagues in the procedure.  He personally performed hours and hours of grafting on Martina and was very often at her side during the multiple dressing changes and debridements that followed.  And in his face she saw someone completely and absolutely unwilling to give up on her. By the time Martina was finally discharged, Dr. Duane had already returned home to Nebraska. Having graciously thanked the others involved in her care, she still had not been able to “properly” thank the man whose face gave her hope thru her darkest moments, until two weeks ago when she and her husband received word of his return.

How to thank someone who saved your life?  How about a shuka, a goat and two chickens -- that was Martina’s gift to her friend Dr. Duane. And his response, “Thank you. I would have gone to hell and back for you. I don’t need anything. My reward is to see you beautiful and smiling.” It was an extraordinary moment, one filled with joy, smiles and laughter - a magical moment between a patient and a doctor who share a special bond for life. 

Happy Thanksgiving to our generous supporters and partners, who continue to pave the way for powerful moments like these between patients and doctors at FAME Medical.  We are forever grateful to be sharing this journey WITH you.

Martina and her husband gift Dr. Duane with two chickens

Dr. Joyce and Rizwani at work in the lab 

by Volunteer, Dr. Joyce Cuff

We continue to see a wide variety of patients at FAME Medical. Not only are there lots more patients coming to FAME, they now range from the very healthy and just checking category, to the comatose and at death's door group. I rejoice in the increasing number of patients being monitored for chronic or life-style diseases. For the most part, these are otherwise healthy people whose clotting time is being monitored to prevent stroke or other cardio-vascular complications, whose blood sugar needs to be and can be controlled, whose lipids are being monitored and controlled, or whose thyroid levels are monitored periodically to keep them functioning well. These are conditions that, even 5-10 years ago would remain unmonitored and possibly even undetected, as many are asymptomatic until you're in real trouble. Being controlled and being monitored before an incident occurs increases the likelihood that they will not become clinical or critical. Of course, with so many more patients in dire straights when they arrive, we are unable to save them all. That is a harsh reality that cannot be changed. But the miracles continue to abound and astound.