by Co-Founder, Susan Gustafson

Nurses taking Riziki to the OR, photo by Moon Lai

Full term, Riziki began feeling labor pains and prepared to give birth at home. She labored for two full days, and was given local herbs believed to help her with contractions. Riziki’s contractions continued but her baby was not descending. Alarmed and worried, her family took her to a dispensary near her remote village where her labor was monitored for another four hours. With no progress of labor, the healthcare provider knew there was something terribly wrong and referred her to FAME Medical for help. When she arrived, she was having very strong contractions. Dr. Gabriel examined her and performed an ultrasound. What at first glance looked like an enormous cyst, was upon closer examination, the infant’s head showing massive hydrocephalus. Riziki had been pushing for so long her uterus was showing signs of a possible rupture. The team knew they needed to get her into the OR fast and called for blood product from the lab to prepare for the worst. Upon opening the stomach, Dr. Gabriel could see that the uterus was buldging and there were signs of a lower segment hemmorhage. They worked quickly, delivering a baby boy. Despite the hydrocephalus, his Apgar score was strong and he was active. While a nurse cared for the baby, Riziki started bleeding badly. Treating her with the first line of treatment for post-partum hemmorhage, she was slow to respond. As they moved to the second line of treatment, she went into shock. Sehewa, our anesthetist, immediately intubated her and inserted an NG tube. The team began rescusitation and giving her IV fluids while transfusing intra-operatively what would be two units of blood. Her pressure began coming up and when she was able to breathe on her own again, she was extubated and returned to the ward where she stabilized and soon recovered. She still faces some serious challenges, specifically that of taking a medically compromised baby back to the boma. But thankfully, we were able to refer the child to a pediatric surgeon 2.5 hours away who inserted a shunt. Riziki has already returned for her post C-section follow-up visit, reporting that her baby is recovering well. We rejoice in knowing that another precious mother was saved by the FAME team.

By Volunteer, Dr. Carolyn Apple

The phone rings in the volunteer house.  I glance at the clock – almost 10pm.  This is not good.  The voice states a patient has been brought by family to FAME after having a motor bike accident and appears to have a head injury.  Can I come?  This is not good.  A few minutes later, I am standing by Dr. Gabriel and Dr. Kiduge looking down at a young man with abrasions to his face, scalp and shoulders.  The patient occasionally calls out nonsense and only arouses to pain. This is not good. The FAME team has already placed a cervical collar and started the initial assessment and stabilization of the patient and Dr. Gabriel performs a focused abdominal ultrasound for trauma exam – no evidence of blood in the abdomen/pelvis. This is good.  We proceed through the remaining primary and secondary assessments taught in trauma care. The patient becomes agitated, requiring cautiously administered sedation.This is not good. Within minutes, a FAME nurse anesthetist is at our side, helping with sedation and airway management.  This is good.  Laboratory study results return and blood typing has taken place.  This is good.  We are notified the radiology technician has arrived and X-rays and CTs are performed quickly.  This is good.  The CT reveals a subdural hematoma.  This is not good.  CT of the cervical spine and x-rays of the chest and pelvis are negative.  This is good.  Dr. Loie Sauer, a volunteer surgeon, joins the team.  This is good.  The team confers and quickly agrees the patient needs a referral for neurosurgical care.  The family agrees to a transfer.  This is good.  The local ambulance is called as the patient receives continued monitoring, medical and nursing care from the team.  This is good.  The ambulance arrives and the FAME nurses equip the vehicle with the necessary equipment and supplies for transport. This is good. The patient is loaded up, along with the FAME nurse anesthetist who will monitor the patient’s vital signs, airway, need for additional sedation and general condition enroute.  This is good.  I return to the volunteer house three and a half hours after having left my bed.  What the FAME Medical team was able to do tonight was very, very good.

by Director of Development, Roanne Edwards

It was perfect timing for Justine. She was at church the day FAME’s social worker, Angel, began visiting churches, mosques, open markets and water collection points to announce the free-of-charge Cervical Cancer Screening clinic at FAME Medical. Justine had been experiencing lower abdominal pain and had heard about cervical cancer on social media. At FAME, the following week for the screening procedure, she learned that there was an abnormality in her cervix. She felt frightened and apprehensive but was ready to undergo the recommended treatment for pre-cancerous dysplasia. Six months later, the FAME team screened her again and returned with wonderful news – the treatment had cured her abnormality. Justine went home to share the news with her family and to encourage all the women in her life to undergo this simple procedure that could literally save their lives.

Cervical Cancer is the leading cause of cancer-related death in women in Tanzania.
—  ICO HPV Information Center 2017 Report

Mary's Healthcare Providers, Dr Ivan & Sehewa (Anesthetist/Wound Care)

For 58 year old Mary, feeling healthy and strong seemed completely out of reach. A poorly managed Type II diabetic, Anna had never taken her medications regularly, nor had she ever fully understood the havoc her diabetes was wreaking on her health. Feeling terribly ill and discouraged, she heard about FAME and decided to make the 40 minute road trip between her village and Karatu.  She arrived at FAME with a high fever and an old wound on her foot – one she had been battling with for 9 long years -- septic and oozing. The team quickly discovered that her blood sugar was dangerously high as was her blood pressure. She was immediately admitted to the ward and over the next 4 days, cared for by our team.  They cleaned and dressed her wound and treated her infection with IV antibiotics.  Having a well stocked pharmacy at their fingertips, they managed to bring both her blood sugar and blood pressure back into normal range.

So began the long road to healing for Mary. A few days later she was discharged but not without a rigorous follow-up program in place and a new understanding of her diabetes --  that it was a chronic disease and would require lifelong medicine and management.  With this new understanding, she began taking her medicines regularly and coming in for follow-up visits.  Despite careful attention to her diabetes, after nearly a year of weekly dressing changes and care, her wound was still not completely healed. The FAME team decided to try something that hadn’t yet been tried. Equipped with skin grafting equipment, some previous training from a volunteer and a visiting surgeon on hand, they scheduled Anna for a skin graft. Once in the OR, the donor site was prepared and draped and the recipient site cleaned and debrided. They completed the long and tedious procedure and hoped for the best, and sure enough the graft took! Anna was discharged with the wound clean and dry, and we are happy to report that it has finally healed up completely. Mary is feeling healthy, strong AND mobile again, and it is largely due to the comprehensive care she received at FAME Medical from a committed team of providers who refused to give up on her.

By Volunteer Olivia Herrington

Birth is miraculous. You know this before you see it, but seeing it makes you certain. This birth, the first I had ever observed, was by C-section because the baby was breech and because the mother had previously had a C-section—there was concern her tissue was therefore more likely to tear if she delivered vaginally. So the doctor took the baby out feet-first, and, with only her head left inside, Hosiana, one of the nurses, exclaimed, “She is crying inside the womb.” She was, indeed.

When she fully emerged, she was pink and smeared all over with cream-colored paste—the vernix caseosa—and beautiful. Hosiana told me that all babies are born pink, that any other hue is a concerning sign. This baby tried very hard to shut her eyes against Hosiana’s tetracycline ointment, which it is government-required protocol to squeeze into all newborns’ eyes. But her eyes were beautiful, too, a very deep brown.

The next birth was to a young woman who cried out to Jesus as the agony of labor overcame her. Her sister-in-law left the room and wept for the woman’s pain. She had lost her first baby, so terror, if this was what she felt, would have been entirely understandable. From the moment her daughter became visible, delivery was smooth, instantaneous—faster than I could crack open the tiny vial of oxytocin and draw up the liquid with a syringe.

The baby’s head was large and elongated, and her emergence into the world was exhilarating. Her color was more purple than the first but not unusual enough to alarm anyone. She opened her eyes for the first time in my arms. “Mrembo sana,” I murmured, holding her warm body, “very beautiful.”

“Mrembo sana,” Lydia, another nurse, agreed, “kama wewe—like you.” I laughed. Outside, I congratulated the new mother’s own mother. She, in turn, congratulated me.