Volunteer Entries

It’s who we are. It’s why we’re here.

 Nurse Siana Nkya and Safi Mbwambo in the OR

Nurse Siana Nkya and Safi Mbwambo in the OR

By Volunteer Nurse Practitioner Brad Snyder

It’s being a chameleon, becoming whoever the person you’re with needs you to be. It’s waking up everyday knowing that undoubtedly you will change a life and in return have yours changed. It’s pushing yourself to new limits, frequently on the edge of comfort as you try your best to fix and heal the person in front of you. It’s brainstorming at the bedside with a team of gifted clinicians trying to figure out the cause of a man’s internal bleeding as his blood counts continue to drop. It’s checking on a 1 day old then suddenly grabbing the oxygen and performing a resuscitation when he changes without any warning. It’s coming together in a moment’s notice and becoming one skilled unit, fighting the battle to keep a little life alive. It’s winning the battle.

It’s watching a doctor’s skill as he diagnoses cardiac anomalies with an echo or saves a woman from bleeding out during a complicated C-section. It’s opening books and crunching numbers as you try to solve a medical mystery alongside other uncertain fighters pulling deep on dusty knowledge and experience. It’s coming to a solution while vulnerably admitting that you’re not 100% certain of this plan, but it’s the best we can do with what we have. It’s feeling the slight relief of a definitive partnership amidst ambiguity and uncertainty. It’s seeing a nurse take peanut butter and a spoon into the room of a patient with severe burns and watching her patiently give one spoon at a time. It’s looking into her  determined eyes as she says, “I know I can’t fix the burns but this is what I can do, so I’m doing it.” It’s feeling a rush of compassion flow through your body.

It’s a nurse’s poignant assessment as she picks up danger signs in pregnancy and prevents a catastrophe. It’s giving a woman a chance to be a mother, one of life’s greatest gifts. It’s a counselor gently comforting a suicidal woman buried deep in a cloud of depression with the fear of no way out. It’s giving her a glimpse of light and the possibility that this doesn’t have to last forever. It’s walking into a room as a midwife with experience twice as long as you’ve been alive turns the breech baby of a woman in active labor. It’s hearing the cry of a healthy baby and taking a collective sigh of relief. It’s feeling grateful to have such skilled, passionate people on your team.

It’s hearing the gentle humming of a mother who just lost her 6-year old to a battle against sickle cell disease. It’s walking outside with a father as he holds back tears surrounded by family and friends and giving him a safe space to feel whatever he needs to feel. It’s being a quiet presence as he sobs in your arms in a moment of utter grief and disbelief. It’s realizing that pain like this can only be felt by others who have experienced such a profound loss.

It’s staying up through the night diligently monitoring two premature babies as they struggle to survive in an incubator instead of the safety of their mother’s womb. It’s reading neonatology articles, emailing colleagues and adapting guidelines to what we can do here. It’s watching mothers give their babies life-saving breast milk to keep their tiny bodies growing. It’s praying that it all works out. It’s going home and preparing to wake up and do it all over again tomorrow. It’s holding onto hope. It’s who we are. It’s why we’re here.

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

A Shuka, A Goat and Two Chickens

 Martina presents Dr. Duane with a Shuka

Martina presents Dr. Duane with a Shuka

By Nancy Allard

Thanksgiving came a little early this year at FAME. One of our former patients paid us a visit. Some of you may remember Martina, a patient who came to FAME in 2014 with second and third degree burns over 35% of her body, some already infected. She ended up spending the next 342 days in FAME’s inpatient ward fighting for her life and being cared for by our team. Well, Martina got word that visiting surgeon, Dr. Duane Koenig, had returned to FAME Medical for another volunteer stint and she wanted to personally thank him for the central role he played in saving her life. You see, Dr. Duane is the one who brought skin grafting to FAME Medical, donating the equipment and training his Tanzanian colleagues in the procedure.  He personally performed hours and hours of grafting on Martina and was very often at her side during the multiple dressing changes and debridements that followed.  And in his face she saw someone completely and absolutely unwilling to give up on her. By the time Martina was finally discharged, Dr. Duane had already returned home to Nebraska. Having graciously thanked the others involved in her care, she still had not been able to “properly” thank the man whose face gave her hope thru her darkest moments, until two weeks ago when she and her husband received word of his return.

 Martina and her husband gift Dr. Duane with two chickens

Martina and her husband gift Dr. Duane with two chickens

How to thank someone who saved your life?  How about a shuka, a goat and two chickens -- that was Martina’s gift to her friend Dr. Duane. And his response, “Thank you. I would have gone to hell and back for you. I don’t need anything. My reward is to see you beautiful and smiling.” It was an extraordinary moment, one filled with joy, smiles and laughter - a magical moment between a patient and a doctor who share a special bond for life. 

Happy Thanksgiving to our generous supporters and partners, who continue to pave the way for powerful moments like these between patients and doctors at FAME Medical.  We are forever grateful to be sharing this journey WITH you.

 

Helping Those With Chronic Disease At FAME Medical

 Dr. Joyce and Rizwani at work in the lab&nbsp;

Dr. Joyce and Rizwani at work in the lab 

by Volunteer, Dr. Joyce Cuff

We continue to see a wide variety of patients at FAME Medical. Not only are there lots more patients coming to FAME, they now range from the very healthy and just checking category, to the comatose and at death's door group. I rejoice in the increasing number of patients being monitored for chronic or life-style diseases. For the most part, these are otherwise healthy people whose clotting time is being monitored to prevent stroke or other cardio-vascular complications, whose blood sugar needs to be and can be controlled, whose lipids are being monitored and controlled, or whose thyroid levels are monitored periodically to keep them functioning well. These are conditions that, even 5-10 years ago would remain unmonitored and possibly even undetected, as many are asymptomatic until you're in real trouble. Being controlled and being monitored before an incident occurs increases the likelihood that they will not become clinical or critical. Of course, with so many more patients in dire straights when they arrive, we are unable to save them all. That is a harsh reality that cannot be changed. But the miracles continue to abound and astound.

The Long Road to Health

By Angel Hertslet

Six-year old Allan came to FAME a few weeks ago with a serious medical issue: he could not swallow food.

Most of us count eating food as one of the great joys in life, and how easy it is to take it for granted. Although Allan greeted the medical team with smiles and laughter, his situation was grave: he weighed only 22 pounds (10 kilos), the weight of a healthy one-year old. To complicate things, his small malnourished body was suffering from chest rattling pneumonia.

FAME Medical treated Allan for his pneumonia and started him on nutritional support. After a few days of charming the doctors and nurses, he was stable enough to return home. Yet Allan’s esophagus was still constricted and only a complex surgery could address this congenital problem. FAME Medical began the search for someone who could operate on Allan, sending emails to the extended family of FAME supporters.

Luckily, a few people were well positioned to help him. The first was a doctor in Arusha who had seen Allan before and knew of his need for esophageal surgery. A specialized pediatric surgeon from Finland came to volunteer at her hospital, so she called FAME and invited Allan to return for surgery. The second was an anonymous donor, well aware of his situation, who committed to helping him get the best care possible. It would be remiss not to mention Brad, the nurse practitioner at FAME, and Angel, the social worker, both of whom took on the responsibility of traveling with Allan and his mother to Arusha to support and advocate for the family. I also traveled to Arusha, and serendipitously, had the same blood type (and arguably the same attitude) as Allan: B positive. His mother Mary and I both donated in case he needed a transfusion during the procedure due to complications.

In some cases, an esophagus can be dilated with a balloon or by other means (my grandmother recently had such a surgery), but after laparoscopically exploring Allan’s esophagus, it was clear it could be addressed only through removal of the strictureand resectioning the esophagus to the stomach. The FAME team reviewed possible outcomes with the specialist and guided the decision that it was too dangerous to perform the partial esophagectomy on his compromised body. He needed to build strength to endure the removal of the portion of his esophagus. Operating in his malnourished state could have lead to the worst outcome of all.

As a means to an end, the surgeon inserted a feeding tube, or G-tube, into his stomach, allowing for nutrients to bypass his uncooperative esophagus and enter his stomach directly. I spent some time with Allan and Mary post-surgery and felt such compassion for them. He was clearly in a lot of pain and his mother was doing all she could to soothe him. This feeding tube, while clearly an essential step to improving his nutrition, I knew would be a big adjustment for both of them.

A few days later, Brad and I joined up with the team at Rift Valley Children’s Village (RVCV) to check up on Allan. Another conspiring actor, RVCV, in addition to contracting FAME to provide medical care to the orphanage and community thru a mobile medical service, also provides daily health support, follow-up and education to the community, where Allan and Mary live.
The RVCV nurse, social worker, and nutritionist worked alongside Brad and I to educate Mary about how to feed Allan through the G-tube. You can imagine the joy on all our faces when with our help, Mary mixed together the ingredients to make F-100, a therapeutic milk designed to treat severe malnutrition, and fed it to Allan through the G-tube. “Nice job!” Allan exclaimed in Swahili, and offered his mom a high five.

The right to a healthy life may be universal, but the road to getting there certainly isn’t. Allan isn’t healthy yet, but his future is looking much brighter. He has a short-term solution that is allowing him to properly gain weight and build strength for the first time in six years. He has RVCV within walking distance, and FAME Medical a short drive away. Most of all, he has his dedicated mother who so demonstrably loves him.  She is doing everything in her power to nurture Allan to health.

At some point in the next year or two, Allan will be strong enough for a life changing surgery. He will wake up groggy in bed, free of his G-tube, with his mom nearby. He will take a few weeks to heal. And then, he will sit down to the first proper meal of his life. May the tears of joy – and not of hunger – flow that day.

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.

The Strength in What Remains

 Dr. Michael with a little patient, Photo by Ali Mendelson

Dr. Michael with a little patient, Photo by Ali Mendelson

By Neurologist, Dr. Michael Rubenstein

I am taking today's blog title from an amazing book by Tracy Kidder about a young medical student who survives the genocide in Burundi to find himself in the United States. It's a true story and so as not to give away too much I will suggest that you find a copy and read it. The inspiration for today's blog, though, is another amazing story of strength and hope here in Northern Tanzania.

Our very first patient of the day was a young woman who had recently been diagnosed with epilepsy and was on a medication that she was not taking on a regular basis. Thus, she was continuing to have seizures. After taking our history and examining her, though, we had some concern for the type of epilepsy she had and felt that an EEG would help to sort it out as the medication one uses is often dictated by the type of underlying epilepsy the patient has. We brought her over to the ER which is serving as our makeshift EEG lab for the time being and the epilepsy team hooked her up for a study. She was patient No. 1 for this groundbreaking technology at FAME. Amazingly, she had exactly the type of epilepsy that IS NOT well treated by the medication she was taking and she was converted over to a medication more effective for her condition. In fact, the medication she was on can sometimes worsen seizures for patients with her condition. This could certainly make the difference between well controlled and poorly controlled epilepsy which would make all the difference in the world for this young woman.

We saw an early tremor dominant Parkinson's patient who we had not seen before - Dr. Thu was incredibly excited since she will be going into a movement disorder fellowship next year and this was right up her alley. We saw another stroke patient who I first saw in 2011 and continue to follow up with on a regular basis even though he has continued to do well. The hardest thing here is to get patients to remain on their long term medications, though, as it is just something they aren't used to doing. We had wanted him to remain on aspirin but he had unfortunately stopped it several months ago after his prescription ran out. It is not due to non-compliance, or lack of adherence as they now refer to it, but rather that it's just something that isn't build into their culture at the present time. We'll continue to work on that.

So now for the story that inspired the title for today. A woman was brought to FAME today by her friend and eldest son. She is 47-years-old and the single mother of five children and the primary caregiver for her elderly mother. One year ago, during the night and for no apparent reason, people came into her home and threw acid onto her face. Those responsible have never been caught and there was no clear motive to suggest why it may have happened in the first place. She spent two days in a local dispensary (about three hours from FAME) before they realized that she needed more extensive care. She was then transferred to another hospital where she spent only three days. Antibiotics and bandages were applied and she was sent home. When she arrived home she found that many of her possessions there had been stolen. The acid has disfigured her face to such a degree that she has lost both of her eyes and is now blind and all that remains of her nose are two small holes for nostrils.

Despite this horrendous injury and disfigurement, she has persevered and has a remarkable attitude. When asked about any sad thoughts, she does admit to some concerns as to how she will continue to care for her children and her elderly mother, but says that she has accepted what has happened to her and is ready to move on. Her only complaint to us was a minor headache. She was an incredibly lovely woman and when she spoke it was quite easy to forget her disfigurement or the ordeal that she had been through. At the end of our visit, she asked if she could have a photo of her with Thu and myself. I think all of us wondered if we would have that amount of strength had we been put through a similar situation. And, almost to add insult to injury, we found today that she also has diabetes as her blood sugar was extremely elevated and that this will also need to be dealt with. As I walked beside her to the lab for her blood work, I could feel the strength and livelihood emanating from this woman who made me realize that in the depth of our struggle for survival, there are always those unlikely individuals who have demonstrated an even superior strength to have risen from further depths and will always give us eternal hope that we may do the same. It is these unlikely encounters that remind of us of our internal strengths. 

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.

Shedding Mud

 Chana with little patient on discharge day, after a very long healing process

Chana with little patient on discharge day, after a very long healing process

by Chana Schaffer

It had just rained.  My morning walk was weighted with layers of thick red mud stuck like glue to the bottoms of my sneakers.  I had been at FAME for just over a month and I could feel my inner pace of life slowing with every sunrise and walking meditation each morning. The heaviness of my life in the U.S. seemed to lift with each layer of mud shed.  It would build, one, two, three inches thick on my heels, and I would excitedly wait for the step when it would all fall off and I would feel 10 pounds lighter.  What a relief.

Every day at FAME was different than the last.  The anticipation and unknown was similar to that which I experienced working in the Coronary Care Unit (CCU) at home.  Added cultural and language differences made it even more interesting and challenging.  I had already learned so much in such a short period of time; yet I had only scratched a miniscule area of the surface.

It was my last day and I was working in the ward with Safi, one of the many amazing nurses employed at FAME.  We admitted a young woman who was very lethargic with a blood pressure that is considered “incompatible with life”.  Dr. Luigi informed me that she had a large pericardial effusion- fluid accumulates in the sac surrounding the heart, putting pressure on the muscle and making it difficult for the heart to beat properly.  Dr. Luigi asked me if I knew how to do a pericardiocentesis- a needle is used to puncture the sac surrounding the heart and a catheter is thread over the needle so that the fluid can drain into a bag.  This procedure relieves the pressure and is often lifesaving.  In addition to the dangerously low blood pressure, the woman’s heart started to show signs that it was giving up.  Her heart rate would “brady down” (become very slow) and then speed up again.  Her heart was threatening to stop.  I knew that if we didn’t do something heroic and fast, the woman would die. 

Dr. Luigi and I found Dr. Frank and told him that we had a patient that needed a pericardiocentesis.  Dr. Frank heard the urgency in our voices, took one look at the worry on our faces, and came immediately to our aid. I have watched and assisted with this procedure many times in the CCU, so I thought setting up would be easy.  The nurses and I brought the crash cart into the room, gathered the sterile supplies and the ultrasound machine…but where was the pericardiocentesis tray?  It was time to get creative.  FAME has a lot of medical supplies available and at hand, but some specialty items are not readily available.  Everyone mobilized.  When something unfamiliar is happening at FAME, everyone (both nurses and doctors) is ready to step up to the challenge, learn quickly, and contribute any skills and expertise he or she has to offer.  The teamwork and sense of community never ceased to amaze me.  I felt so blessed to work side by side with such intelligent, resourceful, and caring individuals.  I always felt like I was learning far more than I was contributing.

With many hands at the bedside to help, Dr. Frank successfully performed a pericardiocentesis and drained almost 1200 ml of fluid that was compressing our patient’s heart.  The patient’s heart rate was still intermittently dropping, and the blood pressure remained dangerously low.  We began administering life saving medications, and I taught the nurses how to mix and titrate them to support the patient’s blood pressure and heart function.  It was a long night.

The nurses rose to the occasion and provided a high level of ICU care that was new to them.  Everyone worked together and supported each other to keep this woman alive, and we succeeded.  I was in partial disbelief when I walked into her room 3 days later (I came back to visit with my dad during our safari travels) and she was sitting up at the side of the bed talking to her husband.  The cardiac supportive medications had been weaned off, and the drain was removed.  The joy that I experienced after witnessing her recovery was unparalleled.  I knew that my knowledge and skillset, paired with unending support from my FAME colleagues, helped to save her life that first night. 

My time at FAME was profound.  The environment demanded self-reflection and growth in a beautiful way.  I was outside my comfort zone of fancy cardiac ICU monitoring and toys, immersed in a new culture, and trying to understand an unfamiliar language.  I was helping to care for patient populations very unfamiliar to me (i.e. burn victims, children, pregnant woman etc.).  I could feel the layers of self-doubt and hesitation shed with each passing day.  I realized that everyone was doing his or her best to provide excellent healthcare to an amazingly resilient community in need.