Empowering Rural Health: Diabetes Care at FAME

Ensiankik

Esiankik* is a charming young Maasai girl. She exudes a vibrant charm that conceals her challenges. She doesn't know her age and her mother doesn't either. “Mayelo!” she giggles when we ask. In the Maasai language, "Mayelo" translates to "I don't know,". FAME's social worker, Kitashu, estimates her age to be around 13-15.

For the past five years, Esiankik has been battling illness. It all started when she suddenly lost a lot of weight and became weak. Most days she had leg pain, which got so bad that she couldn't walk to school anymore, so she stopped attending. House chores that had always been easy and fun for her, such as fetching water from the river, where she would spend hours with her friends telling stories, became impossible for her to do. She often just wanted to lie down because she was tired, despite not having done anything. Then on one rainy morning, Esiankik fainted and was unconscious for hours. 

We rushed her to the local dispensary after trying everything to wake her up and nothing worked. The doctor at the dispensary told us that her case was very serious. He recommended that we take her to one of two hospitals, FAME Hospital or Kilimanjaro Christian Medical Centre (KCMC), a zonal referral hospital located in the Kilimanjaro Region, as he only trusted one of the two to figure out what was wrong with her.
— Esiankik’s Mother

Both hospitals were many miles away. Esiankik and her family live in a small secluded village 150 miles from FAME and 220 miles from KCMC. 

Both options left me heartbroken as they were very far from home and I did not have money to afford such a long journey. But Esiankik was critically ill, so I sold the two cows I had left after the drought and got some money. We took a bodaboda (motorcycle), two buses and a bajaji (autorickshaw) to get to FAME from our village.
— Esiankik’s Mother

Esiankik (right) poses with her mother (left) and her little brother (center) in FAME’s Ward 1.

Once at FAME, Esiankik was diagnosed with Diabetes Type 1, a chronic autoimmune condition requiring consistent insulin therapy. Insulin injections are administered to keep blood sugar levels within a specific range to prevent complications. She also suffered from diabetic ketoacidosis (DKA), a serious and potentially life-threatening complication of diabetes caused by a severe shortage of insulin. She was immediately started on insulin therapy. 

I was very scared when we got to FAME as I thought Esiankik was already dead. I was happy after a few hours when she opened her eyes. The doctors explained her disease to me and since I don’t speak Swahili, they brought in a translator [Social Worker Kitashu] who spoke my language. Once I understood the lifelong nature of the disease, my heart broke for my daughter. She is so young! How can I care for her when we live so far away and don’t have enough money?
— Esiankik’s Mother
 

Esiankik (middle) is flanked by Nurse Moinan Letion (left) in FAME’s Ward 1. With her discharge scheduled, Esiankik was moments away from having her cannula gently removed, marking the end of her hospital stay as she prepared to return home.

This would signal the start of Esiankik's journey with diabetes. The compassionate nurses at FAME taught her mother how to handle the insulin, give injections and properly store it. Although terrified, her mother was determined to learn and asked many questions to ensure she understood everything. 

It's been five years since and yet diabetes continues to be a challenge for Esiankik and her family. This time, she has been admitted to FAME’s inpatient ward for five days. Accompanied by her mother and little brother, she had come to pick up her insulin which FAME generously provides without charge to help subsidize their costs and ease their financial burden. However, since she had missed a week of insulin shots, her sugar was dangerously high and she had to be admitted

I do everything I can to take care of her. This time, we were late picking up the insulin because I didn’t have enough money for the transport to get here, so she missed a couple of days. I feel terrible! I try so hard to make sure we pick up the medication on time and give her the injections twice a day without fail. But sadly, I have let her down.
— Esiankik’s Mother

Esiankik’s mother explains that she tries to follow all the advice that the doctors have given her. 

I follow the diet advice provided by the doctors. However, sometimes we don’t have enough food, so she eats what the rest of us eat. Still, I always try to put her recommended food aside when I can. As for the insulin, I store the vials in a clay pot in the corner of our hut; the pot has soil that keeps the insulin cold. This has worked well. When I run errands in the local market, our elderly neighbor helps me give her insulin injections as he is a nurse and knows how to do it.
— Esiankik’s Mother
Esiankik is my second child. I am thankful that her five siblings are healthy; none have this illness. While I can leave three of the children at home alone when I bring Esiankik to FAME, my youngest son comes with us since he is so small. For some reason, he enjoys our FAME visits very much and I know he will be sad when he’s older and I must leave him home when I come here!
— Esiankik's Mother
Before Esiankik’s diagnosis, I knew nothing about this disease. I also didn’t know anybody who had ever had it. She was the first. I am so thankful to FAME, who continue to support me in this journey; for over five years now. Without their help, I would not be able to handle this situation. They have taken great care of us. Ashe Oleng [Thank You]!
— Esiankik's Mother

Asked about FAME, Esiankik giggles, smiles and covers her mouth shyly. Her giggles and smiles say more than words ever could.

 

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

FAME Africa
Before and After: A Mother's Journey Through Pregnancy and Birth

Before birth

Arafa

Arafa (right) poses with her mother (left)

30-year-old Arafa* is a mother of one and is pregnant with her second child. She has known about FAME for a long time as most of her neighbors come here for medical help, despite living more than half an hour away. When she fell pregnant with her first child six years ago, she attended prenatal clinics at a hospital close to her, hoping to come to FAME for the delivery. Due to the distance and the transport costs, she could not afford to come to FAME for the monthly prenatal classes, which would mean taking days off work for the trips.  

I had planned to deliver my first child at FAME, but during my last prenatal visit to the hospital, the nurse asked why I was going so far to give birth. She said since I was healthy and had an easy pregnancy with no complications, this would be an easy birth and I should just do it at the hospital. ‘Anyone can deliver this baby!’ she said. So I agreed and I regret that decision to this day.
— Arafa

When Arafa’s baby was born, she did not cry for over six hours. The doctors told her that delayed crying did not mean the baby wasn't okay; the baby would cry when they were ready. However, Arafa realized something was wrong the more she held the baby.

I told my mother I felt something was wrong with the baby and asked her to accompany me to FAME for a second opinion. Since I was still weak from childbirth and could not take the bus, I asked her to find a private car. We arrived at FAME two days later, where we were well received and I believe they saved my child’s life. Sadly, she continues to suffer developmental delays that I am still trying to fix with therapy all these years later, as I was advised by some doctors here at FAME who help children like mine [Dr. Michael Rubenstein and his Neurology Residents from the University of Pennsylvania].
— Arafa

When Arafa got pregnant with her second child, she decided to do everything at FAME. She attended her prenatal clinics and on her due date, she came to FAME to deliver. However, she didn't go into labor. At 42 weeks, the doctors decided that if she didn’t go into labor soon, they would have to induce (a medical procedure to initiate uterine contractions).

This baby is not ready to come! I am so tired! The doctors have done tests and tell me the baby is healthy and I can feel the baby always moving. I’m hoping to deliver soon! This is all new to me as my daughter was born on exactly her due date.
— Arafa

Asked about the gender of the baby, Arafa admits she doesn't know and doesn't want to find out.

All I want is a healthy child. That’s my prayer.
— Arafa

After Birth

Arafa with her new baby boy

The night after our interview, Arafa finally went into labor. We caught up with her after her baby was born. Unfortunately, due to complications, she had to have a C-section. 

It was a difficult delivery. My labor was progressing slowly, so I had to be induced. Then the baby couldn’t come out since he was so big; he was born at 9 lbs! So I had to go for a c-section. The doctors and nurses were kind to me; they held my hand and encouraged me. And when they recommended a c-section, I was not afraid because I trusted the doctors to deliver my baby safely. When I heard my baby cry in the operating room, the joy that filled my heart was out of this world.
— Arafa
I am so happy! I thank FAME for ensuring I delivered a healthy baby, from the prenatal clinics to delivery. I don’t know how I could ever repay you. I can’t help but think that if I had given birth somewhere else, maybe they would have insisted on pulling out the baby and causing damage both to the baby and myself. Giving birth is seen as normal and easy, but it can be very complicated and dangerous and I thank FAME for helping mothers.
— Arafa

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

FAME Africa
Significance of Breastfeeding in Promoting Maternal and Infant Wellness

World Breastfeeding Week, celebrated annually from August 1st to August 7th, and National Wellness Month in August, provide a unique opportunity to celebrate the profound connection between breastfeeding and the overall wellness of mothers and infants. 

Access to adequate healthcare services, including breastfeeding support, can be limited in rural areas. This is why FAME continues to play a crucial role in empowering mothers by providing comprehensive breastfeeding assistance as part of its Maternal Health Program. Breastfeeding extends beyond sustenance for the child; it plays a profound role in wellness for both the mother and the baby. However, many women experience intense challenges, frustration and sometimes pain around breastfeeding.

This week we interviewed two new mothers to discuss their views and experiences on breastfeeding. They shared their stories of joy, their challenges and the support they received from FAME’s Reproductive Child and Health Clinic (RCH) when they started breastfeeding.  

My Breastfeeding Story-Asha*

25-year-old Asha was surprised at how different her breastfeeding journeys were with each of her children. 

“I breastfed my first child for 11 months, so I was familiar with breastfeeding when I gave birth to my second child four days ago. Breastfeeding my first child was challenging and frustrating as my daughter was born premature and thus had an underdeveloped sucking reflex, making it difficult for her to latch onto the breast and effectively extract milk. However, I was lucky to have given birth at FAME, as the doctors and nurses supported and encouraged me on my breastfeeding journey. I wanted to quit many times due to the difficulty I experienced and the heaps of self-doubt, but they encouraged me to persevere. I am so glad I did because I went on to have a wonderful breastfeeding experience.

This time, my baby was born full term and he latched on very quickly and since I am much more confident and relaxed this time, breastfeeding is easy! After learning the benefits of breastfeeding, I take great pride in knowing my breastmilk contains antibodies that help protect my baby against infections and diseases, fostering a strong foundation for his immune system. Breastfeeding has also enabled me to bond with my baby, which I greatly enjoy. 

Breastfeeding is not always easy, some days, I still find breastfeeding exhausting and overwhelming and this is when I rely on the RCH nurses to help me. RCH supports mothers before, during and after pregnancy and I am very lucky to have their support. My advice to new mothers is to not be too hard on yourself if you find breastfeeding difficult and never be too afraid to ask for help.”

My Breastfeeding Story-Agatha*

24-year-old, first-time mother Agatha thought breastfeeding would be easy and natural as she had seen many mothers around her do it and make it look so easy! She looked forward to that experience and decided to breastfeed her child when the time came. However, she encountered a couple of challenges. 

“I came from Arusha, 95 miles away, to deliver my baby at FAME. My sister-in-law works at FAME and delivered her child here, so I trusted her when she recommended this hospital. As a first-time mother, it was important for me to get the best quality maternal healthcare. My husband supported my decision and brought me for three prenatal clinic visits to FAME before I was admitted on my due date. Unfortunately, there were complications during birth and I had to be rushed to an emergency C-section. Still, I’m forever grateful that the qualified FAME team cared for me and was skilled enough to deliver my daughter safely. 

After the C-section, my breast milk did not come, so I could not breastfeed my child. This saddened me, as it was the opposite of what I had expected. The nurses could see how distraught I was; they were very supportive and encouraged me. They assured me this was normal and I had to give it time for my breast milk to kick in. And sure enough, after one day, I had a lot of milk. I could feed my daughter and still have so much left! If it were not for the support of the nurses, I would have given up. Everything looked tough initially, but I only needed a little help and support! Now I am a happy mother with a well-fed baby who is grateful to FAME.”


FAME believes breastfeeding is not merely a biological process but a holistic practice that aligns with wellness on multiple levels. We recognize the significance of breastfeeding in promoting children’s wellness. As such, we offer a supportive environment that encourages and celebrates this natural practice to empower mothers to embrace breastfeeding and foster a healthier, more connected, well-rounded society.

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

FAME Africa
Saved By The Church: Mbula’s Story

Mbula

When my condition deteriorated, I asked my family to take me to the hospital. I had been sick for four months after trying medicine from the local clinic and traditional herbs, none of which worked. My family disagreed with my going to the hospital; they wanted me to give the herbs more time to work. In the absence of medical attention, I only became weaker and sicker. In fact, I would be dead today if the church had not intervened and rescued me.
— Mbula

This is the story of Mbula*, a 24-year-old man who lives in Ngorongoro. A year ago, he traveled to Mwanza, north-western Tanzania, to study pharmacy. 

It was a very proud moment for our village. My three friends and I were accepted to study pharmacy at a college in Mwanza. Despite it being 300 miles away from home, everyone was so excited! My friends and I were more like brothers; we had grown up together. Sadly, during my first year at college, I fell sick and after seeing different doctors with no relief, I decided to go back home and be closer to my family. On my way home, I stopped at a clinic close to my village. The doctor told me I had pneumonia and prescribed medication for five days. I went home feeling relieved.
— Mbula

Unfortunately for Mbula, the medicine did not work. He returned to the clinic, where the doctor gave him more pneumonia medicine, telling him that this medication was much stronger than the one he had before. Two months later, his condition continued to worsen and that's when his family suggested that he start taking traditional herbs again and forget the clinic. 

I took herbs for two months. I was getting sicker and sicker. I was suffering a lot. I had a cough, chest pain and was always tired [fatigue]. I had a fever, sometimes shaking [chills] and had no appetite. That’s when I asked my family to take me to a hospital in the nearby town, but they said I should give the herbs more time to work. When I protested, they upped the number of herbs I took, believing they would eventually work. This was the extent of their mistrust of the care provided in hospitals.
— Mbula

Finally, Mbula’s neighbors reported the situation to the church.

The priest came to my home. He could see my condition was dire. He begged my family to let him take me to the hospital, but they refused.
— Mbula

The priest did not give up. He called FAME’s Social Worker, Kitashu, whom he had known for a long time and informed him of Mbula’s plight. He asked whether FAME could handle such a dire situation if he managed to get him here. The answer was a resounding yes! FAME’s emergency department would be ready to receive him and provide urgent medical intervention. 

With this assurance, the priest returned to Mbula’s home, but this time, he decided to talk to his mother alone instead of his whole family. 

The priest told my mother I needed urgent medical help as I had been sick for a long time. He said the church congregants had contributed some money to cover my treatment and that he would provide a car to bring me to FAME. All he asked was that a family member accompany me due to the seriousness of my condition. My mother agreed, but my brothers could not be persuaded. So my old and sickly mother accompanied me herself.
— Mbula

Mbula arrived at FAME in critical condition. After various tests, he was diagnosed with severe Tuberculosis (TB), an infectious disease primarily affecting the lungs. He was admitted and isolated in the inpatient ward for six days and started on a combination of antibiotics, which would need to be taken for six months. His adherence to the prescribed treatment plan was crucial for successful TB management and preventing the spread of the disease.

I am happy to have finished my treatment. It took a long time, but it was worth it! I struggled at the beginning of my treatment as the medicine was very strong and I wasn’t eating much since I had no appetite. But it became better.
— Mbula
I am currently teaching at a local school to save money to return to school. I also volunteer at the church as they saved my life and I would like to give back. When I came home from the hospital, the church held a Thanksgiving service in my honor. This made me very happy!
— Mbula

*The patient's name has been changed to protect his privacy and permission was secured to share his story. The quotes from this interview have been translated from Swahili to English.

FAME Africa
Maternal Health in Rural Tanzania: A Young Mother's Story

Disclaimer: The following story contains sensitive content and mentions of baby loss, which may be distressing for some readers. Reader discretion is advised.

Naisiae

When I gave birth to my first child, it was a horrible experience. I was in labor for a long, long time. The nurses kept shouting at me that I wasn’t walking long enough and that if I wanted my baby to come, I would have to stop being lazy and keep walking. And walking, I did. Finally, they sent me for a C-section when I had no more strength left. Unfortunately, it was too late. My baby, a girl I looked forward to and would name after my mother, was dead.
— Naisiae

This is the story of Naisiae*, a 25-year-old girl and her supportive mother. They live in a village in Ngorongoro, 96 miles from FAME. Four years ago, at only 21, Naisiae suffered a traumatic birth experience that resulted in the death of her child. After this, she swore never to have children as she was too traumatized to go through childbirth again. That was until she came to FAME as an intern in the Pharmacy Department.

When I was in college, I applied as an intern to FAME as part of my pharmacy degree and worked here for four months. During this time, I would pass by the maternity ward every day, as this was the only way to get to the pharmacy storeroom. The more I observed the pregnant women before and after delivery, I quickly realized how well they were cared for at FAME. There was no one shouting at them. Nobody was forcing them to do things they didn’t want or could not do in their condition. The women were always smiling and friendly and that’s when I realized that my birth experience was not normal. Giving birth did not have to be a dehumanizing experience.
— Naisiae

Naisiae (right) poses with her mother (left) and Baby Blessing (center)

After her internship, Naisiae finished her degree and decided to give motherhood another chance. Inspired by the proverbial statement, “To know the hidden truths of a place, one must walk its halls, not as a visitor but as a dedicated laborer,” she had seen enough to trust FAME to offer her a safe, supportive delivery. 

As an intern, Naisiae gained unique insights and first-hand experiences of how FAME’s maternity ward operates. It was soon clear that the public portrayal of FAME’s maternity ward as offering quality, patient-centered and compassionate care aligned with the reality behind the scenes. 

Naisiae was determined to give birth at FAME when she got pregnant, but due to the long distance from her home, she could not attend the monthly prenatal clinics. She attended a local clinic closer to home and planned to deliver the child at FAME. 

I went into labor 18 days before my due date. My mother and I panicked as we were not ready. We thought we had more time to make plans for the birth. Luckily a neighbor who owns a car offered to bring us to FAME.
— Naisiae

Once at FAME, Naisiae was rushed to the maternity ward. She wanted to try a vaginal birth after a cesarean (VBAC), but the doctors decided she needed a C-section due to complications.

You would think this would be traumatizing for me, especially because of what happened the first time. But I had full confidence in the doctors. I had seen them do this successfully many times, so I knew I was in good hands. My mother needed a little more assurance, she was very sad and felt like history was repeating itself, but I assured her if anyone could deliver this child successfully, it would be the FAME team.
— Naisiae

Naisiae’s c-section went well and she delivered a healthy baby girl! Her mother is ecstatic and quotes her favorite verse from the bible, one with a message of hope and restoration. 

My favorite bible verse is where God says that he will make up for the losses we suffer and bless us with renewed prosperity. This came true for us today. God has blessed us with a baby girl through FAME, just like the one we lost. Thank you, FAME, for doing God’s work. We are thankful.
— Mama Naisiae

Mama Naisiae

I am happy I survived another surgery and my girl is healthy. I have named her ‘Blessing’ because she is exactly that, a blessing!
— Naisiae
Thank you, FAME, for everything. The care, service and support that you have given me have been amazing. It has been wonderful to reconnect with my former colleagues and introduce them to my baby.
— Naisiae

*The patient's name has been changed to protect her privacy and permission was secured to share her story. The quotes from this interview have been translated from Swahili to English.

FAME Africa