The Foundation for African Medicine and Education (FAME) is not only about medicine and healthcare. As our name suggests, education is in our DNA! Whether it is weekly training sessions for the nurses and doctors or our volunteer program, where western-trained medical professionals from overseas work alongside our Tanzanian medical team sharing knowledge and expertise, FAME is an institution committed to lifelong learning. 

A few weeks ago, FAME faced a unique situation. Rebecca*, a 13-year-old student, came in with severe appendicitis, just one day before her government-mandated national examinations. Missing this examination would mean she would have to repeat a year of school. 

FAME believes that the long-term benefits of quality secondary education for girls are indisputable and the benefits to a community are immeasurable. In rural Tanzania, there are many formidable barriers blocking girls from fully participating in or completing their education. With Tanzania having one of the lowest secondary education enrollment rates in Africa, at 32% (UNESCO), FAME did everything possible to ensure this girl did not miss her exams. 

This is Rebecca’s incredible story of resilience in times of great turmoil and FAME’s fight to ensure that no one should have to choose between their health and their education.

PART 1: PASTOR LEAH, REBECCA’S MOTHER

Pastor Leah sits in a reflective and prayerful mood beside her daughter Rebecca’s hospital bed. Rebecca was admitted to FAME the previous night, presenting with abdominal pain and vomiting, symptoms she had been suffering from for a week. Her local clinic had diagnosed her with stomach ulcers and prescribed antacids, but her condition worsened.

“Yesterday evening, after a week, Rebecca’s condition got worse. On top of the one-sided abdominal pain and vomiting, her eyes were turning yellow. I am a pastor, so I dropped to my knees and said a prayer. I asked God to save her life. Then, because God helps those who help themselves, I called a taxi and brought her to FAME.”

After receiving and ultrasound and CT scan at FAME, Rebecca was diagnosed with appendicitis; however, she also had a large abscess, which had to be drained and treated with antibiotics before surgery to remove the appendix would be possible. Rebecca was taken to the operating room for the procedure.

“The drainage of the abscess would typically be done under sedation. Rebecca didn't want that; she wanted to be alert for the exam in the morning. The doctors were very kind to her and told her they would use local anesthesia to ensure that she was alert and awake once medicine wore off.”

Rebecca planned to go to school for her exams the following morning, but sadly she was too weak. “The school is only four miles from FAME, so she thought it was doable. But when she got up, she was frail. The dirt road from FAME to the main road is full of potholes, so it would not be an easy drive either. She was in no condition to go.”

Rebecca was devastated. 

“The nurses were just as heartbroken as she was. The nurse supervisor said she would call the head doctor and see if the school could send the exams to the hospital."

PART 2: DR. GABRIEL PAUL KISSIMA, HEAD DOCTOR

“Nurse supervisor, Hosiana, called me and said that Rebecca was facing missing her national examinations and asked if I could help in any way. I immediately sprung into action and called her school to inform them of the situation and request that they send the examination to her at FAME. They declined.” 

Determined and undeterred, Dr. Gabriel reached out to the DEO, who turned out to be a former FAME patient. He confirmed that the government exempted students in extraordinary circumstances, and Rebecca’s case qualified. He was gong to send an officer to ascertain that Rebecca was strong enough to sit for her examination despite being ill. 

The DEO officers came to FAME, and after a meeting with Rebecca, her mother and the FAME medical team, they agreed to let her sit for her examinations at FAME. They assigned an exam officer to sit with her throughout the assessment and every morning the officer would bring the test, ensuring that the whole process was done by the book and adhered to strict government testing rules.

“We are all so happy that everything worked out. It was a group effort from the FAME staff, who took the initiative to go the extra mile for Rebecca. She is a bright and determined girl and I’m sure she will succeed.”

PART 3: REBECCA, PATIENT & STUDENT

Nurse Amana Amini walks Rebecca to the exam room, giving her a pep talk along the way!

“When I started getting sick a week before my examination, I thought it was because of stress. I had been studying very hard and staying up late most nights to get more study time."

"After the fourth day of being ill, I started to panic. There was a real possibility that I might be too sick to do the exam, which worried me. Missing it meant that I would have to repeat the class. All my friends would go to the next class and I would be left with the younger kids who would catch up with me, making me the oldest in the class! So I was determined to do it, come rain or shine.”

“As my mum was waiting for the taxi to take us to FAME, she was kneeling, praying fervently that I would be healed and that God would save my life, but I asked her to pray so that I could be able to do the exams instead! If any interventions were taking place, I wanted them geared towards me sitting for these tests I have been preparing for, for a long time.”

— Rebecca

“After my procedure at FAME, I woke up the next morning ready to go to school, but I was too weak and tired. I cried bitterly as I felt my mind was sharp and ready for the assessment, but my body was failing me!”

She had worked hard for half a year to prepare, late-night and early-morning studying, all of which now proved useless. Then she received the good news, that she would be doing her examinations at FAME and that a room in the ward had been converted into an exam room. The nurses helped Rebecca on the walk every day from her hospital bed to the examination room, giving her pep talks along the way. 

“I am so happy. And so thankful. I can't believe this is happening! From the bottom of my heart, I thank the FAME team for making this work.”

“The exams have been okay, nothing I haven't read before. I expect a passing grade! The exams are two and a half hours each, but I don't struggle sitting up and writing the exam, as there is no pain.”

“We couldn’t believe it. We were so happy! I asked one of the nurses why the team fought so hard for Rebecca to be able to do her exams. I said, ‘you don’t know her! She’s just another patient!’ And she said ‘education is part of FAME’s name and is just as important as healthcare.’ And I told her, ‘a place that cares about my daughter’s health AND education? What more can I ask for? What more could I pray for? You are who you say you are and for that, my family is eternally grateful.”

— Pastor Leah, Rebecca's Mother

This Thanksgiving, we at FAME are thankful for stories like Rebecca's, and we are grateful to our friends and supporters whose generosity and constant support are the reason we are able to provide patient-centered care in rural Tanzania. Despite the challenges facing the world today, your support has been unwavering. 

Thanks for always being with us.

Happy Thanksgiving from our FAME Family to Yours!

*While the patient’s name has 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

This World Prematurity Day, FAME highlights its Special Care Nursery (SCN), which offers advanced care to premature babies and their families. FAME’s capacity in preterm care has expanded to enable admitting infants as young as the gestational age of 27 weeks with good health outcomes. In 2021, FAME treated 24 preemies; to date this year, we have already treated 33 preemies, a 37% increase from last year, and we expect that number to continue to increase as we come to the end of the year.

The burden and challenges of preterm birth in low-resource areas such as rural Tanzania are enormous because of the complexities of caring for these vulnerable infants and preventing complications. This is why we are excited that this year, FAME’s SCN was fortunate to receive a donation of phototherapy units used for treating neonatal jaundice, which has been instrumental in reducing the number of referrals of babies with newborn jaundice. In 2021 FAME referred at least two jaundiced babies every month to other hospitals but this year, we have successfully treated 40 children with jaundice at FAME, thanks to the new phototherapy units. 

The following are stories from mothers with preterm infants admitted to FAME’s SCN. At different stages of preterm birth, we meet Naserian, born extremely preterm at 27 weeks, George, very preterm at 28 weeks and Bernard, born moderate preterm at 32 weeks. These stories of resilience, hope and faith demonstrate how important FAME’s SCN is in our catchment area. 

Naserian: Extremely preterm (born at 27 weeks [estimated])

Naserian’s mother holds her little girl.

When Naserian’s* mother was five months pregnant, she began to feel ill. She thought it was normal abdominal pregnancy pains, but as the weeks went by, her condition became worse. She was six months pregnant when she went into labor. She had contractions, vomiting and her water broke. Her children ran to call the traditional birth attendant (TBA) who lived nearby, as Naserian had planned for home delivery. The TBA confirmed that she was in labor and that the baby was coming any minute.

“When the baby was born, she was abnormally small. I could see the birth attendant’s face was shocked and scared. She advised my husband and me to visit a local clinic. I had given birth to three healthy full-term babies at home, so this was all very confusing!”

— Naserian's Mother

At the local clinic, the doctor asked them to look for a bigger hospital, as the baby needed specialized care that he could not provide. Determined to save their child, the family got a neighbor to drive them to the hospital; he knew about FAME and that it was the closest “big” hospital, so he drove them 30 miles to get there. 

Once at FAME, they were received and the baby was rushed to the SCN. The mother did not know the child's gestational age, but the doctors estimated it to be 27 weeks. The baby weighed 2 lbs. 

Naserian

“I am so grateful that FAME helped me. By the time we got here, I was already preparing for the worst. But the doctors and nurses have been so good at caring for her and she’s getting better. I have been here 12 days already and I can see some improvement. She’s 2.5 lbs today. I’m very hopeful. FAME also takes great care of me. They bring me a lot of good food every day. I can’t finish it all and I wish my other kids were here to eat the rest!”

— Naserian's Mother

George: Very preterm (born at 28 weeks)

Leah holding her son, George.

George’s* mother, Leah, was only 28 weeks pregnant when she went into labor. She owned a busy restaurant and had no time to attend prenatal classes since she got pregnant. This was her fourth pregnancy and because the previous pregnancies were uneventful, resulting in healthy children born to term, she thought this would be the same. 

“I was in my restaurant when it happened. My water broke, and it was a lot of water! Then the blood came. One of my employees rushed home to call my husband, who brought me to FAME in his car. I was crying the whole way. I thought this would not have happened if I had just attended the prenatal classes. I felt very guilty. I felt like I had killed my child.”

— Leah

Leah’s son, George, was born naturally at 28 weeks, weighing 1.9 lbs.

George

“He was so small! The doctors encouraged me to be positive, and they took him to the special care nursery. We stayed at this hospital for 29 days before I could take him home.”

— Leah

George was 2.7 lbs when he went home. The doctors and nurses taught Leah how to feed and clean her son, who was still quite small. 

“When I came home, because of the support and information I had received at FAME, I was able to care for the baby. So far, he is doing well. He suffers from stomach issues sometimes, but we have made good progress; he's 3 lbs today! He is always on my chest feeding or sleeping, and I have had to close my restaurant to take care of him. I guess I could hire someone to run it on my behalf, but that would divide my attention and I want to give my son my full attention. I cannot let him down again.”

Bernard: Moderate Preterm (born at 32 weeks)

Bernard in a neonatal incubator with a phototherapy lamp at FAME’s SCN.

We meet Bernard's* mum, Linda, in the SCN at FAME’s maternity ward. She is 20 years old and this is her first child. Linda lives in Morogoro, 390 miles from FAME. Her mother, who lives in Karatu, fell ill and asked Linda to come to help her around the house until she was strong enough to do her daily chores. Linda took a bus and came to Karatu. When she arrived in Karatu 12 hours later, she felt extremely sick. She was 32 weeks pregnant.

“Immediately, I got to my mother's house; I knew something was wrong. My stomach hurt in a way it has never hurt before. My mother asked me to rest since I had been on a long bus journey. I went to bed, but that's when the bleeding started. Despite this being my first pregnancy, I knew something was wrong. I was worried since I had done all my prenatal classes in Morogoro and my doctor was there. I didn't know what to do. My mum got very scared and called my uncle, who works at a hospital and asked him if his hospital could help. The hospital turned out to be FAME.”

At this point, Linda was experiencing contractions. Her mother got a taxi that brought them to FAME. Once at FAME, she was taken to the labor ward, where she delivered her baby naturally and he was sent to the SCN. He was born prematurely at 32 weeks, weighing 3.5 lbs. 

“I cried a lot. I thought my baby was dead because he was so small! The doctors were nice to me and explained everything. They told me that some babies are born younger than my son and they survive! I couldn’t believe it!”

— Linda

After 16 days at FAME, Bernard is ready to go home with his mum. His weight has increased by 0.2 lbs and Linda is happy. Every little gain counts. 

“I’m very happy that FAME has saved my child’s life. Every day I hold him close to my chest for hours [kangaroo care]; other times, he’s in this box with the light [Neonatal incubator with phototherapy lamp] that you can see. Take a picture of him; I want to show him how small he was when he’s older because I know he won’t believe me when I tell him.”

— Linda

FAME staff at the neonatal conference. From Left: Jacob Ignatus, Nurse, Martha Jerome, Nurse, Dr. Joselina Mumbee, Catherine Duwe, Nurse and Dr. Ken Karanja.

On top of quality essential equipment, FAME continues to invest heavily in its staff and ensure they are up to date on any developments in the neonatal world. Last month, two doctors and three nurses from FAME participated in a neonatal conference called “Tiny Feet, Big Steps” in Arusha. The five-day conference was sponsored by Arusha Lutheran Medical Center (ALMC) and covered topics such as thermoregulation, neurodevelopment care in NICU and apnea of prematurity, among others. This training helped improve their knowledge, skills, motivation and capacity to care for the preterm infants that pass through our doors.

*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.

Nurse Barb, as she's affectionately called, has been coming to FAME for seven years. She first learned about FAME from a friend who donated supplies and knowing that Nurse Barb was interested in global health, encouraged her to check out this hospital in northern Tanzania that practiced sustainable healthcare. 

“My first impression of FAME, once I arrived, was that staff members were incredibly resourceful. They could do life-saving work that we can only do in an intensive care unit in the United States. They managed to care for complex patients with few resources but with much knowledge, care and diligence. Despite the sometimes difficult conditions, the staff remained smiling, collegial and always in a good mood. They would take my hand at tea time and ask if I had taken chai [tea].”

— Nurse Barb

Nurse Barb has been back five times since joining the FAME board four years ago. 

“When Dr. Frank and Susan honored me by asking me to join the board, there was no question that I wanted to be more involved and was ready to do everything needed to support FAME’s vision. So I rolled up my sleeves and got down to work.”

As a volunteer, one of Nurse Barb’s responsibilities was to train the Tanzanian staff. 

“It’s been beyond inspiring because everyone wants to learn. The staff is hungry for knowledge and eager to ask about topics they want to learn. Whenever I come to FAME, I do not presume to know what people want to learn; I discuss it with the team and design a program suitable for them.”

— Nurse Barb

Training, however, did not end in the classroom.

“I would sit in a department, for example, the Reproductive and Child Health Clinic (RCH) and the staff would ask me questions as situations arose. They were willing to acknowledge things they were unfamiliar with or had not learned. I was very respectful as I was a visiting guest. The staff had enormous amounts of knowledge that I did not know and they were always generous with teaching me all sorts of things. It's truly a collaboration. I have learned so much from the FAME staff.”

Nurse Barb advises would-be volunteers to step back and observe while listening twice as much as they speak.

Since she started coming to FAME, Nurse Barb has been purview to FAME’s incredible growth, which has happened without compromising the quality and efficiency of care provided. FAME has ensured hospital processes are working at full capacity before expanding and taking more responsibility. 

“The COVID-19 response was extraordinary and helped cement FAME as a sustainable model that doesn't need volunteers to save the day. The FAME staff responded to the global pandemic and implemented solutions that worked. Egbert [head of pharmacy] created non-rebreather masks from locally available materials. At FAME, I have witnessed ingenuity, creativity, initiative and the drive to make Karatu safer and healthier.”

Nurse Barb talks about FAME’s social workers and their work. 

“FAME social workers inspire me. How they handled the rabies case was impressive. They speak multiple languages, ensuring that all patients are treated with the same level of respect as everyone else and that language is not a barrier to accessing healthcare. This enforces the egalitarian nature of FAME.”

— Nurse Barb

FAME is always looking for new donors, as our patient fees only cover a fraction of the costs associated with running the hospital. Nurse barb has a message for anyone looking to support FAME.

“At FAME, a little goes a long way. The number of people FAME serves in a year on its budget is remarkable. Talented people are working every day with minimal resources and performing miracles. Your donations help elevate healthcare for some of the poorest people in the region!”

— Nurse Barb

FAME’s mission has always been to advance patient-centered care in rural Tanzania. Over the years, FAME has also encouraged families to play an active role in the patient’s medical care, thus promoting individual and family health. The patient and family-centered approach to healthcare emphasize collaboration between the healthcare staff and families, leading to better outcomes and improved patient experiences. 

Today, FAME received new patients at its Outpatient Clinic (OPD): Mzee Lengele*, age 56, and his son Matthias, age 19. With new patients accounting for 43% of FAME’s patients in 2021, FAME is always happy to see new faces at the hospital! 

Mzee Lengele has been suffering from back pain for the last couple of weeks, making it difficult for him to take his cows out for grazing. He’s not sure what caused the injury but thinks it could be when one of his cows kicked him hard. 

“I can stand still without discomfort but can’t move around much or run after the cows.”

— Mzee Lengele

His son Matthias* suffers from an eye infection and his mouth is lopsided. He comes from a boarding school where his father picked him up. His teacher had called his father and explained that she feared he needed more specialized care than they could offer at the school.  

“I have been unwell for the last week. My teacher sent me to the school dispensary several times, but it didn’t help. After a week, she said she would have to call my father to take me to the hospital.”

— Matthias

When Mzee Lengele got the call that his son was sick and needed to see a doctor, he had also been thinking about seeking medical attention for his back.

“I have always heard about FAME from my neighbors, but I have never been here. This is my first time. When my son’s teacher called to say he needed urgent hospital care, I knew I had to get a place to treat my back and Matthias’s illness at the same time without compromising on the quality of care. My neighbors assured me that FAME is for the whole family and that everyone receives the best possible patient-oriented care at a reasonable cost.”

— Mzee Lengele

The father-son duo had a long journey to FAME as their village is 200 miles away from FAME. However, this did not deter them; they were among the first patients at the OPD today. 

“We left home when it was still dark! I’m happy we made it here early. From my first impression, this is a very good hospital. The buildings look very nice, and the reception we received was fast and efficient. And indeed, FAME is for families, as I see everyone here: fathers, mothers, children of all ages and even old mzee’s like me! I’m happy we came.”

— Mzee Lengele

FAME continues to value and embrace patients and their families as essential partners and is always looking to identify strategies to improve the provision of patient and family-centered care in our catchment area. 

*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. Cuff on one of the training sessions for FAME staff.

Dr. Cuff training FAME staff: looking on is FAME’s Dr. Ken (middle) and Dr. Gabriel (right).

Few people get to have a post-retirement career, let alone one as rewarding and challenging as the one I was given when I signed up to volunteer at FAME for 13 months in 2010-2011. I have watched and sometimes participated in seismic shifts as FAME matured from a simple Clinic to an established Hospital. In 12 short years, FAME has opened a free-standing and well-equipped lab; an in-patient hospital; routine surgeries; a rapidly growing Reproductive and Child Health program; a free-standing maternity center; on-site housing for staff and volunteers; and even a cafe for residents and visitors.

The following is a true story and one that gets at who, what and where FAME is. It is the story of Lazarus (not his real name, but an obvious choice, as the story reveals). Lazarus came to us when we were at a clinic housed in a single building. Lazarus looked like any ordinary patient with his shuka (traditional Maasai Blanket) over his head. 

One day a volunteer doctor/legend at FAME, Dr. Duane, brought Lazarus to see me in the lab. Dr. Duane wanted me to do a test on Lazarus. As I waited for a hint about what sort of test, Lazarus removed the shuka from his head and revealed a growth almost as large as his head, growing out of his neck. It was an anthrax tumor. We did some sampling and found that there did not appear to be active anthrax present. The doctor removed the tumor and, since we did not yet have an inpatient ward, sent the patient to a nearby guest house so he could come back daily for a while to make sure everything was ok and to have dressing changes. 

Three days went by and no word from Lazarus. Concerned that something awful had happened, reception called the number on record for Lazarus. We were told the patient had died, but nobody seemed upset at FAME for the death. The doctor was quite beside himself. The next day as the doctor entered the clinic, there was Lazarus sitting on a chair, waiting to see him!

When shown the number that was called to see how he was progressing, Lazarus said he did not recognize the number. No excuse was ever given for the three-day disappearance. One wrong number; one successfully recovering patient; one doctor trying to roll with the punches - a snapshot of FAME: who, what and where FAME is.

“FAME is a community that cares deeply for its patients; it is a place where extraordinary things can and do happen with surprising regularity; it is located in a place where ongoing or even frequent contact with patients can be quite a challenge.”

— Dr. Cuff

PS. A few years later, reception tracked down Lazarus at the doctor's request. Lazarus responded by coming to the clinic and strolling in with their neck exposed, accompanied by his new wife for a delightful reunion.