Welcome, Dr. Kelly!

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This June, we welcomed Dr. Kelly Shine to the FAME team as a part of a new partnership with Creighton University and their Global Surgery Fellowship Program.  Dr. Kelly comes to us after having practiced general surgery on the East Coast for 15 years. She graduated from the Yale University School of Medicine and completed her residency at the University of New Mexico Health Sciences Center. She has experience in general surgery, vascular surgery, and acute care surgery. 

When asked about her fellowship, she responded that the program is about "more than me." Creighton's goal with the Global Surgery Fellowship is to build relationships with hospitals abroad that may need resources that Creighton can provide. There is a particular emphasis on bidirectional learning through the fellowship. The idea is that both sides of the partnership will be able to enhance their knowledge and skills. Kelly mentioned that practicing here at FAME has already helped her revisit certain skill sets she doesn't use as often in the states. She also mentioned that she's seeing many cases that she wouldn't see in the US in her specialty, such as rabies or shoulder dislocations, as doctors who do surgery in rural Africa typically function as generalists as well. Through this program of partnership, Creighton has a vision of building ongoing relationships and, ideally, creating a foundation for the fellows to pursue a career in global surgery. 

A new program at Creighton, Kelly is the first fellow to participate in the Global Surgery Fellowship. She'll be spending a full year at FAME as a general surgeon, partnering with our doctors to teach them crucial components of general surgery and learning how to practice medicine in developing countries. She mentioned that when she's in the operating room, she’s not necessarily the one always doing the surgery. She said, "it's not for me to just do, it's for me to teach." In line with FAMEs mission of building local capacity, Kelly’s goal is to leave a substantially strengthened surgical team behind when she moves on.

In addition to building surgical capacity within our team, Kelly has already helped to put systems in place that have enabled us to shift where surgery patients are recovered. With new monitors now in place and nurse anesthetists and ward nurses working more closely together, Dr. Kelly looks forward to using our hospital’s Recovery Room more efficiently and consistently for post-op patients. We are so excited to see all that Dr. Kelly and our team accomplish together in the year ahead! To learn more about the Creighton Global Surgery Fellowship Program, visit Creighton's website.

Why I Will Keep Coming

by Volunteer Cardiologist, Dr. Reed Shnider

 Dr. Reed during heart checkups at a primary school

Dr. Reed during heart checkups at a primary school

The 3 year old Maasai was likely deathly ill from the time that his family set out for FAME on a trip that was likely many hours. By the time they arrived he was in severe respiratory distress, minimally responsive, limp with a barely palpable pulse. His father, sensing his son’s grave condition passed him wordlessly to the nurses and doctors and sat silently at the end of the bed. We were called to help. Initial measures included IV fluids and oxygen, which were provided quickly as the history of his illness was obtained and comfort provided to his worried parents. It appeared likely that our little patient was suffering from a severe systemic infection . IV steroids, antibiotics, fluids and epinephrine were infused without delay. With no Pediatrician on site, contact was made with an overseas consultant, Dr. Rachel, who, being a veteran of several visits to FAME, was able to provide insight and additional recommendations, validating our impression and treatments. Shortly following her call, despite our best efforts, our new arrival suffered a respiratory arrest. CPR and respiratory support were initiated immediately. Medications given without delay.  As if in anticipation of this course of events, we had completed a review of Advanced Life Support just the day before, and the team had learned admirably as evidenced by their efforts. Although it became clear that recovery was unlikely, no one was ready to give up. Even so, there came a time when it was clear that it was time to stop and I called the code as over. As I did, I realized that the father had been sitting at the foot of the bed the whole time quietly observing. Nurse Safi, the Ward Supervisor,  and I  led him to a quiet corner. We explained how sorry we were that we couldn’t save his son. The illness had weakened him too much, that sometimes even our strongest dawa (medication) and greatest efforts were not enough. As parents and grandparents we felt his loss and pain. I think Safi and I were both tearful at that point, waiting to hear what he had to say. He was quiet for a moment then spoke, “I brought him here because we knew that he was very sick, and we knew that you would do everything possible to make him well. I watched and saw that this was true. You have nothing to be sorry for. Thank you for working so hard to save him.”

I like writing about successes. Cases that make us happy. Cases that highlight how far we’ve come. But I realize that the essence of what makes FAME so special is also highlighted by stories like this one. How much the doctors and nurses wanted to save that 3 year old as if he were each one’s child. How painful the loss. How that feeling of caring was communicated wordlessly to the father who came so far to have his child cared for by very special people. How it made an immeasurably painful loss a little more bearable. That’s what I feel a part of when I come to FAME, that’s why I will keep coming.

A Sense of Shared Mission

by Dr. Thu Vu

 Dr. Thu (left) with Dr. Michael Rubenstein and Dr. Ali at FAME Medical

Dr. Thu (left) with Dr. Michael Rubenstein and Dr. Ali at FAME Medical

Of the experiences I had in residency and the stories I tell over and over again, my time in Karatu is the one I reference the most. I cannot even truly enumerate all of the things that I learned there, which ranged from clinical skills and reasoning, to the business of medicine and public health. The rotation I spent there was truly formative in my style of practice, making me a better neurologist, teaching me the importance of healthcare quality and safety, and allowing me to contribute to social good through teaching and clinical care.

Learning to practice in a resource-limited environment was a test of clinical skills including physical exam, localization of lesion, triaging of problems and prioritization of testing. We could not simply rely on other experts or advanced diagnostic testing. For the patient with hand weakness that came in, with large burn scars covering his right arm, we were forced to think carefully and ascertain the localization of his lesion based on examination alone, without the assistance of imaging or EMG. In the realms of treatment, we had to consider the whole patient carefully, including the social context in which they lived, and tailor treatment accordingly — what is the distance this patient would need to travel to obtain their medications? Do they understand that they need to take this medication every day? Every patient came with a piece of critical thinking, rather than rote protocols to follow and panels to order.

The frustrations of local healthcare delivery were educational as well. In an environment like this, it can be very easy to slip into a learned helplessness, an apathy of "well, we did what we could." I have been in other resource-limited areas of the world in which this is true, but not at FAME. FAME embodies the true spirit of quality improvement and patient safety initiatives, which is quite simply asking the question repeatedly, "What can we do better?" I felt that at FAME, I learned more about the best ways to approach healthcare quality and safety improvement from the ground up, and doing so in a cost-effective fashion. I think that these larger systemic initiatives in trying to deliver quality care to patients may have the most impact on the region, perhaps even more so than just seeing individual patients -- it sets a standard for the area which other local hospitals will try to emulate in order to compete.

Seeing patients in this way, carefully considering each case one-by-one, and maximizing resources to do the most good for each patient, enabled us to feel like we were truly doing the best we could for each patient. Often times in residency, one can lose a sense of personal accomplishment -- there is always another consult to see, another call night, another rotation. However, at FAME, the mission of education and patient care, put into perspective by our medical leaders Dr. Rubenstein and Dr. Artress, made all of us who went feel like we had truly done good in the world, that we had made a difference in the lives of the people living in and around Karatu, and made a difference in the lives of the staff working there. That sense of shared mission is clearly evident in everyone there, and it renewed my sense of hope and ambition in my chosen profession. If there is a solution to residency burnout, this feels like one of them.

Global health opportunities were one of the reasons I chose to train at Penn, and my time at FAME with Dr. Rubenstein and Dr. Becker went above and beyond my expectations. What FAME has been able to accomplish in its community has been nothing less than remarkable, and the visiting resident rotation is a program that I feel strongly should be nurtured and expanded as we continue to serve that community and build up a standard for neurologic care in such areas.

Riziki's Story

by Co-Founder, Susan Gustafson

 Nurses taking Riziki to the OR, photo by Moon Lai

Nurses taking Riziki to the OR, photo by Moon Lai

Full term, Riziki began feeling labor pains and prepared to give birth at home. She labored for two full days, and was given local herbs believed to help her with contractions. Riziki’s contractions continued but her baby was not descending. Alarmed and worried, her family took her to a dispensary near her remote village where her labor was monitored for another four hours. With no progress of labor, the healthcare provider knew there was something terribly wrong and referred her to FAME Medical for help. When she arrived, she was having very strong contractions. Dr. Gabriel examined her and performed an ultrasound. What at first glance looked like an enormous cyst, was upon closer examination, the infant’s head showing massive hydrocephalus. Riziki had been pushing for so long her uterus was showing signs of a possible rupture. The team knew they needed to get her into the OR fast and called for blood product from the lab to prepare for the worst. Upon opening the stomach, Dr. Gabriel could see that the uterus was buldging and there were signs of a lower segment hemmorhage. They worked quickly, delivering a baby boy. Despite the hydrocephalus, his Apgar score was strong and he was active. While a nurse cared for the baby, Riziki started bleeding badly. Treating her with the first line of treatment for post-partum hemmorhage, she was slow to respond. As they moved to the second line of treatment, she went into shock. Sehewa, our anesthetist, immediately intubated her and inserted an NG tube. The team began rescusitation and giving her IV fluids while transfusing intra-operatively what would be two units of blood. Her pressure began coming up and when she was able to breathe on her own again, she was extubated and returned to the ward where she stabilized and soon recovered. She still faces some serious challenges, specifically that of taking a medically compromised baby back to the boma. But thankfully, we were able to refer the child to a pediatric surgeon 2.5 hours away who inserted a shunt. Riziki has already returned for her post C-section follow-up visit, reporting that her baby is recovering well. We rejoice in knowing that another precious mother was saved by the FAME team.

It was very, very good

By Volunteer, Dr. Carolyn Apple

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The phone rings in the volunteer house.  I glance at the clock – almost 10pm.  This is not good.  The voice states a patient has been brought by family to FAME after having a motor bike accident and appears to have a head injury.  Can I come?  This is not good.  A few minutes later, I am standing by Dr. Gabriel and Dr. Kiduge looking down at a young man with abrasions to his face, scalp and shoulders.  The patient occasionally calls out nonsense and only arouses to pain. This is not good. The FAME team has already placed a cervical collar and started the initial assessment and stabilization of the patient and Dr. Gabriel performs a focused abdominal ultrasound for trauma exam – no evidence of blood in the abdomen/pelvis. This is good.  We proceed through the remaining primary and secondary assessments taught in trauma care. The patient becomes agitated, requiring cautiously administered sedation.This is not good. Within minutes, a FAME nurse anesthetist is at our side, helping with sedation and airway management.  This is good.  Laboratory study results return and blood typing has taken place.  This is good.  We are notified the radiology technician has arrived and X-rays and CTs are performed quickly.  This is good.  The CT reveals a subdural hematoma.  This is not good.  CT of the cervical spine and x-rays of the chest and pelvis are negative.  This is good.  Dr. Loie Sauer, a volunteer surgeon, joins the team.  This is good.  The team confers and quickly agrees the patient needs a referral for neurosurgical care.  The family agrees to a transfer.  This is good.  The local ambulance is called as the patient receives continued monitoring, medical and nursing care from the team.  This is good.  The ambulance arrives and the FAME nurses equip the vehicle with the necessary equipment and supplies for transport. This is good. The patient is loaded up, along with the FAME nurse anesthetist who will monitor the patient’s vital signs, airway, need for additional sedation and general condition enroute.  This is good.  I return to the volunteer house three and a half hours after having left my bed.  What the FAME Medical team was able to do tonight was very, very good.

 

Justine's Story

by Director of Development, Roanne Edwards

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It was perfect timing for Justine. She was at church the day FAME’s social worker, Angel, began visiting churches, mosques, open markets and water collection points to announce the free-of-charge Cervical Cancer Screening clinic at FAME Medical. Justine had been experiencing lower abdominal pain and had heard about cervical cancer on social media. At FAME, the following week for the screening procedure, she learned that there was an abnormality in her cervix. She felt frightened and apprehensive but was ready to undergo the recommended treatment for pre-cancerous dysplasia. Six months later, the FAME team screened her again and returned with wonderful news – the treatment had cured her abnormality. Justine went home to share the news with her family and to encourage all the women in her life to undergo this simple procedure that could literally save their lives.

 

Cervical Cancer is the leading cause of cancer-related death in women in Tanzania.
—  ICO HPV Information Center 2017 Report

 

Refusing to Give Up!

 Mary's Healthcare Providers, Dr Ivan & Sehewa (Anesthetist/Wound Care)

Mary's Healthcare Providers, Dr Ivan & Sehewa (Anesthetist/Wound Care)

For 58 year old Mary, feeling healthy and strong seemed completely out of reach. A poorly managed Type II diabetic, Anna had never taken her medications regularly, nor had she ever fully understood the havoc her diabetes was wreaking on her health. Feeling terribly ill and discouraged, she heard about FAME and decided to make the 40 minute road trip between her village and Karatu.  She arrived at FAME with a high fever and an old wound on her foot – one she had been battling with for 9 long years -- septic and oozing. The team quickly discovered that her blood sugar was dangerously high as was her blood pressure. She was immediately admitted to the ward and over the next 4 days, cared for by our team.  They cleaned and dressed her wound and treated her infection with IV antibiotics.  Having a well stocked pharmacy at their fingertips, they managed to bring both her blood sugar and blood pressure back into normal range.

So began the long road to healing for Mary. A few days later she was discharged but not without a rigorous follow-up program in place and a new understanding of her diabetes --  that it was a chronic disease and would require lifelong medicine and management.  With this new understanding, she began taking her medicines regularly and coming in for follow-up visits.  Despite careful attention to her diabetes, after nearly a year of weekly dressing changes and care, her wound was still not completely healed. The FAME team decided to try something that hadn’t yet been tried. Equipped with skin grafting equipment, some previous training from a volunteer and a visiting surgeon on hand, they scheduled Anna for a skin graft. Once in the OR, the donor site was prepared and draped and the recipient site cleaned and debrided. They completed the long and tedious procedure and hoped for the best, and sure enough the graft took! Anna was discharged with the wound clean and dry, and we are happy to report that it has finally healed up completely. Mary is feeling healthy, strong AND mobile again, and it is largely due to the comprehensive care she received at FAME Medical from a committed team of providers who refused to give up on her.

Birth Is Miraculous

By Volunteer Olivia Herrington

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Birth is miraculous. You know this before you see it, but seeing it makes you certain. This birth, the first I had ever observed, was by C-section because the baby was breech and because the mother had previously had a C-section—there was concern her tissue was therefore more likely to tear if she delivered vaginally. So the doctor took the baby out feet-first, and, with only her head left inside, Hosiana, one of the nurses, exclaimed, “She is crying inside the womb.” She was, indeed.

When she fully emerged, she was pink and smeared all over with cream-colored paste—the vernix caseosa—and beautiful. Hosiana told me that all babies are born pink, that any other hue is a concerning sign. This baby tried very hard to shut her eyes against Hosiana’s tetracycline ointment, which it is government-required protocol to squeeze into all newborns’ eyes. But her eyes were beautiful, too, a very deep brown.

The next birth was to a young woman who cried out to Jesus as the agony of labor overcame her. Her sister-in-law left the room and wept for the woman’s pain. She had lost her first baby, so terror, if this was what she felt, would have been entirely understandable. From the moment her daughter became visible, delivery was smooth, instantaneous—faster than I could crack open the tiny vial of oxytocin and draw up the liquid with a syringe.

The baby’s head was large and elongated, and her emergence into the world was exhilarating. Her color was more purple than the first but not unusual enough to alarm anyone. She opened her eyes for the first time in my arms. “Mrembo sana,” I murmured, holding her warm body, “very beautiful.”

“Mrembo sana,” Lydia, another nurse, agreed, “kama wewe—like you.” I laughed. Outside, I congratulated the new mother’s own mother. She, in turn, congratulated me.

Meet Nurse Salimu

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By Volunteers Olivia Herrington & Emma Duge

Salimu has some family members in medicine and knew even before beginning secondary school that he wanted to pursue a career in the field. As he got a bit older, his heart told him that nursing was his calling.

He came to FAME almost fresh out of college, graduating in 2015 and joining FAME’s staff in 2016 as a Registered Nurse. He grew up in Karatu and has been familiar with the hospital for some time. He loves the work environment here, the good equipment and supplies, and the opportunity to be involved in providing advanced medical care.

Salimu works hard in the inpatient ward, giving injections, taking vitals, providing medications, performing catheterizations, and completing a variety of other tasks in the ward to help FAME's most seriously sick and injured. He is glad he chose nursing and particularly enjoys being with patients and doing what he can to decrease their suffering and promote their healing.

Meet FAME Nurse Anesthetist, Sehewa

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By Volunteers Olivia Herrington & Emma Duge

Sehewa was born outside Dodoma, Tanzania’s capital. He began primary school at age eleven, having spent the previous several years caring for his younger sister. Throughout primary school, he sang in his church’s choir. One day, as his graduation was approaching, his pastor made an announcement: the church had decided to facilitate applications for young people at his stage of education to enter nursing college. This was when the country had only a handful of formally trained Tanzanian healthcare workers to serve a rapidly growing population, particularly in rural areas. His mother, a farmer, had always wanted the best for her children and applied to the pastor on Sehewa’s behalf. After an interview, he was selected. So, straight out of primary school, eighteen years old and entirely uncertain what this new stage in his schooling would hold, he began his studies at the Kilimatinde School of Nursing in Tanzania’s Singida Region.

These years were difficult ones for Sehewa. He returned home every college break to help his mother farm in order to raise money to pay his school fees. But, in the final year of the three-year nursing program, even their extremely hard work did not earn enough to make the payment. Five months before he was due to take final exams, the school sent him away. The situation was desperate, but no one at home was willing to give up on Sehewa’s studies. A close family friend sold one of the cows her son was herding. The price of the cow still did not quite meet the full cost of the school fees, but it came close enough to persuade the college to let Sehewa take his exams. The college deducted the remainder from his salary over the next few months, as he transitioned from being their pupil to working in their hospital as a TN III (Trained Nurse Grade III).

Sehewa remained at Kilimatinde for five years and learned there how to work as a surgical nurse. He assisted ophthalmic surgeons and became fascinated by the field. Pulled by the voracious intellectual appetite that has defined his adult life, he sought further education to pursue specialized ophthalmic training, this time in Mvumi—back in the Dodoma area. When he returned to Kilimatinde, he was moved from the surgery department to the eye department. He served the surrounding communities through mobile clinics, screening people in their home villages for cataracts and glaucoma.

In 1998, the physicians he had assisted, who visited Kilimatinde regularly but were based in Mvumi, convinced him to work for them full-time in Mvumi. Sehewa spent the next fifteen years providing crucial medical care there. At Mvumi, ophthalmic treatment included the full suite of outpatient, inpatient, and surgical care. Just as he had been trained at Mvumi, he at that point took on the responsibility of training others. He also continued his mobile clinic work, treating patients with minor concerns immediately and bringing those who required surgical intervention to the hospital for care. The Christian Blind Mission (CBM), then based in Germany, provided funding to expand their reach and annually increase the number of patients served. CBM also supplied intraocular lenses, car maintenance, medications, and food for the hospital, in addition to paying for students to travel to Mvumi to learn.

In 1999, Sehewa again felt inspired by the needs he saw at the hospital to enhance his medical expertise. Babies were coming to Mvumi with congenital conditions, and, unlike adults, infants cannot undergo eye operations with only local anesthesia. They squirm too much for a procedure to be performed safely. Sehewa moved to Kenya for three months to learn more about putting babies under general anesthesia. Eventually, Sehewa completed his secondary school education through evening classes while working in Mvumi and then continued his formal education in nursing, ultimately becoming a Registered Nurse and Nurse Anesthetist. 

In 2012 he learned of FAME through his cousin, who was already on the hospital’s staff. He applied for an open position at the hospital and was accepted, beginning work here as a nurse anesthetist and eye clinician. Sehewa is “very, very proud” that he is able to work at FAME and that his sons, Steve and Stanely, are receiving an excellent education at the Tumaini Junior School and Tumaini Pre-Primary School, respectively, just a few minutes down the road. He loves how much he is able to learn here, particularly through comparing techniques and exchanging knowledge with the volunteer doctors. He is also grateful that he can send money regularly to his mother in Dodoma, showing his appreciation for her commitment to him—without which he could not have become a nurse.

Sehewa enjoys the challenge of working with complex equipment at FAME. He is also glad he can seek advice from Dr. Frank, whom he very much admires, when he has especially difficult questions about operating such equipment. He finds deep meaning in his capacity to work hard and care for people in critical condition. Sehewa looks forward to spending the rest of his working life here.