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.