Sisina

Sisina (center) poses with her husband (right) and his friend (left)

Sisina* is a 28-year-old woman and mother of four. She lives in a village in Ngorongoro, 37 miles from FAME. For a few weeks now, Sisina has suffered from severe stomach pain and nausea. She had been to three different clinics close to her home, but she had found no relief. One of the clinics had suggested that she might be pregnant with her fifth child, but she wasn't. The other diagnosed her with indigestion and prescribed an antacid, but this did not help.

“I was feeling poorly. I couldn’t take care of my children. I was in pain and miserable. My husband was very worried. He told me he wanted to take me to a hospital in Karatu called FAME to see a doctor. But it was very far from our village, and I didn’t want to leave my kids alone. So I said No.”

— Sisina

However, Sisina’s symptoms got worse. She was now vomiting, experiencing fever, and having a bloody stool. That’s when her husband put his foot down and forced her to come to FAME. 

“She was very sick but still very stubborn. She didn't want to leave home. But she was getting worse, and we had exhausted all possible medical interventions close to home. A friend had told me about this hospital called FAME in Karatu, and I thought we should try it. So I put my foot down and brought her here.” - Sisina’s Husband.

Accompanied by a friend, the couple took a bus to Karatu town and then a bajaji (auto rickshaw) the remaining two miles to FAME. Once at FAME, Sisina was received by the emergency department. She had a CT scan and blood work done. The doctors gave her a prompt diagnosis of gallbladder perforation and informed her that she would require immediate surgery. 

“When the doctor mentioned surgery, I was very scared. My husband and I asked the doctor many questions, and he was very patient with us and explained everything. Together, we agreed on the surgery.”

— Sisina

The surgery was a success, and after two hours, Sisina was reunited with her husband in FAME’s inpatient ward. 

“I was very happy when they brought her back to the ward and said that everything had gone well. She was still unconscious, so I sat by her bedside and waited for her to wake up. When she did, I asked her how she felt, and she said better than before! This made me very happy. I made a joke that I saved her life by bringing her to FAME, but she didn't find it funny. Sisina is always very serious.” - Sisina’s husband.

“I am thankful to FAME for the good service they have given me and the fact that it’s affordable. When I saw how beautiful it was when we arrived, I was worried it would be very expensive! I am pleasantly surprised that they put the welfare of their patients before money. Thank you, FAME.”

— Sisina

After nine days, Sisina was allowed to go back home.

We are very happy about the service, and we pray that FAME continues to provide this much-needed help in our community.” - Sisina’s husband.

“I want to congratulate FAME. What you are doing here is amazing. We pray that you continue to do it for years to come.” - Sisina’s husband’s friend.

*While the patient’s name has been changed to protect privacy, permission was secured to share her photos and story with FAME supporters, and to raise awareness of available medical care at FAME Medical

It was a sunny morning when 7-year-old Leah* and her friends left school for home. She goes to a government school close to her house, so she usually walks home after school. Everyday on her walk, there is a big busy road that Leah has to cross. One day, while the cars stopped for Leah and her friends to  safely cross the road, a boda boda (motorcycle) came full speed past the stopped cars and hit Leah.   

“I heard a lot of screaming from my house. Since it's a busy road with a big market, I thought the vendors were having a dispute. That was until one of my neighbors barged into my house. She told me that a boda boda had hit my daughter and that some good samaritans who saw the accident had taken her to a nearby clinic on a bajaji (autorickshaw).” - Mama Leah

Mama Leah rushed to the clinic, where she found her daughter being given first aid. Her head was bleeding, and she had a huge gash. The doctor was starting to stitch her up. 

“I fell on my knees when I saw she was alive. I thought she had died. I was relieved that the cut wasn’t too bad and that her eye had not been injured”

— Mama Leah

After Leah was stitched up, she started vomiting blood. Concerned, the doctors asked Leah’s parents to bring her to FAME, as they did not understand why she was throwing up blood when she only had a head wound. They thought she might need a CT scan, which they could not do. FAME’s CT scan machine is the only one in a 75-mile radius.

In a panic, Leah’s father called a friend with a car to bring them to FAME. He had been to FAME before when he was involved in a boda boda accident last year.

Once at FAME, Leah was quickly taken to the emergency room. She had an ultrasound and CT scan, and the doctors diagnosed her with a serious liver injury. Thankfully, all her other organs had not been impacted. 

“My husband and I were shocked. We didn't know that she was hurt anywhere else besides her head, and we were focusing on that. We thought the vomiting blood was due to the head injury! If it were not for FAME, Leah would have died as we continued treating the head wound!” - Mama Leah 

Leah was referred to KCMC hospital in Moshi for surgery. FAME provided the ambulance and one medical staff. The surgery was successful and Leah and her mom were allowed to go home after spending a week in the hospital. This week they came back to FAME for a medical check-up. 

“We owe everything to FAME. The compassion FAME showed us is remarkable, and the quality of the service provided is impeccable! The emergency department received us quickly, and the test results didn’t take long! I don’t know what would have happened if we had had to wait hours to see a doctor, or worse if we never got the right diagnosis”

— Mama Leah

Over the next 5 years, FAME is focused on expanding its general surgery and emergency response, so cases like Leah’s can be treated entirely at FAME.

Leah is now much better and back to her playful ways. She’s also eating well and misses her school. “Every day, Leah asks if she can go back to school. She misses her friends and teachers. I tell her I think she should stay home a little longer, as she’s just survived a horrible accident!” -Mama Leah.

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*While the patient’s name has been changed to protect privacy, permission was secured to share her photos and story with FAME supporters, and to raise awareness of available medical care at FAME Medical

This week we had a special visitor to FAME, little Maria*! 

In 2018, 2-year-old Maria was born in a Karatu clinic, six miles from FAME. She was one of three triplets and sadly, the only one to survive. Born at only 30 weeks and after the loss of the other triplets, the doctors at the clinic in Karatu advised her to come to FAME urgently. Maria and her mother arrived at FAME as a last resort to try to save her life. 

Mama Maria knew of FAME, having grown up and still living in Karatu; however, she had never been here before. Doing everything she could to save the life of her baby, she looked for a taxi that would bring her and her critically sick daughter to FAME. 

Mama Maria had not expected this tragic turn of events. Her first children are twins, who were delivered naturally and are healthy and thriving. When she found out that she was expecting triplets, she was shocked but expected an experience similar to her first one.

Once at FAME, Maria spent 26 days at FAME’s special nursery on oxygen. She was in a critical condition and the mother was losing hope that she could recover. 

“I cannot put into words how good the medical care at FAME is. When we came here, I had suffered a huge loss and had completely lost hope that she could be saved. Over those 26 days that Maria was in the special nursery, my mental health took a hit. I was sure that she was going to die just like the others.”

However Mama Maria found lots of support and encouragement from the nurses at FAME.

“The nurses really talked to me and encouraged me. Without them, I would not have survived that terrible time. They became my friends! We celebrated every little progress Maria made, and that slowly started giving me hope.”

After 26 days, Maria was ready to go home and meet her older siblings.

“I recommend that everyone come to FAME when they’re sick. The level of care is very high. I wish I had given birth here, maybe all my babies would have survived!”

— Mama Maria

*While the patients’ names have been changed to protect privacy, permission was secured to share his photos and stories with FAME supporters, and to raise awareness of available medical care at FAME.

Frank* is only 4-years-old. He is at FAME because he suffers from epilepsy, a brain disorder characterized by repeated seizures. He has had this disorder since he was nine months old. 

This is not Frank’s first visit to FAME. Frank has been here many times, including once to see Dr. Michael Rubenstein and the team of neurology residents and fellows from the University of Pennsylvania and Children’s Hospital of Philadelphia, who come to FAME twice a year to provide neurological care to our patients. 

Frank is back at FAME because he suffered 16 seizures last night, according to his mother. Lately, he has experienced an increase in seizures, which has led to him being pulled out of school. His school has been very supportive of his condition, but when his seizures happen every other hour, they cannot handle it. He's also running a fever that won't break. His mother is very worried about him

“The seizures have gotten worse lately, and the high fever is a new thing. I'm happy that a well wisher helped me bring him to FAME. Frank was on medication for six months before, and that helped him tremendously. I’m here to ask the doctors if they can help me control these seizures, maybe with the same medication again.” - Mama Frank 

At FAME, Frank and his mother are working with Dr. Anne Ghati, FAME’s focal neurologist. For almost 10 years, Dr. Anne has been working closely with Dr. Rubenstein’s team of Neurology residents and fellows, learning a lot in the process.  And just this May, Dr. Anne spent one month at University of Pennsylvania doing an observership with their neurology team.

“I am very familiar with Frank’s case. On the day he was admitted to the inpatient ward in the morning, he had already suffered four seizures. His mother explained that he got seizures after every one to two hours. I prescribed him phenobarbital, a prescription medicine used to treat and prevent the symptoms of seizures. Due to this, he only suffered a few seizures during admission.” - Dr. Anne Ghati

In some cases, epilepsy can have a genetic component, which may be the case with Frank, as his mother recalls having something similar between the ages of three and seven. 

“My mother tells me that I also had seizures when I was young. She is not sure whether it was epilepsy since I never saw a doctor and the condition resolved itself, but I fear this might be what Frank has. His two older siblings are okay though, they don’t get seizures. It’s only Frank.” - Mama Frank 

Frank also had the chance on this visit to consult visiting volunteers, Marin Jacobwitz, NP and Dr. Daniel Licht, who are visiting pediatric neurologists from the University of Pennsylvania.

“I love FAME for their good and caring service. When he was admitted to the inpatient ward, every time Frank suffered a seizure the medical staff would come running to help me and make sure that he was okay. When I came to the reception the first time, they immediately fast tracked me into seeing a doctor. I didn’t have to wait in line with a child suffering seizures. I was and still am very grateful to FAME. You share the burden of this disease with me. Thank you!”

— Mama Frank

*While the patients’ names have been changed to protect privacy, permission was secured to share his photos and stories with FAME supporters, and to raise awareness of available medical care at FAME.

As neurologists, our instinct is to observe and start assessing patients from the moment they walk through the door. When I first spotted this child, it was not immediately clear why she had come to see neurology.  Having no pre-registration and no prior medical records available, I sat looking at her while the interpreter introduced us to her mother in Swahili. I noted a bright, beautiful, 2-year-old child, who was smiling at me and curious about the clinic visit. Only when her mother started to explain why she had come, did I notice a mildly spastic right arm and leg. Her mom said that she always had weakness on the right side, and although she was now 2 years old, had not yet started walking. It quickly became apparent that the child had suffered a neonatal stroke. 

The most important intervention for children who have suffered a neonatal stroke is therapy. This is especially true early in life to help their brain rewire the area that was injured and avoid spasticity and contractures, which can make it permanently difficult to use the limb. I was only a few days into my rotation in Tanzania and had already learned that access to physical therapy, especially in the more rural area where we were practicing, was challenging. I started to feel a sense of frustration, that I had little to offer this family as they likely would not be able to afford a trip to one of the larger cities to get the therapy services she needed. After talking with her mother more and conducting an exam, I learned that she was already pulling to stand and taking steps with very little hand-holding from mom. Despite the weakness, she was able to support herself well on her right leg and also was using the right arm to reach for and hold objects. Her speech and thinking were right on target for her age, my doorway assessment of a bright, curious child was spot-on. 

I explained the diagnosis of neonatal stroke to her mother, but I was encouraged by her development so far. Although she will definitely be a left-handed person, and probably walk with some degree of a limp, I was optimistic that she would soon start walking independently, and she would do very well cognitively. It was also impossible not to comment on what a beautiful, “mzuri” child she was. She was one of those kids that as soon as you start to interact with them, you can’t stop smiling. She was engaging, playful, and had an infectious smile. 

As the interpreter started to translate, I sat in shock as her mother burst into tears. I wasn’t sure if this was the first time anyone had used the word “stroke”, or if she was upset about my comments on her daughter’s weakness. I felt terrible, and wondered if I had been too direct in my delivery. To my surprise, I then realized her mom was crying tears of happiness. She was relieved to hear my assessment and finally have a diagnosis. She has been told by a doctor in the past that her daughter would never walk, talk, or interact with the world in a meaningful way. This had been weighing on the family for the entirety of her daughter’s life. Not only is this sad, but can be incredibly detrimental to the child. If the family believes there is no hope and does not engage with and support their development, the child can have significantly worse outcomes. Fortunately, this was not the case with my patient. 

I was reminded at this moment that healing someone does not always involve doing something. Many people who go into medicine, myself included, are motivated by a desire to “fix” things, either with medication, procedure, or intervention. One of the both challenging and motivating things about neurology is the many diseases for which we still don’t have a “fix. Practicing in the United States where we are surrounded by “cutting edge” research and technology, and heroic survival stories flooding our news feeds, patients come to us expecting miracles, often after irreparable neurologic injury. While we have made some incredible advances, diagnostics and therapies are not available to everyone equally even within the US, and especially less so in most other parts of the world. In this moment, I was reminded of the incredible healing power of knowledge and thoughtful dialogue. In residency, I realize now I had lost sight of this. We are often stressed, rushed, tired, and burned out. I found myself skipping that extra step to explain things a little more slowly, thoroughly, and empathetically. This mzuri child and her mother reminded me how powerful this can be, and is something I will consciously try not to lose sight of upon returning home. 

I am certain that I gained more from my experience at FAME than I was able to offer to the patients in my short month there. This is not how it is supposed to be, but I think it is inevitable as I have so much to learn. It serves as motivation to use what I have learned to help others for the rest of my life, both in practicing medicine and in being a kind, responsible, and empathetic human during our short time on earth.