Back to School - Meet Yona!

0818_Jonah blog vertical.JPG

As someone who likes to take care of people and wanted to pursue a career that allowed him to do so, Jonah chose to go to college to study nursing. In Nursing School in Dar es Salaam, Jonah 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 Jonah has been with us as a Nurse Assistant ever since he graduated in 2015. Currently, Jonah 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, Jonah 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.

 Jonah 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

IMG_9414.jpg

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).

IMG_20180908_094213.jpg

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

Margreete.jpg

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

IMG_6844.JPG

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

DSC07555.JPG

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

DSC07226.JPG

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.

Welcome, Dr. Kelly!

Kelly-Shine.jpg

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.