Family is important in Tanzania. It is important the world over. For 35 year old Tasiana, starting a family was beginning to seem like an impossibility. After multiple doctors and hospitals, and 4 unsuccessful pregnancies, two of which were stillbirths at term, she was beginning to think she would never be a mother. Pregnant with her 5th child, she was desperate to get some answers. That’s when she found Dr. Walii Msuya and FAME Medical. After taking a complete history and reviewing her records during that initial consult, Dr. Msuya made a commitment to Tasiana – he would do his level best to determine what was causing her inability to deliver a healthy baby. Reaching out to volunteer US-based OB/GYN consultants and his colleagues at home, studying on-line journals, and using his own clinical skills in the days and weeks to follow, he came up with a working diagnosis—Antiphospholipid Syndrome or APS. APS is an autoimmune disorder in which the body recognizes certain normal components of the blood and/or cell membrane components as foreign substances and produces antibodies against them. In pregnancy, this is a very high-risk situation for both mother and unborn baby, with mother’s body essentially attacking the placenta which damages the blood supply to the baby and usually causes death to the unborn child. Needless to say, the management is exceedingly delicate, requiring closely controlled anticoagulation for the mother during pregnancy.

Anxious to get high quality prenatal care, Tasiana began FAME’s prenatal program in March, while Dr. Msuya and our maternal health nurses followed her closely. Following treatment protocols for this condition, she was admitted to the labor ward at 38 weeks for close observation and fetal monitoring, with a scheduled C-section to follow a few days later. Both Tasiana and her unborn baby remained stable, so she was taken to the Operating Room on August 23rd where she delivered a strong 7 pound baby boy. And after just a few short days in the hospital, Tasiana was able to take her healthy newborn home — her hope renewed, her dream finally a reality.

A culture of patient-centered care and life-long learning is what we try to cultivate at FAME Medical. Dr Msuya exemplifies both. A doctor who treated this woman like a member of his own family, a doctor who committed himself to finding some answers that would make a difference in a family’s life, and a doctor courageous enough to step up to the plate despite the challenges, knowing that Tasiana was out of options. Thank you , Dr. Msuya. We are proud to have you on the FAME team!

Nurse Siana Nkya and Safi Mbwambo in the OR

By Volunteer Nurse Practitioner Brad Snyder

It’s being a chameleon, becoming whoever the person you’re with needs you to be. It’s waking up everyday knowing that undoubtedly you will change a life and in return have yours changed. It’s pushing yourself to new limits, frequently on the edge of comfort as you try your best to fix and heal the person in front of you. It’s brainstorming at the bedside with a team of gifted clinicians trying to figure out the cause of a man’s internal bleeding as his blood counts continue to drop. It’s checking on a 1 day old then suddenly grabbing the oxygen and performing a resuscitation when he changes without any warning. It’s coming together in a moment’s notice and becoming one skilled unit, fighting the battle to keep a little life alive. It’s winning the battle.

It’s watching a doctor’s skill as he diagnoses cardiac anomalies with an echo or saves a woman from bleeding out during a complicated C-section. It’s opening books and crunching numbers as you try to solve a medical mystery alongside other uncertain fighters pulling deep on dusty knowledge and experience. It’s coming to a solution while vulnerably admitting that you’re not 100% certain of this plan, but it’s the best we can do with what we have. It’s feeling the slight relief of a definitive partnership amidst ambiguity and uncertainty. It’s seeing a nurse take peanut butter and a spoon into the room of a patient with severe burns and watching her patiently give one spoon at a time. It’s looking into her  determined eyes as she says, “I know I can’t fix the burns but this is what I can do, so I’m doing it.” It’s feeling a rush of compassion flow through your body.

It’s a nurse’s poignant assessment as she picks up danger signs in pregnancy and prevents a catastrophe. It’s giving a woman a chance to be a mother, one of life’s greatest gifts. It’s a counselor gently comforting a suicidal woman buried deep in a cloud of depression with the fear of no way out. It’s giving her a glimpse of light and the possibility that this doesn’t have to last forever. It’s walking into a room as a midwife with experience twice as long as you’ve been alive turns the breech baby of a woman in active labor. It’s hearing the cry of a healthy baby and taking a collective sigh of relief. It’s feeling grateful to have such skilled, passionate people on your team.

It’s hearing the gentle humming of a mother who just lost her 6-year old to a battle against sickle cell disease. It’s walking outside with a father as he holds back tears surrounded by family and friends and giving him a safe space to feel whatever he needs to feel. It’s being a quiet presence as he sobs in your arms in a moment of utter grief and disbelief. It’s realizing that pain like this can only be felt by others who have experienced such a profound loss.

It’s staying up through the night diligently monitoring two premature babies as they struggle to survive in an incubator instead of the safety of their mother’s womb. It’s reading neonatology articles, emailing colleagues and adapting guidelines to what we can do here. It’s watching mothers give their babies life-saving breast milk to keep their tiny bodies growing. It’s praying that it all works out. It’s going home and preparing to wake up and do it all over again tomorrow. It’s holding onto hope. It’s who we are. It’s why we’re here.

“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.