Anita.

World Health Day advocates that everyone should have access to quality healthcare services when and where they need them without facing financial hardship. Unfortunately, many people still lack access to essential and life-saving health services, especially those living in rural areas, which can result in preventable illnesses, disabilities and even death.

FAME continues to work towards health equity and improved healthcare access to underserved communities in rural Tanzania. FAME believes everyone should be able to achieve good health and well-being regardless of where they live or their social and economic status. 

Today we share a story about the lack of access to healthcare due to financial difficulties. Anita* is a 35-year-old single mother of one who is suffering from Multiple Sclerosis (MS). MS is a chronic autoimmune disease that affects the central nervous system. Unfortunately, MS is a relatively rare condition in Tanzania and progress has been very limited regarding the diagnosis and treatment of MS in Tanzania (MSIF).

After diagnosis, Anita could not afford the MS medication due to its unavailability locally and high prices in neighboring countries. Access to affordable MS medications is not just an issue in Tanzania but also a critical issue in the United States (NMSS). The cost of MS drugs has doubled in the last seven years, despite introducing a generic form of the widely used drug. Access to treatments is difficult in many countries and often impossible in others.

Anita’s Story

Anita* lives in Arusha with her 6-year-old son. She works in a rehabilitation center for disabled children as an occupational therapist. Her first symptom was muscle weakness and stiffness, making it difficult to move around or perform everyday tasks. Then came the deliberating extreme fatigue. She also had difficulty with coordination and balance, leading to falls and challenges performing activities that require balance. 

“When the symptoms started in 2019, I went to an Arusha hospital where the doctor ordered a brain MRI, but she ruled out MS and gave me medicine to reduce my symptoms, which worked. However, in early 2022 the symptoms became worse. Eating became a problem as anything in my mouth, whether food or a toothbrush, would trigger numbness on my right side, which stopped me from talking. I would faint in public and be completely out for around five minutes, which was most embarrassing. I returned to the doctor, who sent me to KCMC referral hospital in Moshi for another MRI. It is here that I was diagnosed with MS.”

— Anita

Step 1: Dr. Wells demonstrates to Anita how to self-administer injections with a dummy injector for optimal medication management.

Step 2: Now for the real thing!

Step 3: Anita winces in discomfort as compassionate Dr. Wells administers the injection.

Step 4: “It’s not so bad!” A relieved Anita flashes a smile after Dr. Wells administers a successful injection.

“I was in denial of my diagnosis and refused to believe that I had MS. Sadly, my symptoms worsened and started affecting my job performance and I had to share my struggles with my supervisor. She recommended that I come to FAME and see Dr. Rubenstein for a second opinion.”

— Anita

Dr. Michael Rubenstein has been coming to FAME for the past thirteen years with neurology residents and fellows from the University of Pennsylvania and Children’s Hospital of Philadelphia. In partnership with FAME, they provide neurological care for those living in our catchment area both at FAME and in outreach clinics where they venture into the villages.

“After Dr. Rubenstein confirmed my diagnosis, I quickly realized that MS medication was unavailable in Tanzania. This added to my feelings of depression that I already had after my diagnosis. I didn’t know what to do. While the medication does not treat MS, it helps with the symptoms and pain and would give me some normalcy and quality of life. I was told I could get it in a neighboring country at $8,600 per year. Not even in my wildest dreams would I afford this.”

— Anita

For a year after diagnosis, Anita did not take any medicine. It just wasn't attainable. In 2023, after sourcing for approval from the Tanzania Ministry of Health, Dr. Rubenstein and his residents brought her MS medicine from the US, which had been donated. They brought enough medication to last her for more than six months, with plans to bring additional medication when they return in September.

“I cannot thank Dr. Rubenstein and his residents enough! They have saved my life. My biggest worry was that this disease would affect my job so much that I couldn’t provide for my son.”

— Anita

Anita says that she has suffered a lot of stigma surrounding her disease, including from her own family. 

“My family did not and still does not understand this disease. My auntie always tells me: ‘This disease of yours is so weird one would rather have HIV!’ They have taken me to church many times to be prayed for as they believe only God can cure me!”

— Anita

“The biggest challenge is losing my independence. I often have to rely on relatives for help. The other day I fell in front of my son and he was terrified! So we can’t be just two of us in the house alone.”

— Anita

Neurologist Resident, Dr. Wells Seldes Andres, teaches Anita how to inject her medicine. He assures her that the medicine has no significant side effects except maybe a sore arm. He also tells her that MS doesn't change life expectancy with proper treatment.

“I’m so happy! Looking forward to getting my life back.”

— Anita

Dr. Michael Rubenstein (far left) talks to Anita and reassures her.

Dr. Michael Rubenstein

“Multiple sclerosis is a disease that is thought to be very uncommon in sub-Saharan Africa. However, recent data suggest its incidence is increasing here just as in other parts of the world. 

There are several reasons why it is uncommon here, including environmental and hereditary reasons, the lack of specialists (neurologists) and the lack of technology used to make the diagnosis that has only recently existed in this region of Africa. Unfortunately, due to the belief that it is uncommon here, there are also very few studies looking at MS in East Africa, which will hopefully change in the coming years as we learn more.

In the thirteen years that I have been coming to Northern Tanzania, there have been a number of cases in which we were concerned about MS. Still, due to the very limited resources (monetary and technological), we have been unable to pursue the diagnosis fully. 

Anita is one of the more fortunate patients who were not only able to have the appropriate study done but, more importantly, was able to come to our clinic where we confirmed her diagnosis and were able to begin treatment against all odds as there are no medications in Tanzania that are specifically designed for MS.” 

*The patient’s name has been changed to protect their privacy and permission was secured to share her story.

Magdalena breastfeeds her newborn child at FAME’s maternity ward. This is her third baby, but she says she is still learning new things about breastfeeding!

FAME continues to provide breastfeeding support to new mothers to ensure successful breastfeeding outcomes for both mothers and infants. Breast milk is ideal for infants, as it contains all the necessary nutrients for growth and development. In rural areas such as our catchment area, where there are often higher poverty rates, breastfeeding is a simple, smart and cost-effective way to ensure all children survive and thrive.

According to FAME’s Reproductive Health Clinic (RCH) nurse, Kitangile Masheyo, breastfeeding can be challenging for some mothers who may require support and guidance from healthcare providers.

“With proper support and education, most mothers can successfully breastfeed their infants and reap the benefits for themselves and their infants.”

— FAME’s Kitangile Masheyo, Nurse, RCH clinic.

FAME understands that before educating mothers on the importance of breastfeeding, it has to educate its healthcare providers to enable them to offer the best possible support for newly breastfeeding mothers. As part of these efforts, FAME encouraged Kitangile to attend a two-week breastfeeding course offered by the Tanzanian Ministry of Health in Karatu. 

“The course trained me on breastfeeding support techniques, such as instruction on proper latch techniques, common breastfeeding challenges and how to address them promptly. This course taught me how to provide one-on-one support to new mothers by answering questions, providing guidance and troubleshooting any issues. I received books from this course that I still refer to occasionally.”

— Kitangile

FAME’s Reproductive Health Clinic (RCH) shows a breastfeeding video in the waiting area. These short videos educate mothers on different issues concerning breastfeeding and how to overcome them.

“At FAME’s postnatal clinic, breastfeeding is a central theme. We provide one-on-one consultations to mothers who encounter breastfeeding challenges such as latch and positioning or how to increase milk supply. We also provide educational materials in the form of short breastfeeding videos in the waiting area that educate them on different things, including how long you should breastfeed your child, among others. We also encourage HIV-positive mothers to breastfeed as some are unaware that this is an option for them.”

— Kitangile

Maureen’s Story

Maureen.

Maureen’s son, undergoing phototherapy due to his jaundice.

Maureen* just delivered her fourth child at 32 weeks, weighing 3.6 lbs. She has been unable to breastfeed for two days, which the doctors think is due to stress. You see, Maureen was not prepared to go into labor so early. All her other children had been born to term. So when she woke up at 4 am to her water breaking, she was scared.

“My water broke at around 4 am. I woke up panicked. My husband rushed me to FAME, where they confirmed I was in labor. But it was too early! I begged the doctors to help me; I didn’t want to give birth to a premature baby! I was terrified of all the complications that come with it, but sadly, it was too late and I had to deliver.”

— Maureen

Maureen’s baby spent a night in FAME’s Special Care Nursery (SCN) and on the second day, was placed under FAME’s phototherapy units as he had jaundice.

“The medical staff have educated me a lot on breastfeeding. When I got the baby, my milk did not come immediately as it had with the other children. I was very stressed! My child was very small and I couldn’t even feed him! But the staff has educated me on what to eat and to reduce stress and now two days later I have milk! I can pump some milk for him and he is fed by bottle. He’s slowly learning to suckle.”

— Maureen

Maureen is confident about going home soon.

“Being a fourth-time mom, I immediately knew I wanted to breastfeed. However, I was aware that breastfeeding could be challenging in my case as my child was born prematurely. So I was nervous about whether or not I could do it successfully. The guidance and support from the nursing staff at FAME were invaluable and I am very grateful. I have overcome the initial difficulties I encountered while trying to stimulate breast milk and am confident my milk supply will increase as I continue to breastfeed my child.”

— Maureen

Dr. Ken Karanja explains how breastfeeding a premature baby can differ from breastfeeding a full-term baby, how it can be challenging and why the mothers of premature babies may need extra support and guidance from healthcare providers to help them establish and maintain successful breastfeeding. 

“Sometimes premature babies have not fully developed the reflexes needed for successful breastfeeding. For example, they may be unable to coordinate sucking, swallowing, and breathing. On the other hand, full-term babies are generally born with fully developed reflexes. Mothers of premature babies may experience delayed or reduced milk production due to the baby’s early arrival. In contrast, mothers of full-term babies may have an easier time establishing milk production. These are key differences to keep in mind while supporting a mother of a preemie.”

— Dr. Ken Karanja

Carol’s story

Carol and her 3-month-old baby at FAME’s Reproductive Health Clinic (RCH).

Carol* is 27 years old and has two children. She has brought her 3-month-old to FAME’s RCH for routine under-5 vaccinations. She is happy to have discovered FAME, although she wishes she had discovered it earlier. 

“When I had my first child eleven years ago, nobody talked to me about breastfeeding and the benefits. When my daughter was two months old, I transitioned her to solid food and stopped breastfeeding. I didn’t know I had to exclusively breastfeed for six months as everyone around me gave solids and liquids to infants at the two-month mark. Looking back, I am so sad that I was not well educated and informed on the benefits of breastfeeding.”

— Carol

Carol first came to FAME a year ago when she was five months pregnant. She had been working outside Karatu and when she returned, she was looking for hospitals where she could deliver her child. That's when her friends recommended FAME.

“I came for my first prenatal class at FAME’s RCH and was blown away by everything I learnt about pregnancy from that first session, so I kept coming for the prenatal classes and delivered here three months ago. This time, I am breastfeeding my baby with much support from RCH. When I got the baby, I struggled to breastfeed as my milk supply wasn’t enough and the baby did not know how to latch onto the breast; thus, he couldn’t get anything from the breast. It was all very stressful. The RCH nurses answered my questions, advised me when my milk supply dwindled and taught me how to position the baby so they could latch properly on the breast and feed. My baby is now exclusively breastfed and is healthy, happy and thriving. I want to encourage new mothers considering breastfeeding to try and seek help when they face difficulties.”

— Carol

*The patients’ names have been changed to protect their privacy and permission was secured to share their stories. The quotes have been translated from Swahili to English.

Mama Ntimama and her daughter during the interview.

World Tuberculosis (TB) Day aims to raise public awareness about TB's devastating health consequences and highlights the efforts to treat and eliminate it. 

Tanzania is one of 30 “high-burden” countries for TB, with only 65% of TB patients receiving treatment. Poverty, malnutrition, HIV infection and diabetes are the main determinants of TB disease in the country (USAID).

In the first few months of 2023, FAME has already treated 29 TB patients, an increase from 19 patients treated by this time last year. 

This week, the same week we are recognizing World TB Day, FAME had two TB patients in the inpatient ward. One was Mama Ntimama, a 79-year-old woman from Ngorongoro who traveled 60 miles to FAME to access TB treatment.  

Accompanied by her daughter, Mama Ntimama came to FAME after months of being sick: suffering from an extreme chronic cough and chest pains. 

“I had been to my local dispensary twice, but the medicine they gave me did not work. So I turned to local herbs and roots for treatment, but my condition worsened.”

— Mama Ntimama

Mama Ntimama’s children decided to send her to a hospital, as her condition was worrying.

“My children told me that I needed to go to a hospital or I would die. I remembered FAME, where I was admitted in 2019 when I was very sick and was cured after a few days, so I asked them to bring me here. At this point, I couldn’t eat or walk. My children could not afford the long journey to FAME or the treatment, so they sold some cows for the money.”

— Mama Ntimama

Mama Ntimama passionately tells her story.

Once at FAME, diagnostic tests were done and Mama Ntimama was diagnosed with TB.

“I knew nothing about this disease before the doctor told me. I thought I had a bad cold that couldn’t go away. I was admitted five days ago and after the medicine, I already feel better than I have in months. I’m looking forward to going back home.”

— Mama Ntimama

Cases like Mama Ntimama’s are not uncommon. According to WHO, TB remains a significant concern in rural areas of Africa, where the disease often goes undiagnosed and/or untreated. Factors such as poverty, poor living conditions, limited access to basic healthcare services and social stigma contribute to the high incidence of TB in rural areas.

“The doctors at FAME have educated me about this disease. Now I understand what it is and how dangerous it can be if left untreated. If I adhere to my treatment, I will be completely cured.”

— Mama Ntimama

TB is treatable but early diagnosis and treatment are needed to prevent serious complications. To combat TB in our catchment area, the government-sponsored TB program at FAME continues to focus on prevention, early diagnosis and effective treatment. Educating communities about TB and its symptoms and increasing access to diagnostic tools and treatment options are crucial services in order to combat TB in the communities FAME serves and throughout Tanzania. 

“On World TB Day, I would like to tell people if you have symptoms like mine or have been in contact with someone who has TB, get medical attention immediately. People with TB should not have close contact with others until they receive medicine because they can spread the disease when they cough. I want people also to know that local herbs and roots will not cure TB. It is only cured by medicine from the hospital and following what the doctor says about how to take it.”

— Mama Ntimama

Acknowledging this year’s theme of “Yes, We Can End TB!”,  FAME’s TB and HIV/AIDS coordinator, Dr. Jacob Olekeiya, says: 

“Tanzania bila kifua kikuu inawezekana. Tuungane pamoja kutokomeza kifua kikuu (A TB-free Tanzania is possible. Let’s work together to eradicate TB.) ”

— Dr. Jacob

*The patient’s name has been changed to protect their privacy and permission was secured to share their story. The quotes have been translated from Maasai to English.

From Left: Nurse Ruhama Lyanga, Diane Berthel and Nurse Safiniel Shedrack Mbwambo.

FAME, February 2019.

Diane’s going away party.

FAME, November 2019

FAME staff after a training session with Diane.

FAME, January 2018

Sue [FAME’s Digital Media Manager] asked me to do a volunteer reflection. But I think she is asking, “Why are you here and not sipping drinks on a beach somewhere?” Good question!

I have been retired for ten years and believe that “purpose fuels passion” (the theme of my blog) and passion is the fountain of youth. In short, the people and mission of FAME keep me young! Add to that the opportunity to truly EXPERIENCE Tanzania's natural beauty and cultural richness and I’m in!

I’m not a medical volunteer, so what is it that I do? I’m a management coach, a strategist, whatever is needed volunteer. I mostly look, feel, listen and then respond: What do I notice? What is shared? How can I help adjust the direction to maximize resources at FAME? To do this, the staff must trust me. I come every year for three months for the consistency that drives trust.

Dr. Julius said it eloquently when I arrived this year. He said, “Before you came, I thought administration-insignificant. Now I see we are all heading in the same direction. It is good!”

Dr. J’s comment was encouraging because I meet with every department here. I call them “look-up” sessions. No matter what specific work we are doing, we see the mission and vision when we look up: Patient-centered care, an environment that encourages lifelong learning, and resources to do our work! And we each play a role in healing patients.

“Everyone here is a healer. In this morning’s meeting, I reminded housekeeping about their role in healing. I start with my standing joke that the toilets at FAME are so clean I could eat my lunch there. Then I asked them to imagine how good it feels to lie on clean sheets with
newly washed floors when sick. When patients feel good, they can begin recovering.”

— Diane

For groundskeepers, I tell them to imagine how a frightened patient feels sitting in a beautiful garden while waiting for a doctor. So much about this healing environment is a model for healthcare everywhere. Kind receptionists, prescriptions that can be filled, accurate and quick lab tests, a safe and tranquil campus, good food and drinking water, and many more reasons for patients to relax into the patient-centered care that FAME promises and provides.

Another elixir for me is the commitment to learn and improve, with “patient care” always at the heart of it. As an addicted learner, I am thrilled when I hear things like “since your meetings last year, everyone knows that we start on time” or when talking the “FAME DNA” of lifelong learning comes up.

After an orientation with new employees, it is amazing when they share how excited they are to be here.

“Management and supervisors are so responsive because they genuinely want the best for their patients and teams. Frank, Susan and William gently bring me back to earth when my ideas go too far!”

— Diane

So why wouldn’t I just move in permanently? Tempting, but I do need an occasional drink on a

beach or in my backyard in Minnesota!

Women are the majority of patients we treat at FAME, making up 63% of the total patient visits in 2022. FAME invests heavily in women's comprehensive healthcare services including reproductive health services such as preventative care, prenatal and postnatal care, family planning and obstetric and gynecological care. 

This year, on International Women’s Day, we highlight three female FAME healthcare workers committed and dedicated to their work. These women have worked at FAME for over a decade. They understand the unique needs of the women in our catchment area and provide culturally sensitive and gender-responsive care.

Dr. Anne Ghati has been at FAME for 11 years and Nurses Siana N’kya and Safiniel Mbwambo have been at FAME for 15 years. Siana and Safi were the first nurses hired at FAME, back when it was just a mobile clinic and they have been a part of FAME’s growth over the years. In the spirit of International Women's Day, we talked to each of them about the services FAME offers for women, the importance and impact of offering these services, and why FAME is a wonderful place for women to work. 

Dr. Anne Ghati- FAME NEUROLOGIC focal DOCTOR

Dr. Anne Ghati.

Dr. Ghati talks to a new mother at FAME’s RCH.

Dr. Anne Ghati (left) pictured with Nurse Safi (right). FAME 2012.

Dr. Ghati is FAME’s focal neurologist and is also involved in obstetrics and gynecology at FAME. 

After working in Dar es Salaam for a few years, she experienced a growing dissatisfaction with city life and sought something different. That's when she stumbled upon a FAME job advert.

“The advert said a female doctor would be an added advantage, so I quickly applied. I’m glad I did because working at FAME has been a dream! FAME’s support for women’s health and well-being is unmatched. In our catchment area, gender inequality often dangerously impacts women’s access to healthcare. Cultural and social norms prevent women from seeking healthcare services, particularly for reproductive health issues. FAME continues to address these barriers and create a healthcare system that is equitable and accessible to all, and I’m very proud to be part of this.”

— Dr. Ghati

Dr. Ghati believes that education is essential for addressing gender inequality in healthcare. By increasing education and awareness, FAME empowers women to take control of their health and break down barriers to accessing care. 

“FAME offers more than healthcare. We always talk to our patients, advise them and teach them to make informed decisions about their bodies and healthcare needs. We also work to reduce the stigma surrounding many women’s health issues in our catchment area.”

— Dr. Ghati

Dr. Ghati also notes that the increased female presence in the healthcare workforce is important as women have been historically underrepresented in many healthcare professions, including medicine and nursing. She is proud that 48 percent of the employees at FAME are women and is hopeful that education will help promote gender equality by challenging gender stereotypes and discriminatory practices.

Siana Nkya, FAME’s Head of Emergency Department

Nurse Siana Nkya.

Nurse Siana during FAME’s first Mobile Clinic to Lake Eyasi, September, 2009.

Nurse Siana (right) with Nurse Safi (left). FAME 2009.

Nurse Siana during one of FAME’s mobile clinics in 2010.

“One of the things I love about FAME is that we are always coming up with new programs to ensure that the women in our area have access to quality healthcare. The Maternity Center and Reproductive Child Health (RCH) Clinic continue to be instrumental in reducing complications during birth by providing quality prenatal and postnatal care. What started as simple rooms are now fully equipped departments supporting nearly 850 deliveries every year. Our Special Care Nursery, the only one of its kind in our district, helps save the lives of premature babies without having to refer them miles away. Cervical cancer screenings have also been a helpful addition to our program, as we see more rising cervical cancer cases at FAME. FAME doctors and nurses received training on treating and detecting cervical cancer in 2017 and 2018, which has been a huge help”

— Siana

Siana, a mother, says that balancing a career in healthcare and motherhood can be challenging.

“At FAME, all genders have equal access to opportunities, resources and treatment. The men do not get any preferential treatment! When I went on maternity leave, I wasn’t worried that my career development would stall. FAME was very supportive and I am very grateful for this; not all women have the luxury to take maternity leave and not have it affect their career.”

— Siana

Siana talks about how gender inequality impedes women’s access to healthcare.

“Our catchment area is primarily patriarchal and women are often scared of admitting they are sick lest they be seen as lazy. They are expected to prioritize their domestic responsibilities over their health. In the past, when the men brought the women to FAME, they insisted on explaining their interpretation of her condition to the doctors. Another challenge has been that women would never say anything about their private parts in front of men, so they tend to lie about their condition. FAME has dealt with these problems by hiring translators of different local dialects, so we don’t have to rely on spouses to translate and politely ask them to wait outside. This has worked well, and more women are opening up about their health problems.”

— Siana

FAME continues to educate women on health issues through the local radio station programs where our doctors discuss common problems affecting women’s health. FAME also uses the television screens at the Outpatient Clinic and RCH waiting rooms to educate the women as they pick up a lot of information while waiting to see the doctor. 

Siana explains that there is still a lot of work to be done in terms of healthcare for women.

“Despite the progress FAME has made in the last 15 years in providing quality healthcare to women, there is still room for improvement and expansion. As our catchment area grows, FAME needs to be able to handle the healthcare needs of these women who would otherwise have limited to no access to these kinds of services.”

— Siana

Safi - FAME Nurse, Ward 1

Nurse Safiniel Mbwambo, affectionately known as Safi!

Nurse Safi, FAME 2010.

From Left: Nurse Siana, Nurse Safi and Nurse Patricia have a quick lunch on one of FAME’s mobile clinics in 2010.

“I am very proud that FAME prioritizes women’s healthcare. Sometimes in our catchment area, we see men being healthy while the women are neglected and some even suffer from adult malnutrition. FAME works with local media to educate men on the importance of women’s health, as it is critical for the development and well-being of their families and communities.”

— Safi

A program that Safi is very proud of is FAME’s outreach program to work hand in hand with Traditional Birth Attendants (TBA). 

“We have had many cases of women giving birth at home and when complications occur, the TBAs do not have the skill to handle it and by the time the woman is brought to FAME, she has lost too much blood. Sometimes, the women suffer from severe anemia due to home births. Working with TBAs, FAME provides them with the necessary knowledge and skills to help women come to FAME for prenatal care and to help identify high risk conditions for pregnancy. They are also taught to recognize signs of complications and the importance of early referral to a medical facility to reduce the risk of maternal and neonatal mortality and morbidity.”

— Safi

Safi reflects on the developments that FAME has made in women's health. She sees FAME’s surgical department as changing women's lives in our catchment area. The well-equipped operating rooms and trained personnel provide emergency obstetric care such as cesarean section delivery, which may be necessary to save the mother's life in case of complications during delivery. FAME’s operating room has also been instrumental in managing gynecological conditions such as ovarian cysts and uterine fibroids, which require surgical intervention.

Editor’s Note: Special Thanks to FAME’s Caroline Epe who provided all the throwback pictures! Asante Sana.

Join FAME in advocating for gender equality in healthcare in rural Tanzania by donating today!