FAME’s investment in maternal healthcare services stems from its commitment to supporting pregnant mothers, as childbirth and pregnancy complications are leading causes of death among women of reproductive age, especially women from rural areas (UNFPA). Tanzania's maternal mortality rate remains one of the highest in the world (World Bank).

FAME’s multi-pronged approach to maternal and reproductive health, including our: family planning clinic, prenatal care program with a high-risk clinic and maternal health ward with a special care nursery, aims to improve maternal health outcomes by increasing access to high-quality healthcare services before, during, and after pregnancy. With an average of 700 deliveries per year, FAME continues to offer a tailored intervention to improve maternal health outcomes for underserved women in northern Tanzania.

These are just some of the pregnant women that FAME has supported this year.

Amina*, Age 27. First Pregnancy

Today is Amina’s first-ever visit to FAME. It is also her due date! 

Working as a clinical assistant, Amina recently moved to Tloma to be closer to her new job. As luck would have it, it also brought her much closer to FAME! 

Amina is due to give birth any minute. She is worried, as she attended her prenatal clinics in a small dispensary close to her old home, which is now too far for her to access. She’s come to FAME hoping they will help her, but she is quite nervous.

“Some of my friends have been turned away from some hospitals that don't take it kindly to women showing up to give birth when they haven't done their prenatal classes with them. So I was a bit apprehensive about coming here. I mean, it's my due date today! But I have been received very well, and the service has been great.”

This being her first pregnancy, Amina is extremely scared of childbirth. She has heard horror stories and is concerned about how bad labor will be. 

“I am terrified of labor. I haven't gone through it before, so that's a big worry. The doctors at FAME have explained the process and promised to be with me every step. This brings me great relief. I can’t wait to meet my baby!” 

Emma*, Age 39. Advanced Maternal Age 

“I listened to FAME’s maternal health program over the local radio station. FAME doctors were talking about the services and support available to pregnant women here, and it sounded like a friendship between the doctors and patients. When I got pregnant with my fourth child, I chose FAME.”

Emma is talking about Lumen radio, the only radio station in Karatu that caters exclusively to the area's local residents. FAME doctors have been on this radio more than 18 times this year, talking about everything from diabetes management to surgery to maternal health, focusing specifically on mother and baby health during and after pregnancy. 

“I’m five months pregnant. This pregnancy has been harder on me than the rest; maybe it's my age. I don’t know. What I know is that I have told my husband this is the last child! I loved being pregnant when I was younger, but I am always tired now.”

Emma and her husband agree that the services at FAME have been a great help. 

“We have been coming to FAME for five months now, and in that time, we have received a high degree of quality care that we have never received before. Thank you, FAME.” - Emma’s husband

Catherine*, Age 29. High-Risk Pregnancy 

Every two weeks, Catherine attends the high-risk pregnancy clinic at FAME. Catherine suffers from high blood pressure, exposing her to more complications before, during and after birth, which may also harm the baby. Catherine has experienced this tragically, having had three miscarriages in the past two years.

The FAME high-risk clinic has been monitoring Catherine since she became pregnant. She is currently 36 weeks pregnant and very excited! 

“FAME has brought me to this point! 36 weeks! Can you believe it? This is the furthest I have ever come in a pregnancy! I have been so scared since the beginning; I didn't think I had any hope of becoming a mother. But since I started coming to FAME, they have helped me so much. I would not be pregnant today without FAME.”

Catherine, a teacher, has taken an indefinite leave from her job to focus on carrying her pregnancy to term. The work-life balance stress caused her blood pressure to rise, so she took a break. 

“I’m trying not to jinx it, but I think I will be a mama!” 

Catherine continues her visits to the high-risk clinic. When the time comes, she plans to deliver at FAME. 

*While the patients’ names have been changed to protect privacy, permission was secured to share their photos and story with FAME supporters and to raise awareness of available medical care at FAME Medical.

Dr. Willey with FAME’s radiologist Japhar Hassan, performing an ultrasound.

Dr. Willey and team on morning rounds.

Dr. Willey and Dr. Ken Karanja

Dr. Alicia Willey, an Obstetrics & Gynecology Specialist in Phoenix, Arizona, volunteered at FAME for two months this summer. Dr. Willey is the second volunteer from the Creighton University of Medicine Global Women's Health Fellowship, which maintains a partnership with FAME to send OB/GYN fellows annually to support FAME’s maternal health team. FAME has partnered with Creighton University School of Medicine-Phoenix Global Women's Health Fellowship since 2022. This two-year fellowship program for OB/GYN physicians provides advanced training in the delivery of women's healthcare worldwide through clinical experience, education and mentorship.

Through this partnership, the first volunteer at FAME was Dr. Elyssa Metas, who spent time with us in 2020 and 2021. You could read her reflection on her time at FAME here if you missed it. Dr. Metas is now the Fellowship Director. 

This is Dr. Willey’s first time at FAME. She first heard about FAME from Dr. Elyssa Metas, her mentor. She had always desired to work overseas, and when Dr. Metas told her about FAME, it sounded like the right fit. 

“Dr. Metas was so inspired when she came back from FAME. She talked about the work FAME does and the people it helps. This intrigued me and I decided to come here to work alongside FAME medical staff.”

— Dr. Willey

Once at FAME, Dr. Willey settled in with the Tanzanian medical team. 

“I love everything at FAME! The location, the lifestyle, the flora, the fauna and the people are amazing! Everyday life here is much more rewarding and hands-on than I’m used to at home. At FAME, you get enough time with each patient, allowing you to see the difference you are making by treating them. It is also very stimulating as we sometimes have to problem-solve to complete certain procedures given we have different tools here.” -Dr. Willey 

Did FAME reach the expectations that Dr. Metas had set?

“It was not far from what I expected since I had talked extensively to Dr. Metas, so I knew a lot about FAME, including the types of lab tests available to order.” -Dr. Willey

Dr. Willey has, however, encountered some differences between the medical practice at FAME and in America.  

“In America, doctors must be present for every vaginal delivery, but this is not the case at FAME. I did not anticipate this, but it has been amazing to be involved in vaginal deliveries since getting here.”

— Dr. Willey

Talking about what she likes about the medical practice at FAME, Dr. Willey says that she loves the camaraderie between medical teams and that a single doctor gets to see all the patients in the ward.

“I participate in the ward rounds every morning and have learned much about general medicine since I came here. I have also experienced a different pace of work which I enjoy! I will be better at taking care of my patients now because I’m not only looking at them through the lens of an obstetrician-gynecologist, but I can now review their medicines, or discuss diabetes, hypertension and other disorders much better.”  

“Dr. Metas and I are talking about coming back next year. She has been trying to come back to FAME for over a year and finally got some time off. I plan to bring my 6-month-old baby with me so I can stay a little longer.”

— Dr. Willey

It is these types of partnerships, which provide consistent support year after year, that are crucial for the sustainability of our capacity-building work at FAME. Currently, we have partnerships with the University of Pennsylvania for neurology, Creighton University, Arizona for OB/GYN, Creighton University, Omaha for surgery, and Stanford University for anesthesiology.

FAME’s volunteer program is a rich, collaborative learning experience for our Tanzanian medical team and volunteers. Western-trained doctors, nurses and laboratory specialists from overseas medical communities work side by side with our Tanzanian medical professionals, sharing knowledge and expertise on behalf of patients. As part of our new strategic plan, FAME is now looking to its volunteer program more than ever to build the capacity of our team to align with the most pressing needs in the community.

FAME marks this International Day of the Girl Child by raising awareness and addressing health needs affecting girls and young women, especially their access to healthcare.

In rural Tanzania, where we work, rural girls encounter numerous constraints in accessing affordable, adequate health services compared to girls living in urban areas. Household financial decision-making, disapproval of unassisted travel, long travel times and lack of prioritization of spending on girls' health are just some barriers girls face in accessing healthcare. Due to this, there is a significant value and need to increase interventions in pediatric care in rural Tanzania.

FAME plans to grow its pediatric department over the next five years. It aims to give all children, including young adolescents, safe, effective and timely healthcare for their age and stage of development. This will improve girls' health outcomes and offer much-needed continuity of care.

FAME has several programs that it already runs for girls. Through its reproductive health and family planning program, FAME provides knowledge, agency and resources to enable adolescents to make decisions regarding their reproduction. Despite child marriage being unconstitutional in Tanzania, adolescent pregnancies are common mainly due to poor sexual and reproductive health education. Childbearing increases the risk of maternal and neonatal mortality and perpetuates gender disparities in educational attainment (World Bank, 2022). In the first eight months of 2022, FAME has received nine adolescent pregnancies, the youngest being 14.

Over the years, FAME has been involved in numerous interventions to improve girls' sexual and reproductive health in our catchment area. When the Government of Tanzania rolled out the national HPV vaccination drive two years ago, FAME was instrumental in ensuring that the community HPV vaccination outreach got to not only the school-going girls in our catchment area but also the out-of-school girls. Full immunization against HPV infection reduces the chances of getting cervical cancer.

Despite these interventions, much is still needed to improve girls' lives. Click here to support FAME’s pediatric expansion, which will provide the accessibility of health service utilization among women and girls in our catchment area and help them achieve their dreams! Empowering girls and ensuring they have access to the care they need to lead healthy lives is necessary. 

“I have been sick for a long time. I want to get well so I can return to school. I want to return to school and become a teacher; then, I can build a big house! This is my first time at FAME; we made the long trip because we heard that FAME cures people. I hope that FAME will give me my life back.”

-Saloni*, Age 15

“My 2-year-old son is my life; I care for him daily.  He’s been quite sick the last month, so I’m happy my husband and I could afford to bring him to FAME for treatment. My life dream is for my son to be as tall and strong as his father!” 

-Nataana*, Age 16

“This is my third time at FAME. I had tuberculosis, but I’m happy that I’m now better and can go back home. I do not attend school, but that's okay, as I love my home. My dream is to own a lot of cows someday and get a lot of kids!”

-Nashipai*, Age 17

“I always ensure Naisola goes to school every day unless she is sick, like today. Her brothers always go to school, so why shouldn't she? That’s why we came to FAME; the medicine here always works fast! My dream is for her to do well in school and maybe become a doctor and help our community, as in our village, we have no doctors and have to travel miles to get to one. I would be happy for her to be educated because I know she will have a good life.”

-Mama Naisola speaking on Naisola*, Age 5

*While the patients’ names have been changed to protect privacy, permission was secured to share her photos and story with FAME supporters and to raise awareness of available medical care at FAME Medical.

Sarah* during the interview.

Today is World Mental Health Day, and FAME joins the rest of the world in raising awareness of mental illness and mobilizing efforts to support access to mental health services. 

In northern Tanzania, where we work, the stigmatization and marginalization of people with mental illness are still rampant. Access to mental health services is restricted, resulting from limited healthcare facilities treating mental health, lack of mental health caregivers and lack of funding for tackling these illnesses.

Even though FAME is not a psychiatric hospital, we still get patients with various mental illnesses. For example, this week, we met Sarah* and her daughter Caroline* at FAME’s outpatient clinic. Caroline has brought her 66-year-old mother to FAME because she suffers from high blood pressure. Her mother has also not been herself for a couple of weeks. Sometimes she becomes harsh and lashes out at her little grandchildren, unlike her.  Other times, she sits in a corner alone and talks to herself; other times, she just bursts into tears out of the blue. 

“This is a secret my siblings and I keep. My mother is a somewhat unofficial local leader, considered a big honor, but she would lose this social standing if people found out she talks to herself. If our extended family or neighbors hear that she might not be all there in the head, she will be ostracized. I’m glad that we can say that we came here because she has high blood pressure, so people won’t know we are also dealing with another illness.”

— Caroline*

Cases like Sarah’s are familiar. Dr. Michael Rubenstein has volunteered at FAME since 2013, bringing residents and fellows from the University of Pennsylvania and Children’s Hospital of Philadelphia. He runs the neurology clinic, which conducts neurological clinics at FAME and outreach to FAME’s catchment area dispensaries. This is his reflection, in his own words:

Dr. Rubenstein on Neuro outreach.

From my first visit to FAME in 2010, it became clear that mental health care in Africa was in need. As I began seeing patients with psychiatric rather than neurologic illnesses, I was told:

“You’re the closest thing to a psychiatrist that we have in Northern Tanzania.”

— Dr. Michael Rubenstein

In an article published in The Lancet Global Health in 2018, it was noted that of the 637 articles published in their journal in the last five years dealing with the world’s most economically disadvantaged region, Africa, only 39 articles had explicitly referred to the psychiatric aspects of the disease, and none to schizophrenia. A 2014 WHO mental health survey reported that only 46% of African countries had implemented standalone mental health policies and further noted that the number of Africans receiving treatment for mental health issues was exceedingly low – with a global annual rate for visits being 1051 per 100,000; in Africa, the rate was only 14 per 100,000.  The treatment gap for mental health care in many African countries approaches 100%.

Over the last twelve years of treating patients here at FAME, our neurology group has evaluated and treated countless patients with primary psychiatric illnesses such as depression, schizophrenia, anxiety and bipolar disease. In all these cases, our assessments have been thorough. Our treatment recommendations, most often consisting of medications indicated for these conditions, have provided relief from their symptoms, and patients have returned to see us on subsequent visits. Both patients and families have benefitted from our care. However, it should be noted that we are neurologists, not psychiatrists, and we provide this care without adequate mental health services or healthcare workers.

Though our impact can be significant, it should not serve as a formal substitute as it detracts from our mission to improve neurologic care within Tanzania. I do recall one particular patient, who I had first seen several years ago with the complaint that he was having difficulty focusing and sleeping and, over the last year, his wife had left him, and he had lost his children. He was a college graduate with a good job and was distraught over his plight. He had bipolar disorder for many years and improved dramatically after placing him on the appropriate medication regimen. He has continued to follow up with us every six months and remains fully functional and improved. Though his case was a success story, I am certain countless other patients in need of similar care are not as lucky to make it to our clinic for treatment and continue to suffer in silence.

-By Dr. Michael Rubenstein.

FAME recognizes that the mental health and well-being of many health, social care and frontline workers have been affected by the COVID-19 pandemic, and our medical staff is no different. Work stress is also a possible trigger of psychological problems. 

The FAME wellness club and the football team have been a great source of stress relief for employees and help reduce anxiety. FAME has strengthened our systems of communication, empathy and assertiveness to better support its staff not only during times of crisis but also during day-to-day operations. All this ensures that FAME has a healthy and engaged workforce.

FAME’s Director of Operations, William Mhapa, leads the FAME football team in a tournament

*While the patients’ names have been changed to protect privacy, permission was secured to share her photos and story with FAME supporters and to raise awareness of available medical care at FAME Medical.

From Left: Dr. Msuya Walii, Dr. Elyssa Metas and Dr. Anne Ghati

Dr. Metas with FAME’s Director of Operations, William Mhapa

FAME has continually enhanced its volunteer program through the development of strategic partnerships. These partnerships, where both parties learn and grow together, build capacity and give the FAME team access to additional skills, resources and knowledge. 

One of these important partnerships is with Creighton University, Arizona. Since 2020, Creighton University has sent OB/GYN fellows to join us at FAME for two to three months to build the capacity of our team. 

Dr. Elyssa Metas, an obstetrician and gynecologist in Phoenix, Arizona, was our first-ever fellow from this partnership. Here, she reflects on her past stay at FAME and its impact on her.  Read her reflection below.

My journey with FAME started in January 2020. After nearly 3 amazing months, I, unfortunately, had to cut my first time at FAME short due to the pandemic. Over the course of the last year, in the face of all the unknown, I continually asked myself when I would be able to return. When I felt safe to travel again, I jumped at the opportunity to come back to FAME.

I did not know what to expect when I returned to FAME. Although there had been communications regarding patient care and zoom lectures during that year, it was hard to know what it would be like actually being there. My anxiety was alleviated very shortly after my arrival. FAME did not diminish but rather seemed to have flourished in the face of the pandemic. The doctors, nurses and support staff, despite the adversity the year had brought, continued to grow and improve. I really saw this on the Maternity Ward.

External fetal monitoring was something very new when I first came to FAME. After a year of hard work and learning, the nurses honed their skills in interpreting fetal heart tracing. One case, in particular, stands out in my mind. One of the nurses alerted me to abnormalities in the heart tracing that did not resolve with the usual resuscitative measures. With further monitoring, it was evident the baby was in distress and needed an emergency cesarean section to help save its life. The team recognized the urgency of the situation and worked together to bring the mother to the theater. I was so impressed by how fast everyone assembled to take care of the mother and baby. The baby was delivered happy and healthy and discharged home with the mother. This was in large part to the early recognition of fetal distress and how well the team worked together.

Another area where I saw definitive improvement was the effort to safely reduce the cesarean section rate. It starts with how the nurses and doctors work together as a unit to manage labor. They utilize appropriate interventions to help facilitate vaginal delivery. There also seems to be a constant review of cases from the daily rounds to the larger quarterly meetings. I was fortunate enough to participate in one of the quarterly meetings where all the cesarean sections during that period were reviewed. It was great to see the level of participation amongst the doctors during the meeting. You could really see the desire to learn from past cases to see what could be changed for future ones. It is evident that this is an area that will continue to improve.

“The time I spent at FAME will always be incredibly special to me and really has been one of the greatest honors of my career. I know this will not be goodbye forever but only for now.”

— Dr. Elyssa Metas

*Part 2 of the FAME Creighton University partnership will be published in two weeks. It will feature a piece by Dr. Alicia Willey who just finished two months volunteering at FAME.