Maternal & Child Health

Hope Prevails

Family is important in Tanzania. It is important the world over. For 35 year old Tasiana, starting a family was beginning to seem like an impossibility. After multiple doctors and hospitals, and 4 unsuccessful pregnancies, two of which were stillbirths at term, she was beginning to think she would never be a mother. Pregnant with her 5th child, she was desperate to get some answers. That’s when she found Dr. Walii Msuya and FAME Medical. After taking a complete history and reviewing her records during that initial consult, Dr. Msuya made a commitment to Tasiana – he would do his level best to determine what was causing her inability to deliver a healthy baby. Reaching out to volunteer US-based OB/GYN consultants and his colleagues at home, studying on-line journals, and using his own clinical skills in the days and weeks to follow, he came up with a working diagnosis—Antiphospholipid Syndrome or APS. APS is an autoimmune disorder in which the body recognizes certain normal components of the blood and/or cell membrane components as foreign substances and produces antibodies against them. In pregnancy, this is a very high-risk situation for both mother and unborn baby, with mother’s body essentially attacking the placenta which damages the blood supply to the baby and usually causes death to the unborn child. Needless to say, the management is exceedingly delicate, requiring closely controlled anticoagulation for the mother during pregnancy.

Anxious to get high quality prenatal care, Tasiana began FAME’s prenatal program in March, while Dr. Msuya and our maternal health nurses followed her closely. Following treatment protocols for this condition, she was admitted to the labor ward at 38 weeks for close observation and fetal monitoring, with a scheduled C-section to follow a few days later. Both Tasiana and her unborn baby remained stable, so she was taken to the Operating Room on August 23rd where she delivered a strong 7 pound baby boy. And after just a few short days in the hospital, Tasiana was able to take her healthy newborn home — her hope renewed, her dream finally a reality.

A culture of patient-centered care and life-long learning is what we try to cultivate at FAME Medical. Dr Msuya exemplifies both. A doctor who treated this woman like a member of his own family, a doctor who committed himself to finding some answers that would make a difference in a family’s life, and a doctor courageous enough to step up to the plate despite the challenges, knowing that Tasiana was out of options. Thank you , Dr. Msuya. We are proud to have you on the FAME team!

Oh, how things have changed

If you build it, they will come
 Dr. Mark and Dr. Monica with one of the triplets

Dr. Mark and Dr. Monica with one of the triplets

Although that quote was most famously related to a baseball field in “Field of Dreams”, it applies to the Obstetric unit at FAME Medical as well. We first came to volunteer at FAME in December 2014, just a few months after the opening of the new unit. During our 2 week visit, we assisted in 2 deliveries and 2 hysterectomies. We also saw patients with the FAME doctors in the outpatient clinic. Although we didn’t have as many operative teaching opportunities as we had hoped, we both were overwhelmed by the enthusiasm of the doctors and staff and their genuine desire to gain as much clinical information as we could provide. We planned to be back for another visit as soon as we could arrange it.

In the same way that this blog was going to be sent to Susan within 2 weeks (it’s now been 6!), our next opportunity had to be delayed until we could schedule it in December 2016. Oh, how things have changed!

Whereas we had only 2 deliveries in 2 weeks in 2014, there are now more than 40 per month. The reputation of the staff and facility have spread so quickly that new facilities are being built for maternal and child health, and plans are being developed for a maternity wing that would include space for antepartum admissions as well as postpartum care. In this two week visit, we assisted the FAME doctors with several Cesarean deliveries, including for the mother who had the first Cesarean delivery at FAME returning for her repeat Cesarean. Another was for a mother with spontaneous triplets diagnosed only three weeks before she presented to FAME at 32 weeks with leaking fluid. (One week later, all three babies were gaining weight and were able to go home, thanks to a donor who funded formula to supplement her breast milk primary feedings.) We had the opportunity to participate in several other surgeries as well, tubal ligations, cervical cerclage, myomectomies: we began to wonder what we had wished for in 2014!

The donations that allow FAME to continue to expand have also funded an infant warmer, without which many babies might not have survived. The most astounding example is the infant born at least 12 weeks early (may have been more like 15 weeks early, as gestational age is sometimes difficult to document in Tanzania) who weighed <500 grams (1 lb 1.5 oz) at birth. We were blessed to be there the day the little one surpassed the 1 kg milestone! That is a miracle anywhere in the world, even more so in rural Tanzania. There isn’t a way to describe the joy in the mother’s smile as the nurse showed her the baby’s weight on the scale.

Which brings us to the best part of our visit – the staff! We knew the doctors we had met two years before had been enthusiastic to learn, but we didn’t have the opportunity to work then with the nursing staff as much. The staff in the “Operating Theater” wanted to review proper scrub procedures, the maternity staff sought information on post-partum hemorrhage, the staff in the outpatient clinic asked about cervical cancer screening, the doctors questioned surgical techniques…. We have never met a group of people so dedicated to the work they have chosen and so intent on improving their own abilities so that the care they provide is the best it can be. The new doctors and nurses added to the staff are just as enthusiastic as the “veterans” from our first visit.

It is truly humbling to help take care of more exceptionally high risk patients in 2 weeks than we would see in months, if not years, in the U.S. Two women presented with eclamptic seizures and several more with severe hypertension in pregnancy, one with a severe shoulder dystocia at delivery, another with post-partum bleeding, a case of infection after a miscarriage…. And the doctors at FAME take it in stride. Cases like these can intimidate anyone, even when the best facilities in the world are available. Watching the staff at FAME provide excellent care in creative ways, using the available equipment, is amazing.

We can’t wait to see what they are able to accomplish by the time we return next! Best wishes to the entire FAME family in 2017, with profound thanks to all of the friends and donors who have helped make FAME possible.

Dr. Monica Norwick
Dr. Mark LaRose
Waconia MN, USA

An Extraordinary Day

by Volunteer Nurse Practitioner Barb Dehn

 Nurse Evelyn, Volunteer Nurse Barb and newborn

Nurse Evelyn, Volunteer Nurse Barb and newborn

On my 2nd day, here at FAME, I saw something, extraordinary. I was privileged to be at the right place at the right time and witnessed a jaw dropping display of talent and knowledge in a most unexpected place. Pauline Diaz, the volunteer coordinator was giving me a tour and suggested that we bring the new donated baby hats from the US and the brand new Tanita baby scale to the maternity ward. Sure! Why not?

Here in Africa, many people come to see the Big 5 animals on safari. Yes, I know there are birders out there and plenty of people who love the cheetahs, warthogs, jackals, hyenas, antelopes, giraffes and zebras. Thousands of dollars are spent, and thousands of miles traveled to catch a glimpse, or perhaps get close enough to see the elephant, cape buffalo, lion, rhino, leopard, all of whom belong to the exclusive group of the Big 5.

However on that 2nd day at FAME, within seconds of arriving in the maternity ward and setting up the new baby scale, what I saw was Nurse Evelyn, a 62 year-old experienced midwife, who delivered a baby, kept traction on the cord, and then resuscitated the new infant.

She then moved calmly back and forth between mother and baby to deliver the placenta, examine it carefully, give the mother the medications that prevent hemorrhage, check on baby and then administer glucose via the umbilical cord. Her assistant nurse, Moinan, helped throughout, while they both very graciously invited me to watch, learn and help out.

There’s no rest for the weary here at FAME, and truth be told, it’s energizing to be here. As soon as the new mom and baby were stable and settled, it was time to go check on the other moms and babies, because the Maternity ward here was full with 7 new mothers and their babies, plus a room where 2 growing premies and their moms are staying.

This safe delivery is also a direct result of a very generous donation from Every Mother Counts (http://www.everymothercounts.org/pages/ourwork-grants/#Tanzania) and Christy Turlington Burns’ vision that together, we can make pregnancy and childbirth safe for every mother, everywhere.

Thanks to Every Mother Counts, many of the moms here in the maternity ward, received regular prenatal care, ultrasounds, vitamins and malaria prevention from Mama Joyce, who oversees the RCH (Reproductive maternal, Child Health) program here. We call here Mama Nurse Doctor Joyce because like Evelyn, she wears many hats and does whatever it takes to educate, dispel myths and reassure pregnant women who previously would have opted to deliver in a hut on a dirt floor without any clean blankets or even a clean clamp for the umbilical cord.

 Nurse Moinan, Volunteer Nurse Barb and newborn

Nurse Moinan, Volunteer Nurse Barb and newborn

Before I can really consider how many lives are saved here, it’s time to tuck the newborn baby’s head into a brand new baby hat to keep him warm and join Nurse Evelyn and Nurse Moinan in the ward to check on the other moms, babies and premies.

I walked behind Evelyn and kept looking at her back, convinced that there would be a small sign of her superhero cape. I asked her where it was and whether she preferred red or blue, she even let me peek under her scrubs to show me that it was just an ordinary day for her and she didn’t have any special super powers. She just laughed and laughed and then started charting, but I’m not convinced.

I didn’t see any of the Big 5 that day, but I did see a hero in action, one that had what she needed to provide the kind of care that most of us in the other parts of the world take for granted. Here at FAME, the level of care is exceptional, and it’s all provided by a dedicated team of Tanzanian nurses and doctors.

I’m learning so much here and am so grateful to all of the staff who have very patiently taken me under their wings and invisible capes.

If You Build It, They Will Come

by Co-Founder Susan Gustafson

 Photo by Ali Mendelson

Photo by Ali Mendelson

Paulina arrived at FAME at 1:30 pm on a Friday, having already been in labor for 14 hours. Nawaso, only 33 weeks pregnant, arrived a few hours later. Having suffered a seizure two days prior, it didn’t take the doctors long to diagnose Nawaso with severe eclampsia and make the decision to perform an immediate C-section. Just as the team was prepping her for surgery, Paulina’s condition began to deteriorate. Still in labor but not progressing, she was wearing out and her baby was showing signs of fetal distress. This would soon be another “first” at FAME, with both Operating Rooms being put to use at the exact same time. Still understaffed, volunteers stepped up to the plate and our Tanzanian team rallied. In OR #1 the FAME team performed an emergency C- section on Nawaso, delivering a 4 pound baby boy. The baby was ventilated and warmed by one of our nurses and then transferred to the incubator where grandmother and father were anxiously awaiting news. In OR #2, a second FAME team was performing another C-section on Paulina, resulting in the birth of a healthy 6 pound baby girl. Soon thereafter, both mothers were recovering in the ward with their newborns, alive today because of the services YOU are enabling FAME Medical to provide.

In addition to these two women and their newborn babies, you are helping our doctors and nurses touch the lives of thousands more. We are thrilled to report that 159 women have delivered their babies at FAME Medical so far this year, and many more were treated for antenatal complications. Your generosity has enabled us to create, train and support our committed team of Tanzanian healthcare providers to provide emergency obstetrical care — a service women desperately need in rural Tanzania.

There have already been 20,433 outpatient visits this year as well and another 867 general hospital admissions. These patients are facing everything from life threatening emergencies to devastating diseases to long neglected common infections robbing them of their quality of life. They are doing so in an environment with extremely limited medical resources. Your giving enables us to provide them with the medical care they need. Join us in making this and more possible in 2016. Please consider making as generous a donation as you can. Regardless of the size, your gift will make a tangible difference in the lives of our patients. It will quite literally save lives and restore hope for a people and community we hold dear.

Taking it to the Village

By Sokoine Kipaiwa

 Sokoine with Traditional Birth Attendant

Sokoine with Traditional Birth Attendant

My name is Sokoine Kipaiwa, and I have one year and a half working at FAME reception. I recently started new responsibilities as a community outreach counselor. My first task, working on a project for our Every Mother Counts grant, was to make sure that we visit, as much as we can, all the Traditional Birth Attendants (TBAs) around the nearby areas of Karatu District and Ngorongoro. Our main goal is to make pregnancy and childbirth safe for every mother by informing all the nearby communities about the new services we offer at FAME medical, including Reproductive and Child Health (RCH), the delivery ward and the operating theater.

I remember my first visit was at Jilambo Village in the Karatu District on June 2nd at 10:30am. The RCH team and I visited one active TBA, Regina Christopher, at her own home. The first question she asked us was “why is FAME visiting the TBAs? Why are you using your time and money this way?” We thought she was going to chase us away from her home, so I had to look down and so did my fellows, and everyone was quiet. Then she said “we are a community of low income and so very poor that nobody ever remembers to visit you at your home.”

Then my heart began to pound, and I told her “Bibi, we are both human, and we were born to help each other every time in every place without minding costs and time we spend.” We explained to her the importance of working together with the local dispensary’s health providers and home birth attendants as well.  We explained the signs for pregnant women to seek help at a hospital, danger signs during labor or birth, danger signs during pregnancy, danger signs after birth, and for the newborn, and all the other services we offer at FAME. We gave her our brochures and emergency cell phone numbers.

She was very delighted to hear that FAME Medical was cooperating with the TBAs and providing quality healthcare services within Karatu villages and nearby areas. She said, “throughout my life, now I’m 67 years old, I never held and shared information from health organizations who educated and appeared to a TBA like me, but only you are doing this in our village” She provided with us her cell phone number for anything we need from her and said we can call her back at any time and she will be together with us and help us. Finally, every one of us was very happy to have met with an active and experienced TBA as we start our outreach program.

 FAME RCH Coordinator, Joyce Ngowi, with TBA's&nbsp;

FAME RCH Coordinator, Joyce Ngowi, with TBA's 



Godbless Joseph

by Volunteer Nurse Chana Schaffer

At the end of February a seemingly delicate, extremely premature baby boy was brought to FAME. He was hanging on to life by a thread when he arrived, and we weren’t sure if he would make it through the night. We supported him with warmth, oxygen, intravenous sugar water and love.

With the help of his amazing mother, our nurses and doctors helped Godbless Joseph (GBJ) to grow and thrive. After he survived that challenging first night, we all recognized that this little one had a lot of fight in him. He may have appeared physically weak, but he was drawing strength from somewhere.

Initially GBJ required an incubator to maintain his body temperature. We gave him sugar water through an IV, and then progressed to using a feeding tube that went into his nose and down to his stomach. His mother was by his side always. Even when she couldn’t hold him, she talked to him, touched him in the incubator, and played him music. Maybe it was her strength and continuous love and support that kept him fighting to live.

 FAME Volunteer Pediatrician Dr. Verena Moreno with Godbless Joseph and his mother

FAME Volunteer Pediatrician Dr. Verena Moreno with Godbless Joseph and his mother

Our not so delicate miracle baby boy went home with his mama just over a week ago! He was cared for at FAME for four weeks.  When he arrived he weighed less than 2 pounds (800 grams), mostly skin and bones. On discharge day he weighed almost 4.4 pounds! Godbless Joseph astounded us all. On the day he went home he was wrapped in a colorful kanga and breastfeeding in his mother’s arms. All the tubes and supportive devices were gone, leaving a tiny, yet incredibly resilient babe.

Miracles, Losses and Pulling Together

 Volunteer Nurse Chana Schaffer with new mother and her healthy twins

Volunteer Nurse Chana Schaffer with new mother and her healthy twins

By Volunteer Nurse Chana Schaffer

Days at FAME are long. About a week and a half ago I had an especially long day. It started at 7:30AM and ended at 3AM. Our labor ward was full. We admitted a very sick mom and preterm baby who arrived after the mom delivered on her way to FAME. She tried to make it to the hospital for the delivery, but had to stop along the way to give birth.

The baby looked to be about 30 weeks gestation and was cold, blue and barely breathing when he arrived. We put him under the warmer immediately and helped him breathe with oxygen and a resuscitation mask. We put in a nasogastric tube and an IV to give him dextrose. He was struggling. We were able to warm him up to normal body temperature and keep his blood sugar up.

In the meantime we also admitted his mama. We discovered that she had severe pre-eclampsia, explaining her pre-term delivery. It took the teamwork of three nurses and one nurse practitioner to stabilize her. We treated her pre-eclampsia and controlled her blood pressure with a combination of intravenous and oral medications.

The other patients on our labor ward included a woman in active labor, a woman with postpartum sepsis and a blood clot in her leg, a woman with a suspected intra-abdominal pregnancy in severe abdominal pain, and another woman with postpartum sepsis who had a C-section at another hospital and had to have a lifesaving hysterectomy at FAME due to severe infection. A very heavy patient load indeed!

We were short-staffed on the night shift; Mama Mshana was by herself in the labor ward. The level of care that this group of women required was far too much for one nurse. Safi (our Ward Supervisor) came in to help, and so did I. We rose to the challenge and worked as a cohesive team.

At 11 PM we got an admission. Our on call doctor came into the ward with another preterm baby. The mother of the baby had delivered a month earlier at another hospital. The baby looked to be about 28 weeks gestation. They kept the baby in an incubator at the other hospital for a week, and then the incubator broke so they sent mom and baby home. For 3 weeks, the mother did her best to keep her baby alive, finally recognizing she could not do it alone.

This little baby boy was skin and bones. He was barely breathing and gray. We all thought that the chances for survival were low. We warmed him and supplied oxygen, and then we waited. To all of our surprise, he made it through the night! What a resilient little one. The next day we started intravenous dextrose to maintain his blood sugar and continued our supportive care. He was fighting to survive and we would give him every chance possible.

The first preterm baby boy mentioned was in severe respiratory distress throughout the night. Mama Mshana knew that he and his mother would need one nurse assigned to care for them both. She was already caring for the young woman in active labor, so she asked me to stay in their room to provide 1:1 care. I held the baby’s hand and stroked his head when he cried. It was painful on every level to watch him struggle so vigorously to breathe. I wished I could breathe for him to relieve his suffering. He passed away the following night. We supported him physically and with love until he took his last labored breath.

Another nurse, Julieth, had come to our aid at 11 30 PM and so did Kelley, our Women’s Health NP. Between the four of us we were able to provide safe and quality care to all of the patients on the labor ward. In addition to caring for our two preterm infants, we welcomed a healthy baby boy into the world when our laboring mama gave birth at 2 30 AM. This night was another amazing example of the teamwork that happens at FAME.

As exponential growth continues, more nurses are being hired to safely staff the two inpatient wards at FAME. Finding experienced nurses is no easy task. According to WHO statistics, Tanzania has 24 nurses/midwives for every 100,000 people. By comparison, the United States has 981 nurses/midwives for every 100,000 people.

The miracle of this very busy night is our 28-week baby who is defying all odds. He is gaining weight, eating expressed breast milk by mouth, crying loudly, and spending time out of the incubator on his mama’s chest for kangaroo care. He has astonished us all, and I feel blessed to be part of the team caring for him. We may not have all of the advanced technology available in the more developed world, but the nurses and doctors at FAME are moving small mountains in the care they are providing.

When a Team Comes Together....

By FAME Clinician, Dr. Anne Ghati

Sunday mornings at FAME Medical are usually much quieter than other days of the week. But not always. During one of my last night duty rotations, a young pregnant woman arrived very early in the morning, having traveled over rough roads while in full labor. With two of our esteemed nurses at my side, we rushed her into the labour ward hoping for a normal labour and delivery.

In talking with her, it became quickly clear that she had a very complicated obstetrical history, with two previous C-sections, including one during which the baby did not survive. But then she never lost hope.

My heart began to race, as I knew this woman needed an emergency C-section. Just then, while one of our nurses was examining her, the membranes ruptured and there was meconium staining. We had to act very fast. Dr. Mshana was my back up and he arrived quickly, along with Mama Mshana, one of our lead nurses in the Operating Room. With the mobile phone network down in the area, I had to run to get our Anesthetist on call. Because he lives on campus, we were able to race right back.

The nurses were preparing the patient to go to the OR. Dr. Mshana and I scrubbed and the emergency C/S commenced under General Anesthesia. With many adhesions from the two previous C-sections, evidence of a ruptured uterus, and meconium staining, the surgery was complicated. The baby was extracted, but he did not cry and was not breathing. We quickly cut the cord and our Clinical Education Coordinator received the baby and began resuscitation. I believe prayers do wonders so I quickly said one. As we were busy removing the placenta, finally the baby cried! What a nice feeling. Everyone felt happy. The baby's Apgar shot up to 10. He was fine. Two of our nurses took the baby out of the OR and the team finished the surgery. The mother and the baby were saved and we rejoiced.

 

 

 

 

Friday Night Lights

By Women's Health Nurse Practitioner Kelley Brennan

I'm not talking about the near blinding lights and deafening cheers that signal Friday night high school football in the USA but rather the spot-lights in the Operating Room at FAME. Lights that bring just as much adrenaline and excitement, along with possibly even greater significance and life changing results. You see, we've spent three of the past four Friday nights performing life-saving cesarean deliveries. FAME opened its doors for Reproductive and Child Health, including a Labor and Delivery ward on the first of October. Since then we have saved six lives with the ability to perform emergency cesarean sections; something far too many women do not have access to in rural Tanzania.

On Friday, October 10, a woman arrived to see me in clinic, 15 days overdue with her first baby. At first, she simply said she wanted an ultrasound to see when her baby was due. But as I have learned while providing medical care in Tanzania for the past two months, you rarely get the full story upfront. The patients are strong and resilient and they don't want to worry or burden their doctors. It often takes quite a bit of questioning to get down to the real problem. In this case, the baby initially appeared active and full term on ultrasound, but there was virtually no fluid surrounding him. This young mother-to-be also had high blood pressure and protein in her urine, indicating pre-eclampsia, a potentially dangerous condition for mom and baby that can only be cured by delivering the infant and removing the placenta.

The patient was admitted and soon the baby was showing signs of distress. FAME's head doctor/surgeon, Dr. Mshana, and I made the decision to go for a cesarean section. This would be the first cesarean section ever performed at FAME. The patient was frightened, and rightfully so as surgery can be risky business in Tanzania. As Mama Mshana, one of FAME's extremely talented nurse midwives, consoled her, the patient revealed the full story as to why she had travelled several hours from her home in Ngorogoro to be seen at FAME. Shortly after sunrise that morning, she was walking near her home and was charged by a Cape Buffalo. These massive animals can be quite dangerous and aggressive. As this terrified young woman ran for her life and the life of her baby, she fell twice, landing on her swollen pregnant belly. This trauma provided even more of a reason for an overdue baby, lacking enough amniotic fluid, to be in distress.

At this point, the patient was rushed into FAME's operating room, which is remarkably well equipped. You'd almost believe that outside of those OR doors you'd find a large, well funded, stocked and supplied hospital in California or New York or Boston, and not a small, rural hospital in Tanzania. Dr. Mshana, an amazing doctor and surgeon with decades of experience, performed the operation with my assistance and the assistance of his wife, Mama Mshana, who acted as our scrub nurse. We were tremendously fortunate to have both FAME anesthesiologists, Sehewa and Doctor Frank, at our disposal along with Siana, the head nurse, Chana, a nurse volunteer from Washington DC, and Dr. Doug, a volunteer pediatrician from Philadelphia. Under the glowing OR lights, on a beautiful Friday evening, this young woman had the very first cesarean section at FAME. Dr. Mshana and Mama Mshana worked as a well oiled machine; you'd never know it had been a few years since they'd last performed a cesarean section.

This patient was complicated. She'd suffered a trauma on top of being pre-eclamptic; her baby was 15 days overdue and surrounded by almost no fluid, covered in meconium and clearly in distress. After delivering the infant, a baby boy, we noted that the placenta had abrupted, starting to separate from the wall of the uterus and soon the patient was hemorrhaging. Due to the talented and dedicated staff at FAME, along with the availability of necessary supplies and equipment, this young mother and her baby boy survived. FAME is an amazingly special place, that provides tremendous care to all of its patients and saves lives on a daily basis. I can't think of a place I'd rather spend my Friday nights than under the OR lights in the operating room at FAME. It was such an amazing experience to take part in that I've decided to repeat it twice more on the past two Friday nights. I think if I keep this up, attracting the high risk Obstetric patients for cesarean sections every Friday night the staff here just might kick me out.

Three Beautiful Babies

Three beautiful babies brought into the world so far at FAME Medical. The second and third were emergency C-sections. Two have been discharged and one is recovering well in the ward right now. Lots of joy around here.

“I could not get my fill of looking.There should be a song for women to sing at this moment or a prayer to recite. But perhaps there is none because there are no words strong enough to name that moment.” ― Anita Diamant, The Red Tent