Wednesday, April 19, 2017

Mbingo 2017

Chuck just got back from a 2.5 week trip to Mbingo.  It was the first time Chuck has been to Mbingo without the family.  It was hard leaving Angela and the kids, but it was great to be back to see our "Mbingo family".  Here are a few photos from his time there.

Chuck and JR Young (pediatrician) traveled together to Mbingo this time.  JR is actually still there working for another 1.5 weeks.  Chuck came back sooner since we are planning on returning for about 6 weeks this summer (with Angela and the kids!).

Chuck brought an internal medicine resident with him from Charlotte.  This is Dr. Stephen Beasley rounding on the men's ward with 2 of the African internal medicine residents and a house officer.  Stephen is doing a great job and will be staying for another 1.5 weeks to finish his month long rotation.  He has been rounding/teaching on the wards, leading conferences, and doing procedures.

Stephen has already matched into a GI fellowship for next year.  This picture shows him trying to load the esophageal bands onto the six shooter by hand while Denis (endoscopy tech) looks on.  This device is used to treat esophageal varices (enlarged blood vessels in the esophagus at risk of bleeding usually from liver disease).  Chuck was able to start teaching him to do EGDs while at Mbingo and he continues to improve.  He will have plenty more time to learn endoscopy in fellowship, but this was his first and likely his last time to load the esophageal bands by hand!

Dr. Kamdem (recent CIMS graduate) who Chuck taught to do EGDs and colonoscopies has become quite proficient.  Here he is looking on as he teaches one of the 4th year CIMS residents, Dr. Christelle, to do an EGD.  This is incredibly exciting to see those residents that we have taught passing on their knowledge to the next group of residents.  This is happening on the wards, in clinic, in conferences, and with procedures.  God is using this residency program to affect the quality of medical care that Cameroonians will have in the future.

Chuck was able to spend some time with Dennis Palmer (CIMS program director) while at Mbingo.  Dennis was just returning from India where he was formalizing a partnership with the Christian Medical College at Vellore.  This is an incredible hospital that serves the Lord by providing medical care in India and is able to provide essentially all of the services we would expect from a large hospital in the US.  Our CIMS (Christian Internal Medicine Specialization) residents at Mbingo are going to be able to do 4-6 month rotations at this hospital as part of their training.  We are very excited about this opportunity.  Dr. Kamdem (pictured above) just returned from spending 3 months at Vellore to advance his GI technique in endoscopy.

Here are 3 of the 4 new CIMS residents.  From the left, Dr. Ntumsi, Dr. Nina, and Dr. Tadfor.  Unfortunately, Dr. Nkweta was on vacation and missed the picture.  These 4 residents have been a great addition to the CIMS program.  Chuck enjoyed working with each of them on the wards, in the ICU, and in conferences.

 This chest x-ray shows severe TB with a military pattern as well as cavitary lesions.  It is also notable that it is a picture of a computer screen.  Our digital x-ray at Mbingo is working well and is now being automatically uploaded to the new EMR system.  Dennis Palmer has put an incredible amount of work into this.  Most of us were doubtful that it would work given the other challenges we face at Mbingo, but it is working quite well.  We are even able to pull up a patient's labs and imaging on our smartphones/tablets at the bedside.

Some of our patients try traditional medicines/therapies before coming to our hospital.  Cutting is a type of traditional therapy in Cameroon.  Small cuts are made in the skin at the site of pain or swelling in the hope that it will offer relief.  We sometimes see the negative effects of this such as infection.  This picture show a patient's leg with the small cuts visible.  His leg was swollen from a blood clot (DVT) and the unpictured part of the leg also had cellulitis (infection) likely from the cuts.

Chuck was happy that he was able to be at Mbingo for Easter.  The celebration of the resurrection of Jesus starts early with a sunrise service on Mbingo Hill (which involves a pre-sunrise hike up the hill in the dark!).  This procession up the hill is accompanied by drums, dancing, and singing.  This picture shows part of the crowd singing and dancing just as the sun was rising.

After the mountain top sunrise service, the crowd walks down the hill and along the roads back to the church.  Again, there is singing, dancing, and praising God the entire way.  Once we arrived back at the church, there was a celebratory church service.  The joy of Easter is so easy to see among the believers in Cameroon.

A trip to Mbingo would not be complete without some incredible hiking.  This picture shows Dennis Palmer leading Chuck (and JR who is taking the picture) on a new route.  We went through farms, over wooden plank bridges, up the right side of the mountain range and then wrapped back around behind the prominent mountain in the distance (aka half dome).

This picture was from a hike on a different day.  We were able to get to the top of a mountain that looks down on an incredible waterfall.  The rains have started at Mbingo, so the waterfalls are starting to strengthen and the landscape is quickly turning green again.

Chuck and JR bought this load of mangos, pineapples, avocados, bananas, and papayas on the way to Mbingo and then finished it all in less than 2 weeks.  There are many things we miss when we are not at Mbingo and this is certainly one of them.  More importantly, we miss our Mbingo family and the ability to serve those in need, teach the residents and other learners, and share the love of God with patients that travel near and far to receive medical care.  We are looking forward to the next trip in July!

Sunday, May 8, 2016

Mbingo 2016 - Part 2

It is hard to believe that this trip to Mbingo is coming to an end soon.  Here are some updates from the past few weeks.

Operation Christmas Child is a program through Samaritan's Purse that allows people in America to pack shoeboxes full of toys and other gifts for children in other countries.  Many of you have probably packed a shoebox in the past.  Many churches have the boxes and instructions to help you take part in this around the Christmas season.  Those shoeboxes are delivered throughout the year to remote areas of the world to children that have few if any toys.  When the shoeboxes are given out, the children also get to hear the Gospel.  This past week, Operation Christmas Child made a delivery of shoeboxes to the School for the Deaf here at Mbingo.  We got to take part in this and Isaac even got to hand out some shoeboxes.  There was incredible joy on each child's face as they opened the shoebox full of toys and other gifts that was just for them!

In addition to rounding on the wards and leading the teaching curriculum for the CIMS program, Chuck has been involved in improving the care in the new ICU (opened last year).  This picture shows Dr. Nshom Ernest and Dr. Tumi Divine.  Dr. Nshom is a 2nd year resident working in the ICU this month and he has a specific interest in critical care.  Dr. Tumi graduated last year from the CIMS program and spent 3 months at Kijabe Hospital in Kenya learning critical care in their ICU.  He now helps greatly in the day to day management of the ICU patients at Mbingo.  Our ICU is certainly more limited than what you would see in the US, but it is a great step up in our ability to care for the sickest patients here in Cameroon.  Chuck has been teaching on oxygen delivery, BiPAP use, shock, sedation, and ventilator management to the CIMS residents and the ICU nurses.

This picture shows some of the ICU equipment we have been using.  The first item is a BiPAP machine to deliver "ventilator-like" treatment to a patient through a mask without an endotracheal tube (breathing tube).  The second machine is a baby CPAP machine.  This had been donated and had not been used because the staff at Mbingo was not sure how to use it.  Angela figured it out (including calling the support line in the UK) and started using it and teaching others how to use it.  The third item is one of our ventilators.  They are quite basic, but Chuck sorted out the settings and how to best use it here at Mbingo.  It is the minority of patients that would benefit from it here, but it is great to have for those people it can help.  One challenge is that we use 5L oxygen concentrators to deliver oxygen and even though we often put two machines together, this setup is still far less than optimal for intubated patients.  There are other technology limitations in our ICU, but things are changing here fast and we are excited about the future.

Angela has also been teaching a pediatric resuscitation course to all of the children's ward nurses.  She has been doing this before or after rounds and even on a couple evenings to catch the night nurses.  Ethan Helm is the full-time pediatrician here at Mbingo now as part of the Samaritan's Purse Post-Residency Program (the same 2 year program that we did).  Angela has been able to work with him some as well as round on the ward to allow him to work on other projects at Mbingo.

This picture shows Chuck with Dr. Norah (4th year resident) and Tom and Edie Welty.  Drs. Tom and Edie Welty have been involved in healthcare in Cameroon for many years and more recently focused on public and women's health issues.  They have asked Chuck to join the board for CHEF (Cameroon Health and Education Fund).  This is a non-profit organization that helps fund projects in Cameroon including many projects at Mbingo.  Chuck will be the Mbingo representative on the board as well as learn about other projects in Cameroon.  One of the most recent projects involved raising money to help fund Dr. Norah and other residents to do their ICU rotation in Kenya.

SIL (Bible translation ministry) has a helicopter to help them get into remote areas of Cameroon.  They also use it when needed to fly patients to Mbingo that would otherwise not be able to get here.  This picture shows Isaac and Ben with some of the Schmedes kids (ENT missionary surgeon) after a recent helicopter arrival.  Chuck has taken care of a few patients brought by helicopter over the past few weeks.

One of our favorite things to do at Mbingo is to have Isaac and Ben go to the children's ward and hand out gifts about once a week.  This year, they brought cars, coloring books, crayons, and blankets.  This gives the kids on the ward something to do and play with and allows us to show God's love in a tangible way.

This is Ben with Dr. Kamdem - a recent CIMS graduate who has continued to work at Mbingo.  Each year we host a big dinner party at our house for all of the CIMS residents, house officers, and nurse practitioners.  Dr. Kamdem arrived to the house and Ben immediately went to sit beside him.  We enjoy hosting this dinner and it is a great way for all of us to connect outside of the hospital.

This is a mango fly larva (aka tumba fly).  We had heard about these, but never experienced them before this week.  It is similar to the botfly of South America.  The mango fly can lay eggs on wet clothes as they dry on the clothesline.  The larva then gets under your skin when you wear the clothes.  They cause a boil and if not removed, will grow for 3 weeks before dropping out of your skin.  Gross!  Isaac and Ben both developed these boils on their skin this week.  We knew they looked a little funny, but then realized that they were indeed mango fly larvae.  We covered them with vaseline to block their air hole and then pulled them out with a tweezer.  Isaac and Ben each had 2 spots and now are gladly larva free!  This picture is of the last larva we removed.  We are now going to invest in a dryer as this eliminates the opportunity for eggs to get on your clothes.

Isaac continues to do incredible hikes.  This was from the top of the "Three Sisters".  It is a hike that he has been planning since our trip to Mbingo last year.  It is 8 miles and has 2000 feet of climbing with a summit over 6500 feet.  The final ascent involved pushing through a fern field and through some fairly dense vegetation.  You can see the hospital in the distance off of Chuck's right shoulder.  This is essentially the hardest of the usual hikes at Mbingo.

Here is Ben hiding in a grouping of banana trees.  He loves to play outside and is enjoying activities like this that he can only do in Africa.

When we leave we will miss our Mbingo family, but look forward to seeing our family and friends in Charlotte.  Thanks for all of your prayers during our trip.

Monday, April 18, 2016

Mbingo 2016

As many of you know, we have been at Mbingo now for a little over 2 weeks.  It has been busy, but we have enjoyed being back.  Here are some updates from our time so far...

The trip over was pretty smooth.  Isaac and Ben love watching movies on the plane instead of sleeping - they get this from Angela.

This past week, Angela started teaching a 2 week course for the nurses in the maternity ward.  The goal of the course is to teach the nurses to provide good care to the newborn babies.  At the end of the course they are called "Baby Care Providers".  They then are responsible for seeing the newborn babies and notifying a doctor if there is anything abnormal.  There is never enough medical staff for the doctors to see all of the babies, so this allows the physicians to focus on those that have a possible abnormality or illness.

This is Victory.  Some of you may remember her from an earlier blog post (click here to go to that post from 2013).  She swallowed a caustic alkaline solution and had severe esophageal damage.  Chuck started dilating her esophagus in 2013 to help relieve the stricture.  She has continued to get dilations at Mbingo over the past 2.5 years (every 4-8 weeks) and is almost to the point of not needing them anymore.  This time Chuck injected some steroids (Kenalog) into the stricture through the scope to hopefully decrease how much the esophagus strictures in the future.  She is a very sweet little girl and her mother has diligently brought her to every needed appointment over the past few years.  It is great when we can have this kind of follow up with patients when we are back at Mbingo.

Two internal medicine residents from Carolinas Medical Center in Charlotte came with Chuck this trip.  Julie Harris and Priscilla Givens are both 3rd year residents in the residency program where Chuck is an attending.  Julie and Priscilla have been rounding on the wards and the ICU, doing procedures, and have been able to do a few outreaches as well.  They went with Gilda (one of the palliative care nurses) to do home visits in some nearby villages for patients with cancer.  This involved doing exams, delivering morphine for pain control, and offering support in any way needed.  This is a unique program that Mbingo offers and it was great that they were able to take part in it.  Julie and Priscilla also went to New Hope Village on another outreach.  The picture shows them with the team that goes on Wednesdays to the leprosy village just a few miles from the hospital.  The village is made up of patients that have been cured of leprosy, but for a variety of reasons needed a new home.  The hospital created New Hope Village to meet this need many years ago.  Now leprosy is often cured before severe disfigurement and patients are typically accepted back into their villages.  New Hope Village has provided a home and support for many leprosy patients through the years.

 If you were looking for one of the ways that Mbingo has changed dramatically since we first came in 2012, the lab would have to be at the top of the list.  When we first arrived, there was a basic hematology machine and a simple chemistry machine.  The chemistry machine could do one test on one sample at a time.  Now there is a room full of high tech lab equipment with a full assortment of staff.  In a very early post (click here) from 2012, we told you about how we used some donated money to buy a chemistry machine for the hospital.  That machine is still in use (far left of this picture), but is now small compared to the new machines the hospital is using.  The mixture of dropping prices for these machines and increased availability have allowed us to provide improved lab services to our patients and thereby improving their care.  We still have frustrations like running out of reagents for the lab tests, ants crawling into a machine and obstructing the reagents (true story), or labs not drawn on time and results delayed, but we are thankful for the incredible progress that has been made.

The CIMS (Christian Internal Medicine Specialization) residency program at Mbingo has a weekly Bible study.  This used to be led by a hospital chaplain or one of the missionaries.  Over the past year or so, we have turned the leading of the Bible study over to the residents.  Each resident leads about once every 2 months and they have been doing a good job.  It usually starts with singing a couple songs and then a time for the resident to share something from the Bible with some discussion and prayer.  This past week was especially good as Samuel Kafoe led a Bible study on suffering.  Samuel is a doctor from Sierra Leone and is training with us for 4 years before going back to Sierra Leone to work in his home country.  He worked in Sierra Leone in the midst of the Ebola epidemic and has seen suffering far beyond what any of us have experienced.  Despite this, his faith in God remains strong.

This is Julius.  He is the head chaplain at the hospital and Chuck has gotten to know him pretty well over the past couple years.  The chaplains provide spiritual support to our patients here by sharing the Bible with patients in their local language (pidgin English, French, or local dialects) as well as praying for patients and their families.  Julius is also in charge of the "Needy Patient Fund".  This is supported by donations and provides for those patients that truly have nothing.  Julius is able to give them money for food and clothing or even money to pay for transportation to get home.  He represents the front lines at Mbingo of providing for the least of these... (Matthew 25:40).

Angela is now 31 weeks pregnant and feeling well.  All of our Cameroonian friends at the hospital have been happy about us having another child.  They think of Isaac and Ben as Cameroonian children and say this child will be too.

This picture is from the top of "Half Dome" - about 7 miles round trip and one of our favorite hikes.  Isaac continues to be a strong hiker and Ben hitched a ride in the pack on Chuck's back to the top.  Angela did about half the hike before the pregnancy finally slowed her down.

Isaac and Ben have been playing with Charlie Shinar almost every day since we arrived.  Charlie's parents are Josh and Lori Shinar.  They are missionaries to a more remote area of Cameroon, but have been at Mbingo for the past few weeks as Josh has been helping work on our internet/network.  Lori has also been watching the boys in the mornings so both of us can work at the hospital.  They left today and we will all miss the Shinars.

Thanks for your prayers for our time here at Mbingo and for following along with us.

Friday, September 11, 2015

Mbingo 2015 - Part 2

Our time at Mbingo on this trip is quickly coming to an end, but a lot has happened in the past few weeks.

These are the 4 new CIMS (internal medicine residency) residents.  From the left, their names are:  Sih Colette, Kafoe Samuel, Epande Richard, and Sunday David.  Colette, Richard, and David are all Cameroonian and graduated from the new medical school in Buea, Cameroon.  They were pictured in the White Coat Ceremony from the last blog post.  Samuel is from Sierra Leone and just arrived yesterday to Mbingo.  It always takes some time to get the necessary paperwork to travel between African countries, but we are happy he has made it.  He represents a big step for the CIMS program - he is the first resident that we have accepted from outside of Cameroon.  Like the other residents, he will train at Mbingo for 4 years, but at the end, instead of working here in Cameroon, he will return to Sierra Leone to serve the people there.

This is a picture of the new ICU at Mbingo.  It is functional now and Chuck has been rounding with Dr. Albert (3rd year CIMS resident pictured) on the critically ill medical patients.  The ICU allows better nursing oversight and monitoring, improved respiratory support, and dopamine infusions for shock.  In addition, we have treated 3 patients (2 adults and 1 child) with peritoneal dialysis in the past 6 weeks and this care is delivered in the ICU.

One of the benefits of returning to Mbingo regularly is getting to see patients in follow-up.  We wanted to share one miraculous story of healing here.  This is a picture of a little girl who came to Mbingo all the way from Gabon (south of Cameroon) who presented at 4 months of age with a massive vascular tumor of her right shoulder and chest (likely a kaposiform hemangioendothelioma for the medical folks). The tumor was consuming all of the little girl's red blood cells and platelets and causing her to have trouble breathing.  She required several blood transfusions and we ultimately treated her with chemotherapy, steroids, and a year long course of propranolol.  She was critically ill, but survived.

 Angela got to see her again on this trip to Mbingo and this is her now!  She is currently 2 years old, she has had no further tumor complications, and is doing very well.

Chuck has also been rounding in the female ward.  As you can see the beds have been full and even overflowed to the orthopedic ward last week - 30+ patients!  Dr. Ernest (2nd year resident pictured on the right) has done a great job of teaching the first year residents and helping the house officers on daily rounds.

Last weekend we hosted the CIMS residents and spouses to our house for dinner.  It was great to spend time together and enjoy some non-medical conversation.  It is always inspiring to hear where they each came from to get to where they are today.  God has had a hand on each of their lives.  We had the hospital kitchen make jellof rice and chicken for the dinner (local favorites) and Helen baked her famous chocolate chip cookies.

This is Isaac going with Angela to the children's ward to give out some gifts.  He gave bouncy balls, toy cars, and crayons with paper.  He wasn't sure about the ward at first, but then opened up and was excited to go back a few more times.  The kids on the ward are always happy to see him and to get some toys!

 Isaac has also been busy doing some incredible hiking on Saturdays.  Two weeks ago, he hiked to the "Back Waterfall".  It is a 7 mile hike with 1500 feet of climbing that starts at 5000 feet.  Chuck was amazed that he made it there and back and the last 45 minutes was in driving rain.  Last Saturday, Isaac hiked to the top of "Half Dome" (pictured) which is a 6.5 mile hike with 1000 feet of climbing.  All of this and he just turned 5 years old this week!

 Ben has been having a great time here as well.  This shows him after church getting some help from a Cameroonian boy in catching grasshoppers.  The older boys helped him get a good hold on them.  His other favorite activity continues to be digging in the dirt with what he calls his "trouble" (aka "shovel").

We also had a snake at the very edge of our yard.  A man saw it while digging a hole and killed it.  It was not very big, but he thought it was poisonous.  After it was dead, Isaac and Ben got a good look at it. 

Angela's Dad, Mike Kimbrell, has been here with us for the past 3 weeks.  He is an internist and has been rounding on the men's ward each day.  After rounding, he has been helping watch the boys the rest of the day.  Isaac and Ben have loved having Papa here!  He will be traveling back to the US with us as well which will really help on the plane and through the airports.

We are heading back to Charlotte soon so we look forward to seeing our family there, but we will miss our family here at Mbingo.  We are already planning to return to Mbingo in the spring!

Wednesday, August 26, 2015

Mbingo 2015

As many of you know we are back at Mbingo and have been since the beginning of August.  We are able to stay here for 6 weeks on this trip.  We wanted to give you an update on how things are going.

The flight over went really well.  The boys slept and watched some movies and there were no breakdowns.  They adapted to the time change very quickly.  This picture shows Benjamin sleeping in a relaxed pose in his seat.  Thanks for buckling your seatbelt for landing Ben!

The teaching school year starts on August 1st at Mbingo, so Mbingo was welcoming the new residents just as we arrived.  Dennis Palmer is in the US while we are here, so Chuck has been filling in as the CIMS (internal medicine residency) program director.  This involved speaking at the White Coat Ceremony for the new residents just 2 days after arriving.  PAACS (surgery residency) was also involved with the ceremony.  The picture shows Chuck speaking while the other CIMS and PAACS leadership is at the table and the new residents are off to the left.

Chuck was also able to bring two residents from Charlotte with him this time.  Chuck is on faculty at Carolinas Medical Center and has developed an international rotation for the internal medicine residents there.  This was the first trip for them to come with him to Mbingo.  The picture shows Dr. Ruchi Jain rounding on the female ward with the ward team.

Dr. Todd Gandy is the other resident that came and this picture shows him rounding on the men's ward.  He is surrounded by two CIMS residents, a house officer, and a nurse practitioner student.  Todd and Ruchi were able to round on the wards, lead daily teaching conferences, and do many procedures.  They did ultrasound-guided fine needle aspirations, thoracenteses, paracenteses, bone marrow biopsies, and even a few EGDs.  They also enjoyed many hikes into the beautiful mountains here.

This is a picture of the GeneXpert machine.  It is a PCR test for tuberculosis.  It is much more accurate than looking for AFB on smears and we finally have one at Mbingo.  Prior to this we were sending our samples to be run on a machine in Bamenda.  The machine takes about 2 hours to run a sample and can do 4 at a time.  You can see the blue topped specimen container that fits directly into the GeneXpert machine below.  The results are then displayed on the computer to the left.  This machine has made a huge difference in our ability to diagnose TB and therefore properly treat our patients.

Yes, that is a chicken in our house.  We bought a chicken, but we were not able to get it killed that day.  While we were out of the house, he got out of his bag and was wandering around the house.  Chuck tried to guide him back to the mudroom, but the chicken was having none of it.  Finally, we had to trap him, pick him up, and carry him back to a box to keep him in until the morning.  Isaac and Ben thought this whole thing was hilarious.

It has been raining like usual in August at Mbingo.  Everything is nice and green and the boys are enjoying walks, rain or shine.  This is Ben walking around with Angela.  This is one of the rare times he was standing under the umbrella.

This picture shows Isaac and Ben with Nathaniel at the Mbingo II Church.  Nathaniel is the oldest son of Jason and Meridith Axt.  Jason is one of the faculty surgeons here at Mbingo with the PAACS program and a friend from Nashville, TN.  We kept Nathaniel for them for the weekend while they celebrated their anniversary with a weekend trip.  The boys had a lot of fun together.  The Mbingo II Church has been expanding and recently put the walls and roof up on this new building.  It is fully functional now while they continue to raise some money to fill in the walls and finalize the flooring.

Helen has been able to cook for us at our house again this time.  This picture shows her making cookies while the boys watch.  Her banana bread and cookies are hard to beat!  We are thankful for her help.

Mbingo really is a paradise for our little boys.  They drive their toy trucks, dig in the mud, collect bugs, swing sticks, and get as dirty as possible.  This picture shows Isaac with his bug collecting box. He is showing some new colorful bugs to Ben who is pushing his toy truck around.

Did we mention mud, rain, shovels, and getting dirty.  Here are the boys digging in a puddle behind our house after a heavy rainstorm.  They are usually so dirty by the end of the day that they have to have baths/showers before coming inside for dinner.

Thanks to all of you for following along on this trip.  We appreciate all of your prayers and support.  It has been great to reconnect with our Cameroonian friends here and jump right back in to work at the hospital.  Thankfully, we still have another 2.5 weeks here before heading back to Charlotte.