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.

My daily life in Cameroon

It’s hard to believe I’ve already been here in Cameroon 2 weeks, but it’s been easy to fall into a routine here. The mornings (Monday thru Saturday) – as I mentioned – usually involve going to the morning conference then seeing pediatric patients in the newborn nursery and Children’s Ward. There aren’t really individual patient rooms here and the ward consists basically of 1 big room with rows of about 30 beds. The hospital complex has multiple buildings (i.e. Men’s Ward, Women’s ward, outpatient clinic, operating rooms, etc.) that are all connected with outdoor covered walkways. I posted a few photos here, including some of the Cameroonian staff that we’ve been working with. You can tell that some of them are posed since the patient has a big smile on his face while Kohta and I are pretending to look at his leg. We usually finish rounding on the wards by around 12 or 1pm and we usually have lunch at the hospital canteen (which invariably involves rice and beans and maybe an orange Fanta if I’m feeling adventurous!).

The afternoons are usually spent working on our research project on the computer, entering data. Some days instead of working on the inpatient wards, we travel to various schools to administer our research surveys. We have dinner at the Rest House around 5:30pm which usually is a Western type dish cooked by the Cameroonian women who take care of the rest house (pasta, mashed potatoes, pizza, rice, etc.).

That being said, there has been no shortage of Cameroonian food to be enjoyed here. Something I’ve already had a few times – is called “soya,” (see photo) which are sticks of meat kebabs that are grilled and sold in stalls along the street. It costs 100 cfa per stick (about 25 cents in the US) and usually is eaten with “chips” which are basically French fries. The other night, one of the ladies that cooks at the rest house for us invited us over to her home for dinner. She made some traditional Cameroonian food including “fufu” (basically a big ball of bland corn, yam, or cassava), “njama-njama” which is a mash up of huckleberry leaves - looks like spinach but more bitter, and “groundnut (peanut) soup.” Another favorite of mine has been something called “puff-puffs” which are balls of fried dough similar to zeppolis. Sometimes they come with fish or beans or a hard-boiled egg inside (a.k.a. “Scotch eggs”) but I like the plain ones and there is always a big tray of them at the coffee break for the doctors. Needless to say, I have been well-fed here but I know by the end of my trip I will be craving a nice juicy cheeseburger or some sushi from back home.

This past Sunday I went to Mass at the Catholic church in town (St. Theresia’s Cathedral; see photo), which is about a 10 minute walk from the hospital complex. Most of the Mass was in English, but there were some parts that were also in “pidgin English” which is kind of a hybrid between English and the local dialect here and is spoken in about 10% of the country. The church was packed with people sitting shoulder-to-shoulder in the pews and the Mass was very lively with a lot of singing, not as somber as the Mass usually is in the US. It was also about 3 hours long.

All in all, life has been enjoyable, I'm learning a lot, and it's nice to have a break from some of the work responsibilities back home.

Animals on moving vehicles

I just had to share these photos of things I've observed while here. The first is a pig stuffed in the back of a car stuck in the middle of a bunch of bags of grains. The second is a guy carrying a sheep upside down while riding on the back of a motor bike.

Birthday weekend in Cameroon

Last weekend, we set out on a 5-day journey to Limbe and Buea which are in the Southwest province - about 8 hours drive from Kumbo.

We spent the first 2 days (including my birthday!) in Limbe, which is a coastal town with beautiful black sand beaches. We had fish along the water where you can buy the fish direct from the fisherman, have them grilled in spices, and eat them with your hands with bobolo (cassava). We had what they call “bar fish” here, which tasted pretty much like mackerel. We also went to the Limbe Zoological Garden (upon Alla’s recommendation), which is one of the few primate sanctuaries in the world and they had various chimpanzees, gorillas, etc. I included a picture of Kohta, me, and Gill (a doctor from Scotland who is also volunteering at CBC). The night of my birthday, the group surprised me with a tower of chocolate beignets complete with candles. All in all, a good birthday – at least as good as it can be being away from home.

We then traveled to Buea which was formerly the capital of Cameroon (for a short period under the Germans). There, we embarked on a hike up Mount Cameroon, which is over 4000 meters tall and is the 2^nd tallest mountain in Africa (the 1^st is Mount Kilimanjaro). It was a rough steep hike and unfortunately, I only made it about 3000m up before altitude sickness hit me hard. Kohta and Lee made it up to the summit – despite fog and rain – while I and the rest of the group waited for them. Regardless, it was beautiful scenery especially when you get up above the clouds. There is also a “magic tree” that we took a picture of – supposedly, it’s magical because it never seems to get closer no matter how much you hike towards it.

We returned home, exhausted.

Kingomen Waterfall

Last week we set out on a short hike near the hospital to visit the Kingomen Waterfall. Lee and I went with two American Peace Corps volunteers and a Cameroonian Green Care worker. It was about an hour’s hike away and on our way to the waterfall, we happened to walk by a primary school where classes were ending. As we were walking we soon realized we had a gathering of about 30-40 school children following us. I suppose they have a natural fascination with us since we look different from them and they often yell out “White man!” to get our attention which I think is funny since I am neither white nor a man. I guess this could probably be misinterpreted negatively but I think for these kids it is simply because they don’t know what else to call us!

The waterfall was nice and there was a small cave that you could walk into behind the waterfall. Not bad for a late afternoon activity after working in the hospital.

I included some pictures of the rest house we are staying in with the backdrop of the hills of Kumbo and also a picture of “Squares,” which is kind of the downtown of Kumbo where there are a handful of restaurants and small stands that sell vegetables, cooked food, supplies, etc. It looks more like a triangle to me rather than a square but hey, who am I to judge.

Jumping right in

(An entry from last week that i wasn't able to post due to lack of internet)

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.