It seems like I’ve been here in Banso (a.k.a. Kumbo) for much more than 5 days. It has been a constant adjustment as I am slowly getting into a routine of work at the hospital, research, and getting to know the town. It has been very helpful to have Lee and Kohta here since they know their way around both the hospital and are more familiar (at least more so than I am) with Cameroon.
Our mornings have mainly been consisting of getting up around 6 or 6:30am, attending morning report at 7:15am (i.e. usually a gathering of all the doctors where they present an interesting case or lecture), going back to the rest house for breakfast, then heading out to start working on the Pediatrics Wards around 8:30 or 9am. In general, there are no pediatricians working at Banso Baptist Hospital and normally, there is one nurse practitioner who takes care of all the pediatric patients, but she does not have any formal pediatrics training. Other times, visitors like us can help see the pediatrics patients. In just a few days, we’ve already seen many cases of malaria, sickle cell disease, HIV, pneumonia, and even a couple of parasites.
I think one of the most difficult things about practicing medicine here which became apparent very quickly (although not unexpected) is that the resources here are quite limited. So, while in the US for a certain medical condition, we would normally order a number of blood tests and imaging, we don’t always have the luxury of doing that here. This is especially hard when you have kids that are quite sick where you know there is still something medically possible to do for them and yet, we can’t. There are no CT scans or MRIs. No ventilators. No intravenous nutrition. No specialists (i.e. Cardiologist, Pulmonologists, Oncologists) to call if you need their expertise.
What’s more is that with every medical decision you make, the bill starts to add up. Even to be admitted to the hospital, families must make a deposit of 30,000 francs (about $66 in the US), which may not seem like a lot, but when you consider that each x-ray or blood test or dose of antibiotic adds to the bill, you can understand why some families just refuse to be admitted to the hospital.
Yesterday, Kohta and I had a very difficult case that really illustrated this. We went back to the hospital in the late afternoon just to check on one of the patients we had seen earlier that day and one of the nurses called us aside to evaluate a new patient that had just come in. He was 6 years old and otherwise healthy. His mom and uncle had brought him in because 4 days ago he had fallen out of a tree while playing and the day before he started to act “funny.” As soon as we walked over we knew something was terribly wrong because he was not responding and barely breathing. His neurologic exam was basically consistent with brain death. We have no way of knowing for sure, but he probably hit his head when he fell and had a very serious bleed in his brain. Now, in the US, we would have gotten a CT scan of the head, put him on a breathing machine, and called the neurosurgeons. The outcome may have been the same, but at least there would have been at least a little bit of hope. Instead, without any of those things available to us, we suggested to the family they just take him home. There was no need for us to keep him there when nothing we could have done would have changed his outcome and instead the family would just be left with a large bill to pay. So they took him home to die in peace.
I know this is not news. But it's still a shock when you see it firsthand.
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