http://www.youtube.com/watch?v=51gY5P3tC9s
Sunday, August 17, 2008
Thursday, July 31, 2008
Juju Standoff in the Nso Fon's Palace (Part 1)
Nko (the Juju with the big black head) vs. the jumping Juju
http://www.youtube.com/watch?v=Gvs7DFvOxvA
Juju Standoff in the Nso Fon's Palace (Part 2)
Nko (the Juju with the big black head) vs. the jumping Juju
http://www.youtube.com/watch?v=-vHls9IwzDw
---------------------------------------------
Monday, May 12, 2008
Goodbye Banso Baptist Hospital
Tuesday, May 6, 2008 – 11:43pm Cameroon Time
I woke up this morning around 7:00am. After breakfast, Kadidja and I spent the rest of the morning packing and tying up loose ends. I had quite a few items left over that I did not use, so I decided to take a large bag of goodies up to OPD. Marcel has been suffering from “belly bite” the last couple days, so he is now the proud owner of a bottle of Pepto-Bismol. I also gave two auxiliaries a few cans of bug spray for their children and the clinic staff a huge bottle of hand sanitizer. When I brought in these items among others, everyone in the clinic stopped what they were doing and started dancing out of great appreciation. It’s interesting how far something as simple as a can of bug spray can go!
After the dancing and rejoicing, I was informed hastily by a screener that a 15yo girl had just arrived in acute distress. This would be my last patient at BBH. She had a history of a non-productive cough and her caretaker apparently gave her a few tabs of Paracetamol that were bought at the market – not exactly the best place to purchase medicine. This is when everything supposedly went downhill for the patient. She was breathing very fast (RR 60) and had a heart rate of 160bpm. Her caretaker told me that she had also been sweating profusely – although she looked and felt fairly dry to me. Interestingly, she also had flexion contractures of the 2nd through 5th fingers bilaterally. There were no such contractures in the toes or any other muscle group for that matter. Her cranial nerves were all grossly in tact and she showed no other signs on exam. Nothing was really checking out to be acetaminophen poisoning – or ASA poisoning if the drug given was mistaken or mixed up by the caretaker. I dug a little deeper in the history and found out that she had a husband – significantly older – in the men’s ward. He was suffering from AIDS complications, specifically cryptococcal meningitis, and was not looking good. When the man was admitted she too was tested for HIV and was found to be positive. She was one of several wives this man had and was not allowed to see him in the hospital. She said she was extremely worried about him and has not eaten in many days. She also has not slept recently and has had bouts of crying episodes. Things were starting to shift from an organic origin to something more supratentorial (psychogenic). I probed and prodded and finally just asked the patient to stand up out of the wheelchair and that everything would be okay. She stood up and slowly her contractures ceased and her heart rate slowed down. She agreed to try an antidepressant and after I finished writing in her book she walked out of the clinic unshaken.
After wrapping up a few more things and saying some goodbyes, Kadidja and I set out to deliver Justice to Judit. We told Judit we would be stopping by at 6:00pm to show her a movie we had made for the BBH staff and to say goodbye. Little did she know that a goat was coming with us! Kadidja knocked on the door and Judit answered happily. I then swooped in with the goat and she went crazy! She could not stop thanking us for the goat. The rest of her family rushed to the front door to see what all the commotion was and they too began yelling and jumping with joy. Her husband then saw the new member of the family and he too was very excited. We were invited in and everyone continued to celebrate. Judit had one of her children bring out some food and we all watched the movie together. Judit, her husband, Kadidja, and I then gave formal speeches wishing one another the best – in Cameroon, you cannot just say “goodbye” and then leave. Judit told us that since we arrived at the hospital, she felt like someone important. She said that she works with doctors all day and as an auxiliary she did not feel like she contributed that much. My hope is that one day she will realize that she is the backbone of OPD and that nothing would get done without her. In all, it was a very peaceful and joy-filled evening. I can’t imagine a better way to end my stay at BBH than in Judit’s home like this.
After we left Judit’s house, we went back to the rest house to say our goodbyes to Drs Sandine, Nina, and Arega. It was all very difficult for everybody, but there was a good sense of closure in the air. Although I felt sorrow having to leave these wonderful people, I truly believe I have accomplished everything I set out to do during my short time here in Cameroon. Kadidja and I will be leaving BBH tomorrow morning at 6:00am for Limbe, a costal town near Douala, for debriefing. I will then be flying back to the United States on Friday.
Three-stranded cord,
Mark
---------------------------------------------
I woke up this morning around 7:00am. After breakfast, Kadidja and I spent the rest of the morning packing and tying up loose ends. I had quite a few items left over that I did not use, so I decided to take a large bag of goodies up to OPD. Marcel has been suffering from “belly bite” the last couple days, so he is now the proud owner of a bottle of Pepto-Bismol. I also gave two auxiliaries a few cans of bug spray for their children and the clinic staff a huge bottle of hand sanitizer. When I brought in these items among others, everyone in the clinic stopped what they were doing and started dancing out of great appreciation. It’s interesting how far something as simple as a can of bug spray can go!
After the dancing and rejoicing, I was informed hastily by a screener that a 15yo girl had just arrived in acute distress. This would be my last patient at BBH. She had a history of a non-productive cough and her caretaker apparently gave her a few tabs of Paracetamol that were bought at the market – not exactly the best place to purchase medicine. This is when everything supposedly went downhill for the patient. She was breathing very fast (RR 60) and had a heart rate of 160bpm. Her caretaker told me that she had also been sweating profusely – although she looked and felt fairly dry to me. Interestingly, she also had flexion contractures of the 2nd through 5th fingers bilaterally. There were no such contractures in the toes or any other muscle group for that matter. Her cranial nerves were all grossly in tact and she showed no other signs on exam. Nothing was really checking out to be acetaminophen poisoning – or ASA poisoning if the drug given was mistaken or mixed up by the caretaker. I dug a little deeper in the history and found out that she had a husband – significantly older – in the men’s ward. He was suffering from AIDS complications, specifically cryptococcal meningitis, and was not looking good. When the man was admitted she too was tested for HIV and was found to be positive. She was one of several wives this man had and was not allowed to see him in the hospital. She said she was extremely worried about him and has not eaten in many days. She also has not slept recently and has had bouts of crying episodes. Things were starting to shift from an organic origin to something more supratentorial (psychogenic). I probed and prodded and finally just asked the patient to stand up out of the wheelchair and that everything would be okay. She stood up and slowly her contractures ceased and her heart rate slowed down. She agreed to try an antidepressant and after I finished writing in her book she walked out of the clinic unshaken.
After wrapping up a few more things and saying some goodbyes, Kadidja and I set out to deliver Justice to Judit. We told Judit we would be stopping by at 6:00pm to show her a movie we had made for the BBH staff and to say goodbye. Little did she know that a goat was coming with us! Kadidja knocked on the door and Judit answered happily. I then swooped in with the goat and she went crazy! She could not stop thanking us for the goat. The rest of her family rushed to the front door to see what all the commotion was and they too began yelling and jumping with joy. Her husband then saw the new member of the family and he too was very excited. We were invited in and everyone continued to celebrate. Judit had one of her children bring out some food and we all watched the movie together. Judit, her husband, Kadidja, and I then gave formal speeches wishing one another the best – in Cameroon, you cannot just say “goodbye” and then leave. Judit told us that since we arrived at the hospital, she felt like someone important. She said that she works with doctors all day and as an auxiliary she did not feel like she contributed that much. My hope is that one day she will realize that she is the backbone of OPD and that nothing would get done without her. In all, it was a very peaceful and joy-filled evening. I can’t imagine a better way to end my stay at BBH than in Judit’s home like this.
After we left Judit’s house, we went back to the rest house to say our goodbyes to Drs Sandine, Nina, and Arega. It was all very difficult for everybody, but there was a good sense of closure in the air. Although I felt sorrow having to leave these wonderful people, I truly believe I have accomplished everything I set out to do during my short time here in Cameroon. Kadidja and I will be leaving BBH tomorrow morning at 6:00am for Limbe, a costal town near Douala, for debriefing. I will then be flying back to the United States on Friday.
Three-stranded cord,
Mark
---------------------------------------------
A Goat Named “Justice”
Monday, May 5, 2008 – 9:09pm Cameroon Time
Judit is an auxiliary in the outpatient department of BBH. She is quite possibly the hardest working staff member I have come across during my time here. She has also been a faithful interpreter between English and Pidgin and other local dialects – Lamso, Nso, Oku, etc. Everyday you enter the OPD, you are greeted with a bright smile from Judit – and sometimes a dance if you initiate it! She has become one of my close friends here at BBH. She has been such an encouragement to us all that I decided a goat would be an appropriate gift for Judit. She has never had a goat, but has always wanted one to raise and bread as a method of income.
It happens that today was a small market day. After finishing up with patients in the children’s ward and clinic, Kadidja and I went down to the market to purchase the goat. Because we came late in the day, all of the goats had been packed up in two large trucks ready to be taken away. They were standing on each other about 10 feet high in the bed of these huge trucks – it did not look comfortable! I told the man that I was looking for a small female goat. He brought out a medium sized female and offered it to me for 38,000 CFA (close to 100 USD!). I told him that this price was probably adequate for a tourist, but I wanted a native’s price. Those around the man began to laugh as they came to realize that I meant business and wasn’t going to be cheated in this transaction. Many times, locals will mark up the price 4-5 fold for a white person. Accordingly, I offered 10,000 CFA. All eyes were on the man to see what his next move would be. He walked away and came back with a small female goat, as I originally asked for. He told me 20,000 CFA. I laughed and told him he would never sell the goat at the big market tomorrow – let alone at that price! I responded with 6,000 CFA. We went back and forth for some time and he stopped at 8,500 CFA. Unfortunately for him, my limit was 7,500 CFA. I told Kadidja that we should be on our way because his prices were too expensive. As we were about to leave the coral, we heard the man come after us yelling that he would accept 7,500 CFA. Once again, the “walk away” move was successful and with this, the goat was purchased. Nadine, Rose’s daughter, named her “Justice.” Nontraditional names such as Justice, Promise, Confidence, etc are growing more and more popular in the Banso area.
We took Justice back to the rest house (kicking and screaming might I add) and tied her up in some grass so she could eat. Then, with the powers vested in me, I “Sheyed” the goat – i.e. gave it a scarf from the leftover material that was used to make my Shey outfit.
After dropping off the goat, I changed into my Shey stuff and went down to Rose’s house with Kadidja for dinner. On the way, we came across an elderly woman carrying a large bag of rice on her head. She stepped to the side of the path and took the bag off of her head. Then she clapped twice and bowed to greet me. Unfortunately, I didn’t have a kola nut to give her. The woman began to laugh and we joined her – what a ridiculous sight it must have been to onlookers. We reached Rose’s house and sat down for dinner. The meal consisted of foo foo kon, jama jama, papaya juice, goat meat, and bitta leaf. After dinner, Nadine stood up and began dancing and singing a traditional song. The father then stood up and started dancing as well. All of a sudden, the whole family was dancing and singing in front of us. We joined in and it made for an exciting evening. Watch the following video as I attempt to introduce "The Robot."
Acres of hope,
-Mark
---------------------------------------------
Judit is an auxiliary in the outpatient department of BBH. She is quite possibly the hardest working staff member I have come across during my time here. She has also been a faithful interpreter between English and Pidgin and other local dialects – Lamso, Nso, Oku, etc. Everyday you enter the OPD, you are greeted with a bright smile from Judit – and sometimes a dance if you initiate it! She has become one of my close friends here at BBH. She has been such an encouragement to us all that I decided a goat would be an appropriate gift for Judit. She has never had a goat, but has always wanted one to raise and bread as a method of income.
It happens that today was a small market day. After finishing up with patients in the children’s ward and clinic, Kadidja and I went down to the market to purchase the goat. Because we came late in the day, all of the goats had been packed up in two large trucks ready to be taken away. They were standing on each other about 10 feet high in the bed of these huge trucks – it did not look comfortable! I told the man that I was looking for a small female goat. He brought out a medium sized female and offered it to me for 38,000 CFA (close to 100 USD!). I told him that this price was probably adequate for a tourist, but I wanted a native’s price. Those around the man began to laugh as they came to realize that I meant business and wasn’t going to be cheated in this transaction. Many times, locals will mark up the price 4-5 fold for a white person. Accordingly, I offered 10,000 CFA. All eyes were on the man to see what his next move would be. He walked away and came back with a small female goat, as I originally asked for. He told me 20,000 CFA. I laughed and told him he would never sell the goat at the big market tomorrow – let alone at that price! I responded with 6,000 CFA. We went back and forth for some time and he stopped at 8,500 CFA. Unfortunately for him, my limit was 7,500 CFA. I told Kadidja that we should be on our way because his prices were too expensive. As we were about to leave the coral, we heard the man come after us yelling that he would accept 7,500 CFA. Once again, the “walk away” move was successful and with this, the goat was purchased. Nadine, Rose’s daughter, named her “Justice.” Nontraditional names such as Justice, Promise, Confidence, etc are growing more and more popular in the Banso area.
We took Justice back to the rest house (kicking and screaming might I add) and tied her up in some grass so she could eat. Then, with the powers vested in me, I “Sheyed” the goat – i.e. gave it a scarf from the leftover material that was used to make my Shey outfit.
After dropping off the goat, I changed into my Shey stuff and went down to Rose’s house with Kadidja for dinner. On the way, we came across an elderly woman carrying a large bag of rice on her head. She stepped to the side of the path and took the bag off of her head. Then she clapped twice and bowed to greet me. Unfortunately, I didn’t have a kola nut to give her. The woman began to laugh and we joined her – what a ridiculous sight it must have been to onlookers. We reached Rose’s house and sat down for dinner. The meal consisted of foo foo kon, jama jama, papaya juice, goat meat, and bitta leaf. After dinner, Nadine stood up and began dancing and singing a traditional song. The father then stood up and started dancing as well. All of a sudden, the whole family was dancing and singing in front of us. We joined in and it made for an exciting evening. Watch the following video as I attempt to introduce "The Robot."
Acres of hope,
-Mark
---------------------------------------------
Oku
Sunday, May 4, 2008 – 11:23pm Cameroon Time
I woke up this morning around 6:00am, ate some breakfast with Kadidja, and then walked up to the outpatient department to meet up with Simon’ family and Marcel. We were going to travel to Oku today. Oku is home to Marcel and is near Jikijam – Simon’s village. The villages are at the base of Mt. Oku, which is said to be the second largest mountain in Cameroon (Mt. Cameroon is the largest in the country and all of West Africa). After meeting up with the gang, we headed out to try to bargain a taxi ride to Oku and back. It’s about an hour’s drive on roads that aren’t exactly ideal. The taxi driver settled on 12,000 CFA (about 30 USD) to drive us all day there and back in addition to stopping any time we wanted to see a sight – it was quite the deal considering we received a foreigner’s quote yesterday at 60,000 CFA!
Upon reaching Oku, we stopped at a craftsman’s shop who specialized in wood carvings and masks. He gave us a personal tour of his shop where he led us into many rooms. The second room we entered was the mask room. Simon’s wife was not allowed to enter – nor did she want to – as the tradition holds that if she were to see the masks, she would turn sterile – I would not recommend it for birth control. Kadidja decided to take the chance. Inside the room were monstrous masks, some about 4ft by 4ft. Although interesting, the room of masks had a strange feeling to it. The expressions on the masks did not fit in with the Disney Jungle Book archetype I was used to. Many had fangs with a red stain in the mouth to symbolize blood. Others were juju masks from jujus that died. The masks were so frightening that Simon’s child nearly had a panic attack. I was not allowed to take pictures inside the room.
After seeing the masks, the man took us into several other rooms before leading us into a dark room that seemed to be empty. I wondered what all the buzz was about with this room. After we all got inside, he closed the door and turned on a flashlight (they call it a “torch”). When the room lit up there was a large bee hive in the corner with gigantic African bees flying about! This time, I almost had a panic attack! I tried to get out of the room as quickly as I could, but the man grabbed me and insisted that I stay. He said, “Bee no afraid” – although I think I was the only one who picked up on the. The man and his friend wanted to teach me about Oku’s staple – honey. Fortunately I did not get stung during this experience.
After leaving the craftsman’s shop, we met up with Simon’s wife’s father. Typically, the head of the household, Shey, Shufai, or any other man of importance will sit inside with the entrance on his left (as seen in the photo). All of us gathered into his home and I think everyone was so surprised that no one really had anything to say. After a long while of silence and surveying one another, I thought the camera would break the ice. We took several photos and then Simon informed us that we should probably head out.
Our next stop was Fon’s palace. We had to pay a fee in order pass through to get to Lake Oku (a crater lake at the top of the mountain). In the palace, there were many women and about 50-75 children. We were informed that they were all his wives and kids. We asked how many wives the Fon had and both Simon and Marcel chuckled and said in unison, “As many as possible!”
After passing through the palace, we traveled up a steep road to Jikijam. On the way, there was a juju with a small group of people following him coming right towards us. He passed by the taxi giving us an evil stare. Apparently, someone in Jikijam had committed a crime and the juju was sent out by the Fon to collect a goat from the individual as a payment. The crime was not necessarily against the law of Cameroon. Rather, it might have been a crime against the tradition or culture of the Oku people, such as traveling on a certain day or not greeting the Fon or Shufai correctly (with two claps and a bow).
After the juju encounter, we traveled up the road about 20 more minutes when we reached Jikijam. This was Simon’s village so we were able to visit with his mother and several of his childhood friends. After a few stops in Jikijam we drove up some additional steep road until we got to the lake. There were a few children who met us when we stopped and took it upon themselves to lead us down a path to the lake. They were wielding machetes to cut through the bush.
We spent some time at the lake and then had to head out because of the incoming thunderstorm. On the way out, we met up with some more of Simon’s family and were invited to stay for a meal of foo foo kon (corn without the “R”) and jama jama.
Having visitors is always a special occasion. As such, many of Simon’s family and their friends came out to greet us.
We then left Jikijam and began on our way back to Banso. Before leaving Oku, we met up with Marcel’s family. They gave him some yams, kola nuts (which are very bitter), and potatoes from their farm to take with him. Close to 100% of households outside of the cities have farms and rely on them for income as well as food to survive. Here is a photo of Marcel’s family in front of the home where he grew up – Simon and his family decided to pose in the picture as well. From the looks of Marcel’s father’s hat, he might very well be a Shey!
We got back to Banso somewhere around 5:00pm. Traveling to Oku was a wonderful experience that I’ll never forget. I’m very happy that we were able to take Simon and Marcel with us – they have not been able to go home in many months because of the high cost of a taxi.
Be lifted up,
-Mark
---------------------------------------------
I woke up this morning around 6:00am, ate some breakfast with Kadidja, and then walked up to the outpatient department to meet up with Simon’ family and Marcel. We were going to travel to Oku today. Oku is home to Marcel and is near Jikijam – Simon’s village. The villages are at the base of Mt. Oku, which is said to be the second largest mountain in Cameroon (Mt. Cameroon is the largest in the country and all of West Africa). After meeting up with the gang, we headed out to try to bargain a taxi ride to Oku and back. It’s about an hour’s drive on roads that aren’t exactly ideal. The taxi driver settled on 12,000 CFA (about 30 USD) to drive us all day there and back in addition to stopping any time we wanted to see a sight – it was quite the deal considering we received a foreigner’s quote yesterday at 60,000 CFA!
Upon reaching Oku, we stopped at a craftsman’s shop who specialized in wood carvings and masks. He gave us a personal tour of his shop where he led us into many rooms. The second room we entered was the mask room. Simon’s wife was not allowed to enter – nor did she want to – as the tradition holds that if she were to see the masks, she would turn sterile – I would not recommend it for birth control. Kadidja decided to take the chance. Inside the room were monstrous masks, some about 4ft by 4ft. Although interesting, the room of masks had a strange feeling to it. The expressions on the masks did not fit in with the Disney Jungle Book archetype I was used to. Many had fangs with a red stain in the mouth to symbolize blood. Others were juju masks from jujus that died. The masks were so frightening that Simon’s child nearly had a panic attack. I was not allowed to take pictures inside the room.
After seeing the masks, the man took us into several other rooms before leading us into a dark room that seemed to be empty. I wondered what all the buzz was about with this room. After we all got inside, he closed the door and turned on a flashlight (they call it a “torch”). When the room lit up there was a large bee hive in the corner with gigantic African bees flying about! This time, I almost had a panic attack! I tried to get out of the room as quickly as I could, but the man grabbed me and insisted that I stay. He said, “Bee no afraid” – although I think I was the only one who picked up on the. The man and his friend wanted to teach me about Oku’s staple – honey. Fortunately I did not get stung during this experience.
After leaving the craftsman’s shop, we met up with Simon’s wife’s father. Typically, the head of the household, Shey, Shufai, or any other man of importance will sit inside with the entrance on his left (as seen in the photo). All of us gathered into his home and I think everyone was so surprised that no one really had anything to say. After a long while of silence and surveying one another, I thought the camera would break the ice. We took several photos and then Simon informed us that we should probably head out.
Our next stop was Fon’s palace. We had to pay a fee in order pass through to get to Lake Oku (a crater lake at the top of the mountain). In the palace, there were many women and about 50-75 children. We were informed that they were all his wives and kids. We asked how many wives the Fon had and both Simon and Marcel chuckled and said in unison, “As many as possible!”
After passing through the palace, we traveled up a steep road to Jikijam. On the way, there was a juju with a small group of people following him coming right towards us. He passed by the taxi giving us an evil stare. Apparently, someone in Jikijam had committed a crime and the juju was sent out by the Fon to collect a goat from the individual as a payment. The crime was not necessarily against the law of Cameroon. Rather, it might have been a crime against the tradition or culture of the Oku people, such as traveling on a certain day or not greeting the Fon or Shufai correctly (with two claps and a bow).
After the juju encounter, we traveled up the road about 20 more minutes when we reached Jikijam. This was Simon’s village so we were able to visit with his mother and several of his childhood friends. After a few stops in Jikijam we drove up some additional steep road until we got to the lake. There were a few children who met us when we stopped and took it upon themselves to lead us down a path to the lake. They were wielding machetes to cut through the bush.
We spent some time at the lake and then had to head out because of the incoming thunderstorm. On the way out, we met up with some more of Simon’s family and were invited to stay for a meal of foo foo kon (corn without the “R”) and jama jama.
Having visitors is always a special occasion. As such, many of Simon’s family and their friends came out to greet us.
We then left Jikijam and began on our way back to Banso. Before leaving Oku, we met up with Marcel’s family. They gave him some yams, kola nuts (which are very bitter), and potatoes from their farm to take with him. Close to 100% of households outside of the cities have farms and rely on them for income as well as food to survive. Here is a photo of Marcel’s family in front of the home where he grew up – Simon and his family decided to pose in the picture as well. From the looks of Marcel’s father’s hat, he might very well be a Shey!
We got back to Banso somewhere around 5:00pm. Traveling to Oku was a wonderful experience that I’ll never forget. I’m very happy that we were able to take Simon and Marcel with us – they have not been able to go home in many months because of the high cost of a taxi.
Be lifted up,
-Mark
---------------------------------------------
The Chosen Children
Saturday, May 3, 2008 – 10:36pm Cameroon Time
I woke up this morning around 7:00am. As I went to fill up my water bottle, Rose (the rest house keeper) asked me an interesting question: “Is everything on the internet true?” As I informed her that a vast amount of the internet is indeed false, she looked downward toward the kitchen floor and seemed to be distraught. She then informed me that she had read on the internet about various ways to loose weight and that she had tried one of the methods in particular. For the last several months, she has been rubbing cinnamon around her lips as well as mixing it into various meals in hopes of shedding a few pounds. Her use of cinnamon has gotten to the point where it is costing too much money and is starting to affect the family. Although dumbfounded by the idea that everything on the internet is not true, Rose was delighted to hear that she didn’t have to keep rubbing cinnamon around her lips – talk about a butterfly effect!
After breakfast, Kadidja and I walked up to the administrators’ offices to meet with Lawrence, one of the field workers for the Chosen Children Program. Today we were going to join him as he made home visits throughout the town of Kumbo and its surrounding villages. Again, the Chosen Children Program was started about a decade ago and was created to meet the needs of those orphaned due to AIDS. Initially, in order to obtain services, only one of the parents must have died from AIDS – now, the criteria includes both parents. Even more so, because of limited funds, the program can only take in new cases if the child is HIV positive as well. There are around 3,500 chosen children in Cameroon, yet only some 700 receive services.
We set out and arrived at the first home after about a mile and a half of trekking. Each home visit is unannounced and random as to keep the caretakers on their toes. We needed to get a good idea about what the home environment is like as well as gain perspective with regards to the health of the children. During the first home visit, the parents were not present; however, we were able to meet with 3 of the children who had been orphaned. Only 2 were receiving services. Because it is impossible to support all children orphaned by AIDS, the decision as to which children receive services is left up to the caretaker. This is undoubtedly a very difficult decision for the caretaker to make. Nonetheless, in this home, all three children were doing very well. They were all as healthy as any other child and the home environment was above average for the area. At the end of the home visits, the field worker will write up a report and submit it to Pastor Bambo, the head of the CCP.
We trekked a bit further down the path and came across the second home. The caretaker was home this time as was the child. The home was made out of tree branches and mud and had a grass roof. Although one might think this is not ideal, the home was very well made and provided a safe environment for the child. The caretaker was elated to have us. She invited us in and told us she was very blessed that we came her way. She insisted on us staying for a meal, but we had a schedule and unfortunately had to keep moving. Here is a photo of the child and his caretaker:
We walked a fairly large distance before we arrived at the next home – again, a joyful caretaker was present. He informed us that the child was doing very well in school and had no health problems. He too proclaimed that he was honored and blessed to have the services for the child, as she probably would not be going to school and receiving the health care she needed with out the CCP. The field worker informed us that there were a few children in the program who have gone on to become great contributors to their communities. Some became nurses while others became teachers and autoworkers. Here is a photo of this chosen child:
We continued on to various other homes and by the time we were done, we had trekked numerous miles around the edges of the valley. It seemed as if we were walking up hill the whole way. Kadidja and I were about to collapse of exhaustion by the time we reached Lawrence’s home. Lawrence treks large distances everyday and is in wonderful shape – I’m not even sure he broke a sweat! We were invited into his home for something to drink where we met his wife and two boys. As it turns out, Lawrence’s wife is HIV positive as well as his oldest son who is 12. They are both on ARVs. Lawrence and his youngest son remain HIV negative. It was a poignant moment when we found out about this news. The following is a very powerful image which evokes a sense of agape love, compassion, and hope. It is of Lawrence with his oldest son:
Pastor Bambo has informed us of a very interesting ethical and public health issue that has come to rise as a consequence of the CCP and MTCT+ (mother to child transmission) program, which was put into place years ago to treat both the mother and the newborn for HIV. In the programs, children who are HIV positive have been taking pills all of their lives. In fact, it has become quite normal for them. Recently, a few children and adolescents have been asking their caretakers why they are taking the pills if they’re not sick – a valid question. The issue that the programs have struggled with is when and how to tell the children of their condition – if at all. On one hand, if the children are not told, then this will obviously lead to more HIV transmissions. On the other hand, when is a child mature enough to understand the condition and how to handle this new information? Because there is a great deal of stigma still associated with the disease, how will they handle the intense pressure? Does keeping the diagnosis silent only add to this stigma? These are questions that will most likely become more and more important to answer as the many surviving children grow older.
Kadidja and I reached the rest house and collapsed on our beds. After a good nap, we got ready for a party we were throwing for all of the physicians and surgeons we have grown close to in the last several weeks. I think we should have thought more carefully before using the word “party,” because almost everyone showed up in formal wear. Kadidja and I boasted our traditional Shey (now Shufai/Fon with my new hat) and Yah outfits. It was a most excellent evening of fellowship as we showed our great appreciation to these wonderful people of BBH.
Where the trees stand still,
-Mark
---------------------------------------------
I woke up this morning around 7:00am. As I went to fill up my water bottle, Rose (the rest house keeper) asked me an interesting question: “Is everything on the internet true?” As I informed her that a vast amount of the internet is indeed false, she looked downward toward the kitchen floor and seemed to be distraught. She then informed me that she had read on the internet about various ways to loose weight and that she had tried one of the methods in particular. For the last several months, she has been rubbing cinnamon around her lips as well as mixing it into various meals in hopes of shedding a few pounds. Her use of cinnamon has gotten to the point where it is costing too much money and is starting to affect the family. Although dumbfounded by the idea that everything on the internet is not true, Rose was delighted to hear that she didn’t have to keep rubbing cinnamon around her lips – talk about a butterfly effect!
After breakfast, Kadidja and I walked up to the administrators’ offices to meet with Lawrence, one of the field workers for the Chosen Children Program. Today we were going to join him as he made home visits throughout the town of Kumbo and its surrounding villages. Again, the Chosen Children Program was started about a decade ago and was created to meet the needs of those orphaned due to AIDS. Initially, in order to obtain services, only one of the parents must have died from AIDS – now, the criteria includes both parents. Even more so, because of limited funds, the program can only take in new cases if the child is HIV positive as well. There are around 3,500 chosen children in Cameroon, yet only some 700 receive services.
We set out and arrived at the first home after about a mile and a half of trekking. Each home visit is unannounced and random as to keep the caretakers on their toes. We needed to get a good idea about what the home environment is like as well as gain perspective with regards to the health of the children. During the first home visit, the parents were not present; however, we were able to meet with 3 of the children who had been orphaned. Only 2 were receiving services. Because it is impossible to support all children orphaned by AIDS, the decision as to which children receive services is left up to the caretaker. This is undoubtedly a very difficult decision for the caretaker to make. Nonetheless, in this home, all three children were doing very well. They were all as healthy as any other child and the home environment was above average for the area. At the end of the home visits, the field worker will write up a report and submit it to Pastor Bambo, the head of the CCP.
We trekked a bit further down the path and came across the second home. The caretaker was home this time as was the child. The home was made out of tree branches and mud and had a grass roof. Although one might think this is not ideal, the home was very well made and provided a safe environment for the child. The caretaker was elated to have us. She invited us in and told us she was very blessed that we came her way. She insisted on us staying for a meal, but we had a schedule and unfortunately had to keep moving. Here is a photo of the child and his caretaker:
We walked a fairly large distance before we arrived at the next home – again, a joyful caretaker was present. He informed us that the child was doing very well in school and had no health problems. He too proclaimed that he was honored and blessed to have the services for the child, as she probably would not be going to school and receiving the health care she needed with out the CCP. The field worker informed us that there were a few children in the program who have gone on to become great contributors to their communities. Some became nurses while others became teachers and autoworkers. Here is a photo of this chosen child:
We continued on to various other homes and by the time we were done, we had trekked numerous miles around the edges of the valley. It seemed as if we were walking up hill the whole way. Kadidja and I were about to collapse of exhaustion by the time we reached Lawrence’s home. Lawrence treks large distances everyday and is in wonderful shape – I’m not even sure he broke a sweat! We were invited into his home for something to drink where we met his wife and two boys. As it turns out, Lawrence’s wife is HIV positive as well as his oldest son who is 12. They are both on ARVs. Lawrence and his youngest son remain HIV negative. It was a poignant moment when we found out about this news. The following is a very powerful image which evokes a sense of agape love, compassion, and hope. It is of Lawrence with his oldest son:
Pastor Bambo has informed us of a very interesting ethical and public health issue that has come to rise as a consequence of the CCP and MTCT+ (mother to child transmission) program, which was put into place years ago to treat both the mother and the newborn for HIV. In the programs, children who are HIV positive have been taking pills all of their lives. In fact, it has become quite normal for them. Recently, a few children and adolescents have been asking their caretakers why they are taking the pills if they’re not sick – a valid question. The issue that the programs have struggled with is when and how to tell the children of their condition – if at all. On one hand, if the children are not told, then this will obviously lead to more HIV transmissions. On the other hand, when is a child mature enough to understand the condition and how to handle this new information? Because there is a great deal of stigma still associated with the disease, how will they handle the intense pressure? Does keeping the diagnosis silent only add to this stigma? These are questions that will most likely become more and more important to answer as the many surviving children grow older.
Kadidja and I reached the rest house and collapsed on our beds. After a good nap, we got ready for a party we were throwing for all of the physicians and surgeons we have grown close to in the last several weeks. I think we should have thought more carefully before using the word “party,” because almost everyone showed up in formal wear. Kadidja and I boasted our traditional Shey (now Shufai/Fon with my new hat) and Yah outfits. It was a most excellent evening of fellowship as we showed our great appreciation to these wonderful people of BBH.
Where the trees stand still,
-Mark
---------------------------------------------
Fowl Play
Friday, May 2, 2008 – 11:47pm Cameroon Time
I woke up this morning at 6:40am, had some papaya and coffee, and then hit the children’s ward. After a few patients, I looked over toward the ICU and saw an interesting character. She was a redhead with an attitude. I’ve never seen anyone strut their stuff like this magnificent chick. The rhythmic way she bobbed her head was nothing less than enchanting and it was difficult not to track her intently as she walked across the room. No one knows what her intentions were this morning, but in the end, Dr. Jume cried fowl. I kept him abreast of the situation and told him not to ruffle his feathers over this one – that more would surely come. “It’s always important not to keep all your eggs in one basket,” I continued. “Sure, yolk it up why don’t you,” he must of thought.
After becoming almost mesmerized by our new friend, we decided to leave the coup and head over to the Burkitt’s ward. Wonderful things were happening in the ward today. Among them was a girl of about 8 who had previously managed a large tumor in her left orbit. I was told that it was about the size of a grapefruit when she presented. After her bouts of chemo, it had retracted to what you see in the following photograph. Amazingly, she is still capable of seeing with her left eye. Please view with care:
Of note, the results from the Tchintseme et al study shown below have produced a gold standard treatment regimen for Burkitt’s lymphoma patients. It is promoted by the World Health Organization and is currently used around the world.
After finishing up with the children’s ward, we had coffee with Dr. Sandrine and then went to the outpatient clinic. One of my first patients was a man presenting with back pain. On further investigation, he was getting up multiple times a night to urinate and on exam had a 1cm or marble-sized nodule on the right side of his prostate. I ordered an ultrasound and the results were interpreted to be Grade IV BPH. I was still concerned about prostate cancer, so I referred the man to the surgeons for a biopsy. As for BPH, there are no medical therapies offered here – no matter what the grade – every case is handled surgically.
After a dozen patients or so, an elderly man from a village walked into the clinic. With him he brought a Shufai/Fon hat. Apparently Judit had arranged him to come show me this hat. I cannot wear it here as it is only for Shufais and Fons. If I were to wear it in public, the palace would send a juju after me for committing a crime against the tradition. I was told, however, that I could wear it in the rest house:
One of my last patients of the day was a middle-aged woman coming in for a refill of diabetic meds. She also came in complaining of a rash on her neck and left shoulder. She said the rash had developed a few months back and attributed it to the insulin she was started on. I took a look at the rash and it was clearly Kaposi’s Sarcoma. I delved into the history a bit more and her eyes began to tear up. I asked her what was wrong, but she insisted that everything was alright. She will be coming back in two weeks to follow up with her diabetes management, for she was not well controlled. She will also be receiving an HIV test. Unfortunately, the treatment regimen for Kaposi’s is extremely expensive and not very efficacious. She will likely have to face some serious information in the coming weeks.
After finishing up in the clinic, Kadidja and I set out to buy some chickens to give as gifts for the rest house ladies – Rose, Genecia, and Julia. We trekked to the market and came across three good-looking country chickens. These kinds of chickens can be let out when the individual leaves the home and will return when the daylight fades. I had to get myself into the bargaining spirit. The man wanted 9,000 franks (about $20) for all three – clearly a tourist price. I informed him that he must be dreaming, because the chickens looked like they were only worth 3,000. He laughed at my offer and told me 7,500. I told him I would pay 5,000 and that was my limit. He then said 7,000 and I told Kadidja we should look elsewhere because the chickens were markedly overpriced. As we started to walk away, the man called us and told us he would sell them for 5,000. He put all three chickens in one basket and we went on our way. Although I only wanted to pay 4,500, I believe it was a successful bargaining venture.
As we were walking back to the rest house with the chickens, Kadidja and I heard a shrill coming our way. It got louder and louder until finally we realized what it was. The squeals were coming from a large pig that someone had strapped on the back of a motorcycle! It was surely not a boaring way to travel! Unfortunately, we were too slow to capture it on camera.
The sun is shining,
-Mark
---------------------------------------------
I woke up this morning at 6:40am, had some papaya and coffee, and then hit the children’s ward. After a few patients, I looked over toward the ICU and saw an interesting character. She was a redhead with an attitude. I’ve never seen anyone strut their stuff like this magnificent chick. The rhythmic way she bobbed her head was nothing less than enchanting and it was difficult not to track her intently as she walked across the room. No one knows what her intentions were this morning, but in the end, Dr. Jume cried fowl. I kept him abreast of the situation and told him not to ruffle his feathers over this one – that more would surely come. “It’s always important not to keep all your eggs in one basket,” I continued. “Sure, yolk it up why don’t you,” he must of thought.
After becoming almost mesmerized by our new friend, we decided to leave the coup and head over to the Burkitt’s ward. Wonderful things were happening in the ward today. Among them was a girl of about 8 who had previously managed a large tumor in her left orbit. I was told that it was about the size of a grapefruit when she presented. After her bouts of chemo, it had retracted to what you see in the following photograph. Amazingly, she is still capable of seeing with her left eye. Please view with care:
Of note, the results from the Tchintseme et al study shown below have produced a gold standard treatment regimen for Burkitt’s lymphoma patients. It is promoted by the World Health Organization and is currently used around the world.
After finishing up with the children’s ward, we had coffee with Dr. Sandrine and then went to the outpatient clinic. One of my first patients was a man presenting with back pain. On further investigation, he was getting up multiple times a night to urinate and on exam had a 1cm or marble-sized nodule on the right side of his prostate. I ordered an ultrasound and the results were interpreted to be Grade IV BPH. I was still concerned about prostate cancer, so I referred the man to the surgeons for a biopsy. As for BPH, there are no medical therapies offered here – no matter what the grade – every case is handled surgically.
After a dozen patients or so, an elderly man from a village walked into the clinic. With him he brought a Shufai/Fon hat. Apparently Judit had arranged him to come show me this hat. I cannot wear it here as it is only for Shufais and Fons. If I were to wear it in public, the palace would send a juju after me for committing a crime against the tradition. I was told, however, that I could wear it in the rest house:
One of my last patients of the day was a middle-aged woman coming in for a refill of diabetic meds. She also came in complaining of a rash on her neck and left shoulder. She said the rash had developed a few months back and attributed it to the insulin she was started on. I took a look at the rash and it was clearly Kaposi’s Sarcoma. I delved into the history a bit more and her eyes began to tear up. I asked her what was wrong, but she insisted that everything was alright. She will be coming back in two weeks to follow up with her diabetes management, for she was not well controlled. She will also be receiving an HIV test. Unfortunately, the treatment regimen for Kaposi’s is extremely expensive and not very efficacious. She will likely have to face some serious information in the coming weeks.
After finishing up in the clinic, Kadidja and I set out to buy some chickens to give as gifts for the rest house ladies – Rose, Genecia, and Julia. We trekked to the market and came across three good-looking country chickens. These kinds of chickens can be let out when the individual leaves the home and will return when the daylight fades. I had to get myself into the bargaining spirit. The man wanted 9,000 franks (about $20) for all three – clearly a tourist price. I informed him that he must be dreaming, because the chickens looked like they were only worth 3,000. He laughed at my offer and told me 7,500. I told him I would pay 5,000 and that was my limit. He then said 7,000 and I told Kadidja we should look elsewhere because the chickens were markedly overpriced. As we started to walk away, the man called us and told us he would sell them for 5,000. He put all three chickens in one basket and we went on our way. Although I only wanted to pay 4,500, I believe it was a successful bargaining venture.
As we were walking back to the rest house with the chickens, Kadidja and I heard a shrill coming our way. It got louder and louder until finally we realized what it was. The squeals were coming from a large pig that someone had strapped on the back of a motorcycle! It was surely not a boaring way to travel! Unfortunately, we were too slow to capture it on camera.
The sun is shining,
-Mark
---------------------------------------------
Labor Day!
Thursday, May 1, 2008 – 10:29pm Cameroon Time
I woke up today at 6:00am to the church’s keyboard playing many old time tunes such as Yankee Doodle Dandy and other ice cream truck favorites. Today was Labor Day in Cameroon, which is much more widely celebrated here than in the US. We had breakfast and headed up to the hospital for the diabetic clinic. There were no rounds today, nor were any of the other departments open. It was treated as a Sunday with an exception of the diabetic clinic. Other than the nurses on the wards and a few of us in the clinic, the rest of the hospital staff and administration were heading Tobin, which is south of Kumbo, to march. They all wore their hospital uniforms and had made signs and posters that promoted who they were and what services they provided. Everyone had a great amount of pride in the fact that they worked for BBH.
After seeing quite a number of diabetics, as well as other outpatients, we all joined up with the rest of the hospital staff in the chapel for lunch. They served foo foo kon and jama jama – as well as the blackened fish (which I passed on). Kadidja and I then went back to the rest house and rested before heading down to Simon’s shop.
We walked down the hill and met Simon, his wife, and his son. Simon then took us onward down the hill to see his home. As we walked through the community of homes, we were greeted warmly by everyone as they were very excited to be having guests. We sat down in his house and enjoyed each other’s company. After a while, his wife and son brought in a liter of fruit soda for us – which is very expensive for the average Cameroonian. It was quite an honor when his family offered this gift to Kadidja and me. Simon expressed his wish for us to travel with him to Oku – the village where he grew up. It turns out that we were planning on traveling to Oku this Sunday! Hopefully he can join us.
Long time comin’,
-Mark
---------------------------------------------
I woke up today at 6:00am to the church’s keyboard playing many old time tunes such as Yankee Doodle Dandy and other ice cream truck favorites. Today was Labor Day in Cameroon, which is much more widely celebrated here than in the US. We had breakfast and headed up to the hospital for the diabetic clinic. There were no rounds today, nor were any of the other departments open. It was treated as a Sunday with an exception of the diabetic clinic. Other than the nurses on the wards and a few of us in the clinic, the rest of the hospital staff and administration were heading Tobin, which is south of Kumbo, to march. They all wore their hospital uniforms and had made signs and posters that promoted who they were and what services they provided. Everyone had a great amount of pride in the fact that they worked for BBH.
After seeing quite a number of diabetics, as well as other outpatients, we all joined up with the rest of the hospital staff in the chapel for lunch. They served foo foo kon and jama jama – as well as the blackened fish (which I passed on). Kadidja and I then went back to the rest house and rested before heading down to Simon’s shop.
We walked down the hill and met Simon, his wife, and his son. Simon then took us onward down the hill to see his home. As we walked through the community of homes, we were greeted warmly by everyone as they were very excited to be having guests. We sat down in his house and enjoyed each other’s company. After a while, his wife and son brought in a liter of fruit soda for us – which is very expensive for the average Cameroonian. It was quite an honor when his family offered this gift to Kadidja and me. Simon expressed his wish for us to travel with him to Oku – the village where he grew up. It turns out that we were planning on traveling to Oku this Sunday! Hopefully he can join us.
Long time comin’,
-Mark
---------------------------------------------
LAP Party
Wednesday, April 30, 2008 – 10:12pm Cameroon Time
I woke up today about 6:45am and was greeted by Dr. Kidd, an OB/GYN from Arizona. She was teaming up with two family practice doctors, Tom and Iddie, from Idaho and a midwife also from Arizona to implement a cervical cancer screening program at BBH and some of the surrounding health centers. They will be facing some very strong cultural impediments in their efforts. In particular, there is a large Muslim population in the area and it is common for a woman to be examined prior to marriage in order to make sure her hymen is still intact. This “ensures” her virginity. A speculum exam would obviously make a young woman vulnerable to being rejected by her community if the community is not educated as to what really had been done. This is just one of many examples of how culture plays an extremely large role in global health.
A party was thrown today at the LAP resource center in Bamkika’ai for Drs Pat and Geoff Mitchell. The Mitchells began the LAP program years ago and it has now grown into one of the cornerstone public health service organizations in the country. The celebration was three-fold. It was Pat’s birthday, the Mitchell’s 50th wedding anniversary, and the retirement of these two highly regarded individuals. Kadidja and I took motorcycles up to the LAP center and were escorted to the administration seating area. I am always very humbled when locals treat me as they would treat a top official or someone of great importance.
We took our seats and enjoyed many speakers who recalled the history of the LAP program and how influential the Mitchells have been in the country. It was truly an honor to be at this occasion. After the speaking was finished, we sang two songs and then were escorted inside for lunch. The food was an arrangement of local favorites, such as foo foo kon and jama jama, fish heads, plantains, rice, and some sort of meat concoction that I don’t know the name of. A missionary also had baked 3 cakes for everyone to enjoy. After we finished our meal, the Mitchell’s approached Kadidja and I and we had a great conversation about our experience in Cameroon thus far. Geoff had a thick British accent, so you felt more intelligent just by speaking with the gentleman. Here is a photo of many of the top ministers and administrators in the CBC Health Services who attended the party:
The LAP program sends teams of health educators, and on occasion physicians and nurses, to small villages scattered about Cameroon – mainly in the Northwest Province. After arriving via helicopter, Cessna, or van, the educators teach the villagers about preventative health topics such as hand washing, storing food, latrine sanitation, and so on and so forth. It has greatly reduced the incidence of many preventable illnesses such as diarrhea and malnutrition in the area. Unfortunately, I came at a time when the LAP team members were on a retreat, so the opportunity to travel with them did not present itself.
Come one, come all,
-Mark
---------------------------------------------
I woke up today about 6:45am and was greeted by Dr. Kidd, an OB/GYN from Arizona. She was teaming up with two family practice doctors, Tom and Iddie, from Idaho and a midwife also from Arizona to implement a cervical cancer screening program at BBH and some of the surrounding health centers. They will be facing some very strong cultural impediments in their efforts. In particular, there is a large Muslim population in the area and it is common for a woman to be examined prior to marriage in order to make sure her hymen is still intact. This “ensures” her virginity. A speculum exam would obviously make a young woman vulnerable to being rejected by her community if the community is not educated as to what really had been done. This is just one of many examples of how culture plays an extremely large role in global health.
A party was thrown today at the LAP resource center in Bamkika’ai for Drs Pat and Geoff Mitchell. The Mitchells began the LAP program years ago and it has now grown into one of the cornerstone public health service organizations in the country. The celebration was three-fold. It was Pat’s birthday, the Mitchell’s 50th wedding anniversary, and the retirement of these two highly regarded individuals. Kadidja and I took motorcycles up to the LAP center and were escorted to the administration seating area. I am always very humbled when locals treat me as they would treat a top official or someone of great importance.
We took our seats and enjoyed many speakers who recalled the history of the LAP program and how influential the Mitchells have been in the country. It was truly an honor to be at this occasion. After the speaking was finished, we sang two songs and then were escorted inside for lunch. The food was an arrangement of local favorites, such as foo foo kon and jama jama, fish heads, plantains, rice, and some sort of meat concoction that I don’t know the name of. A missionary also had baked 3 cakes for everyone to enjoy. After we finished our meal, the Mitchell’s approached Kadidja and I and we had a great conversation about our experience in Cameroon thus far. Geoff had a thick British accent, so you felt more intelligent just by speaking with the gentleman. Here is a photo of many of the top ministers and administrators in the CBC Health Services who attended the party:
The LAP program sends teams of health educators, and on occasion physicians and nurses, to small villages scattered about Cameroon – mainly in the Northwest Province. After arriving via helicopter, Cessna, or van, the educators teach the villagers about preventative health topics such as hand washing, storing food, latrine sanitation, and so on and so forth. It has greatly reduced the incidence of many preventable illnesses such as diarrhea and malnutrition in the area. Unfortunately, I came at a time when the LAP team members were on a retreat, so the opportunity to travel with them did not present itself.
Come one, come all,
-Mark
---------------------------------------------
Retrospective Malaria Study
Tuesday, April 29, 2008 – 7:07pm Cameroon Time
I woke up this morning around 8:00am. Kadidja had gone with Dr. Sandrine to the village of Bangolan for a doctor’s visit. There is a health center out there that is run by nurses and a physician will come once a month to see the patients. The health center makes announcements to the villagers weeks in advance when a doctor is coming. This makes for a large crowd when one shows up – sometimes in the hundreds! I may be going to Ndu next Tuesday – although, because it is the day before I leave BBH to travel down south, it may not be feasible.
I had breakfast and went up to the billing office to meet with Joseph, one of the hospital’s statisticians. Although the hospital keeps track of how many cases of a particular disease it sees in a year, not much more is done in terms of research or surveillance. As such, I decided to do a small cross-sectional study on malaria in the area. The hospital only has records of inpatients and no records of outpatients, so that will play a factor in the final results – as will many other issues. These records are hand written, so you can imagine sifting through a year’s worth of patients to find every inpatient malaria case. I was very fortunate to have Joseph and his colleague’s help. They gave up their whole day to assist me in finding and logging the data – we were able to get through adult men and children. The records for women were misplaced, so we will continue at a later date after the ledgers are found. Upon leaving, I thanked Joseph and his colleague for helping me and they insisted that they were blessed to be able to have the opportunity to help.
Out of fervent curiosity, I got back to the rest house and took a quick look at the data in graphic form and there were some great trends! I can’t wait to finish collecting the women’s data so I can sit down and dissect it all.
If the hospital implemented a computer-based record system and included outpatient visits, imagine the enormity of information and research possibilities that would be available. With this type of data, the hospital would be better suited to assist the LAP program in streamlining some of the village trips rather than taking the shotgun approach currently used for health education and promotion.
Manner and means,
-Mark
---------------------------------------------
I woke up this morning around 8:00am. Kadidja had gone with Dr. Sandrine to the village of Bangolan for a doctor’s visit. There is a health center out there that is run by nurses and a physician will come once a month to see the patients. The health center makes announcements to the villagers weeks in advance when a doctor is coming. This makes for a large crowd when one shows up – sometimes in the hundreds! I may be going to Ndu next Tuesday – although, because it is the day before I leave BBH to travel down south, it may not be feasible.
I had breakfast and went up to the billing office to meet with Joseph, one of the hospital’s statisticians. Although the hospital keeps track of how many cases of a particular disease it sees in a year, not much more is done in terms of research or surveillance. As such, I decided to do a small cross-sectional study on malaria in the area. The hospital only has records of inpatients and no records of outpatients, so that will play a factor in the final results – as will many other issues. These records are hand written, so you can imagine sifting through a year’s worth of patients to find every inpatient malaria case. I was very fortunate to have Joseph and his colleague’s help. They gave up their whole day to assist me in finding and logging the data – we were able to get through adult men and children. The records for women were misplaced, so we will continue at a later date after the ledgers are found. Upon leaving, I thanked Joseph and his colleague for helping me and they insisted that they were blessed to be able to have the opportunity to help.
Out of fervent curiosity, I got back to the rest house and took a quick look at the data in graphic form and there were some great trends! I can’t wait to finish collecting the women’s data so I can sit down and dissect it all.
If the hospital implemented a computer-based record system and included outpatient visits, imagine the enormity of information and research possibilities that would be available. With this type of data, the hospital would be better suited to assist the LAP program in streamlining some of the village trips rather than taking the shotgun approach currently used for health education and promotion.
Manner and means,
-Mark
---------------------------------------------
Waiting Anxiously
Monday, April 28, 2008 – 8:52pm Cameroon Time
I woke up this morning around 6:45am for breakfast, after which Kadidja and I two-stepped up to the wards. Because labor and delivery has been slow lately, Kadidja joined Dr. Jume and me as we rounded on the children’s ward. A child had come in with histiocytosis, and not knowing hardly anything about this condition other than “Tennis Rackets,” we looked it up. Apparently, this is not a rarity around here as there is was a treatment protocol posted on the wall in the Burkitt’s ward. After seeing the rest of the patients and discharging a few, we went down to the conference room for coffee.
Dr. Jume then went up to the clinic and Kadidja and I went over to Pastor Bambo’s office to speak with him about the Chosen Children Program (CCP). The program is for children who have been orphaned because of AIDS. It began almost a decade ago here at BBH and currently has 3,500 children on its roster throughout Cameroon; however, CCP is currently only able to provide services for 742 children due to a lack of funding. There is no orphanage or house where the children live – rather, they live with extended family, friends, or surrogates. Field workers of the CCP are paid 10,000 CFA a month (a little over $20) and their duties include home visits to document how the children are doing – what the home environment is like, the level of their health, whether or not they have a bed to sleep on, etc. If a child needs immediate care, further actions are taken. Kadidja and I will be meeting up with one of the field workers on Saturday at noon to do home visits throughout the Kumbo community and surrounding village areas.
After our meeting with Pastor Bambo, we went over to the outpatient clinic to see how everything was going. After seeing a number of patients, we found ourselves closing down the fort. There was a 20yo male who was waiting outside to be seen. He came in every now and again to let us know that he was anxious to leave. We grabbed his book to see what he was coming in for. He had an HIV test and the results couldn’t have been more obscure. There were about 6 or 7 words listed and a positive or negative marked next to each one. Kadidja, Judit, and I had never heard of any of these results, so we weren’t about to tell him anything. It turns out that the remaining physicians were in a “do not disturb” meeting and wouldn’t be out for some time. The patient had arrived at the clinic early in the morning and it was now late afternoon. To imagine what must have been going through his mind during these long hours and the anxiety of not knowing whether he was positive or negative escapes me.
Five feet high and rising,
-Mark
---------------------------------------------
I woke up this morning around 6:45am for breakfast, after which Kadidja and I two-stepped up to the wards. Because labor and delivery has been slow lately, Kadidja joined Dr. Jume and me as we rounded on the children’s ward. A child had come in with histiocytosis, and not knowing hardly anything about this condition other than “Tennis Rackets,” we looked it up. Apparently, this is not a rarity around here as there is was a treatment protocol posted on the wall in the Burkitt’s ward. After seeing the rest of the patients and discharging a few, we went down to the conference room for coffee.
Dr. Jume then went up to the clinic and Kadidja and I went over to Pastor Bambo’s office to speak with him about the Chosen Children Program (CCP). The program is for children who have been orphaned because of AIDS. It began almost a decade ago here at BBH and currently has 3,500 children on its roster throughout Cameroon; however, CCP is currently only able to provide services for 742 children due to a lack of funding. There is no orphanage or house where the children live – rather, they live with extended family, friends, or surrogates. Field workers of the CCP are paid 10,000 CFA a month (a little over $20) and their duties include home visits to document how the children are doing – what the home environment is like, the level of their health, whether or not they have a bed to sleep on, etc. If a child needs immediate care, further actions are taken. Kadidja and I will be meeting up with one of the field workers on Saturday at noon to do home visits throughout the Kumbo community and surrounding village areas.
After our meeting with Pastor Bambo, we went over to the outpatient clinic to see how everything was going. After seeing a number of patients, we found ourselves closing down the fort. There was a 20yo male who was waiting outside to be seen. He came in every now and again to let us know that he was anxious to leave. We grabbed his book to see what he was coming in for. He had an HIV test and the results couldn’t have been more obscure. There were about 6 or 7 words listed and a positive or negative marked next to each one. Kadidja, Judit, and I had never heard of any of these results, so we weren’t about to tell him anything. It turns out that the remaining physicians were in a “do not disturb” meeting and wouldn’t be out for some time. The patient had arrived at the clinic early in the morning and it was now late afternoon. To imagine what must have been going through his mind during these long hours and the anxiety of not knowing whether he was positive or negative escapes me.
Five feet high and rising,
-Mark
---------------------------------------------
Sunday, May 4, 2008
The Cave
Sunday, April 27, 2008 – 9:03pm Cameroon Time
I woke up this morning at 6:40am for church. When I got to there, a keyboard was playing (rather well might I add), but no one was to be seen! The building was completely empty. I thought that maybe because of the wedding the previous day, that the service would be held later. As any sane person would do, I went back to the rest house and took a nap.
I woke up only to have missed the service. I had breakfast with Kadidja and then went outside to sit and relax on the picnic table. After a little bit, I looked to my left and Sister Doris was making her way down the path. She had come in with Glory, the patient with the large orbital mass who I wrote about earlier. She had heard through the grapevine that funds were raised for Glory’s surgery and was very excited to announce that everything could now proceed with her care.
After this, Kadidja and I went up to the clinic and met Dr. Sandrine and Marcel (an auxiliary in the outpatient department). Marcel was going to take us to a nearby cave today that had been used centuries ago by natives to hide from the slave traders. We walked up the road and turned off into the bush near the L.A.P. program office. A group of kids saw us and they followed us all the way down the trail until there was another turn off. This was the last turn off before the cave and all of a sudden the kids stopped and let us go on alone. We chopped our way through the bush with sticks and came upon a large valley with steep slopes. We traversed across the hill and then down another path. Next, we went vertical. One miss-step and you would be on the bottom of the valley floor. Finally, we reached the cave. There was talk of locals that the cave was used currently for traditional black magic ceremonies and such, but I wanted to confirm it with Marcel – a trusted source and new expedition guide. Marcel told us how the cave formed, but was reluctant to answer what the cave was used for in the past or if anybody used the cave in the present time. He dodged questions right and left. We entered the cave and Marcel turned even more suspicious. There was an uneasiness quality about him. We explored around a little bit and then began climb out. I don’t think we will ever know for sure what goes on in the cave, but it was truly a unique experience straight out of Indiana Jones.
I had grabbed a walking stick during our trek and on the way back, once we reached the dirt road, Marcel advised me to ditch the stick. He said that a certain Juju carries a stick like that and it would raise some serious trouble if the Juju knew I was carrying a similar one. Also, if someone is banished from the Nso, he will be given a stick like this to leave the village. As I didn’t want either option (1) or (2), I figured I would toss the stick to the side.
Climb on,
-Mark
---------------------------------------------
I woke up this morning at 6:40am for church. When I got to there, a keyboard was playing (rather well might I add), but no one was to be seen! The building was completely empty. I thought that maybe because of the wedding the previous day, that the service would be held later. As any sane person would do, I went back to the rest house and took a nap.
I woke up only to have missed the service. I had breakfast with Kadidja and then went outside to sit and relax on the picnic table. After a little bit, I looked to my left and Sister Doris was making her way down the path. She had come in with Glory, the patient with the large orbital mass who I wrote about earlier. She had heard through the grapevine that funds were raised for Glory’s surgery and was very excited to announce that everything could now proceed with her care.
After this, Kadidja and I went up to the clinic and met Dr. Sandrine and Marcel (an auxiliary in the outpatient department). Marcel was going to take us to a nearby cave today that had been used centuries ago by natives to hide from the slave traders. We walked up the road and turned off into the bush near the L.A.P. program office. A group of kids saw us and they followed us all the way down the trail until there was another turn off. This was the last turn off before the cave and all of a sudden the kids stopped and let us go on alone. We chopped our way through the bush with sticks and came upon a large valley with steep slopes. We traversed across the hill and then down another path. Next, we went vertical. One miss-step and you would be on the bottom of the valley floor. Finally, we reached the cave. There was talk of locals that the cave was used currently for traditional black magic ceremonies and such, but I wanted to confirm it with Marcel – a trusted source and new expedition guide. Marcel told us how the cave formed, but was reluctant to answer what the cave was used for in the past or if anybody used the cave in the present time. He dodged questions right and left. We entered the cave and Marcel turned even more suspicious. There was an uneasiness quality about him. We explored around a little bit and then began climb out. I don’t think we will ever know for sure what goes on in the cave, but it was truly a unique experience straight out of Indiana Jones.
I had grabbed a walking stick during our trek and on the way back, once we reached the dirt road, Marcel advised me to ditch the stick. He said that a certain Juju carries a stick like that and it would raise some serious trouble if the Juju knew I was carrying a similar one. Also, if someone is banished from the Nso, he will be given a stick like this to leave the village. As I didn’t want either option (1) or (2), I figured I would toss the stick to the side.
Climb on,
-Mark
---------------------------------------------
Wednesday, April 30, 2008
Wedding!
Saturday, April 26, 2008 – 10:54pm Cameroon Time
I woke up this morning about 7:00am, had some breakfast with Kadidja, and both of us went up to see some of the patients we admitted in the men’s ward. We also saw a patient at the outpatient clinic who was returning with her labs from the previous day. After seeing these few patients, we then went back down to the rest house and garbed ourselves with our new traditional attire for a wedding that was to take place at 10:00am. The wedding was between Girard and Helen (one of our secretaries in the administration office). I wore my Shey outfit and Kadidja wore her newly made dress.
We walked over to the chapel and it seemed like everyone’s eyes were on us – great, we’re going to take away the attention from the bride. It turns out that this was certainly not the case. We walked inside and took a seat. After about 30 minutes of waiting, the excitement and anticipation in the air seemed to rise with each breath. Then, all of a sudden, about 8 women and 8 men with palms in their hands came dancing down the center aisle. They inched along – which made it seem like they weren’t making much progress – as they got down to traditional music. The whole procession of this group took about 15 minutes. Next came the groomsmen. They too inched their way along as they boogied to the drums choir voices – there were two choirs! After about 10 minutes of groomsmen procession, the bridesmaids came down the aisle in a similar fashion – there were about 15-20 of them! After all was said and done, the bride finally danced her way down the aisle as everyone stood to dance with her. The entire procession, from the palm people to the bride took about 40 minutes to an hour. It was quite the experience.
After this, the MC did A LOT of talking. In his spiel, he continued to say, “This is serious,” and almost every time after he would say this, something would happen that was outrageously ridiculous – so there was an odd comic value attached with the whole thing. After a few more announcements and recognition of guests, the pastor gave a one hour and thirty minute sermon on marriage. After this, vows and rings were exchanged and a cake was cut – then came the gifts:
First, the groom’s family and friends (from Banso) presented their gifts to the newlyweds. They danced slowly down the aisle (as before), each person with his or her gift in hand. Some of the gifts I saw included stools, cooked meals, chickens, money, and small baskets. They also carried babies down the aisle as they danced to bless the couple with good fertility – which is very important in this culture. After the groom’s side was finished, the bride’s side (from the village of Oku) presented their gifts in the same way. I would have to say that the bride’s side was about 5 times larger than the groom’s. After this, the two choirs presented their own gifts along with other people in attendance.
More words were said and by this time it was about 5:00pm. The MC announced that this was the conclusion of Part I of the wedding and that Part II would take place outside and in another building on the church grounds. Kadidja and I were exhausted from Part I, so we decided to head back to the rest house. On our way back, Kadidja and I came across a small girl standing by a bush. She looked up to me and quietly said, “Shey?!” I was told that if I was greeted as a Shey that I should give the person a cola nut from my bag. I haven’t had a chance to get cola nuts just of yet; however, I did have some Runts and Sugar Babies. I reached in my bag and handed the girl a couple pieces of candy. She was very happy to receive the gift. After we got back, we ate dinner and went straight to our rooms to rest. The wedding could be heard into the night.
Hopefully you can appreciate the energetic atmosphere with the following video:
Just another day in paradise,
-Mark
---------------------------------------------
I woke up this morning about 7:00am, had some breakfast with Kadidja, and both of us went up to see some of the patients we admitted in the men’s ward. We also saw a patient at the outpatient clinic who was returning with her labs from the previous day. After seeing these few patients, we then went back down to the rest house and garbed ourselves with our new traditional attire for a wedding that was to take place at 10:00am. The wedding was between Girard and Helen (one of our secretaries in the administration office). I wore my Shey outfit and Kadidja wore her newly made dress.
We walked over to the chapel and it seemed like everyone’s eyes were on us – great, we’re going to take away the attention from the bride. It turns out that this was certainly not the case. We walked inside and took a seat. After about 30 minutes of waiting, the excitement and anticipation in the air seemed to rise with each breath. Then, all of a sudden, about 8 women and 8 men with palms in their hands came dancing down the center aisle. They inched along – which made it seem like they weren’t making much progress – as they got down to traditional music. The whole procession of this group took about 15 minutes. Next came the groomsmen. They too inched their way along as they boogied to the drums choir voices – there were two choirs! After about 10 minutes of groomsmen procession, the bridesmaids came down the aisle in a similar fashion – there were about 15-20 of them! After all was said and done, the bride finally danced her way down the aisle as everyone stood to dance with her. The entire procession, from the palm people to the bride took about 40 minutes to an hour. It was quite the experience.
After this, the MC did A LOT of talking. In his spiel, he continued to say, “This is serious,” and almost every time after he would say this, something would happen that was outrageously ridiculous – so there was an odd comic value attached with the whole thing. After a few more announcements and recognition of guests, the pastor gave a one hour and thirty minute sermon on marriage. After this, vows and rings were exchanged and a cake was cut – then came the gifts:
First, the groom’s family and friends (from Banso) presented their gifts to the newlyweds. They danced slowly down the aisle (as before), each person with his or her gift in hand. Some of the gifts I saw included stools, cooked meals, chickens, money, and small baskets. They also carried babies down the aisle as they danced to bless the couple with good fertility – which is very important in this culture. After the groom’s side was finished, the bride’s side (from the village of Oku) presented their gifts in the same way. I would have to say that the bride’s side was about 5 times larger than the groom’s. After this, the two choirs presented their own gifts along with other people in attendance.
More words were said and by this time it was about 5:00pm. The MC announced that this was the conclusion of Part I of the wedding and that Part II would take place outside and in another building on the church grounds. Kadidja and I were exhausted from Part I, so we decided to head back to the rest house. On our way back, Kadidja and I came across a small girl standing by a bush. She looked up to me and quietly said, “Shey?!” I was told that if I was greeted as a Shey that I should give the person a cola nut from my bag. I haven’t had a chance to get cola nuts just of yet; however, I did have some Runts and Sugar Babies. I reached in my bag and handed the girl a couple pieces of candy. She was very happy to receive the gift. After we got back, we ate dinner and went straight to our rooms to rest. The wedding could be heard into the night.
Hopefully you can appreciate the energetic atmosphere with the following video:
Just another day in paradise,
-Mark
---------------------------------------------
FNA – No Way!...Just give me some medicine
Friday, April 25, 2008 – 11:03pm Cameroon Time
I woke up this morning around 6:50am, had some breakfast, and sidestepped with Kadidja up to the hospital. Drs. Jume and Gi were in Sakilbaka and Drs. Francine and Sandrine had the day off. As a result, the hospital was severely short staffed which made for quite a large workload today.
In the morning, it was decided that a pregnant patient at 42 weeks was to have a C-section. Kadidja and I decided to attend. Usually there is only enough staff to tend to the mother during deliveries. There is no newborn exam – the baby is weighed and then passed off to the mother. If a problem arises with the baby while with the mother, then the issue will be addressed – but otherwise, the care of the baby is left to the mother. One can see how hemorrhagic disease of the newborn, respiratory distress syndrome, and other life threatening disease processes can be very dangerous if not screened for. Kadidja and I decided to tend to the baby today. The baby seemed to be large for gestational age – despite being 42 weeks. It must have weighed 10+ pounds! The baby was breathing very well and everything else checked out to be normal. We ordered a random glucose because of the baby’s macrosomia – it was within normal limits as well. I am happy to say that the C-section itself was much more sterile and organized than the LP and bone marrow tap I witnessed earlier in the week.
After the procedure, Kadidja and I went to the men’s ward to follow up on a malignant hypertension patient we had come in yesterday. His blood pressure had dropped to 160/94 on IV hydralazine over the course of the night and morning, so we were able to switch him over to oral agents.
I also saw a new patient who came in with an undulating fever, diffuse joint pain, and muscle weakness. He had been treated with Falcimon for malaria about 5 days ago but has continued to deteriorate. On physical exam, he had a palpable spleen and liver which were about 3-4cm and 5cm below the costal margin respectively. He was diaphoretic and had upper and lower extremity muscle strength of 4/5. Other than that, there was no joint swelling or warmth and there were no other physical exam findings. I placed him on Quinine for 7 days. Hopefully it will knock down any resistant malaria that may be lurking and causing all this ruckus.
After rounds and coffee, we hit the outpatient department. My first patient was a woman in her late 50’s who had epigastric pain, shortness of breath, and white vaginal discharge for one year. She was joined by her husband who was on antiretroviral therapy – for HIV. The husband wished that his wife tested for HIV, but his wife did not want to have anything to do with it. This was a clear example of the stigma that still exists in a majority of the world and continues to be a potent hindrance to HIV/AIDS prevention and treatment efforts. Marcel, one of the outpatient auxiliaries, told me that some villages rebuke those who enter with the main goal of educating the villagers about HIV/AIDS. Many individuals and communities want to simply pretend that the disease does not exist.
A few patients later, a known hypertensive woman came in from a village far away. She also had an obvious right-sided thyroid mass. She had gained a significant amount of weight recently, had a cold intolerance, and felt weak and fatigued. All of the signs and symptoms pointed toward Hashimoto’s Thyroiditis, but there was no way to be sure it wasn’t something else without getting further lab tests and a fine needle aspiration of the mass. I informed the patient that I wanted to get a TSH and an FNA of her thyroid mass. In order to do this, the patient would have had to stay overnight at the hospital – i.e. sleep outside the clinic until staff showed up in the morning. Because she came from a village far away and did not bring enough money for labs, she requested that I skip the tests and just give her some medicine. There was no way I was going to do this, so I only wrote for her HCTZ and Captopril. She told me that between now and her next check-up she would find money to pay for the labs and FNA.
As I was seeing the last few patients, I developed a stomach ache of death. It caused me so much anguish that I was forced to leave in the middle of a history. I came back and finished with the patient and then went down to the rest house where I took some Tums and tried to sleep it off. I got up right before bible study at Dr. Arega’s house and it had gone down much to my relief. I had a gut feeling this would happen on this trip!
Beauty for ashes,
-Mark
---------------------------------------------
“Shey Mark”
Thursday, April 24, 2008 – 9:55pm Cameroon Time
I woke up today at 6:20am for a lecture on immune reconstitution syndrome that occasionally happens with antiretroviral therapy for HIV patients. After the lecture, Kadidja and I had breakfast and then sauntered up to our respective wards.
On the ward, Dr. Jume and I were able to discharge a good number of children who had recovered from their malaria infections. After an hour or so of rounding, an adolescent brought in his younger brother who was experiencing a relapse of Burkitt’s. I thought it was odd that the adolescent brought in the child without the mother or father. It was soon brought to my attention that they had lost their parents to AIDS. As early noted, there are a select number of orphans from AIDS in the Chosen Children’s Program at the hospital, but the resources are too limited to provide services to every orphan in the area. Kadidja and I will be joining up with a Chosen Children team member next week to do home visits in Kumbo.
Kadidja then joined us and we walked down to the conference room for a recharge. After some delicious coffee, we all headed up to the outpatient department. After seeing a couple patients, Martin (the chief nurse that organizes physician trips to surrounding villages) informed me that I would not be able to go to Sakilbaka. Sakilbaka is a northern village in the bush that is far away from Banso. Unfortunately the helicopter we were going to take broke down and won’t be back in operation for a while. As such, those scheduled to go would have to take ground transportation. This put a limit on the numbers who could go and turned a short flight into a day’s trip in a cooped up van. Despite this setback, I may be able to go to Bangolan or Ndu (villages closer by) in the following weeks.
In the clinic today, a man from a village far away came in with hemorrhoids and constipation. With limited drinking water, GI complaints such as these are fairly common. He also brought in his son who had rectal prolapse. When we attempted to examine the child, he was very resistant – so much so that even Jamal the Giraffe couldn’t ease his anxiety. On physical exam, it looked as if he was anemic, so we ordered a Hgb. Kadidja and I saw a few more patients and then went to get lunch. At lunch, we saw the father and the son and asked if he got his lab results – he did not. As we were speaking with the father, the child walked off and after the conversation he was nowhere to be seen. Kadidja finally found him way out in front of the hospital. Here, the driver of the father and son was waiting. He complained to Kadidja that we were taking too long and he threatened to leave unless they left at that moment. Dr. Gi came out and informed the driver that the child’s health was in jeopardy and if he took them back to the village now, he would be to blame for the child’s death. He then forced the driver to walk with them to the lab to get the child’s test results. In the end, everything checked out to be normal and the child finally cracked a smile after a most distressful physical exam:
After a few more patients a woman came in with a blood pressure of 240/110. She had a minor headache and complained of vision changes. Clearly we needed to admit the patient; however, because she did not have a caretaker (a family member or friend to take care of her while she was in the hospital) a senior physician did not think the hospital would take her. There are nurses in the hospital, but they do not aid the patients in activities of daily living – nor do they feed or bathe the patients. These are the responsibility of the caretakers. No care taker = no admission. The concept seems a bit ridiculous from the prospective of an outsider, especially in emergent cases such as this. We ended up seeking help from the chaplain and were then able to admit the patient and put her on IV hydralazine stat. In hopes of cutting down the risk of stroke, Kadidja will be working on developing a protocol where the screeners automatically admit a patient to the hospital with malignant hypertension instead of making them wait many hours outside before being seen by a doctor.
A little later, the man from the market who made Kadidja’s dress and my Shey outfit showed up in the clinic with the finished product. Of course I had to try it on – we all had a good laugh – “Shey Mark!” everyone exclaimed. I title the following photograph “Sheyngsta.” Kadidja said I should be aSheymed of myself as Sheys don’t live in the hood.
Here’s a picture of some other local Sheys and village leaders:
Our happy home,
-Mark
---------------------------------------------
I woke up today at 6:20am for a lecture on immune reconstitution syndrome that occasionally happens with antiretroviral therapy for HIV patients. After the lecture, Kadidja and I had breakfast and then sauntered up to our respective wards.
On the ward, Dr. Jume and I were able to discharge a good number of children who had recovered from their malaria infections. After an hour or so of rounding, an adolescent brought in his younger brother who was experiencing a relapse of Burkitt’s. I thought it was odd that the adolescent brought in the child without the mother or father. It was soon brought to my attention that they had lost their parents to AIDS. As early noted, there are a select number of orphans from AIDS in the Chosen Children’s Program at the hospital, but the resources are too limited to provide services to every orphan in the area. Kadidja and I will be joining up with a Chosen Children team member next week to do home visits in Kumbo.
Kadidja then joined us and we walked down to the conference room for a recharge. After some delicious coffee, we all headed up to the outpatient department. After seeing a couple patients, Martin (the chief nurse that organizes physician trips to surrounding villages) informed me that I would not be able to go to Sakilbaka. Sakilbaka is a northern village in the bush that is far away from Banso. Unfortunately the helicopter we were going to take broke down and won’t be back in operation for a while. As such, those scheduled to go would have to take ground transportation. This put a limit on the numbers who could go and turned a short flight into a day’s trip in a cooped up van. Despite this setback, I may be able to go to Bangolan or Ndu (villages closer by) in the following weeks.
In the clinic today, a man from a village far away came in with hemorrhoids and constipation. With limited drinking water, GI complaints such as these are fairly common. He also brought in his son who had rectal prolapse. When we attempted to examine the child, he was very resistant – so much so that even Jamal the Giraffe couldn’t ease his anxiety. On physical exam, it looked as if he was anemic, so we ordered a Hgb. Kadidja and I saw a few more patients and then went to get lunch. At lunch, we saw the father and the son and asked if he got his lab results – he did not. As we were speaking with the father, the child walked off and after the conversation he was nowhere to be seen. Kadidja finally found him way out in front of the hospital. Here, the driver of the father and son was waiting. He complained to Kadidja that we were taking too long and he threatened to leave unless they left at that moment. Dr. Gi came out and informed the driver that the child’s health was in jeopardy and if he took them back to the village now, he would be to blame for the child’s death. He then forced the driver to walk with them to the lab to get the child’s test results. In the end, everything checked out to be normal and the child finally cracked a smile after a most distressful physical exam:
After a few more patients a woman came in with a blood pressure of 240/110. She had a minor headache and complained of vision changes. Clearly we needed to admit the patient; however, because she did not have a caretaker (a family member or friend to take care of her while she was in the hospital) a senior physician did not think the hospital would take her. There are nurses in the hospital, but they do not aid the patients in activities of daily living – nor do they feed or bathe the patients. These are the responsibility of the caretakers. No care taker = no admission. The concept seems a bit ridiculous from the prospective of an outsider, especially in emergent cases such as this. We ended up seeking help from the chaplain and were then able to admit the patient and put her on IV hydralazine stat. In hopes of cutting down the risk of stroke, Kadidja will be working on developing a protocol where the screeners automatically admit a patient to the hospital with malignant hypertension instead of making them wait many hours outside before being seen by a doctor.
A little later, the man from the market who made Kadidja’s dress and my Shey outfit showed up in the clinic with the finished product. Of course I had to try it on – we all had a good laugh – “Shey Mark!” everyone exclaimed. I title the following photograph “Sheyngsta.” Kadidja said I should be aSheymed of myself as Sheys don’t live in the hood.
Here’s a picture of some other local Sheys and village leaders:
Our happy home,
-Mark
---------------------------------------------
Sterile Technique
Wednesday, April 23, 2008 – 10:13pm Cameroon Time
I woke up this morning at 6:40am, had breakfast, and headed up to the children’s ward. We saw many of the same patients – and many different. Each chart is placed on the patient’s bed and when a physician comes across it, he or she sees the patient. With this method, it is possible to see a whole new set of patients each day, which undoubtedly detracts from the concept of continuity of care. Nonetheless, it is the method that the children’s ward physicians have adopted and it seems to work out just fine.
Once again, there were a large number of malaria and Burkitt’s lymphoma cases. Of note, we administered chemotherapy to a child with Burkitt’s today. He was wheelchaired over to the surgical amphitheater and left in front of the table where he would receive his treatment. There did not seem to be much interaction between the hospital staff and the child. In fact, during the whole ordeal nothing was said to the child and the child himself did not make a peep. In Cameroon, health care has taken on somewhat of a paternalistic form. In other words, the patient can always decide not to receive treatment – but the usual scenario is whatever the doctor says, goes. The patients have an extraordinary amount of faith and trust in the doctor’s decision making capabilities that you rarely see any questions raised about a particular diagnosis or treatment regimen. Moreover, the patients will rarely want to know the details about their diagnosis, as even with the knowledge, they understand that they themselves will play no significant part in the treatment process. Many times when I ask if they have any questions, patients will respond, “Why would I have questions? You are the doctor.” Although this detracts from a physician’s accountability, all other physicians hold each other to the their highest standards.
I tried to interact with the child and was met with an emotionless face. No matter what I did, I could not get any reaction out of him – be it good or bad. As you can see in the photo, a small mass can be appreciated under the right angle of the mandible:
After about 20 minutes, a nurse in the OR grabbed the child and placed him on the table in the lateral recumbent position. The child did not try to fight it, but rather he just went limp. Many times, little or no anesthesia is given to the children for the treatments, needle aspirations, and biopsies. In this case, it was given. Furthermore, it is common for the procedures to be performed in the ward and when the children don’t receive anesthesia, the intense screaming and terror can be heard by all. I can’t imagine what sorts of images and memories of the hospital the children in the ward will carry with them for the rest of their lives.
Dr. Jume dabbed some iodine on the child’s back in a rake-like fashion at the puncture site. There were no drapes and only one application was applied in order to conserve the resources. He inserted a needle, after which a vial of the CSF was collected. He then administered one component of the chemotherapy. After the needle was pulled out, a second larger needle was rather forcefully inserted into the child’s hip to get a bone marrow sample. Because the correct syringe was not placed out with the rest of the instruments, the large needle was left in the child’s hip as everyone went to look for the right syringe. At one point, the needle came loose from the bone and fell at a 45 degree angle. In addition, as one of the nurses tried to leave the room, he walked in front of the IV line and was clothes-lined by it. Fortunately, the IV did not come out of the patient’s hand and did not cause the patient any pain. My teeth were clinched in both cases nonetheless. When the nurses came back with the correct syringe, Dr. Jume placed the needle back in its original position and proceeded to aspirate a small amount of marrow. After this ordeal, a sample of the jaw mass was taken – first from inside the patient’s mouth, which was unsuccessful, and then from the outside.
Needless to say, the whole thing was very difficult to watch. Although I am not as familiar with surgical procedures as others, I do know that there is a great need for an improvement in the technique and methods by which procedures are carried out. Because there is little data concerning iatrogenic pathology and nosocomial infections, it is difficult to say how much the current methods affect the overall morbidity and mortality within the hospital. I do know that the Burkitt’s program has an incredibly high success rate and thousands of lives have been saved – so I tried to remember this when witnessing what went down in the amphitheater.
Dr. Jume and I returned to the ward only to find a child in the ICU (a small room next to the nurse’s station) who was clearly in much distress. On exam, he was tachycardic and seemed to have an S4 gallop. He was also very diaphoretic and his abdomen was markedly distended. His labs indicated a WBC of 10,700 and the malaria panel was +1. The urinalysis was inconclusive. Other than the malaria, it was difficult to determine what was going on with the child. More investigation will need to be done.
Inside the children’s ward there are public health posters right and left. The following is an example of a poster promoting the polio vaccine:
Here is a photo of a promotion of a health week for mothers and children:
After rounding in the children’s ward, Dr. Jume and I met up with some of the other physicians and Kadidja for some coffee. Kadidja and I then went to the outpatient clinic, while Dr. Jume hitched a ride to Bamenda to see his brother who was graduating from seminary.
After seeing a few patients in the clinic, I finished up my series on the EKG at 2:00pm. I think that everyone was able to understand at least the basics and hopefully they will put their new knowledge to use on the wards.
Kadidja and I then went back to the rest house and got ready for our hike. We did not know where we were going – we just went. As we traveled along, we saw a water pipe in the middle of the road that seemed to be a bit superficial to us:
You can only imagine the public health consequences if the pipe were to lose its integrity and allow foreign material to enter the drinking water.
We walked on and came across a small village below Kumbo. Two young men joined up with us and asked many questions about the United States. They asked if there were poor people in the US, whether or not Mexico was a state, why Mexico and Canada don’t just become states, why it is so easy to make money in the US, among other interesting questions. They seemed to be very down on their living situation, saying that we probably thought they “lived like gorillas.” We assured them that we did not think this and we continued our walk.
One of the first questions that they asked was whether Kadidja and I were married. Kadidja has had to face her own unique challenges while being here. Many times, a man will meet here and instantly want to marry her – mainly in hopes to come to the US. This encounter with the two young men was no different. At the end of our journey, they wanted to take pictures with us (her) and then exchanged phone numbers and e-mails insisting they would call her in the states. Some men will tell her, “I love you. Do you love me?” You can imagine that this makes for some uncomfortable and awkward circumstances.
I woke up this morning at 6:40am, had breakfast, and headed up to the children’s ward. We saw many of the same patients – and many different. Each chart is placed on the patient’s bed and when a physician comes across it, he or she sees the patient. With this method, it is possible to see a whole new set of patients each day, which undoubtedly detracts from the concept of continuity of care. Nonetheless, it is the method that the children’s ward physicians have adopted and it seems to work out just fine.
Once again, there were a large number of malaria and Burkitt’s lymphoma cases. Of note, we administered chemotherapy to a child with Burkitt’s today. He was wheelchaired over to the surgical amphitheater and left in front of the table where he would receive his treatment. There did not seem to be much interaction between the hospital staff and the child. In fact, during the whole ordeal nothing was said to the child and the child himself did not make a peep. In Cameroon, health care has taken on somewhat of a paternalistic form. In other words, the patient can always decide not to receive treatment – but the usual scenario is whatever the doctor says, goes. The patients have an extraordinary amount of faith and trust in the doctor’s decision making capabilities that you rarely see any questions raised about a particular diagnosis or treatment regimen. Moreover, the patients will rarely want to know the details about their diagnosis, as even with the knowledge, they understand that they themselves will play no significant part in the treatment process. Many times when I ask if they have any questions, patients will respond, “Why would I have questions? You are the doctor.” Although this detracts from a physician’s accountability, all other physicians hold each other to the their highest standards.
I tried to interact with the child and was met with an emotionless face. No matter what I did, I could not get any reaction out of him – be it good or bad. As you can see in the photo, a small mass can be appreciated under the right angle of the mandible:
After about 20 minutes, a nurse in the OR grabbed the child and placed him on the table in the lateral recumbent position. The child did not try to fight it, but rather he just went limp. Many times, little or no anesthesia is given to the children for the treatments, needle aspirations, and biopsies. In this case, it was given. Furthermore, it is common for the procedures to be performed in the ward and when the children don’t receive anesthesia, the intense screaming and terror can be heard by all. I can’t imagine what sorts of images and memories of the hospital the children in the ward will carry with them for the rest of their lives.
Dr. Jume dabbed some iodine on the child’s back in a rake-like fashion at the puncture site. There were no drapes and only one application was applied in order to conserve the resources. He inserted a needle, after which a vial of the CSF was collected. He then administered one component of the chemotherapy. After the needle was pulled out, a second larger needle was rather forcefully inserted into the child’s hip to get a bone marrow sample. Because the correct syringe was not placed out with the rest of the instruments, the large needle was left in the child’s hip as everyone went to look for the right syringe. At one point, the needle came loose from the bone and fell at a 45 degree angle. In addition, as one of the nurses tried to leave the room, he walked in front of the IV line and was clothes-lined by it. Fortunately, the IV did not come out of the patient’s hand and did not cause the patient any pain. My teeth were clinched in both cases nonetheless. When the nurses came back with the correct syringe, Dr. Jume placed the needle back in its original position and proceeded to aspirate a small amount of marrow. After this ordeal, a sample of the jaw mass was taken – first from inside the patient’s mouth, which was unsuccessful, and then from the outside.
Needless to say, the whole thing was very difficult to watch. Although I am not as familiar with surgical procedures as others, I do know that there is a great need for an improvement in the technique and methods by which procedures are carried out. Because there is little data concerning iatrogenic pathology and nosocomial infections, it is difficult to say how much the current methods affect the overall morbidity and mortality within the hospital. I do know that the Burkitt’s program has an incredibly high success rate and thousands of lives have been saved – so I tried to remember this when witnessing what went down in the amphitheater.
Dr. Jume and I returned to the ward only to find a child in the ICU (a small room next to the nurse’s station) who was clearly in much distress. On exam, he was tachycardic and seemed to have an S4 gallop. He was also very diaphoretic and his abdomen was markedly distended. His labs indicated a WBC of 10,700 and the malaria panel was +1. The urinalysis was inconclusive. Other than the malaria, it was difficult to determine what was going on with the child. More investigation will need to be done.
Inside the children’s ward there are public health posters right and left. The following is an example of a poster promoting the polio vaccine:
Here is a photo of a promotion of a health week for mothers and children:
After rounding in the children’s ward, Dr. Jume and I met up with some of the other physicians and Kadidja for some coffee. Kadidja and I then went to the outpatient clinic, while Dr. Jume hitched a ride to Bamenda to see his brother who was graduating from seminary.
After seeing a few patients in the clinic, I finished up my series on the EKG at 2:00pm. I think that everyone was able to understand at least the basics and hopefully they will put their new knowledge to use on the wards.
Kadidja and I then went back to the rest house and got ready for our hike. We did not know where we were going – we just went. As we traveled along, we saw a water pipe in the middle of the road that seemed to be a bit superficial to us:
You can only imagine the public health consequences if the pipe were to lose its integrity and allow foreign material to enter the drinking water.
We walked on and came across a small village below Kumbo. Two young men joined up with us and asked many questions about the United States. They asked if there were poor people in the US, whether or not Mexico was a state, why Mexico and Canada don’t just become states, why it is so easy to make money in the US, among other interesting questions. They seemed to be very down on their living situation, saying that we probably thought they “lived like gorillas.” We assured them that we did not think this and we continued our walk.
One of the first questions that they asked was whether Kadidja and I were married. Kadidja has had to face her own unique challenges while being here. Many times, a man will meet here and instantly want to marry her – mainly in hopes to come to the US. This encounter with the two young men was no different. At the end of our journey, they wanted to take pictures with us (her) and then exchanged phone numbers and e-mails insisting they would call her in the states. Some men will tell her, “I love you. Do you love me?” You can imagine that this makes for some uncomfortable and awkward circumstances.
Come together,
-Mark
---------------------------------------------
Tuesday, April 29, 2008
First Day on the Peds Ward!
Tuesday, April 22, 2008 – 10:51pm Cameroon Time
I woke up today at 6:20am and shimmied up to the conference room with Kadidja to give the second part of my EKG series. We did some example strips and the docs seem to be picking it up rather nicely. After the lecture, I had breakfast and then headed over to the children’s ward.
This was my first day on this ward and it was a drastic change from the men’s ward. A vast majority of the children had malaria and a good fraction had terrible complications from the infection with cerebral malaria being the most prominent. We use Quinine for malaria with complications and Falcimon and Coartem for outpatient cases of uncomplicated malaria. If the case has extreme complications or resistance was detected, we used a combination of Fansider and Quinine.
I rounded with Dr. Jume and saw a large number of very sick kids. Among them was a child who had fallen out of a tree and gashed her leg – this was several months ago. She now had developed an unsightly infection that has eaten its way down to the bone and all the way up to her hip. She cried out with agony each time they move her to change the dressing. She is on some heavy duty antibiotics – which are also very expensive. Many times the parents will discharge the child AMA if they do not see any improvement within a couple days of admission – especially if expensive drugs are on board. There is no such thing as Child Services here. If the child is near death, the parent has the right to take him or her home. Despite this flaw in the system, we always attempt to be advocates for the children and explain to the parents that their child’s health may deteriorate if they leave the hospital prematurely.
As we passed from the children’s ward to the Burkitt’s ward, I saw a child who looked to have a severe infection on both of her arms. She was alone with no caretaker. I held up my hand to wave and she stood up and waved back with a huge grin on her face. I later found out that she was orphaned as a result of AIDS. There is an AIDS orphan program that was started by BBH for children who have lost both parents to the disease. Despite the efforts of the program, there are not enough care givers to remain with the children if they have to go to the hospital – many times they must go it alone:
We walked into the Burkitt’s ward and about 90% of the 15 or so children had the classic mandibular mass. The chemo regimen includes weekly bouts of cyclophosphamide and intrathecal methotrexate. If there is no improvement or resistance is detected after 3 doses, then vincristine is added as a salvage drug. If the treatment fails at this point, the child is assigned to palliative care. To think of a child in hospice escapes my mind. The good news is that Burkitt’s is very treatable and has an excellent prognosis if treated early in the disease process – this means that a vast majority of the kids make it out of the hospital.
We rounded on one child who is not so fortunate. She had been treated for Burkitt’s in the past and was determined to be cancer free. She now came back with a relapse, but this time there are masses below the diaphragm and there is nerve involvement – which makes it the highest class with the worst prognosis. There is a mass right behind her left eye, which prevents it from moving. Unfortunately, there is nothing more we can do for this child medically except for comfort care. Here is a photograph of her eyes:
After finishing up with the children’s ward, Dr. Jume and I grabbed some coffee and headed up to the outpatient clinic. Among the many patients, there was a man who had traveled from Douala (an 8-12 hour drive and a few days journey by foot and hitchhiking). He had severe chronic back pain that traveled down both of his legs and into his perineum. He also had urinary retention. The OMM exam surprisingly did not yield much except for an increased lumbar lordosis and extreme muscle hypertonicity in the L5/S1 region. We ordered an x-ray and it looked like he had spondylolisthesis between L4 and L5 – although we did not have an oblique view, so I couldn’t see the Scottie Dog. It almost looked like he did not have a disc between these two vertebral bodies. I wrote for some pain meds and for a surgeon to see. The back surgery and trip back up from Douala will be very costly for this gentleman and this fact weighed very heavily on his mind. He drives a taxi for a living and does not make much.
After the clinic, I worked on my final powerpoint for the EKG series.
Wholly yours,
-Mark
---------------------------------------------
I woke up today at 6:20am and shimmied up to the conference room with Kadidja to give the second part of my EKG series. We did some example strips and the docs seem to be picking it up rather nicely. After the lecture, I had breakfast and then headed over to the children’s ward.
This was my first day on this ward and it was a drastic change from the men’s ward. A vast majority of the children had malaria and a good fraction had terrible complications from the infection with cerebral malaria being the most prominent. We use Quinine for malaria with complications and Falcimon and Coartem for outpatient cases of uncomplicated malaria. If the case has extreme complications or resistance was detected, we used a combination of Fansider and Quinine.
I rounded with Dr. Jume and saw a large number of very sick kids. Among them was a child who had fallen out of a tree and gashed her leg – this was several months ago. She now had developed an unsightly infection that has eaten its way down to the bone and all the way up to her hip. She cried out with agony each time they move her to change the dressing. She is on some heavy duty antibiotics – which are also very expensive. Many times the parents will discharge the child AMA if they do not see any improvement within a couple days of admission – especially if expensive drugs are on board. There is no such thing as Child Services here. If the child is near death, the parent has the right to take him or her home. Despite this flaw in the system, we always attempt to be advocates for the children and explain to the parents that their child’s health may deteriorate if they leave the hospital prematurely.
As we passed from the children’s ward to the Burkitt’s ward, I saw a child who looked to have a severe infection on both of her arms. She was alone with no caretaker. I held up my hand to wave and she stood up and waved back with a huge grin on her face. I later found out that she was orphaned as a result of AIDS. There is an AIDS orphan program that was started by BBH for children who have lost both parents to the disease. Despite the efforts of the program, there are not enough care givers to remain with the children if they have to go to the hospital – many times they must go it alone:
We walked into the Burkitt’s ward and about 90% of the 15 or so children had the classic mandibular mass. The chemo regimen includes weekly bouts of cyclophosphamide and intrathecal methotrexate. If there is no improvement or resistance is detected after 3 doses, then vincristine is added as a salvage drug. If the treatment fails at this point, the child is assigned to palliative care. To think of a child in hospice escapes my mind. The good news is that Burkitt’s is very treatable and has an excellent prognosis if treated early in the disease process – this means that a vast majority of the kids make it out of the hospital.
We rounded on one child who is not so fortunate. She had been treated for Burkitt’s in the past and was determined to be cancer free. She now came back with a relapse, but this time there are masses below the diaphragm and there is nerve involvement – which makes it the highest class with the worst prognosis. There is a mass right behind her left eye, which prevents it from moving. Unfortunately, there is nothing more we can do for this child medically except for comfort care. Here is a photograph of her eyes:
After finishing up with the children’s ward, Dr. Jume and I grabbed some coffee and headed up to the outpatient clinic. Among the many patients, there was a man who had traveled from Douala (an 8-12 hour drive and a few days journey by foot and hitchhiking). He had severe chronic back pain that traveled down both of his legs and into his perineum. He also had urinary retention. The OMM exam surprisingly did not yield much except for an increased lumbar lordosis and extreme muscle hypertonicity in the L5/S1 region. We ordered an x-ray and it looked like he had spondylolisthesis between L4 and L5 – although we did not have an oblique view, so I couldn’t see the Scottie Dog. It almost looked like he did not have a disc between these two vertebral bodies. I wrote for some pain meds and for a surgeon to see. The back surgery and trip back up from Douala will be very costly for this gentleman and this fact weighed very heavily on his mind. He drives a taxi for a living and does not make much.
After the clinic, I worked on my final powerpoint for the EKG series.
Wholly yours,
-Mark
---------------------------------------------
Last Day on the Men's Ward
Monday, April 21, 2008 – 9:43pm Cameroon Time
I woke up today at 6:20am, grabbed my computer, and strolled up to the hospital’s conference room. I gave Part I of my three-part lecture series on EKGs. I figured I would start with the basics and then work my way through some of the more complicated intricacies as we go along. The lecture was received very well. My hope is that the physicians will rely less on the computer’s interpretation and more on their own newly formed knowledge.
After the lecture, Kadidja and I snagged some breakfast and then hit the wards. This was my last day on the men’s ward. I was very excited to be able to discharge one of my stroke patients. This was the patient who was found on the floor of his home and was brought to the hospital with aphasia, flailing arms, and CNIII-VII compromise. His discharge condition was stable. He is able to walk with assistance and can open both of his eyes – although his right eye still has some ptosis and exotropia. He is able to follow simple commands, but cannot respond with more than 1 or 2 words. With the limited resources in the hospital, there was simply nothing more we could do for him. It will take some time and intense physical therapy to regain some of his motor skills. I think it will be quite a struggle for the rest of his life.
As I was heading toward my next patient, I walked passed the group of 4 surgeons rounding on a patient. The chief called me over and asked me what my assessment and plan were for the patient. Pimping (the act of asking challenging questions to subordinate residents and medical students) is taken to the extreme among this particular group of surgeons – so much so that they will pimp anyone and everyone who they can lay their eyes on. I had never seen the patient before and I told the chief just that. He let me off the hook. Note to self, dodge the pack of surgeons when they are rounding at all costs.
Dr. Sandrine and I finished up our rounding and then went down to the conference room for some coffee. I have introduced her and a few other doctors to Coffeemate (caramel vanilla). They have named it “The Love Potion,” as anyone who tastes it instantly falls in love with the delightfully delicious mixture. At times, it almost feels like I’m dealing drugs. I bring the Coffeemate powder in a plastic bag and the first thing that is asked when I enter the conference room is, “You got the stuff?”
After getting recharged with the coffee, we all went up to the outpatient department. Kadidja and I decided to double team with the patients. There was one particular case that baffled all of us all. A 40yo woman came in with the chief complaint of left breast pain. She said that whenever she ate brown nuts (peanuts) she would feel the pain, but then it would go away. We asked her if it was in her breast or in her chest only to receive a vague answer that included both. She also complained of recurring coughing episodes and shortness of breath. She denied any ankle swelling or palpitations (aka “broken heart” in Pidgin). After a long history, nothing pertinent was found on the physical exam. The differentials ranged from A to Z – angina to Zenker’s diverticulum. After many consultations, we decided upon reactive airway disease and that the discomfort was in fact not in her breast. We shall see if the beclamethasone and salbutamol work.
After several hours in the clinic, I went back to the rest house to work on Part II of the EKG series, which took me into the night.
Sweet illumination,
-Mark
---------------------------------------------
The Big Market
Sunday, April 20, 2008 – 10:35pm Cameroon Time
I woke up today around 6:40am and moseyed on over to church with Kadidja. During the service, Nadine (Rose, the rest house keeper’s daughter) left her own service multiple times to remind us to come to the children’s church after the main service. After the main service was over, we walked over to the children’s building and they were in the middle of a lesson. Nadine insisted that we come in, so we did only to stop the lesson dead in its tracks. The teacher welcomed us and told us that the service was almost over. Of course, all eyes were on us. We ended up sitting behind the pulpit and tried not to distract the children throughout the rest of the lesson. This failed miserably much to our efforts.
We then headed back to the rest house and took long naps, after which we packed up our cameras and got ready to hit the big market. Judit (an auxiliary in the outpatient department) met us at the rest house with her son to guide us. As we walked down the road toward the big market, you could feel the excitement in the air. The shouting got louder and louder as we got nearer. All of the surrounding villages brought their goods in to sell. There were herds of goats, many baskets of chickens, and a good amount of beans, rice, and other foods. There were no prices on anything in the market – bargaining was the name of the game. As visitors, the initial price for a particular item will be set at about 5 to 6 times what the item is actually worth to a local. With this in mind, Judit told us she would bargain for us.
Once we reached the market, all of the shouting seemed to be directed at us. We were told that visitors were in a sense a goldmine for those who were selling. We went to the garment portion of the market to pick out some fabric to make my Shey outfit. We were also looking for fabric to make a dress for Kadidja. I asked Judit if I should get a piece of fabric I saw in the first hut. She shook her head and laughed. She said that this particular fabric was not Shey fabric. We left this hut and Judit took me into a smaller hut a few stands down. We went inside and Judit introduced me to the owner as “Shey Mark.” Immediately the owner took a very respectful and humble stance – as he was in the presence of a Shey. She asked him to show me some fabric that would be suitable for my Shey outfit. He pushed some things aside, almost as if uncovering a secret vault, and after a some shuffling around he pulled out 3 different fabrics and offered them to me to choose from. I consulted Judit and Kadidja and we chose a particular pattern. The owner then left the store, only to return with a seamstress. He measured me and assured me that he would make it just right. Judit told me that they would deliver the outfit personally on Wednesday or Thursday to the outpatient department. Considering that the market is a decent walk away from the hospital, this was quite the service. After this incredibly unique experience, we walked through the market some more and found another fabric supply shop where Kadidja picked out fabric for her dress. She too was measured and the dress was to be delivered with my Shey outfit.
To go along with my Shey outfit, I needed a Shey knife/machete. We came across a place that had just the right design for a Shey. The man and Judit went back and forth in a bargain war to settle on a price. It was quite the sight. I had no idea what they were saying, but after a while Judit said, “Pa, please...” and thus a price was agreed upon and the knife was sold. All I needed now was a Shey hat and a bag with cola nuts – to hand out to people when they greet me. I believe we will be traveling down to where the Fon’s Palace is on Thursday to pick out these items.
After we finished up in the market, we wanted Judit and her son to be able to purchase some things. Her son graciously carried all of our purchases even after we insisted upon carrying them ourselves. We asked her son if he wanted to get some candy – he smiled and looked excited. He then paused and said, “Can I get shoes instead?” We had completely and rather ignorantly looked passed what the kid really needed. It was a clear case of necessity vs. luxury. We went over to where the shoes were and he picked out a good pair of sturdy black shoes – which cost 1,500 francs (3 USD). He was overjoyed with his new shoes and continuously thanked us upon leaving. Judit picked out some beans and we made our way back to the rest house.
We said goodbye to Judit and her son, after which I worked on my EKG powerpoint for tomorrow. The physicians at the hospital rarely order an EKG simply because they don’t know how to read it. If they do order one, they will rely on the computer’s interpretation at the top for their diagnoses and treatments. I decided to split my lecture up into a three part series – for Monday, Tuesday, and Wednesday.
At 7:00pm we hiked up to Dr. Sandrine’s house for dinner. We were joined by 3 other physicians from – 2 internists and a surgeon. Dr. Sandrine had a TV and had on Jay Leno. It was an odd experience to be watching TV, let alone Jay Leno. Let’s just say that a vast majority of Jay’s jokes were not understood by those in the house. More questions arose from the viewers than laughter. Jay had a guest on who brought in various animals, including a large turtle and a snake. The doctors were wondering why they would bring a snake out and put it right in front of Jay! They insisted that these were wild animals and they could not be tamed – something could go wrong at any moment!
Dr. Sandrine finished up in the kitchen and brought out her masterpieces, which included bitta leaf (which was the spiciest food I’ve ever eaten), jama jama (like spinach), fruit, some sort of pasta dish, and kasava root! When I saw the kasava, I thought to myself, “Oh boy – here comes the pancreatitis!” It has the shape and texture of an umbilical cord. When you first bite into it, there is no taste. However, as it sits in your mouth, you begin to notice hints of a lemon-like flavor. The kasava with the bitta leaf made for a delicious meal. We finished our meals and immediately afterward Dr. Sandrine was called down to the hospital. We walked her down and then wished her a good night.
(Kasava Root)
Table for two,
Mark
---------------------------------------------
I woke up today around 6:40am and moseyed on over to church with Kadidja. During the service, Nadine (Rose, the rest house keeper’s daughter) left her own service multiple times to remind us to come to the children’s church after the main service. After the main service was over, we walked over to the children’s building and they were in the middle of a lesson. Nadine insisted that we come in, so we did only to stop the lesson dead in its tracks. The teacher welcomed us and told us that the service was almost over. Of course, all eyes were on us. We ended up sitting behind the pulpit and tried not to distract the children throughout the rest of the lesson. This failed miserably much to our efforts.
We then headed back to the rest house and took long naps, after which we packed up our cameras and got ready to hit the big market. Judit (an auxiliary in the outpatient department) met us at the rest house with her son to guide us. As we walked down the road toward the big market, you could feel the excitement in the air. The shouting got louder and louder as we got nearer. All of the surrounding villages brought their goods in to sell. There were herds of goats, many baskets of chickens, and a good amount of beans, rice, and other foods. There were no prices on anything in the market – bargaining was the name of the game. As visitors, the initial price for a particular item will be set at about 5 to 6 times what the item is actually worth to a local. With this in mind, Judit told us she would bargain for us.
Once we reached the market, all of the shouting seemed to be directed at us. We were told that visitors were in a sense a goldmine for those who were selling. We went to the garment portion of the market to pick out some fabric to make my Shey outfit. We were also looking for fabric to make a dress for Kadidja. I asked Judit if I should get a piece of fabric I saw in the first hut. She shook her head and laughed. She said that this particular fabric was not Shey fabric. We left this hut and Judit took me into a smaller hut a few stands down. We went inside and Judit introduced me to the owner as “Shey Mark.” Immediately the owner took a very respectful and humble stance – as he was in the presence of a Shey. She asked him to show me some fabric that would be suitable for my Shey outfit. He pushed some things aside, almost as if uncovering a secret vault, and after a some shuffling around he pulled out 3 different fabrics and offered them to me to choose from. I consulted Judit and Kadidja and we chose a particular pattern. The owner then left the store, only to return with a seamstress. He measured me and assured me that he would make it just right. Judit told me that they would deliver the outfit personally on Wednesday or Thursday to the outpatient department. Considering that the market is a decent walk away from the hospital, this was quite the service. After this incredibly unique experience, we walked through the market some more and found another fabric supply shop where Kadidja picked out fabric for her dress. She too was measured and the dress was to be delivered with my Shey outfit.
To go along with my Shey outfit, I needed a Shey knife/machete. We came across a place that had just the right design for a Shey. The man and Judit went back and forth in a bargain war to settle on a price. It was quite the sight. I had no idea what they were saying, but after a while Judit said, “Pa, please...” and thus a price was agreed upon and the knife was sold. All I needed now was a Shey hat and a bag with cola nuts – to hand out to people when they greet me. I believe we will be traveling down to where the Fon’s Palace is on Thursday to pick out these items.
After we finished up in the market, we wanted Judit and her son to be able to purchase some things. Her son graciously carried all of our purchases even after we insisted upon carrying them ourselves. We asked her son if he wanted to get some candy – he smiled and looked excited. He then paused and said, “Can I get shoes instead?” We had completely and rather ignorantly looked passed what the kid really needed. It was a clear case of necessity vs. luxury. We went over to where the shoes were and he picked out a good pair of sturdy black shoes – which cost 1,500 francs (3 USD). He was overjoyed with his new shoes and continuously thanked us upon leaving. Judit picked out some beans and we made our way back to the rest house.
We said goodbye to Judit and her son, after which I worked on my EKG powerpoint for tomorrow. The physicians at the hospital rarely order an EKG simply because they don’t know how to read it. If they do order one, they will rely on the computer’s interpretation at the top for their diagnoses and treatments. I decided to split my lecture up into a three part series – for Monday, Tuesday, and Wednesday.
At 7:00pm we hiked up to Dr. Sandrine’s house for dinner. We were joined by 3 other physicians from – 2 internists and a surgeon. Dr. Sandrine had a TV and had on Jay Leno. It was an odd experience to be watching TV, let alone Jay Leno. Let’s just say that a vast majority of Jay’s jokes were not understood by those in the house. More questions arose from the viewers than laughter. Jay had a guest on who brought in various animals, including a large turtle and a snake. The doctors were wondering why they would bring a snake out and put it right in front of Jay! They insisted that these were wild animals and they could not be tamed – something could go wrong at any moment!
Dr. Sandrine finished up in the kitchen and brought out her masterpieces, which included bitta leaf (which was the spiciest food I’ve ever eaten), jama jama (like spinach), fruit, some sort of pasta dish, and kasava root! When I saw the kasava, I thought to myself, “Oh boy – here comes the pancreatitis!” It has the shape and texture of an umbilical cord. When you first bite into it, there is no taste. However, as it sits in your mouth, you begin to notice hints of a lemon-like flavor. The kasava with the bitta leaf made for a delicious meal. We finished our meals and immediately afterward Dr. Sandrine was called down to the hospital. We walked her down and then wished her a good night.
(Kasava Root)
Table for two,
Mark
---------------------------------------------
Saturday, April 19, 2008
Nevirapine Reaction – Caution: Graphic Medical Photographs Ahead
Saturday, April 19, 2008 – 8:31pm Cameroon Time
I woke up today at 6:20am for chapel. After chapel and a hearty breakfast, Kadidja and I went up to the wards. I pulled the chart of the patient who came in with a severe case of pneumonia – in fact, I did not believe he would make it though last weekend. Over the course of the week, he continued to surprise me with his improvement. Today, I am excited to say that I was able to discharge him. He had a small cough, but clear sounds and his repeat chest x-ray was as clean as a whistle. His smile and laugh is unforgettable. He shook my hand for at least five minutes as we both laughed with joy. His family was incredibly grateful and around 11:00am he walked out the door.
I was also able to discharge the man with the GI bleed and Hgb of 4.2. He now had a Hgb of 8.6 after having received 3 units of blood that was graciously given by his friends and family. I sent him to follow up with a doc in Mbingo who can do endoscopies.
After all the good news, I unfortunately had to inform yet another patient of his new HIV status. This patient was a hospital staff member and came in with an undulating fever that spiked exactly every 24 hours at midnight. He was sweating diffusely and had a rigid abdomen. He had no other complaints. I put him on antibiotics for malaria, but after a few days, his symptoms just didn’t fit. I received the HIV report today and delivering the news went down exactly as the others – with a blank stare and a loss of hope.
In the outpatient clinic, we had quite a number of interesting patients. First was a lady who came in with a complaint of left leg pain that traveled from her ankle up to her knee. She would then put pressure on her thigh with her hands an the pain would go back down to her ankle and stop. She also had +1 to +2 pitting edema in both legs. She did not have any shortness of breath or any other complaints for that matter and nothing was found on exam. I ordered a creatinine, UA, and random blood sugar – all of which came back within normal limits. After poking and prodding with further history questions, it dawned on us that the lady had filariasis. We put her on diethylcarbamazine.
I was called into the next room by Dr. Sandrine who had a patient with a left mandibular/neck mass that had eroded through his skin. Because he was not my patient, I do not know the complete history; however, the mass was hard to the touch and had been growing for some time. It seemed to be some sort of lymphoma. He will see the surgeons on Monday. Again, please do not distribute the following photograph and view with care:
After a few more patients, a young lady came in with the complaint of a 6-day history of painful rash over a majority of her body. She also complained of swollen and painful lips. She was put on TMP-SMX 3 months ago and began antiretroviral therapy about a week ago. The rash on the abdomen, arms, and legs looked almost on molluscum contagiosum. On the palms of her hands and the soles of her feet were purpuric lesions. Her lips were indeed swollen and there were weeping lesions present. I had no idea what was going on so I consulted Dr. Francine – one of the more senior clinicians that was present in the clinic. She had seen one case like this before and the final diagnosis was a reaction to Nevirapine (a component of her 3 drug regimen for HIV). We told her to immediately stop the Nevirapine and return to her treating physician for a different regimen of ART therapy:
After clinic, Kadidja and I went into town to get some bread. As we walked back to the rest house, we were approached by Nadine who invited us to come meet some of her friends. There were 3 soccer games going on and a choir practice – all in the same small field. We rested and listened to the choir for a while. Here’s a picture of some of Nadine’s friends:
Come and listen,
-Mark
---------------------------------------------
I woke up today at 6:20am for chapel. After chapel and a hearty breakfast, Kadidja and I went up to the wards. I pulled the chart of the patient who came in with a severe case of pneumonia – in fact, I did not believe he would make it though last weekend. Over the course of the week, he continued to surprise me with his improvement. Today, I am excited to say that I was able to discharge him. He had a small cough, but clear sounds and his repeat chest x-ray was as clean as a whistle. His smile and laugh is unforgettable. He shook my hand for at least five minutes as we both laughed with joy. His family was incredibly grateful and around 11:00am he walked out the door.
I was also able to discharge the man with the GI bleed and Hgb of 4.2. He now had a Hgb of 8.6 after having received 3 units of blood that was graciously given by his friends and family. I sent him to follow up with a doc in Mbingo who can do endoscopies.
After all the good news, I unfortunately had to inform yet another patient of his new HIV status. This patient was a hospital staff member and came in with an undulating fever that spiked exactly every 24 hours at midnight. He was sweating diffusely and had a rigid abdomen. He had no other complaints. I put him on antibiotics for malaria, but after a few days, his symptoms just didn’t fit. I received the HIV report today and delivering the news went down exactly as the others – with a blank stare and a loss of hope.
In the outpatient clinic, we had quite a number of interesting patients. First was a lady who came in with a complaint of left leg pain that traveled from her ankle up to her knee. She would then put pressure on her thigh with her hands an the pain would go back down to her ankle and stop. She also had +1 to +2 pitting edema in both legs. She did not have any shortness of breath or any other complaints for that matter and nothing was found on exam. I ordered a creatinine, UA, and random blood sugar – all of which came back within normal limits. After poking and prodding with further history questions, it dawned on us that the lady had filariasis. We put her on diethylcarbamazine.
I was called into the next room by Dr. Sandrine who had a patient with a left mandibular/neck mass that had eroded through his skin. Because he was not my patient, I do not know the complete history; however, the mass was hard to the touch and had been growing for some time. It seemed to be some sort of lymphoma. He will see the surgeons on Monday. Again, please do not distribute the following photograph and view with care:
After a few more patients, a young lady came in with the complaint of a 6-day history of painful rash over a majority of her body. She also complained of swollen and painful lips. She was put on TMP-SMX 3 months ago and began antiretroviral therapy about a week ago. The rash on the abdomen, arms, and legs looked almost on molluscum contagiosum. On the palms of her hands and the soles of her feet were purpuric lesions. Her lips were indeed swollen and there were weeping lesions present. I had no idea what was going on so I consulted Dr. Francine – one of the more senior clinicians that was present in the clinic. She had seen one case like this before and the final diagnosis was a reaction to Nevirapine (a component of her 3 drug regimen for HIV). We told her to immediately stop the Nevirapine and return to her treating physician for a different regimen of ART therapy:
After clinic, Kadidja and I went into town to get some bread. As we walked back to the rest house, we were approached by Nadine who invited us to come meet some of her friends. There were 3 soccer games going on and a choir practice – all in the same small field. We rested and listened to the choir for a while. Here’s a picture of some of Nadine’s friends:
Come and listen,
-Mark
---------------------------------------------
Shey
Friday, April 18, 2008 – 9:42pm Cameroon Time
I woke up this morning at 6:50am, had breakfast, and strolled up to the men’s ward. After seeing a few patients, I pulled the chart of the young man who came in with fever, diffuse sweating, productive cough with black sputum, and shortness of breath. He looked extremely ill when he came through the outpatient clinic and is now showing signs of improvement. He is no longer febrile and his shortness of breath has dissipated. He still has diffuse rhonchi in his right lung and is continuously soaked with sweat. I had ordered an HIV lab when he first came through and it came back today – positive. Once again, I had to share the news with the patient for the first time. He had a similar reaction as the previous patient – his eyes went blank and I’m sure a million thoughts rushed through his head. The temptation is to give them as much information as you can – educating them on all the treatment regimens and the support they can get. I have found, however, that it is best to keep it short and simple as there is only so much a patient can process at a time.
We just received some malaria education posters and a large shipment of insecticide treated bed nets (ITNs). We will hang up the posters around the hospital and will be sending home an ITN with every patient who is under the age of 5 for free. Young children and pregnant women are at the highest risk of developing malaria complications as their immune systems are considered to be diminished. Here is a photograph of Fada, the head nurse in the men’s ward – and invaluable Pidgin translator – reviewing the new posters:
Dr. Sandrine and I finished rounding in the men’s ward and then headed down for come coffee. I brought some Coffee Mate powder today and had Dr. Sandrine try some – she was immediately hooked! She requested that I bring it everyday. After our delicious coffee, we shimmied up to the outpatient clinic.
A young man came in with constipation for one year and has noticed pain in his anal region as well as some blood in the little stool that he produces. Just after I finished checking him, a screener ran into my room and told us there was a man going into shock. We ran in and indeed there was a young man with a gunshot wound to the right thigh who was not looking good. We transferred him onto a gurney and got IV access. I squeezed as hard as I could on the bag of fluid as Kadidja tried to get a blood pressure. After 3 liters of fluid, she finally got one at 80/40. The man’s eyes kept rolling back in his head, but he responded each time I tried to keep him with us. His hands, arms, legs, and feet were cold as ice. His body shook as he tried to stay warm. As we were working on him, the patient’s father came in with a pot of Foo Foo Kon – kind of like cream of wheat, but in a big clump. He insisted that we feed him, but we denied him of his request and escorted the man out of the room. After we got the patient stabilized, we took him to the operating theater and the surgeons took over. When all was said and done, I returned to my patient with constipation.
I saw a few more patients when in walked a Shey. A Shey is appointed by the Fon to be a distinguished ruler in the community. He is highly regarded by the general public. In fact, you are not supposed to shake a Shey’s hand, but rather hold both hands together and blow humbly. Although not appointed by the Fon, Judit (a nurse in the outpatient clinic) made me a Shey this week – Shey Mark – it was quite the honor. We will be going into the market on Sunday to get my traditional Shey garb, beads, and hat.
The Shey was complaining of blood in his urine for 3 months. He also had penile pain and was getting up 8 times in the night to urinate. He denied smoking tobacco; however, I have seen some Sheys around town and they can smoke from pipes with the best of them. I ordered a PSA and a pelvic ultrasound with attention to the bladder. After it was calculated by Judit, the Shey would have to pay 10,000 franks – about 20 USD. He only had 5,000 with him. I decided to ditch the PSA, but the ultrasound alone would cost him 6,000. They were going to send him home, so I pitched a thousand to Judit and he was able to get the ultrasound. As expected, the results came back that there as a mass in his bladder. We then immediately referred him to surgery. If he would have gone home, it is unlikely that he would have returned to get the ultrasound and the cancer would not have been detected.
(Two girls carrying “Pekins” on their backs – the preferred mode of traveling with a baby)
Nothing compares,
-Mark
---------------------------------------------
I woke up this morning at 6:50am, had breakfast, and strolled up to the men’s ward. After seeing a few patients, I pulled the chart of the young man who came in with fever, diffuse sweating, productive cough with black sputum, and shortness of breath. He looked extremely ill when he came through the outpatient clinic and is now showing signs of improvement. He is no longer febrile and his shortness of breath has dissipated. He still has diffuse rhonchi in his right lung and is continuously soaked with sweat. I had ordered an HIV lab when he first came through and it came back today – positive. Once again, I had to share the news with the patient for the first time. He had a similar reaction as the previous patient – his eyes went blank and I’m sure a million thoughts rushed through his head. The temptation is to give them as much information as you can – educating them on all the treatment regimens and the support they can get. I have found, however, that it is best to keep it short and simple as there is only so much a patient can process at a time.
We just received some malaria education posters and a large shipment of insecticide treated bed nets (ITNs). We will hang up the posters around the hospital and will be sending home an ITN with every patient who is under the age of 5 for free. Young children and pregnant women are at the highest risk of developing malaria complications as their immune systems are considered to be diminished. Here is a photograph of Fada, the head nurse in the men’s ward – and invaluable Pidgin translator – reviewing the new posters:
Dr. Sandrine and I finished rounding in the men’s ward and then headed down for come coffee. I brought some Coffee Mate powder today and had Dr. Sandrine try some – she was immediately hooked! She requested that I bring it everyday. After our delicious coffee, we shimmied up to the outpatient clinic.
A young man came in with constipation for one year and has noticed pain in his anal region as well as some blood in the little stool that he produces. Just after I finished checking him, a screener ran into my room and told us there was a man going into shock. We ran in and indeed there was a young man with a gunshot wound to the right thigh who was not looking good. We transferred him onto a gurney and got IV access. I squeezed as hard as I could on the bag of fluid as Kadidja tried to get a blood pressure. After 3 liters of fluid, she finally got one at 80/40. The man’s eyes kept rolling back in his head, but he responded each time I tried to keep him with us. His hands, arms, legs, and feet were cold as ice. His body shook as he tried to stay warm. As we were working on him, the patient’s father came in with a pot of Foo Foo Kon – kind of like cream of wheat, but in a big clump. He insisted that we feed him, but we denied him of his request and escorted the man out of the room. After we got the patient stabilized, we took him to the operating theater and the surgeons took over. When all was said and done, I returned to my patient with constipation.
I saw a few more patients when in walked a Shey. A Shey is appointed by the Fon to be a distinguished ruler in the community. He is highly regarded by the general public. In fact, you are not supposed to shake a Shey’s hand, but rather hold both hands together and blow humbly. Although not appointed by the Fon, Judit (a nurse in the outpatient clinic) made me a Shey this week – Shey Mark – it was quite the honor. We will be going into the market on Sunday to get my traditional Shey garb, beads, and hat.
The Shey was complaining of blood in his urine for 3 months. He also had penile pain and was getting up 8 times in the night to urinate. He denied smoking tobacco; however, I have seen some Sheys around town and they can smoke from pipes with the best of them. I ordered a PSA and a pelvic ultrasound with attention to the bladder. After it was calculated by Judit, the Shey would have to pay 10,000 franks – about 20 USD. He only had 5,000 with him. I decided to ditch the PSA, but the ultrasound alone would cost him 6,000. They were going to send him home, so I pitched a thousand to Judit and he was able to get the ultrasound. As expected, the results came back that there as a mass in his bladder. We then immediately referred him to surgery. If he would have gone home, it is unlikely that he would have returned to get the ultrasound and the cancer would not have been detected.
(Two girls carrying “Pekins” on their backs – the preferred mode of traveling with a baby)
Nothing compares,
-Mark
---------------------------------------------
Friday, April 18, 2008
The Mass Effect
Thursday, April 17, 2008 – 8:23pm Cameroon Time
I woke up this morning around 6:30am for a lecture and case presentation on nephrotic syndrome in children. We have a significant amount of minimal change disease patients come in, so it was very useful. I will be giving a lecture on EKGs on Monday. I have been consulted many times to read an EKG. If nobody is around who can read it, the physician will trust what is interpreted by the machine and we all know that many times the machine can interpret readings improperly. Hopefully I can pass on some good material. After the presentation, Kadidja and I went back for breakfast at the rest house. We then ambled up to our respective wards.
I grabbed the chart of the patient with severe pneumonia. When he first came in, he was in respiratory distress and almost did not make it. He has progressed so far in the last several days that I am proud to announce that he was well enough to be discharged this morning. It was a very satisfying feeling to have taken part in his recovery.
We finished rounding in the men’s ward and headed over to the conference room for our daily coffee. After a good break, Kadidja and I went up to the outpatient clinic while Dr. Sandrine went down to the HIV department. Our first patient was a woman who came in complaining of leg swelling and pain. Upon examination, there was a large scab-like lesion covering the majority of her they and into her calf. Further history clued us in that this was indeed a case of Kaposi’s Sarcoma. Unfortunately, we have not had good success with the chemotherapy regimens at BBH. In addition, a single chemo treatment would cost the patient over 150,000 francs or 360 USD. This was clearly not a good option. We informed the patient that she could travel to an oncologist for a second opinion in the nation’s capital or simply live with the disease – I’m afraid she will have to do the latter.
A little later I was approached by Joseph to see a patient who came in with a large mass on the right side of her face that had originated from the orbit. She had first noticed the mass growing in 1997 and it had grown so large that it pushed out her prosthetic eye in 2002. She is from a village far away from Banso and has been unable to receive any quality health care. She went to a health center in 2006, but unfortunately it was comprised of only nurses and they were not capable of offering any sort of treatment or surgery. Upon examination, the mass was of a spongy texture – not firm like I expected. It was also very warm. The patient said she had been in the sun for a while, but the rest of her body was cool to the touch. I believe that the increased warmth was more likely to be due to the increased vascularity of the mass. She is able to eat only with the left side of her mouth and has no trouble seeing out of her left eye. She did not present with any other significant signs or symptoms. The mass seems to be benign in nature, but further investigation and biopsies will need to be preformed. I was extremely honored to be allowed to take the following photograph of the patient. Please do not distribute this photograph and view it with care and good intentions:
A plastic surgeon will be available to remove the mass. However, because the patient comes from a small village and has next to nothing, she is unable to pay for the surgery in addition to the pre and post-op care on her own. Knowing that the dollar goes a long way here in Cameroon, I thought I would take up a collection for her. If you would like to make a special contribution for the care and surgery of this patient, you may do so by clicking the donation link at the beginning of this blog (scroll down).
After seeing many more patients in the outpatient department, Kadidja and I headed down the road to see our friend Simon at his store. After our visit with Simon, all 3 of us headed back to the rest house for dinner. It was nice to have a guest two days in a row! We had potatoes, salad, and some sort of meat concoction. During the meal, it seemed as if Simon was a little bit uncomfortable. I did not know if it was overwhelming for him to have such a grand meal or if something else was bothering him. We invited Simon back any time along with his family. Upon this invitation, we were informed that many people would feel uneasy about eating with us in the rest house – this due to the notion that we would believe they were begging. It was an interesting cultural moment. We assured Simon that we did not think that and he was always welcome to come and eat with us – along with his wife and child.
(Dr. Sandrine doing “The Alveoli” with her new ridiculously large pharmaceutical company pen)
(Exam gloves washed and hung out to dry for reuse)
Hands of the potter,
-Mark
---------------------------------------------
I woke up this morning around 6:30am for a lecture and case presentation on nephrotic syndrome in children. We have a significant amount of minimal change disease patients come in, so it was very useful. I will be giving a lecture on EKGs on Monday. I have been consulted many times to read an EKG. If nobody is around who can read it, the physician will trust what is interpreted by the machine and we all know that many times the machine can interpret readings improperly. Hopefully I can pass on some good material. After the presentation, Kadidja and I went back for breakfast at the rest house. We then ambled up to our respective wards.
I grabbed the chart of the patient with severe pneumonia. When he first came in, he was in respiratory distress and almost did not make it. He has progressed so far in the last several days that I am proud to announce that he was well enough to be discharged this morning. It was a very satisfying feeling to have taken part in his recovery.
We finished rounding in the men’s ward and headed over to the conference room for our daily coffee. After a good break, Kadidja and I went up to the outpatient clinic while Dr. Sandrine went down to the HIV department. Our first patient was a woman who came in complaining of leg swelling and pain. Upon examination, there was a large scab-like lesion covering the majority of her they and into her calf. Further history clued us in that this was indeed a case of Kaposi’s Sarcoma. Unfortunately, we have not had good success with the chemotherapy regimens at BBH. In addition, a single chemo treatment would cost the patient over 150,000 francs or 360 USD. This was clearly not a good option. We informed the patient that she could travel to an oncologist for a second opinion in the nation’s capital or simply live with the disease – I’m afraid she will have to do the latter.
A little later I was approached by Joseph to see a patient who came in with a large mass on the right side of her face that had originated from the orbit. She had first noticed the mass growing in 1997 and it had grown so large that it pushed out her prosthetic eye in 2002. She is from a village far away from Banso and has been unable to receive any quality health care. She went to a health center in 2006, but unfortunately it was comprised of only nurses and they were not capable of offering any sort of treatment or surgery. Upon examination, the mass was of a spongy texture – not firm like I expected. It was also very warm. The patient said she had been in the sun for a while, but the rest of her body was cool to the touch. I believe that the increased warmth was more likely to be due to the increased vascularity of the mass. She is able to eat only with the left side of her mouth and has no trouble seeing out of her left eye. She did not present with any other significant signs or symptoms. The mass seems to be benign in nature, but further investigation and biopsies will need to be preformed. I was extremely honored to be allowed to take the following photograph of the patient. Please do not distribute this photograph and view it with care and good intentions:
A plastic surgeon will be available to remove the mass. However, because the patient comes from a small village and has next to nothing, she is unable to pay for the surgery in addition to the pre and post-op care on her own. Knowing that the dollar goes a long way here in Cameroon, I thought I would take up a collection for her. If you would like to make a special contribution for the care and surgery of this patient, you may do so by clicking the donation link at the beginning of this blog (scroll down).
After seeing many more patients in the outpatient department, Kadidja and I headed down the road to see our friend Simon at his store. After our visit with Simon, all 3 of us headed back to the rest house for dinner. It was nice to have a guest two days in a row! We had potatoes, salad, and some sort of meat concoction. During the meal, it seemed as if Simon was a little bit uncomfortable. I did not know if it was overwhelming for him to have such a grand meal or if something else was bothering him. We invited Simon back any time along with his family. Upon this invitation, we were informed that many people would feel uneasy about eating with us in the rest house – this due to the notion that we would believe they were begging. It was an interesting cultural moment. We assured Simon that we did not think that and he was always welcome to come and eat with us – along with his wife and child.
(Dr. Sandrine doing “The Alveoli” with her new ridiculously large pharmaceutical company pen)
(Exam gloves washed and hung out to dry for reuse)
Hands of the potter,
-Mark
---------------------------------------------
Family Feud
Wednesday, April 16, 2008 – 8:58pm Cameroon Time
I woke up this morning about 6:20am, rambled up to the chapel with Kadidja and then back down to the rest house for breakfast. We then went to our respective wards. Last night an episode occurred that was made for Hollywood. We have a patient in Bed 9 who has lung cancer that is inoperable. Last night, his son hunted down and slaughtered an acquaintance with a machete. The family members of the victim took him to the hospital I’m stationed at. He died on the taxi ride up. There was loud screaming throughout the night as the family members mourned. Shrikes and shrills echoed throughout the streets as the group went hysterical. Apparently, this type of mourning can last up to 3 days if not a week. Once one family member stops yelling out, another family member shows up and finds out the bad news, creating a cycle that seems to never end.
Once the family dropped the body off at the hospital, they went on a mission to hunt down and kill the son of the patient in Bed 9 – and succeeded. It is very possible that this cycle of killing will continue between these two families over the next few days until only few survivors are left. Please keep all parties in your prayers.
On the brighter side, one of my patients made an enormous stride today. It is a middle-aged male who was found lying on the floor of his home unconscious. He was brought to the hospital and since the incident he has been unable to open his eyes, speak, or sit up. He also had a mild left facial droop. He was able to move all of his extremities (albeit in a choreaform manner), listen to and understand someone who was talking to him, and follow simple commands. After 3 days, the patient sat up in bed with assistance and once his head was vertical he spontaneously opened his eyes! He had ptosis (eye lid droop) of the right eye and the same eye was pointed downward and adducted when he looked straight forward. I asked him if he could see me and he said yes! The nerves involved seem to be the 3rd and 4th cranial nerves. I’m not too sure if the palsy originated from a process involving the posterior communicating artery or if he has a tentorial mass. Nonetheless, he has made drastic improvements today.
In the outpatient department, a woman came in who had been working on her farm when she accidentally grabbed a snake. She was unsure if the snake bit her, but had felt numbness up her right arm and into her neck. She also felt her heart beating and described other flu-like symptoms. The snake event took place yesterday afternoon. Nothing seemed to add up. If she was really bitten by the snake, she would have gone into shock and died within a few hours. It was a case made for the psych books. We reassured her and sent her home with some Tylenol for the pain.
Late in the afternoon, I went down to Simon’s store with Kadidja. He is the one who started up a business last fall that specializes in copies, printing, and transferring of phone credit (i.e. adding minutes). We spent some time with him during which a young girl who was mute came running up to us. None of us could really understand what she wanted, until she grabbed my camera and pointed at herself. She wanted her picture taken – and not just one mind you. She really milked the opportunity along with Simon’s son:
After we visited with Simon, we headed up to Dr. Sandrine’s home and then went for a hike up the hill behind the hospital. It was quite the trek. We found ourselves walking through a farm, past a boarding school, in between two forests, and ending up at the L.A.P. program station. We then used the main road to help us find our way back to the hospital in the dark. When we got back, we had dinner at the rest house – meat over rice. We then said goodnight to Dr. Sandrine as we ended our adventurous day here in Banso.
Open skies,
-Mark
---------------------------------------------
I woke up this morning about 6:20am, rambled up to the chapel with Kadidja and then back down to the rest house for breakfast. We then went to our respective wards. Last night an episode occurred that was made for Hollywood. We have a patient in Bed 9 who has lung cancer that is inoperable. Last night, his son hunted down and slaughtered an acquaintance with a machete. The family members of the victim took him to the hospital I’m stationed at. He died on the taxi ride up. There was loud screaming throughout the night as the family members mourned. Shrikes and shrills echoed throughout the streets as the group went hysterical. Apparently, this type of mourning can last up to 3 days if not a week. Once one family member stops yelling out, another family member shows up and finds out the bad news, creating a cycle that seems to never end.
Once the family dropped the body off at the hospital, they went on a mission to hunt down and kill the son of the patient in Bed 9 – and succeeded. It is very possible that this cycle of killing will continue between these two families over the next few days until only few survivors are left. Please keep all parties in your prayers.
On the brighter side, one of my patients made an enormous stride today. It is a middle-aged male who was found lying on the floor of his home unconscious. He was brought to the hospital and since the incident he has been unable to open his eyes, speak, or sit up. He also had a mild left facial droop. He was able to move all of his extremities (albeit in a choreaform manner), listen to and understand someone who was talking to him, and follow simple commands. After 3 days, the patient sat up in bed with assistance and once his head was vertical he spontaneously opened his eyes! He had ptosis (eye lid droop) of the right eye and the same eye was pointed downward and adducted when he looked straight forward. I asked him if he could see me and he said yes! The nerves involved seem to be the 3rd and 4th cranial nerves. I’m not too sure if the palsy originated from a process involving the posterior communicating artery or if he has a tentorial mass. Nonetheless, he has made drastic improvements today.
In the outpatient department, a woman came in who had been working on her farm when she accidentally grabbed a snake. She was unsure if the snake bit her, but had felt numbness up her right arm and into her neck. She also felt her heart beating and described other flu-like symptoms. The snake event took place yesterday afternoon. Nothing seemed to add up. If she was really bitten by the snake, she would have gone into shock and died within a few hours. It was a case made for the psych books. We reassured her and sent her home with some Tylenol for the pain.
Late in the afternoon, I went down to Simon’s store with Kadidja. He is the one who started up a business last fall that specializes in copies, printing, and transferring of phone credit (i.e. adding minutes). We spent some time with him during which a young girl who was mute came running up to us. None of us could really understand what she wanted, until she grabbed my camera and pointed at herself. She wanted her picture taken – and not just one mind you. She really milked the opportunity along with Simon’s son:
After we visited with Simon, we headed up to Dr. Sandrine’s home and then went for a hike up the hill behind the hospital. It was quite the trek. We found ourselves walking through a farm, past a boarding school, in between two forests, and ending up at the L.A.P. program station. We then used the main road to help us find our way back to the hospital in the dark. When we got back, we had dinner at the rest house – meat over rice. We then said goodnight to Dr. Sandrine as we ended our adventurous day here in Banso.
Open skies,
-Mark
---------------------------------------------
Arachnophobia
Tuesday, April 15, 2008 – 10:02pm Cameroon Time
I woke up today about 7:00am and was greeted by Kadidja with, “There is a HUGE spider in the bathtub.” I just had to see it. I went in and one of the house keepers had put a toilet plunger on top of it. Apparently, killing spiders is culturally unacceptable as they are considered a noble creature. They ended up calling someone from the hospital to come take it away.
I waltzed on up to the men’s ward and started rounding. I had ordered a pelvic x-ray of the CVA/hemiparesis patient because he continued to complain of hip and back pain. I thought he may have fallen and fractured something during his episode. He was also complaining of urinary symptoms, so I ordered a PSA. The PSA came back at 86 (normal < 4) and the x-ray showed multiple densities in the lumbar spine. With the new working diagnosis of prostate cancer with mets, I referred him on to surgery. Surgery saw him and scheduled a biopsy for Friday. The patient’s family wished that he come back home. We signed the patient up for palliative care so that when public health workers travel through his village, he will be able to obtain pain medication. He will not, however, be receiving any medical care for his condition.
I saw a few more patients and then I pulled a new patient’s chart from the rack. He was a 32yo male who had been vomiting blood and black foul smelling diarrhea since 2002. He was afebrile and was not short of breath. His extremities were cool to the touch and a cap-refill could not be performed because there was no blood in his finger tips to begin with. The labs came back and he had a hemoglobin of 4.2. His friend who had come along with him happened to have O(-) blood, so we were able to transfuse a unit. There is no blood bank at the hospital, so the policy is BYOB – Bring Your Own Blood – or at least a friend who is willing to give some up. I was asked if I would give some, but unfortunately I am not O(-). I put him on some antibiotics and a PPI. We’ll see how he’s doing tomorrow morning – hopefully we can give him another couple units.
We finished up rounding relatively early because of the recent discharges on the floor and then sashayed over to the conference room for some coffee. Here, Kadidja and I found out that there were some docs heading out to a distant village on Friday for a clinic – hopefully we can tag along. After the coffee break, we went up to the outpatient clinic.
It was not as busy today as it was yesterday. I first saw two patients who I sent to get labs yesterday. One of them was infertile. She had light regular non-painful menses and her TSH was within normal limits. She also complained of nipple discharge. I was banking either on sperm dysfunction or a prolactinoma. We did not have any bromocriptine, so I told her to bring in her husband and we would take a look at his sperm.
After about 10 patients, I was called back to Room 9 – where minor procedures are done. They were doing a thoracentesis I ordered yesterday for a man with a pleural effusion. The man was sitting somewhat hunched over on the table. A tube ran from his back, to the end of the table, and dangled into a small bucket. They were just about finished and had drained 2.5 liters of light yellow foamy fluid. Hopefully this will be quite therapeutic for the gentleman.
You’ve heard of Chicken in a Biscuit. How about Chicken in a Basket!?
Fowl joke, I know.
We delight,
-Mark
---------------------------------------------
I woke up today about 7:00am and was greeted by Kadidja with, “There is a HUGE spider in the bathtub.” I just had to see it. I went in and one of the house keepers had put a toilet plunger on top of it. Apparently, killing spiders is culturally unacceptable as they are considered a noble creature. They ended up calling someone from the hospital to come take it away.
I waltzed on up to the men’s ward and started rounding. I had ordered a pelvic x-ray of the CVA/hemiparesis patient because he continued to complain of hip and back pain. I thought he may have fallen and fractured something during his episode. He was also complaining of urinary symptoms, so I ordered a PSA. The PSA came back at 86 (normal < 4) and the x-ray showed multiple densities in the lumbar spine. With the new working diagnosis of prostate cancer with mets, I referred him on to surgery. Surgery saw him and scheduled a biopsy for Friday. The patient’s family wished that he come back home. We signed the patient up for palliative care so that when public health workers travel through his village, he will be able to obtain pain medication. He will not, however, be receiving any medical care for his condition.
I saw a few more patients and then I pulled a new patient’s chart from the rack. He was a 32yo male who had been vomiting blood and black foul smelling diarrhea since 2002. He was afebrile and was not short of breath. His extremities were cool to the touch and a cap-refill could not be performed because there was no blood in his finger tips to begin with. The labs came back and he had a hemoglobin of 4.2. His friend who had come along with him happened to have O(-) blood, so we were able to transfuse a unit. There is no blood bank at the hospital, so the policy is BYOB – Bring Your Own Blood – or at least a friend who is willing to give some up. I was asked if I would give some, but unfortunately I am not O(-). I put him on some antibiotics and a PPI. We’ll see how he’s doing tomorrow morning – hopefully we can give him another couple units.
We finished up rounding relatively early because of the recent discharges on the floor and then sashayed over to the conference room for some coffee. Here, Kadidja and I found out that there were some docs heading out to a distant village on Friday for a clinic – hopefully we can tag along. After the coffee break, we went up to the outpatient clinic.
It was not as busy today as it was yesterday. I first saw two patients who I sent to get labs yesterday. One of them was infertile. She had light regular non-painful menses and her TSH was within normal limits. She also complained of nipple discharge. I was banking either on sperm dysfunction or a prolactinoma. We did not have any bromocriptine, so I told her to bring in her husband and we would take a look at his sperm.
After about 10 patients, I was called back to Room 9 – where minor procedures are done. They were doing a thoracentesis I ordered yesterday for a man with a pleural effusion. The man was sitting somewhat hunched over on the table. A tube ran from his back, to the end of the table, and dangled into a small bucket. They were just about finished and had drained 2.5 liters of light yellow foamy fluid. Hopefully this will be quite therapeutic for the gentleman.
You’ve heard of Chicken in a Biscuit. How about Chicken in a Basket!?
Fowl joke, I know.
We delight,
-Mark
---------------------------------------------
Tuesday, April 15, 2008
“Where do I sleep?”
Sunday, April 14, 2008 – 10:18pm Cameroon Time
I woke up today at 6:50am and skedaddled up to the men’s ward. I walked in rather hesitantly, as I could only imagine what had happened to my patient who was decompensating quickly on Saturday from a severe respiratory infection. I headed strait for the charts, looked to my left at Bed 7, and was jubilant to see that he was still there! Not only was he still there, he looked better than ever. I checked his O2 sat and it was 94%, which is a drastic improvement from his 76% two days ago. I felt him and no longer did he have the piping hot fever – although he was still sweating profusely. His lungs still sounded rather “rhonchous,” but they had improved significantly. Needless to say, I was very happy with what I saw, and thus my day began.
I traveled from bed to bed, reviewing, examining, and updating patients with additions and discontinuations of various treatments. I found myself at Bed 13. This was my patient with recurrent mental status changes and a cornucopia of AIDS complications and opportunistic infections. He has done much better after the addition of the antipsychotic. No longer does he flail his arms and jabber in the middle of the night. In addition, his lungs sounded great and he no longer had any difficulty breathing. For all intensive purposes, he had progressed to the point I wanted him to be and I was able to let him go home.
Dr. Sandrine and I finished up rounding on the ward and then headed over for some coffee. After discussing the intricacies of the Pidgin language, we skipped up to the outpatient clinic. There was a large stack of booklets in the bin “For Doctors to See.” The policy at the clinic is, “If you show up, you will be seen.” There are no doctor’s appointments. This can lead to some days being extremely busy, which was the case today.
One of my first patients was a 19yo female who was having an 8-month history of diffuse abdominal discomfort. She was breastfeeding her baby of 8 months and was not having menses. She did not show any other signs of symptoms that would give me any other clues. No fever, nausea, vomiting, diarrhea, constipation, dizziness, vision changes, muscle pain, etc. I asked if the patient was mating (yes, that is the correct wordage to use out here), and she insisted she was not – as she was not married and in front of her mother. I thought to myself, “We’ll see about that.” As I got finished with my history, her baby began to cry in her mother’s arms. The mom passed the baby to the patient and as I was going in to listen to the heart, the baby latched on. I told the patient we would multitask. After the baby was finished nursing, I had the patient lie on the table so I could see what was going on with this abdomen. I listened and percussed, and then went in for palpation. I palpated the RUQ, then the LUQ, and then the RLQ and LLQ – only to find nothing. Then I palpated the suprapubic region – jackpot! There was a mass about 6cm long between the umbilicus and the pubic bone. I had caught her lying through her teeth. She had indeed been mating. I ordered a pregnancy test and an abdominal/pelvic ultrasound. She came back with the results and I prepared myself to tell her of the news. I eagerly opened the ultrasound report to see how far along she was, and read, “lymphadenopathy.” You mean to tell me the baby I palpated was a monstrous lymph node!? Well, there goes my clinical suspicion. With the new finding, almost anything was possible with regards to her diagnosis. I referred her on to follow up with surgery for a lymph node biopsy.
I walked around the corner to find Dr. Sandrine with a 1yo male. The semi-malnourished boy had a mass under his left mandible and into his neck. At first I thought it was Burkitt's lymphoma, but then when I palpated the area there was a cystic quality to it. I then thought it might have been a branchial cleft cyst. We conducted an ultrasound and consulted surgery. It turned out to be a cystic hygroma. The boy will go into surgery tomorrow to have it removed as it seems to be compressing some vital structures. Please do not distribute the following photograph and view with care:
I finished up my day with an extremely difficult case. A 33yo male came in complaining of productive cough with brown sputum. He also had extreme neck pain that radiated all the way down his spine and complained of recent vision changes. In addition, he had diffuse abdominal pain. On exam, the lungs were coarse, the abdomen was tender in all quadrants except the LLQ, and his pupils seemed to constrict paradoxically to light. I had asked him if he was HIV positive or negative and he told me he was positive – it being the 12th year since his diagnosis. This led me down many rabbit trails. Cryptococcal meningitis? PCP pneumonia? TB? The list goes on and on. I wanted to get an x-ray, aspirate for AFB, spinal tap, and a couple other labs but he would have to wait until tomorrow. He did not have enough money to be admitted and had very traveled a long distance to come to the clinic. In addition, he insisted that he just pick up medications and be on his way back to the village. I consulted Dr. Sandrine and she asked him the same questions. This time, however, he said, “No one has ever told me I was HIV positive.” The situation thus started to get ridiculous. Was he having a mental status change right before my eyes? Was I having a mental status change hearing he had been positive for 12 years? Needless to say, we had to get an HIV test to narrow down our differential. Unfortunately, he would have to spend the night at the hospital. “Where do I sleep?” he asked. We told him to get in contact with security and he would be shown a patch of grass. Sleeping outside on a patch of grass with a possible life-threatening condition made my stomach churn.
(Born to Ride)
Caught up in the middle,
-Mark
---------------------------------------------
I woke up today at 6:50am and skedaddled up to the men’s ward. I walked in rather hesitantly, as I could only imagine what had happened to my patient who was decompensating quickly on Saturday from a severe respiratory infection. I headed strait for the charts, looked to my left at Bed 7, and was jubilant to see that he was still there! Not only was he still there, he looked better than ever. I checked his O2 sat and it was 94%, which is a drastic improvement from his 76% two days ago. I felt him and no longer did he have the piping hot fever – although he was still sweating profusely. His lungs still sounded rather “rhonchous,” but they had improved significantly. Needless to say, I was very happy with what I saw, and thus my day began.
I traveled from bed to bed, reviewing, examining, and updating patients with additions and discontinuations of various treatments. I found myself at Bed 13. This was my patient with recurrent mental status changes and a cornucopia of AIDS complications and opportunistic infections. He has done much better after the addition of the antipsychotic. No longer does he flail his arms and jabber in the middle of the night. In addition, his lungs sounded great and he no longer had any difficulty breathing. For all intensive purposes, he had progressed to the point I wanted him to be and I was able to let him go home.
Dr. Sandrine and I finished up rounding on the ward and then headed over for some coffee. After discussing the intricacies of the Pidgin language, we skipped up to the outpatient clinic. There was a large stack of booklets in the bin “For Doctors to See.” The policy at the clinic is, “If you show up, you will be seen.” There are no doctor’s appointments. This can lead to some days being extremely busy, which was the case today.
One of my first patients was a 19yo female who was having an 8-month history of diffuse abdominal discomfort. She was breastfeeding her baby of 8 months and was not having menses. She did not show any other signs of symptoms that would give me any other clues. No fever, nausea, vomiting, diarrhea, constipation, dizziness, vision changes, muscle pain, etc. I asked if the patient was mating (yes, that is the correct wordage to use out here), and she insisted she was not – as she was not married and in front of her mother. I thought to myself, “We’ll see about that.” As I got finished with my history, her baby began to cry in her mother’s arms. The mom passed the baby to the patient and as I was going in to listen to the heart, the baby latched on. I told the patient we would multitask. After the baby was finished nursing, I had the patient lie on the table so I could see what was going on with this abdomen. I listened and percussed, and then went in for palpation. I palpated the RUQ, then the LUQ, and then the RLQ and LLQ – only to find nothing. Then I palpated the suprapubic region – jackpot! There was a mass about 6cm long between the umbilicus and the pubic bone. I had caught her lying through her teeth. She had indeed been mating. I ordered a pregnancy test and an abdominal/pelvic ultrasound. She came back with the results and I prepared myself to tell her of the news. I eagerly opened the ultrasound report to see how far along she was, and read, “lymphadenopathy.” You mean to tell me the baby I palpated was a monstrous lymph node!? Well, there goes my clinical suspicion. With the new finding, almost anything was possible with regards to her diagnosis. I referred her on to follow up with surgery for a lymph node biopsy.
I walked around the corner to find Dr. Sandrine with a 1yo male. The semi-malnourished boy had a mass under his left mandible and into his neck. At first I thought it was Burkitt's lymphoma, but then when I palpated the area there was a cystic quality to it. I then thought it might have been a branchial cleft cyst. We conducted an ultrasound and consulted surgery. It turned out to be a cystic hygroma. The boy will go into surgery tomorrow to have it removed as it seems to be compressing some vital structures. Please do not distribute the following photograph and view with care:
I finished up my day with an extremely difficult case. A 33yo male came in complaining of productive cough with brown sputum. He also had extreme neck pain that radiated all the way down his spine and complained of recent vision changes. In addition, he had diffuse abdominal pain. On exam, the lungs were coarse, the abdomen was tender in all quadrants except the LLQ, and his pupils seemed to constrict paradoxically to light. I had asked him if he was HIV positive or negative and he told me he was positive – it being the 12th year since his diagnosis. This led me down many rabbit trails. Cryptococcal meningitis? PCP pneumonia? TB? The list goes on and on. I wanted to get an x-ray, aspirate for AFB, spinal tap, and a couple other labs but he would have to wait until tomorrow. He did not have enough money to be admitted and had very traveled a long distance to come to the clinic. In addition, he insisted that he just pick up medications and be on his way back to the village. I consulted Dr. Sandrine and she asked him the same questions. This time, however, he said, “No one has ever told me I was HIV positive.” The situation thus started to get ridiculous. Was he having a mental status change right before my eyes? Was I having a mental status change hearing he had been positive for 12 years? Needless to say, we had to get an HIV test to narrow down our differential. Unfortunately, he would have to spend the night at the hospital. “Where do I sleep?” he asked. We told him to get in contact with security and he would be shown a patch of grass. Sleeping outside on a patch of grass with a possible life-threatening condition made my stomach churn.
(Born to Ride)
Caught up in the middle,
-Mark
---------------------------------------------
Monday, April 14, 2008
The Dance
Sunday, April 13, 2008 – 9:51pm Cameroon Time
I woke up at 6:50am this morning and walked across the street to church with Kadidja. Again, it was a refreshing experience. The choir began the service with a procession down the aisles. I, unfortunately, did not receive a back massage during the service. However, I was able to get down and move with the best of them.
After the service, we walked back to the rest house only to fine Nadine, the rest house keeper’s youngest daughter, hiding trying to scare us. We all had a good laugh and then decided to go for a walk into town. Nadine took us down the road, explaining the sites as we went along. When we reached the bottom of the hill, she began to point out a few individuals. “There’s my brother…and there’s my sister…and my other brother…and my other brother…and my sister…and my oldest brother.” Apparently Rose had quite the number of children! I have found that this is fairly common – at least more so than in the U.S. I have come across many patients with 6+ children.
Further on, I had noticed that a goat who I befriended the last few weeks was gone. People will buy goats for about 6,000 francs (14 USD) and tie them to anything that is close to grass or other things to eat. Once they are ready, the goats go from the grass to the dinner table. I’m afraid Mr. Bill-E-Goat is now on the other side – R.I.P.
We headed up the hill and into the market. All of the stores were very small – about the size of a small elevator. We saw almost anything being sold, from secondhand clothes and sugarcane to wigs and cow legs. Here’s Nadine showing us through the market and the cow legs:
---------------------------------------------
I woke up at 6:50am this morning and walked across the street to church with Kadidja. Again, it was a refreshing experience. The choir began the service with a procession down the aisles. I, unfortunately, did not receive a back massage during the service. However, I was able to get down and move with the best of them.
After the service, we walked back to the rest house only to fine Nadine, the rest house keeper’s youngest daughter, hiding trying to scare us. We all had a good laugh and then decided to go for a walk into town. Nadine took us down the road, explaining the sites as we went along. When we reached the bottom of the hill, she began to point out a few individuals. “There’s my brother…and there’s my sister…and my other brother…and my other brother…and my sister…and my oldest brother.” Apparently Rose had quite the number of children! I have found that this is fairly common – at least more so than in the U.S. I have come across many patients with 6+ children.
Further on, I had noticed that a goat who I befriended the last few weeks was gone. People will buy goats for about 6,000 francs (14 USD) and tie them to anything that is close to grass or other things to eat. Once they are ready, the goats go from the grass to the dinner table. I’m afraid Mr. Bill-E-Goat is now on the other side – R.I.P.
We headed up the hill and into the market. All of the stores were very small – about the size of a small elevator. We saw almost anything being sold, from secondhand clothes and sugarcane to wigs and cow legs. Here’s Nadine showing us through the market and the cow legs:
After walking through the market, we traveled back to the rest house. We stopped by Nadine’s house along the way and met some of her siblings:
After we reached our final destination, the other Kadidja and I were as tired as a goat after a large meal. Nadine watched Curious George at the rest house as we napped – for 3 hours. After our naps, we said goodbye to Nadine and headed into town with Joseph and Dr. Sandrine. We walked down some roads, exploring around the Fon’s palace, only to come across some curious kids. “White man!!!” They all came running. They wanted to get their picture taken, but I don’t think they’ve experienced a flash before. When the flash went off, all of them scattered like chickens in a coop.
We traveled down the path and looped around kitty-corner to the palace only to find out that the same group of kids had took a short cut so that they could see us again. I decided to take the opportunity to teach them a new dance move – one that is very near and dear to some of our hearts. Hopefully the following photograph captures the moment:
I finally was able to upload a video! Enjoy!
(Just push play)
"The Alveoli" has gone global!
Sparks fly,
-Mark
---------------------------------------------
Rumble in the Palace
Saturday, April 12, 2008 – 9:11pm Cameroon Time
I woke up this morning around 6:20am for chapel. The Kadidja (new medical student from Tennessee) and I headed up and sat in the fourth row. It is custom for any new visitors or guests of a church or chapel to be introduced. Because we weren’t sitting by the hospital administration, I was not too sure who would introduce her and when. At the end of the service, one of the administrators stood up and made a few announcements, after which he had the Kadidja stand to be introduced. She said hello and told everyone her name and where she was from. As she was sitting down there was a roar of laughter from everyone in the chapel. She melted in her seat and said, “Mark, what’s going on!?” I told her, “I have no idea, but just go with it.” The whole situation was somewhat comical, although quite embarrassing to her. As we left the chapel, we encountered one a financial administrator from Canada who was staying in the rest house for a night. Kadidja asked him why everyone was laughing after her introduction. He smiled and said, “You spoke with such a strong accent and a little too quickly that no one heard or understood what you said.” – Ashia!
We then went back to have breakfast and then headed up to our respective wards. I was able to discharge a 20yo who had malaria as well as an elderly man with vague right sided abdominal pain who had unremarkable labs, images, and physical exams for two days.
As I was rounding, a daughter of an elderly man came up to a nurse and me requesting that I to educate her father about healthy eating and alcohol cessation. She said that if a doctor would tell him he would take it to heart and truly change, but would not do so if a nurse told him. I also think that gender played a part in her request. I told her I would do it, but I still had plenty of patients to see. An hour later while I was still rounding, the daughter came back up to the same nurse and threatened to take her father out of the hospital because we weren’t doing our job. I certainly don’t have a problem with her request, but I think educating the man upon discharge would be a more appropriate time. There were dying patients in the ward who had not been seen yet, and to take time to fulfill the request right away did not seem proper. It turns out that this daughter wanted to take the father out of the hospital from the beginning – in order to take him to a traditional healer – and that there was a second daughter who did not believe in traditional healers and wanted the father to remain in the hospital to receive contemporary health care. It was quite an interesting dynamic – old tradition vs. contemporary medicine. I ordered for a social worker to speak with the two daughters to discuss each of their concerns. Meanwhile, the patient remains clearly coherent and wishes to receive “anything possible” that can help him.
I then grabbed Bed 7’s chart from the cart and walked up to his bedside. This patient is an elderly man who came in a couple days ago with fever, chills, diffuse sweating, productive cough with white sputum, mild hypoxia, and tachycardia. The chest x-ray showed a right apical lung consolidation. After the last couple days of seeing him, it is clear that this patient has TB. The TB department, however, will not administer an anti-TB regimen of antibiotics until either the sputum or gastric aspirate is positive for AFB. I believe the reason is for cost containment. For certain conditions, the hospital wants to make absolutely sure that the patient has a definitive diagnosis before they will administer a certain treatment – to keep unnecessary expensive treatment regimens down. We have the patient on ampicillin and erythromycin. Unfortunately, today he has taken a turn for the worse, his oxygen saturation was at 85, he was soaking his sheets with sweat, and he was so hot to palpation you could fry an egg on him. TB patients here without treatment tend to decompensate relatively quickly. I’m afraid that if he doesn’t have a positive AFB by tonight and start a proper treatment stat, he may not make it through the weekend.
Dr. Sandrine and I then went over to the outpatient clinic after coffee. We saw about 8 patients each and then went home to change. We met back up with the Kadidja and Joseph to head down to the palace. Apparently the Jujus were out in heavy numbers today. We decided to walk to the palace, which is about 2 miles form the hospital. On our way, we saw hoards of tribesman and their children wreaking havoc among the different road-side stores. They had large staffs and spears that they used to ravage these small stores. They also chased after various individuals – mainly to frighten them. They did not, thankfully, come after us.
The main center was packed this afternoon. Everyone had gotten the memo about the Juju extravaganza. We bobbed and weaved through the people into the palace. A military soldier approached us and told us not to take pictures – if we wanted to, we would have to pay 5,000 francs (which would then go directly into his pocket). We obliged and when we got past his sight, we broke out the cameras again. We found a building with some room on the balcony, so we made our way up top to get a better view (and to stay out of harm’s way from the Jujus!).
All of a sudden, there was a large uneasiness in the mass of people (somewhere in the thousands) and something was causing a good amount of ruckus. The Juju with the monstrous head who was dressed in all black then came into our line of vision. He was wielding throwing objects and looked to be extremely agitated. Sometimes, the Jujus will put poison on the tips of the objects – which may have curare-like properties – so it is very risky to get in the way of certain Jujus. This Juju is not like Shinkan, the Juju that chased me through the streets. This Juju means business. Of course the crowd of people egged him on and he started to go out of control. The tribesmen had him on four leases and kept a good hold of him – so he didn’t hurt anyone at this particular time. In just a few minutes, a second Juju started coming down the path towards the palace and strait for the dominant Juju with the large head. Apparently, the Jujus are not to meet – or even to see each other. If they do, there will be pandemonium, a vicious fight, and many lives will be lost as a result. As the two approached each other, tribesmen belonging to each Juju ran ahead and stopped the Juju and his pack of people from coming any further. This happened two times and got so out of control that they had to call in for a military presence, who did their best to keep the Jujus from coming any closer to each other. This clearly was not enough, so the Fon left his thrown and came out into the open area of the palace. As he walked out into the people, everyone seemed to make a clear path for him. There is much respect for the Fon and anything he says goes. He commanded the Juju who was coming down the path and his respective tribesmen/handlers to turn around and the signaled the big head Juju to return to behind the palace. He then ordered the military to evacuate the palace court of the thousands of people. At this point, the rumble in the palace had begun to cease. After everyone had been evacuated, no more Jujus were to come out today. It was amazing that this circumstance would cause such chaos and pandemonium and that it took the Fon’s presence to settle it down. It’s almost the equivalent of George Bush walking out of the White House to settle down a riot in D.C. The locals said that this type of thing had not happened in decades – where two Jujus come close to meeting. In fact, the Jujus haven’t even come out in force since the year 2000.
There’s nothing like a good Juju showdown to end the day.
Under the Sun,
-Mark
---------------------------------------------
I woke up this morning around 6:20am for chapel. The Kadidja (new medical student from Tennessee) and I headed up and sat in the fourth row. It is custom for any new visitors or guests of a church or chapel to be introduced. Because we weren’t sitting by the hospital administration, I was not too sure who would introduce her and when. At the end of the service, one of the administrators stood up and made a few announcements, after which he had the Kadidja stand to be introduced. She said hello and told everyone her name and where she was from. As she was sitting down there was a roar of laughter from everyone in the chapel. She melted in her seat and said, “Mark, what’s going on!?” I told her, “I have no idea, but just go with it.” The whole situation was somewhat comical, although quite embarrassing to her. As we left the chapel, we encountered one a financial administrator from Canada who was staying in the rest house for a night. Kadidja asked him why everyone was laughing after her introduction. He smiled and said, “You spoke with such a strong accent and a little too quickly that no one heard or understood what you said.” – Ashia!
We then went back to have breakfast and then headed up to our respective wards. I was able to discharge a 20yo who had malaria as well as an elderly man with vague right sided abdominal pain who had unremarkable labs, images, and physical exams for two days.
As I was rounding, a daughter of an elderly man came up to a nurse and me requesting that I to educate her father about healthy eating and alcohol cessation. She said that if a doctor would tell him he would take it to heart and truly change, but would not do so if a nurse told him. I also think that gender played a part in her request. I told her I would do it, but I still had plenty of patients to see. An hour later while I was still rounding, the daughter came back up to the same nurse and threatened to take her father out of the hospital because we weren’t doing our job. I certainly don’t have a problem with her request, but I think educating the man upon discharge would be a more appropriate time. There were dying patients in the ward who had not been seen yet, and to take time to fulfill the request right away did not seem proper. It turns out that this daughter wanted to take the father out of the hospital from the beginning – in order to take him to a traditional healer – and that there was a second daughter who did not believe in traditional healers and wanted the father to remain in the hospital to receive contemporary health care. It was quite an interesting dynamic – old tradition vs. contemporary medicine. I ordered for a social worker to speak with the two daughters to discuss each of their concerns. Meanwhile, the patient remains clearly coherent and wishes to receive “anything possible” that can help him.
I then grabbed Bed 7’s chart from the cart and walked up to his bedside. This patient is an elderly man who came in a couple days ago with fever, chills, diffuse sweating, productive cough with white sputum, mild hypoxia, and tachycardia. The chest x-ray showed a right apical lung consolidation. After the last couple days of seeing him, it is clear that this patient has TB. The TB department, however, will not administer an anti-TB regimen of antibiotics until either the sputum or gastric aspirate is positive for AFB. I believe the reason is for cost containment. For certain conditions, the hospital wants to make absolutely sure that the patient has a definitive diagnosis before they will administer a certain treatment – to keep unnecessary expensive treatment regimens down. We have the patient on ampicillin and erythromycin. Unfortunately, today he has taken a turn for the worse, his oxygen saturation was at 85, he was soaking his sheets with sweat, and he was so hot to palpation you could fry an egg on him. TB patients here without treatment tend to decompensate relatively quickly. I’m afraid that if he doesn’t have a positive AFB by tonight and start a proper treatment stat, he may not make it through the weekend.
Dr. Sandrine and I then went over to the outpatient clinic after coffee. We saw about 8 patients each and then went home to change. We met back up with the Kadidja and Joseph to head down to the palace. Apparently the Jujus were out in heavy numbers today. We decided to walk to the palace, which is about 2 miles form the hospital. On our way, we saw hoards of tribesman and their children wreaking havoc among the different road-side stores. They had large staffs and spears that they used to ravage these small stores. They also chased after various individuals – mainly to frighten them. They did not, thankfully, come after us.
The main center was packed this afternoon. Everyone had gotten the memo about the Juju extravaganza. We bobbed and weaved through the people into the palace. A military soldier approached us and told us not to take pictures – if we wanted to, we would have to pay 5,000 francs (which would then go directly into his pocket). We obliged and when we got past his sight, we broke out the cameras again. We found a building with some room on the balcony, so we made our way up top to get a better view (and to stay out of harm’s way from the Jujus!).
All of a sudden, there was a large uneasiness in the mass of people (somewhere in the thousands) and something was causing a good amount of ruckus. The Juju with the monstrous head who was dressed in all black then came into our line of vision. He was wielding throwing objects and looked to be extremely agitated. Sometimes, the Jujus will put poison on the tips of the objects – which may have curare-like properties – so it is very risky to get in the way of certain Jujus. This Juju is not like Shinkan, the Juju that chased me through the streets. This Juju means business. Of course the crowd of people egged him on and he started to go out of control. The tribesmen had him on four leases and kept a good hold of him – so he didn’t hurt anyone at this particular time. In just a few minutes, a second Juju started coming down the path towards the palace and strait for the dominant Juju with the large head. Apparently, the Jujus are not to meet – or even to see each other. If they do, there will be pandemonium, a vicious fight, and many lives will be lost as a result. As the two approached each other, tribesmen belonging to each Juju ran ahead and stopped the Juju and his pack of people from coming any further. This happened two times and got so out of control that they had to call in for a military presence, who did their best to keep the Jujus from coming any closer to each other. This clearly was not enough, so the Fon left his thrown and came out into the open area of the palace. As he walked out into the people, everyone seemed to make a clear path for him. There is much respect for the Fon and anything he says goes. He commanded the Juju who was coming down the path and his respective tribesmen/handlers to turn around and the signaled the big head Juju to return to behind the palace. He then ordered the military to evacuate the palace court of the thousands of people. At this point, the rumble in the palace had begun to cease. After everyone had been evacuated, no more Jujus were to come out today. It was amazing that this circumstance would cause such chaos and pandemonium and that it took the Fon’s presence to settle it down. It’s almost the equivalent of George Bush walking out of the White House to settle down a riot in D.C. The locals said that this type of thing had not happened in decades – where two Jujus come close to meeting. In fact, the Jujus haven’t even come out in force since the year 2000.
There’s nothing like a good Juju showdown to end the day.
Under the Sun,
-Mark
---------------------------------------------
“You ride on motacycle?”
Friday, April 11, 2008 – 10:08pm Cameroon Time
I woke up this morning around 6:55am and walked out into the main area of the rest house to have breakfast with a few new faces. There have been quite a number of groups come in and out in the last week. A film crew was here a few days ago to do a documentary on the hospital. A group of bible translators to native languages was also here. Last of all, a new medical student, Kadidja, showed up from Tennessee! She’ll be working in the peds ward.
I hit the wards around 7:30am, starting with my CVA patient. He came in about 5 days ago with left hemiparesis (could not move the left side of his body). It is quite amazing how far he has come. Today, he was up walking with a walker. He had 5/5 strength in his left arm and 4/5 in his left leg. I imagine he will be able to go home in a few days with the help of the physical therapy department.
I then passed by Dr. Sandrine to see my patient with HIV/AIDS, fleeting mental status changes, and a cornucopia of other complications. She waived me over to a new patient she was seeing. He had Neurofibromatosis Type I (Von Recklinghausen Disease). She was consulting me on how to manage his care and not being a Von Recklinghausen specialist myself, we both looked it up together. Here is a photograph of the patient’s abdomen – notice too the markings left behind from the traditional healer – please view with care:
I now have my fleeting mental status change patient on an antipsychotic and it seems to be working quite well. He is now able to get some sleep and his care giver has not noticed any other psychotic episodes – flaying of arms and screaming out in the night and whatnot. I still haven’t put my finger on exactly what is causing his swings – HIV Encephalopathy? Crypto? Extrapulmonary TB? With the limited lab tests and imaging available, I probably will never know.
We finished up seeing the rest of the patients and headed for some coffee. During our coffee break, I spoke with Dr. Berri (the medical director) about spending a few weeks with the L.A.P. (Life Abundant Primary care) program. Basically, this is a public health program run by the hospital that focuses on remote villages, emphasizing basic public health principles – such as sanitation, nutrition, infection control, etc. They also many times take a travel clinic along with them. I think it would be a very interesting experience.
She told me that Joe (a nurse in the ophthalmology department) could take me up to the home base for the L.A.P. program. She then asked, “You ride on motacycle?” I said, “Oh yeah, of course,” as I imagined how ridiculous it would be when I toppled the thing over on the way out of the hospital.
I saw about 10 patients in the outpatient department and then headed up with Joe on his motorcycle. It was much smoother than I imagined it would be. He seemed to dodge the potholes (i.e. excavation sites) with perfect precision. At first I thought I would have to lean to one side to help in keep the balance, but I found that it was perfect just to go somewhat limp and go with the flow. We reached the top of the hill and entered the L.A.P. building only to find out that Peter, one of the leaders of the program, had gone down to Bamenda for the day and wouldn’t be back until the evening. So it looks like I’ll have to speak with him on Monday. We headed back down to the hospital – and it was just as exciting. I’m not too sure I’ll venture out to get on a motorcycle taxi – they ride ridiculously fast – but for now, the hospital motorcycle seemed to work just fine!
Come awake,
-Mark
---------------------------------------------
I woke up this morning around 6:55am and walked out into the main area of the rest house to have breakfast with a few new faces. There have been quite a number of groups come in and out in the last week. A film crew was here a few days ago to do a documentary on the hospital. A group of bible translators to native languages was also here. Last of all, a new medical student, Kadidja, showed up from Tennessee! She’ll be working in the peds ward.
I hit the wards around 7:30am, starting with my CVA patient. He came in about 5 days ago with left hemiparesis (could not move the left side of his body). It is quite amazing how far he has come. Today, he was up walking with a walker. He had 5/5 strength in his left arm and 4/5 in his left leg. I imagine he will be able to go home in a few days with the help of the physical therapy department.
I then passed by Dr. Sandrine to see my patient with HIV/AIDS, fleeting mental status changes, and a cornucopia of other complications. She waived me over to a new patient she was seeing. He had Neurofibromatosis Type I (Von Recklinghausen Disease). She was consulting me on how to manage his care and not being a Von Recklinghausen specialist myself, we both looked it up together. Here is a photograph of the patient’s abdomen – notice too the markings left behind from the traditional healer – please view with care:
I now have my fleeting mental status change patient on an antipsychotic and it seems to be working quite well. He is now able to get some sleep and his care giver has not noticed any other psychotic episodes – flaying of arms and screaming out in the night and whatnot. I still haven’t put my finger on exactly what is causing his swings – HIV Encephalopathy? Crypto? Extrapulmonary TB? With the limited lab tests and imaging available, I probably will never know.
We finished up seeing the rest of the patients and headed for some coffee. During our coffee break, I spoke with Dr. Berri (the medical director) about spending a few weeks with the L.A.P. (Life Abundant Primary care) program. Basically, this is a public health program run by the hospital that focuses on remote villages, emphasizing basic public health principles – such as sanitation, nutrition, infection control, etc. They also many times take a travel clinic along with them. I think it would be a very interesting experience.
She told me that Joe (a nurse in the ophthalmology department) could take me up to the home base for the L.A.P. program. She then asked, “You ride on motacycle?” I said, “Oh yeah, of course,” as I imagined how ridiculous it would be when I toppled the thing over on the way out of the hospital.
I saw about 10 patients in the outpatient department and then headed up with Joe on his motorcycle. It was much smoother than I imagined it would be. He seemed to dodge the potholes (i.e. excavation sites) with perfect precision. At first I thought I would have to lean to one side to help in keep the balance, but I found that it was perfect just to go somewhat limp and go with the flow. We reached the top of the hill and entered the L.A.P. building only to find out that Peter, one of the leaders of the program, had gone down to Bamenda for the day and wouldn’t be back until the evening. So it looks like I’ll have to speak with him on Monday. We headed back down to the hospital – and it was just as exciting. I’m not too sure I’ll venture out to get on a motorcycle taxi – they ride ridiculously fast – but for now, the hospital motorcycle seemed to work just fine!
Come awake,
-Mark
---------------------------------------------
“Are you aware of your HIV status?”
Thursday, April 10, 2008 – 9:00pm Cameroon Time
I woke up again right before 7:00am to have some breakfast before I started the day. I entered the men’s ward and I was again met with somber news. A new patient who I had seen yesterday had died this morning around 1:00am. His chest x-ray and some other lab tests had not come back yet, so it is difficult to lay a finger on exactly what he died from. He had respiratory compromise and I suspect CHF was the underlying cause. His death was very unexpected.
Nonetheless, I had to move on. Once again, the man with the bladder stone had brightened up my day. His second stone had passed! In addition, he told me he was a chief today and passed his village’s wishes and thanks on to me and the hospital. In fact, he wanted to bring one of us back to his village to live with them. Not everyday you get to treat a chief!
A few patients later, I saw the man who I believe has milliary TB. I got some of his labs back and it turns out he is HIV positive – as expected. A majority of the patients in the hospital are HIV positive, but I have never had to inform a patient of their new status. I started asking my basic review of systems questions and asked a few extra to give me some time to try to figure out how I would communicate the news with him. Unfortunately, the beds are so close to one another that it makes patient confidentiality nearly impossible. Finally, I decided to ask him if he knew what his HIV status was. He told me he did not know. I paused for a brief moment and told him that we had ran a few tests…I pointed at the lab result (which comes in a number here) and then wrote a “+” sign next to it as to try to give him as much confidentiality as possible. Interestingly, it was one of the most difficult things I’ve had to do here. I could see the fear in his eyes and the immediate loss of all hope. I’m sure he has seen what those with HIV/AIDS go through and knows what he is about to face. In Africa, HIV/AIDS is pretty much a death sentence if you don’t have money, which is quite the opposite in the United States. I did as much as I could to comfort him and to give him as much hope as I could, but it was still an extremely difficult situation.
We finished up rounding on the men’s ward patients and then went for a coffee break. In the outpatient clinic, a 32yo man came in who looked very cachexic. It turns out that he had adenocarcinoma of the ascending colon. He had surgery and then a course of chemotherapy a while back. Now he has lost a significant amount of weight and is experiencing severe fatigue and diffuse pain throughout his body. He has not been eating well and seems to be severely malnourished. What to do, what to do. He then informed me that he had a CT scan in the city and the results would be available tomorrow or Monday. A CT scan! This you rarely – if ever – hear of out here. Hopefully something will show up or not show up that will lead us in the right direction in terms of his treatment regimen. I consulted the other physicians in the clinic and they agreed that we should admit the man to palliative care for now for pain management and to increase his nutrition. Once we get everything back, including his CT scan, we will go from there.
A few patients down the line, I called for a patient outside. An elderly man slowly stood up, albeit hunched over, and shuffled slowly inch by inch toward the door of the clinic. He eased his way inside, and slowly sat down. He also had an essential tremor and an almost “pill-rolling” motion of his fingers and thumb. Any guesses? He came in for follow up for his hypertension – which was still a bit high, so I added an ACE. I also tried to put him on Levodopa/Carbidopa, but it ended up that this would cost the patient 142,000 francs a month – which is about a couple hundred US dollars. Clearly, this option was not viable and there were no other anti-Parkinson medications available. I decided to put him on diphenhydramine, which has been shown to have some minor efficacy for those with Parkinson’s – it was also affordable for the patient. I have much doubt that this will do anything and I think the patient will just have to live with the condition. There is simply not enough money and resources to treat a condition like this here.
You are my joy,
-Mark
---------------------------------------------
Mental Status Changes
Wednesday, April 9, 2008 – 8:50pm Cameroon Time
I woke up around 6:50am this morning, had some local fruits and bread, and shimmied on up to the wards. I greeted Dr. Sandrine with a good morning and right away I had to tell her about my Juju experience. She was quite amazed and found the whole thing somewhat comical. A couple nurses came up to us while we were saying good morning and told us that Bed 23 was having metal status changes. I looked over and sure enough he was my patient. He came in with a duodenal ulcer and now he’s going Juju on me. The patient was attempting to leave and his family member was putting forth his best efforts to convince him to stay. One of the staff called in a pastor to assist with the situation. I grabbed his chart and went to see what was going on. The patient agreed to at least have me look at him. On physical exam I found a new onset A Fib. I wanted to get an EKG in case he may have had an MI, but the patient refused. We gave him an antipsychotic, but it didn’t seem to phase him. I told him and his family member the risk of him leaving the hospital and then wrote some orders in his chart. When I just got finished writing, I looked over and he was out the door. I’m thinking he’ll be back, just not in as good of condition as he was when he left.
I thought I would go to another altered mental status patient – the one who almost died yesterday. I was overjoyed when I saw him sitting in his bed enjoying a nice breakfast that was prepared by his family. I was amazed when he was able to converse with me without any difficulties. It will be an awesome day when he is able enough to be discharged.
I then finished off my altered mental status patients, seeing the one with AIDS, Crypto Meningitis, PCP, Diabetes, and Hypertension. He has made so much progress since he first came in. I remember when he was rambling words with little meaning. Now, he too was able to converse without missing a step. I may be able to discharge him in a couple days!
Dr. Sandrine and I finished off our patients and headed off to snag our daily coffee. We then went up to the outpatient clinic. For those in the medical field, when you ask a patient when a particular condition began, you usually expect an answer in days – maybe months. It seems as if about 90% of the patients here will answer in years – if not decades!
Patient: “I’m having pain in my skin (body).”
Me: “When did this begin?”
Pidgin Interpreter: “When di you fist burn skin noti”
Patient: “12 years ago.”
It is difficult, because it may have indeed been that long ago when it started for many conditions, as patients will wait until the last possible moment to see a health care provider. But, most of the time you will take a further history and do a thorough physical exam and find out what is really going on.
I heard though the grapevine that the Jujus were going to come out for the next couple days. I just had to go back to the palace to see them! Joseph and I took a cab back to the entry of the palace. We saw two tall Jujus – they were on stilts. I focused in to film them, not looking at what was right in front of me and BAM!...there was the same Juju that came after us yesterday! – Shinkan! Everyone scrambled and he chased me though out the street. I darted in and out among the people, hopped over some chairs, and ended up pinned between the window opening of a store front and the Juju’s huge stick. He started yelling some sort of Juju language at me and began hitting my arm with his stick. I looked him directly in the eyes while I tried to think of any kung fu I knew of. Once again, thousands were looking on in anticipation – the “white man” has been cornered by Shinkan. After a few minutes of being tapped on the arm by the huge stick, I finally gave in and gave him 500 francs (a little over a dollar). He was satisfied and went on his way to wreak more havoc. I think I need to sit him down so we can have a little talk about his recent actions…maybe even give him a hug. For some reason, I don’t think this will ever happen.
Joseph and I left the palace and up to the center square to see the Jujus from a distance. We saw a few more average Jujus come out over the hours after which we saw the head Juju. This was the big cheese. The head honcho. The grand puba. The chief Juju. He was dressed in all black and had a huge head. He carried with him two baseball bat-looking pieces of wood that he through at the crowd as he made his way though. All of the Jujus are afraid of this one. In fact, this is the only thing in all of the earth other than death that can de-throne the Fon. Yes, that’s right. If this Juju feels like the Fon is not representing the people or is operating above the law of the Nso, he will de-throne him and a new Fon will take his place. The road to Fon-ship is by means of lineage. The Fon is the Fon until he dies, and then the next of kin takes his place.
It was another unique day here in Banso. I was speaking with the rest-house attendant and she said that on Saturday, the Jujus were supposed to take the streets by storm. She said that hundreds of them will be out at the same time! I’ve only experienced it when one is out at a time. With the pandemonium caused by one, imagine what will go down when hundreds of them are out!
You alone,
-Mark
---------------------------------------------
Wednesday, April 9, 2008
Jujus and the Nso
Tuesday, April 8, 2008 – 7:16pm Cameroon Time
I got up this morning around 6:50am, had some rich Cameroon coffee, and walked up to the ward:
I got up this morning around 6:50am, had some rich Cameroon coffee, and walked up to the ward:
My PDA battery had died over night – so I had nothing to lean on today. No Epocrates or Merck Manual to cover my tracks – today, I flew solo. As I went to pull the first chart, I was approached by a nurse who had somber news. A patient of mine had died this morning at 5:30am. My heart dropped. I started to back track to think of anything that I might have done wrong or anything that I failed to do. It’s amazing that if it’s a patient’s time to go, it is only natural for those in the health profession to believe that they can prevent it. In this case, it was time for him to go. He died of a severe pneumonia.
I was also surprised that another patient had taken a turn for the worse overnight. He was tachypnic and had a horizontal nystagmus. He was also febrile and his right arm was twitching. His family member told me that his mental status had declined and now he wasn’t able to respond verbally. At points like this, it becomes extremely difficult to pin point exactly what the problem is. At first I thought I would order a blood pH stat thinking he might be in respiratory acidosis, but the lab wasn’t able to do it or a bicarb due to shortage of supplies – or lack thereof. I checked his pulse-ox and it was at 72%. I put him on 3L of oxygen by nasal canula (remembering back to one of Dr. Nickell’s questions) and got a blood sugar level – which was 273. At this point, I received his chest x-ray that I ordered yesterday and it showed a severe lobar pneumonia with diffuse patchy infiltrates. Oh boy. I then ordered a K+ (no BMP or CMP here) and put him on ceftriaxone stat. I also ordered for some bicarb, but was unable to get it because it too was out of stock. After 15 minutes, his pulse-ox was at 90% and he looked to be a little bit more stable. I checked up on him over the hour and ordered a few more labs and he seemed to be doing well. I am nervous about what I will find tomorrow. This is medicine in its rawest form – back to the basics – only relying on clinical suspicion. If I had a benzo, I would have taken it, because my whole body was shaking.
I traveled a few beds down to find that one of my other patients had passed his bladder stone! Finally something to rejoice about!
I traveled down to the end of the hall to see a boy with what I think is a bad case of malaria only to be stopped by his neighbor. The man called me over and began talking to me – but I couldn’t understand his Pidgin. He then flopped his foot up and unwrapped the cloth around it. Good thing I didn’t eat a lot of breakfast! He had burnt his foot and had it grafted back in January. There had to be something cooking in there because oh did it smell – probably pseudomonas. Other than the smell, it looked to be healing pretty well. (For those who get nauseated by medical images, look no further...)
I saw a few more patients and then headed down to the conference room with Dr. Sandrine to have some coffee after a long morning. She went to the women’s ward and I took off for the outpatient clinic. For some reason, a majority of my patients today were not too easy for me (maybe it was the lack of my PDA!). I had a case of amenorrhea – well not me, my patient – with a negative ultrasound for PCOS, normal thyroid level, and a hemoglobin of 13.8. She was not pregnant and has had this problem for a year and 3 months. I didn’t notice anything on physical exam that would make me think of a hyperandrogenic state, so with all of this I sent her down to the fertility clinic for some birth control pills – we’ll see what happens because I’m clueless when it comes to these sorts of things.
A few patients later I had a 24yo male who showed up at 2:00am last night with shortness of breath, fever, +1 pitting edema in his feet, right flank pain, and dizziness. I checked his blood pressure and it was 86/52. He had brought with him an x-ray that they took last night. I popped it up and here’s what I saw (amazing how it turned out on my camera!).
Needless to say, I admitted him with the working diagnosis of TB with the possibility of cor pulmonale.
As I was walking out, I ran into a surgeon having a serious conversation with a patient and her mother. This was a 12yo girl with some specific form of congenital lymphedema that I’m not familiar with. It was a difficult conversation to walk in on. The surgeon was informing the patient and her mother that the only feasible option was to amputate the leg at the hip. The mother insisted that the surgeon try to amputate at the knee, but when the surgeon lifted up the leg, the whole thing went limp like a plastic sack of water. There was no way a below the knee amputation would do any good. The girl had to weigh the options of dragging the leg every where she went or using crutches for the rest of her life. She had been mocked and made fun of and had quite a bit of shame. When offered the option of amputation, tears were flowing down her face. I was very honored to have been given the opportunity to take this picture for academic purposes. Please view it (as well as the rest of the photographs) with care:
After I left the hospital, Joseph (the hospital’s statistician) invited me to go down with him to the Fon’s palace. Again, the Fon is the ruler over all of the native people. Apparently, the Jujus were out today. I knew a little bit about them based on some of the research I did before the trip, but to see one live and in person…who could resist!?
We grabbed a taxi down to the palace and the place was packed. People had come from all of Cameroon and even from out of the country to see what was about to go down. We met up with nurse at the hospital and mixed and mashed between people until we made it within the palace grounds. All of a sudden we were at one of the entry ways to where the Nso people and the Fon live. It was heavily guarded and we were told that we could not enter unless we made an offering of 5000 francs to the Fon. I guess Joseph knew better. We went around to another entrance and swiftly passed through only to find a statue of a lion staring us right in the face – to the Nso people, we were on holy ground. After a little bit, we decided to get out of there before we caused any trouble. As we passed back through the entrance corridor we ran into the Fon’s secondhand man. He is the ruler over all of the sub-Fons and is second in command for all of the native people here. In other words, it was like running into Dick Cheney. Neither Joseph, the nurse, or I knew what to do or say. We waited for him to make the first move. He greeted us warmly and all of a sudden we could breathe again. I went to shake his hand only to find a limp wrist. I soon found out that I had done a “no no.” They Nso people don’t shake hands and many times find offense to it. He pulled back, gazed at me with squinted eyes, and then pardoned my offense saying, “You are doctor in hospital and touch people plenty – it is your nature.” It also helped that he knew I was a foreigner and didn’t know what I was doing. We talked for a bit about Banso Hospital and then we went on our way back out of the sacred place.
As we were walking up the road we saw a massive amount of people running our way – a Juju was coming! I learned that the Jujus have different personalities. Some are good and some – well, let’s just say that you don’t want to get in their way. This Juju was one of the latter. The Jujus live behind the palace among the Nso. They are people who take on almost an animal-like persona when magic is cast upon them. When they enter the public, a lot of times they get confused and then combative. They will throw things – including spears and small pieces of wood at people who provoke them. You might compare a Juju to a werewolf (or someone with dissociative personality disorder). Some had masks and painted faces – not so intimidating. Others looked like the creature in the movie “The Village.” Nonetheless, there we were coming up on this thing and Joseph told me to get out the camera to take a picture – I had heard that some don’t like their pictures taken but ignorantly I took my camera out regardless. There he was right in front of me and I took a picture. BAM! He came running up with me with this huge stick. He swung it around a bunch of people on either side of the road and they scattered like flies. He then stood before me and a person told me to give him an offering because I had offended him. So there I was in some sort of confrontation with this Juju. Joseph and the nurse had backed off and kind of took a low stance. I thought they were getting ready to book it but after words I found out that you were supposed to get low like that to show them respect. I asked Joseph what I should do and he didn’t answer. It turned into 2-minute showdown with thousands looking on in anticipation. The nurse made a move and tossed him a thousand francs and the Juju slowly backed off. We changed our pants and then got out of there as fast as we could. I was told that the Jujus come out in the night as well. I think I’ll be staying in tonight. The picture that started it all:
What a day. A life was lost, a life was saved, a leg was in jeopardy, royalty was encountered, and a Juju was confronted.
Help pour out the rain,
-Mark
---------------------------------------------
“I give you big cow.” – An Utterly Swell Day
Monday, April 7, 2008 – 9:52pm Cameroon Time
I woke up this morning around 6:15am, ate breakfast, and headed up to the wards. Last night I prepared some material for Simon and the dental student to study from. It included the major bugs and drugs as well as some basic science (anatomy, physiology, biochemistry, etc) and systems (cardiovascular, respiratory, GI, etc) information. They are desperate for knowledge out here and long for a higher education. In fact, Simon is trying ever so hard to save up money in order to take on online pharmacy technician course. This is a common theme in Cameroon. You will see small children working diligently and saving up money just to attend elementary school. Some carry items back and forth throughout the town for cash as seen below:
I woke up this morning around 6:15am, ate breakfast, and headed up to the wards. Last night I prepared some material for Simon and the dental student to study from. It included the major bugs and drugs as well as some basic science (anatomy, physiology, biochemistry, etc) and systems (cardiovascular, respiratory, GI, etc) information. They are desperate for knowledge out here and long for a higher education. In fact, Simon is trying ever so hard to save up money in order to take on online pharmacy technician course. This is a common theme in Cameroon. You will see small children working diligently and saving up money just to attend elementary school. Some carry items back and forth throughout the town for cash as seen below:
After I dropped off my flash drive, I went to the wards to see my patients. I was very excited that I was able to discharge one of my patients. I had the opportunity to manage him from when he was admitted and all the way through his course of treatment – all while never understanding a word he was saying! (I had to have a translator from Pidgin to English each time I saw him.) When I told him he could go home, he was thrilled and proceeded to inform me, “I give you big cow,” as he stretched his arms out as wide as he could. We both laughed hysterically, but I think only one of us was serious about the cow.
For some reason, I had a lot of GI cases today – everything from PUD to an anal fissure. Dr. Sandrine and I worked the men’s ward until about 1:00pm when we finished up and decided to snag some coffee. After this, we went over to the outpatient clinic – which was very busy!
One of my first few patients came in with the chief complaint of “Sexual Sickness.” I thought to myself, “Now what could this be?” Was it an STD? Was it pain? I asked a nurse and she almost dropped to the floor in laughter. Sure enough, it was impotence. I looked on the formulary and didn’t see anything so I went ahead and passed this one on to Dr. Sandrine – maybe she knew of a “traditional treatment” that could be of some use. She thanked me later, although reluctantly, for this assist.
Another interesting patient came in today with what I think was a duodenal ulcer. When he lifted his shirt to let me listen to his heart I noticed about 20-30 dark scars intermixed with some sort of rash. I had no idea what it was – it almost looked like Kaposi’s Sarcoma. I asked him about it and he told me he had gone to a traditional healer before coming to the hospital. Apparently the healer had scorched his abdomen with a flaming hot prod/branding instrument as to light his illness on fire so that it would come out of him. This is just one of many examples of how certain cultural beliefs can hinder or impede access to bona fide health care services. Many times patients will go to village healers first and then come to the hospital when their condition is at its worst. I was unable to get a picture of this particular patient’s burns, but here another example that was much less extensive:
I asked Dr. Sandrine if the hospital kept any sort statistics on what diseases were most prevalent and where these diseases were coming from (i.e. if the hospital had any sort of surveillance or disease monitoring methods in place). She did not think so, but advised me to ask the administrators. There exists what are known as the “Essential Services of Public Health.” These services include assessment, policy development, and assurance. In the assessment division, a disease or health condition is identified and investigated. In addition, surveillance and monitoring methods are utilized to provide vital epidemiological data. Without local disease monitoring methods in place, any attempt at policy development and assurance of health would be extremely difficult. If any attempts are made, they are in a sense a shot in the dark and fail most of the time. For example, malaria has certainly been identified and has been for hundreds, if not thousands of years. In addition, massive research has taken place regarding the transmission, pathogenesis, and even the genomics involved with the disease. Although large scale epidemiological data has been produced, many times there is little to be said about the state of local community surveillance methods. With this said, it is only natural that there is little development in regulatory standards such as distribution of bed nets, spraying in higher-risk communities, clearing of mosquito breeding grounds, and small scale chemoprophylaxis when malaria is “in season.” I will ask the hospital administrators and if nothing is in place, a public health intervention opportunity may have just been born!
Walk with me,
Mark
---------------------------------------------
Back Massage
Sunday, April 6, 2008 – 9:44pm Cameroon Time
I woke up this morning about 8:00am as it was my day off. I didn’t know what time church started, so I just waited around until I heard drums and singing. Sure enough, they were going strong across the road. I saw a few of the hospital staff and the rest house keeper, Rose – she cooks some marvelous meals! We talked for a little bit and then she told me to go snag a seat. I went inside and sat in the fourth row in the middle. All of a sudden, two choirs started coming down the two aisles in a procession. They were swaying back and forth as they sang a traditional African praise song. It was all very exciting. Once they got to the front, a soloist stepped out and the whole congregation started to get down. There was a lot of singing and dancing – needless to say, I shook a leg and swooped “way down low” like the best of them.
After a few announcements they had the guests stand up (including me) to introduce themselves. At this time a couple hundred people were now inside. They handed me a microphone and I told them I was blessed and honored to be in Cameroon and that I brought greetings and wishes from the United States. We sang a few more songs with the choir and then sat down. In the middle of the message, I noticed some hands on my back. I was wondering, “Hmm, that feels good.” There’s nothing like a good massage in the middle of a sermon. As it turns out, kids who have never seen a white person before will try to touch them to feel if their skin is made of anything different than their own.
After church, I went back and had some lunch and then headed down to Simon’s store – the pharmacy/stock staff person at the hospital. Simon, a Cameroonian dental student, and I then walked around town. Along the way, each of them explained certain aspects of the town to me. For instance, there is a plant in a certain area that signifies political peace. If it is chopped down, it lets the people know that there is conflict going on nearby and to be on guard. They also explained to me the role of the Fon. He is the traditional ruler and guardian of the area. Under him are servants who will make sure everything is in order in the surrounding areas and then report back to him. The Fon is loosely connected to the central government and plays the role of a contracted ruler. However, the title of the Fon is slowly starting to lose favor in the community. There is some corruption going on behind the scenes that people do not approve of.
We passed a few government public health offices and clinics along the way. Simon and the dental student explained to me that people prefer not to go to the government-sponsored clinics as they don’t provide very good care. They will make the patient pay for the doctor’s travel into the area and will tend to cut of the patient’s medication on a whim. As such, mission hospitals are the way to go around here – Banso Baptist Hospital being the most popular in the North West Provence if not all of Cameroon – what an honor to be here!
Later on, we came up to where they hold the market. I was asked if we, as Americans, bought secondhand clothes. I told him about Salvation Army and Goodwill. He then explained that a vast majority of Cameroonians bought used clothing shipped in from outside countries. In fact, if they weren’t shipped in, there would be a huge problem – people would be clothes-less. The people here greatly appreciate and value aid such as this from other countries as they simply cannot afford the things that we can.
Part of the poverty issue, which was explained to me, is that the government is too centralized. The outer quadrants of the country do not receive a lot of the government program benefits and are in a sense left out of the loop. There is a strong push to decentralize the country and give more power to the regions. Speaking of local politics, there was a large taxicab strike about a month ago due to alleged unfair government taxation. As a result, many other sectors and industries began to strike and riots and protests filled the streets of the whole country. Political analysts claim that it might have been instigated by the political party that is not in power as to put blame on the current leadership. I thought this was an interesting and brave move by the opposing party. If this happened in the US, think of the media explosion!
As we finished our stroll through the different parts of the town, Simon and the dental student told me that people were amazed that they were walking around with a “white man” – they are very happy when visitors come – it really boosts there spirits. As a matter of fact, as we would be walking down the streets, children would yell out, “White Man!” and then run out waving. I have come to understand that this does not necessarily have a racist slant to it, but rather is just a way of identifying a type of person they hardly ever see. They are extremely friendly and welcoming here with such great hospitality. I was told that if a Cameroonian and a visitor got into a conflict, then the police would tend to be harsher on the Cameroonian for giving the visitor problems. This is completely the opposite in most other Western countries. Usually the visitor is regarded as the problem, not the citizen.
We made our way back to the store and I hung out there for a few hours – when you visit, you visit – time is not of the essence. I then walked back up to the rest house (sunburned despite using 45 sunblock).
Tomorrow starts a new week on the wards – hopefully I can discharge a few patients!
Nothing without you,
Mark
---------------------------------------------
“They stole our ball!” – Standing up for those who can’t stand up for themselves
Saturday, April 5, 2008 – 9:18pm Cameroon Time
I woke up this morning around 6:00am for morning chapel. The whole hospital staff goes on Wednesday and Saturday mornings (except those needed to care for the patients) and it’s quite the experience and celebration! I was accompanied by the main nurse in the men’s ward. We sat right in the front row. The physiotherapy (physical therapy) department stood up in the front of the chapel and sang a traditional African worship hymn with a drum and bean-shaker in the background. It was energetic and refreshing. As they were singing, more and more people trickled in. By the end of the song, the chapel was packed. Apparently each week one department will do a song and give a message. The message this week as told through a sketch by the PT department was standing firm in the faith.
After chapel, I went back to the rest house for breakfast and then up to the wards to round. This morning, a nurse stood in the middle of the ward and called the attention of the patients and family members. He announced that they would be giving out meningococcal vaccines at noon for 1000 franks (about $2). This is a good demonstration of the type of public health promotion they use here. In addition, everyday a nurse will go outside in front of those waiting to be seen and their families and give a mini lecture about a health topic – may it be diabetes, HIV, malaria, hypertension, nutrition, sanitation, etc. Educating the public in this way gives them power to make good health choices and increases their autonomy. Patients and families will travel from FAR away to receive health care. They will in a sense camp out on hospital grounds. In fact, family members who care for the patient will sleep on the concrete under the patient’s bed during the night. You will also see them doing laundry, eating, drinking, doing dishes, socializing, grooming themselves – all out in front of the wards (I’ll try to get a picture, it’s quite the sight). So it is good opportunity to do a little health promotion and education.
Today on the wards was a bit like the others. I’ve discovered that you have to be very direct when ordering a lab. For instance, I ordered a blood smear and was called back by the lab wondering what I meant. I told them to look for schistocytes or any unusual red blood cell morphologies. They said, “Schistosoma in the blood?” I told them, “No, schistocytes – broken up fragments of red blood cells.” We both laughed. Also, I’m trying to figure out how to work up a patient who I think might have Wilson’s Disease. I thought, “What the heck, I’ll order a ceruloplasmin level and a 24-hour urine copper and see what happens.” Sure enough, they came back and asked me what it was – so told them to just get an AST/ALT – which they could do. Sometimes you don’t know if the lab has a certain capability. Some days they do and some days they don’t. Sometimes they have random tests that are very useful, so I tend to order it and if they don’t have it, then I try to figure out some other way to give me clues.
Dr. Sandrine and I saw one of the patients with cryptococcal meningitis (the first patient I saw here). He has been becoming more and more distressed lately. He is yelling out and is seems to be experiencing quite a bit of terror in his hallucinations. We have him on Fluconazole (we don’t have Amphotericin B), Ceftriaxone (in case there’s an underlying bacterial meningitis as he does have AIDS), and a few other meds. Nonetheless, an interesting scenario took place with this patient today. One of his family members snuck him some sleeping medication that he bought in Douala. We were thinking about adding haloperidol and the family member was apprehensive of us adding anything else. We asked him what his concern was and he broke (after a couple minutes of prodding and silence) and admitted to his action. He told us that he was concerned that the patient was in a lot of distress and needed sleep. Unfortunately, there’s no telling what he gave the patient, but since he gave it to him the previous night Dr. Sandrine and I thought we would be in the clear to give him the antipsychotic. We started him on the lowest dose. Hopefully it will help to calm him a bit.
Adjacent to the hospital is a school for primary education. They have a soccer field and as you would guess it is in use almost all hours of the afternoon. Soccer is the sport of choice here in Cameroon. I was advised by Mr. Magrino to bring some soccer balls, so I did. Although, what I did not know is that they would be such a hot commodity. As I was walking back from the wards, I saw some kids playing soccer with an apple-sized ball. I went back to the rest house, picked up a ball and took it back to them. They were overjoyed with the gift – and I mean overjoyed. I’ll never forget the smiles on their faces. I went back to the hospital to do some work and as I returned to the rest house, 5 or 6 smaller boys came running up to me saying, “They stole our ball!” They pointed to the group of older boys (who they were previously intermixed with) across the field playing with the ball. I asked them why they stole it and they told me it was because they were older. I thought, “Oh boy, I just created something I shouldn’t have.” I told them that the older boys could have their own ball and that I just happened to have a second ball that this group could have. I went and snagged the second ball as well as a thick sharpie pen. I took the ball back to the younger boys and again they were overjoyed. I told them to write their names on the ball so that they could claim it as theirs. That way, if anyone would try to take it, they would know that it belonged to this group of kids. Each one wrote his name on the ball and I knighted them as “Team Cameroon” and told them I would one day seem them in the World Cup. They all laughed and agreed.
Later on that day, I was again approached by this same group of kids. “They stole our ball again!” they came up to me yelling. Oh my. They knew the group of older kids because they went to the same school. They also knew where they lived. I told them to take me to the older boys and we would make things right. It was funny, one of the kids had a machete in hand – it was almost like he was ready to fight, but he said it was just for cutting grass. We walked down to their house and saw the ball sitting outside. The group of boys ran up and picked it up. One of the sisters of the older kids was standing at the door. I told her what happened and she agreed that it was wrong of her brother to steel the ball. The group of kids and I then told some adults nearby and they said they would monitor things. Hopefully a lesson was learned on both sides. First, don’t steal. Second, that there was someone in the world who would stand up for you.
Lastly, I have come to learn that in African culture, it is common to pay visits to neighbors, friends, and those who you don’t know. In fact, if you don’t visit someone in their home, it is frowned upon. When you do visit, the person will automatically stop what they are doing and meet with you. Many times they will make a meal for you. They discourage setting appointments and encourage just randomly showing up unannounced. They love visitors, what else can I say. They will even send you home with something (usually a small bit of food from their garden). When you leave they won’t see you off at the door – they’ll see you off at the end of the walkway, or many times halfway to your home (no matter the distance). This way they can extend the visit so you can build a better relationship with them. This is a drastic difference from American culture where appointments, office hours, and privacy are the mainstay.
Tomorrow I will be traveling into town with my friend from the pharmacy/stock department. It should be good time!
Never let go,
Mark
---------------------------------------------
I woke up this morning around 6:00am for morning chapel. The whole hospital staff goes on Wednesday and Saturday mornings (except those needed to care for the patients) and it’s quite the experience and celebration! I was accompanied by the main nurse in the men’s ward. We sat right in the front row. The physiotherapy (physical therapy) department stood up in the front of the chapel and sang a traditional African worship hymn with a drum and bean-shaker in the background. It was energetic and refreshing. As they were singing, more and more people trickled in. By the end of the song, the chapel was packed. Apparently each week one department will do a song and give a message. The message this week as told through a sketch by the PT department was standing firm in the faith.
After chapel, I went back to the rest house for breakfast and then up to the wards to round. This morning, a nurse stood in the middle of the ward and called the attention of the patients and family members. He announced that they would be giving out meningococcal vaccines at noon for 1000 franks (about $2). This is a good demonstration of the type of public health promotion they use here. In addition, everyday a nurse will go outside in front of those waiting to be seen and their families and give a mini lecture about a health topic – may it be diabetes, HIV, malaria, hypertension, nutrition, sanitation, etc. Educating the public in this way gives them power to make good health choices and increases their autonomy. Patients and families will travel from FAR away to receive health care. They will in a sense camp out on hospital grounds. In fact, family members who care for the patient will sleep on the concrete under the patient’s bed during the night. You will also see them doing laundry, eating, drinking, doing dishes, socializing, grooming themselves – all out in front of the wards (I’ll try to get a picture, it’s quite the sight). So it is good opportunity to do a little health promotion and education.
Today on the wards was a bit like the others. I’ve discovered that you have to be very direct when ordering a lab. For instance, I ordered a blood smear and was called back by the lab wondering what I meant. I told them to look for schistocytes or any unusual red blood cell morphologies. They said, “Schistosoma in the blood?” I told them, “No, schistocytes – broken up fragments of red blood cells.” We both laughed. Also, I’m trying to figure out how to work up a patient who I think might have Wilson’s Disease. I thought, “What the heck, I’ll order a ceruloplasmin level and a 24-hour urine copper and see what happens.” Sure enough, they came back and asked me what it was – so told them to just get an AST/ALT – which they could do. Sometimes you don’t know if the lab has a certain capability. Some days they do and some days they don’t. Sometimes they have random tests that are very useful, so I tend to order it and if they don’t have it, then I try to figure out some other way to give me clues.
Dr. Sandrine and I saw one of the patients with cryptococcal meningitis (the first patient I saw here). He has been becoming more and more distressed lately. He is yelling out and is seems to be experiencing quite a bit of terror in his hallucinations. We have him on Fluconazole (we don’t have Amphotericin B), Ceftriaxone (in case there’s an underlying bacterial meningitis as he does have AIDS), and a few other meds. Nonetheless, an interesting scenario took place with this patient today. One of his family members snuck him some sleeping medication that he bought in Douala. We were thinking about adding haloperidol and the family member was apprehensive of us adding anything else. We asked him what his concern was and he broke (after a couple minutes of prodding and silence) and admitted to his action. He told us that he was concerned that the patient was in a lot of distress and needed sleep. Unfortunately, there’s no telling what he gave the patient, but since he gave it to him the previous night Dr. Sandrine and I thought we would be in the clear to give him the antipsychotic. We started him on the lowest dose. Hopefully it will help to calm him a bit.
Adjacent to the hospital is a school for primary education. They have a soccer field and as you would guess it is in use almost all hours of the afternoon. Soccer is the sport of choice here in Cameroon. I was advised by Mr. Magrino to bring some soccer balls, so I did. Although, what I did not know is that they would be such a hot commodity. As I was walking back from the wards, I saw some kids playing soccer with an apple-sized ball. I went back to the rest house, picked up a ball and took it back to them. They were overjoyed with the gift – and I mean overjoyed. I’ll never forget the smiles on their faces. I went back to the hospital to do some work and as I returned to the rest house, 5 or 6 smaller boys came running up to me saying, “They stole our ball!” They pointed to the group of older boys (who they were previously intermixed with) across the field playing with the ball. I asked them why they stole it and they told me it was because they were older. I thought, “Oh boy, I just created something I shouldn’t have.” I told them that the older boys could have their own ball and that I just happened to have a second ball that this group could have. I went and snagged the second ball as well as a thick sharpie pen. I took the ball back to the younger boys and again they were overjoyed. I told them to write their names on the ball so that they could claim it as theirs. That way, if anyone would try to take it, they would know that it belonged to this group of kids. Each one wrote his name on the ball and I knighted them as “Team Cameroon” and told them I would one day seem them in the World Cup. They all laughed and agreed.
Later on that day, I was again approached by this same group of kids. “They stole our ball again!” they came up to me yelling. Oh my. They knew the group of older kids because they went to the same school. They also knew where they lived. I told them to take me to the older boys and we would make things right. It was funny, one of the kids had a machete in hand – it was almost like he was ready to fight, but he said it was just for cutting grass. We walked down to their house and saw the ball sitting outside. The group of boys ran up and picked it up. One of the sisters of the older kids was standing at the door. I told her what happened and she agreed that it was wrong of her brother to steel the ball. The group of kids and I then told some adults nearby and they said they would monitor things. Hopefully a lesson was learned on both sides. First, don’t steal. Second, that there was someone in the world who would stand up for you.
Lastly, I have come to learn that in African culture, it is common to pay visits to neighbors, friends, and those who you don’t know. In fact, if you don’t visit someone in their home, it is frowned upon. When you do visit, the person will automatically stop what they are doing and meet with you. Many times they will make a meal for you. They discourage setting appointments and encourage just randomly showing up unannounced. They love visitors, what else can I say. They will even send you home with something (usually a small bit of food from their garden). When you leave they won’t see you off at the door – they’ll see you off at the end of the walkway, or many times halfway to your home (no matter the distance). This way they can extend the visit so you can build a better relationship with them. This is a drastic difference from American culture where appointments, office hours, and privacy are the mainstay.
Tomorrow I will be traveling into town with my friend from the pharmacy/stock department. It should be good time!
Never let go,
Mark
---------------------------------------------
Friday, April 4, 2008
“I want to see the white doctor.” – Ethical Dilemmas
Friday, April 4, 2008 – 5:06pm Cameroon Time
I had a very interesting day on the wards today. We rounded this morning and Dr. Sandrine had me see more of the patients. I hope I made the right decisions?! This is an ethical dilemma that was brought up in my International Medicine public health class at Des Moines University. Should medical students trained in the US provide medical care in a third world? I’m not too sure if there is a right answer. What does everyone think? If you want to post a comment, just click on “# comments” below this post (or any post).
At first I thought I would just provide basic care and education, but I’m finding that everyone wishes for me to provide more than that. Am I adequately trained in US standards? – obviously not. Am I adequately trained in Cameroon standards? – probably more so. There is an alarming expectation for me as a known medical student to provide care and I have been consulted by an attending on several occasions about differentials and treatments. In addition, I believe that the opportunity cost for me not to put forth my knowledge in a practical means is too high. Thus, I have begun to feel more comfortable with the whole idea. I will not, however, take any case that I am not familiar with or uncomfortable with – that is where I draw the line. Even if I might be able to make a better educated guess, I want to stick to the ethical standard of primum non nocere – first do no harm. Here, there is a clear conflict between beneficence and nonmaleficence.
As the title of this post implies, I encountered a particular situation today that raises many questions and thoughts and stirs up many conflicting feelings. A man and a woman had traveled from Douala to Banso – about a 10-15 hour drive (who knows how long it would take by foot and taxi). They arrived today and in their patient log (which they carry with them), they requested to see “the white doctor.” The nurse told me what they wanted, handed their log to me, and then called the patients in. Not only was this placing a high expectation on me, but I also felt like it was a significant slap in the face to the Cameroonian physicians. I was caught off guard with this and I still don’t know how I feel about it or whether I did the right thing even seeing the patient simply because he requested me in this way.
I’m going to have to think long and hard about these situations and I welcome any feedback or suggestions. Hopefully we can get a good dialog on the comments section. What do you think?
Go tell it on the mountain,
-Mark
---------------------------------------------
I had a very interesting day on the wards today. We rounded this morning and Dr. Sandrine had me see more of the patients. I hope I made the right decisions?! This is an ethical dilemma that was brought up in my International Medicine public health class at Des Moines University. Should medical students trained in the US provide medical care in a third world? I’m not too sure if there is a right answer. What does everyone think? If you want to post a comment, just click on “# comments” below this post (or any post).
At first I thought I would just provide basic care and education, but I’m finding that everyone wishes for me to provide more than that. Am I adequately trained in US standards? – obviously not. Am I adequately trained in Cameroon standards? – probably more so. There is an alarming expectation for me as a known medical student to provide care and I have been consulted by an attending on several occasions about differentials and treatments. In addition, I believe that the opportunity cost for me not to put forth my knowledge in a practical means is too high. Thus, I have begun to feel more comfortable with the whole idea. I will not, however, take any case that I am not familiar with or uncomfortable with – that is where I draw the line. Even if I might be able to make a better educated guess, I want to stick to the ethical standard of primum non nocere – first do no harm. Here, there is a clear conflict between beneficence and nonmaleficence.
As the title of this post implies, I encountered a particular situation today that raises many questions and thoughts and stirs up many conflicting feelings. A man and a woman had traveled from Douala to Banso – about a 10-15 hour drive (who knows how long it would take by foot and taxi). They arrived today and in their patient log (which they carry with them), they requested to see “the white doctor.” The nurse told me what they wanted, handed their log to me, and then called the patients in. Not only was this placing a high expectation on me, but I also felt like it was a significant slap in the face to the Cameroonian physicians. I was caught off guard with this and I still don’t know how I feel about it or whether I did the right thing even seeing the patient simply because he requested me in this way.
I’m going to have to think long and hard about these situations and I welcome any feedback or suggestions. Hopefully we can get a good dialog on the comments section. What do you think?
Go tell it on the mountain,
-Mark
---------------------------------------------
Thursday, April 3, 2008
Day One on the Wards!
Thursday, April 3, 2008 – 7:44pm Cameroon Time
I began today on the men’s ward with Dr. Sandrine. As I was told, everyone in the hospital thought of me as a doctor – the patient’s, the staff, and the Cameroonian physicians. At first, I was a bit apprehensive, but I remembered, “To whom much is given, much is expected.”
My first patient was a 19yo male with cryptococcal meningitis. It was a very interesting case in that he had been serially tested for HIV and each time had come back negative. As such, the government will not give him assistance for his treatment. He was in such agony and was crying out “Atai! Atai!” I’m not sure what it meant and all I could tell him was “Ashiah” (see previous blog for Pigeon English translation).
Two patients down from him was a patient with the largest liver I’ve ever felt. He also had right sided back pain (paraspinal changes T5 through about L1 – yes, I checked for it just because I could). He also had some muscle rigidity and a transient essential tremor. In addition, his FBS was about 186. The most advanced imaging we have here is an ultrasound – which actually helps a lot! The tech saw cystic nodules in the liver. The attending made the diagnosis of hepatocellular carcinoma and proceeded to tell the patient and his family. We have a palliative care house here at the compound, so the patient will be transferred today or tomorrow. For some reason, I was a little bit insecure about this diagnosis. I looked in his eyes and may have seen Kayser-Fleisher rings, but I’ve never seen them in person, so I’m not sure if I actually saw them or if I wanted to see them to support my internal working diagnosis of Wilson’s Disease. I’ll have to do a bit of research tonight to see if I can come up with any other physical exams I can do tomorrow to give me a better clue if he is still there.
A few patients down from him was another HIV(+) patient. He was a 22yo male with not only HIV, but diabetes, hypertension, candidiasis, and some sort of encephalopathy – I’m not too sure if it was HIV encephalopathy or one of the opportunistics. There were so many other things going on with this patient that we didn’t really know where to start. Unfortunately, it does not look good for him.
We saw about 20 more patients and then had some coffee – which was excellent!
After this, we went to the clinic for outpatients. The system is as follows. Patients will begin in the screening room. Here an individual trained in basic medicine (i.e. can answer the question “does he/she look sick?”) will make a decision whether or not to let the patient to see the nurse. The nurse will then take a brief history (aka chief complaint) and then bring the patient to us in the office. Basically, the screening room has somewhat of a similar role as does the emergency room or an FP doc in the US.
There were quite a number interesting cases in the office. I’ll just write about a couple of the most memorable. A woman came in with an 11 month-old with the chief complaint, “My baby will not eat…and her head flops down – she cannot keep it up.” Oh boy. I had to dig back to December when I had my pediatric rotation with Dr. Sekman. The mother was healthy during the delivery and it was an otherwise normal term birth. However, the infant was extremely jaundiced for days after the delivery – her whole body (you can calculate the bili amount – I can’t remember the number off the top of my head)…nonetheless, the infant was put under bili lights (they either put them out in the sun or shine a light on the infant) without success. For some reason, no transfusion was done (although they do them here). I did an infant exam the best I could and everything checked out normal – except for a floppy head and an abnormally strong palm-grasp...almost hulk strong! On further history, the milestones did not check out – based on the little I remember from the Denver II. The baby clearly had kernicterus and unfortunately there’s not much we could do for her except offer a referral for physical therapy. She will mostly likely be mentally handicapped.
Another woman came in with a rather large visible goiter (but no thyroid bruit). It was extremely tender to the touch. She did not show any signs or symptoms that would convince me she was hyper or hypo-thyroid. I think she may have had granulmoatous thyroiditis. We ordered an ultrasound and a TSH. We’ll see what happens.
May I not forget the man with a hurt foot. He was one of our last patients of the day. He walked into the office sat down. We did our formal greetings (which can be minutes of “Hello” “How are you” “Fine” “Good” “How are you” “Fine” “How did you sleep” “Well” etc.) and then we got down to the matter. He said, “My foot hurts.” I said, “Can you point to where it hurts the most?” He then proceeded to pull up his left pant leg and pointed to his knee – which was obviously swollen.
I have noticed a few observations thus far about medicine in a developing country as compared to the US. Note – these are merely observations and should not be taken as judgments.
First, throughout my brief time on rotations, I have noticed that a lot of patients in the US do not necessarily want to get better. Whether this is for secondary gain or an intrinsic psychological process, this trend is out there and one always has to keep it in the back of his or her mind. In Cameroon, which may be generalized to other developing countries, this trend is not present nearly as much. Patients will travel miles upon miles (mainly by foot on dirt paths) to be seen by a doctor. They value physicians and health care providers very highly. In fact, I was told that the people pray and pray and pray for visiting health care providers to come – just as they pray for rain in the dry season…and when it rains, they celebrate…and boy do they celebrate. You can see the gratitude in their eyes when you offer them advice or you tell them you will give them a medicine that will help them feel better. You can also see the pain and agony in their eyes when there is nothing you can do.
Second, I have noticed that there are many physicians and health care workers in the United States who do not genuinely care for their patients. They might care – but not a deep down to their bone kind of care. In other words, many would not offer up their lives for their patients. In Cameroon, at Banso Hospital, this is exactly the opposite. The physicians do not do this for money, lifestyle, prestige, etc. They do it to reach out to the patient – genuinely – to the deepest part of their soul.
Third, we all know of the friction between different departments in the typical US hospital…don’t quote me on the use of the word “typical.” Doctors clash with nurses, surgeons clash with internists, students clash with professors, and on and on and on. Here, everyone works as a team – it is very amazing. I’m not sure I’ll ever get to see anything like this again in my life. While one member of the hospital might lack in a certain area, another member will pick it up without missing a step or complaining. It is very encouraging to see that it is indeed possible for a group of individuals to work this way.
Lastly, reimbursement is polar opposites. In the US, typically services are rendered (to cover our bases so as to prove to 6 out of 10 people that we did the right thing), and then it is figured out if the patient can pay or not. If the patient cannot, we find out who can or the hospital/clinic bites the bullet. At Banso Hospital, it is first determined what the patient can pay, and then the best services are selected. Here, all the patient has to pay for is medicine, x-rays, ultrasound, etc. There is no fee to see a doctor. In addition, if a doctor orders a test – it is taken from everyone’s salary (which is not exactly large to begin with).
To close I just wanted to mention I relaxed to the sounds of another choir outside my room this afternoon.
Let it be a sweet, sweet sound in your ear,
-Mark
(My friend, a pharmacy/supply organizer, working his second job after a long day at the hospital. He started up this business last September. It's probably the equivalent to a Kinkos. You can make copies, type, print, and even exhange credit. He hopes to add a scanner and a few more computers to help boost his business.)
---------------------------------------------
Trip to Banso – My Home Base
Wednesday, April 2, 2008 – 10:16pm Cameroon Time
I woke up this morning around 4:30am (after a long sleepless night) to roosters crowing. Apparently their internal clocks were off. I waited for the cock to crow, but didn’t here him so I went back to sleep. Dr. Palmer told me that the cock is actually the term used for a bugle…so count that myth – BUSTED!
I woke back up at 6:15 and got ready to hit the road. While leaving the city of Bamenda, we came upon a unique traffic jam. Apparently a group of individuals had groomed the road just so that when it rained, it became incredibly muddy. As such, some of the taxis were getting stuck in the mud. The group stood post at that point and waited for a car to get stuck. Then they would offer to help push it out in exchange for money – an interesting tactic.
After this, it was pretty smooth sailing out to Banso – or shall I say BUMPY! If you’ve ever been on the Indiana Jones ride at Disneyland, it felt like that. It was a rough ride for about 3 hours when we finally arrived at the hospital.
I dropped my luggage off at the guest house, which is adjacent to the hospital, and then headed up to the wards to see what was going on. I was immediately greeted by the pharmacy/supply stock organizer. He was extremely welcoming and showed me around a little bit. I then met back up with Dr. Palmer and we headed up to the main building. I met the Pastor, after which I was given a complete tour by one of the nursing coordinators – and I mean complete. He took me to each department and introduced me to about 25 different individuals. Everyone was so warm and welcoming. They stopped what they were doing – even if they were seeing a patient – and introduced themselves and showed me around their department. It is customary to shake hands with your right while holding your right elbow with your left hand. You can also bow a little bit with your hands in a praying position. It was a wonderful experience. However, despite the fact that the nurse knew that I was a medical student he introduced me as a doctor from the United States. I was thinking to myself – oh boy, what have I got myself into.
The hospital compound itself is made up of about 10 to 12 small buildings including a building for HIV/AIDS, TB, men’s ward, women’s ward, pediatrics, labor and delivery, physiotherapy, lab, a grocery store, rest houses, and a few others. The insides remind me a lot of what it might have been like in the early 1900’s. In the different wards, there are many beds lined up in a row with an aisle going down the middle of them. Used gloves are washed and hung up to dry for reuse, soiled surgical gowns are waiting to be washed, and there is a unique smell in the stagnant air due to little ventilation.
Also, of note is the Burkitt’s Lymphoma ward. Apparently, there is an area in the flats (which we drove through to get to Banso) which has the second highest population of Burkitt’s Lymphoma patients in the world. The missionary doctor who has been working with them has developed a treatment protocol that has now been accepted as the gold standard across the world. She is very well known as has spoken at Geneva many times.
After the tour, I went back to the rest house and met up with Dr. Cole, who was left back to the US today. I had lunch with her, over which she gave me advice about working at the hospital. She began listing off the major conditions and the exact modalities on how to treat them. It was slightly overwhelming. I asked her what my role was going to be at the hospital as a medical student and what the locals expected of me. She told me that they would think of me as a doctor and the staff would treat me as a doctor. She told me that past medical students have had the exact same fear, but there was nothing to worry about. She said that if I don’t know how to treat someone, just to ask for help. I think I’ll be doing A LOT of asking tomorrow. After lunch, I took a nap – I haven’t quite adjusted to the time difference…hopefully by the end of the week everything will be functioning as normal.
After my nap, I woke up again (around 4:30pm) to a choir singing. I think this is the neatest thing. There were actually two choirs singing – one in a school house across the path and another up in the hospital’s chapel. They are very good. I will try to record some their singing so everyone can hear their magnificent voices.
I met up with my friend I met today. He is a computer tech that works for the CBC. He is very interested in the United States and our culture. In fact, he visited Silicone Valley and Washington State not too long ago. He said he was so amazed at how quickly Americans move and how they do so many things at once…he said it was somewhat frustrating to him. No one seemed to give each other the time of day because they were so caught up in what they were doing. I agreed and we had a good laugh.
He was also very interested in the health care system in the US. He said it was very complicated. I explained the role of insurance companies, Medicare, Medicaid, and of course lawyers to him. He had a huge laugh when I mentioned the concept of “defensive medicine.” He told me there are some lawsuits out here, but because there are so few doctors, people are afraid to hold them accountable in fear that they might leave.
Another hilarious concept to him was the “drive through.” He said that he saw Americans doing this and thought it was the funniest thing. Who talks to a microphone and then gets food and drives off?!?! I thought about it for a moment and began to think the same thing. Again, we both had a good laugh.
He was also very aware of the election happenings. In fact, most of the hospital staff were aware and up-to-date on all the news. I’d even venture to say that people know more about the US election and politics than the average person does in the US. They asked me about the controversy with Obama and his relationship with Reverend Write. It was amazing that they had heard all of this information. It just goes to show you how far and how fast information can travel. My friend was also interested in the role of You Tube and the election – as well as other related concepts such as libel.
Well, I hope tomorrow will be as interesting as today – I’m sure it will be, if not more!
Good night, and good luck,
-Mark
(Grocery Store)
---------------------------------------------
Note to Self . . .
Wednesday, April 2, 2008 – 2:30am Cameroon Time
. . . Do not drink Cameroonian coffee in the evening.
-Mark
---------------------------------------------
Trip to Bamenda
Tuesday, April 1, 2008 – 10:16pm Cameroon Time
I woke up today around 6:15am. It was hot and muggy in my dorm room and the sounds of bugs chirping and flying about was in the air. I milled around for about 15 minutes and then hopped in the shower. I remembered not to wash my face so I wouldn’t get any water in my mouth or nose. After that, I packed up my stuff and met Vincent outside.
There was a mother and her baby sitting in the middle seat of the van and Vincent had packed the rest of it with car parts including 4 or 5 windshields and many boxes of headlights. We crammed my stuff wherever we could and hit the road. I smiled and said hello to the woman sitting in the back. She acknowledged me with a nod, but showed no emotion. In fact, she did not say a single word our 6-hour trip…and her baby was quiet the whole way.
We went a few blocks and around the corner to a bakery where I picked out a cinnamon roll-type thing and a bottle of water. I went to pay the man at the counter and handed him a bill and he returned the change. As I was about to leave, he called over to me telling me I owed him 350 francs – except I couldn’t understand him all that well. He repeated it a few times until Vincent came up and explained what was going on to me. Apparently, he didn’t have the right change in the register to give me and I needed to find 350 to make it even. I did and we went on our way.
The van ride from Douala to Bamenda was indescribable. It started out weaving and dodging people, motorcycles, goats, and yaks and turned into an autobon race down big stretches of pothole-littered road. In the city, there were families riding on the same motorcycle. Usually the taxi driver/rider would drive, with the husband in the middle and mother riding in the back with her infant on her hip. I’ll try to take a picture next time I see it – it is quite remarkable.
As we drove down the road, there were military stops every now and again where the AK-manned authorities would stop vehicles every now and again and request for documentation. At one point, we saw a large truck that did not have what the soldier wanted, so he handed him a couple hundred francs and they let them on their way. Vincent told me that this was fairly common.
The countryside was beautiful. Forests of palms and brush went as far as you could see – which wasn’t very far because the jungle is so thick. There was also a certain smell that I’ll never forget. It was almost sweet like maple, but also had a burnt tinge to it.
Another site that will remain with me forever were the countless 5-10 year-olds wielding machetes walking down the road. At first I thought, “Child Services would shut this country down if they knew about this.” But then some sense came into me and I began to think that the risk of starving to death without a machete to cut down food to sell and eat is much greater than the risk of a child hurting himself with it. In addition, I saw quite a few of them working and they were very skilled at what they did.
We would pass through village to village and kids would come up to the van trying to sell anything they could. It was truly heartbreaking. I can’t describe the emotion I was feeling at the time – it was very surreal. The closest thing I can think of that I can relate to it is the scene in Indiana Jones Temple of Doom, where Dr. Jones, Shorty, and “Doll” go to the village that just had their magical rocks stolen.
After about 4 hours, I fell asleep – only to be woken up by a villager yelling “WAKE UP!” as we passed through.
We got to Bamenda and dropped off the auto parts and then headed up to the Cameroon Baptist Convention compound. It has a row of dorms, a dining, hall, a library, main office, hospital, and a few other areas to it. We parked the car and headed over to the main office, where I met George – the person who has helped me organize this trip for months now. It was good to finally see a face who has been of such great assistance. We then went back to the van and started to unload my luggage when a kid came up and tried to help us with my bags. Of course he went for the 71 pounder. Not to be embarrassed he struggled at it for a bit and then Vincent laughed and told him we would take care of it. Sitting outside my room was James – a man in his 60’s or 70’s who had a cheerful, welcoming personality. The two kids were also playing outside my room. James and the kids were selling different items – drums, wooden masks, and other African art. Everything was very beautiful. The child grabbed something that was two wooden heads on a chain – like nunchucks. I asked him if he made it and he said his dad did. Then he asked me if I knew the meaning behind it. I told him no. Apparently, the two heads/bodies were to symbolize two individuals who got married. Now they are chained together as one and cannot be separated. If the husband is in an upset mood or cranky on a certain day, he will turn one of the head/bodies toward the home, leaving the other facing out. If he is in a cheerful mood, he will leave both facing out. This will tell the wife whether or not it is ok to bother him. I thought it was quite comical and we all had a good laugh. One of the men told me it would be a perfect gift for my brother who recently got married. I’ll see if I can pick one up later on during my trip.
After this, I went over to meet Joy – a woman who gives orientation and does a lot of administrative work for the convention. She told me about the culture and tried to teach me some Pidgin English – hopefully I’ll pick this up quick, because I’m having a tough time understanding people. For instance, “I bi done go” means “I went a while ago.” “Ashiah” is a word one should use to tell someone they are sorry or feel empathy. In the United States, the vernacular would be “I feel ya.” Apparently, it gives people a great amount of encouragement, and you can see their spirits rise right in front of your eyes if you say it to them. Another example is “Dash,” which means a tip or a free small gift. To make a word plural, you’re supposed to add “dem” to it… “Pekin” = Child while “Pekin dem” = Children. There is also Pidgin for medical terminology. For instance, “Skin” means the whole body, not just the skin. People will say “My skin is sick” if they feel sick to their stomach, have a headache, etc. Also, individuals might say “I di shit wata-wata.” This means they have diarrhea and the four-letter word isn’t meant or understood to be vulgar as it is in the US – neither are other four-letter words.
After the lessons in African culture and Pidgin English, Joy and I made our way into downtown Bamenda. It reminded me somewhat of Tijuana but with a different flavor and much poorer and chaotic. Joy wanted to pick up some Cameroonian coffee to give to Nancy Palmer (Dr. Palmer’s wife) to take home to the US with her. I ended up getting some laundry detergent. Now all I need is a bucket and some water!
We got back to the compound via taxi (aka 4-5 people stuffed in a yellow escort with no seatbelts that whipped through the streets dodging people, other taxis, and animals like the Rodger Rabbit ride at Disneyland). I then met Nancy and Dr. Dennis Palmer. They were going to treat me to dinner tonight, so we met briefly and I went back to my room. I had quite a bit of a headache, so I took a nice nap for an hour or so.
I woke up to a choir singing outside of my room. The voices were angelic. I thought I must be dreaming, but I wasn’t. It was the coolest feeling in the world. I didn’t see them, I just heard them. The music that came out of their mouths was so sweet and pure and the harmony was magnificent. It was a nice blessing after a well-needed nap.
I then headed up to the Field Director’s house (Dr. Palmer’s) and had a candle-light dinner under a grass-woven canopy. It began to rain and you could hear each rain drop hit the canopy and then drain off onto the ground. There was a fresh scent in the air. Nancy cooked beef over rice, which was DELICIOUS. Dr. Palmer and I then talked for hours.
I wish I could have recorded the conversation, because he is a very wise man and has decades of African mission years under his belt. As a matter of fact, he is the author of the Handbook of Medicine in Developing Countries, which is a must have for third-world/mission medicine. A third addition will be hitting the shelves soon.
Dr. Palmer was saying that medical missions is not what it used to be. In the past, physicians would come out to Africa and work 15-hour days, seeing as many patients as they could. Now, the philosophy is to train African doctors – an exponential model. In fact, we will be heading up to Banso tomorrow to teach a new round of medical students/residents the basics of HIV/AIDS prevention and treatment modalities. It should be an interesting experience.
Dr. Palmer also told me of his days in Kansas City – he is a D.O. He was a professor at the M.D. school in KC for a couple years and really enjoys teaching. He says that one of his main sacrifices in coming out here was his students.
A majority of the rest of our conversation had to do with the corruption present in Cameroon. This has infected the nation (and a majority of the African continent) from the lowest man on the totem pole all the way up to the heads of state. Dr. Palmer says the people of Cameroon voice that they refuse to change until the government deals honestly with them without exploitation, manipulation, and maltreatment. He continued to say that even if one or two honest people work their way up in the government, once they are found out of being honest, they are usually outnumbered and undercut. In addition, there is no justice for crimes that are committed. The individual may spend a few months in jail for a certain offense, but the officials will let them out prematurely if bribed, have alternative motives, etc. On the bright side, Dr. Palmer says things are slowly starting to get better. In fact, there were a few arrests of high level government officials this last week, including the Minister of Public Health. Apparently, she was embezzling finances that were supposed to be put toward HIV/AIDS services. When poverty is the foundation for most health care crises in developing countries, this sort of corruption only worsens the conditions already plaguing the common person.
Nevertheless, this trip hasn’t even begun and I’ve already had the experience of a life time!
Remember – the spin stops here,
-Mark
I woke up today around 6:15am. It was hot and muggy in my dorm room and the sounds of bugs chirping and flying about was in the air. I milled around for about 15 minutes and then hopped in the shower. I remembered not to wash my face so I wouldn’t get any water in my mouth or nose. After that, I packed up my stuff and met Vincent outside.
There was a mother and her baby sitting in the middle seat of the van and Vincent had packed the rest of it with car parts including 4 or 5 windshields and many boxes of headlights. We crammed my stuff wherever we could and hit the road. I smiled and said hello to the woman sitting in the back. She acknowledged me with a nod, but showed no emotion. In fact, she did not say a single word our 6-hour trip…and her baby was quiet the whole way.
We went a few blocks and around the corner to a bakery where I picked out a cinnamon roll-type thing and a bottle of water. I went to pay the man at the counter and handed him a bill and he returned the change. As I was about to leave, he called over to me telling me I owed him 350 francs – except I couldn’t understand him all that well. He repeated it a few times until Vincent came up and explained what was going on to me. Apparently, he didn’t have the right change in the register to give me and I needed to find 350 to make it even. I did and we went on our way.
The van ride from Douala to Bamenda was indescribable. It started out weaving and dodging people, motorcycles, goats, and yaks and turned into an autobon race down big stretches of pothole-littered road. In the city, there were families riding on the same motorcycle. Usually the taxi driver/rider would drive, with the husband in the middle and mother riding in the back with her infant on her hip. I’ll try to take a picture next time I see it – it is quite remarkable.
As we drove down the road, there were military stops every now and again where the AK-manned authorities would stop vehicles every now and again and request for documentation. At one point, we saw a large truck that did not have what the soldier wanted, so he handed him a couple hundred francs and they let them on their way. Vincent told me that this was fairly common.
The countryside was beautiful. Forests of palms and brush went as far as you could see – which wasn’t very far because the jungle is so thick. There was also a certain smell that I’ll never forget. It was almost sweet like maple, but also had a burnt tinge to it.
Another site that will remain with me forever were the countless 5-10 year-olds wielding machetes walking down the road. At first I thought, “Child Services would shut this country down if they knew about this.” But then some sense came into me and I began to think that the risk of starving to death without a machete to cut down food to sell and eat is much greater than the risk of a child hurting himself with it. In addition, I saw quite a few of them working and they were very skilled at what they did.
We would pass through village to village and kids would come up to the van trying to sell anything they could. It was truly heartbreaking. I can’t describe the emotion I was feeling at the time – it was very surreal. The closest thing I can think of that I can relate to it is the scene in Indiana Jones Temple of Doom, where Dr. Jones, Shorty, and “Doll” go to the village that just had their magical rocks stolen.
After about 4 hours, I fell asleep – only to be woken up by a villager yelling “WAKE UP!” as we passed through.
We got to Bamenda and dropped off the auto parts and then headed up to the Cameroon Baptist Convention compound. It has a row of dorms, a dining, hall, a library, main office, hospital, and a few other areas to it. We parked the car and headed over to the main office, where I met George – the person who has helped me organize this trip for months now. It was good to finally see a face who has been of such great assistance. We then went back to the van and started to unload my luggage when a kid came up and tried to help us with my bags. Of course he went for the 71 pounder. Not to be embarrassed he struggled at it for a bit and then Vincent laughed and told him we would take care of it. Sitting outside my room was James – a man in his 60’s or 70’s who had a cheerful, welcoming personality. The two kids were also playing outside my room. James and the kids were selling different items – drums, wooden masks, and other African art. Everything was very beautiful. The child grabbed something that was two wooden heads on a chain – like nunchucks. I asked him if he made it and he said his dad did. Then he asked me if I knew the meaning behind it. I told him no. Apparently, the two heads/bodies were to symbolize two individuals who got married. Now they are chained together as one and cannot be separated. If the husband is in an upset mood or cranky on a certain day, he will turn one of the head/bodies toward the home, leaving the other facing out. If he is in a cheerful mood, he will leave both facing out. This will tell the wife whether or not it is ok to bother him. I thought it was quite comical and we all had a good laugh. One of the men told me it would be a perfect gift for my brother who recently got married. I’ll see if I can pick one up later on during my trip.
After this, I went over to meet Joy – a woman who gives orientation and does a lot of administrative work for the convention. She told me about the culture and tried to teach me some Pidgin English – hopefully I’ll pick this up quick, because I’m having a tough time understanding people. For instance, “I bi done go” means “I went a while ago.” “Ashiah” is a word one should use to tell someone they are sorry or feel empathy. In the United States, the vernacular would be “I feel ya.” Apparently, it gives people a great amount of encouragement, and you can see their spirits rise right in front of your eyes if you say it to them. Another example is “Dash,” which means a tip or a free small gift. To make a word plural, you’re supposed to add “dem” to it… “Pekin” = Child while “Pekin dem” = Children. There is also Pidgin for medical terminology. For instance, “Skin” means the whole body, not just the skin. People will say “My skin is sick” if they feel sick to their stomach, have a headache, etc. Also, individuals might say “I di shit wata-wata.” This means they have diarrhea and the four-letter word isn’t meant or understood to be vulgar as it is in the US – neither are other four-letter words.
After the lessons in African culture and Pidgin English, Joy and I made our way into downtown Bamenda. It reminded me somewhat of Tijuana but with a different flavor and much poorer and chaotic. Joy wanted to pick up some Cameroonian coffee to give to Nancy Palmer (Dr. Palmer’s wife) to take home to the US with her. I ended up getting some laundry detergent. Now all I need is a bucket and some water!
We got back to the compound via taxi (aka 4-5 people stuffed in a yellow escort with no seatbelts that whipped through the streets dodging people, other taxis, and animals like the Rodger Rabbit ride at Disneyland). I then met Nancy and Dr. Dennis Palmer. They were going to treat me to dinner tonight, so we met briefly and I went back to my room. I had quite a bit of a headache, so I took a nice nap for an hour or so.
I woke up to a choir singing outside of my room. The voices were angelic. I thought I must be dreaming, but I wasn’t. It was the coolest feeling in the world. I didn’t see them, I just heard them. The music that came out of their mouths was so sweet and pure and the harmony was magnificent. It was a nice blessing after a well-needed nap.
I then headed up to the Field Director’s house (Dr. Palmer’s) and had a candle-light dinner under a grass-woven canopy. It began to rain and you could hear each rain drop hit the canopy and then drain off onto the ground. There was a fresh scent in the air. Nancy cooked beef over rice, which was DELICIOUS. Dr. Palmer and I then talked for hours.
I wish I could have recorded the conversation, because he is a very wise man and has decades of African mission years under his belt. As a matter of fact, he is the author of the Handbook of Medicine in Developing Countries, which is a must have for third-world/mission medicine. A third addition will be hitting the shelves soon.
Dr. Palmer was saying that medical missions is not what it used to be. In the past, physicians would come out to Africa and work 15-hour days, seeing as many patients as they could. Now, the philosophy is to train African doctors – an exponential model. In fact, we will be heading up to Banso tomorrow to teach a new round of medical students/residents the basics of HIV/AIDS prevention and treatment modalities. It should be an interesting experience.
Dr. Palmer also told me of his days in Kansas City – he is a D.O. He was a professor at the M.D. school in KC for a couple years and really enjoys teaching. He says that one of his main sacrifices in coming out here was his students.
A majority of the rest of our conversation had to do with the corruption present in Cameroon. This has infected the nation (and a majority of the African continent) from the lowest man on the totem pole all the way up to the heads of state. Dr. Palmer says the people of Cameroon voice that they refuse to change until the government deals honestly with them without exploitation, manipulation, and maltreatment. He continued to say that even if one or two honest people work their way up in the government, once they are found out of being honest, they are usually outnumbered and undercut. In addition, there is no justice for crimes that are committed. The individual may spend a few months in jail for a certain offense, but the officials will let them out prematurely if bribed, have alternative motives, etc. On the bright side, Dr. Palmer says things are slowly starting to get better. In fact, there were a few arrests of high level government officials this last week, including the Minister of Public Health. Apparently, she was embezzling finances that were supposed to be put toward HIV/AIDS services. When poverty is the foundation for most health care crises in developing countries, this sort of corruption only worsens the conditions already plaguing the common person.
Nevertheless, this trip hasn’t even begun and I’ve already had the experience of a life time!
Remember – the spin stops here,
-Mark
(Home to Many)
---------------------------------------------
I made it!
Monday, March 31, 2008 - 8:26pm Cameroon Time
I had my own two seats on the left side of the plane flying from Paris to Douala. It was pretty nice. It looked as if about 90% of the plane was made up of native Cameroonians and the rest were European businessmen. There were also a few adventurers scattered about as demonstrated by their rolled up tatami/yoga/sleeping mats. As we approached Douala, I peered out of the window upon rolling hills, valleys, and muddy rivers. The lushness went as far as the eye could see. Let’s just say it puts Oregon to shame with regards to its greenery. When we were about to land, I thought we were going to land in the forest. The tree line came closer and closer … and closer – then bam! – an air strip. As the plane braked, I could see people walking about the tarmac…public health issue #1.
I got off the plane and it went down exactly as I was told. I took off my coat, rolled up my sleeves and went for it. The airport was empty until I came across 3 or 4 desks in the middle of a huge common area. People were lined up at all of them, so I figured I would too. A man came up to me and started talking to me, but I couldn’t figure out what he was saying. He motioned for me to give him my passport, so I did and he took it up to the desk. The person manning the desk gave it back to him and he directed me over to another desk. Then he said he would go get a cart to pick up my bags. Because he wasn’t in a green shirt, I refused and he backed off. I handed the lady at the desk my passport and yellow fever card. She stamped it and I proceeded down the hall.
I came upon baggage claim. Oh boy. It was packed. There were to carousels and about 100 or so porters waiving at me. They swarmed me, each telling me they could carry my bags. I decided on one in a bright green vest with an airport pin on his chest. He seemed bona fide. We found my bags – they had made it through! He then proceeded to tell me I owed him money for customs. Then two others came up and cornered me for customs money. I told them firmly that my driver was going to pay them and that I didn’t owe any customs fees. They insisted and insisted until they finally gave up after several firm “No’s.” I think they got the sense that I wasn’t going to give in. We approached customs and they propped one of the 71 pound bags up on a table and opened it. After they searched it, my porter tried to fasten up the green strap again, but the customs lady slapped his hand and yelled at him. I just took my bag and got out of there. I instantly found the driver for CBC. His name is Vincent. He has become my new best friend over here.
Vincent, the porter, and I took my bags down stairs and loaded up the CBC van. Vincent paid the porter about 1000 francs, which is about 2USD. The guy was yelling that Vincent was short-changing him, but Vincent and I went on our way without looking back. If I had not known what was going to happen ahead of time and didn’t have an experienced driver picking me up, this could have been disastrous.
Once we left the airport, it was an instantaneous change…this was indeed a developing country. There were tattered homes/shacks made out of scrap metal and random pieces of wood. People were walking across the road seemingly oblivious to the fact that it was a road and cars were driving on it at very high speeds. There were also many people on the sides of the road trying to sell various items…anything from crafts to empty bottles of coke. I don’t know how we didn’t hit anyone on our way to the guest house, but we didn’t. There didn’t seem to be any driving laws/rules…it seemed more like a free-for-all. Vincent would honk twice at an intersection to let people know that he was coming…and somehow they got out of the way.
Once we got to the CBC guest house, we unloaded my stuff and then Vincent and I went to an American style restaurant for dinner – although he didn’t eat. We stepped inside, found a table, I ordered, and then Vincent left to go pick some things up. So there I was alone in this place. He told me to get the hamburger, fries, ice cream, and coke…talk about a heart attack on a plate! He said that’s what people usually got. I didn’t recognize anything else on the menu, so I went for it. The food was pretty good and the ice cream was sweeter than it is in the US.
As I was eating, I did some people watching. There is a clear-cut dichotomy with regards to the have’s and the have not’s. This was definitely a middle-upper class place (in the US it would probably be comparable to a Dairy Queen with a waiter.) Businessmen would walk in looking slick in their sharp suits. Many times they would be accompanied by 2 or 3 women. Speaking of which, there was also a sharp distinction between conservatives and more “loose” individuals in the way they dressed.
Vincent came back after about an hour (I have learned to not keep track of time and waited patiently) and we headed over to exchange my cash. He said that the dollar has gone down and that if we went to a bank, they would exchange it at 350 francs/dollar or something like that. So, of course we didn’t do that. Instead we went in front of some building, he hoped out of the van with it still running in the middle of the road. After about 3 minutes, he came back and told me he found a guy who could exchange it at 420 francs/dollar. They guy came up to my window and started counting out Cameroonian notes. We exchanged the cash and went on our way…and thus my first Cameroon black market experience.
When we got back to the guest house, there was a man and a woman pushing a car, with a pregnant woman looking on. Apparently, they accidentally left the radio on and drained the battery. I hopped in there and started pushing with them as Vincent tried to turn over the car, but it wouldn’t go…so we pushed it to the back of the compound.
After that, Vincent took me to get a bottle of water and he told me that we would be leaving at 7am tomorrow – after we hit up the bakery for breakfast. I went in my room and rubbed a bunch of cortisone cream on my sausage shaped finger and arms from the mosquito bites. I sprayed around the window and door ways. Hopefully I won’t get attacked in the middle of the night by the Anopheles!
It was a great day – I love the country already. I can’t wait to see what it’s like out in the bush tomorrow!
And now you have the rest of the story,
-Mark
I had my own two seats on the left side of the plane flying from Paris to Douala. It was pretty nice. It looked as if about 90% of the plane was made up of native Cameroonians and the rest were European businessmen. There were also a few adventurers scattered about as demonstrated by their rolled up tatami/yoga/sleeping mats. As we approached Douala, I peered out of the window upon rolling hills, valleys, and muddy rivers. The lushness went as far as the eye could see. Let’s just say it puts Oregon to shame with regards to its greenery. When we were about to land, I thought we were going to land in the forest. The tree line came closer and closer … and closer – then bam! – an air strip. As the plane braked, I could see people walking about the tarmac…public health issue #1.
I got off the plane and it went down exactly as I was told. I took off my coat, rolled up my sleeves and went for it. The airport was empty until I came across 3 or 4 desks in the middle of a huge common area. People were lined up at all of them, so I figured I would too. A man came up to me and started talking to me, but I couldn’t figure out what he was saying. He motioned for me to give him my passport, so I did and he took it up to the desk. The person manning the desk gave it back to him and he directed me over to another desk. Then he said he would go get a cart to pick up my bags. Because he wasn’t in a green shirt, I refused and he backed off. I handed the lady at the desk my passport and yellow fever card. She stamped it and I proceeded down the hall.
I came upon baggage claim. Oh boy. It was packed. There were to carousels and about 100 or so porters waiving at me. They swarmed me, each telling me they could carry my bags. I decided on one in a bright green vest with an airport pin on his chest. He seemed bona fide. We found my bags – they had made it through! He then proceeded to tell me I owed him money for customs. Then two others came up and cornered me for customs money. I told them firmly that my driver was going to pay them and that I didn’t owe any customs fees. They insisted and insisted until they finally gave up after several firm “No’s.” I think they got the sense that I wasn’t going to give in. We approached customs and they propped one of the 71 pound bags up on a table and opened it. After they searched it, my porter tried to fasten up the green strap again, but the customs lady slapped his hand and yelled at him. I just took my bag and got out of there. I instantly found the driver for CBC. His name is Vincent. He has become my new best friend over here.
Vincent, the porter, and I took my bags down stairs and loaded up the CBC van. Vincent paid the porter about 1000 francs, which is about 2USD. The guy was yelling that Vincent was short-changing him, but Vincent and I went on our way without looking back. If I had not known what was going to happen ahead of time and didn’t have an experienced driver picking me up, this could have been disastrous.
Once we left the airport, it was an instantaneous change…this was indeed a developing country. There were tattered homes/shacks made out of scrap metal and random pieces of wood. People were walking across the road seemingly oblivious to the fact that it was a road and cars were driving on it at very high speeds. There were also many people on the sides of the road trying to sell various items…anything from crafts to empty bottles of coke. I don’t know how we didn’t hit anyone on our way to the guest house, but we didn’t. There didn’t seem to be any driving laws/rules…it seemed more like a free-for-all. Vincent would honk twice at an intersection to let people know that he was coming…and somehow they got out of the way.
Once we got to the CBC guest house, we unloaded my stuff and then Vincent and I went to an American style restaurant for dinner – although he didn’t eat. We stepped inside, found a table, I ordered, and then Vincent left to go pick some things up. So there I was alone in this place. He told me to get the hamburger, fries, ice cream, and coke…talk about a heart attack on a plate! He said that’s what people usually got. I didn’t recognize anything else on the menu, so I went for it. The food was pretty good and the ice cream was sweeter than it is in the US.
As I was eating, I did some people watching. There is a clear-cut dichotomy with regards to the have’s and the have not’s. This was definitely a middle-upper class place (in the US it would probably be comparable to a Dairy Queen with a waiter.) Businessmen would walk in looking slick in their sharp suits. Many times they would be accompanied by 2 or 3 women. Speaking of which, there was also a sharp distinction between conservatives and more “loose” individuals in the way they dressed.
Vincent came back after about an hour (I have learned to not keep track of time and waited patiently) and we headed over to exchange my cash. He said that the dollar has gone down and that if we went to a bank, they would exchange it at 350 francs/dollar or something like that. So, of course we didn’t do that. Instead we went in front of some building, he hoped out of the van with it still running in the middle of the road. After about 3 minutes, he came back and told me he found a guy who could exchange it at 420 francs/dollar. They guy came up to my window and started counting out Cameroonian notes. We exchanged the cash and went on our way…and thus my first Cameroon black market experience.
When we got back to the guest house, there was a man and a woman pushing a car, with a pregnant woman looking on. Apparently, they accidentally left the radio on and drained the battery. I hopped in there and started pushing with them as Vincent tried to turn over the car, but it wouldn’t go…so we pushed it to the back of the compound.
After that, Vincent took me to get a bottle of water and he told me that we would be leaving at 7am tomorrow – after we hit up the bakery for breakfast. I went in my room and rubbed a bunch of cortisone cream on my sausage shaped finger and arms from the mosquito bites. I sprayed around the window and door ways. Hopefully I won’t get attacked in the middle of the night by the Anopheles!
It was a great day – I love the country already. I can’t wait to see what it’s like out in the bush tomorrow!
And now you have the rest of the story,
-Mark
(Taxi!)
---------------------------------------------
---------------------------------------------
Monday, March 31, 2008
Made it half way!
I just landed in Paris after a short trek across the Atlantic. The plane was VERY nice. It had monitors in all of the seatbacks and you could select from 100’s of movies, TV shows, music, and video games…I of course took the opportunity to play Centipede and Asteroids. I don’t think anybody spoke English on the plane and all anybody ordered to drink was vodka on the rocks with some sort of twist – very sophisticated.
I didn’t have too much trouble getting on the plane. Both of my checked bags were 71 pounds and the limit they’ll take is 70. The woman at the check-in counter graciously wrote 70lbs on both bags so I didn’t have to ditch anything last minute. When I was going through the check point, I was stopped and they went through all my bags. They were suspicious of the ophthalmoscope – which is basically a fancy metal pipe. I saw it in their eyes that they were going to let me through without any further hassle…the guy told me “You may go” and I was tempted to say “eye-eye” but I resisted as hard as I could.
Navigating the Paris airport is no easy task. I got off and sort of followed the pack the best I could. There were signs to a parachute point – I didn’t think I wanted that considering I didn’t pack mine. I finally found a hostess to ask…I went up to her with a deer in the headlights look and offered up my plane ticket. She said I had to catch transport to Terminal C – and that I did. I got to Terminal C and it was a ghost town. I was directed to go down some hallway, then take a left at the desk, and then down another hallway, then shimmy twice, and then moonwalk into my gate – C83. I finally made it.
I’m not sure if I’m hungry or just tired. It’s 3am in the US right now and 9am here. I’m not too sure what the time difference is from here and Cameroon, but I do know that the driver is supposed to feed me once I get there.
Hopefully this next flight will be pretty empty so I can sprawl out in the seats.
Here is the information that was given to me about my arrival at the airport – I found it somewhat comical, but we’ll see how it goes!
“The baggage claim area will be the most negative experience of your entire trip, so hang in there. Don't be intimidated by the porters vying for your business. Choose only one person and stick with him. Be sure to use only a porter with a green shirt. We have had some trouble with other porters telling people they owe customs fees, but I'm sure they just pocketed the money. The real customs person (sometimes a woman) walks around with a clipboard and sometimes is not in uniform. If you aren't bringing extra boxes, you probably will not get hassled by customs. You should not have to pay any customs for bringing your personal things for your own use. Don't volunteer information that isn't asked for; that just confuses things. If you are asked to pay legitimate customs fees for some equipment you are bringing, they will give you a receipt fro m the customs office. Also, tell them you need to get francs from your driver who is outside. This should get the driver inside and then he can help you determine if it is really the true customs person who is asking for the money. When you get your bags, proceed to the door. There won't be much of a line. Do not be surprised or get angry; be patient. Someone at the door will ask to look at (and keep) your baggage claim tickets as you leave the airport building. You might be asked to open your suitcase(s), but probably not. If not, just keep going out the door! The driver will pay your porter after you get outside. (The normal charge is 500-1000 cfa francs per bag ($1-2). Do not pay more, even though the porter will say you cheated him no matter how much you pay him.)”
(I was about to post this blog entry and I went to my blog site only to realize that it’s in French! … Hopefully I can navigate it.)
-Mark
---------------------------------------------
I didn’t have too much trouble getting on the plane. Both of my checked bags were 71 pounds and the limit they’ll take is 70. The woman at the check-in counter graciously wrote 70lbs on both bags so I didn’t have to ditch anything last minute. When I was going through the check point, I was stopped and they went through all my bags. They were suspicious of the ophthalmoscope – which is basically a fancy metal pipe. I saw it in their eyes that they were going to let me through without any further hassle…the guy told me “You may go” and I was tempted to say “eye-eye” but I resisted as hard as I could.
Navigating the Paris airport is no easy task. I got off and sort of followed the pack the best I could. There were signs to a parachute point – I didn’t think I wanted that considering I didn’t pack mine. I finally found a hostess to ask…I went up to her with a deer in the headlights look and offered up my plane ticket. She said I had to catch transport to Terminal C – and that I did. I got to Terminal C and it was a ghost town. I was directed to go down some hallway, then take a left at the desk, and then down another hallway, then shimmy twice, and then moonwalk into my gate – C83. I finally made it.
I’m not sure if I’m hungry or just tired. It’s 3am in the US right now and 9am here. I’m not too sure what the time difference is from here and Cameroon, but I do know that the driver is supposed to feed me once I get there.
Hopefully this next flight will be pretty empty so I can sprawl out in the seats.
Here is the information that was given to me about my arrival at the airport – I found it somewhat comical, but we’ll see how it goes!
“The baggage claim area will be the most negative experience of your entire trip, so hang in there. Don't be intimidated by the porters vying for your business. Choose only one person and stick with him. Be sure to use only a porter with a green shirt. We have had some trouble with other porters telling people they owe customs fees, but I'm sure they just pocketed the money. The real customs person (sometimes a woman) walks around with a clipboard and sometimes is not in uniform. If you aren't bringing extra boxes, you probably will not get hassled by customs. You should not have to pay any customs for bringing your personal things for your own use. Don't volunteer information that isn't asked for; that just confuses things. If you are asked to pay legitimate customs fees for some equipment you are bringing, they will give you a receipt fro m the customs office. Also, tell them you need to get francs from your driver who is outside. This should get the driver inside and then he can help you determine if it is really the true customs person who is asking for the money. When you get your bags, proceed to the door. There won't be much of a line. Do not be surprised or get angry; be patient. Someone at the door will ask to look at (and keep) your baggage claim tickets as you leave the airport building. You might be asked to open your suitcase(s), but probably not. If not, just keep going out the door! The driver will pay your porter after you get outside. (The normal charge is 500-1000 cfa francs per bag ($1-2). Do not pay more, even though the porter will say you cheated him no matter how much you pay him.)”
(I was about to post this blog entry and I went to my blog site only to realize that it’s in French! … Hopefully I can navigate it.)
-Mark
---------------------------------------------
Sunday, March 30, 2008
About to Take Off!
Well, I’m about to head on over to the airport in Newark, NJ to catch my flight this evening. Right now I’m doing some last minute packing and organizing (trying to get everything under the weight limit). As the time draws nearer and nearer, I feel quite a bit of nervousness and excitement…I really don’t know what to expect. It will be quite the adventure – that’s for sure.
I would like to thank the following 6th Graders from Foothill Middle School in Walnut Creek, CA for taking the time to write letters for the kids in Cameroon. They’re going to love them! Annie H., Megan H., Spencer J., Lindsay D., Gian Delos S., Jamie H., Dylan B., Arthur G., Ryan C., Eddie C., Austin C., Mackenzie, Charlie A., Amanda K., Ian Mc., Connor C., Val W., Stephen W., Maddie T., Whitney, Ali T., Katie, Kyle R., Majid D., Alexandra N., Meaghan O., Tyler M., Troy M., Maddy M., Nicholas K., Mona K., Brayden L., Vicky L., Zachary L., Isabel L., Kris D., Jasmine F., Tory F., Cole H., Spencer C., Dashiell C., Megan D., Cyrene H., Anna W., Andie T., Rachael T., Mikey A., Lauren L., Jarrett T., Shayan S., and Shannon M. If I missed anyone, sorry about that – just leave a comment under this post and I’ll make sure to add ya!
Below is a picture of all of the non-monetary contributions. Obviously this was too much for me to take with me on the plane, so I had to leave behind about 500 pairs of sterile surgical gloves and some drape and gown kits. I was, however, able to take everything else. I will be taking the remaining supplies down with me to the INMED International Medicine Conference in Kansas City to pass off to the next person(s) who are going out there as to ensure that everything is put to good use.
On another note, after discovering that a significant amount of useful medications and other health care supplies are discarded by hospitals throughout the country due to quality control purposes, I have begun to think about ways to possibly utilize these supplies that are not put to use here in the United States to help meet the some of the needs in developing countries. I will continue to ponder this situation and may work on it upon my return.
I will see everyone in Cameroon!
-Mark
---------------------------------------------
I would like to thank the following 6th Graders from Foothill Middle School in Walnut Creek, CA for taking the time to write letters for the kids in Cameroon. They’re going to love them! Annie H., Megan H., Spencer J., Lindsay D., Gian Delos S., Jamie H., Dylan B., Arthur G., Ryan C., Eddie C., Austin C., Mackenzie, Charlie A., Amanda K., Ian Mc., Connor C., Val W., Stephen W., Maddie T., Whitney, Ali T., Katie, Kyle R., Majid D., Alexandra N., Meaghan O., Tyler M., Troy M., Maddy M., Nicholas K., Mona K., Brayden L., Vicky L., Zachary L., Isabel L., Kris D., Jasmine F., Tory F., Cole H., Spencer C., Dashiell C., Megan D., Cyrene H., Anna W., Andie T., Rachael T., Mikey A., Lauren L., Jarrett T., Shayan S., and Shannon M. If I missed anyone, sorry about that – just leave a comment under this post and I’ll make sure to add ya!
Below is a picture of all of the non-monetary contributions. Obviously this was too much for me to take with me on the plane, so I had to leave behind about 500 pairs of sterile surgical gloves and some drape and gown kits. I was, however, able to take everything else. I will be taking the remaining supplies down with me to the INMED International Medicine Conference in Kansas City to pass off to the next person(s) who are going out there as to ensure that everything is put to good use.
On another note, after discovering that a significant amount of useful medications and other health care supplies are discarded by hospitals throughout the country due to quality control purposes, I have begun to think about ways to possibly utilize these supplies that are not put to use here in the United States to help meet the some of the needs in developing countries. I will continue to ponder this situation and may work on it upon my return.
I will see everyone in Cameroon!
-Mark
---------------------------------------------
Friday, March 21, 2008
Contributions!
(This is my first try at a video!)
-Mark
---------------------------------------------
Saturday, March 15, 2008
Final Preparations
After many months of research and preparation, the final pieces of this mission are coming together. I received my visa from the embassy this week and I’m scheduled to get my Yellow Fever and Hep-A vaccines on Tuesday. I will also be gathering the rest of the supplies this week.
Thank you to all of you who contributed to this mission either financially, through prayer, or by sending items to take with me. I know that I will not be traveling alone, but with hundreds of individuals and four organizations that have sacrificed a significant amount of time and resources to make this happen. Your contributions will go farther than you can imagine.
If you would still like to send items for me to take with me for the Cameroonians, please make sure they arrive at my address (shown below) by this Thursday, March 20th. You may continue make financial contributions at any time.
Thanks!
Mark
---------------------------------------------
Friday, February 29, 2008
Location In Cameroon...
The following are observations of Banso by Phyllis Kaberry, a social anthropologist:
"The Nso are a people of the Grasslands region in the Northwest Province of Cameroon. Their traditional language is Lamnso (language of Nso) and their capital is Kumbo. Both the people and the capital are sometimes referred to as Banso (people of Nso) - the addition of the Ba prefix is attributed to the Fulani conquerors in the 17th century; the prefix resonates in the names of towns around the area.
The Fon is the traditional ruler. He is both the head of the traditional government and the chief religious authority in charge of keeping the ancestors happy. His power is kept in check by regulatory groups such as the "Ngwerong" (also "Nwerong") and the "Ngiri" (comparatively, lower and upper chambers of parliament). New Fons are selected from a group of eligible princes by a system kept secret from those eligible, thus eliminating a possible source of corruption. The present Fon is Sehm Mbinglo I. Young and dynamic, he has reinforced traditional authority and the respect for human dignity despite the pressures of the modern world. The princes are called WONTOH and regularly meet in the presence of the Fon to discuss family matters.
Nso society is divided into groups according to lineage. Each lineage group is lead by a "Fai". Tradition dictates that the hand of a Fai is not to be shaken. Fais can be recognized by their glass bead necklaces and fancy walking sticks. Several lineage groups are grouped together under a "Shufai".
Jujus, masked spirits, are an important part Nso culture. (The word "Juju" can also refer to some type of magic.) Jujus come out on important occasions. Ngwerong and Ngiri (the prince's society) each have seven jujus, often seen passing by on the way to the death celebration of one of the society members. The passing by of a juju being lead by its handlers and followed by children is quite the street performance. Other jujus include groups that dance to drums and xylophones.
Another traditional organization is "Mfu", a warrior society. Each village has its own chapter with its own meeting house where the group gathers every eighth day (the traditional week). It is a place where men in the village can come to hear the latest news and where the village leaders can disseminate information or organize village work. Most Mfu houses are richly decorated with carved posts, both inside and outside. To enter the Mfu house, one must wear a hat and a cutlass, and one must bring a drinking cup to partake in the drinking of "Melu" (raffia palm wine). Each member of Mfu must take their turn supplying the group with palm wine. When a member has done an adequate job of "celebrating" Mfu, the drums will come out for dancing."
-Mark
---------------------------------------------
Sunday, February 24, 2008
INMED Exploring Medical Missions Conference
INMED and a few other health care organizations are hosting an “Exploring Medical Missions" conference on May 30-31, 2008 in Kansas City, MO.
Some of the objectives of the conference are:
-How to prepare for international service with professional, cross-cultural, and personal skills
-How to choose a sending organization and select a community to serve
-The greatest issues in world health today
-The diagnosis and management of common diseases of poverty
-The principles of cross-cultural adaptation and communication
-The health interventions that are most appropriate for resource-poor nations
For the conference schedule and registration go to their website at http://inmed.us/conference.asp.
Check it out if you can! It should be a fun, informative, and thought-provoking couple of days.
-Mark
---------------------------------------------
Saturday, February 23, 2008
Shots and Plane Tickets
I headed up to University Hospital’s Travel Clinic in Cleveland this week. They were very complete and provided me with a large packet of information specific for the Northwest Province of Cameroon. This time I received three shots: meningococcal, adult polio, and flu. I was also given a set of oral Typhoid vaccine capsules, which I’ll probably start on Sunday as they’re supposed to upset your bowels quite a bit for the first round. They were out of the Yellow Fever vaccine, so I’ll be getting that in a few weeks. I haven’t decided whether I want to get the Hep A vaccine just of yet – if I do decide to get it, I’ll probably get it along with the Yellow Fever. I’ll be taking Doxycycline for malaria prophylaxis...I didn’t think the neuropsychiatric side effects from some of the other anti-malarials would be too much fun, even though you take them once a week instead of everyday as with the Doxy. They also wrote for a couple other antibiotics to take along with me for traveler’s diarrhea and other infections I may pick up.
I also purchased the plane tickets this week. Here’s my itinerary:
DEPARTING
30 MAR 08 - SUNDAY
Leave Newark Liberty at 6:15pm for Paris/Degaulle, arriving at 7:45am (3648 miles)
31 MAR 08 - MONDAY
Leave Paris/Degaulle at 1025am for Douala, Cameroon, arriving at 4:00pm (3127 miles)
I’ll be staying in Douala that night and then head out to Banso the next morning (an 8-9 hour drive)
RETURNING
09 MAY 08 - FRIDAY
Leave Douala, Cameroon at 10:45pm for Paris/Degaulle, arriving at 6:15am (3127 miles)
10 MAY 08 - SATURDAY
Leave Paris/Degaulle at 9:55am for Newark/Degaulle, arriving at 12:05am (3648 miles)
From there, I’ll be taking a non-stop flight back to Portland, Oregon to recoup for a week…then back to Ohio for a cardiology rotation.
Now that I have the plane tickets, my next step will be to get a visa…I’ll be working on that this week as I start my OB rotation.
-Mark
---------------------------------------------
I also purchased the plane tickets this week. Here’s my itinerary:
DEPARTING
30 MAR 08 - SUNDAY
Leave Newark Liberty at 6:15pm for Paris/Degaulle, arriving at 7:45am (3648 miles)
31 MAR 08 - MONDAY
Leave Paris/Degaulle at 1025am for Douala, Cameroon, arriving at 4:00pm (3127 miles)
I’ll be staying in Douala that night and then head out to Banso the next morning (an 8-9 hour drive)
RETURNING
09 MAY 08 - FRIDAY
Leave Douala, Cameroon at 10:45pm for Paris/Degaulle, arriving at 6:15am (3127 miles)
10 MAY 08 - SATURDAY
Leave Paris/Degaulle at 9:55am for Newark/Degaulle, arriving at 12:05am (3648 miles)
From there, I’ll be taking a non-stop flight back to Portland, Oregon to recoup for a week…then back to Ohio for a cardiology rotation.
Now that I have the plane tickets, my next step will be to get a visa…I’ll be working on that this week as I start my OB rotation.
-Mark
---------------------------------------------
Sunday, February 10, 2008
Sunday, January 27, 2008
In what ways can I contribute to this mission?
Consider contributing in the following ways...
-Financial Support (estimated costs are between $4,000-5,000)
-Prayer
-Writing letters of encouragement for the mission doctors and health care professionals who are currently serving in Cameroon
-Writing letters to the children of Cameroon (please include pictures of you and/or your family and pets)
-Conducting a medication drive in your small group, church, workplace, or school (i.e. putting a box out with a sign)
-Sending unopened over-the-counter medications or prescription samples that have not expired (aspirin, Tylenol, anti-diarrhea and cough/cold meds, antibiotics, inhalers, etc.)
-Sending health care supplies (bandages, gauze, tape, scalpels, latex-free gloves, suture, penlights, tongue depressors, cotton balls, etc.)
-Sending diagnostic instruments (old stethoscopes, manual sphigmomanomters, thermometers, etc.)
-Sending insecticide-treated bed nets
-Forwarding this link to your family and/or friends who you think may want to contribute
-Any other method you can think of – be creative!
If you would like to send any of these items, please send them to:
Mark Marshall
1436 North Road SE
Warren, OH 44484
Thanks!
---------------------------------------------
Saturday, January 26, 2008
Videos on Infectious Disease Prevention
In the 20th century, smallpox was responsible for an estimated 300–500 million deaths worldwide. The global eradication of this virus between the years 1979 and 1980 is arguably the most distinguished public health accomplishment to date.
Watch these videos from the Carter Center and Nothing But Nets to learn about other preventable disease processes and what simple actions are being taken to stop their vicious cycles.
Lymphatic Filariasis (Elephantiasis)
http://www.youtube.com/watch?v=pw7TSYLRrmQ
Guinea Worm
http://www.youtube.com/watch?v=u4kQWvUv_Ns
Onchocerciasis (River Blindness)
http://www.youtube.com/watch?v=eDFvhiQcwA8
Malaria
http://www.youtube.com/watch?v=D4LIsAgf_P0
---------------------------------------------
Watch these videos from the Carter Center and Nothing But Nets to learn about other preventable disease processes and what simple actions are being taken to stop their vicious cycles.
Lymphatic Filariasis (Elephantiasis)
http://www.youtube.com/watch?v=pw7TSYLRrmQ
Guinea Worm
http://www.youtube.com/watch?v=u4kQWvUv_Ns
Onchocerciasis (River Blindness)
http://www.youtube.com/watch?v=eDFvhiQcwA8
Malaria
http://www.youtube.com/watch?v=D4LIsAgf_P0
---------------------------------------------
Saturday, January 19, 2008
Global Health Goliaths - Issues and Challenges
You can view in a full screen on YouTube . . .
http://www.youtube.com/watch?v=pqS_g5OujBs
---------------------------------------------
Friday, January 18, 2008
Subscribe to:
Posts (Atom)
