Sarah* during the interview.

Today is World Mental Health Day, and FAME joins the rest of the world in raising awareness of mental illness and mobilizing efforts to support access to mental health services. 

In northern Tanzania, where we work, the stigmatization and marginalization of people with mental illness are still rampant. Access to mental health services is restricted, resulting from limited healthcare facilities treating mental health, lack of mental health caregivers and lack of funding for tackling these illnesses.

Even though FAME is not a psychiatric hospital, we still get patients with various mental illnesses. For example, this week, we met Sarah* and her daughter Caroline* at FAME’s outpatient clinic. Caroline has brought her 66-year-old mother to FAME because she suffers from high blood pressure. Her mother has also not been herself for a couple of weeks. Sometimes she becomes harsh and lashes out at her little grandchildren, unlike her.  Other times, she sits in a corner alone and talks to herself; other times, she just bursts into tears out of the blue. 

“This is a secret my siblings and I keep. My mother is a somewhat unofficial local leader, considered a big honor, but she would lose this social standing if people found out she talks to herself. If our extended family or neighbors hear that she might not be all there in the head, she will be ostracized. I’m glad that we can say that we came here because she has high blood pressure, so people won’t know we are also dealing with another illness.”

— Caroline*

Cases like Sarah’s are familiar. Dr. Michael Rubenstein has volunteered at FAME since 2013, bringing residents and fellows from the University of Pennsylvania and Children’s Hospital of Philadelphia. He runs the neurology clinic, which conducts neurological clinics at FAME and outreach to FAME’s catchment area dispensaries. This is his reflection, in his own words:

Dr. Rubenstein on Neuro outreach.

From my first visit to FAME in 2010, it became clear that mental health care in Africa was in need. As I began seeing patients with psychiatric rather than neurologic illnesses, I was told:

“You’re the closest thing to a psychiatrist that we have in Northern Tanzania.”

— Dr. Michael Rubenstein

In an article published in The Lancet Global Health in 2018, it was noted that of the 637 articles published in their journal in the last five years dealing with the world’s most economically disadvantaged region, Africa, only 39 articles had explicitly referred to the psychiatric aspects of the disease, and none to schizophrenia. A 2014 WHO mental health survey reported that only 46% of African countries had implemented standalone mental health policies and further noted that the number of Africans receiving treatment for mental health issues was exceedingly low – with a global annual rate for visits being 1051 per 100,000; in Africa, the rate was only 14 per 100,000.  The treatment gap for mental health care in many African countries approaches 100%.

Over the last twelve years of treating patients here at FAME, our neurology group has evaluated and treated countless patients with primary psychiatric illnesses such as depression, schizophrenia, anxiety and bipolar disease. In all these cases, our assessments have been thorough. Our treatment recommendations, most often consisting of medications indicated for these conditions, have provided relief from their symptoms, and patients have returned to see us on subsequent visits. Both patients and families have benefitted from our care. However, it should be noted that we are neurologists, not psychiatrists, and we provide this care without adequate mental health services or healthcare workers.

Though our impact can be significant, it should not serve as a formal substitute as it detracts from our mission to improve neurologic care within Tanzania. I do recall one particular patient, who I had first seen several years ago with the complaint that he was having difficulty focusing and sleeping and, over the last year, his wife had left him, and he had lost his children. He was a college graduate with a good job and was distraught over his plight. He had bipolar disorder for many years and improved dramatically after placing him on the appropriate medication regimen. He has continued to follow up with us every six months and remains fully functional and improved. Though his case was a success story, I am certain countless other patients in need of similar care are not as lucky to make it to our clinic for treatment and continue to suffer in silence.

-By Dr. Michael Rubenstein.

FAME recognizes that the mental health and well-being of many health, social care and frontline workers have been affected by the COVID-19 pandemic, and our medical staff is no different. Work stress is also a possible trigger of psychological problems. 

The FAME wellness club and the football team have been a great source of stress relief for employees and help reduce anxiety. FAME has strengthened our systems of communication, empathy and assertiveness to better support its staff not only during times of crisis but also during day-to-day operations. All this ensures that FAME has a healthy and engaged workforce.

FAME’s Director of Operations, William Mhapa, leads the FAME football team in a tournament

*While the patients’ names have 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.

From Left: Dr. Msuya Walii, Dr. Elyssa Metas and Dr. Anne Ghati

Dr. Metas with FAME’s Director of Operations, William Mhapa

FAME has continually enhanced its volunteer program through the development of strategic partnerships. These partnerships, where both parties learn and grow together, build capacity and give the FAME team access to additional skills, resources and knowledge. 

One of these important partnerships is with Creighton University, Arizona. Since 2020, Creighton University has sent OB/GYN fellows to join us at FAME for two to three months to build the capacity of our team. 

Dr. Elyssa Metas, an obstetrician and gynecologist in Phoenix, Arizona, was our first-ever fellow from this partnership. Here, she reflects on her past stay at FAME and its impact on her.  Read her reflection below.

My journey with FAME started in January 2020. After nearly 3 amazing months, I, unfortunately, had to cut my first time at FAME short due to the pandemic. Over the course of the last year, in the face of all the unknown, I continually asked myself when I would be able to return. When I felt safe to travel again, I jumped at the opportunity to come back to FAME.

I did not know what to expect when I returned to FAME. Although there had been communications regarding patient care and zoom lectures during that year, it was hard to know what it would be like actually being there. My anxiety was alleviated very shortly after my arrival. FAME did not diminish but rather seemed to have flourished in the face of the pandemic. The doctors, nurses and support staff, despite the adversity the year had brought, continued to grow and improve. I really saw this on the Maternity Ward.

External fetal monitoring was something very new when I first came to FAME. After a year of hard work and learning, the nurses honed their skills in interpreting fetal heart tracing. One case, in particular, stands out in my mind. One of the nurses alerted me to abnormalities in the heart tracing that did not resolve with the usual resuscitative measures. With further monitoring, it was evident the baby was in distress and needed an emergency cesarean section to help save its life. The team recognized the urgency of the situation and worked together to bring the mother to the theater. I was so impressed by how fast everyone assembled to take care of the mother and baby. The baby was delivered happy and healthy and discharged home with the mother. This was in large part to the early recognition of fetal distress and how well the team worked together.

Another area where I saw definitive improvement was the effort to safely reduce the cesarean section rate. It starts with how the nurses and doctors work together as a unit to manage labor. They utilize appropriate interventions to help facilitate vaginal delivery. There also seems to be a constant review of cases from the daily rounds to the larger quarterly meetings. I was fortunate enough to participate in one of the quarterly meetings where all the cesarean sections during that period were reviewed. It was great to see the level of participation amongst the doctors during the meeting. You could really see the desire to learn from past cases to see what could be changed for future ones. It is evident that this is an area that will continue to improve.

“The time I spent at FAME will always be incredibly special to me and really has been one of the greatest honors of my career. I know this will not be goodbye forever but only for now.”

— Dr. Elyssa Metas

*Part 2 of the FAME Creighton University partnership will be published in two weeks. It will feature a piece by Dr. Alicia Willey who just finished two months volunteering at FAME. 

Three of the five children that FAME successfully treated for rabies.

On this World Rabies Day 2022, FAME revisits and remembers one of our most powerful stories from this year, “A Rabies Diagnosis and a Race Against the Clock to Save Lives.”

This story, published in FAME’s journal in April 2022, was about six children who had been bitten and scratched by a stray dog while herding cows. 

As they were tiny bites and scratches, the boys thought nothing of the attack. Two weeks later, one became seriously sick and was rushed to the local clinic. The doctor diagnosed him with rabies and referred him to FAME for a rabies post-exposure prophylaxis (PEP) vaccine. Unfortunately, he passed away an hour after arriving at FAME. His condition had become fatal once the symptoms began. FAME quickly reached out to the other children in the village. As time was of utmost importance, volunteer Dr. Shama Cash-Goldwasser and FAME's social worker, Nganana Kitashu, spearheaded a trip to their village, ensuring that the children received the PEP vaccine, thus saving their lives. 

At FAME, we always have a story to tell. This one was extraordinary and resonated with many of our FAME family members. So today, on World Rabies Day, we followed up with the affected children to see how they were doing. 

It is a cold morning at the FAME campus in Karatu when the children show up for a wellness checkup. It is an offer that FAME had given them after the rabies incident; they were free to come back and receive free healthcare any time they wanted. Today, they took us up on our offer, traveling 50 miles to get here. 

Sitting at FAME’s Outpatient Department (OPD), the children look happy and animated. They are here with their mother and a ten-month-old small sister. They whisper amongst themselves and giggle, sharing an inside joke. The mother assures us that nothing is wrong with the children. They have been doing okay and are back in school and herding cows, but she thought it was time to bring them for a check-up. 

“It’s a serious disease they had. Rabies is very serious. I worry that it may have caused some damage that we cannot see.”

— The boys mother

Dr. Ken Karanja and volunteer Dr. Elissa Zirinsky meet one of the boys.

FAME’s Dr. Ken Karanja and volunteer Dr. Elissa Zirinsky, a pediatric infectious disease doctor, are ready to see the children. We are lucky to have Dr. Elissa, who just started a year-long fellowship with FAME, to help build our pediatric capacity. Since Dr. Elissa was not at FAME when the boys got rabies, Dr. Ken has brought her up to speed. 

The boys, aged ten, nine and eight, enter one by one, accompanied by their mother to see the doctors. The boys are not intimidated; if anything, they’re eager to show the doctors the scars from the dog attack, more like a badge of honor. 

“When we went back to school after the attack, we were very popular! Everyone came to talk to us. They wanted to see where the dog had bit us. They told us they were sorry that our brother had died but were happy we were still alive. We told them always to stay away from stray dogs! ”

— The boys

Not only have the boys gone back to school, but they’re also herding cows in their free time. The oldest boy explains that they are now scared of stray dogs and if they see any approaching them, they run away screaming and calling for help. They dare not fight or try to touch it as they did before. 

“We are cautious of the dogs, NOT scared!”

— the young one corrects his brother, to which he nods in agreement.

The mother explains that it has been a hard time coming to terms with the death of their son, but they have taken solace in the fact that they will not lose another child to rabies.

“We may have lost a son, but we wake up every morning knowing our children will not die as he did. FAME has educated us, and we now know timely intervention is key, and we advise the children always to run away from stray dogs!”

— The boys mother

Dr. Ken and Dr. Elissa examining the youngest boy, who turned out to have pneumonia, unrelated to his previous rabies diagnosis.

The youngest boy shows the doctors where the dog bit him.

The oldest boy showing the dog marks on his arm.

Dr. Ken and Dr. Elissa find the children in good health; however, the eight-year-old has a congested chest unrelated to his past rabies case. After sending him for some lab tests and X-rays, the boy was diagnosed with pneumonia and given antibiotics. All three boys were prescribed deworming medicine. 

“We continue to be indebted to FAME. Even after the rabies case, they continue to check on us and ensure the kids remain healthy. We feel very blessed.” - The mother

The mother assures us that she will return to FAME with the children if they have any health problems. 

“FAME is quite far from where we live, so it's not an easy journey. But for some crazy reason, the children love the trip! I don't understand it. Sometimes the bus is overcrowded and dusty, but the boys treat it like a safari, looking out for exciting things on the way!” - The mother. 

“We are happy we came. We love this place. It's nice to come when we are not sick because then we just have a lot of fun!” - The youngest boy. 

This inspiring story is a testament to the impact of FAME’s unique model of advancing quality medical care in rural Tanzania, which we first developed 20 years ago. 

Following the theme of World Rabies Day, “One Health, Zero Deaths,” FAME continues to advocate and participate in efforts to eliminate dog-mediated rabies in northern Tanzania. 

Next month, the team at Resolve to Save Lives (RTSL) will have an event on rabies in Tanzania, where FAME’s response to this rabies case will be highlighted in their annual report called Epidemics that Didn’t Happen (ETDH). We couldn't be more proud to showcase this project and demonstrate how dedicated collaborative public health action can successfully prevent epidemics. 

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

A happy David poses for a picture on his hospital bed.

Peter (left) poses with David.

“Thank you, FAME, for being good to us. When we got here, we were all confused. We had an injured person and were also in very unfamiliar surroundings. But we were received and treated well.”

— Peter

In Northern Tanzania, where FAME is located, boda bodas (motorcycle taxis) provide an affordable transportation option and an important employment opportunity for people in our catchment area. 

While boda boda drivers have ways to improve safety, they are inherently a dangerous form of transportation as they are vulnerable and exposed to traffic risks. Adherence to safety habits remains low with limited safety equipment use. 

David*, age 32, has been in FAME’s inpatient ward for the last three days. He does not remember how he got to FAME. All he remembers is hiring a boda boda to take him 20 minutes away to see his friend.

“I was bored at home with nothing to do, so I called one of our neighbors who owned a boda boda to take me to visit my friend. On the way, we were laughing and talking, and that’s the last thing I remember.”

— David

David’s brother-in-law, Peter, tells the rest of the story.

“I had gone home for my lunch break from work when someone came to the homestead at around 1 pm to say that he had heard the terrible news. David and one of our neighbors had been in a boda boda accident. He said some men had told him that the driver was okay, but David was badly injured.”

Peter called two male relatives and they rushed to the accident site together. 

“Everyone at home was screaming, fainting and crying hysterically. Many would not be able to accompany me in such a state, so I asked two of my brothers who seem more clear-headed to come with me.” -Peter. 

Once at the site, things were not looking good. The driver only had minor scratches, but David was unconscious and bleeding. He had not been wearing a helmet, so they feared his head had borne the brunt of the fall. Some of the onlookers who gathered around the accident suggested they take him to a nearby clinic, but one of them said: 

“I know a hospital with a machine that can see inside the head.”

The hospital they were talking about was FAME, and the machine was a CT scan.

In 2016, FAME acquired a CT Scan machine, generously donated by GE Africa. FAME’s CT scan machine is the only one within a 75-mile radius. In 2021, FAME performed 326 CT scans. 

Since Peter’s main concern was the damage to David’s head and brain, he asked for directions to FAME, and together with his two relatives, they brought him here in a taxi.

“I was scared. Everything was happening so fast! And now we were in a hospital I had never been to before. Praying that they can heal him.”

— Peter

The CT scan showed no acute traumatic brain injury. His chest exam also showed that everything was ok internally. David was only suffering from some severe cuts and bruises.

“I am happy with the service at FAME. They have looked after me well, and I’m ready to go home now.”

— David

*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.

FAME celebrates World Patient Safety Day! As an organization committed to patient-centered care, FAME recognizes its duty to the safety of its patients first and works tirelessly to prevent and reduce risks, errors and harm to patients.

This year's theme is Medication Safety. While medications are the most widely utilized interventions in health care, the World Health Organization (WHO) has found that medication-related harm accounts for 50% of the overall preventable harm in medical care.

FAME’s pharmacy is the backbone that strengthens our work, and it plays a critical role in the provision of cost-effective quality pharmaceutical care. With almost 30,000 patient visits in 2021 alone, FAME’s pharmacy stays quite busy! 

FAME’s Head Pharmacist, Egbert Chogo, explains how FAME ensures medication safety: by giving the correct prescriptions and developing standard prescribing procedures that are adopted hospital-wide. The FAME pharmacy staff receive weekly training focused on strategies to eliminate pharmacist challenges with prescribing, dispensing and storing medication. As errors can occur at different levels of the medication use process, FAME doctors and nurses are also routinely trained to understand better the conditions they treat and the broad range of impacts that medication has on patients, enabling them to write the correct prescriptions based on individual patient needs and administer the drugs correctly. 

FAME is heavily invested in ensuring the proper storage of medicines. Some medicines, such as vaccines, must be kept within a specific temperature range to ensure they do not lose their effectiveness or shorten their shelf life. Storage of such drugs within the required temperature is paramount. On top of having fridges for this exact purpose, FAME’s drug storage room has an air conditioner and internal temperature regulation to ensure the temperature never exceeds 32°F.  It is always kept dark and dry, as exposure to light and moisture can accelerate the breakdown of certain medications, reducing efficacy. 

“To help reduce the risk of medication errors at FAME, we are guided by the Five Rights of Medical Administration. These help us ensure we give the right drug, dose and route [how the drug is administered] to the right patient and at the right time. While this is not the only thing we consider to ensure medication safety, the five rights play a decisive role in handling medication.”

— FAME’s Head Pharmacist, Egbert Chogo.

FAME has an automated system that flags drugs near their expiry date; while it is not a problem for fast-moving drugs such as anti-pain medications, slow-moving medicines such as antimalarials sometimes require the pharmacy to search for another facility to use the stock before expiration.

In such cases, FAME contacts the supplier to negotiate a swap to then be dispensed to health centers that might need them urgently. FAME also works with our neighboring hospitals, Rhotia Health Center and Karatu Lutheran Hospital. FAME’s pharmacists reach out to ask for an exchange of drugs in case their demand is higher. This is guided by the District Pharmacist from the Ministry of Health in Tanzania.

Because of this system and our diligent staff, FAME rarely sees medications go completely unused due to expiration dates. This is just one of the ways we ensure safe medication practices to prevent medication errors and reduce medication-related harm.

FAME continues to invest in medication safety to ensure medicine use is safe and reliable for all, improving patient outcomes and helping FAME fulfill its mission