Sankale (middle) poses with his dad (left) and FAME’s Operating Theater Supervisor, Moses Kikonya (right).

Sankale (left) and his father.

FAME, located in rural Tanzania, was established to provide quality healthcare services to the people living in its surrounding areas. Despite its remote location and limited resources, FAME has served its catchment area effectively by employing local people. This creates job opportunities for the villagers and a sense of ownership and responsibility towards the hospital. For this reason, FAME has prioritized recruiting staff from the local community whenever possible. As a result, FAME has a dedicated team of doctors, nurses and other healthcare workers committed to providing the best possible care to their neighbors, friends and family.

FAME staff from the local community deeply understand the local culture, traditions and language. This has made it easier for them to communicate with the patients and understand their healthcare needs. They also have a good rapport with the community and have built trust and confidence among the people. 

FAME staff shares their positive experiences about the hospital with friends and family, encouraging them to seek medical care at FAME. Despite its growth, FAME never forgets its roots and 40 percent of its workforce comes from the community where we are based.

This week, we ran into a father and son duo at FAME's Outpatient Clinic (OPD). The son, Sankale*, was bringing his father for a three-week review after successful surgery and treatment at FAME.

“When Mzee [father] started getting sick, we were all very worried. We went to a local hospital that advised us to take him to Arusha, more than 220 miles away, as they claimed his condition was serious. That’s when I called Kikonya. He comes from our village and works at FAME. We trust him with our lives. He is our brother and son; we know he always tells us the truth as he is one of us! He asked me to bring Mzee to FAME for additional tests before deciding on the next action.”

— Sankale

The "Kikonya" Sankale referred to is Nurse Moses Kikonya, FAME's Operating Theater Supervisor, who has worked at FAME for three years.

“Sankale and I come from the same village in Loliondo, which borders Kenya to the north. He called me immediately after visiting a local clinic that referred them to Arusha and explained to me in detail the diagnosis they had been given. I advised them to come to FAME to run some tests before making the long trip. After investigations at FAME, we discovered that the original diagnosis was incorrect. We diagnosed Mzee with a condition easily fixable by surgery at FAME. After a successful surgery, Mzee is now fully recovered. Many people from Loliondo, not just from my village, know me well and about my work [Loliondo contains more than 40 villages]. They always call me to seek advice on health issues that need intervention. Today I received another call from home and directed the patient to FAME. People in my community are more likely to trust one of their own who works at a hospital than an outsider. The fact that I work at FAME creates a sense of familiarity and comfort, making them likely to trust my advice. I feel very honored to be in a position to help my community.”

— Kikonya

Mzee (left) explains to Kikonya (right) how he is no longer in pain and his hands work just as they did before!

FAME hires staff from all different tribes in our catchment area. The Maasai are our largest growing patient population and it has been important that we ensure we have staff that represents our entire patient population. As a historically underrepresented group in Tanzania, many Maasai patients have expressed an appreciation for how FAME treats all its patients equally, no matter where they come from.

Overall, the benefits of employing people from the local community in healthcare cannot be overstated. FAME's success is a testament to the fact that by investing in local communities, it's possible to build sustainable healthcare systems that cater to the needs of the people. FAME remains a symbol of hope and progress for the people in our catchment area and a shining example of how a small rural hospital can make a big difference in people's lives.

*The patients’ names have been changed to protect their privacy and permission was secured to share their story. The quotes have been translated from Swahili to English.

Agnes

At FAME’s Outpatient Clinic (OPD), we meet a very upbeat Agnes*. This is her third time at FAME, having discovered it last year when she had recurrent infections that wouldn't go away. Since her first visit, Agnes has been impressed with the care she received at FAME and keeps coming back. Today, she is here on a very special mission:

“I’m here to talk to the doctor about trying for a baby at 47!”

— Agnes

Agnes already has four adult children with her ex-husband. However, she remarried recently, and her current husband is yearning for kids, as he does not have any of his own. 

“My husband is very good to me. He treats me well. He loves me very much. But I am scared he will leave me if I don’t give him a child. He says he will be okay if we can’t have children, but I don’t believe him.”

— Agnes

Agnes confesses that she has been trying for a baby for a year without success. She has taken traditional herbs and medicines, but this has not worked, and she has now come to FAME to talk to the doctor and run some tests to understand the problem. She is hopeful that with FAME’s help, she can get pregnant.

“When I had my second baby in 1996, I was only 20 years old and gave birth in the village. The baby was very big, but the nurses forced me to deliver anyway. Immediately leaving the hospital, I received no aftercare and was back to doing hard manual work. My back and stomach have had on-and-off pain since then. I did go on to carry two more children, but I still wonder if this problem could be what’s stopping me from conceiving.”

— Agnes

Agnes meets with FAME’s Dr. Omary Mvano for a consultation.

Advanced maternal-age pregnancies, or pregnancies in women over 35, are associated with increased risks of pregnancy complications for the mother and chromosomal abnormalities for the baby (WHO). However, with proper medical care and monitoring, many advanced maternal-age pregnancies can be handled well, resulting in healthy outcomes for both the mother and baby.

“I know I am old, but I firmly believe I can have a baby despite my age. My neighbors at home are Maasais, and the women give birth at very advanced ages, sometimes even older than me, and they have healthy children! I’m praying I am blessed the same way.”

— Agnes

FAME’s Head Doctor, Gabriel Kissima, explains how FAME handles fertility issues. In 2022, FAME’s maternity center saw 847 deliveries; the average age of mothers was 29. Still, FAME also encounters infertility in young women too.  

“We run tests when a woman comes to FAME with fertility issues. Some of our tests include a hysterosalpingogram (HSG), an X-ray procedure used to check whether the fallopian tubes are open and if the uterus is normal. A pelvic ultrasound is done to rule out tumors or cysts. We check thyroid functions and other infections. If this is all clear, we check the partner’s quality of sperm, which is essential in maintaining male fertility. We test for other hormones such as testosterone, estrogen and progesterone, but for this, we send the lab samples to Arusha. If a patient needs in vitro fertilization (IVF), we refer them to a specialized clinic in Arusha.”

— Dr. Gabriel

On why she is so happy:

“I love everything about FAME. The nurses are very cheerful, and their demeanor is comforting. When I come here, I already feel better even before seeing the doctor because of the wonderful reception I receive!”

— Agnes

*The patient’s name has been changed to protect their privacy and permission was secured to share her story. The quotes have been translated from Swahili to English.

Mzee Tajiri

78-year-old Mzee Tajiri* has never had surgery in his life before. He has managed to stay, in his words, “very healthy” and has needed little to no medical intervention over the years. Sadly, he recently suffered a traumatic illness that almost left him dead and surgery was the only way to save his life.

“My stomach was very big, painful and I could not pass any stool. I asked my family to take me to the hospital. They carried me four miles to the local village clinic, where I was admitted for three days, but my condition worsened. I quickly resigned to my fate, that I was going to die. My time had come.”

— Mzee Tajiri

As Mzee Tajiri’s condition quickly deteriorated, his family wanted to take him to a bigger hospital, hoping he would access better healthcare. But Mzee Tajiri was not having it.

“I knew I would die and wanted everyone to leave me in peace. Finally, my family called my brother, who works in a big town. He came and forcibly discharged me from the clinic, put me in his car and drove me to FAME. He said FAME was a good hospital that saved lives and that I should give it a chance. Since I was too weak to fight him, we drove to FAME.”

— Mzee Tajiri

Mzee Tajiri and his brother arrived at FAME at 3 am. He was coherent and conscious and knew what was happening, but he was in severe pain and begging for help.

“When we received him at FAME, it was clear that this was a fight against the clock. He was very sick and we reckoned we had little time to save him. We quickly summoned FAME’s surgeon, Dr. Emmanuel Erick Manjira, to consult on the case and he determined that Mzee Tajiri needed an emergency laparotomy to save his life.”

— Nurse Joram Sumawe

Mzee Tajiri presented with an abnormally swollen outward abdomen. Dr. Manjira ordered an abdominal X-ray which revealed he had intestinal obstruction, which occurs when a loop of the intestine twists around itself, causing bowel obstruction. The team had to perform a laparotomy to repair this as it was impairing blood flow, causing him much pain. 

The operation was a success and Mzee Tajiri was discharged after four days. He was asked to continue dressing the wound in a hospital closer to his home and to return for a check-up after four weeks.

“This condition can occur to anybody but mostly people with excess redundancy in the sigmoid colon [a redundant colon is an abnormally long colon that cannot fit inside the body without looping or twisting]. Another possible cause is a tumor; however, in Mzee Tajiri’s case, it was just the redundancy of the colon.”

— Dr. Manjira

Mzee Tajiri poses with his son in FAME’s Ward 1.

“When the doctors told me that I had to have surgery, I was not scared, even though this was the first surgery ever in my life. I just needed the pain to stop. This surgery saved my life and took the pain away. This has been my first time at FAME and I’m so glad my brother insisted on bringing me here. I have received good care. I’m looking forward to going back home and starting my healing journey. I feel like a young man!”

— Mzee Tajiri

“When Mzee Tajiri woke up from surgery, he immediately looked at his abdomen and exclaimed, ‘Where is my stomach?!’ in response to the fact that his big stomach when he came to FAME was now flat. We had to explain it was part of his healing process!”

— Nurse Joram Sumawe

*The patient’s name has been changed to protect their privacy and permission was secured to share her story. The quotes have been translated from Maasai to English.

Joyce (left) poses with Monica (right) and their babies at FAME's Special Care Nursery.

"The babies are already friends!" says Monica

Hospitals the world over can be difficult and overwhelming for parents with premature babies. However, for two mothers, FAME’s Special Care Nursery (SCN) became the place where they found a lifelong friendship. Monica* and Joyce* met in FAME’s SCN because their babies had been born prematurely. Monica's baby was born at 27 weeks and Joyce’s at 28 weeks. Together, they have been navigating the ups and downs of having premature babies and have offered each other support and strength through this tough time.

While Joyce’s baby was born at FAME, Monica gave birth to her daughter in a local hospital that did not have the resources to care for her premature baby.

“After giving birth at 27 weeks, the baby was put in an incubator for a few days. Then the doctor asked me to stay with the baby in the ward, as many children needed the incubator. I stayed with the baby for 17 days in the ward until we were discharged to go home. The baby, born at 3.3 lbs, was now 2.2 lbs and looked very sick, so instead of going home, I came to FAME.”

— Monica

Monica’s and Joyce’s babies required extensive medical care and support in the SCN and the mothers shared a room. 

“This is my third baby. The other two were born full-term, which made having a preemie new to me. I was scared when they told me I would have to deliver the baby at 28 weeks because of my high blood pressure. Luckily, the FAME team is experienced in caring for these tiny babies.”

— Joyce

As Monica and Joyce spent more time together, they began to open up to each other and share their experiences, realizing they were not alone in their struggles. They found that they had a lot in common and bonded over their shared experiences of having premature babies. They shared tips and advice on coping with the stress of having a baby in the SCN and offered each other emotional support during the ups and downs of their babies' medical journeys. They continue to support each other as they navigate the challenges of parenthood.

““We have formed a powerful friendship! We are sisters! We have a strong bond that will continue long after we leave FAME. Monica lives 30 minutes from home, but I plan to visit her often. I am very grateful for this friendship. It has helped me through a difficult time. As much as FAME doctors have provided me with reassurance and guidance, I found more hope and comfort from Monica as we share a similar experience. The encouragement from this friendship has been very uplifting. I am happy that FAME recognizes the value of peer support in patient care and they have encouraged our friendship where we have found hope and strength to keep pushing forward.”

— Joyce

*The patients’ names have been changed to protect their privacy and permission was secured to share their stories. The quotes have been translated from Swahili to English.

Anita.

World Health Day advocates that everyone should have access to quality healthcare services when and where they need them without facing financial hardship. Unfortunately, many people still lack access to essential and life-saving health services, especially those living in rural areas, which can result in preventable illnesses, disabilities and even death.

FAME continues to work towards health equity and improved healthcare access to underserved communities in rural Tanzania. FAME believes everyone should be able to achieve good health and well-being regardless of where they live or their social and economic status. 

Today we share a story about the lack of access to healthcare due to financial difficulties. Anita* is a 35-year-old single mother of one who is suffering from Multiple Sclerosis (MS). MS is a chronic autoimmune disease that affects the central nervous system. Unfortunately, MS is a relatively rare condition in Tanzania and progress has been very limited regarding the diagnosis and treatment of MS in Tanzania (MSIF).

After diagnosis, Anita could not afford the MS medication due to its unavailability locally and high prices in neighboring countries. Access to affordable MS medications is not just an issue in Tanzania but also a critical issue in the United States (NMSS). The cost of MS drugs has doubled in the last seven years, despite introducing a generic form of the widely used drug. Access to treatments is difficult in many countries and often impossible in others.

Anita’s Story

Anita* lives in Arusha with her 6-year-old son. She works in a rehabilitation center for disabled children as an occupational therapist. Her first symptom was muscle weakness and stiffness, making it difficult to move around or perform everyday tasks. Then came the deliberating extreme fatigue. She also had difficulty with coordination and balance, leading to falls and challenges performing activities that require balance. 

“When the symptoms started in 2019, I went to an Arusha hospital where the doctor ordered a brain MRI, but she ruled out MS and gave me medicine to reduce my symptoms, which worked. However, in early 2022 the symptoms became worse. Eating became a problem as anything in my mouth, whether food or a toothbrush, would trigger numbness on my right side, which stopped me from talking. I would faint in public and be completely out for around five minutes, which was most embarrassing. I returned to the doctor, who sent me to KCMC referral hospital in Moshi for another MRI. It is here that I was diagnosed with MS.”

— Anita

Step 1: Dr. Wells demonstrates to Anita how to self-administer injections with a dummy injector for optimal medication management.

Step 2: Now for the real thing!

Step 3: Anita winces in discomfort as compassionate Dr. Wells administers the injection.

Step 4: “It’s not so bad!” A relieved Anita flashes a smile after Dr. Wells administers a successful injection.

“I was in denial of my diagnosis and refused to believe that I had MS. Sadly, my symptoms worsened and started affecting my job performance and I had to share my struggles with my supervisor. She recommended that I come to FAME and see Dr. Rubenstein for a second opinion.”

— Anita

Dr. Michael Rubenstein has been coming to FAME for the past thirteen years with neurology residents and fellows from the University of Pennsylvania and Children’s Hospital of Philadelphia. In partnership with FAME, they provide neurological care for those living in our catchment area both at FAME and in outreach clinics where they venture into the villages.

“After Dr. Rubenstein confirmed my diagnosis, I quickly realized that MS medication was unavailable in Tanzania. This added to my feelings of depression that I already had after my diagnosis. I didn’t know what to do. While the medication does not treat MS, it helps with the symptoms and pain and would give me some normalcy and quality of life. I was told I could get it in a neighboring country at $8,600 per year. Not even in my wildest dreams would I afford this.”

— Anita

For a year after diagnosis, Anita did not take any medicine. It just wasn't attainable. In 2023, after sourcing for approval from the Tanzania Ministry of Health, Dr. Rubenstein and his residents brought her MS medicine from the US, which had been donated. They brought enough medication to last her for more than six months, with plans to bring additional medication when they return in September.

“I cannot thank Dr. Rubenstein and his residents enough! They have saved my life. My biggest worry was that this disease would affect my job so much that I couldn’t provide for my son.”

— Anita

Anita says that she has suffered a lot of stigma surrounding her disease, including from her own family. 

“My family did not and still does not understand this disease. My auntie always tells me: ‘This disease of yours is so weird one would rather have HIV!’ They have taken me to church many times to be prayed for as they believe only God can cure me!”

— Anita

“The biggest challenge is losing my independence. I often have to rely on relatives for help. The other day I fell in front of my son and he was terrified! So we can’t be just two of us in the house alone.”

— Anita

Neurologist Resident, Dr. Wells Seldes Andres, teaches Anita how to inject her medicine. He assures her that the medicine has no significant side effects except maybe a sore arm. He also tells her that MS doesn't change life expectancy with proper treatment.

“I’m so happy! Looking forward to getting my life back.”

— Anita

Dr. Michael Rubenstein (far left) talks to Anita and reassures her.

Dr. Michael Rubenstein

“Multiple sclerosis is a disease that is thought to be very uncommon in sub-Saharan Africa. However, recent data suggest its incidence is increasing here just as in other parts of the world. 

There are several reasons why it is uncommon here, including environmental and hereditary reasons, the lack of specialists (neurologists) and the lack of technology used to make the diagnosis that has only recently existed in this region of Africa. Unfortunately, due to the belief that it is uncommon here, there are also very few studies looking at MS in East Africa, which will hopefully change in the coming years as we learn more.

In the thirteen years that I have been coming to Northern Tanzania, there have been a number of cases in which we were concerned about MS. Still, due to the very limited resources (monetary and technological), we have been unable to pursue the diagnosis fully. 

Anita is one of the more fortunate patients who were not only able to have the appropriate study done but, more importantly, was able to come to our clinic where we confirmed her diagnosis and were able to begin treatment against all odds as there are no medications in Tanzania that are specifically designed for MS.” 

*The patient’s name has been changed to protect their privacy and permission was secured to share her story.