Tales from the Bush: Courtney Nall, MD

Volunteering at the FAME clinic in Tanzania was an incredible experience. Having worked with other international medical missions in the past, I always look forward to experiencing a new place, new friends, new food, new culture, and the new lessons that I will learn. One thing that I learned while working at the FAME clinic was the importance of teamwork when providing exceptional patient care. All of us had our own jobs from sweeping the floors, checking in patients, diagnosing and treating, running the lab, filling prescriptions, organizing finances, getting more donations, recruiting volunteers, etc. Each task was essential and required great thought and care given that money and resources were limited. When there was a challenging patient case, we would all work together to come up with the best possible solution for the patient. This is how medicine should be— individuals bringing their knowledge and talents together to create something better then anyone could have done on their own. One specific patient comes to mind—a 5 year old girl that was severely malnourished with little family to take care of her. We all played a part in trying to help her: the doctors examined her and discussed possible diagnoses, the nurse was able to start an IV, the cooks made her rice to eat, the lab was able to draw blood and run rests, one of the assistants was able to translate for her tribe's dialect, the pharmacy organized her medications, and a local social worker researched possible hospitals for her to go for further care. We all depended on each other. It's sometime easy to forget at FAME that we were lacking in some resources, as the hearts of the people made up for it. Now that I'm back home, I hope to continue to practice what FAME taught me: be grateful for what you have, work as a team, and love what you do.

Tales from the Bush: Dr. Joyce Cuff

Moving Day – May 4th – it really happened. At first it looked like we would have to wait for the furniture people to come and assemble the furniture. As an interim measure, I asked if I could pilfer some furniture from the shipment that had come the day before that was to be used in the various bungalows and the hospital. They said yes and we put an interior design scheme together that is unique in all the world. Eclectic doesn't begin to describe it. We have wicker stands that would probably be used to store bath towels and others that are probably flower pot stands. We have some stackable plastic bins that look like those things you put your cat in and others whose original function I can't begin to imagine. But of course, beauty is in the eye of the beholder and it is sheer beauty to these eyes. The front two-thirds of the building were totally functional throughout the entire day of moving. We timed each move between patients so we didn't miss a beat with regard to patient service. The day after the big move the furniture assembly team came. When I came in on OD3 (Operational Day 3), the new furniture had been assembled. The lab guys had completely cleaned and organized the new lab. All of the boxes of miscellaneous stuff has been emptied and properly (or at least neatly) shelved. I spent all day either doing blood chemistries using the new machine coupled with some more old-fashioned tests or sitting at the lab bench next to the window that overlooks the cornfields with the mountains in the distance. The masked weavers are just outside that same window. It was better than I could ever have imagined. And when I look around the lab with its state of the art equipment and stainless steel counters juxtaposed with the wicker bookcase and the plastic cat bins, I think it is quite perfect. And when I further reflect on my impatience while waiting for a full year for the lab to be completed, I also think of the residents of this area who have been waiting for generations for this kind of access to quality health care. Somehow my vision seems pretty myopic. Yet another lesson learned.

Tales from the Bush: Deana Miller

For as long as I can remember, I have dreamed of traveling to Africa to do something that would benefit those less fortunate than myself. And for the longest time, I was unsure what I could possibly do to help. After finishing grad school, receiving my degree in Occupational Therapy, I decided it was the perfect time to make the long awaited journey to Africa to see what I could do to help out.

Originally, a friend and I arranged to spend 4 weeks volunteering at the Rift Valley Children’s Village. We thought that we would only be able to visit the FAME clinic due to our busy schedules at the Children’s Village. We were very fortunate that things worked out and we were both able to join the remarkable FAME team. We accompanied 18 other FAME staff and volunteers as we traveled to Laghangareri for the first of 24 mobile clinics. I was unsure what to expect, but extremely excited and curious about the mission.

I was stunned on the second day of clinic when what seemed like hundreds of people were lined up seeking medical treatment when we arrived early that morning, and even more showed up on each of the following days. I was astonished by the stories I heard of how far and for how long many of these sick individuals had traveled to obtain medical care. One elderly woman asked us if she could sit down to rest for a little while, she had traveled for 2 days to get to the mobile clinic. It amazed me how these individuals who in many cases are very frail and sick are able to travel such extreme distances to get the medical care they needed. In many cases it was not only a sick parent, but also one or several sick children that made the treacherous journey.

On this same day, an older man was brought in by a community leader, by truck because he was unable to walk. The man suffered from paralysis below the waist following a sickness approximately 2 years ago that continues to persist and now also suffers with severe decubitus ulcers on his buttock and opposite hip. They were some of the worst ulcers I have seen. His wounds were treated at the clinic and he was started on antibiotics. Things were then set up to check on him at the end of the week, and arranged for him to be seen at the FAME clinic. I was able to help transport him back to his boma (mud hut). I was stunned by the condition this man was living in; he had to lay on a piece of cardboard on the dirt floor with a thin blanket covering it, and his blankets were filthy and soiled. We provided him with a foam cushion to help with comfort and positioning. I helped to educate the family through a translator, instructing them on proper positioning, wound care, and hygiene. They were also provided with the materials for dressing changes until he was seen at the clinic. With very few resources and limited knowledge of the language, this intervention and patient/family education was lot different than it would have been done in different circumstances. Despite the limited resources, it amazed me how resourceful all the medical professionals were and the incredible things that could be done in “the bush” to help these individuals.

As I begin my career as an Occupational Therapist I will now take with me something very special, something that will stay with me forever. Dr. Frank and his team are incredible; they make such a huge impact on so many lives. Joining the FAME mobile clinic was such a life changing experience that I am so glad I was able to be part of and I hope that I am able to be part of something so special again someday soon. 

Tales from the Bush: Dr. Golru Ghaffari-Greene

I spent 4 years of my childhood in western Africa and always knew that when I became a doctor, I would go back to Africa to help. When I actually got into medical school and subsequently into emergency medicine residency, returning to Africa was still my goal. I was lucky enough to find Dr. Frank and the FAME clinic through a friend who had worked with him. Dr. Frank was gracious enough to take on an emergency medicine resident.

After months of correspondence with the volunteer coordinator, I found my way to Karatu and the FAME clinic just in time to go off on my “African bush” mobile clinic experience. I didn’t know what to expect or what we would see. The 4 hour road trip to Babati was spent picking Dr. Frank’s brain apart. At the mention of snakes, I began to wonder what I was thinking.

We hopped off the bus when we got to our clinic destination. We were given a tour of our ‘clinic.’ The building had several rooms but no windows. I looked outside and saw the farm animals walk past our examination area. I kept thinking, what did I get myself into.

The first day of the clinic, after seeing the 2nd patient, any apprehension I had was gone. I was reminded why I wanted to come to Africa. We had a father bring in his 2 young sons, a boy of 8 or 10 and a young man of 16 or so. His younger son was brought in with an infection cut to his leg. His friend and he were playing with a machete and he was cut. Luckily, the cut was not deep, but he was developing infection to the leg. While I was tending to the younger son, the older brother was sitting in the chair and initially I could not understand why he was “ill.” It was when I turned my attention to him that I realized that he was guarding his right arm and had an improvised bandage around his arm. As I began to unwrap the ‘bandage’, I noticed the drainage coming from the wound. When we finally exposed the area, we found that he had an old extensive burn to his arm which had exposed bone. I was shocked. He was an epileptic who was unable to obtain his seizure medication, had seized and fell into fire. This had happened at least 4 months prior and he had not obtained any medical care. We were able to make this young man comfortable, clean his arm, and bandage it properly. We gave antibiotics to him and were able to refer him to a hospital for proper follow up care.

This was just one of many incredible stories that I experienced. I have only begun my journey as a physician and my time in Africa will stay with me forever. Even before I left, I was planning when I could return and work with Dr. Frank again. The work he does and the care he provides is life saving for many of the patients. The people in these regions don’t have access to medical care and being able to see over 800 patients in 6 days was life altering not only for the patients, but for those of us taking care of them.

Tales from the Bush: Jesse McKenna

Over the last two months at FAME, I have learned and experienced much more than I could have expected. There is one day, though, that stands out from the rest and it involves a little girl and her family. Renata is an eight-year-old FAME patient, who is currently in congestive heart failure due to rheumatic heart disease. During one of her follow-up visits, her weight, which had dropped since her last visit, became a major concern, so we all pulled together to determine how best to put some weight back on this frail little girl. Armed with a shopping list and some pocket money, Jacob (FAME's translator), and I headed into Karatu town to purchase some food items for Renata and her family. After getting all the items on our list, Jacob and I visited the family in their house, and we explained exactly how we wanted Renata to eat in order to gain weight. We bought very simple items: eggs, peanut butter, honey, bread, bananas, biscuits, and chocolate. Had anyone been there to observe the thanks we received, they would have thought we had bought them a new house. Everyone in the family individually thanked Jacob and I, and then they prayed for several minutes. I asked Jacob afterward what the prayers were, and he told me that they were thanking the director of the hospital and the people who were helping Renata to have a better life. This day is one of those days that makes me realize I am doing exactly what I want and need to do. Renata and her family inspire me to continue the work I am doing with those that need it most.

Tales from the Bush: Katie Williams, MD

Perhaps the most striking thing about working at FAME was the rhythm of the day. I woke up with the sun to the serenade of birds and other morning sounds. After a leisurely breakfast with my volunteer bungalow roommates, we walked around the hospital construction, through the red clay, to the clinic, arriving as the staff pulled in. Working side by side with Tanzanian providers, nurses, lab technicians and interpreters, I helped to take care of a range of patients with a multitude of problems in an efficient, cost-effective manner relying a great deal on clinical skills. It really did feel like the way medicine is meant to be practiced, unfettered by appointment schedules to follow, e-mails to return, insurance issues to deal with, prescriptions to refill. By the end of each clinic day, there was an unmistakable feeling of collective accomplishment, perhaps most profound during the busy days in the bush. Nights were short. After enjoying a prepared dinner, I crawled into bed, reading by flashlight so as not to use electricity, before falling asleep to the nighttime sounds of Africa.

It is hard to come up with a single word to describe the experience. It covered a range of emotions from inspiring, beautiful, and amazing to sad, upsetting, and desperate. I feel this reflects Tanzania, and the contrasts its tribal and western cultures hold. Returning to California has been jarring. We are so spoiled with lives made busy by self-imposed schedules and possessions. We have lost the rhythm of the day, rising and retiring with the sun. It is my hope that I will be able to hold onto a piece of this experience each day, to simplify, and to focus on what is truly important.

Tales from the Bush: Meredith Bowen

On one of my first days at FAME Medical as the new Volunteer Coordinator, a very young girl arrived from Oldeani Village with one of the worst cases of funzas to date.  Funzas are worms, found in the local red clay dirt, that start off microscopic in size and, burrowing into your skin, grow to the size of small peas.  I have seen some pretty bad cases, during previous trips to this area, but nothing compares to this little girl. We were told that she lives in a mud hut and is raised by grandparents, too elderly to care for her properly.  After sedating her, Dr. Ivan and Nurse Safi went to work removing dozens of funzas from her fingertips and toes.  It was a long and intense process.  Luckily for this girl, she didn’t feel a thing, and the funzas were removed before permanent damage was done.  Thank goodness for the kindness and skill of the staff here at FAME who treated her like she was their own!\

Tales from the Bush: Michael Rubenstein, MD

It’s so strange to sit here writing to you - everything in Karatu still seems so cloe as though I’m going to wake up there tomorrow and walk to clinic.  It’s hard to explain, but I’m sure you’ve had others describe some difficulty making the transition home, even after such a short visit.  I think it’s obvious that my time at FAME Medical and in Karatu was an experience unlike any before it and it’s been difficult to put it into perspective with the world here - they are so different.  Everyone here asks me how my trip went and I don’t really know what to say to the - I tell them “fantastic,” “wonderful,” or maybe “amazing,” but none of those can really capture or even come close to the true magnitude of the experience.  I haven’t been able to really get my arms around it yet.

So I’ve found myself telling everyone now that it’s really impossible to describe because it’s so different, so foreign, so unlike our lives here.  Perhaps because every moment is so meaningful there, I really can’t explain it.  I’ll tell someone what it was like walking up to the clinic in the morning for a new day, but it doesn’t capture the real emotion of that moment on the other side of the world in such a different land.

To tell you that I’ve thought about the clinic, Karatu, red clay and dust, the smell, the sun, every single person there, those whose names I knew and those who I never really did, every day, if not every hour, since my return would be the truth, but it would still not express the full extent of the impact my visit had.