The education aspect of FAME has been an essential factor from its very founding and has continued to be one of the most important parts of FAME that has set it apart from similar organizations that have brought healthcare to underserved areas of Africa and elsewhere. The “E” in FAME has been integral in both providing opportunities for Tanzanian healthcare workers to further their education through provided sponsorships allowing them to return to formal education programs and earn advanced diplomas or certificates that would have been otherwise impossible without funding. Those opportunities have always been one of the cornerstones of what FAME has had to offer the Tanzanian medical community and those that have chosen to work with them.

The other educational aspect of FAME, though, has been their volunteer program providing an opportunity for physicians and nurses from the United States and Europe to come and work side by side with the Tanzanian caregivers at FAME and to bring new ideas and alternative means of offering healthcare to the local population. This collaboration, though, has always been a bidirectional exchange of information and has offered a platform that allows both the Tanzanian caregivers and the volunteer caregivers to not only work together, but in complete unison, to enhance the level of care provided. The advantage for FAME and the people of Tanzania has clearly been tangible based on the outcomes data as well as the introduction of new services. The ability to provide burr holes for subdural and epidural hematomas, a life-saving procedure that was previously unavailable at FAME until the equipment was brought and personnel trained as a result of Penn neurology and neurosurgery’s collaboration with FAME and the addition of FAME’s head doctor and lead surgeon, Dr. Manjira. These patients were previously transported to Arusha or Moshi, two to three hours away, with many having died en route or even after arrival. Similar services in many other specialties have also been brought to FAME through our robust volunteer program.

These educational programs, providing further education for FAME caregivers and employees through sponsorship, as well as the volunteer program providing bidirectional learning opportunities, are what makes FAME so special and unique in this world of global medicine where so many good intentions fail to come to fruition, and both programs and equipment brought low resource countries so often fail to improve healthcare and are ultimately for naught. This is why I have spent the last sixteen years working to further develop and maintain the partnership that originally began with an unplanned visit hoping to simply see a Tanzanian medical center, but instead, finding this mecca of healthcare and all those individuals who have given their time and energy to make FAME Hospital what it is today.

Clinic today was moderate once again, with eleven patients total, as this was our third week here and we had seemingly done a good job in stamping out neurologic disease in the Karatu district. This was the last week for the current group of residents as they would be departing on Saturday and a new group would be arriving on Sunday, hopefully, given the current world events and specifically the Middle East Crisis. The arriving residents had unfortunately all been scheduled to originally travel with Qatar Airways, though because of the crisis and the closed Qatari airspace, they all had to cancel those reservations and scramble to find flights with an airline that wouldn’t be flying close enough to the Middle East to pose a problem. They had all opted to fly with Ethiopian Air through Addis Ababa, which I had also chosen to rebook my return ticket, while Jill booked with KLM traveling via Amsterdam.

After clinic was over for the day, I had planned to bring everyone to visit with Daniel Tewa. I have written about Daniel so often in the past as I have brought each and every group of residents to visit with him, though it would be helpful to once again give a bit of background for this incredible individual whom I have known for over sixteen years. When I had first come to Tanzania in 2009 with my children, Thomson Safaris, the company I had chosen to take our trip with, had offered to set up a volunteer experience for us which is how we ended up spending three days in Karatu and what set in motion the events that changed my life forever. Our volunteer time was to be spent at the Ayalabee Primary School in Karatu, where we would be helping paint the school, and we had also brought school supplies with us to give to the teachers and children. As one of the village elders who was acting as a liaison, we were introduced to Daniel Tewa, and we very quickly became friends – we visited Daniel’s home where he has built a replica of an underground Iraqw house, similar to what he grew up in for the first twenty years of his life, and learned a bit about the Iraqw culture.

Fast forward an entire year to when I was planning my return to Tanzania to work at FAME, and I contacted Daniel to find out about visiting again with him, and he endeared himself when he recalled our visit the year before and actually remembered both of my kid’s names. He invited me again to his home, and this time, I learned about Tanzanian hospitality and the fact that a guest to your home in the afternoon is never allowed to leave without first being offered dinner, otherwise it would be considered rude. We shared a traditional Iraqw meal in the central room of his typical Bantu house, just the two of us as women would normally only eat after the men had finished, and shared stories of our families and the world. Daniel is a self-taught (he only went through primary school) historian and political scientist who can quickly recall statistics about any of the fifty United States (capital, when it became a state, square miles, etc.) as well as give you a dissertation on any current topic in world politics. In the early years of my coming to FAME alone and not with residents, I would always visit Daniel for dinner at least once during my trip here, and we would always have long discussions about essentially whatever was going on in the world that day, or even deeper subjects such as homosexuality, a very controversial topic here given the fact that it is very illegal and punishable by death. We didn’t always agree on everything, but there was mutual respect between the two of us and our discussions were always heartfelt, lasting well into the evening time.

When the visits began to involve my residents, our dinners moved from his home to his daughter’s, Isabella, who lived close by and could accommodate more people as our group now numbered five or more. Despite my insistence on helping with the cost of these outings, Daniel would never hear of it for he said that we were honoring his family by our presence and for what we were doing for his country of Tanzania by our act of volunteering and working at FAME. On one occasion perhaps ten years ago, as Danielle Becker and I were leaving town, we stopped by to say goodbye, and his youngest son Stanley (who by the way was adopted by Daniel and his wife, Elizabeth, after Stanley’s mother died during childbirth, and he became their 12^th child) was at home. Daniel told me that they had just been to the local hospital as Stanley’s knee had become swollen – Danielle and I were in shock when we looked at his knee and even two neurologists could see that it was infected and in need of intravenous antibiotics, not something that had been given to them by the hospital. I called FAME and arranged for Stanley to be seen immediately and, sure enough, he had a horribly infected knee that without proper treatment would have been a disaster. It was incredibly serendipitous that we had just happened to stop by at the right time and it’s a story that Daniel and I have shared many times over the years.

I had thought our visit this evening would be for the typical African coffee (coffee boiled with fresh milk and strained) and perhaps some sweet cake that Isabella would often pick up in town, but when we arrived, there seemed to be a bit more going on than just that. I had Daniel show everyone his methane gas gathering system that’s still in use even though since my first visit he has plugged into the local electrical grid. When I first arrived, their lighting and cooking were done entirely with methane gas that is produced from the urine and manure of his three cows mixed with water into a large underground tank which then ferments with the methane gas routed out the top and into pipes running into his house. The remnants of the process form a sludge that is then forced out of the tank by the pressure and is used as fertilizer as it runs into the fields after it’s formed. They still use the gas for their cooking but have since plugged into the grid for lighting.

We then went to tour his underground Iraqw house that he built in the early 1990s after he was tired of his children not believing him when he told them stories of growing up underground in such a house. Prior to and for a number of years since independence in the early 1960s, the Iraqw and Maasai were enemies primarily because the Maasai believed that all cattle were God’s gift to them such that when they took the cattle from the Iraqw, they were only taking what was rightfully theirs and it wasn’t stealing. To protect their cattle from the Maasai, the Iraqw would take all their livestock into their underground house to join them for the night and could hear if anyone came walking on the roof of their house which was forbidden at night with anyone doing so was immediately considered to be a thief and attacked. It was not until 1986 that the Maasai and the Iraqw finally signed a treaty.

As we gathered at the table and chairs in front of the house that he is building for his grandchildren to stay in, we were informed that it was his daughter, Bernadeta’s, birthday and that his family (remember, twelve kids in all) always celebrates his children’s birthdays even if they may be elsewhere in the country living at the time. As such, they had prepared a delicious dinner for us of roasted chicken and chips (fries) along with drinks. We absolutely hadn’t expected this, though it was incredibly fortuitous as we hadn’t yet eaten and for whatever reason, the dinner that had been brought to our house which we checked before we left seemed to be somewhat inadequate for us. We sat enjoying first his African coffee, and then our dinner, chatting away about world politics and listening to him recite those challenging facts about each of our states. There was so much food for us that we departed that evening quite full and very satisfied.