Visiting FAME — our new grantee in Tanzania

Jessica Bowers is EMC’s Portfolio Director. Last month, she traveled to Tanzania to check out our newest grantee, the Foundation for African Medicine and Education (FAME).

We drove through the Arusha countryside along one of the few paved roads in northern Tanzania. Outside our window there were rolling hills of bush, farmland filled with maize, and mountains in the distance. Maasai men and boys as young, as 6 or 7-years-old guided their herds of weathered cows, donkeys and goats. The country felt so vast and empty — it seemed to go on forever. From this vantage point you’d never guess that nearly 50 million people live in Tanzania, three quarters of them in the rural regions.

Every place we visited in Tanzania provided a piece of the puzzle that reflected why 8,000 women and girls die every year in this country from pregnancy complications. Maternal healthcare facilities are often simply too far away from where Tanzanian women live — a fact that’s made more clear when you’re in one of the few cars on the only paved road for miles and miles. If poor people living in rural communities need to get anywhere, they usually have to walk.

One of the first women to give birth at FAME’s inpatient hospital in Karatu, which is about 140 kilometers (or 87 miles) from Arusha, arrived on foot having risked her life to make the journey. At nine-months pregnant, she had no choice but to walk to reach the hospital. At one point during her trip, she was chased by a water buffalo and fell. She knew she was in trouble and that her baby was in distress, but she kept walking until she reached the hospital and the medical help she needed to make sure and she and baby were okay.

Most midwives and nurses at government clinics and hospitals in Tanzania do their best to provide patient care with what little support they get. They often lack proper training, adequate space, or critical medical supplies they need to do their jobs. They grapple with overcrowded conditions that sometimes require several women to share a bed. Working in conditions like these it’s no wonder that many become frustrated, overwhelmed and feel hopeless.

As soon as we landed in Dar es Saalam we visited Temeke Municipal Hospital. Temeke delivers approximately 20,000 babies every year — roughly 385 per week. Temeke suffers from many of the conditions mentioned above — poorly trained staff, not enough healthcare providers, and limited resources, space and supplies. For a long time it was not uncommon for women to deliver alone or with little supervision in this hospital because it was understaffed and over-crowded. Some women gave birth in hallways while waiting for beds. Record keeping was so inadequate that nurses and midwives wouldn’t know who was pre-eclamptic or which women were at greatest risk. As a result, Temeke Hospital earned a reputation for having one of the highest rates of pregnancy-related deaths in the region.

In recent years however, the Tanzanian government, together with several private non-governmental organizations (NGOs), launched an extensive capacity building initiative in 22 health facilities, including Temeke Hospital. They trained and retrained healthcare providers, improved critical infrastructure and distributed equipment. In addition, the nursing staff received incentives like certificates and trophies to reward good work.

On the afternoon that we visited the hospital, the outpatient crowds had already gone home but the maternity ward and post-op departments were both full. We met with Deodata and Elizabeth, two of Temeke’s nurse-midwives. Both were visibly tired but were friendly and professional even though it was the end of a long day. In the maternity ward, they were tracking patients on a big white-board attached to a wall at the entrance. They reported they had a 10 percent C-section rate. That’s above average for developing countries where surgery is rarely an option for women who need it most. The nurses talked openly about their work and the challenges they used to face, and about how this new program has improved the quality of care they are able to provide. In fact, it’s been so successful that in September, for the first time anyone could remember, Temeke Hospital recorded zero maternal deaths. They recorded zero deaths again in February.

I’ve visited a lot of government health clinics and hospitals in Africa, and I found myself almost giddy at all they’ve accomplished even in the early stages of this program. It shows what is possible when you invest in people, equip them with the tools they need, and teach them how to provide respectful care. They’ve proven that with even small investments to improve quality of care, when women know their needs will be met and that they’ll be safe, they will travel great distances to deliver at a health facility. That’s what’s possible.

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