Filled With Thanks and Giving

 Dr. Badyana and a healthy and grateful Paulo

Dr. Badyana and a healthy and grateful Paulo

It was 11:30 at night when Paulo, a young male in his 20s, arrived at FAME with severe abdominal pain. Dr. Badyana and Dr. Julius, the clinical team on night duty, immediately jumped into action, performing his work-up, putting him on IV fluids and performing X-rays to try to determine a diagnosis. Following his x-ray, they called in Dr. Kelly, our global surgery fellow from Creighton University for guidance and support. When Dr. Kelly arrived, there still wasn’t a clear diagnosis. They did know, however, that Paulo had an acute abdomen, and that there was something emergent going on inside. Dr. Kelly and Dr. Badyana called the OR team, explaining that they needed the OR opened as fast as possible. Despite the late hour, the team rallied. Thank goodness the OR supervisor lives on campus and a driver is “on call” to pick up others for just such situations. In no time at all, the OR team was in place and ready to go. When the surgeons opened Paulo’s abdomen, they found what is called small bowel volvulus, a situation in which the small bowel twists on the mesentery, the tissue that fans out to the small bowel. When this happens, all blood flow to the small intestine is cut off, leaving only a finite amount of time before all of the bowel dies.  

As Dr. Kelly and Dr. Badyana worked to save Paulo’s life, they noticed that his intestine was already showing signs of injury. They untwisted his small intestine and placed warm saline over it. They waited a few minutes and much to their relief, the color of the bowel improved. Fortunately, none of the intestine needed to be removed and the surgery was a success. Following the operation, Dr. Kelly expressed that if FAME didn’t exist, considering how time sensitive his condition was, this young man would have died.

Young and strong, Paulo recovered remarkably fast over the next few days. He’s been back in clinic twice since surgery, asking the doctors when he’ll be well enough to be back playing soccer. He is also exceedingly thankful: “I appreciated how they received my father and I. Immediately, I was taken to the doctor’s office and they began treating me.” Paulo’s story illustrates what a proactive and patient-centered team can accomplish at a small hospital on a hill in rural Tanzania. His life saved, hopefully Paulo will be back on the soccer pitch soon! 

We are deeply grateful for you, our friends and supporters. Your generosity and support are enabling us to save lives, like Paulo’s, every single day in Karatu, Tanzania. Be blessed this Thanksgiving and always.

Inspiring the Next Generation of Healthcare Providers

This past month, three Tanzanian young people training to become healthcare professionals chose to spend their annual school holiday volunteering at FAME. We welcomed Lucy, studying Laboratory Sciences at Mvumi in Dodoma, Christina, studying to receive her diploma as a Pharmacy Tech at Muhimbili in Dar Es Salaam, and Abdul, studying to receive his degree as a Medical Doctor also at Muhimbili.

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Lucy, soon to be Laboratory Tech

Lucy found FAME Medical after having grown up in Karatu. When she left to begin her training in laboratory sciences, she knew she would be spending her holiday home with her family and wanted the opportunity to get hands on experience in a laboratory for the first time. She had never been to FAME before, but she heard that our campus had one of the most advanced labs in the area. With only one year remaining in lab tech school, she wanted to gain practical knowledge to contribute to her studies. She spoke on how much she had learned in such a short time – learning how blood is tested and about parasitology. She was thankful for our staff – for taking the time to teach her, for their patience and for giving her a chance to really learn from the experience. As she heads into her final year of school, she’s excited about applying the knowledge she gained over her holiday at FAME!

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Christina, soon to be Pharmacy Tech

Christina spent her time at FAME assisting in our pharmacy. She chose our hospital because it was close to her family home in Karatu and had the proper resources. She knew to get the best experience, she would need to be in a hospital that had a lot of medicine present in the clinic and FAME’s pharmacy was well stocked. As she finishes up her final year in school, she looks forward to finding a stable job to earn some money to support her future. After a few years working, she plans to return to school to upgrade from her diploma to a degree. She found FAME to be an ideal place to get practice before entering the workforce. She really enjoyed the staff she was working with, saying that they were incredibly friendly and willing to share information. They were always ready to teach her and provided explanations when she needed them. She said she learned a lot during her time in the pharmacy about medicine and about the lifestyles of people who pass through our clinic. Spending most of her time around students of her own age in school, she found it interesting to learn from adults and their experiences as her peers. She was very grateful for the opportunity to work with a knowledgeable staff in a pharmacy that had an adequate supply of medicine for her to learn about.

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Abdul, soon to be Medical Doctor

Abdul also hails from Karatu and is the nephew of our Head Housekeeper. While growing up in Karatu, he saw the work FAME was doing and had dreamt of being a doctor in a hospital similar to ours. He’s currently heading into his fourth year of medical school, with two years of schooling and one year of internship to go before he receives his degree. He chose to use this holiday as an opportunity to learn. The hospital at Muhimbili, where he attends medical school, is a referral hospital where students see very complicated patients and many emergencies. Abdul was grateful for the opportunity to gain exposure to other aspects of medicine at FAME, particularly in the outpatient clinic, where he’s shadowing FAME doctors and learning how to interact with patients. Abdul had an added bonus during this time at FAME. He was chosen to be a translator for our biannual neurology clinic, getting to work with and learn from neurology residents and their attending. He spent two weeks assisting them in clinic, traveling with them on outreach, and learning how to examine a neuro patient. In clinic, he also got to see a patient with Parkinson’s for the very first time. He’s enjoyed working with the neurology team because he’s learning how this specialty can save lives and improve quality of life. As someone who loves to help people, Abdul admires the work FAME is doing and hopes to work in a hospital with a similar culture of philanthropy. He spoke very highly of FAME saying, “I’ve never seen a hospital like this. Regardless of one’s position (doctor, nurse, housekeeper or groundskeeper), they are all working hard to support the organization.” Additionally, Abdul said that upon arriving at FAME, he immediately felt like a part of the family. Like the other students, he found the hospitality and kindness of the staff to be one of the biggest takeaways from his time volunteering at FAME. He believes the work being done at FAME is very good for Tanzania and is excited to share what he’s learned here with his peers.

Thanks to our generous supporters, we have been able to build a medical facility and entire team of Tanzanian healthcare providers that are now serving to inspire the next generation of healthcare professionals in this country. If we’re lucky, maybe we’ll even see these young people back on the FAME campus one day.

Back to School - Meet Yona!

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As someone who likes to take care of people and wanted to pursue a career that allowed him to do so, Yona chose to go to college to study nursing. In Nursing School in Dar es Salaam, Yona had a few classmates who were from the Karatu district and spoke very highly of a certain hospital in the hills of Karatu called FAME hospital. We’re grateful that our reputation was so far reaching because Yona has been with us as a Nurse Assistant ever since he graduated in 2015. Currently, Yona works in the pharmacy for FAME, assisting our pharmacist with the critical task of always having medication in stock and readily available, as well as making certain patients are receiving the correct prescriptions and understand how to safely take their medicine.

When asked about his experience at FAME thus far, he says he appreciates the way the doctors have fostered a culture of service here on campus, which he’s really gotten to see in the way the doctors treat each patient and handle each case. On a more applied level, he’s been able to learn a lot about treatment for patients during his time in the pharmacy, the place he enjoys working the most. All of this led up to his decision to pursue his certification as a Pharmacy Technician at Spring Institute of Business and Sciences in Moshi.

 Having started on October 15, Yona will be attending school in Moshi to receive his certificate. He believes that this certificate is just the beginning for him, a “first step” to his future. Following his certificate, he would eventually like to continue his studies for a master’s degree, but he recognizes this as the best place to start and understands that hands-on experience back at FAME will be important to his overall professional development. His plan is to return to FAME after his certification and apply his new knowledge in our pharmacy. He believes his education will enhance his abilities and allow him to develop his skills as he employs all he has learned in Moshi.

Yona is able to attend higher education due to the generosity of FAME supporters who are helping sponsor him. He wanted to extend his appreciation to all of those who have supported his goals, as well as those who already have, and will in the future, support other FAME staff in pursuing their educational goals!

A Day in the Life of a Consulting Radiologist at FAME Medical

By Dr. Barbara Sharp

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When I arrived at FAME, I found two very capable and industrious X-ray technologists, Onaely and Japhar, who introduced me to the equipment:  a sixteen slice GE CT scanner, a PACS system, and two ultrasound machines, one for body work and one for vascular studies. It is quite special to find such sophisticated equipment in rural Africa. I found the African doctors to be compassionate, inquisitive, and interested in providing the highest possible care with the available resources.

In case it is interesting to you, here is what a Monday as a radiologist at FAME is like.

I began the day by getting up to make breakfast of French toast, local honey and wonderful coffee from Arusha, Tanzania, brewed with a French press. There is a kitchenette in our quarters, which we used frequently, and is quite serviceable.

I then proceeded to morning report to learn about the interesting cases admitted the day before and to learn about progress of the inpatients.

Many interesting cases were admitted and we learned more about each patient in ward rounds. I have found the clinical correlation with X-ray findings really great, which doesn’t happen in typical Radiology practice in the US.   

My radiology skills were needed for four inpatients on this particular day:

One was a 66 yr old male admitted for alcoholic hepatitis.  His family said he drinks a lot of moonshine. I did a kidney and abdominal sonogram and found his real problem was an enlarged prostate with bladder outlet obstruction, bilateral hydronephrosis and shrunken kidneys due to chronic bladder distention due to prostate enlargement causing obstruction to the flow of urine.  He had other findings such as fluid in his abdomen (ascites), fluid in his lungs (large pleural effusions) and cardiomyopathy (large heart).

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Next patient was a three-year-old boy with loss of consciousness and seizures. His Maasai family brought him to FAME after two weeks of trying to eliminate his symptoms with traditional remedies. Many people from the Maasai community live traditionally, herding cattle and living in houses made of dried cow dung. They drink cows milk and eat goat meat. A non-contrast Head CT revealed a bleed in the brain on the left. Contrast was administered which revealed TB meningitis (for you radiologists, meningeal enhancement, left basal ganglia bleed due to involvement of the lentriculistriate arteries, irregular, thickened tentorium and falx enhancement.  Diffuse ventricular enlargement and transependymal periventricular edema).


My next case was a 23 yr old woman who is 3 feet and 6 inches, weighing 32 kilograms, and is 26 weeks pregnant. I did an obstetric ultrasound and found an active baby with somewhat delayed fetal growth.

Last inpatient was an infant, also from the Maasai community, with seizures due to tetanus infection. One traditional practice within the Maasai community is to cover the infant with mud poultices at birth. This happened when the umbilical cord had not yet healed, and is the likely route for infection with tetanus. The nurses had to remove caked dirt off the baby on admission. I helped ascertain nasogastric tube position with X-ray.

From the outpatient center I had many normal chest X-rays and an elbow fracture.  

On my way home I encountered Kelly in the hallway. She is an American surgeon who is working at FAME for one year. She said my patient with the large bladder needed a catheter placed through the skin of the pelvis as his large prostate would not permit the placement of a normal drainage catheter. I detoured into the procedure room with Dr. Kelly. I found my services once again useful when the patient’s heart stopped and my free hands could check for a femoral pulse and pass syringes. After 5 minutes of CPR, I did a transxyphoid ultrasound and found a nice heartbeat.

Voila! A nice day. I then proceeded home to enjoy a delicious dinner on our back porch, looking out over the beautiful trees, ridges, and farmlands of Karatu.

"Do Unto Others" - Reflections of a Volunteer Pediatrician

By Volunteer, Dr. Margreete Johnston

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One morning, we walked into a patient room to find a Maasai mother in tears. Today was day three of a difficult recovery for her two year old, whom had been admitted with a severe burn.  Not fully understanding the seriousness of the toddler’s condition and vulnerability to infection, the mother wanted desperately to go home to her boma. Later that same day, there was another youngster admitted with a similar accidental burn. While this child was from a more educated and affluent family, their shared situation led both parents to reach out to one another instinctively. The Maasai mother consoled the new family, speaking from her experience. In turn, the young parents of the second child encouraged her not to leave until her child was ready.

Similarly, in the labor ward, a mother from Karatu delivered a tiny baby at about 8 months gestation. We were not surprised that this premature newborn needed our support for a few days to be well enough to nurse. However, the mother was disheartened. In an adjacent room, another mother from the Maasai community who had recently lost a baby due to an unexplained fetal death encouraged the new mother. In fact, when it was time for her discharge, even after having lost her own baby, she stopped by their room to wish them well. I am tearing up just remembering this.

An American colleague and I witnessed these scenes and although we did not understand the conversations in Swahili, we did understand the universal nature of what was unfolding before us – parents deeply empathizing with one another and feeling love and devotion for a vulnerable child.  I have expanded my definition of "do unto others" having seen the unconditional love at work at FAME Medical. There are many more stories that I will always remember from my time there. I am thankful for the opportunity to share in FAME’s vision in a small way.

Sometimes We Can Only Offer Compassion …. And Maybe a Little Hope

By Volunteer, Dr. Apple

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The door opens and color fills the room as the Maasai family enter.  Seated in a wheelchair, the patient is rolled into Dr.  Jacob’s room by her son, also accompanied by her daughter and two-year-old grandson.  All are surprised and immediately put to ease as Dr. Jacob welcomes them in their own language.  Quietly the story is told of how over two months ago the patient fell while gathering wood for the fire.  She has not been able to walk since the fall and continues to have significant pain.  All too often, patients and their families seek care only after long delays and/or exhausting attempts at traditional medicine to heal. Dr. Jacob efficiently gathers further history and proceeds with his examination, all while addressing the patient and family with kindness and compassion.  Concerned the patient may have injured her hip, he explains the need for an x-ray, being mindful of how even the meager cost of this diagnostic test may overwhelm this family.  The x-ray is able to be quickly performed and a diagnosis is made.  This 57-year-old woman has a very serious hip fracture, suffering all these weeks since her injury.  To those of us in medically resource rich countries, this delay seems unbelievable. 

Though a diagnosis has been made, Dr. Jacob knows further challenges exist.  Though thousands of hip surgeries are performed daily in many well-off countries, surgeries like this are frequently not available or affordable to many of the patients served by FAME.  After consultation with several of the FAME doctors, Dr. Jacob returns to his patient to discuss options.  The best care for the patient would be referral for orthopedic surgical repair of her fracture.  However, Dr. Jacob knows this requires traveling more than four hours from their home and will be very costly, an expense this family may not have the resources to undertake.  He listens carefully as the patient and family begin to grapple with this information, deciding they will need to return home to discuss this information with the entire family.  Knowing there are occasions where charitable organizations visit Tanzania to perform such surgeries free of charge, Dr. Jacob gathers the patient’s contact information and pertinent physical exam features to pass on to Dr. Frank, in case he is notified of such a program coming nearby.  While the patient is still in the clinic, it is learned there currently is a low cost orthopedic program several hours away that might be available to the patient, so this information too is provided to the patient and family.  At least there may be hope the family and community could afford the surgery at reduced expense.  Realizing the patient and family will need time to reach a decision and that surgery may not be an option after all, Dr. Jacob proceeds with obtaining crutches for the patient, realizing that navigating with crutches on one leg will be almost impossible for this woman with a painful hip fracture who lives in the natural surroundings of a traditional Maasai boma.

As the patient is wheeled away to head home, we have a few minutes for reflection before the next patient arrives.  While the treatment options for this patient are very limited as compared with much of the world and it is discouraging to know successful treatment would likely return this patient to an active life as opposed to a life of virtual immobility, for today we have done the best we can for this patient.  Sometimes the best we can do is to provide compassionate care to the patient and family, mindful of the complexities of their lives ……… and maybe offer a little hope. 

Note – In the five weeks I was at FAME, I helped with the care of two patients who both arrived with hip fractures which were several weeks old.  To those of us in medically resource rich countries, this type of common occurrence seems incomprehensible, but is a daily reality at FAME.

Reaching and Teaching

by Volunteer Nurse Practitioner and Diabetes Educator, Kim Hall

 Dr. Jackie and PA Volunteer, Joyce, meeting with a patient during Diabetes clinic

Dr. Jackie and PA Volunteer, Joyce, meeting with a patient during Diabetes clinic

Diabetes (mostly type 2) is on the rise in Africa with an estimated 15 million plus cases in 2017 (up from 14 million in 2015), and there are approximately one million documented cases in Tanzania according to the World Diabetes Federation.  Experts predict that only about 1/3 of cases have been identified, implying that as many as 3 million cases of type 2 diabetes exist in Tanzania.   The costs of the severe complications that can arise when type 2 diabetes goes untreated far outweigh the cost of treatment and efforts for prevention.

 Kim and members of "TEAM SISI"

Kim and members of "TEAM SISI"

Given these alarming statistics, I am happy to report that the FAME Diabetes/Chronic Disease Clinic continues to build steam! My favorite time at FAME is spent working with the fabulous staff, especially of “TEAM SISI,” the self-proclaimed name of the diabetes team formed during my March FAME visit.  SISI means “us” in Kiswahili and is a clear indicator of the spirit of teamwork, which continues to prevail in this dedicated multidisciplinary team.   The diabetes/chronic care clinic was launched by the TEAM with the help of Dr. Michael Zimmerman in April, 2018, with enthusiastic patient participation from the start.  The SISI team continues to assist patients with self-management of diabetes and hypertension at FAME.

Anecdotally there are several success stories and informal reports of high patient satisfaction and reported positive behavior changes.  A favorite is of a honey farmer who heavily used his own product, reporting marked thirst associated with his high blood sugars, which he quenched with a case of coke weekly.  Changing these two behaviors, and resuming medications which he had run out of, brought his sugars down from over 500 to under 100 in one week! FAME also intends to begin gathering more formal data by documenting improved outcomes and instituting patient exit surveys to continue to reach and teach this population.

I left a piece of my heart at FAME when I first visited it in 2015. When I came back to reclaim it in 2018, I left more of it there instead.  Thanks to all the great FAME staff for taking good care of it, until I return next time!

Advancing Patient Monitoring

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In late 2017, we received an amazingly generous donation from a longtime FAME volunteer!  During her stay with us she noted FAME’s need for more robust monitoring equipment. With a growing number of emergencies finding their way to our ER, increasing numbers of high acuity patients in our general ward, and a rapidly expanding surgery program inspired her to do what she could to help us help our patients. Her gift enabled us to purchase additional and much needed state-of-the-art monitoring equipment. We received 4 bedside monitors to help with continuous monitoring of patients -- finally arriving this past July! The monitors are now up and running and strategically located in our Recovery Room, Small Procedure Room, Emergency Room, and Inpatient Ward.  These invaluable pieces of equipment are helping our doctors and nurses provide a superior level of health management for our patients who need close observation and continuous monitoring. When the equipment arrived on campus, a trainer arrived along with it, orienting our staff on how to properly use the machines for patient care. As soon as they were installed, our doctors and nurses were putting them to good use! We want to express our sincerest thanks to our volunteers for their continuous support and for embracing our mission to advance patient-centered care in rural Tanzania!

It Takes A Team

By Volunteer Dr. Apple

 Dr. Apple and Dr. Badyana with their patient

Dr. Apple and Dr. Badyana with their patient

Afternoon clinic was winding down on the quiet Saturday afternoon, when a young woman was wheeled into Dr. Badyana’s office.  “Oh, this is not good,” was my immediate thought.  The patient before us had extreme swelling of her face, neck and upper chest and was not able to swallow anything, including her own saliva.  The patient’s mother quickly provided a history of her daughter starting with dental pain and some swelling three weeks prior.  She had received antibiotics from two other hospitals, but her condition progressively worsened.  The patient had a history of diabetes, controlled by her diet, but there had been no recent testing. 

Our examination and a bedside ultrasound performed by Dr. Badyana confirmed a diagnosis of an extensive oral infection spread to the tissues of the face, neck and upper chest, a rather rare condition called Ludwig’s Angina.  A very serious and potentially lethal condition, the patient needed immediate surgical drainage of the infected area, monitoring for swelling closing the airway producing inability to breath, intravenous antibiotics and treatment of her diabetes, which was found to be uncontrolled.  The young woman was seriously ill.

Our patient was immediately taken to the procedure area where a surgery to open the infected area was performed.  That afternoon began our FAME team’s long journey with this patient, with the team working tirelessly to treat her infection and manage several life-threatening complications that arose during her treatment. 

And yes, it took a team to bring this patient safely through her illness.  From the FAME staff doctors caring for the patient around the clock, to the volunteer doctors with expertise in diabetes care, infection treatment, surgical wound management and skin grafting, to Dr. Frank working with the anesthetists to find the best procedural sedation for this complicated patient, to our nurse/architect Nancy who suggested and acquired a high protein tube feeding supplement made from ground legumes used to improve wound healing, to the nurses who monitored and cared for the patient 24/7, to all the FAME support staffs, etc., etc.  

Five weeks after her arrival at FAME the young woman returned home, having survived an illness to which she likely would have succumbed had she not arrived at FAME on that Saturday afternoon and had the FAME team not been there with the facilities, equipment and expertise to save another life.

A Second Source of Water

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The drilling team flushing out the new pipe for our second borehole

In early May, we were able to complete the drilling of a second borehole on the FAME campus. The manual work was not easy after Tanzania experienced an uncharacteristically heavy rainy season this year. The muddy aftermath of the rains meant that the drilling team was working in difficult and challenging conditions. It took nearly two full days of drilling to hit a strong and reliable source of fresh water at 170 meters deep. According to the technicians and experts on site, the borehole should produce between 30,000 liters to 40,000 liters per hour. With both boreholes operational, we will be able to pump the water between the two sources. This solution will decrease the daily demand on the current borehole water and will provide a back-up solution in case of an emergency such as a failed pump or a drained aquifer. Overall, the drilling of this new borehole adds a vital layer of security to the FAME water supply for the entire hospital and all of our patients, and we are grateful to the very special supporters who saw the need and made this possible.