My journey to Tanzania started online. One day, I was checking some documentaries on YouTube when a video titled “Dr. Frank, the bushdoctor” popped up. Little did I know that my clicking it would be the start of a journey to Tanzania. And back in 2002, little did dr. Frank and his wife Susan know that climbing the Kilimanjaro would put their lives upside down. How these two Americans came to setting up a medical centre in the middle of nowhere in Tanzania is a story best explained by this video.
For many reasons, I have always had strong reservations and hesitations about being a medical volunteer in Africa. When I read about FAME’s mission however, I felt that this was the right project at the right time for me. Decisive for me was the focus on education, on putting local people in charge, and on working on establishing sustainable improvements in health care. As a volunteer at FAME, you are not filling a gap in staffing or replacing their expertise. You are there as an extra, to observe and to learn about working in the tropics and in a resource poor area, in a cultural context that differs entirely from your own. Another advantage of FAME is that you are working in a setting where basic materials are available, which allows you to work in a responsible way.
FAME stands for “Foundation for African Medicine and Education”. In 2006, FAME started with a bus, providing medical care in rural areas. In 2008, they opened an outpatient clinic in Karatu, a rural district in the Northern Highlands of Tanzania, in the midst of Maasai land. In 2011, a laboratory became operational allowing for diagnostic services and in 2012 the FAME Medical Health Centre opened. In 2013, they got a theatre operational and in 2014 the first FAME baby came into the world in the labour ward.
Let me give you a short tour around FAME Medical Health Centre. You enter the site through a big gate that gives access to a square where you will find cars and motorcycles parked, with their drivers waiting to bring patients or staff to town. You will find yourself right in front of the administration building, where everyone involved in the management of FAME has an office.
At the right side of the administration building, there is the Reproductive Child Health Clinic (RCH), an important place in the fight to reduce maternal and neonatal mortality rates in Tanzania. Here, the FAME staff provides prenatal and postnatal controls, vaccinations, medical follow ups for under 5 years of age, malaria profylaxe, information on a healthy lifestyle and several forms of contraception. You will love to see this place, filled with colorfully dressed mothers with the cutests little babies on their arms. It is a place ruled by new life. Sometimes, there are also some big baby tears, as having an injection is not one of the pleasures of life. But there is always a nurse or doctor with a big smile around to make things right and distract the child with a balloon made of a glove.
On the other side of the administration building, the laboratory is located. Here you can get your blood, urine or stool tested. You will often see patients sitting on the benches in front of the building, waiting for their tests. The lab is capable of producing results within an hour. It is the only lab of its kind in the region and plays a key role in making accurate diagnoses and in starting an appropriate treatment plan.
Behind the laboratory building, you will find the canteen. I already talked about the feeding system of staff in another blog. The canteen is not only the place to get food, but also to socialize while having one of the cups of sweet FAME tea, not seldomly hindered by a cloud of dancing wasps. I admire the canteen staff highly. They have an endless stream of dishes to wash and spend most of their time behind hot cooking pots. However, they always stay kind and friendly. As medical staff you often get compliments of grateful patients. We also should give our compliments to those feeding us and allowing us to serve our patients in the best way possible.
From the laboratory, covered pathways lead you down to the inpatient (left) and the outpatient departments (right). A path bordered by sweet-smelling lavender plants takes you to the outpatient clinic. In front of it, benches and a tv screen await you, offering patients’ relatives some distraction while waiting. You will find a colorful mix of patients in front of the OPD, representing the full range of tribes and age groups, and even regularly some tourists or expats among them. The number of outpatients at FAME keeps growing. On busy days, FAME doctors will likely see more than 100 patients with all sorts of conditions, ranging from acute diseases like respiratory infections, STD’s, and UTI’s to chronic diseases like diabetes and hypertension. Patients can buy the medication prescribed by the doctors right away at the FAME pharmacy. This helps to guarantee that they get the right medication and the right user instructions.
Medical help is not free at FAME, but has a layered structure. Those who are better off, like tourists, expats and insured Tanzanians, pay a higher fee. With donations and grants, this allows for a reduced fee or free treatment for those who would otherwise be deprived of access to medical care. I support this idea that people need to pay for health care. It will help in making them realise that good health care has its price and that you need to put money aside for it. It stimulates a sense of responsibility and ownership of their own situation.
In the outpatient clinic, there is a well-organised pharmacy with quite an impressive diversity of medications available. When FAME doctors prescribe medications, the pharmacy can dispense right away to the patient what is needed, accompanied by clear user instructions. Also the wards and theaters are daily provided with all the necessary supply of medications.
From the outpatient clinic, a path takes you to a building close to the main gate. A bit aside of the hospital and all its excitement, there is Cafe Lilac, an oasis of rest allowing you a mental break. It is open from early morning until late in the evening and serves as the meeting point for tourists, volunteers in the area, family members of patients, staff, and business people. It offers breakfast, lunch and snacks. The food is pretty good and I really loved hanging out there. You just have to take into account that everything goes pole, pole, pole… slowly. Don’t rush into the place thinking that your food will be served in less than 20 minutes. They seem to be of the opinion that it takes their customers an hour or so to stir up their appetite… ;-) Tanzania teaches you to slow down, to be in the moment, to take your time to enjoy life. In Karatu town, Lilac Cafe has two other locations. Those too are very nice places to hang around, providing an oasis of calmness and service amid the sometimes noisy and chaotic life in town.
Hospitals in Tanzania generally don’t provide food for their inpatients, with their families being responsible for feeding them. At FAME, however, patients often come from far away, and having to keep someone around to arrange the feeding would be a burden on their families. That is why FAME opted for another system: it built this small cafe at the entrance of the hospital site and leased it to a local business man. From Lilac’s kitchen, meals are distributed to the wards and are registered on the patients bill. This also gives some control of the nutritional quality of the food the patients eat while at FAME.
That’s it for now. In my next blog, I will be your guide in the inpatient clinic and the other departments. Keep watching this blog!
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