On a cold and foggy Tuesday morning, staff in the Maternity Center gather together as they prepare to surprise one unsuspecting mama. Heads turn as they stride uniformly into the Maternity Ward, huddled around something not quite visible. The cluster of nurses slowly parts to reveal Maternity Ward Supervisor, Ruhama Lyanga, holding a cake she’d baked the night before. Ruhama makes her way over to Kanoni, a mama under care in the Maternity Center for just under three months. As they present the cake, Kanoni smiles, her eyes lighting up in anticipation.

Kanoni came to FAME mid-November when her water broke just 26 weeks  into her pregnancy. After seeing a doctor she was given antibiotics and steroids to help the baby’s lungs develop.  She stayed at FAME for two weeks, before finally giving birth to Imani. While Imani was brought into this world through a normal vaginal delivery, her first few months would be anything but normal.

Born a meager 1.15 kilograms or 2 ½ pounds, Imani was quiet and tired, unable to cry forcefully as most babies do after birth. Imani was placed into one of the infant incubators in our Special Care Nursery (SCN), where she was monitored and fed around the clock. FAME’s SCN has the only incubators and CPAP machine in the district.  In order to breathe and slowly gain weight, Imani needed continuous positive airway pressure therapy, a.k.a. a CPAP Machine, for nearly two months. Yet when the time came to take her off the CPAP Machine, the situation took a turn for the worse. While her lungs were continuing to develop, she was struggling to breathe without the assistance of the CPAP Machine — an uncommon situation for premature infants that gain weight and show improvement.  

In order to figure out why Imani was still having trouble breathing, FAME staff did an X-ray of her lungs which showed some anomalies. Shortly after, they consulted with Dr. Swanson who runs the Neonatal Intensive Care Unit (NICU) of the Arusha Lutheran Medical Centre (ALMC), a private hospital based in Arusha and partner of FAME. Dr. Swanson suggested that the difficulty in breathing was a symptom of bronchopulmonary dysplasia, a chronic lung disease that develops in preterm babies due to the extended use of CPAP and oxygen. This is just one of the many possible complications that arise from premature birth. He recommended a medication regime of steroids for Imani, which helped wean her off the CPAP Machine within a week.

It had been a long three months for Kanoni, and the Maternity Center staff wanted to do something special for her.  As a long-term patient, she had become part of the FAME family, and Ruhama wanted to show her just how much all the nurses and midwives care and love her. And now that Imani had been off oxygen for four days, she was clearly looking much healthier, and a celebration was in order.

“I am proud of them because they know how to care for preemies and are confident”

— Ruhama Lyanga, Maternity Ward Supervisor

This cake was just as much a celebration for Kanoni and Imani, as it was for FAME staff. In the two and a half months that FAME staff had meticulously cared for Imani, she had grown to 2.25 kilograms or 5 pounds. Every time the Nurses went in to check on Imani they relied on the skills and training they developed during the Nursery Care Workshop, taught by our Maternal Health Coordinator, Leesha Mafuru. Everything from IV fluids, feeding times, and even positioning Imani correctly in a little nest within the infant incubator had to be precisely calculated to keep Imani as healthy as possible.

The Maternity Center filled with warmth and joy as cake was shared between all the mamas and staff. Kanoni held back tears of joy as Ruhama and many of the nurses shared kind words and sentiments. Relief washed over the room, as everyone took a moment to relax from the demanding care they provided over the past couple of months. Imani had made it; she no longer needed special care and now has a bright future ahead of her. Kanoni spent one last day in the Maternity Ward enjoying the company of the staff, before being discharged. She then headed home with her beautiful baby girl.

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.