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.

Arrival in Cameroon

I safely arrived yesterday in Banso, one of the more rural towns in the NW Province of Cameroon. It only took a 6 hour plane ride from NY to Paris, a 6 hour plane ride from Paris to Douala, an overnight stay in Douala, a 6 hour car ride north to the large town of Bamenda, and a 3 hour car ride up the mountains to Banso. Needless to say, I was exhausted by the time I arrived here last night and for the first time in a very long time, I went to sleep at 8pm.

Arriving in Douala airport was much less daunting than the Volunteer Coordinator’s email had suggested. All it took was some patience and being okay with large mobs of people waiting on an unorganized line – waiting for customs, waiting for your luggage, waiting to leave the airport. I had to suppress the New Yorker inside me that wanted to yell out, “Hey! Don’t even THINK about cutting me in line!” But, in reality, there wasn’t really a line – just a huge crowd of people. All in all though, my luggage arrived safely in Douala and the Cameroon Baptist Convention (CBC) driver found us with no problems. I guess it wasn’t too hard to pick out 2 Asian girls (Marcia and me) in a huge crowd of Cameroonians.

We arrived in Cameroon in the evening time so we stayed the night at one of the CBC guest houses in Douala, which was fairly nice with even a swimming pool (although it was too cold to swim). The next morning we picked up some breakfast at a local bakery and left early for the long drive up to Banso. The drive was long, but beautiful and, although it is just nearing the end of rainy season, there wasn’t a cloud in the sky. All of the landscape is lush and green and almost reminded me of the opening scene from Jurassic Park. I don’t really think the pictures fully capture how beautiful it is.

The drive up was fairly smooth – figuratively, not literally. The road itself has more potholes than I have ever seen in my life and avoiding them – even in the 4x4 vehicle we were riding in – was like a video game. There are many people selling fruit or snacks on the street and any time the car slowed or came to a stop 3 or 4 vendors would come up trying to sell peanuts or bananas or some sort of cassava wrapped in banana leaves.

When I arrived in Banso, I was happy to see Kohta (one of the other Med-Peds residents) and Lee (a Peds ID fellow), who are both Sinai doctors with whom I am working on a research project with. They have already been here for almost 5 weeks so they showed me around the hospital campus, introduced me to some of the hospital staff, and oriented me to the rest house we are staying at. The rest house is fairly nice and I have my own room, unless more people arrive, which it doesn’t sound like will be happening any time soon. We get 3 meals a day, cooked by 3 Cameroonian ladies and I have been well-fed so far. The biggest challenge has been communicating back home. The internet is only at the hospital and the wireless is not very reliable, depending on the rain, power outages (that can happen a few times a day), and how many people are on the network. I am working on getting a Sim card for my phone but that requires a car ride into town, so hopefully this week that will happen.

Today was my first full day here. We attended chapel this morning and during it, they asked if there were any visitors. I, obviously, could not just hide in the background because I would stick out like a sore thumb so I stood up and they asked me to come up to the podium in front of about 200 people and introduce myself. Luckily, Kohta and Lee were there for moral support. I attended morning rounds today on the Pediatrics Ward, where we see some interesting cases. I haven’t actually started working on the wards yet, but hopefully later this week I will.

More to be updated again soon, but so far, Cameroon has been nothing but welcoming.