Late one evening in June, three-year old Sironka was sleeping peacefully in his bed while his mother, Esiankiki, was outside milking the cows. As is common in most Maasai houses, there is a small communal fire in the center of the home for cooking and warmth. As Sironka turned over in his sleep, he rolled off the bed and fell into the fire.

Esiankiki, alerted to his screams, ran inside to see what had happened.  Sironka was badly burned and needed urgent medical attention. His father knew other Maasai from the village who had been treated at FAME, and decided that was where Sironka needed to go. The four hour journey from their village of Endulen to FAME was made by Sironka and Esiankiki on a Dala Dala, the local form of public transportation.

Upon reaching FAME, Esiankiki, who speaks KiMaasai, had difficulty communicating with the doctors and nurses who were speaking Kiswahili. Fortunately, the next morning Esiankiki was greeted by Kitashu, a FAME social worker fluent in KiMaasai, or KiMaa, and Kitashu became the translator between the little boy’s mother and the medical staff.

In the weeks following, Kitashu checked on Sironka frequently to monitor his recovery and was pleased to see that he was healing well and becoming more energetic. Appreciating the difficulty for this little patient and his mother being surrounded by foreign-sounding people in an unfamiliar environment, and wanting them to feel more comfortable, Kitashu started playing Maasai gospel music for Sironka and his mother on his phone. And little Sironka, absolutely delighted, began to dance!

After that first dance, Kitashu returned every day to hold little dancing sessions with Sironka and his mother out on FAME’s central lawn. He created a playlist of Maasai songs, and the one being played when this photo was taken is called Osim Lai by a Maasai artist called Tychius, and translates to “you are my hope.” All three looked forward to their daily entertainment.

Soon, Sironka will be able to return home, fully recovered. While this has been a very difficult journey for him and was a particularly heart-wrenching case for everyone involved in his care, we at FAME share tremendous pride in having managed his recovery with the assistance of many teams, including the creativity of Kitashu who worked to help Sironka and his mother adapt to FAME’s unfamiliar environment. We’re hoping to see Sironka again, under different circumstances, and look forward to more of his dance moves!

*Names have been changed to protect the privacy of the patients

By COVID-19 Coordinator & Emergency Department Supervisor, Siana Nkya

Over the last several months at FAME, no day has been the same.  In the early months as COVID-19 was busy spreading all across the world, we were busy preparing here at FAME. Initially we had tons of trainings. For the most part, I was training all of our staff along with our new Head Nurse Kizito and Head Doctor Gabriel, on how to properly don and doff Personal Protective Equipment (PPE).

Because of COVID-19, I’ve taken on a lot of additional responsibilities at FAME. While now I mainly train our staff on decontamination of PPE and medical equipment, a few months back I was doing a lot of trainings with Dr. Gabriel for other healthcare providers in our district. By the time we were finished, we had trained over 300 government healthcare workers. Eventually we were asked to join the District Level COVID-19 Task Force to provide technical support and to serve as a resource for providers in low-resource settings around the district. 

It wasn’t long after hearing about the coronavirus, that we had our first suspected case at FAME. I was very scared the first time I had to put on PPE and actually go into our Isolation Unit to see a patient. But as patients continued to come I kept going in and eventually just got used to it. However, I have still not gotten used to the heat from wearing all the PPE.

Nowadays, things have sort of hit a rhythm. There is still a lot of work to be done, but each day in the morning I go to check on the Emergency Department and see if there’s anything that they need from me. Then I head over to the Isolation Unit, and either check-in with the nurse on duty there, or suit up and head in. I try to go in about every other day, because I try to do as much as I can for the patients mental health and well-being. While the nurses in the isolation unit make sure they are receiving medication and treatment, I remind the patients to exercise, take showers, eat their meals, and just spend time talking to them. I will ask them about their family or if they are feeling better today, just to take their minds off of isolation for a bit. Before going home at the end of every day, I make sure to check again at the emergency department and isolation unit to see if there’s anything they need before I go home. 

Aside from PPE, caring for COVID-19 patients doesn’t seem that different from all the other patients I’ve cared for. The main thing is making sure not to use the same equipment on more than one patient, and if you do, you have to be sure to decontaminate it before using it again.

From what I have seen, I can say that all the staff at FAME have been doing really well. We are lucky that FAME management cares about us and about keeping us healthy. Whatever we need to be safe and to properly care for our patients, we get.  

When Mary started bleeding five months into her pregnancy with twins, she knew the risks and that she needed to seek medical care.  Mary immediately went to the closest hospital in Endamarariek, a small town 12 ½ miles directly south of Karatu. She stayed at the local hospital for one week and after her condition appeared to improve, she was discharged. 

Upon returning home, Mary’s pregnancy progressed normally until mid-April. Just under 29 weeks into her pregnancy, she suddenly went into labor and birthed her first premature baby at home. As is common in Tanzania, a relative was there to help and escorted her back to the hospital in Endamarariek. She gave birth to the second baby on the way.

Mary reached the hospital with her twins, distraught, exhausted and devastated, knowing that their chances of survival were very low since they were premature and extremely small.  Babies born at less than 28 weeks are not expected to survive since they are particularly susceptible to numerous health complications. However, when she spoke to the doctor at Endamarariek he assured her and her husband not to worry--these babies would be fine at FAME--and he referred her to us.

Mary travelled directly to FAME where her twins were placed into one of our two neonatal incubators in our Special Care Nursery. When her babies were admitted, they had an alarmingly low birth weight, each weighing less than 1,000 grams (2.2 pounds). Staff worked tirelessly to support the twins and meticulously provided medications, milk, fluids, and intensive care around the clock.  

After a difficult month at FAME, the twins started showing signs of improvement by the end of May, and Mary knew they would be all right.

“It’s not a good feeling staying at the maternity ward for such a long time, but it was worth it since my babies are alive. I am thankful to FAME Medical and the team. I can’t even express how I feel, only God can pay you.”

In early June, after more than six weeks at FAME, Mary and her babies were discharged, excited to go home.

We at FAME are grateful to have the confidence of the doctor at Endamarariek, as there are many challenges when providing adequate healthcare in a low-resource setting. We are continually striving to improve our services and outcomes for our patients, and are lucky to have a medical staff committed to consistently raising the bar at FAME. As Mary was sent home with her healthy twins, she left our staff with this bit of inspiration to lift our spirits:  

“What you should know is that your existence in Karatu is a miracle for the community.”

 NOTE: The names in the story have been changed to protect their privacy

Richard Samson

Richard is from Maliasili in Karatu District. He graduated from the Assistant Medical Officer Training Center in Tanga Region in August 2019, with a Clinical Officer Certification. He joined FAME as a trainee on April 21st, 2020. During his course of study he received training in clinical medicine across departments. At FAME, Richard is taking vital signs and screening patients at RCH, OPD, and at the entrance to the hospital as part of our COVID-19 strategy. He has also participated in doctors meetings and doctor education sessions. He wishes to study medicine abroad some day and specialize in a medical field that will allow him to help as many people as possible.

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Africanus John

Africanus is from Rhotia in Karatu District. He completed his Clinical Officer program at Machame Health Training Institute in August 2019. He started training at FAME in February 2020 to gain professional medical experience. His Clinical Officer classes included training in all medical departments including: internal medicine, pediatrics, obstetrics,  reproductive and child health, and gynecology. Eventually Africanus hopes to get a bachelors in medicine and go on to take a specialty in internal medicine. At FAME he screens patients at OPD for symptoms of COVID-19 and provides assistance to FAME doctors wherever he can.

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Allice Saul

Allice is from Kimandolu, which is located 74 miles west of FAME in Arusha. She also completed her Clinical Officer program at Machame Health Training Institute in August 2019. She became a trainee at FAME in April 2020. Her training at Machame was broadly focused, giving her experience in all medical departments. However, she is most interested in specializing in obstetrics and gynecology. At FAME Allice has been screening patients for COVID-19 symptoms at RCH, OPD, and the entrance to the hospital. She has also been working with FAME’s doctors as they conduct cervical cancer screenings. Allice chose to become a doctor because she likes working with people. She finds it rewarding to help patients, their families, and the community as a whole.

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Boniface Evance

Boniface has lived in Karatu for the past six years. Originally from Moshi, he graduated from Mount Meru Tour Guide School in 2016. He started helping at FAME in April 2020. At FAME, Boniface has helped to implement new policies and practices developed in response to COVID-19. He works outside the outpatient clinic, helping to manage the flow of patients and ensure everyone adheres to FAME policies regarding masks and hand washing. Eventually, Boniface hopes to study medicine and become a Pharmacist.

By Volunteer OBGYN Specialist, Dr. Paul Indman

Dr. Paul and Dr. Anne conduct Cervical Cancer Screenings at an outreach clinic.

Dr. Paul, Dr. Anne, and Head Nurse Siana, confer about the results of a colposcopy exam.

Dr. Anne and Head Nurse, Siana, show a patient the results of her colposcopy exam.

Dr. Paul at a Cervical Cancer outreach clinic

Cervical cancer is the most common form of cancer in Tanzania, killing nearly 7,000 women each year. Traditional screening methods, such as PAP and HPV testing, require reliable follow up and multiple visits if treatment is needed.  This is impractical for much of the population of Tanzania, due to the vast distances women need to travel to reach medical facilities.  

A large part of my GYN practice in the San Francisco Bay Area was devoted to the evaluation and treatment of dysplasia (pre-cancer) of the cervix by examination with a special microscope called a colposcope.  For many years I taught colposcopy to the residents at Stanford University as well as gynecologists and mid-level practitioners.  Developing countries often lack the luxury of using specialized equipment such as a colposcope. Instead they rely on a simplified method of inspecting the cervix called VIA (Visual Inspection with Acetic acid). This can identify some cases of dysplasia and allow immediate treatment in the same visit, and has been shown to decrease deaths from cervical cancer by about 30%.  However, without magnification many smaller abnormalities are missed and some normal areas are over diagnosed as precancerous, leading to unnecessary treatment. 

Advances in technology led to the development of a small colposcope, the EVA MobileODT, which uses a smartphone to take magnified photographs of the cervix.   I brought the colposcope to FAME with slides and a comprehensive video on cervix examinations to demonstrate exactly what we were looking for.  All of the Tanzanian staff including Dr. Anne, Dr. Caren and Nurse Midwives Siana and Joyce, spent a lot of time watching the video and going over the slides when we weren’t screening patients.  Well in advance, they arranged outreach programs in the neighboring communities, in order to screen women who were at high risk of cancer but had never been screened. By the end of the November we had screened 93 women at FAME, 83 at the Gorofani and Barazani clinics near Lake Eyasi, and four women in the Endulen Hospital in Ngorongoro.  All in all, we found 42 precancerous lesions that were treated on the spot, making it highly unlikely they will progress to cancer.  We found two cases of cervical cancer, which were treatable in their early stage. 

Sometimes a biopsy is needed to determine whether a lesion is cancerous, but in Tanzania many women struggle to even afford the small cost of having their biopsy read.  While dysplasia can be treated on the spot, that treatment is not suitable for invasive cancer, which is treated entirely differently.  Also, the ability to get biopsy feedback on the exam is essential to the learning process.  Before leaving FAME, I worked with FAME leadership to form and personally support a special fund so that biopsies can be done without regard for one’s ability to pay. 

Due to the lack of widespread knowledge about cervical cancer, it’s not easy to go into the communities and encourage women to come in for screening.  While HPV vaccination programs will greatly reduce the risk of developing cancer, it will take years before the effects are seen across the country.  While it is satisfying to know that we likely prevented 42 women from dying of cervical cancer, I am even happier that the staff at FAME learned to use the colposcope to improve the accuracy of their screening.  After all the successful screenings we did together, there was no way I could take the colposcope home with me.  At the request of every one of the practitioners, the EVA mobileODT has a new home at FAME.  I’m eagerly looking forward to spending another month at FAME in 2020.