Friday, June 29, 2018

Chuck at Mbingo in May 2018

Chuck was at Mbingo in May and here are some updates from his trip.

Guess the diagnosis?...TB is always a good guess.  In this case it is the largest TB pericarditis effusion any of us had ever seen.  He showed up as an outpatient with increased shortness of breath and had early tamponade on his echo.  He had 3L of fluid removed from around his heart by pericardiocentesis that night and a drain was left in.  He had another 1.5L removed the next morning.  He was put on TB drugs and steroids and will be followed and hopefully he will not develop constrictive pericarditis in the future.  We see a lot of this at Mbingo, but this was the most extreme effusion we had ever seen.

As Angela mentioned before when she was there in March, the CT scanner is up and running.  This shows a picture from the control room.  The technicians are doing a great job and we are getting digital images quickly.  The images are then sent over the internet and read by residents and faculty at Rush University usually within 24 hours.  The cost is very fair for our area in Cameroon and really as low as we can make it.  It costs about 50,000 CFA for a non-contrasted scan and a little more with contrast.  That is about 90 US dollars.

This is a CT scan that shows a ring-enhancing lesion from toxoplasmosis.  This is an infection in the brain associated with HIV.  It is treatable with antibiotics, but difficult to diagnosis without a CT scan.   This is one example of how the CT scanner has greatly benefited our patients.

The infrastructure at the hospital continues to improve.  This is the new pathology lab with plenty of space for preparation of slides and specimens.  You can see the new chemistry lab through the back windows as well.  There is finally room for all the staff and pathology techs that are helping Dr. Bardin (missionary pathologist/internist at Mbingo).  This is such a huge improvement over the small dark room that he had been working out of for years.

Chuck had 2 internal medicine residents join him on this trip.  This picture is from the back waterfall hike just after it started raining.  Daniel Herlihy (left) and Anthony Roohollahi (center) had a great time at Mbingo.  They both rounded on the wards and helped with teaching conferences.

This shows Anthony teaching the residents and NP students about the lung exam in our new conference room.  Anthony is doing a pulmonary/critical care fellowship next year and also spent time working in our ICU at Mbingo.

Daniel is doing a GI fellowship starting next year and was able to help with some endoscopy while at Mbingo.  This shows him in our new endoscopy suite with Emmanuel on the left (tech) and Dr. Albert Nyanga behind on the right (Internist and Assistant Program Director of the CIMS residency). Dr. Nyanga and Chuck helped Daniel with endoscopy and he did great job.

This is a picture from the new chapel church service for patients on Sunday mornings.  This service has been going for about a year and it provides a way for patients and families to go to church and worship God without having to walk to one of the local churches.  The chapel is right at the hospital and the service is run by the chaplains.  This is a great ministry and we enjoyed being a part of it. 

This is Dr. Chukwuemeka, his wife, and newborn son, Joshua.  He is a new PAACS resident (surgery) at Mbingo and he is from Nigeria.  When he found out he was coming to Mbingo in Cameroon, he did not know anything about our hospital.  He Googled it and found our blog.  He read the whole thing and felt better about moving his family to a new country for his training.  Chuck told him that he had to be on the blog now!

This tiny little frog was parked just beside the lock to our house.  He was there most of the day just enjoying his little spot.  We see frogs often, but never one this tiny or green.

Chuck had a good trip in May, but the political unrest in the Northwest and Southwest regions of Cameroon has continued to escalate.  Chuck thought he might have to cancel this trip, but was ultimately able to go.  Since he left, the violence has increased further and we are not going to be able to go this summer for our normal longer trip with our family.  At this time, no kids and no non-essential volunteers are able to go to Mbingo.  We are praying that this changes soon and that peace can return to Cameroon.  We are heartbroken about not being able to go, but even more so for our friends and family in Cameroon.  Please pray for them.  We know God continues to have a plan for Mbingo.

Wednesday, April 11, 2018

Angela Flying Solo...with her Dad

 I (Angela) just got back from my first trip to Mbingo without Chuck or the kids. However, I was not alone as I had the benefit of my dad (Mike Kimbrell) being able to travel to Cameroon with me.

My dad has volunteered at Mbingo several times in the past, but it had been awhile since he had the opportunity to visit. It was fun to show him the new buildings, introduce him to the new residents, as well as have him reconnect with people he had met on previous trips. In addition, it was such a blessing just to get to spend so much one on one time with my father. I cannot remember the last time, if ever, we have had that much time to be together. This is us on one of the hikes we did during our trip.

Mbingo continues to grow and provide better and better care to the people of Cameroon. Each visit, I love spending time with and teaching the residents. It is such a joy to see them grow in their knowledge of medicine, grow in their walks with the Lord, and to see them sharing God's love with their patients. The hospital structure is always growing, and with that is the improved ability to provide laboratory testing and imaging. We mentioned in our last blog that the hospital was installing a CT scanner. This was my first visit with the CT scanner functioning. In the US we take for granted that almost every hospital has a CT scanner and we can easily get needed scans for our patients. The CT scanner at Mbingo is one of only a few scanners available in the country. I wanted to share one quick story of how the CT scanner is already changing lives. A little girl came in with a neck mass that had been growing for 2 years and who had started to have respiratory symptoms. It was unclear on exam what was the origin of the mass, what kind of mass it might be, or what would be the best surgical approach. She was able to get a CT scan, which showed the mass coming off of her thymus and invading into her lungs. This allowed the surgeons to coordinate so that the head and neck surgeons and the chest surgeon where both present for her operation and were not surprised in the OR. She did great and went home with a smile on her face. This is a CT scan image for you medical folks out there. 

I also wanted to update you on a child from several years ago. About 5 years ago we raised funds for a heart surgery (VSD closure) for a little boy named Denis, who is the only child of a single mom. He did very well, but we knew he likely would need a second operation. A few weeks ago he underwent his second heart surgery (aortic valve replacement) at Shisong Cardiac Center in Cameroon. We were again able to help his mom raise the money for this surgery. Denis is a tough kid and did great with the surgery. This picture shows him after the surgery with his mom. One of the joys of going back to Mbingo every year is the continuity that we can have with people and projects there.

This picture shows my welcoming party in the Charlotte airport as we got home.  As with all of our trips to Mbingo, I am always filled with conflicting emotions. I love my time there. I love the staff, I love our missionary families, I love the patients and their families, but it is also hard. It is hard to be in a different culture. It is hard to face the poverty and the severity of medical illness. It is hard to leave and it is hard to stay. I often feel that my heart is split between two places, my home at Mbingo and my home in Charlotte. I think that tugging helps to remind me that earth is not our true home. No place should ever feel completely comfortable, because we are living in a broken world. So we continue to pray that God will use us for His glory whether it be in our trips to Mbingo or here in Charlotte. We continue to pray daily that He would make it clear how we can best serve Him. Thanks for reading!

Thursday, August 24, 2017

Mbingo 2017 - August Part 2

This trip to Mbingo is coming to an end, but here are some updates from the past couple weeks.

We welcomed the new class of CIMS residents earlier this month.  From the left, Dr. Tchinda Gerald, Dr. Eyambe Lydia, Dr. Chia Blessing, and Dr. Eke Marie  They are all Cameroonian and just graduated from medical school.  We look forward to continue working with them during their 4 year residency at Mbingo.

Each year we have a White Coat Ceremony to introduce the new residents and to welcome them to the residency program.  As the chair of the CIMS Advisory Board, Chuck took part in the ceremony.  Dr. Dennis Palmer (CIMS Program Director) gave the opening remarks, Chuck led them in repeating the Christian Physician's Oath, and Dr. Rick Bardin (faculty internist/pathologist) gave them their new white coats with the official CIMS patch on the chest.  In the picture, Chuck is giving them their copies of Harrison's Principles of Internal Medicine which they will read all the way through 2 times during residency (with weekly quizzes as well).

This is Dr. Sam Webb, an internal medicine resident from Charlotte that came with Chuck this month.  The picture shows him rounding on the men's ward with Dr. Ntusmi (2nd year CIMS resident).  He is planning on doing a palliative care fellowship in the future and was able to work with our palliative care team here at Mbingo including going out on home visits for 2 separate days.  This allows our palliative care team to see and help palliative patients (mostly cancer) that are not able to get to the hospital for follow up.  The team appreciated having Sam join them and he was able to see how palliative care can function in our setting.  It is incredibly valuable, but still rare in the developing world.

This is Dr. Ryan Humphries who is also an internal medicine resident from Charlotte.  He also came with Chuck to work this month.  The picture shows him rounding with Dr. Kinne, one of our upper level CIMS residents.  He is considering a nephrology fellowship in the future and in addition to rounding on the wards, he has been able to take care of a few patients receiving acute peritoneal dialysis (PD) for acute renal failure.  We have written about this PD program at Mbingo before, but it is very unique to be able to offer this at a hospital like Mbingo.  Chuck has been involved with overseeing Ryan and Sam's work and teaching them alongside the Cameroonian residents.  They have been seeing all sorts of diseases that are unusual in the US - malaria, TB, Kaposi sarcoma, advanced HIV, leptospirosis, schistosomiasis and many other challenging cases that are made more difficult in our resource-limited setting.

 This is Angela with Kennedy.  He is head of the vaccine program at Mbingo and does a great job in making sure the vaccination programs are running smoothly.  Angela has worked over the years to expand vaccinations at Mbingo like giving monovalent hepatitis B vaccine to newborn babies of Hepatitis B positive mothers and recommending needed vaccines to sickle cell patients.  This is in addition to the government expanding availability in Cameroon of what we consider to be normal vaccines for children.  There are many elements to a successful vaccination program like maintaining a cold-chain to keep the vaccines active, maintaining sterile technique, and getting the vaccinations to villages/areas that are difficult to reach.

Mbingo has been hoping to get a CT scanner for some time.  It is very complex to operate a CT scanner in our setting, but many of the hurdles have been overcome.  The CT scanner has been purchased and cleared customs and arrived this week (in 5 huge wooden boxes).  The new outpatient building has been built with a leaded CT scan room in the new radiology area.  In order to get to this point, we had to have the funds to buy the machine, a place to put it, an in-country supplier/contractor that could guarantee service to keep it running, and a way to get the scans read.  All of this has been done.  The final step is power.  The hospital already is running our transformer and generator at over 100% capacity (due to the rapid growth of the hospital) and it would be difficult to add the CT directly onto the electrical system as it consumes a massive amount of electricity.  The hospital is working on a solution, but upgrading electrical systems can be quite expensive.  We are hoping to get this resolved quickly.  Currently, the closest CT scanner is about 8 hours away in Limbe.  Sometimes we are able to send our sick patients (in a taxi with many other people) to get this done, but as you can imagine, many of our patients that need a CT scan are too sick to make this trip.  The CT scanner will allow us to provide better care to our patients and will likely serve many other hospitals/clinics in this region of Cameroon.

This picture is from Mbingo 2 church which is about a 30 min walk from our house.  Part of the service is in the local dialect (Kom) and there is plenty of African music - we love to visit there.  You can play "Where are Angela and Ben?" in the photo.  They are walking/dancing forward in the crowd to give an offering as part of a thanksgiving celebration for  an elderly woman who regained her ability to walk.

 Nora is enjoying the fresh air here at Mbingo.

Ben is really starting to enjoy hiking.  He did his biggest hike yet - the "Front Waterfall" this past weekend.  It is ~4.5 miles and 1000+ feet of climbing.  The waterfall is in the background and the valley extends the other direction.  Somehow we have hiked many times in the rainy season this trip and not gotten wet - a feat that will not be repeated!

This is Chuck and Isaac with Sam and Ryan at the top of a recent hike.  It has been great to have them here with us and let them see how God is using Mbingo to improve the healthcare of Cameroonians.

All dressed up in our African clothes.  We had these from a few years ago before Nora, so we will have to get an outfit for her next time!  We are sad to be leaving our Mbingo family and we are already looking forward to being back again.

Monday, August 14, 2017

Mbingo 2017 - August

We are at Mbingo and it is great to be back.  This is an update on what has been happening here.

This is Nora's first trip to Cameroon and she has been fully welcomed.  Many of our Cameroonian friends prayed hard for her when she was born unexpectedly with Transposition of the Great Arteries.  She had successful surgery at 6 days old and it was great to be able to share with our Mbingo friends how God provided healing for her.  The picture shows her with with some of the Cameroonians that came to our house for a party for the CIMS program (Christian Internal Medicine Specialization).

Malnutrition is a serious problem that is encountered often on the children's ward.  It is closely linked to extreme poverty and often requires a long hospital stay to get the child back to health.  The children require close medical care and nutritional supplements.  Education is also given to the parents on how to improve nutrition.  These WHO supplements are F-75, F-100, and F-150 (pictured) and are made here at Mbingo for the patients.  One of the problems is that these long hospital stays lead to bills that are difficult for the already poor families to pay.  There is now a dedicated Malnutrition Fund that seeks to raise money to lower the their hospital bills as a way to show God's love to these children and their families.  Donations are tax-deductible and are given through CHEF (Cameroon Health and Education Fund).  There is information on their website (http://cameroonhealthandeducationfund.com) on how to give, but make sure you designate the Malnutrition Fund as the recipient of your donation as they have other projects in Cameroon.  If you have interest in donating towards this much needed service and have questions, please email us.

Jane Murry Bryan is a high school student from our church in Charlotte.  She traveled with us to Cameroon this year and has been helping us a ton.  She watches our kids part of the day and then volunteers or observes at the hospital in the afternoons.  Our kids love her and it has made it easier for both of us to work at the hospital more.  She has really been part of our family here!  She leaves today to get back for school and we are all going to miss her.

Jane Murry, Angela, Isaac, and Ben are in this picture giving small gifts (crayons, coloring books, toy cars, etc) to the children on the peds ward.  Isaac and Ben helped pick out and buy some of the gifts before we left Charlotte.  Jane Murry has also been coming some afternoons to read to the children on the ward from the Jesus Storybook Bible.  We brought enough copies that she can give them away after she reads as well.

This picture shows the first child at Mbingo to survive surgery for a tracheoesphageal fistula and esophageal atresia.  Angela helped take care of the baby after surgery in the ICU.  This condition requires a large surgery for repair and careful support of the child after surgery.  Yes, the child is in a Britax car seat.  One of the surgeons thought of this idea to help with positioning of the child and it seems to have made a big difference.  This was a car seat from one of the missionaries here at Mbingo, but Nora has decided that she will leave her old infant car seat here at Mbingo to help with future cases like this.

Dr. Nkweta (2nd year resident) has been rounding with Dr. Nyanga (CIMS graduate and now faculty) in the ICU.  Chuck has been rounding on the adult wards and also helping with more difficult cases in the ICU.  It is excellent to see the Cameroonian faculty like Dr. Nyanga teaching and mentoring the younger CIMS residents.  We continually see challenging cases and high volume, but it is encouraging to know that the future of Cameroonian healthcare is in the hands of doctors like this.

Just a few miles from Mbingo in the town of Bambui there is an orphanage that we knew about, but had not had the chance to visit until this trip.  The Schilinskis are the missionaries that helped found it and along with some Cameroonian staff, help run the orphanage.  It is a loving, nurturing, compassionate, Christian environment for the kids to grow up in.

This picture is out front of one of the orphanage houses.  Helping Hands Children's Home (HHCH) is set up with individual houses where the kids can have a family-like atmosphere.  Each house can hold 10 boys and 10 girls with a house parent as well as a house aunt/uncle that lives with them.  They currently have 38 kids at HHCH with the possibility of expanding to as large as 120 kids in the future as they expand their infrastructure.  We had a great visit and look forward to stopping by again.

It is rainy season here which means beautiful green mountains and clean air, but a lot of water.  Nora is checking the rain gauge and says it has been averaging almost an inch/day.  It usually comes for a period of time in the afternoon/evening, so we have plenty of clear weather too.

One of Isaac and Ben's favorite activities is drawing maps on big banana leaves.  Certainly one of the things that you don't get to do in Charlotte.

Dr. Tumi, a recent CIMS graduate and old neighbor of ours, recently came back to Mbingo to visit and stopped by our house.  Barry and Isaac seemed to remember each other and both families have added 2 more kids since that time.  The kids loved playing together and were sad when they had to leave.  It is great to hear how the CIMS graduates are working at different hospitals around the country and the difference they are making.

Jane Murry with our crew at the "Back Waterfall".  It was a great hike with a powerful waterfall given that we are in rainy season.  We will miss Jane Murry these next couple weeks.  You are welcome to come back with us to Cameroon anytime!

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!