While the holidays are a time of joy, family, comfort and home, illnesses and injuries do not take a break for any season. Every holiday season presents opportunities to embrace the spirit of connectedness that brings people together: families, friends and even people who don’t know each other. This week, FAME received Nancy, a patient who suffered severe burns at her workplace and could only make it to FAME for life-saving treatment with the help and support of her work family, ensuring that she survived her burns and would be able to celebrate the holidays with her son. 

36-year-old Nancy* works in a restaurant in Mto Wa Mbu, a town 20 miles from FAME. The restaurant where she works is famous for its all-you-can-eat buffets and with it being the festive season, the buffets have peaked in popularity. As usual, it's Nancy’s job to set up the restaurant's buffet, which is available for 2-3 hours. To ensure that the food stays warm the entire time, the restaurant uses an apparatus, usually consisting of a metal dish with a heating appliance beneath it that contains methylated spirit (surgical spirit), which is 95% ethanol and 5% methanol, to keep the food warm. 

“I set up the lunch buffet as I have done many times. As I lit up the heating appliance containing the methylated spirit, it slid off my hand and fell to the ground, where the spirit splashed on my dress. I wore a polyester dress, which immediately caught fire. I didn’t think the flames would spread so fast, but they did! I was screaming my head off, moving back and forth frantically, which in hindsight, was making the fire spread even faster. My colleagues quickly surrounded me and tried to put out the fire, but because of the type of fabric of my dress, it was sticking to the burnt flesh on my legs.”

— Nancy

When they finally put out the flames, Nancy’s co-workers rushed her to a local clinic. Her legs were terribly burnt. The local clinic injected her with a painkiller and asked that they take her to a hospital that could manage her condition because they could not care for her. The clinic explained that the burn care they could offer was scarce and of limited quality and they were not sure that the care they could provide would reduce disability or prevent mortality. Burn management is particularly challenging in resource-limited settings, where there are few trained providers, and medicine and supplies are not widely available for burn treatment.

Unfortunately, neither Nancy nor her colleagues could pay for the transport to get her to a hospital that could help. Nancy’s colleagues called their boss, who was not at the restaurant when the accident happened and updated him on the situation. They asked if he could organize transport to a hospital that could manage her critical case. 

“My boss saved my life. Once he heard about the accident, he brought me to FAME in his car. He chose FAME as everyone in our area is familiar with this hospital and the work it does for our community. We all know of someone treated at FAME with good outcomes. I’m very thankful he brought me here; otherwise, my story would have had a tragic ending. Together with my colleagues, they were selfless and put my needs first and above all else, and for that, I’m very grateful.”

— Nancy

Ten hours after sustaining the burn injury on her legs and thighs, Nancy was received at FAME and offered timely access to safe burn care, starting with first aid, before being transferred to FAME’s inpatient ward for admission. She had suffered second-degree burns (burns that affect both the epidermis and the second layer of the skin, the dermis).

“My colleagues who accompanied my boss to FAME told me I was offered quick service, which saved my life. They said my legs were so burnt; they didn’t think I could ever walk again. The FAME team worked together to ensure I was comfortable and not in pain. Despite never having been to FAME before, they embraced me like family and treated me like one of their own.”

— Nancy

Fire-related burns from extreme temperatures remain a significant health problem, with over 95% occurring in low and middle-income countries, eleven times higher than in high-income countries (WHO). This often results in prolonged hospital stays, disfigurement, disability and death. Long-term morbidity is often a significant problem for burn survivors, creating suffering for the individual and their family.

“When I regained consciousness at FAME, I was in intense pain. The doctors assured me they were doing everything possible to save my legs. I was scared that if they didn’t, I would be unable to provide for my 15-year son. I am a single parent who needs to be able to walk and work to make a living.”

— Nancy

Nancy is now recovered and doing well. After almost three weeks in FAME’s inpatient ward, she is clinically stable, reports only mild pain and her wounds are healing well. She can now walk short distances but cannot bend her knees. The doctors have given her some light exercises to do when she returns home.

“I would like to advise my fellow workers in the hospitality industry to be extra vigilant. When you work with something for so long, you tend to forget it could be dangerous. As part of my job, I have been setting up the buffet consistently for the past eight years, and nothing bad has ever happened. I became complicit and careless as time passed, leading to my accident. This has been a horrific ordeal for my family and me. I am lucky that FAME has provided me with quality healthcare. Since the accident, my friends have told me many stories of people with badly healed burns due to lack of or poor wound care. FAME’s understanding of burn treatment has been a blessing to me.”

— Nancy

An ecstatic Nancy poses with Nurse Naserian John.

Nurse Nanyu Samweli with Nancy.

“After 20 days, I’m happy that I am finally going home today. I leave with the hope that I will get better and go back to work. I’m sad that I am leaving behind my newfound friends, the FAME medical staff. We have shared many laughs and they have consoled me through my lowest of lows. I will still be coming for a change of burn wound dressing, so I will still see them, which makes me very happy. Thank you, FAME staff, for the healthcare, friendship and everything!”

— Nancy

Through the compassion of her work family and the FAME family, what could have been a tragedy turned into a cherished holiday reminder of the healing power of togetherness.

*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.

Anne Hartman - retired Assistant professor of nursing, Cedar Rapids, Iowa.

Nurse Anne Hartman (middle) poses with Nurse Salama Kawaga (left) and Nurse Digna Kiwia (right).

Nurse Hartman (left) during the COVID-19 vaccination drive at Karatu market. She’s pictured with (From left) Elibariki, Head Nurse Kizito Kileu, Social Worker Angel Obeid and Volunteer Diane Berthel.

Nurse Hartman joins the FAME blood donation drive!

I heard about FAME in 2018 on my first trip to Tanzania. I was teaching nursing at a university and brought a group of nursing students to volunteer at schools and health clinics in Tanzania.

We toured FAME, and from that day, I knew I wanted to be involved. We met Dr. Frank on that tour, and he invited the nursing faculty to come back and work with the nursing staff. I volunteered at FAME for the first time in 2019 for one month.

I was invited to come for a longer volunteer stay in 2020 and planned to come for six months as soon as I was done teaching for the year. Then COVID hit, and all travel plans were on hold. I came back in April 2021 for three months and again in January 2022 for another three-month stay.

During my volunteer stays, I have worked with the nurses in every patient care department at FAME. I loved the opportunity to know how each department operates and then to work on quality improvement projects in each area. I taught education sessions with all of the nurses, including Patient Assessment and Nursing Care Plans. I also taught education sessions with the Nursing Supervisors, including Time Management, Communication, Data Collection and Using Resources Efficiently.

My husband, Don, came to stay with me for a week at FAME during my first three-month assignment and then we went on a safari for a week. While there, he saw the value of volunteering at FAME and returned to volunteer for five weeks with me in 2022. He will be sharing his volunteer reflection next. We continue to stay in touch with FAME staff and do monthly coaching sessions via Zoom calls. We plan to come back and volunteer for a month again in 2023 and for many years after that!

Every time I go to Karatu, I see friends from previous trips and make new ones. When I walk through the hospital, I am greeted like family; I’m called Dada (sister) and Mama and everyone knows about my two grandsons, so I am also now called Bibi–Grandma!

From Left: Head Nurse Kizito Kileu, Anaesthetist Theresia Mollel, Don Hartman, Anne Hartman, Volunteer Coordinator Prosper Mbelwa and Volunteer Darcey Rosenblum.

It is hard to describe the impact of a volunteer experience like this. I am incredibly fortunate to be able to volunteer at a place like FAME and to go back several times so that I know the area and the people. It is so rewarding to experience another culture, much more profound than what tourists experience. Tanzanians can teach us so much about community, hospitality, resilience and being joyful even in challenging circumstances. When I traveled with students, I encouraged them to jump in with both feet to take advantage of every opportunity to experience the culture. I try to do the same. And even though I go to do volunteer work, nearly everyone who has taken this kind of trip agrees that we receive so much more than we give.

For people who are interested in volunteering at FAME, come and do it! FAME makes it so easy with a volunteer coordinator to work with, excellent housing and food. It allows the volunteer to focus on their work without worrying about anything else. Family and friends worry about my safety and always ask, “Do you feel safe there?” The answer is Yes! I have always felt safe at FAME and walking around Karatu. Come with an open mind and be ready to learn as much from the Tanzanian staff as you share your skills.

*Anne runs a blog https://annehartmancom.wordpress.com/ where she documents her experiences as a volunteer at FAME. 

Don Hartman - Sr. Engineering Manager at Collins Aerospace in Cedar Rapids, Iowa.

Don and Anne Hartman

Don training the housekeeping team. He’s joined by the HR Manager, Emmanuel Tarimo.

When I was a child, I had a recurring dream I still remember.  In my dream, I travel a long distance in an airplane and finally land in a savanna with one runway.  I exit the aircraft and feel warmth and familiarity in a place I’ve never been. Africa.  Many years later, when I was 48 years old, I traveled to Africa for the first time.  I went to Nigeria as part of a medical team led by my wife, Anne.  It was an incredible experience in a place where I felt the same warmth and familiarity from my dreams as a child.  That feeling has grown in my role as a FAME volunteer.

Again, my wife, Anne, led me to Africa.  This time to go on a safari and saw where she had been volunteering for the prior two years. Anne was finishing up a three-month assignment when I first visited FAME.  I was on the FAME campus for only a few hours before one of the nurses called me “shemeji,” which is “brother-in-law” in Kiswahili.  She called me shemeji because she and many nurses consider Anne, their sister.  Anne had grown so close to this community of people that I felt welcomed as family because I was her husband.  

Don training the doctors. From Left: Dr. Julius Kebola, Dr.Josephat Mtuwa, Dr. Anne Ghati and Dr. Frank Artress.

Immediately I wanted to help.  But I’m not a medical person; I’m an Engineering Manager.  Within a day of arriving to visit Anne, I was asked to develop a spreadsheet for data collection and Dr. Frank asked me to draft a plan for a temporary COVID unit. I was hooked.  This year I returned to volunteer at FAME for five weeks while Anne finished her second three-month assignment volunteering with the Nursing department.   

Because FAME is a growing organization committed to education, patient care and continuous improvement, I found a niche where I can help.  I have utilized my engineering leadership background and recently earned MBA to support the FAME Senior Leadership team and staff.  This year FAME completed a 5-year strategic planning process.  I spent most of my time working on Planning for the Unexpected strategic priority area.  FAME did an incredible job dealing with the COVID crisis, so we decided to conduct a “Lessons Learned” session with every FAME department.  We would build on these Lessons Learned while developing plans for the unexpected.  I met with the doctors, nurses, senior leadership, housekeeping, security, pharmacy, lab, and kitchen staff.  We talked about each department’s role in responding to COVID and their ideas on how best to prepare for a future crisis.  This was an amazing experience for me.  I met with 124 FAME staff in 10 departments in a few short weeks and compiled 428 responses.  The results went into developing an implementation plan for FAME’s new Contingency Response Team (CRT).  FAME’s CRT will monitor local and global data sources such as the WHO and CDC and look for events that could potentially impact FAME.  The CRT will develop contingency plans in response to direct threats and unexpected events, such as major accidents that could simultaneously bring many patients to FAME.

Through the Lessons Learned sessions, I understand the people and mission of FAME. I am impressed by the innovation, creativity, and commitment to improving patient care. Everyone from all departments cares deeply about the patients they serve. If I were to describe FAME in one word, it would be “Caring.”

 I am proud of the mission of FAME and the daily work the staff does to care for patients. Because I have met so many staff at FAME, when I walk through the hospital campus, I am often greeted with, “Shemeji!”  The feeling of warmth and familiarity has evolved into warmth and family.  We continue volunteering at FAME back home in the United States by providing coaching, mentoring, and training via Zoom.  I have been asked to come back next year as a volunteer and continue working with FAME staff on leadership development activities and plans to progress the strategic priorities. 

 I look forward to returning next year to help where I can and to refresh relationships with people we consider family.

*Don is also the proud father of three daughters and his sons-in-law.  Don is also babu (grandfather) to two grandsons, Alexander and Raymond.

Nailantoi

Nailantoi poses with the girl in Ward 1.

There’s an African proverb that says it takes many people (referred to as “the village”) to provide children with a safe, healthy environment. In northern Tanzania, parenting is more collaborative than individual and a child's upbringing belongs to the community regardless of the child's biological parents. These communal societies have shared values for raising children, thus making it a collective social responsibility.

This story of solidarity and collaboration in a community in our catchment area proved that the proverb is more than just words but a common practice. It's a story of a supportive community coming together to help a sick child and her family. 

Nailantoi* is a 46-year-old businesswoman from a village 100 miles from FAME. She has been admitted to FAME’s inpatient ward for the past five days with a sick child that is not hers. She is not a friend of the child’s family or a relative. She didn't meet them until seven days before she came to FAME. 

“I was walking home from my shop one evening when I saw a man and a little girl sitting outside our local clinic, which was now closed. They were unfamiliar to me, but they were clearly distressed, with the father pacing up and down and the little girl crying. I approached them and the father told me that he had come in the morning to bring his sick daughter to the hospital and the doctor had asked him to bring her back every day for an eight-day injection. Their home was 40 miles from the clinic, with poor transport making it impossible to go back and forth for eight days. He also had no money to pay for a place to stay, so I invited them to my home.”

— Nailantoi

The father and daughter lived at Nailantoi’s house for seven days. The man would walk his daughter to the clinic from her house every day, a five-minute walk.

“On the seventh day, I told the father that I had to make the long trip to Karatu to get new stock for my shop, but they were welcome to stay and finish the injections. However, it was clear that his daughter’s condition was getting worse. Her face was swollen and she regularly cried in pain. So when he asked if I could take her with me to Karatu and take her to a hospital, I immediately accepted. In my culture, a child does not belong to the parents but to the village, so it is my responsibility just as much as the parents to ensure she is well.”

— Nailantoi

Nailantoi had been to FAME three years ago when her daughter was diagnosed with pneumonia and a friend recommended FAME. She and her daughter had made the long trip to seek treatment and were happy with the quality of healthcare they received. This experience made Nailantoi confident that FAME could help the little girl. 

Once at Karatu, Nailantoi brought the girl to FAME first as she thought it would be a quick visit to pick up medication. She planned to go to the market that afternoon to buy goods for her shop and return home on the evening bus. Sadly, this was not to be. 

At FAME, the girl was diagnosed with Kwashiorkor, a severe form of malnutrition. She weighed  9 lbs at three years old. She had swelling (edema) that had started on her legs and spread to the rest of her body, including her face, resulting from malnutrition. She was also diagnosed with pneumonia. The doctors recommended that she be admitted to Ward 1 for immediate medical intervention. 

 FAME’s Dr. Ken Karanja examines the girl.

“I was shocked when they told me the child had to stay at FAME. They said she was sicker than we thought and needed close monitoring and treatment. I was scared she could die as only very sick people sleep in a hospital. Without any doubt, I had to stay with the child, so I canceled my afternoon shopping trip. I called home to tell them I won’t return but would be home the next day. I didn’t know we would be here for more than one night. Today is day five.”

— Nailantoi

Nailantoi is happy that the girl is showing significant signs of improvement after just five days. The FAME team has her on a special formula for malnutrition, antibiotics and vitamins, among other treatments. According to FAME’s Pediatrician Dr. Elissa Zirinsky, they expect the girl to stay in the inpatient ward for at least another week. First, they need to fight the edema and then they can work on getting her to gain weight.

Nailantoi calls home while on a walk with the girl.

“I am happy she is doing well. Sadly, I can only stay here for another two days. Her mother just had a baby three weeks ago, making it impossible for her to come. The villagers back home are looking for someone to stay with her when I leave. My shop has already been closed for five days and I need to return before my customers move on to another shop! Every day when I take her for a walk around the hospital, I call my family to see how they are doing. My youngest is only five years old and can be a handful, but my husband tells me that our families and neighbors are helping him care for our six children, so I know they are in good hands. I’m happy that others support my family as I support this child! The FAME staff has also been very supportive of us. They explained the course of treatment and involved me in the decision-making. I’m confident that when I go home, I can explain in detail what is wrong with her and the kind of treatment she is getting. Thank you, FAME.”

— Nailantoi

*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.

Dr. Zirinsky doing the rounds with FAME doctors and nurses in the morning.

Dr. Zirinsky leading one of the morning training sessions.

And another one! FAME never stops learning with Dr. Zirinsky around!

With Dr. Adam on the morning rounds.

There is a feeling I have these days as I walk around campus that I am in the right place at the right time. I first met Dr. Frank and Susan over 15 years ago. At that time, I was a recent college graduate volunteering at the Rift Valley Children’s Village, an organization closely associated with FAME. The FAME team ran mobile clinics from the Children’s Village once or twice a month, and I helped in any way I could: taking vital signs; transcribing medical histories; or organizing the hundreds of patients waiting to be seen every weekend. I have fond memories of meals together as a team after long clinic days and many evening conversations about life and medicine with Dr. Mshana (one of FAME’s first doctors) as we watched children play soccer. Most of all, I remember being moved by the many ways the team treated and comforted a whole community of people. These first experiences with FAME nudged me towards medicine. 

Dr. Zirinsky and FAME’s Nurse Siana Nkya in 2007 at one of FAME’s mobile clinics.

By the end of that year, I decided to go back to school for my pre-medical requirements. It dawned on me recently that I grew into a doctor as FAME grew from mobile clinics into a hospital. I would come back to FAME and the Children’s Village for short visits whenever possible but always hoped I’d be able to return for longer. I eventually completed my training in pediatrics and infectious diseases just as FAME was finalizing their strategic plan to expand pediatric care and services. I joined the team as a pediatrician in September. Together with two pediatric-focused physicians, Drs. Ken and Joselina, we are turning our attention towards the care of premature infants, preventative care for well infants and children, and protocols and close follow-up for our sickest inpatient children.  

Dr. Zirinsky and FAME Social Worker, Kitashu Nganana speak to a patient.

There’s a real joy in returning to a place you know and love and being able to care for the children of that community. Almost every day I am surprised by a familiar face waiting on the benches outside the clinic - a young adult I taught in kindergarten 15 years ago, a friend’s mother bringing one of her grandchildren for vaccines, the child of my favorite shop owner. I’m also lucky to work alongside old friends. I’m greeted every morning by Mary, the head receptionist and one of FAME’s first employees, who feels like family. I love sharing and discussing patients with FAME’s first nurses, Safi and Siana, whom I’ve known since mobile clinic days. I look forward to lunch everyday with close friends from the Children’s Village now working at FAME. 

There is a strong spirit of curiosity, collaboration, and generosity that permeates through all departments here. Conversations about complicated patients involve a multidisciplinary team of people with diverse skills and expertises. There is a universal willingness to go to great lengths to care for patients and their families. Though the work is challenging and the patients are often quite sick, I think this spirit keeps everyone moving forward. As I write this from the ward after morning rounds, I’m watching the charge nurse on the phone with someone in town, conspiring to find a pair of shoes for a child admitted with severe malnutrition who needs to start walking around but has no shoes. I have no doubt the shoes will be here within the hour and the child will be shuffling around the ward in no time. 

25-year-old Joseph* is back at FAME to pick up his medication. Joseph was admitted for two weeks at FAME in November, suffering from severe tuberculosis (TB). He first came to FAME in March of this year, where he was first diagnosed with TB. He was counseled and given medicine. 

“As much as the doctors and nurses emphasized the importance of taking all medication at the right time and day and coming for a refill while I still had some pills left, I didn’t take it seriously. I felt a bit weak when I came to FAME, but this went away after taking medicine for a few weeks. So I stopped taking the medication and returned to work.”

— Joseph

Several months later, Joseph was working in Nairobi, Kenya, when he got terribly sick. 

“I was so sick. I couldn’t breathe, I was coughing and I had chest pains, was weak and could barely stand up and my body was hot like I was boiling from the inside [fever]. I was sure I was going to die and since I didn’t want to be buried in a foreign land, I struggled to get home.”

— Joseph

Joseph’s family lives in Lake Natron, 100 miles from FAME. When he got home, his uncle took one look at him and drove him to FAME. 

“I was resigned to my fate at this point. I knew that death was inevitable. My uncle said he was bringing me back to FAME, but I was too weak to fight him. I didn't see how FAME or any other hospital could help me. The journey was long and uncomfortable and that's the last thing I remember.”

- Joseph

Joseph was received and put in isolation at FAME, where he was treated for ten days before moving to Ward 1. The FAME staff battled to save his life. 

“ I am so grateful to FAME. They did the impossible and brought me back to life! They took very good care of me. They were not harsh or annoyed with me because I had not followed their instructions the first time. They treated me with care and love. They became my friends. They calmly made me understand that I endangered my life and that of others by ignoring the doctor’s orders. I have since returned to FAME three times to pick up my medication and I’m now taking it exactly as the doctor prescribed. Every time I come here, I’m very happy! FAME is home.”

— Joseph

Joseph (left) says hello to the nurses, who,are delighted to see him! Nurse Hosiana Zephania (right) and Nurse Sarah Kimaro are especially ecstatic!

“When Joseph came to FAME, he was very sick and had given up. He thought he would die. Joseph could not believe it when he got better and could return home. Whenever he comes for his medication at FAME, he always comes to Ward 1 to say hello to everyone! All the nurses know Joseph and are always happy to see him. Joseph is always smiling when he sees us! We are very proud of him!”

— Ward 1 Supervisor, Hosiana Zephania

Joseph has since referred one of his friends to FAME, who suffered from TB and diabetes. FAME treated his TB successfully and is now helping him manage his diabetes through the diabetes clinic. 

“I tell everyone who will listen how serious TB is and if they suspect that they might have it, they should go to the hospital immediately. TB treatment might be long [6-12 months], but it's worth it. Nobody has to die from this disease.”

- Joseph.

In collaboration with the Tanzanian Government through the National TB and Leprosy Programme (NTLP), FAME treats TB patients in our catchment area. This year alone, we have had 103 TB cases diagnosed at FAME,

According to Dr. Jacob Olekeiya, FAME’s TB and HIV Coordinator, cases like Joseph’s are not uncommon. Some TB patients do not take their medicine as prescribed, despite the counseling and education they receive at FAME. Some refuse to accept or take the disease seriously, downplaying its effects. For others, cultural beliefs play a part and they claim to have been bewitched and a quick visit to a witch doctor will fix everything. These patients are likely also to have HIV and see the two diagnoses as the crafty work of dark forces trying to hurt them. However, HIV weakens the immune system, increasing the risk of opportunistic infections such as TB. For these patients, continued counseling, support and patience go a long way.

For some patients living in far-to-reach areas where distance, transport and money are a problem, taking medication as prescribed can be a challenge as they cannot come to pick up their medication easily. For these patients, FAME writes a referral letter to their local clinic and regularly follows up with these centers to ensure they are still picking up their medicines. 

Joseph (left) talks to Dr. Emmanuel Mbilinyi, one of the doctors involved in his care.

However, it's not all bleak! 

“Most patients follow doctors’ orders and are cured of TB. They then empower their communities with information about this disease and the need to seek quick treatment and follow all the instructions given by the doctors to the letter.”

— Dr. Jacob

FAME does not provide care to only patients diagnosed in our facility; we also receive visits from patients who have been diagnosed elsewhere but come to FAME for their medication and support. These types of visits are up 33% from last year.

“FAME is fortunate to have the government's support and collaboration in the fight against TB. Most TB cases at FAME are pulmonary TB which involves the lungs, usually taking six months to treat. Sometimes we see cases of extra-pulmonary TB (EPTB) involving the lymph nodes and abdomen, which takes 8-12 months to treat. The free TB medication from the government has been a game changer in ensuring that everybody has access to TB treatment despite where they live and their economic standing.”

-FAME’s TB and HIV Coordinator, Dr. Jacob Olekeiya.

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