A Global Village

Rene, one of the health educators I worked with in Kumbo, loves to say that the world is a “global village.” It really is true. It’s amazing that even being here in Cameroon, I’ve been able to communicate with family on the other side of the world via email, skype, and telephone. That’s why I know that I will still be able to keep in touch with many of the friends I’ve made here. At the Baptist Chapel service this morning, one of the doctors announced that I was leaving tomorrow and the chaplain led everyone – probably a group of about 200 people – in a prayer wishing me a safe journey home and that I should send their greetings to my husband and family back. This is only one of the many examples of kindness that has been shown to me here in Cameroon…and one of the many reasons I have had such a meaningful time here.

Pictured above is one of my favorite patients that I took care of on the Children’s Ward in Mbingo. She came in with anemia and this was taken on the day she was discharged. I knew she was well enough to go home when I walked into the ward that morning and she was singing Christmas songs! Pictured below are two doctors Kamdem and Alvine, who I worked with on the Children’s Ward in Mbingo. They’re actually both Internal Medicine doctors but because there is no pediatrician, they rotate through the pediatrics ward.

I am currently in Bamenda, which is one of the major cities in the Northwest region – about 30-45 minutes south of Mbingo. I've included a few pictures from around the town during my brief stay here. Note the woman carrying the bananas on her head. It never ceases to amaze me all the different things people are able to carry on their heads.

Tomorrow I will make the 6-hour journey to Douala, fly to Paris, then back home to NY. In some ways, my leaving seems very abrupt – there are still many more things I wanted to do, sights I wanted to see, and pictures I wanted to take. But, perhaps one day I’ll get to come back.

On my last day in Cameroon, while in Bamenda, I went to a crafts shop. While there, I was hungry so I wandered into a small café next door. I was shocked to see a latte on the menu, so obviously I had to get one. (Apparently, this is the place where all the non-Cameroonians come to get coffee.) While I was drinking my coffee, a Cameroonian couple sat down next to me. The man introduced himself and his wife. We made small talk for a little bit – some questions about Obama and what I thought of Osama bin Laden and whether I thought we were ever going to have a cure for HIV (It’s World AIDS day on December 1^st). The humor in this conversation started when the wife noticed my wedding ring and asked how much my husband had paid my parents for my bride price. I told them he paid nothing, I was free of charge. Then, about 10 minutes later, another woman appeared and the man introduced her as his wife. Interesting. And another 5 minutes after that, a 3^rd woman appeared and he introduced her as his wife as well. “In America, do they allow a man to have more than one wife?” the man asked. I told him no. One of the women said, “You should tell your husband that you met a man in Cameroon with 3 wives.” I told them, I probably won’t. I don’t want him to get any ideas. We all had a good laugh.

When I got back to the Bamenda Baptist Hospital campus where I am staying the night, right around the corner from the hostel was a man and his son who were selling some Cameroonian wood carvings. This man, named Joseph (almost everyone I’ve met here has a biblical name), makes all the wood carvings himself and many of them are quite impressive. He told me that he had an idea for what he should call his stand and that he wanted to name it after an American store. “Oh, really? What store?” I asked. He said that he wanted to name it “Trader Joe’s.” I laughed and said that that would be a good name and that I love shopping at Trader Joe’s. He also insisted that I take a picture wearing this hat made of feathers. He said that before, queens used to wear hats like this. It didn’t feel very “queen-like” when I was wearing it.

In less than 48 hours, I will be back in NY. I am sad to leave Cameroon since it feels like there is still so much more to learn and experience here, but I cannot wait to see Matt, my parents and Brian, and everyone else back home. When I told one of the chaplains after the service this morning that I had mixed feelings about leaving, she said to me, “You have to go, in order to go back.” How true that is.

Sacrament procession in Kumbo

I was finally able to upload this video of the Sacrament procession in Kumbo from a few weeks ago.
You can see a long procession of people with some of the students from the Catholic school who are studying to be nuns. Underneath the yellow canopy is the Blessed Sacrament.

Mbingo

The first few days at Mbingo have been a combination of difficult medical cases and really enjoying the peacefulness of the area.

Just like in Kumbo, everyone has been very welcoming. I am staying at the rest house here where we get 3 meals a day and is located right on the hospital campus (less than 5 minutes walk to the Children’s Ward). Mbingo is a very small town without a downtown area, really. It is located in a valley that is surrounded by beautiful hills. All the hospital buildings are yellow with red roofs. The hospital is similar in terms of facilities as Banso Baptist Hospital and has men’s, women’s, maternity, and children’s ward. The main difference is that the Surgery department is very robust here and the surgical ward is quite large. They have an orthopedic surgeon, ENT surgeon, and 10 surgery residents.

In the rest house (pictured above), there is quite a mix of people staying. There is an Emergency Medicine resident from Toronto, an older couple who are both anesthesiologist from Scotland, and a couple from the Netherlands where the husband is doing cleft lip and palate repairs here. Before Anna, the ER resident, arrived, it was basically me and a bunch of…how should I say…old people. I mean, old enough to be my grandparents. So, needless to say, I was happy when Anna arrived. There are a number of missionary doctors from America and Australia that live here and they have been very kind and have shown me around. This past Saturday, we all went on a hike. I was worried someone might break a hip, but everyone made it on the walk without any problems, thankfully!

On the Children’s Ward, I am basically the only (partially) trained pediatrician here. Because of this, I’ve really learned to look everything up because there isn’t really any pediatrician more senior than me to consult with. I’ve even sent a few emails to people back home asking their opinion on difficult cases. By far, the most difficult patient I’ve had while here in Cameroon is a young 5-year-old boy that had been brought in for fevers and confusion. He had been to a few different hospitals and clinics before coming to Mbingo Hospital. When I saw him, the 2 most likely things in Cameroon to cause his symptoms are cerebral malaria (malaria that infects the brain) or meningitis. We tested him for malaria and it was positive so we promptly started treating him. However, even after almost 48 hours he wasn’t getting better and, in fact, was getting worse. I thought maybe instead he actually had meningitis and we did a lumbar puncture (spinal tap), but this was negative for meningitis. Because I was worried about this patient, I went to check on him a few times and he was much, much worse and actually was having strange muscle spasms. This is when it occurred to me that, in fact, he most likely had tetanus. Most often people get tetanus after a bad wound. (This patient did not have any wounds.) We don’t worry about it much in the US because everyone is vaccinated. But here – especially since it is a largely agricultural community where most people aren’t vaccinated – it is not so uncommon. We don’t have ways to test for tetanus here other than the symptoms that the patient is having so I decided to treat him for tetanus.

Later that day, the nurse called me because the parents were requesting to be discharged. He hadn’t even gotten any of the tetanus treatment. I asked them why they wanted to go and they said they wanted to bring him to a traditional healer. I explained to them that he has tetanus and basically without treatment he would die. They still insisted. They said they knew that their traditional healer would heal them. I called the chaplain to see if she could intervene but despite 3 hours of discussion with them back and forth they insisted to bring him home. Without having received treatment.

I couldn’t sleep that night thinking about this boy, knowing he will likely die at home. Medicine in some ways is simpler here – you don’t spend time debating what tests you should do or which specialist to call because you don’t have them available. Instead, what you deal with are the conflicts of “Western” medicine vs. traditional medicine, adequate medical management vs. minimizing cost to the patient, the desire to provide treatments despite the gross lack of availability.

The truth is, with this case, if we were in the US and the parents wanted to bring the patient home, we would have referred the case to Child Protection Services (CPS). If a child has a life-threatening illness and the parents are interfering with treatment of that illness, then we as pediatricians have the right to take legal action. There is obviously no such thing here.

Cute kids!

Goodbye Kumbo

As I write this post now, I’m actually at Mbingo Baptist Hospital about 2 hours drive from Kumbo. I’ve decided to spend my last week or so in Cameroon on the Children’s Ward at Mbingo Baptist Hospital. It’s hard to believe that it’s almost time for me to come home. I’m looking forward to going back and seeing my family and friends, but it also feels like just when I’m getting used to life here, I’m getting ready to leave.

My last week in Kumbo (the town where Banso Baptist Hospital) has been great.

This past Sunday, I actually got up to go to church and when I got there, all the church doors were locked. Luckily, a nice lady that was sitting outside the church told me that because it was a special holiday that Mass was being held at the Fon’s Palace in Kumbo and she actually walked me down to that area. A fon – as per Wikipedia and what I’ve gathered while being here – is the chief of a region in Cameroon and are most commonly found in the Northwest (where Kumbo is) and West regions. They don’t really have much political power now, but are still highly respected. Anyway, when I got there the Mass was already half over but then they started a long procession back to the church, complete with singing and dancing. I tried to include a short video, but it wasn't uploading so i included a picture instead. They called this feast “Sacrament” because they travel throughout the town with the Eucharist (under the yellow canopy). It’s been interesting to see how other Catholics practice and even though I’m working at a Baptist hospital, almost 25% of Cameroon is actually Catholic.

This is a picture of the Fon's Palace.

Pictured here is Vera, one of the Cameroonian nurse practitioners who works on the Children's ward at Banso Baptist Hospital. She is fantastic and is basically taking care of all of the children that come into the hospital (since there is no pediatrician on staff).

Here are 2 Cameroonian doctors that I've been working with. On the left is Dr. Ebogo who works on the Adult wards. On the right is Dr. Simo who takes care of the patients on the Maternity Ward and the HIV clinic. He is the only doctor at the HIV clinic right now and one of his most recent frustrations is that there are no HIV meds available. In all of Cameroon. All of the medications for HIV actually come directly from the government and are free. But, very frequently, the government runs out of money to supply HIV meds. Although Cameroon is a fairly politically stable country, what I've learned since being here is that many government officials are actually quite corrupt. Many of the Cameroonian doctors suspect there actually is money allotted for HIV meds but some of that money is falling into the pockets of politicians. It is quite sad when patients come to the hospital over and over wanting to get their anti-retrovirals and they keep having to be turned away because there aren't any available.

Today I left Kumbo and traveled to Mbingo. It was a beautiful, scenic drive and we stopped to overlook Lake Oku. It’s apparently spans 60 miles wide (for reference, Lake Michigan is about 300 miles) and is sort of the pride and joy of the area and also the subject of many local myths. Many people are actually afraid to go swimming in it or even to go to the base of the lake. I admired it from a safe distance!

Ok, that's it for now. I will post pictures from Mbingo soon.

The real Bush Experience

As part of the research project that Kohta, Lee, and I have been working on, we travel to various schools to administer surveys to adolescents about their risk-taking behaviors. At the same time, when we visit the schools, we lecture about various health-related topics including HIV and STDs. One of the great things about this project is that we get to travel to many places in Cameroon (concentrated in the Northwest region) and see much of the countryside.

Earlier this week, we travelled to what Cameroonians call “the Bush.” (Not the “bush experience” I referred to in my prior post! Although there were many of those along the way!) When people say “the Bush,” they usually mean a very remote area in the countryside without electricity or running water. We went to 2 villages (Nkor and Lassin), which are about a 3 hour drive from Kumbo. It takes 3 hours not because it is a very far distance, but the roads are un-paved and very rocky and you can never really go more than 5 to 10km/hr maximum. I would compare it to being on an old wooden roller coaster. Continuously. For 3 hours. With no air conditioning.

While there, we visited 4 different schools where kids between the ages of 10 – 18 years old attend. It was quite an experience. Many of the students had never seen a non-black person before so as we were driving through the villages, many kids would start running alongside the car waving. A lot of them also had never even seen a computer so our powerpoint presentation on a portable projector was also pretty popular. Pictured here is Rene, one of the Cameroonian health educators with whom we’re working on this research project. He is lecturing to the entire Government Secondary School in Nkor.

The other cool thing is that after our lecture, Rene said he wanted to play soccer (a very popular sport here). He basically just found a large open space, blew a whistle 3 times and within 10 minutes local kids started coming to the field for an impromptu soccer game. Here I am with some of the kids who decided we were just going to be spectators (can you find me?! J). They basically spent most of the game asking me questions about America.

While in the area, we visited one of the CBC clinics in Lassin. The day that we were there was the mother-child clinic so many women came with their babies for check-ups and also to hear a lecture on vaccination and nutrition. The facilities are simple with a few beds for maternity and adult wards. I posted a picture of a few of the women who came to the clinic to point out 2 things: (1) The many different beautiful patterns of their clothes, and (2) The way they wrap the babies to carry on their backs (definitely a whole lot more economical than a Baby Bjorn!)

Pictured here is one of the traditional huts in this area of Cameroon (this one is still under construction). The base is usually made out of red stone and the roof is constructed from wood planks topped with many layers of dried grass. It’s amazing that they don’t leak when it rains! Every 5 or 6 years, they change the grass that covers the roof. Inside, the floor is usually also made out of stone and furniture is made from bamboo. And yes, those are 2 chickens on the chair that happened to wander inside.

Favorite things so far

It’s hard to believe I’m more than halfway through my stay here in Cameroon. Since I’ve been here, there have been some things that I have grown to appreciate.

1) “Ashia” – this is a phrase in pidgin English that is said to mean “I’m sorry” usually relating to some sort of hardship or misfortune. If I end up staying in the hospital working later than normal, for example, people come up and say to me “Ashia, doctor” to mean I’m sorry that you still have work to do. Or, if you trip and fall or if you’re carrying something visibly heavy, people may say to you “Ashia.”

2) “You are welcome” – I have heard this countless times since I’ve been here. Usually people say it not in response to “thank you” but to actually express a welcoming attitude since they know you are a foreigner. It’s just a really nice thing to hear and sometimes even random strangers on the street will say it.

3) Greetings – Greetings are very important here. Everyone says “good morning,” “good afternoon,” or “good evening.” At first, I thought it sounded so formal, but I have since gotten used to it. Also, when you see someone you know like an acquaintance or a friend, you always greet them with a nice firm handshake. I’ve probably shook more hands here in the past 3 weeks than I have in my entire life.

4) Going to school in the morning – Because we have taken numerous early morning drives to nearby towns, we often see many school children walking to school in the morning. All schools have uniforms and you can usually tell what kind of school they go to depending on their uniform color (in this picture, the blue color signifies a Baptist school). You literally see dozens of kids of all ages walking to school by themselves – some no more than 3 or 4 years old at the most. If they see you driving by, they often wave with the occasional “white man!” shouted.

5) Tree – I don’t know why, but I really like this tree. It’s on my walk from the hospital to the “town” area.

6) The Market – Every 8^th day, there is a big market where various vendors sell anything from fruit/vegetables to fabric. Often people yell at you to come into their stall and take a look, but usually a “no, thank you” will suffice.

7) Our house ladies – As I mentioned before, there are 3 Cameroonian women who take care of the rest house I am staying at. They basically are there 6 days a week and they keep the place clean, cook meals, etc. All 3 have been taking care of this rest house for many years and are very motherly to anyone staying here. Just today, one of them insisted I take a snack with me to work. They’re also all very concerned that I am lonely and bored (since Kohta and Lee have both left), but I reassure them I’m fine!

Things I could live without:

1) Dust! – I arrived right in the transition period between rainy season and dry (a.k.a. dust) season and it’s amazing how much red dust there is EVERYWHERE. Now I understand what my parents were talking about when they said they don’t like to eat outdoors. That is frequently not a good option here. It’s also amazing to me that the nurses’ uniforms are always perfectly white despite the dust.

2)

Power outages – I have become well-acquainted with my flashlight. Electrical outages happen probably at least once daily and can last anywhere from a few minutes to an hour or two. Luckily since I am staying at the hospital, there is a backup generator so power usually comes back on.

3) “The Bush Experience” – This is just a nice way of saying peeing in the bushes, which is often necessary on long drives. I never leave home without a roll of toilet paper.