Nailantoi

Nailantoi poses with the girl in Ward 1.

There’s an African proverb that says it takes many people (referred to as “the village”) to provide children with a safe, healthy environment. In northern Tanzania, parenting is more collaborative than individual and a child's upbringing belongs to the community regardless of the child's biological parents. These communal societies have shared values for raising children, thus making it a collective social responsibility.

This story of solidarity and collaboration in a community in our catchment area proved that the proverb is more than just words but a common practice. It's a story of a supportive community coming together to help a sick child and her family. 

Nailantoi* is a 46-year-old businesswoman from a village 100 miles from FAME. She has been admitted to FAME’s inpatient ward for the past five days with a sick child that is not hers. She is not a friend of the child’s family or a relative. She didn't meet them until seven days before she came to FAME. 

“I was walking home from my shop one evening when I saw a man and a little girl sitting outside our local clinic, which was now closed. They were unfamiliar to me, but they were clearly distressed, with the father pacing up and down and the little girl crying. I approached them and the father told me that he had come in the morning to bring his sick daughter to the hospital and the doctor had asked him to bring her back every day for an eight-day injection. Their home was 40 miles from the clinic, with poor transport making it impossible to go back and forth for eight days. He also had no money to pay for a place to stay, so I invited them to my home.”

— Nailantoi

The father and daughter lived at Nailantoi’s house for seven days. The man would walk his daughter to the clinic from her house every day, a five-minute walk.

“On the seventh day, I told the father that I had to make the long trip to Karatu to get new stock for my shop, but they were welcome to stay and finish the injections. However, it was clear that his daughter’s condition was getting worse. Her face was swollen and she regularly cried in pain. So when he asked if I could take her with me to Karatu and take her to a hospital, I immediately accepted. In my culture, a child does not belong to the parents but to the village, so it is my responsibility just as much as the parents to ensure she is well.”

— Nailantoi

Nailantoi had been to FAME three years ago when her daughter was diagnosed with pneumonia and a friend recommended FAME. She and her daughter had made the long trip to seek treatment and were happy with the quality of healthcare they received. This experience made Nailantoi confident that FAME could help the little girl. 

Once at Karatu, Nailantoi brought the girl to FAME first as she thought it would be a quick visit to pick up medication. She planned to go to the market that afternoon to buy goods for her shop and return home on the evening bus. Sadly, this was not to be. 

At FAME, the girl was diagnosed with Kwashiorkor, a severe form of malnutrition. She weighed  9 lbs at three years old. She had swelling (edema) that had started on her legs and spread to the rest of her body, including her face, resulting from malnutrition. She was also diagnosed with pneumonia. The doctors recommended that she be admitted to Ward 1 for immediate medical intervention. 

 FAME’s Dr. Ken Karanja examines the girl.

“I was shocked when they told me the child had to stay at FAME. They said she was sicker than we thought and needed close monitoring and treatment. I was scared she could die as only very sick people sleep in a hospital. Without any doubt, I had to stay with the child, so I canceled my afternoon shopping trip. I called home to tell them I won’t return but would be home the next day. I didn’t know we would be here for more than one night. Today is day five.”

— Nailantoi

Nailantoi is happy that the girl is showing significant signs of improvement after just five days. The FAME team has her on a special formula for malnutrition, antibiotics and vitamins, among other treatments. According to FAME’s Pediatrician Dr. Elissa Zirinsky, they expect the girl to stay in the inpatient ward for at least another week. First, they need to fight the edema and then they can work on getting her to gain weight.

Nailantoi calls home while on a walk with the girl.

“I am happy she is doing well. Sadly, I can only stay here for another two days. Her mother just had a baby three weeks ago, making it impossible for her to come. The villagers back home are looking for someone to stay with her when I leave. My shop has already been closed for five days and I need to return before my customers move on to another shop! Every day when I take her for a walk around the hospital, I call my family to see how they are doing. My youngest is only five years old and can be a handful, but my husband tells me that our families and neighbors are helping him care for our six children, so I know they are in good hands. I’m happy that others support my family as I support this child! The FAME staff has also been very supportive of us. They explained the course of treatment and involved me in the decision-making. I’m confident that when I go home, I can explain in detail what is wrong with her and the kind of treatment she is getting. Thank you, FAME.”

— Nailantoi

*While the patient’s name has 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.

Dr. Zirinsky doing the rounds with FAME doctors and nurses in the morning.

Dr. Zirinsky leading one of the morning training sessions.

And another one! FAME never stops learning with Dr. Zirinsky around!

With Dr. Adam on the morning rounds.

There is a feeling I have these days as I walk around campus that I am in the right place at the right time. I first met Dr. Frank and Susan over 15 years ago. At that time, I was a recent college graduate volunteering at the Rift Valley Children’s Village, an organization closely associated with FAME. The FAME team ran mobile clinics from the Children’s Village once or twice a month, and I helped in any way I could: taking vital signs; transcribing medical histories; or organizing the hundreds of patients waiting to be seen every weekend. I have fond memories of meals together as a team after long clinic days and many evening conversations about life and medicine with Dr. Mshana (one of FAME’s first doctors) as we watched children play soccer. Most of all, I remember being moved by the many ways the team treated and comforted a whole community of people. These first experiences with FAME nudged me towards medicine. 

Dr. Zirinsky and FAME’s Nurse Siana Nkya in 2007 at one of FAME’s mobile clinics.

By the end of that year, I decided to go back to school for my pre-medical requirements. It dawned on me recently that I grew into a doctor as FAME grew from mobile clinics into a hospital. I would come back to FAME and the Children’s Village for short visits whenever possible but always hoped I’d be able to return for longer. I eventually completed my training in pediatrics and infectious diseases just as FAME was finalizing their strategic plan to expand pediatric care and services. I joined the team as a pediatrician in September. Together with two pediatric-focused physicians, Drs. Ken and Joselina, we are turning our attention towards the care of premature infants, preventative care for well infants and children, and protocols and close follow-up for our sickest inpatient children.  

Dr. Zirinsky and FAME Social Worker, Kitashu Nganana speak to a patient.

There’s a real joy in returning to a place you know and love and being able to care for the children of that community. Almost every day I am surprised by a familiar face waiting on the benches outside the clinic - a young adult I taught in kindergarten 15 years ago, a friend’s mother bringing one of her grandchildren for vaccines, the child of my favorite shop owner. I’m also lucky to work alongside old friends. I’m greeted every morning by Mary, the head receptionist and one of FAME’s first employees, who feels like family. I love sharing and discussing patients with FAME’s first nurses, Safi and Siana, whom I’ve known since mobile clinic days. I look forward to lunch everyday with close friends from the Children’s Village now working at FAME. 

There is a strong spirit of curiosity, collaboration, and generosity that permeates through all departments here. Conversations about complicated patients involve a multidisciplinary team of people with diverse skills and expertises. There is a universal willingness to go to great lengths to care for patients and their families. Though the work is challenging and the patients are often quite sick, I think this spirit keeps everyone moving forward. As I write this from the ward after morning rounds, I’m watching the charge nurse on the phone with someone in town, conspiring to find a pair of shoes for a child admitted with severe malnutrition who needs to start walking around but has no shoes. I have no doubt the shoes will be here within the hour and the child will be shuffling around the ward in no time. 

25-year-old Joseph* is back at FAME to pick up his medication. Joseph was admitted for two weeks at FAME in November, suffering from severe tuberculosis (TB). He first came to FAME in March of this year, where he was first diagnosed with TB. He was counseled and given medicine. 

“As much as the doctors and nurses emphasized the importance of taking all medication at the right time and day and coming for a refill while I still had some pills left, I didn’t take it seriously. I felt a bit weak when I came to FAME, but this went away after taking medicine for a few weeks. So I stopped taking the medication and returned to work.”

— Joseph

Several months later, Joseph was working in Nairobi, Kenya, when he got terribly sick. 

“I was so sick. I couldn’t breathe, I was coughing and I had chest pains, was weak and could barely stand up and my body was hot like I was boiling from the inside [fever]. I was sure I was going to die and since I didn’t want to be buried in a foreign land, I struggled to get home.”

— Joseph

Joseph’s family lives in Lake Natron, 100 miles from FAME. When he got home, his uncle took one look at him and drove him to FAME. 

“I was resigned to my fate at this point. I knew that death was inevitable. My uncle said he was bringing me back to FAME, but I was too weak to fight him. I didn't see how FAME or any other hospital could help me. The journey was long and uncomfortable and that's the last thing I remember.”

- Joseph

Joseph was received and put in isolation at FAME, where he was treated for ten days before moving to Ward 1. The FAME staff battled to save his life. 

“ I am so grateful to FAME. They did the impossible and brought me back to life! They took very good care of me. They were not harsh or annoyed with me because I had not followed their instructions the first time. They treated me with care and love. They became my friends. They calmly made me understand that I endangered my life and that of others by ignoring the doctor’s orders. I have since returned to FAME three times to pick up my medication and I’m now taking it exactly as the doctor prescribed. Every time I come here, I’m very happy! FAME is home.”

— Joseph

Joseph (left) says hello to the nurses, who,are delighted to see him! Nurse Hosiana Zephania (right) and Nurse Sarah Kimaro are especially ecstatic!

“When Joseph came to FAME, he was very sick and had given up. He thought he would die. Joseph could not believe it when he got better and could return home. Whenever he comes for his medication at FAME, he always comes to Ward 1 to say hello to everyone! All the nurses know Joseph and are always happy to see him. Joseph is always smiling when he sees us! We are very proud of him!”

— Ward 1 Supervisor, Hosiana Zephania

Joseph has since referred one of his friends to FAME, who suffered from TB and diabetes. FAME treated his TB successfully and is now helping him manage his diabetes through the diabetes clinic. 

“I tell everyone who will listen how serious TB is and if they suspect that they might have it, they should go to the hospital immediately. TB treatment might be long [6-12 months], but it's worth it. Nobody has to die from this disease.”

- Joseph.

In collaboration with the Tanzanian Government through the National TB and Leprosy Programme (NTLP), FAME treats TB patients in our catchment area. This year alone, we have had 103 TB cases diagnosed at FAME,

According to Dr. Jacob Olekeiya, FAME’s TB and HIV Coordinator, cases like Joseph’s are not uncommon. Some TB patients do not take their medicine as prescribed, despite the counseling and education they receive at FAME. Some refuse to accept or take the disease seriously, downplaying its effects. For others, cultural beliefs play a part and they claim to have been bewitched and a quick visit to a witch doctor will fix everything. These patients are likely also to have HIV and see the two diagnoses as the crafty work of dark forces trying to hurt them. However, HIV weakens the immune system, increasing the risk of opportunistic infections such as TB. For these patients, continued counseling, support and patience go a long way.

For some patients living in far-to-reach areas where distance, transport and money are a problem, taking medication as prescribed can be a challenge as they cannot come to pick up their medication easily. For these patients, FAME writes a referral letter to their local clinic and regularly follows up with these centers to ensure they are still picking up their medicines. 

Joseph (left) talks to Dr. Emmanuel Mbilinyi, one of the doctors involved in his care.

However, it's not all bleak! 

“Most patients follow doctors’ orders and are cured of TB. They then empower their communities with information about this disease and the need to seek quick treatment and follow all the instructions given by the doctors to the letter.”

— Dr. Jacob

FAME does not provide care to only patients diagnosed in our facility; we also receive visits from patients who have been diagnosed elsewhere but come to FAME for their medication and support. These types of visits are up 33% from last year.

“FAME is fortunate to have the government's support and collaboration in the fight against TB. Most TB cases at FAME are pulmonary TB which involves the lungs, usually taking six months to treat. Sometimes we see cases of extra-pulmonary TB (EPTB) involving the lymph nodes and abdomen, which takes 8-12 months to treat. The free TB medication from the government has been a game changer in ensuring that everybody has access to TB treatment despite where they live and their economic standing.”

-FAME’s TB and HIV Coordinator, Dr. Jacob Olekeiya.

*While the patient’s name has been changed to protect privacy, permission was secured to share his photos and story with FAME supporters and to raise awareness of available medical care at FAME Medical.

FAME celebrates International Volunteer Day! As an organization dedicated to learning, education and capacity building, FAME’s volunteer program is crucial to our mission. Built on a foundation of collaboration, volunteers work hand in hand with the FAME team to gain local knowledge while also providing new ideas and approaches.

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 of the patients and communities we serve.

During the pandemic, FAME’s in-person volunteer program was put on hold. Instead, we connected with volunteer specialists from around the world via zoom. With travel resuming in 2021, FAME was able to host 22 volunteers last year across various specialties, including infectious diseases, internal medicine, nursing, neurology, OBGYN, pediatrics, radiology and surgery. In 2022, this number has continued to rise, and so far, we have hosted XX volunteers this year. 

Here are the stories of three volunteers who are at FAME right now.

FAME’s Volunteer Voices 

Dr. Gary Nichols, MD, Pediatrics Specialist

Dr. Gary conducting a training for the doctors.

While volunteering with a disaster response team following Hurricane Harvey in 2017, Dr. Gary met FAME volunteer Dr. Carolyn Apple. They had been assigned to work in the same response team in Texas. Dr. Gary mentioned to Dr. Apple that he had previously volunteered at a hospital in northern Ghana and was hoping to return to Africa. She enthusiastically recommended FAME and six months later, Dr. Gary first arrived at FAME.

In 2022, Dr. Gary returned for his fifth trip to FAME. 

“Having worked at many medical sites around the world, I was very impressed with FAME. Everything: the housing, the volunteer coordinator, the different clinics, the hospital, the staff and the overall mission, was among the best I’d experienced. Everyone was so welcoming! The commitment to education and staff/patient welfare was exceptional. And, of course, the Ngorongoro district is so beautiful.”

— Dr. Gary

Dr. Gary describes working with the Tanzanian medical team as “a two-way street.”

 “I have learned as much from them as they have from me. They make volunteering at FAME a special thing. It's definitely one of the highlights of being here.”

Dr. Gary explains that the morning education meetings where he had to teach were initially slightly intimidating. However, that went away when he realized that everyone was genuinely interested in learning and was able to teach about common pediatric issues. 

“I’ve discussed various issues such as pediatric orthopedics, urinary tract infections and malnutrition. The malnutrition talk has led to the development of a FAME malnutrition project with young children in the Karatu and neighboring districts, championed by Dr. Ken Karanja. The project will be launched in January 2023”

— Dr. Gary

“Since my first visit, FAME has built the maternity and newborn building. This has provided much-needed space for new moms and their newborns. The staff has also grown steadily.  Seeing existing staff grow in their skills and the young doctors join the team has been exciting.  The new medical officers and doctors are so eager to learn! It’s a real privilege to contribute.”

Dr. Gary has advice for would-be volunteers: 

“Do it and here’s why! I frequently encourage friends to consider FAME as it's an excellent organization to begin or continue as a volunteer global medicine provider. Having a background of working with other NGOs and groups around the world gives me a perspective of why volunteering at FAME is such a positive thing. FAME’s volunteer program is well established, you’ll play an active daily part in patient care, the range of patient care is stimulating and everyone at FAME is so welcoming. You’ll come away learning as much as you contribute.”

“LOVE”

— Dr. Gary when asked to describe FAME in one word.

Nurse Kim Hall, Family Nurse Practitioner, Faculty at UMass Medical School, Graduate School of Nursing

Nurse Hall (right) consults with FAME’s Dr. Adam Likiliwike.

“I was told you may come to Tanzania for the animals, but you will return for the people, and that has been the case for me. I enjoy working with the FAME staff and seeing rural medicine in action”

— Nurse Hall

Nurse Hall first came to FAME in 2018. Four years before, she had met Dr. Frank on safari when she visited a local school in Karatu. Dr. Frank invited her to come back as a FAME volunteer and help with the diabetes clinic. She has been coming back almost twice a year since. 

Nurse Hall could not come as planned in 2020 and 2021 due to the pandemic. She is back after a two-year hiatus and encountering significant changes, such as new buildings and programs, but the same warm and committed people. 

Nurse Hall (second left) consulting with FAME radiologists, Japhar Hassan (left) and Onaely Mullumba (right). She is joined by volunteer Emergency Medicine Doctors Jeffrey Dan and Natalie Strokes. 

“Working with the dedicated FAME staff is always an inspiration. They showed me the true meaning of teamwork every day, including on this trip, where they did some amazing work with premature babies. I have learned to be flexible and work with staff wherever needed and I am enjoying seeing the diabetes clinic get back up and running after two years. After working in a diabetes clinic in the US, I am always impressed by the work I see being done here. Anyone considering volunteer work could not find a better place to do it! Once I get here, I am never ready to leave!”

“AMAZING”

— Nurse Hall, when asked to decribe FAME in one word.

Nurse Leslie Kwiatkowski, Family Nurse Practitioner - Personal Reflection

Nurse Kwiatkowski pictured with Emergency Room nurse, Isdory Mboya.

Nurse Kwiatkowski training medical staff.Pictured: Drs Joselina Mumbee and Gabriel Kissima.

My name is Leslie Kwiatkowski, and I am a Family Nurse Practitioner in Washington, D.C. I work at a community health center in one of D.C.’s most under-resourced areas to provide healthcare to families and individuals often struggling with poverty and homelessness. I first became aware of FAME through Nurse Barb, a nurse practitioner and FAME board member, when she assisted me with an assignment for my doctoral program two years ago. I was to find a leader actively building community and making an impact nationally or globally; most importantly, they couldn’t be someone I already knew. The American Association of Nurse Practitioners (AANP) showcased Nurse Barb on their podcast. When she mentioned her work at FAME in Tanzania, I couldn’t type an introduction email fast enough. I was ecstatic to hear someone so passionate about the country I was lucky to have served in during my time in the Peace Corps from 2015-2017. Barb agreed to an interview and spent hours sharing her leadership style of staying open-minded and curious and how those tie into the important work of FAME hospital, a mission she is so proud to be a part of. I immediately knew that volunteering at FAME would provide me the perfect arena to blend many loves of my life: family medicine, travel and intercultural learning. I was initially nervous about volunteering, as I thought I didn’t know much about tropical medicine, but I had to let that go quickly. I told myself that if I made one friend or made one person’s life a little easier, my time at FAME would be a success. My anxiety waned significantly after numerous Zoom calls with board members, fellow volunteers and hospital staff to introduce me to key players and help me to set expectations for myself. My first impression was how intelligent and passionate the FAME staff was when I arrived. Being a Nurse Practitioner, I straddle the medical and nursing worlds and was grateful for the opportunity to spend time equally with doctors and nurses. Working alongside individual team members helped me learn from each patient interaction which sharpened my clinical skills. I then suggested improved methods such as efficient charting, appropriate lab ordering and updates to chronic disease management. I also had the opportunity to lead cervical cancer screening and diabetes management education sessions, complete with the educational and organizational resources I use in my practice.

I will come back to volunteer at FAME as often as they allow me!

“Connecting cultures by way of compassionate healthcare.”

— Nurse Kwiatkowski, describing FAME in one sentence.

MORE VOLUNTEER VOICES

November is diabetes awareness month. Every year, FAME uses this opportunity to highlight its efforts to strengthen the prevention, diagnosis and treatment of diabetes in our catchment area. 

According to the World Health Organization (WHO), nearly 80% of people with diabetes live in low and middle-income countries, where prevalence is increasing most rapidly. Tanzania’s rate of diabetes prevalence for adults ages 20-79 keeps rising, increasing by 300% in the last ten years (WorldBank). With FAME working in a resource-challenged area in rural Tanzania, we believe scaling up access to diabetes medications, care and education can minimize complications related to diabetes and reduce morbidity and mortality among people with diabetes. Whether an individual has had diabetes for years or is newly diagnosed, diabetes education programs lead to happier and healthier lifestyles. 

This November, FAME hosted its third World Diabetes Day Walk to raise awareness of the impact of diabetes and the importance of physical activity in managing diabetes. The walk also highlighted FAME as a center providing crucial diabetes care and treatment. First started in 2019, the FAME diabetes walk took a break in 2020 due to the COVID-19 pandemic and resumed in 2021. 

This year's walk had 58 participants from the community, a 16% increase from last year. Starting from the Mazingira Bora grounds in Karatu, the group walked 2.1 miles to FAME, carrying a banner that read “Health Education for Better Tomorrow.” Once at FAME, participants received free diabetes and blood pressure screening. Ten people with diabetes were identified and enrolled in our diabetes clinic. 

The FAME diabetes clinic began in 2018 and is designed to provide patients with the necessary knowledge and skills to set a solid foundation for successful self-management. Understanding diabetes is the first step towards managing and preventing it. Lack of diabetes knowledge often causes patients to underestimate how serious diabetes is, and many people wait until they experience complications before seeking treatment.

The FAME diabetes clinic started with 95 patients; the following year, it grew to over 300 patients! That number has now stabilized at around 130 patients per year. The patients receive instruction on topics such as how medications and insulin work, blood glucose monitoring, diet and nutrition and possible complications. They return to the clinic every three months for their HbA1C (blood test showing your average blood sugar) test. Patients who manage their blood sugar can significantly reduce the onset and severity of complications.

FAME Diabetes Walk 2019

FAME Diabetes Walk 2021

FAME Diabetes Walk 2022

FAME deals not only with Type 1 and Type 2 diabetes but also gestational diabetes, a type of diabetes that can develop in women during pregnancy. This condition may disappear spontaneously after delivery, but if misdiagnosed and mismanaged, it may lead to long-term health risks for the mother and the child.

At FAME’s prenatal clinic, blood sugar is one of the first tests a woman receives when she comes in for her prenatal check-up. If diagnosed with gestational diabetes, the woman is enrolled in FAME’s High-Risk Clinic.  

The High-Risk clinic offers special monitoring and care throughout a woman’s pregnancy, including blood sugar tests to monitor the health of the mother and fetus, lifestyle recommendations and medication, if necessary. So far, in 2022, FAME has cared for 14 women with gestational diabetes, all with positive outcomes.

William Mhapa (front) with FAME’s Co-Founders and Co-Directors, Dr. Frank Artress and Susan Gustafson.

“FAME hospital Management and our staff believe in the well-being of all our dear patients. On this day, we are happy to shine some light on the community highlighting the importance of education for better health. We will continue to invest in the health and wellness of our patients sustainably. Welcome to FAME and enjoy the services”

— William Mhapa, FAME’s Director of Operations, in his speech at the Diabetes Day Walk.