For fear of being judged…

This week on call was a tough one for me.  Every week on call can be difficult, but this week I encountered a situation that I still have not been able to fully process.

We admitted an elderly man early in the evening, in his 70’s, with ascites, severe abdominal pain, and hypoxia.  Lab tests showed bacterial peritonitis (an infection of the fluid that had built up in his abdomen) and Hepatitis C, with the beginnings of liver and kidney failure.  We put him on oxygen, and I started him on high-dose antibiotics.  He was unable to eat or walk.  I discussed all of this with his family the day after his admission, and they seemed to understand the severity of his illness, and seemed eager to continue his treatment.

That evening, after just 24 hours of admission, the family decided that he was not getting better fast enough, and so they wanted to take him home.  I explained that, due to the severity of his illness, if they took him home, he would most likely die on the trip.  I explained that the oxygen and antibiotics were the only things keeping him alive, and it would take more than 24 hours to see any improvement. 

It has been my experience here that families want their loved ones to stay in the hospital if they are sick, even when we tell them that the patient’s illness is terminal, and the patient would be more comfortable at home. They tell us taking them home is seen as abandoning them, refusing to help them, and this will cause the whole community to judge them. So this family’s request was very strange.  Strange not just for me, but also for the Cameroonian nurses involved with his care.  But they insisted “We will take him home”. 

So I asked some more questions.  They said, yes they were worried about cost, but their main concern was that, because the decision to bring him to the hospital had been theirs, if he died here, the rest of the family would blame them for his death. They believed that if they took him for the several hour trip over rough roads by a public taxi, they could deliver him to another family member.  It would be the other family member’s responsibility to take care of him and if he died there, they would not be blamed.

So they left – ending treatment, and refusing to take any pain medications with them.

No amount of reasoning by me or the nurses would change their minds.  I harbor no false hopes that he survived the trip.  I do pray he did not have to suffer long.  I pray that his soul is resting in peace. I can’t help but add to this prayer the hope that IF his family would be making decisions for another person they will be thinking more of the patient’s needs than how they may be judged by others.  And yet I know there are complexities to relationships, and responsibility here I cannot possibly understand.  This week on call was a tough one for me. 

  

A Day in my Mission Doctor Life

6:00 AM    
Wake up

6:30 AM    
Out of bed (I am not a morning person)
Breakfast is homemade bread with various toppings and tea.

7:00 AM     
Hospital Meeting

9:00 AM    
Rounds on the Female Ward
These rounds usually include 5-10 women.
Today, at least 3 of them speak no English and no Pidgin, however, with the help of a nurse translator, we make due. 
                    
Rounds on Pediatrics Ward
There are usually 3-8 children on the Pediatric Ward. 
Today, we have two on oxygen, a three week old and an eight month old.  And, a 12-year-old patient with cellulitis, reactive arthritis, and typhoid fever.  The last patient is only 9 weeks old, having severe apnea episodes. 
       
Rounds on Neonates
This is the fun time where you get to play with cute babies.
Currently, we have four newborns; all of them have been or are currently being treated for neonatal sepsis.  One is a premature baby, the others were all born at term.

1:00 PM  
Time for Lunch
I usually go home, reheat leftovers and browse Facebook.

2:00 PM  
Rounds on the Surgical Patients
We currently have 10 or more surgical patients that we are consulting on for diabetes, hypertension, and kidney disease mostly.  Also, we have 2 patients who have just been diagnosed with HIV, so we are getting labs in preparation for starting HAART (highly-active antiretroviral therapy).

5:00 PM   
Saturday Evening Mass at the Hospital Chapel

6:00 PM   
I visited Mission Doctors, Brent Burket and Jennifer Thoene.
This was my last day on call, so I signed out to Brent who will be taking over for me.
Jennifer fed me dinner.

7:00 PM  
Back to the hospital, to check on a sick baby.

8:00 PM  
Home to rest.

12:30 AM  
Called in for an emergency cesarean section.
Thank God, baby is okay

3:00 AM   
Ride the high of a healthy baby back home to bed.

5:30 AM  
Called in for the morning fasting blood sugar of a diabetic woman.
Blood sugar is higher than 300, insulin ordered.
       

Medical Realities

I spent the first month of my time in Cameroon shadowing and working with fellow Mission Doctors Dr. Brent Burket and Dr. Jennifer Theone, as well as Dr. Eugene Chiabi, a Cameroonian physician and the Chief Medical Officer here at St. Martin de Porres Catholic Mission Hospital.  One thing I have learned is that the daily highs and lows of hospital medicine are so much more pronounced here in Cameroon, compared to at home in the US.  Nothing is routine here. 

For the last two weeks, I have been working solo, doing daily rounds on the Female Medical Ward, the Pediatrics Ward, and the Nursery/NICU.  It has been a hard introduction into the realities of practicing medicine in a developing country.  I had three babies die within a week of each other.  One newborn and two 8-month-old babies, and I couldn't do anything to save them.  If they were in the US, they would have been in the ICU, on ventilators, with all sorts of IV lines and medicines, and they may have lived.  But that technology is not available here. 

On the other hand, I was able to discharge a child who was admitted with malaria meningitis.  He came in with seizures, unconscious.  Now he smiles all the time, and is acting as mischievous as any 4 year old.  Sometimes I'm amazed at what medicine can do, and other times I'm furious that it can't do enough.  I'm only 2 months in, and already it's so much harder than I had imagined.  God is teaching me a hard lesson in my own limitations.

Adventures in Packing

A few things you should know about packing to move half way across the world:

    1.    You have no idea what you will actually need.
    2.    150 lbs is not actually that much.
    3.    You will never have enough time to feel truly prepared.

I spent 3 weeks gathering everything I thought I would need, consulting 4 different lists - one made by me, one by Joy Newburn (who has been in Bamenda with her family for 3 years with LMH), one by Dr. Jennifer Thoene (who has been in Njinikom with her family for 2 years with MDA), and one by Janice England, the LMH Director, who spent 4 years in Sierra Leone on her own LMH mission.  I carefully checked off everything that I would need.  I had a week to organize and pack everything.  I took over my parents’ downstairs room, and labelled and categorized everything - Electronics, Household items, Bathroom, Kitchen, Food, Clothes, Medical, Personal.  I had a list of everything I had gathered, so that I could check it off as it went into my suitcases.  And then, all of a sudden, it was Saturday night, 12 hrs before my plane would take off, 10 hrs before I had to be in the car, bags packed, driving to the airport, and still everything was in neat groupings.  I had planned everything, and yet somehow forgot to plan time to actually pack!  Needless to say, I did not sleep that night.  I found out that, although my suitcases were big enough to hold most (but not all) of my things, they certainly were NOT going to weigh 50 lbs each.  I packed and repacked my suitcases several times that night, experimenting with weight and size, trying to decide what the most important things were, but really having no idea how to make that decision.  It was hell.

In the end, I got 3 suitcases and 2 carry-on’s into my dad’s truck, and was at the airport in plenty of time to wait for the plane with the rest of the passengers.  I made it to Njinikom with all my bags, and am getting settled in my new home, but that’s a story for another day.

Messy Bedroom

Njinikom, Cameroon

My Commissioning

I wanted to share with you a brief video of my commissioning from last month. 

Reflection on Formation

I wrote this reflection on the Formation Program for the Mission Doctors newsletter and wanted to share it here too... 

Today is the last week of Formation.  My class is being commissioned on Sunday, and then we disperse, back to home and family for a few weeks before starting our missions in Cameroon.  But it wasn’t until now that I finally started to realize what I have gotten myself into.

When I first contacted MDA, and came to the discernment weekend, I was planning on practicing medicine long-term in some remote part of Africa.  I was trying to find the right group to go with, as heading to Africa alone, as a single woman with virtually no experience, didn’t seem like a smart idea.  What I was really looking for was a facilitator for my dream - I already knew what I was going to do in Africa, I just needed someone to get me there.

Enter MDA.  I was impressed by what I saw during discernment, and later at the MDA board meeting.  Many members of the board were veterans, who loved the experience they had so much that they wanted to continue on in another capacity.  The organization ran smoothly, everyone got along, and they had plenty of experience.  They would be good facilitators for my dream.

Formation started 4 months ago.  I joined four other lay missionaries, shared the same house and the same meals, and had classes with them every day.  This was definitely more difficult than I had anticipated - I had been living on my own for five and a half years prior to formation, and I was not used to changing my habits for others.   The classes, while interesting, were frustratingly lacking in medical instruction.  I wanted to learn how to treat cerebral malaria, and how to make rounds in a hospital with 200 beds, 5 physicians, and no EHR.  I wanted to learn everything I could about practicing medicine in a resource-limited, rural hospital, but instead, I was learning how to interact with other cultures and people, how to acknowledge and validate my own culture and emotions without imposing them on others, and how to incorporate God and prayer into my daily life, and to make it a part of me, rather than just something that is done at Mass.  This was all well and good, but how would it help me to treat the child with severe malnutrition, or the pregnant woman with HIV?

Gradually, I became aware that my mission was not going to be to practice medicine in Njinikom, Cameroon - that would be a part, for sure - but that my mission is to go to Njinikom, meet people, form relationships, learn the culture, and let them change me.  The medicine, while important, is secondary.  As Elise would tell me, my gift to them is myself, not my medical knowledge.