By Volunteer Nurse Barb Dehn

I was standing by the side of an old metal gurney covered in a thin blue pad, holding a small child’s hand. This little boy lived so far from any town or village that he had not had any health care or treatment for a common skin condition that had started four years earlier. His father had carefully explained how the rash started out on the top of his head and was only the size of a small coin, but over time had spread to cover his entire scalp, neck and the side of his face.

What began as small and yet common fungal infection, tinea, was now infected with another infection, oozing and painful, that had completely changed his appearance. The other children in the village made fun of him, so he only went out wearing a borrowed hat, which had never been washed and caused the condition to worsen. 

When we first met, his head was covered in a blood-soaked bandage and he was using an old green cracked mirror to try to see how he looked. I wondered how I might help and later returned to visit him with a few gifts. For some reason, I had slipped a few small handheld folding mirrors in with all the medical supplies I brought to FAME, figuring some of the people in our community might find them useful.

I also had with me a large bag filled with hundreds of colorful Coban self-adhering stretch gauze bandages. I had every color in the rainbow and every size with me when I went back to see him.

He liked the green bandages best and so, through a translator, we decided that I should come with him when his bandages were changed. Because it would be a painful procedure, he would be receiving intravenous anesthesia and pain medication from one of FAME’s nurse anesthetists, Teddie.

I was smiling as I watched the small group of Tanzanian nurses gather the anti-fungal cream, the special yellow gauze and the other supplies. Dr. Badyana and Dr. Jackie, both Tanzanian physicians from FAME, discussed how they would carefully remove the infected skin so that new healthy skin would regrow. 

I was smiling because my job was not to do the procedure or to advise or to interfere. My job was to hold a little boy’s hand and my privilege was to observe what a sustainable hospital and clinic really is. FAME’s highly capable staff of local doctors and nurses were doing what they do every day, day in and day out, 24 hours each day, 7 days each week, providing excellent health care in a remote and rural part of Tanzania. As I watched the dressing change, it occurred to me that this was why I’m here. This is why I am so passionate about raising money and bringing supplies, working on projects and recruiting people who can mentor and share knowledge with the providers at FAME. 

The oxygen tubing he needed to breathe through and the special yellow gauze came out of my suitcases just two days before, not to mention the bright green bandages. It was all necessary to support FAME’s mission – providing patient-centered care to the community. 

If you’re inspired by the care FAME provides in rural Tanzania, near the Serengeti, I hope you’ll consider making a donation directly: FameAfrica.org

By Volunteer Tracy Hoffstetter

My opportunity to engage at FAME came at the invitation of my aunt, Dr. Kim Hall FNP, DNP and the generous approval of Dr. Frank Artress and the volunteer coordination team at FAME.

I have been a registered nurse for 30 years with a specialization in neonatal intensive care for the last 21 years, but have never had the opportunity to serve anywhere abroad. This prospect was so exciting for me and I began my experience on July 30, 2019.  I really had no idea what to expect and was a bit worried that I would not bring anything of value to the table.

What I discovered very quickly was that FAME is an institution of inpatient and outpatient care that covers the entire age and wellness continuum and is staffed by highly trained and experienced staff.  Everyone was so warm and welcoming on my first day of reporting for work. That first morning, I participated in the medical inpatient rounds even though my area of interest is newborn medicine. All the mother/baby action happens when we reach ward 2, the Maternity Ward! This ward staff can do it all!!! They labor mothers, deliver babies, resuscitate and assess newborns and provide post partum care for the maternal/infant couplet after delivery.  Additionally, they are so kind and welcome the collaboration of the ever-changing rotation of volunteers.

On my first afternoon, I was invited to attend the last stage of labor and the delivery of a mother’s first baby. After an uncomplicated labor her full-term baby girl was delivered. The newborn assessment was perfect and the baby was placed with her mom to do all of the normal baby things!  When I saw that mother the next morning during rounds, I smiled at her, greeted her, and told her that her baby was pretty and doing well in my “best” Swahili. She rewarded me with the warmest smile of recognition! As her delivery and post partum course were uncomplicated, she and her baby were discharged after the second day. I treasured the brief connection that we had made.

The next week of duty flew by and I continued to be impressed by the level of care demonstrated by the staff of ward 2. On August 6th was the weekly “Well Baby Day” clinic and I was able to attend this under-five clinic where the new babies receive a check up and their vaccinations. I walked in to find a room full of mothers and babies of various ages waiting to be seen. In that crowd of faces was that same warm smile of recognition that I had seen in the ward the previous week! She was in the clinic to be seen for her one-week post partum check, baby assessment and breastfeeding support.  

What I discovered was that FAME serves the greater Karatu community with a comprehensive prenatal/post partum follow up clinic which provides breastfeeding support, family planning services and five years of well child care in one inclusive package. This continuity of care lays a tremendously strong foundation for a healthy community. Strong, healthy families equal strong healthy communities! FAME is making that happen and the word is getting out.

It is difficult for me to articulate the nuances of all the things I have seen and done. I arrived at FAME with a desire to make the most of this ONCE in a lifetime experience. But if my heart has its way, this will just be my FIRST in a lifetime experience. My deepest heartfelt thanks goes out to all of the wonderful staff and other volunteers at FAME whom I have had the privilege of meeting. Asante sana!

Each week, Creighton’s surgical team convenes to discuss cases and gain insight from one another. Often, depending on the case, the team will also invite relevant specialists to comment on the case and offer their expertise. This week, the FAME team was invited to join the weekly meeting via teleconference. Dr. Kelly, our Global Surgery Fellow from Creighton University, facilitated the call with her colleagues. She had sent the FAME team a presentation featuring several cases we had seen during her time in Tanzania, including tropical pyomyositis, reactivated latent TB, and a dramatic trauma case of a young man who had been gored by an elephant.

The Creighton team presented the cases and asked for input from Dr. Kelly and a few surgery and tropical medicine specialists. On the FAME side, we had nine of our doctors present and one of our radiologists. It was very rewarding to be able to swap ideas and discuss these difficult cases in real time with doctors on the other side of the map. Additionally, it was exciting to be able to see our Creighton colleagues and conduct  question and answer sessions as if we were all seated together around the table in our small conference room in Karatu.

Both teams greatly benefitted from the experience.  We were able to learn new treatment methods and hear diverse opinions, while also being able to teach our Creighton colleagues what it’s like to work in rural Tanzania.  On several occasions, our doctors had a good snicker when we were told to use a type of advanced equipment as an interventional tool when that tool does not yet exist in Tanzania’s medical setting. Dr. Kelly was very open about what resources we have here and how practicing medicine isn’t as simple as it is in the US. We were grateful for the opportunity to share the reality in which our doctors and nurses must work each day. 

The surgeons were nearly speechless when it came to discussing the last case – a patient eviscerated by an elephant tusk. The director of the Global Surgery program, Dr. Philipi, ended the conference saying the experience was “illuminating to many people in this room how limited your resources are.” He praised the FAME team for caring for patients at the level we do even without all the newfangled equipment they have access to in their hospitals.

By Volunteer, Dr. Todd Sack

8/2/2019 Fri: FAME Day 20:  Ulcers:  At Morning Report, we learned that the Maasai baby with pneumonia also has hepatitis (Aspartate Aminotransferase 830) likely due to village herbal treatments. I went back to her room in the inpatient ward later with Kitashu, our Kimaasai translator, to caution her not to give herbs to her family. We discussed an 81-year-old diabetic woman with diarrhea and mild sepsis; a woman with ascites whose abdominal CT by Barbara, my wife and radiology volunteer, seems to reveal TB peritonitis; and a man who traveled 10 hours to us for care of a dental abscess and is doing well after a FAME doctor drained a cup of pus from under his right jaw this week.

During an endoscopy, I found benign duodenal ulcers in a 21-year-old man with five years of epigastric pain. These likely are caused by Helicobacter pylori, themost common bacterial infection in humans. A man in whom I found a large stomach ulcer last week came back and was admitted because he is still vomiting. We hope that he’ll improve if we administer his medicine intravenously, but we also fear that his failure to improve may be because he has stomach cancer rather than a simple ulcer. Unfortunately, we cannot routinely do pathology testing of endoscopic biopsies due to the cost.

Every patient in clinic today seemed to come in with one problem but more emerged. A minor stomach upset was also accompanied by a urinary retention from prostate disease and a massive forearm lipoma. A bad cough was accompanied by low back problems and charcoal stove-induced chronic lung disease (the #1 cause of lung disease in African women). I spoke with a woman with cough, fever, upper abdominal pain and mildly abnormal liver blood tests.  After blood tests and a normal ultrasound by Barbara (it’s fun working together), I prescribed doxycycline for possible Leptospirosis.

A 41-year-old man came to the ER very weak with a blood pressure of 75 systolic and distended abdomen.  Within minutes and before any of his blood test results were back, Barbara had done an ultrasound (necrotic liver masses), I’d done a paracentesis (blood-tinged ascites), and antibiotics were given for liver abscesses.  These cases were a small part of a very busy, fascinating day.

There were lots of good-bye hugs from nurses, doctors and technicians, as our three weeks end tomorrow.  Barbara and I had a nice vegetable curry at our house, with a South African Pinotage. We stepped outside into the cool night for a spectacular sky of stars. We look forward to returning to Karatu and FAME Medical next year.

By Volunteer Saja Erens

One of the first things that struck me at FAME was how versatile the Tanzanian medical staff is. At one moment, you will find them doing a complicated surgery, the next moment they are assisting a delivery, managing a premature baby, dealing with a psychotic patient, or treating a child with a severe viral or bacterial infection. In the relatively short period I stayed as a volunteer, I saw quite a lot of interesting, sometimes “exotic”, medical cases and I learned a lot about conditions I had no previous experience with.

Sometimes we had puzzling cases and had to put everyone’s knowledge and efforts together to find the right approach. For example, we had a case with a pregnant lady who presented herself with severe joint pain and diabetes. We tried different medications that were available, but to no avail. One of the volunteering internists suggested Sulfasalazine, which became accessible at FAME with the help of the pharmacy staff. It finally relieved the patient’s pain and we could see her smiling again.

Another great example of the collaboration at FAME was when we received a pregnant woman who had been rushed to FAME due to complications. The doctors in charge were very fast with diagnosing her with an erupted ectopic pregnancy and even faster with rushing her to the operating theatre and saving her life. Other available staff members responded quickly in finding blood donors and stabilizing the patient after the operation. I was very proud of the staff involved and how they handled this emergency, from the first call to the hospital to the aftercare by the nurses, and the way everybody tried to help the husband cope with this rather traumatic experience. With the entire team working together, I encountered a passion for making both the patient and their families feel better.