Malaria is a serious and sometimes fatal disease caused by a parasite that commonly infects a certain type of mosquito that feeds on humans. In the United States, about 2,000 cases of malaria are diagnosed each year, with the majority of cases in travelers and immigrants returning from countries where malaria transmission occurs (CDC). This is a stark difference from Tanzania, where over 45 million people are at risk of malaria because of the climate and topography (USAID). The Tanzania Ministry of Health reported 4.4 million malaria cases in 2021, resulting in 1,905 deaths. 

FAME is located in northern Tanzania, near the Ngorongoro Crater, at a relatively high altitude of 5,900 feet above sea level. While malaria is a concern in all areas of Tanzania below 5,000 feet, given the altitude of our catchment area, malaria cases are minimal. Malaria thrives in low-altitude regions and is much more unlikely in higher altitudes. 

That's why our team was surprised when Daniel*, a 19-year-old boy who resides in the Ngorongoro area, was admitted to FAME’s inpatient ward with Malaria. 

We learned that Daniel had just returned from a trip to the southern highlands of Tanzania. He had traveled to Songea, a region in southwestern Tanzania, to see his mother for a month. Songea is at an elevation of 3,600 feet above sea level. The altitude, among other factors, makes it a high-risk area for malaria. 

It was on his way back to Karatu from Songea that Daniel started experiencing symptoms: fever, headache, chills, and nausea. The journey was long and traveling 690 miles on a bus is not the most comfortable. Daniel wondered if he could make it home to Karatu. He spoke to the man who sat next to him on the bus, told him that he was unwell and asked him to watch his belongings if he lost consciousness.

More than 17 hours later. Daniel arrived in Karatu. 

“I was nauseous and in pain when we arrived in Karatu at almost midnight. I thought of coming to FAME but then had second thoughts on whether I was really sick or the long grueling journey had taken a toll on me. So I went home, took paracetamol and tried to sleep.”

— Daniel

After a night of restless sleep, tossing and turning and waking up several times, Daniel came to FAME the next morning. 

“I was lucky that my father was in Karatu. I called him and asked him to bring me to FAME. He came on a Boda Boda (motorcycle) to pick me up. I was so sick I couldn’t sit upright; he had to support me.”

— Daniel

Dr. Lingato Olekotoy (right) consults with Dr. Joselina about Daniel’s case.

Once at FAME, Daniel was received by a doctor and sent to the lab for tests. 

“After doing tests at the FAME laboratory, I was diagnosed with malaria and was admitted to the inpatient ward. This is the second time I have gotten malaria, the first time being when I lived in Dar es Salaam [elevation: 187 feet above sea level] seven years ago, but the symptoms this time were different! I don’t remember being this sick!”

— Daniel

After two nights at the inpatient ward, Daniel is ready to go home.

“The care at FAME has been exceptional. The food was delicious; I’m extremely sad that malaria took my appetite away and I couldn’t eat much. I might return for the food alone; this was a missed opportunity! I’m happy with the treatment and thanks to FAME, I’m starting to feel back to my old self again.”

— Daniel

Drs Joselina (left) and Lingato (right) are joined by Dr. Emmanuel Mbilinyi (second right) and Nurse Iluminata Sanka (second left).

Through the National Malaria Control Program (NMCP) and in collaboration with its partners, the Government of Tanzania has made significant strides in the fight against malaria, resulting in a remarkable reduction in malaria cases. This is reflected in the number of malaria patients at FAME: in 2021, we saw 53 malaria cases; this dropped to 38 cases in 2022. 

FAME’s Head Doctor, Gabriel Kissima, explains the malaria cases we receive at FAME: 

“Because of Karatu’s high altitude, we don’t usually get many malaria cases from around here. Often, the patients have traveled outside Karatu or live outside our catchment area. At FAME, close attention is paid to the differential diagnosis of febrile illnesses [fever], as early recognition of symptoms and signs perceived as malaria are vital for effective case management.”

— Dr. Gabriel

*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.

Lugongo poses at FAME’s inpatient ward.

Three months ago, we covered the human-wildlife conflict in our catchment area, where a young boy was attacked by a leopard while herding goats in the Serengeti and was quickly rushed to FAME for treatment, saving his life. You can read his story here.

This week, we encountered a similar case, only this time, it was a buffalo attacking a 59-year-old man, Lugongo*, as he picked some native wild vegetables.

Since the death of his wife a year ago, Lugongo has had to take up her chores, including picking wild vegetables for food from the forest. His home borders the Ngorongoro Conservation Area (NCA), sharing the same ecosystem as the wildlife. Due to this, human-wildlife conflicts are not unusual. 

On this fateful day, Lugongo and his friend ventured deep into the forest, searching for wild vegetables, as they often did. Suddenly, he was attacked from behind and thrown in the air.

“I didn’t understand what was going on. One minute I was laughing hysterically with my friend; the next, I was high in the air. When I fell, I saw that a buffalo was attacking me. Terror, shock and fear engulfed me. I know about the buffalo. It’s a very dangerous animal. Its horns would shred me to pieces; if that didn’t work, it could easily trample on me. It’s a very heavy animal.”

— Lugongo

The African buffalo is a member of the Big Five wildlife animals. It weighs 660 to 1,840 pounds, is 4 to 5 feet tall and is extremely strong (National Geographic). It is herbivorous and favors dense forests and open plains for food. It is easily seen in protected areas and national parks such as the Ngorongoro Crater and the Serengeti.

Lugongo’s friend started screaming and throwing sticks and stones at the buffalo to chase it away. This alerted other people in the village, who ran to help scare the buffalo off. When it finally ran off, Lugongo was in bad shape. The villagers put him in a car and quickly rushed him to FAME. Time was of the essence if he was going to survive. 

Here, FAME’s Head Doctor, Gabriel Kissima, describes Lugongo’s condition when he arrived. 

“Lugongo had suffered a traumatic chest injury from the attack. He had a cut on his chest that was 3.9 inches long and 1.5 inches wide, with many rib fractures and extensive damage to his lungs and internal organs. He had lost a lot of blood and needed emergency surgical intervention. He was sent to the operating room (OR) for trauma assessment and a thoracotomy [a surgical procedure that goes into the chest] was performed. This enabled the surgeon to see through the damaged lung and internal organs. The left lower lobe [lung] was repaired.”

— Dr. Gabriel

African Buffalo, photographed in Ngorongoro by FAME’s Board Chair, Dr. Michael Rubenstein.

At FAME, surgery is increasingly becoming integral to the healthcare we provide. Once it was discovered that the patient required immediate surgical intervention for his life-threatening injuries, FAME’s surgical team moved swiftly and coordinated their work with each other to have a successful operation and save his life. With FAME’s catchment area including national parks, FAME often deals with injuries related to human-wildlife interactions that may not be as common elsewhere, such as Lugongo’s case. FAME’s surgical team is crucial for treating complex cases and saving lives in time-sensitive situations, even as essential surgery remains inadequate and poses significant challenges in rural Tanzania.  

It has been four days since the surgery and Lugongo is awake and fully alert. The doctors expect a full recovery. 

“FAME saved my life. My family confided in me that they were sure I would die since the injuries were so severe. After four days here, I feel much better. I’m still in a little pain, but I can sit up and talk to the doctors and nurses when they come around. I am telling my story to warn people of wild animals’ danger and ask them to be careful. And if they are ever attacked, FAME will save them!”

— Lugongo

*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.

22-year-old Saraphina* is admitted to FAME’s Special Care Nursery (SCN) with her four-day-old son. After a routine baby vaccination visit to FAME’s Reproductive Health Clinic (RCH), he was diagnosed with Jaundice, a yellow discoloration of a newborn's skin that occurs when the baby's blood contains an excess of a yellow pigment in red blood cells (Bilirubin).

“The diagnosis was a huge shock. The baby looked fine and was breastfeeding quite well. After a routine blood test, they told me he had jaundice. I didn’t know what that meant, but the RCH staff went to great lengths to explain what it was and how because my son was born full term and had no other medical issues, it was generally not dangerous in this situation. Still, he needed phototherapy for a day or two”

— Saraphina

Phototherapy involves a special type of light used to treat newborn jaundice by making it easier for the baby's liver to break down and remove the bilirubin from their blood. Phototherapy aims to expose the baby's skin to as much light as possible.

Saraphina and her son at FAME’s Special Care Nursery (SCN).

Saraphina, a first-time mother, came to FAME when she got pregnant on the recommendation of her big sister, who had given birth at FAME six months earlier. Seraphina came to FAME for her prenatal classes, gave birth at FAME and has now enrolled her son in FAME’s baby clinic at the RCH.

“I had an easy pregnancy, with my son being born naturally at full term weighing 7.7 lbs. I thought the pregnancy and the delivery were the hardest part. Still, I’m finding out Kuzaa Si Kazi Bali Kulea Ndiyo Kazi [It is not difficult to nurse a pregnancy, what is difficult is to bring up a child- Swahili Proverb].”

— Saraphina

Saraphina’s son was taken to FAME’s Special Care Nursery for phototherapy. 

“They had explained that my son would have to be under special lights for a day or two to help eliminate jaundice, but I was intimidated once I saw the lights. I was scared the lamp would burn him too hot; he was just four days old! They assured me that the light would not harm the baby and that special glasses would protect his eyes.”

— Saraphina

After two days, Saraphina and her boy are ready to go home. 

“I want to thank FAME for supporting me on this journey of motherhood. FAME has been here from the start. If it weren’t for FAME, I would not have known that there was a problem with my child. I asked the RCH staff how they knew what to test for and they told me that these were routine tests for every newborn coming for a postnatal checkup within seven days. As mothers from this area, we are blessed to have FAME.”

— Saraphina

FAME now has four phototherapy units. The two newest phototherapy lights were very generously donated by Redding West Rotary group. They have been a crucial addition to increase FAME’s capacity to treat newborns for jaundice and reduce costly referrals for families.

*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’s Pediatrician, Dr. Elissa Zirinsky (left) together with FAME’s Social Worker, Kitashu Nganana (right) talk to Sankara and his father (middle) during the consultation.

At FAME’s Outpatient Department (OPD), we meet a dad and son duo who’ve come in for their follow-up appointment. Sankara*, age 11, suffers from brucellosis, an infectious disease caused by direct contact with infected animals, eating or drinking contaminated animal products, or inhaling airborne agents. Sankara’s brucellosis is likely caused by ingesting raw (unpasteurized) milk from infected cows.

Sankara and his father come from a village two hours away from FAME. They first came to FAME a month ago when Sankara had eye problems. He complained of eye pain, redness and blurred vision. He also had a fever and vomiting.

“Sankara suddenly could not see very well. He could not count the cows correctly when they came home from the fields in the evenings, something he had done many times since he was a little boy. He then started having a fever and vomiting and became very weak. After trying local herbs and he wasn’t getting better, I brought him to FAME.”

— Sankara's Father

After having his blood tests done at FAME, Sankara was diagnosed with brucellosis. 

“I have heard about brucellosis before, but I was surprised that Sankara had it. I was very worried about him as it was clear that something was wrong. But the doctor reassured me he would be fine.”

— Sankara's Father

In 2022, FAME treated 30 cases of brucellosis. This number is down from the 33 cases treated in 2021. This decrease is partly due to the Tanzanian Government’s 5-year One Health Strategic Plan (2015-2020) to enhance collaboration among humans, animals and wildlife health sectors to reduce the transmission of infectious diseases from animals to humans.

Sankara was given antibiotics and instructed to come back for a check-up after a month. Today he’s back and ready to see FAME’s pediatrician, Dr. Elissa Zirinsky. FAME’s Social Worker, Kitashu Nganana, joins the consultation to help with the translation, as Sankara’s father only speaks Maasai. 

Dr. Elissa enters the examination room and greets the duo with a cheerful Maasai greeting, “Takwenya!” and Sankara and his father burst into fits of laughter! It turns out this Maasai greeting is only used towards women, never to boys or men! Sankara’s father, however, quickly reassures Dr. Elissa that they are very proud of her for speaking their language!

Dr. Elissa is happy with Sankara’s improvement since his first visit.

“Brucellosis can be challenging to treat, so I’m happy that Sankara is responding well to medication. Today I gave him the first dose of IV antibiotics and with Kitashu’s help, arranged for him to go daily to a health dispensary near his home for the remaining six days. This makes it much easier for the family, as they live far from FAME. I trust the family to complete the antibiotics course and look forward to seeing Sankara in a few weeks for a follow-up. We have talked to them about the importance of boiling milk and cooking meat thoroughly to prevent brucellosis. We asked them to use this opportunity to educate their community as well.”

— Dr. Elissa

“In my community [Maasai], it is common for boys between the ages of 9 and 12 to drink raw milk from the cows. They believe it makes them strong as they prepare for their warrior stage. When we get these cases, such as Sankara’s, we take the opportunity to educate them on the dangers of eating raw meats and drinking raw milk.”

-FAME’s Social Worker, Kitashu Nganana

“I was shocked when FAME called to remind me to bring Sankara for his follow-up visit and asked how he was doing. I was blown away! FAME deeply cares about us and I’m happy that my son is in your care. It might be normal for you to check up on your patients after they leave, but for us, it means the world that someone cares this much about us. Thank you.”

— Sankara's Father

“Thank you for giving me medicine to take the pain away!”

— Sankara

*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.

Dr. Shama with FAME’s doctors.

Dr. Shama training FAME doctors.

Dr. Shama hiking with FAME staff and is joined by volunteer Diane Berthel (second right).

I currently work for the Centers for Disease Control and Prevention (CDC) as an Epidemic Intelligence Services Officer based at the Minnesota Department of Health in St. Paul, Minnesota (https://www.cdc.gov/eis/who-we-are/index.html). Before joining CDC, I lived and worked overseas for years and trained as an infectious diseases doctor.

I first heard about FAME in 2015 when I lived in Moshi for a year. My team was researching brucellosis in the Ngorongoro Conservation Area (NCA), based at Endulen Hospital. We traveled between Moshi and the NCA quite a bit, and on one of those visits, we stopped at FAME to talk to Dr. Frank about brucellosis. 

After this experience, I wanted to return to Tanzania. I wanted to use my specialized training to provide clinical consultation and teach with permanent local staff rather than dropping in as a foreign doctor, seeing patients myself, and leaving – a less sustainable model. FAME offered a short-term opportunity to do all those things. 

I felt very welcome when I arrived at FAME in 2022. The volunteer program is well organized. Communication before my arrival was excellent. All of the travel and other logistics were managed. When I arrived at the hospital, everything was set up for me. Whenever I needed anything or had any questions, Prosper [FAME’s Volunteer Coordinator] was available and cared for everything. The living accommodations are spacious and very comfortable. 

FAME is located in one of the most beautiful places I have been. It is in a gorgeous and quiet setting close to the NCA. It is also within walking distance of the town of Karatu, which is convenient. It feels very safe. The food at FAME is fantastic and in no short supply. For lunch, volunteers and hospital staff eat excellent Tanzanian food prepared by Samweli and his team, and for dinner, food shows up hot at your doorstep! 

The Tanzanian medical team was welcoming to new volunteers. Volunteers are integrated into the schedule depending on what they can offer. The medical staff were eager to welcome new clinicians and learn from them. I worked mostly with doctors and I learned a lot from them about the realities of working in that setting. I found it is best to observe and ask questions to truly understand the issues and realistic potential solutions and then to discuss ways to practice evidence-based medicine in keeping with those realities. 

I gave several morning talks. I found it best to teach on topics the clinical staff asks for or to observe on rounds for a while, then come up with topics that feel salient to the realities you observe and discuss those ideas with clinical leadership. Like medical and residency training talks in the US, it is great to go back to basics and give solid bread-and-butter talks on chosen topics – everyone can benefit from that. 

Unfortunately, because of my work schedule in the US, I have only been able to volunteer once. Still, I want to encourage western trained doctors to consider volunteering at FAME. It can be a very positive experience. But I encourage people to think carefully about why they are doing it, what they think they can contribute, and what they want to get out of it. It is a big trip. You function as support to a self-sufficient organization and the key is to integrate and provide the support that is asked of you. 

Volunteer Dr. Shama Cash-Goldwasser (center) is pictured with FAME's social worker, Nganana Kitashu (far left), during their trip to the village to find rabies-infected persons

Editors Note: Dr. Shama was instrumental in helping FAME save the lives of children in our catchment area who were exposed to rabies leading to the death of one of the children. You can read the story in the FAME Journal here. This story was featured in Resolve to Save Lives (RTSL)’s annual report called “Epidemics That Didn’t Happen.” You can read the report here. It was also picked up by the English newspaper, The Citizen Tanzania, as an example of Tanzania’s swift response to rabies and you can read it here.