Leonard had called me yesterday to let me know that he was traveling with a large group of doctors from the US who were staying at Gibb’s Farm and had been in the Crater for the day. He thought they might be interested in visiting FAME and wanted to see if it was possible to come by in the morning before heading off to the Serengeti. I was thrilled to receive the call from him as this was exactly how my introduction to FAME happened some fourteen years ago while we were here on safari. My kids and I had been with Leonard for tens day on safari and were in Karatu volunteering at a local school for three days. While here, I had asked Leonard to take us to a local health facility and, thinking that he was going to take me to visit a local doctor at their home, he instead brought me to FAME, which at the time was only a single building that was the outpatient clinic.
FAME had only opened a year earlier and was still in its infancy, yet it was somehow clear to me from that brief encounter, going over cases with Frank and Dr. Mshana, that this was to be my home over the coming years. I had spent an hour with the two of them, nearly oblivious to the time or the fact that my children were somehow occupying themselves nearby, but at the end of that chance meeting, Dr. Frank asked if I could return something, and my fate was sealed. Twenty-seven trips later, though we have accomplished so much, I still have more to do both regarding the neurology program that we’ve developed, as well as FAME itself as I now serve on the board and am currently the board chair.
This story has repeated itself time and time again and, for many of the individuals, Leonard has been the common factor. On a number of occasions, I have received phone calls from individuals who have traveled with Leonard, expressing their interest in either volunteering at FAME as a clinician or nurse, or in somehow supporting programs over here that would benefit Tanzanians. At least one of these volunteers became a long-term and very influential volunteer here as she designed most of what the public sees of FAME today through her expertise as both a nurse and an architect.
So, you can never be entirely sure what will come of a chance meeting such as a simple visit while on safari and you should never underestimate the power that such an encounter may have in someone’s life. As we only had our morning report at 8 am, we were in clinic by 8:30 to see patients, though no one would be ready to present to me for some time, so I would be free to give a tour of FAME when Leonard arrived with his group. It was wonderful to see him pull up with his Land Rover and another filled with doctors. He had also mentioned that one of the docs was a pediatric neurosurgeon which was perfect as we would be able to review the images of the young boy with probable Tb that was admitted last night. The boy was actually doing very well after having received his steroids and hypertonic saline as he was up walking (amazingly!) and was talking. Rather than making us feel any better, though, it was merely a testament to how effective steroids could be, at least in the short run as their effects would only be temporizing and we’d eventually have to pay the piper. Regardless, he had survived the night after it became clear that he was not being transferred to Arusha for an EVD.
We reviewed the boy’s CT scans with the visiting neurosurgeon who gave us some reassurance given his present clinical course and also suggested that we add some acetazolamide to our drug regimen to further reduce his intracranial pressure by reducing CSF production. Though it was good to have a second eye on the scans, our concern still remained for we all knew that if took a turn for the worse, we had nothing else at all to offer and it would be impossible to get him to Arusha in time for any lifesaving procedure. It wasn’t our call though and even after explaining this to his uncle, the decision was the same that he would remain here at FAME.
Giving a tour of FAME is always a pleasure given the growth we’ve had over the last decade and the success we’ve had in caring the population of the Karatu district. There is little difficulty in conveying the importance of FAME to the local population based on the attitude of their employees who are all dedicated to same mission that has been in place since its conception. Patients come to FAME based on their trust of the institution and the people that work here. The reaction of any physician who comes to visit FAME is always the same. Visiting rural Northern Tanzania, the last thing one expects to see is a medical institution whose sole purpose is to provide access to a level of medical care that is nearly unavailable anywhere else in the country and is being provided by doctors and nurses whose education and background far exceeds other institutions in the region. Essentially, FAME is a Mecca of healthcare that exists in the middle of a healthcare desert, providing patient-centered care to a population where access was previously non-existent.
Back up to its pre-pandemic numbers, FAME now sees approximately 30,000 patients a year and is continuing to grow on a regular basis. Our recently constructed 25-bed maternity ward is constantly filled with pre- and post-partum women who have come to FAME knowing that it is the safest place for them to deliver their babies, though we also work with traditional birth attendants to constantly improve the safety for mothers and babies alike. Having a radiology department offering services such as a CT scanner and a laboratory providing many automated lab tests, FAME has continued to serve the community with the most up to date services possible.
Walking into this setting after driving two hours from Arusha on a two lane tarmac that will end several kilometers west of town, becoming a dirt road that will traverse the entire northwest portion of Tanzania, one does not expect to stumble upon a center such as FAME, but that is what happens time and time again, and, thankfully so, for it is the Tanzanians themselves who have created this unique and one of a kind institution and have allowed us to assist them in supporting it. In the end, though, FAME is staffed by Tanzanians and is for Tanzanians.
Our young patient with what was suspected to be CNS tuberculosis and multiple mass lesions was certainly doing better and was now on anti-Tb medications, but he was not out of the woods by any means. It was now a matter of watchful waiting and hoping beyond hope that we would not receive a call from nursing that he had worsened. Meanwhile, Pendo, our young patients with the paraplegia who had come into the hospital with urosepsis was continually doing better, but her urinary status would remain an issue for family and caretakers alike. Her mother remained very difficult as she continually wanted to bring her home back to their village where there was not only nothing in the way of healthcare, but she mostly sat on a dirt floor in their home and had little to do. Having a wheelchair in that setting would provide little in the way of improving any function for her. After many lengthy discussions with the mother, though, she was finally in agreement that Pendo could eventually return to school. Unfortunately, what was not entirely clear was how long that would last.
For the afternoon, we had finished a bit early, and it had already been arranged that Dr. Anne would be bringing the entire group of residents and Jill to visit Teddy, who for the several years had taken excellent care of us by making clothing from the wonderfully colorful cloth that truly makes both East and West Africa so unique. I had a workshop scheduled that was on Zoom from 5-8 pm and would be staying at home with a hopefully functional internet for the duration of the program, though highly doubted that would be the case. It is not as much the functionality of the internet here (which, by the way, is almost 100% reliant on the cellular service unless someone has unlimited funds for satellite service), but rather the reliability of the power grid which is notoriously bad and tends to blink out multiple times an evening and is nearly immediately restored by our on-campus generator. Unfortunately, it takes the modem an eternity to reset and recycle each time. This occurred multiple times for Mark’s fellowship interview the night before and would soon occur during my workshop as well.
The workshop was being put on by the American Neurological Association (ANA) and was formally titled a Global Neurology Workshop that has been organized to foster relationships and training programs among the various regional centers of excellence in Africa where there are few neurologists. The global committee had already selected the four regional centers of excellence – Zambia, Uganda, Nigeria, and Ghana – and the workshop’s purpose was to further develop several action plans of short-, medium- and long-term goals. One of the most impressive parts of the workshop, though, was the significant participation of members of the African community which is not always the case and is perhaps one of the most important tenants in global health in that the goals should always be set by the hosting nation and not by those who have offered to provide help. Not heeding to this rule will inevitably end in disappointment and most often by those in need. The workshop was a massive success based on the participation and commitment of those who participated.
The group had a wonderful time at Teddy’s and returned home during my workshop though it wasn’t an issue as I eventually switched to my noise cancelling headphones. I wasn’t able to eat dinner until after 8 pm, which is very late for us, and sometime after that, received a phone call from Onaely, who is our radiology tech, that a neighbor of his had been in a boda boda (motorcycle) accident some days ago, suffering a head injury with intracranial bleeds and was now confused and sedated at his home. He had asked if I could come up to the ED to see the patient which was a bit unusual considering the time and the fact that the patient hadn’t yet been assessed by the doctor on call. That would very likely only prolong the process, so Mark and I eventually trudged up to the ED to see the young man in question, though the story turned out to be much different.
He had been involved in the accident a week earlier and had been admitted to Mt. Meru Hospital outside of Arusha for a week, having suffered parenchymal, subarachnoid and subdural bleeding, though all small. He required no surgery and was actually improving somewhat per his family, though we had never examined him. Given the scenario, we recommended a repeat CT scan that would reassure us that his bleeding was perfectly stable, yet when we made this recommendation, his family declined and wanted to take him to Haydom Hospital which was about five hours away. In the end, it was hard for us to argue with their request as he didn’t seem to be any worse and based on the history and examination that we obtained, he was quite likely on the mend. We walked back to the house, and both promptly went to bed.