By UPenn Volunteer Neurologist, Mike Baer

I met my first, and only, Hadza patient several days after arriving at FAME. We had been told that she was presenting with a seizure and a headache, but when I met her the story was more concerning. She had collapsed suddenly two weeks prior, seized, and since then hadn’t spoken a word to her family. When I examined her she was mute and weak on the right side. A head CT showed that she had a large intraparenchymal hemorrhage extending from the left temporal lobe to the left frontal lobe, which we felt was caused by either a ruptured aneurysm or a mass that bled. Either way, the prognosis was poor. We started her on antiepileptic medications and hoped to gain more information from a CT scan with contrast, which could reveal an underlying mass. 

The Hadzabe, I learned, are an ancient tribe of hunter-gatherers, who are struggling for survival and live in the Lake Eyasi region, just an hour or so away from our home base in Karatu. They traditionally communicate with a “click language” and survive on hunting game and foraging for fruit and honey. There are no formal leaders and little social hierarchy, so most important decisions are made through group discussion. With the rise of agriculture, livestock herding, and tourism their ability to survive as hunter-gatherers has become tenuous, and today less than 1500 individuals remain, including our critically ill patient. 

Unfortunately, just two days into her hospital stay, the Hadza patient had a second seizure. She was extremely lethargic afterwards, and the head CT with contrast showed that the bleeding had extended into her ventricular system, which was beginning to expand to create hydrocephalus. Her prognosis, even with surgery to relieve the hydrocephalus, had gone from poor to grim. We spoke with Dr. Badyana, the physician in charge of her care, and together we sat down with the daughter, who had remained at the patient’s bedside. Dr. Badyana explained that the patient’s condition had worsened and that the bleeding would ultimately end her life. We showed the daughter the images from the CT scan. She didn’t say much and she remained calm but it was clear that the news affected her greatly. Her demeanor was one I had seen before, back in Philadelphia during some of my end of life discussions for similarly dramatic intracranial injuries. The Hadza woman passed away comfortably the following day. 

During our four weeks at FAME, I and the other neurology residents from the University of Pennsylvania had the opportunity to interact with and learn from members of a variety of other tribes. We visited Daniel Tewa, a member of the Iraqw tribe and local farmer and historian, who showed us a traditional house that he had constructed, modeled after the home he was born in. He taught us about the traditions and customs of his people, many of which were changing from the pressures imposed on the Iraqw tribe from outside forces. We also treated a large number of Maasai and one of our translators, Kitashu, a Maasai and a FAME social worker, was helpful in helping us understand Maasai culture and how it related to the counseling and treatments we provided to our patients. I was particularly struck by the close social circle I witnessed and the readiness of the community to help in times of need. 

Working at FAME was an incredibly valuable experience. The clinicians, already proficient in a wide range of domains, were eager to learn about neurological diseases, a topic not widely emphasized in Tanzanian medical education. While we did treat a large number of patients, the most rewarding aspect of my work at FAME was helping the medical staff strengthen their capacity to independently care for many of the neurology patients that we saw. I look forward to seeing how FAME and healthcare in Tanzania advances to address the unique needs of the country’s diverse population, from the Iraqw to the Hadzabe and the Maasai. 

By Volunteer Neurologist, Joyce Liporace

As a neurologist in private practice in the United States for over 30 years, I have found that caring for patients involves ordering a lot of tests and imaging studies. I am dependent on MRI scan results to formulate a treatment plan for my patients. While I was unsure of myself and wondered if I had much to offer without these results, I decided to spend a month volunteering at FAME Medical near Karatu, Tanzania. As soon as I arrived, I respected and understood the value of FAME’s international volunteer program, which encourages participation in patient care and, more importantly, working side by side with FAME’s Tanzanian doctors and nurses to share experiences and skills.

One of my first clinic patients was a 39-year-old man who thought he was having fainting spells. His description of stereotyped events allowed me to confidently diagnose him with seizures. We reviewed the typical risk factors for epilepsy, which were all negative. However, during the examination, I asked him to remove the wool cap from his head and discovered a left frontal skull defect. Stoically, he disclosed that he had been the victim of a leopard attack at age 29, resulting in the removal of a piece of his skull. That was undeniably a novel seizure risk factor — and a perfect example of the resiliency of the Tanzanian people! Their ability to move on from injury or hardships is amazing and inspiring.

On the Inpatient Ward, I cared for a 50-year-old woman who was told that she was pregnant. The pregnancy seemed to be prolonged, so she came to FAME for another opinion. She was NOT pregnant. Instead, Dr. Badyana, one of 14 skilled doctors at FAME, removed an eight-kilogram ovarian mass. She was very pleased that she was not pregnant! This was a perfect example of the comprehensive care provided by FAME doctors. They are excellent diagnosticians (often with limited lab tests), medical providers for the full spectrum of life from neonatal care to geriatric care, and skilled surgeons! I am in awe of the breadth of their abilities and felt humbled to work alongside them.

I did not expect to form solid friendships in my short four weeks at FAME but I was wrong. I was welcomed by the entire staff at FAME — the doctors, nurses, receptionists, support staff and, of course, Dr. Frank and Mama Susan. One of the Tanzanian doctors, Dr. Lisso, even came to Arusha to meet my husband, Tim and son, Michael, when they arrived for our safari. While at FAME, I was honored to travel to Ngorongoro Crater to visit a Maasai village and spend time with FAME’s warmhearted social worker, Kitashu, and his family. That afternoon had a permanent impact on my understanding of other ways of life.

An unexpected pleasure during my time was getting to know other volunteers. I walked with Jen, a volunteer nurse in the Inpatient Ward, to Gibbs Farm to meet Kim and Tracy, a volunteer nurse practitioner who specializes in Diabetes and volunteer neonatal nurse, for a fabulous brunch, went to Sparrow for dinner, and hopped in a bajaji, a three-wheeled vehicle akin to a tuk tuk, with Kathrine, FAME’s communications coordinator, to go fabric shopping.

There are numerous challenges in providing medical care in a developing country. The unique team at FAME finds ways to overcome these hurdles on a daily basis. I will always be grateful for the chance to share my experiences and learn new skills with my FAME family. My voyage to FAME led me to new landscapes far from home, but it felt like familiar territory in just a matter of days.

By Volunteer Neurologist, Dr. Michael Rubenstein

One of the unique aspects of our bi-annual Neurology Clinic is the team’s mobile clinic outreach that they provide for villages surrounding Karatu. Below are reflections on their experiences for their four outreach clinics last month:

RIFT VALLEY CHILDREN’S VILLAGE: Our outreach began in the village of Oldeani at Rift Valley Children’s Village (RVCV). India Howell (Mama India) founded the children’s village in 2004, and over the years, they have continued to grow such that she now has nearly 100 children that call this their home and call her Mama. She has partnered with the community to improve their schools by helping to fund certain programs and she has offered healthcare to the residents of the surrounding community, as they knew that a healthy community would only improve the chance of success for their children. It was on the backdrop of India creating her children’s village in Oldeani that Frank and Susan ultimately decided to locate FAME here in Karatu, allowing them to be in close proximity to India and her children.

After morning report, we all loaded up and began our drive towards the village of Oldeani along a lovely route through cultivated fields and eventually arriving at the coffee plantations surrounding the children’s village. Driving into the parking circle in front of the administrative offices, there is a huge gathering of patients sitting on benches and waiting to be seen. Our first thought is how we are possibly going to see all these patients in one day, but we were relieved to find that the attendees are not all neurology patients as RVCV’s nurse Gretchen was seeing patients today in their regular clinic. Still, there are quite a few patients for us to see so we make sure with our social worker, Kitashu, that the patients are going to be properly screened. Triage, though, it really tough. At FAME, it’s easy for us to send them over to the outpatient department. Here, they would have to see Gretchen and she was definitely going to be a bit overwhelmed today.

Many of the patients here we’ve seen before, some for as long as I’ve been coming. We see some of the children from RVCV with epilepsy or ADHD, but there are more patients from the community that are seen. We usually see a larger percentage of epilepsy patients here than at other clinics, but otherwise, there is the typical smattering of diagnoses. Several of the patients are new to the clinic and we’ve diagnosed them with chronic illnesses, such as epilepsy, and they will require continued medications going forward from the clinic at RVCV. We had planned to finish early, but somehow the time got away from us and clinic stretched to after five.

KAMBI YA SIMBA: Kambi ya Simba is a small village in the Mbulumbulu ward of the Karatu District and about 45 minutes from FAME. It is a totally self-contained clinic, meaning that we bring all of the medications we will prescribe to our neurology patients and all of the tools that we would need to provide our care.

The drive to Kambi ya Simba took us through extremely fertile farmlands past the Rhotia valley and on to the Mbulumbulu ward. Despite the dry season, there is quite a bit of green as we meander through the hills in this area that sits at the top of the escarpment of the Great Rift Valley and continues until the mountains of the Ngorongoro Highlands meet the drop off and the road ends.

As we arrived at Kambi ya Simba, it was evident that the new dispensary has continued to grow even in the last six months since I was here last. In addition to the large number of buildings that are here now, they have rebuilt the original dispensary that we had begun to work in and now there is a covered arcade connecting everything. There is even an area to drop patients off who are arriving by car or motorcycle. Amazingly, a large number of patients arrive at the clinic on the backs of the motorcycle taxis called piki-pikis. Watching a nearly paraplegic patient load onto one of these as one of two passengers, in addition to the driver, can be a bit nerve-wracking to the say the least.

At the clinic today we have a smattering of return and new patients who all have to be screened for neurological disorders. Our purpose here is not to supplant the government medical staff here providing care, but rather to work with them and provide specialty care that would not otherwise be available in most of Northern Tanzania. These clinics allowing us to practice in their community is not something that is merely a given, but rather a sign of trust that we respect.

Before lunch we had seen our general mix of patients, with headaches and epilepsy, along with a few arthralgias, and still had several patients to get to after lunch who had showed up through the morning. The last patient we saw, though, was perhaps the most complicated. He was a gentleman in his thirties who came to see us in a wheelchair because he was unable to walk due to lower extremity “pain.” It turns out that this gentleman has lost most of the use of his legs, with no effects in his upper extremities, about ten years prior and hadn’t been evaluated medically for this condition.

His examination was myelopathic (meaning that he had a problem somewhere in his cord) as we surmised even before Lindsay, one of the U Penn residents, had first tapped on one of his reflexes. The process, though, had occurred gradually over several years and was purely motor-related as the predominance of his sensory examination was fully intact. Without a sensory level, though, we were unable to tell exactly what level in the spinal cord we were dealing with, but it was clearly thoracic in nature. Having purely motor-related findings is more the exception than the rule. There was little else we could come up with for this gentleman and, perhaps more importantly, nothing that we could do to make him better at this late date. Though we tried to explain to him what our thought processes were, in the end, the answer was the same, that very little could be done other than to make him more comfortable by using a medication such as baclofen for his spasticity which we prescribed.

We left Kambi ya Simba in the mid-afternoon to make our way slowly back to Karatu, once again traveling through the gorgeous countryside that we had traversed earlier in the day.

QARU: The drive to Qaru is less than 45 minutes and is on a main thoroughfare, albeit gravel, as there are very few paved roads other than the main highway traveling from Arusha to Karatu, as well as the road that travels east from Makuyuni towards Tarangire.

It is important to understand that the purpose of our neurology mobile clinics is perhaps less to provide care for patients who cannot reach FAME, but rather to bring the concept to them that neurological diseases can be treated effectively. The villages are not so remote that their residents are unable to get to a medical facility capable of providing treatment; rather their illnesses are often just accepted as part of their life. This can often be most impressive for patients with epilepsy where it is merely a matter of placing them on the right medication and they can be seizure free or at least nearly so. Epilepsy carries with it a huge social stigma, which results in severely limited access to adequate medical care in countries like Tanzania. The percentage of these patients who are treated is appallingly low – in the range of 10%. It can be so rewarding to see one of these patients who has never known a life without seizures become seizure free with a simple medication. Thankfully, many of the patients we see are young children with epilepsy and we are able to place them on the appropriate medications at a much earlier age.

At Qaru, the number of patients waiting for us was rather small – a common occurrence at the mobile clinics. We do advertise the clinics much the same way as we do for those we hold at FAME (where we are always packed), but since we’re at each village only one day, if that happens to be a day of planting or harvest or your cow has run away, then you may not be able to make it. There were several new patients with epilepsy and a few follow-ups, as well as our normal smattering of patients with complaints that we couldn’t necessarily attribute to an underlying neurological process.

UPPER KITETE: It was off to Upper Kitete for the day, a trip of less than two hours, but out to the far reaches of the Mbulumbulu area and the top of the escarpment where one can travel only a few kilometers further before running out of land. We took the same road we use to get to Kambi ya Simba and then continue beyond for an equal distance making it almost twice as far as the closer village.

We arrived at the Upper Kitete dispensary only to find a huge gathering of patients that were thankfully not all for us as it was also their well-baby visit day. After some negotiation with the clinical officer here, we eventually ended up using the two offices that we normally use (the nurse’s office, otherwise referred to as the bat cave for the distinct smell of guano coming from the opening in the ceiling, and the labor and delivery room that was not currently being used), along with the outside area that we normally use as our pharmacy, but would now serve as our third examination room. The pharmacy was bumped to the end of the outdoor walkway and we just moved all of our patients to the other side of the building to wait for us so as to maintain some sense of privacy.

We got through our patients, though, and had our lunch around midday with still a few stragglers to see afterwards. One of our later patients was a gentleman who was brought to us sitting in a chair (not a wheelchair). We were told that he had been unable to walk for well over 10 years. His examination was myelopathic, suggesting some sort of cord problem, and we felt he most likely had a cervical myelopathy as it had been gradual in onset. We discussed the possibility of an evaluation, but were realistic with him: We noted that it was very unlikely that we would find anything that would be treatable at this late stage and, therefore, it would not benefit him functionally. The family understood and we did treat him with some baclofen for his spasticity, which was the least that we could do for him. As with our patient at Kambi ya Simba who was also paraplegic, he was eventually helped onto the back of a motorcycle by his sons and began his trip home. Not long after, we also loaded up and headed home, finished with our mobile clinic outreach for this season.

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!