by Volunteer Cardiologist, Dr. Reed Shnider

Dr. Reed during heart checkups at a primary school

The 3 year old Maasai was likely deathly ill from the time that his family set out for FAME on a trip that was likely many hours. By the time they arrived he was in severe respiratory distress, minimally responsive, limp with a barely palpable pulse. His father, sensing his son’s grave condition passed him wordlessly to the nurses and doctors and sat silently at the end of the bed. We were called to help. Initial measures included IV fluids and oxygen, which were provided quickly as the history of his illness was obtained and comfort provided to his worried parents. It appeared likely that our little patient was suffering from a severe systemic infection . IV steroids, antibiotics, fluids and epinephrine were infused without delay. With no Pediatrician on site, contact was made with an overseas consultant, Dr. Rachel, who, being a veteran of several visits to FAME, was able to provide insight and additional recommendations, validating our impression and treatments. Shortly following her call, despite our best efforts, our new arrival suffered a respiratory arrest. CPR and respiratory support were initiated immediately. Medications given without delay.  As if in anticipation of this course of events, we had completed a review of Advanced Life Support just the day before, and the team had learned admirably as evidenced by their efforts. Although it became clear that recovery was unlikely, no one was ready to give up. Even so, there came a time when it was clear that it was time to stop and I called the code as over. As I did, I realized that the father had been sitting at the foot of the bed the whole time quietly observing. Nurse Safi, the Ward Supervisor,  and I  led him to a quiet corner. We explained how sorry we were that we couldn’t save his son. The illness had weakened him too much, that sometimes even our strongest dawa (medication) and greatest efforts were not enough. As parents and grandparents we felt his loss and pain. I think Safi and I were both tearful at that point, waiting to hear what he had to say. He was quiet for a moment then spoke, “I brought him here because we knew that he was very sick, and we knew that you would do everything possible to make him well. I watched and saw that this was true. You have nothing to be sorry for. Thank you for working so hard to save him.”

I like writing about successes. Cases that make us happy. Cases that highlight how far we’ve come. But I realize that the essence of what makes FAME so special is also highlighted by stories like this one. How much the doctors and nurses wanted to save that 3 year old as if he were each one’s child. How painful the loss. How that feeling of caring was communicated wordlessly to the father who came so far to have his child cared for by very special people. How it made an immeasurably painful loss a little more bearable. That’s what I feel a part of when I come to FAME, that’s why I will keep coming.

by Dr. Thu Vu

Dr. Thu (left) with Dr. Michael Rubenstein and Dr. Ali at FAME Medical

Of the experiences I had in residency and the stories I tell over and over again, my time in Karatu is the one I reference the most. I cannot even truly enumerate all of the things that I learned there, which ranged from clinical skills and reasoning, to the business of medicine and public health. The rotation I spent there was truly formative in my style of practice, making me a better neurologist, teaching me the importance of healthcare quality and safety, and allowing me to contribute to social good through teaching and clinical care.

Learning to practice in a resource-limited environment was a test of clinical skills including physical exam, localization of lesion, triaging of problems and prioritization of testing. We could not simply rely on other experts or advanced diagnostic testing. For the patient with hand weakness that came in, with large burn scars covering his right arm, we were forced to think carefully and ascertain the localization of his lesion based on examination alone, without the assistance of imaging or EMG. In the realms of treatment, we had to consider the whole patient carefully, including the social context in which they lived, and tailor treatment accordingly — what is the distance this patient would need to travel to obtain their medications? Do they understand that they need to take this medication every day? Every patient came with a piece of critical thinking, rather than rote protocols to follow and panels to order.

The frustrations of local healthcare delivery were educational as well. In an environment like this, it can be very easy to slip into a learned helplessness, an apathy of "well, we did what we could." I have been in other resource-limited areas of the world in which this is true, but not at FAME. FAME embodies the true spirit of quality improvement and patient safety initiatives, which is quite simply asking the question repeatedly, "What can we do better?" I felt that at FAME, I learned more about the best ways to approach healthcare quality and safety improvement from the ground up, and doing so in a cost-effective fashion. I think that these larger systemic initiatives in trying to deliver quality care to patients may have the most impact on the region, perhaps even more so than just seeing individual patients -- it sets a standard for the area which other local hospitals will try to emulate in order to compete.

Seeing patients in this way, carefully considering each case one-by-one, and maximizing resources to do the most good for each patient, enabled us to feel like we were truly doing the best we could for each patient. Often times in residency, one can lose a sense of personal accomplishment -- there is always another consult to see, another call night, another rotation. However, at FAME, the mission of education and patient care, put into perspective by our medical leaders Dr. Rubenstein and Dr. Artress, made all of us who went feel like we had truly done good in the world, that we had made a difference in the lives of the people living in and around Karatu, and made a difference in the lives of the staff working there. That sense of shared mission is clearly evident in everyone there, and it renewed my sense of hope and ambition in my chosen profession. If there is a solution to residency burnout, this feels like one of them.

Global health opportunities were one of the reasons I chose to train at Penn, and my time at FAME with Dr. Rubenstein and Dr. Becker went above and beyond my expectations. What FAME has been able to accomplish in its community has been nothing less than remarkable, and the visiting resident rotation is a program that I feel strongly should be nurtured and expanded as we continue to serve that community and build up a standard for neurologic care in such areas.

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