Mary, holding her newborn daughter in FAME’s maternity ward.

Mary* is 36 years old and has just given birth to a little girl. This is her fifth child and her fourth pregnancy. Her first child was delivered by an emergency cesarean section (C-section), which was not a very good experience for her. Her last three pregnancies have been vaginal birth after cesarean (VBAC), including a twin pregnancy here at FAME.

“I wanted a vaginal delivery because of the C-section’s downtime. It took half a year for me to recover from the operation completely. I couldn’t work. I stayed home, lying down to rest between simple house chores. My husband does not make much money, so I have to work for our family to live comfortably. That C-section turned our lives upside down and sadly stole our joy as first-time parents.”

— Mary

Mary’s story is not unique. For a long time, medical professionals have told women that once they’ve had one C-section, they had to have the operation with every other pregnancy.

“My husband and I always wanted to have a big family, and thus I wanted to try a vaginal delivery despite already having had a C-section. I couldn't have had many kids if the operation had been my experience every time. It was just too painful.” - Mary.

At FAME, the purpose of any obstetric intervention is not only to reduce morbidity and mortality of the mother and baby but also to increase maternal satisfaction while ensuring patient safety. When Mary walked through our doors, we were ready to help. 

Dr. Anne Ghati

Dr. Anne Ghati, FAME’s Assistant Medical officer, explains the approach that FAME takes towards TOLAC and VBAC.

“At FAME, trial of labor after cesarean (TOLAC) has a 70-75% success rate and reduces maternal morbidity by allowing women to have a vaginal birth after a cesarean (VBAC) which is associated with fewer complications than repeat elective C-sections. When successful, VBAC causes a decrease in maternal morbidity and risk of complications in future pregnancies.”

— Dr. Anne Ghati

However, not all pregnant women are eligible for TOLAC. When they get to FAME, they are first screened and their past and present obstetric and reproductive history is recorded.

“The ideal candidates for TOLAC are patients with a high likelihood of VBAC and a very low likelihood of intrapartum uterine rupture. Some risk factors, such as gestational diabetes and estimated fetal weight of more than 8 lbs 13 oz, are just some of the impending factors. A C-section scar less than 18 months after a previous delivery also disqualifies the woman as it presents a higher risk of uterine rupture. Same as having undergone a classical cesarean delivery, which is a midline uterine incision in the contractile portion of the uterus.” - Dr. Anne

“I was appropriately counseled regarding delivery options. The risks and benefits of elective repeat cesarean delivery versus trial of labor were clearly explained. I didn’t know there were benefits to TOLAC, other than less pain and faster recovery until I attended FAME’s antenatal classes.”

— Mary

FAME can perform TOLAC as it is equipped to handle any emergencies that could arise. Extensive maternal education for its staff, the availability of fetal monitoring tools, and proper monitoring during labor ensure the safety of mothers and newborns. Nurses and doctors are trained to check for the signs of uterine ruptures, such as acute pain and repetitive or prolonged fetal heart rate deceleration, which are both potential risks with TOLAC. 

“As a doctor, I recommend TOLAC as it usually presents fewer complications. However, screening of the women is required to rule out possible risk factors. High C-section rates increase maternal and neonatal morbidity, and VBAC has been a good way to counter this.”

— Dr. Anne Ghati

For women like Mary, avoiding surgical recovery in the postpartum period is the biggest motivator for TOLAC. FAME continues to invest in these procedures so that we can help other women like Mary deliver vaginally despite a history of C-sections, improving maternal and newborn outcomes and meeting the needs of our patients.

*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.

As part of FAME’s critical investment in maternal health services, it provides education and capacity-building opportunities to its team. FAME’s reproductive health program currently employs 21 nurse-midwives, seven medical doctors, and a staff of technicians. Continuing education for FAME’s medical team keeps them updated on the latest advances in care and treatment, enhances practices and protocols and improves patient care.

Last week, FAME hosted a four-day obstetrics training course for its nurses and doctors, to equip them with skills to effectively manage obstetrics emergencies, which are life-threatening for pregnant women and their babies. The course, Advanced Life Support on Obstetrics (ALSO), was led by Professor Mlay Pendo, OB/GYN, and assisted by Dr. Elibariki, both from Kilimanjaro Christian Medical Center (KCMC) in Moshi. 

ALSO is designed to equip the entire maternity care team, including physicians, nurse midwives, registered nurses, and other members of the maternity care team, with skills to effectively manage obstetric emergencies and improve outcomes for women and newborns.

Nine nurses and three doctors from FAME took part in the training. FAME also invited its neighbor health centers to participate: Kambi ya Simba Health Center, Rift Valley Hospital, Karatu Lutheran Hospital, Rhotia Health Center and the district-designated hospital, Karatu Health Center. They all sent a representative to the course.

Some of the topics covered in training included: the management of active third-stage labor, pre-eclampsia and eclampsia, resuscitation of newborns and vacuum extraction, among others. 

After completing the course, the attendees reported a significant increase in their comfort level in managing obstetric emergencies and a greater intention to continue improving maternal care.

“The training was excellent. I did an obstetrics course in 2016 and again in 2018, but this one was completely different! So much new information and updates in obstetrics in the last couple of years! I’ve updated my knowledge and skills, and I’m thankful to FAME for giving us this opportunity.”

— Hosiana Zephania, Registered Nurse, Ward 1 Supervisor

FAME’s investment in maternal healthcare services stems from its commitment to supporting pregnant mothers, as childbirth and pregnancy complications are leading causes of death among women of reproductive age, especially women from rural areas (UNFPA). Tanzania's maternal mortality rate remains one of the highest in the world (World Bank).

FAME’s multi-pronged approach to maternal and reproductive health, including our: family planning clinic, prenatal care program with a high-risk clinic and maternal health ward with a special care nursery, aims to improve maternal health outcomes by increasing access to high-quality healthcare services before, during, and after pregnancy. With an average of 700 deliveries per year, FAME continues to offer a tailored intervention to improve maternal health outcomes for underserved women in northern Tanzania.

These are just some of the pregnant women that FAME has supported this year.

Amina*, Age 27. First Pregnancy

Today is Amina’s first-ever visit to FAME. It is also her due date! 

Working as a clinical assistant, Amina recently moved to Tloma to be closer to her new job. As luck would have it, it also brought her much closer to FAME! 

Amina is due to give birth any minute. She is worried, as she attended her prenatal clinics in a small dispensary close to her old home, which is now too far for her to access. She’s come to FAME hoping they will help her, but she is quite nervous.

“Some of my friends have been turned away from some hospitals that don't take it kindly to women showing up to give birth when they haven't done their prenatal classes with them. So I was a bit apprehensive about coming here. I mean, it's my due date today! But I have been received very well, and the service has been great.”

This being her first pregnancy, Amina is extremely scared of childbirth. She has heard horror stories and is concerned about how bad labor will be. 

“I am terrified of labor. I haven't gone through it before, so that's a big worry. The doctors at FAME have explained the process and promised to be with me every step. This brings me great relief. I can’t wait to meet my baby!” 

Emma*, Age 39. Advanced Maternal Age 

“I listened to FAME’s maternal health program over the local radio station. FAME doctors were talking about the services and support available to pregnant women here, and it sounded like a friendship between the doctors and patients. When I got pregnant with my fourth child, I chose FAME.”

Emma is talking about Lumen radio, the only radio station in Karatu that caters exclusively to the area's local residents. FAME doctors have been on this radio more than 18 times this year, talking about everything from diabetes management to surgery to maternal health, focusing specifically on mother and baby health during and after pregnancy. 

“I’m five months pregnant. This pregnancy has been harder on me than the rest; maybe it's my age. I don’t know. What I know is that I have told my husband this is the last child! I loved being pregnant when I was younger, but I am always tired now.”

Emma and her husband agree that the services at FAME have been a great help. 

“We have been coming to FAME for five months now, and in that time, we have received a high degree of quality care that we have never received before. Thank you, FAME.” - Emma’s husband

Catherine*, Age 29. High-Risk Pregnancy 

Every two weeks, Catherine attends the high-risk pregnancy clinic at FAME. Catherine suffers from high blood pressure, exposing her to more complications before, during and after birth, which may also harm the baby. Catherine has experienced this tragically, having had three miscarriages in the past two years.

The FAME high-risk clinic has been monitoring Catherine since she became pregnant. She is currently 36 weeks pregnant and very excited! 

“FAME has brought me to this point! 36 weeks! Can you believe it? This is the furthest I have ever come in a pregnancy! I have been so scared since the beginning; I didn't think I had any hope of becoming a mother. But since I started coming to FAME, they have helped me so much. I would not be pregnant today without FAME.”

Catherine, a teacher, has taken an indefinite leave from her job to focus on carrying her pregnancy to term. The work-life balance stress caused her blood pressure to rise, so she took a break. 

“I’m trying not to jinx it, but I think I will be a mama!” 

Catherine continues her visits to the high-risk clinic. When the time comes, she plans to deliver at FAME. 

*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.

Dr. Willey with FAME’s radiologist Japhar Hassan, performing an ultrasound.

Dr. Willey and team on morning rounds.

Dr. Willey and Dr. Ken Karanja

Dr. Alicia Willey, an Obstetrics & Gynecology Specialist in Phoenix, Arizona, volunteered at FAME for two months this summer. Dr. Willey is the second volunteer from the Creighton University of Medicine Global Women's Health Fellowship, which maintains a partnership with FAME to send OB/GYN fellows annually to support FAME’s maternal health team. FAME has partnered with Creighton University School of Medicine-Phoenix Global Women's Health Fellowship since 2022. This two-year fellowship program for OB/GYN physicians provides advanced training in the delivery of women's healthcare worldwide through clinical experience, education and mentorship.

Through this partnership, the first volunteer at FAME was Dr. Elyssa Metas, who spent time with us in 2020 and 2021. You could read her reflection on her time at FAME here if you missed it. Dr. Metas is now the Fellowship Director. 

This is Dr. Willey’s first time at FAME. She first heard about FAME from Dr. Elyssa Metas, her mentor. She had always desired to work overseas, and when Dr. Metas told her about FAME, it sounded like the right fit. 

“Dr. Metas was so inspired when she came back from FAME. She talked about the work FAME does and the people it helps. This intrigued me and I decided to come here to work alongside FAME medical staff.”

— Dr. Willey

Once at FAME, Dr. Willey settled in with the Tanzanian medical team. 

“I love everything at FAME! The location, the lifestyle, the flora, the fauna and the people are amazing! Everyday life here is much more rewarding and hands-on than I’m used to at home. At FAME, you get enough time with each patient, allowing you to see the difference you are making by treating them. It is also very stimulating as we sometimes have to problem-solve to complete certain procedures given we have different tools here.” -Dr. Willey 

Did FAME reach the expectations that Dr. Metas had set?

“It was not far from what I expected since I had talked extensively to Dr. Metas, so I knew a lot about FAME, including the types of lab tests available to order.” -Dr. Willey

Dr. Willey has, however, encountered some differences between the medical practice at FAME and in America.  

“In America, doctors must be present for every vaginal delivery, but this is not the case at FAME. I did not anticipate this, but it has been amazing to be involved in vaginal deliveries since getting here.”

— Dr. Willey

Talking about what she likes about the medical practice at FAME, Dr. Willey says that she loves the camaraderie between medical teams and that a single doctor gets to see all the patients in the ward.

“I participate in the ward rounds every morning and have learned much about general medicine since I came here. I have also experienced a different pace of work which I enjoy! I will be better at taking care of my patients now because I’m not only looking at them through the lens of an obstetrician-gynecologist, but I can now review their medicines, or discuss diabetes, hypertension and other disorders much better.”  

“Dr. Metas and I are talking about coming back next year. She has been trying to come back to FAME for over a year and finally got some time off. I plan to bring my 6-month-old baby with me so I can stay a little longer.”

— Dr. Willey

It is these types of partnerships, which provide consistent support year after year, that are crucial for the sustainability of our capacity-building work at FAME. Currently, we have partnerships with the University of Pennsylvania for neurology, Creighton University, Arizona for OB/GYN, Creighton University, Omaha for surgery, and Stanford University for anesthesiology.

FAME’s volunteer program is a rich, collaborative learning experience for our Tanzanian medical team and volunteers. Western-trained doctors, nurses and laboratory specialists from overseas medical communities work side by side with our Tanzanian medical professionals, sharing knowledge and expertise on behalf of patients. As part of our new strategic plan, FAME is now looking to its volunteer program more than ever to build the capacity of our team to align with the most pressing needs in the community.

FAME marks this International Day of the Girl Child by raising awareness and addressing health needs affecting girls and young women, especially their access to healthcare.

In rural Tanzania, where we work, rural girls encounter numerous constraints in accessing affordable, adequate health services compared to girls living in urban areas. Household financial decision-making, disapproval of unassisted travel, long travel times and lack of prioritization of spending on girls' health are just some barriers girls face in accessing healthcare. Due to this, there is a significant value and need to increase interventions in pediatric care in rural Tanzania.

FAME plans to grow its pediatric department over the next five years. It aims to give all children, including young adolescents, safe, effective and timely healthcare for their age and stage of development. This will improve girls' health outcomes and offer much-needed continuity of care.

FAME has several programs that it already runs for girls. Through its reproductive health and family planning program, FAME provides knowledge, agency and resources to enable adolescents to make decisions regarding their reproduction. Despite child marriage being unconstitutional in Tanzania, adolescent pregnancies are common mainly due to poor sexual and reproductive health education. Childbearing increases the risk of maternal and neonatal mortality and perpetuates gender disparities in educational attainment (World Bank, 2022). In the first eight months of 2022, FAME has received nine adolescent pregnancies, the youngest being 14.

Over the years, FAME has been involved in numerous interventions to improve girls' sexual and reproductive health in our catchment area. When the Government of Tanzania rolled out the national HPV vaccination drive two years ago, FAME was instrumental in ensuring that the community HPV vaccination outreach got to not only the school-going girls in our catchment area but also the out-of-school girls. Full immunization against HPV infection reduces the chances of getting cervical cancer.

Despite these interventions, much is still needed to improve girls' lives. Click here to support FAME’s pediatric expansion, which will provide the accessibility of health service utilization among women and girls in our catchment area and help them achieve their dreams! Empowering girls and ensuring they have access to the care they need to lead healthy lives is necessary. 

“I have been sick for a long time. I want to get well so I can return to school. I want to return to school and become a teacher; then, I can build a big house! This is my first time at FAME; we made the long trip because we heard that FAME cures people. I hope that FAME will give me my life back.”

-Saloni*, Age 15

“My 2-year-old son is my life; I care for him daily.  He’s been quite sick the last month, so I’m happy my husband and I could afford to bring him to FAME for treatment. My life dream is for my son to be as tall and strong as his father!” 

-Nataana*, Age 16

“This is my third time at FAME. I had tuberculosis, but I’m happy that I’m now better and can go back home. I do not attend school, but that's okay, as I love my home. My dream is to own a lot of cows someday and get a lot of kids!”

-Nashipai*, Age 17

“I always ensure Naisola goes to school every day unless she is sick, like today. Her brothers always go to school, so why shouldn't she? That’s why we came to FAME; the medicine here always works fast! My dream is for her to do well in school and maybe become a doctor and help our community, as in our village, we have no doctors and have to travel miles to get to one. I would be happy for her to be educated because I know she will have a good life.”

-Mama Naisola speaking on Naisola*, Age 5

*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.