"You Are Welcome Back in Cameroon!"

Today is my first day back in Cameroon.

We (Sr. Jerolin, driver John-Paul, and myself) left St. Padre Pio Hospital (in Douala, where we spent the night), at 5am - not a huge inconvenience for me, as I was up at 3:30am, thanks to the 9 hour time difference.  Due to our early departure, we agreed to eat breakfast on the road.

They mentioned a name, but it didn't ring any bells. I was very pleasantly surprised when, an hour and a half after leaving, John-Paul stopped at my favorite roadside fruit stand! While we made our purchases, we were treated to a breakfast of fresh pineapple and papaya by the proprietor.

This, friends, is the beauty of Cameroon - fresh produce, generosity, and friendship.

Being premature in the developing world

These are the two newest additions to our Neonatal Intensive Care Unit.  They are twin brothers, born at 29 weeks 4 days of gestation (roughly 7 months into the pregnancy), and today they are 13 days old.  They are not only very premature, but they are very small - the first twin weighs 1.25kg (2lb 12oz), and his brother weighs 0.9kg (1lb 11oz).  They are being fed through tubes going through their noses into their stomachs, because they are too young to breastfeed - they can’t coordinate when to swallow and when to breathe, so they would end up inhaling the breast milk.

The NICU here at St. Martin de Porres Catholic General Hospital is different from the NICU’s in the US.  Here, the incubators are made of wood and plexiglass, and they are heated by 4 lightbulbs.  We have 5 incubators, and currently 2 are occupied - one by the twins, and the other by a premie born at 29 weeks, who just turned 1 month old.  When the electricity goes out, if the generator cannot be turned on, then we use hot water bottles to keep the babies warm.  There is also an oxygen concentrator, but no other means of respiratory support, and no monitors.

Although it does not seem like much, this NICU is all that stands between these tiny babies and certain death.  I’m proud to be working at a hospital on the front line of healthcare!

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.