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!

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.