Happy Christmas

We are getting into the Christmas spirit here.  The standard expression here is "Happy Christmas" instead of "Merry Christmas".  We start each day at chapel where two groups sing a couple of Christmas songs each.  It has been fun to see all the nursing wards, hospital administration, different doctor groups, and even the carpenters and metal workers up front singing.  The whole month is together called the "Christmas Singspiration".

This picture shows Irene (head nurse), Norah (medical resident), and Alex (nurse practitioner student) on the men's ward.  Irene was inspecting the medicine cart which is used to carry the medicine around to each patient.  As you can see, it can barely make it down the narrow middle aisle when we are rounding.

This is Kamdem, one of the medical residents, working in one of our newer clinic rooms.  The residents round on the wards in the morning and see patients in a clinic room like this for the rest of the day.  The residents all have interesting backgrounds of school and work.  For example, Kamdem did medical school in the Democratic Republic of the Congo and then worked in Cameroon for almost 10 years before joining the residency.  There are very few doctors in Cameroon that have had any training beyond medical school as it is not required.  This is why the CIMS program at Mbingo is such a great resource to improve the level of medical care in Cameroon.  Kamdem is halfway through his 3rd year and he will be quick to tell you how much his medical knowledge and patient care have improved since he started the residency.

This is Keith Streatfeild (anesthesiologist) with a nurse anesthetist student on the female ward.  Chuck was caring for a young girl with severe hypoxia and was unable to give her enough oxygen with our basic oxygen concentrators.  Keith had recently been home to Australia and built a homemade CPAP (continuous positive airway pressure) machine that requires no electricity and runs off the oxygen concentrators that we already have.  This was the first time we used it and it improved her oxygenation from the 40% range into the 90% range.

This is a Fulani man that lives near the hospital.  The pediatricians recently took care of his son and we saw him on a hike towards his house.  He is always thanking us for caring for his "pekin", which is pidgin for child.  Now that we have been here over 10 months, we often see many local people that we know on walks to the market or hikes through the mountains.

With Christmas comes the dry season.  This is good if you don't like rain, but bad if you don't like dust or the color brown.  In thinking about this, it gave us a chance to remember how our yard looked when we first arrived and the changes that have happened since.  This first picture shows Angela hanging up hand-washed diapers (before our washing machine was installed) on our falling down clothesline in our dirt/rock yard.

And this is how are yard looks now.  Grass and plants have been planted and thrived during the rainy season.  The clothesline was repaired and moved behind the house to allow for a bigger yard.  You can even see Isaac's swing hanging from the side of the clothesline.

We also wanted to give an update on the NICU renovations.  The incubators have been built and this picture shows them.  The carpenters built the top part and the metal workers the bottom.  Then the electricians installed lightbulbs below the baby's bed for warmth and a thermometer to control the heat.  They really did a nice job.  The NICU room is almost done and we look forward to showing you the finished product soon.

This picture is from the Christmas Singspiration at chapel when the missionaries sang.  We were led by Kaye Streatfeild and also benefitted from JR Young's parents being here to visit and willing to sing with us.

This is a typical load of fruit after going to the market on Saturday.  Isaac likes to help unload the bags and pass them to us as we wash them all in dilute bleach water.  All part of the routine here at Mbingo.

We are also getting excited about Christmas because we will be going back to the US to visit our families over the holidays for a few weeks.  We look forward to seeing many of you while we are there.

Thanksgiving

Happy Thanksgiving to all of our friends and family at home. This was the first big family holiday that we have missed, but we are thankful for the missionary family and friends that we have here in Cameroon to spend the holiday with. Fitting to the season, we have also had some wonderful successes recently at the hospital.

We had a large potluck Thanksgiving dinner last night.  This shows the spread just as we were about to dig in.  Unfortunately there are no turkeys here in Cameroon, but we ate delicious chicken, vegetables, and desserts.

Now to what we are thankful for at the hospital recently.  This baby was a 7 week old twin who came in apneic (not breathing), cyanotic (blue) and lifeless. He had a severe case of bronchiolitis that his twin unfortunately had already died from. Thanks to one of our pediatricians (JR Young), a wonderful CPAP machine that was donated, and God’s provision, this child was resuscitated. He stayed with us for several weeks and finally was able to make it home.

Baby Victory (aptly named) came in as a newborn with meconium peritonitis and perforation. Stool got stuck in his intestines, causing a hole which stool leaked out of. He was operated on 3 times due to new perforations and leakage. He was only intermittently able to eat. However, he was a strong and resilient baby. He survived all of these surgeries and has gotten up to full feeds. He is still in the hospital due to a wound infection, but he should be going home soon. It is amazing that such a small baby survived so much.

This little one was born at term and expected to be a healthy baby but then we noticed swelling of his scalp, that continued to get worse and worse. He had a subgaleal hematoma (which is a rare type of bleeding that can happen between the skin and bones of the scalp). Babies can lose a lot of blood this way. This baby’s hemoglobin dropped to less than 4. Unfortunately, the hospital at the time did not have the correct blood type to give him a transfusion. We thought he would die overnight, but he held on until we were able to get blood the next day. After the transfusions and some phototherapy this little baby was able to go home with his parents.

We are thankful for our new bedside ultrasound.  This was donated from Angela's dad's office.  We have been using it for quick bedside evaluations, FNAs (fine needle aspirations), and teaching the residents the basics of ultrasound.  This picture is of Chuck and Kamdem finding the mass in a liver before doing an FNA.  Christy Lee (OB/GYN) has even started using it for some urgent evaluations when there is not time for a more formal ultrasound by the hospital techs. 

We are thankful that Isaac really enjoys playing with Cathen.  He is always watching out for her and likes to take her by the hand when we go walking.  Sidewalk chalk is their new favorite activity.  When playing together, he occasionally bulldozes her over, but she is very forgiving.

We are thankful for the new wildflowers that we see on all of our hikes now.  They are a beautiful addition to the landscape, but they seem to signify the end of the rainy season as the rains have officially stopped.

We hope you are as thankful as we are for the blessings God has given all of us.  We continue to be thankful for the support each of you give us here at Mbingo.

Church

We wanted to introduce to the churches around Mbingo.  We primarily go to church a few houses down from where we live, but like to visit some of the other local churches when we can.

 This is Mbingo Baptist Church on a typical Sunday as church is finishing.  We officially joined this church a few months ago, so it is where we go most weeks.  You can see all the people in this picture crowded on the front lawn to fellowship after the service.

This is the inside of Mbingo Baptist Church.  The service lasts 2 hours or so and includes plenty of singing, some dancing, and a sermon from the pastor.  The service is in English, which makes it easy to listen and enjoy.  We have many hospital employees, some patient caretakers, and other visitors attend each week.  It truly is an extension of the ministry of the hospital.

Isaac usually cannot make it through the whole service, so he gets to go outside and play with the other children.  This is him running with two of his Cameroonian friends.  They love to just watch Isaac and touch his white skin and blonde hair.

Some Sundays, we take the walk to the Mbingo II Church.  Mbingo II is the nearby village where many of the hospital employees live.  It takes about 30 minutes to walk there along the path.  This picture is the view as you approach the village.  As you can see, things are still very green here as the rainy season is just now coming to an end.  As we walk through the village, we see many of our coworkers at their houses and greet them.

This is the Mbingo II Church.  It is basic and still under construction, but it has a roof and some chairs and is a truly African service.  You can see all of the produce to be given in the offering outside the door as people head in for the service.

This is the inside of the Mbingo II Church.  The service is in English and Kom (local dialect).  The music is a mix of English and Kom and there is always plenty of dancing.  This usually occurs around the time of the offering.  They are all certainly cheerful givers!

This is what you get when you try to get a 2 year old to pose.  Angela was taking the picture and asked Isaac to smile.  No matter how many times we tried, his "smiles" involved opening his mouth and closing his eyes.  We thought it was funny anyway.

We always look forward to sharing with you all about our lives here in Cameroon.  If there are other things that you would like to know about or have questions, don't hesitate to email us and we can try to add it to the blog.

Thanksgiving

We continue to be stretched daily in our medical knowledge and abilities here, but God has been faithfully providing what we need to care for our patients.

This is the Men's Ward.  This photo was taken just after Chuck rounded on the 32 patients with the team of residents and nurse practitioner students.  The beds line both sides of the room and extend into an extra room at the end of the middle walkway.  Each patient has a family member that serves as a caregiver to provide food, clean clothes, bathe the patient, etc.  The nurses are only able to provide the direct medical care (IV fluids, medications, vital signs, draw blood, etc).

This chest x-ray is from a 24 year old boy with TB pericarditis.  He presented with shortness of breath, chest pain, and edema.  He has a large pericardial effusion (fluid around the heart) that is seen on the chest x-ray and confirmed by echocardiogram.  Chuck did a pericardiocentesis (needle into the sac around the heart) on him and got bloody fluid back.  He was also found to be HIV positive and this makes the pericardial effusion likely to be due to tuberculosis.  We have actually seen quite a few pericardial effusions like this recently and the challenge is making the firm diagnosis of TB in order to qualify for the TB medications from the government-funded treatment program.

Chuck had a big success story from last week.  A 17 year old boy presented to the hospital with severe anemia after having bloody stools for 3 days (melena).  Chuck did an EGD and found an actively bleeding duodenal ulcer.  He had the pharmacy mix up an epinephrine solution and loaded the new injector into the scope.  He then removed the loose clot on top of the ulcer and injected the epinephrine around the ulcer and the bleeding stopped.  Just after the procedure, the boy dropped his blood pressure and had to be resuscitated in the EGD room.  By the grace of God, three days later, he walked out of the hospital with no bleeding and feeling much better.  This photo shows Gideon and Emmanuel who work in the EGD room holding the injector and the scope.

Yes, that is a snake in a bottle.  Lindsay was on call a few nights ago and got the call that a child was presenting with a snakebite to the face.  The family brought the snake in to the hospital in this bottle and Nesoah (surgery resident) is examining it in this picture.  It was decided that it was indeed a green mamba, but that the bite had not released venom.  We don't have many snakebites here so the antivenom is not always readily available, but thankfully it was that night (even though they ended up not needing it).  Green mambas can be incredibly deadly, but they usually like to hide and stay away from humans.

This is Angela with Chuck Miller.  Chuck is an 82 year old pediatrician who came to work for 2 months at Mbingo with us.  He has an amazing story of clearly feeling God's call to the mission field around the time of his wife's death and has been busy doing mission work around the world ever since.  In fact, he was heading to South Sudan just weeks after leaving Mbingo.  We pray that God will continue to use him through caring for children around the world.

This week was Thanksgiving at our church.  It is quite different than what we are used to.  There was a point in the service when people walked to the front to give their offering of money or produce.  Many people at the church have almost no money, but are farmers and can bring their "first fruits" to give to God.  After the service, the produce was sold to other members of the church with the money going into the offering.  This picture shows the "auctioneer" taking bids for this basket of corn.

This is Isaac and Barry playing in a puddle down the street from our house.  Barry is the son of one of the medical residents and is about the same age as Isaac.  They chased each other, picked up rocks, and dipped leaves into the different puddles until they were both dirty and worn out.

Thanks for following along with our adventures here at Mbingo Baptist Hospital.  We thank God for the opportunities that He gives us to serve here on a daily basis.

Back to Work

We had a great vacation and have been back to Mbingo for almost 2 weeks now.  The volunteers covering for us did a great job and we really appreciate them coming and working and allowing us a much needed break.  We feel much more refreshed and energized to serve.

 This is the current NICU (neonatal intensive care unit) at Mbingo.  Improving the state of this unit is our current big project.  There are 2 old incubators in the NICU and only one works correctly.  Often there are 2 babies in the one incubator and 2 more that could benefit from incubators as well.  We have already started having 3 wooden ones built locally that could be used for larger babies.  The hospital is working to buy another one like the ones in the picture because this type is needed for the tiny babies.  We are also going to completely gut the room and hopefully have room for 5 incubators and a nurse and a mother in the room.  There are many babies that would have a better chance of surviving here at Mbingo if our NICU was better equipped.  We are using some of the money that many of you have given towards our account for this project and we once again appreciate all the generosity that you all have shown.

While we were in Kenya, we were able to visit Kijabe Hospital.  It is also a missions hospital, but is more advanced than we currently are.  They just bought a CT scanner and have a much nicer NICU.  While we were there, we gathered information on how to improve our NICU and the care of the newborns.  We also got tips on how to improve the utilization of bubble CPAP.  Bubble CPAP is a way to easily and cheaply deliver pressurized, oxygenated air to a newborn baby.  Kijabe has been doing it for years and the staff there was helpful to help us troubleshoot our system here at Mbingo.

For our vacation, we first went to Kribi, Cameroon with the Youngs.  It was a grueling 10 hour drive to get there, but we had a nice relaxing time at the beach.  We were able to spend a week there and see a completely different and beautiful side of Cameroon.

Isaac loved playing with the kite that his great aunt and uncle gave him.  The only problem was when it was windy, he did not always see the need to keep holding onto the string tightly.  This is Chuck and Isaac running to get the kite started on a calm day.

 Isaac and Cathen had a great time in the "big sandbox".  We built sandcastles and went swimming and had a nice chance to spend time together as a family without the pull from the hospital.

We took multiple walks a day on the beautiful beaches that we had mostly to ourselves.  It is the rainy season here, so the other visitors were at a minimum.

 After our time in Kribi, Angela and Chuck went to Kenya for a week.  We saw the "Big 5" and enjoyed seeing so many animals in their natural habitat.  This is a large male lion warming up in the early morning sun.  We feel blessed to have been able to do this truly African experience.

 This is a group of young hippos playing in the water.  We were surprised how close we were able to get to the hippos given their reputation for being one of the most deadly animals.  It seems as long as you are not in the water with them, then you are ok.

 We also saw many elephants of all ages.  This was a large herd passing past our jeep just before sunset.  It was surreal to have these large animals completely ignore us most of the time and go about their business.

While we were in Kenya, Betty (Angela's mom) was kind enough to come to Cameroon and keep Isaac at Mbingo.  Isaac had a great time with his Nana.  Betty has also been able to stay with us for a couple more weeks since we got back, but sadly, she will be leaving tomorrow.  Please pray for safe travels for her.

Thanks for following along and we look forward to giving you more updates of some of the projects that we are trying to do around the hospital like the rehab of the NICU.  If you are interested in supporting us and these projects, please look to the right side of the blog for information on giving.

Ready for Vacation

Things have been especially busy this past week at the hospital and we are happy that vacation time is here!  We are going to Kribi, Cameroon for a beach week and then going to Kenya for a week.  The Youngs are joining us for the week at the beach.  Other than the 8 hour drive to the coast, we are looking forward to the much needed break.

 While we are gone, the residents will be carrying more of the workload.  Francine (a recent residency graduate) has been functioning as an attending on the female ward for the past couple months.  This is her rounding with her team. She will continue this as well as lead morning report and deliver the weekly quiz over the reading from Harrison's internal medicine textbook.

This is Angela giving a lecture on malnutrition to the residents and other trainees.  While we are gone, there are volunteers coming to help with the teaching and patient care.  They will be giving lectures, rounding on the wards, seeing clinic patients, and generally trying to cover any gaps that we leave while we are gone.  We are thankful for them coming and allowing us to take a break.

 

This past Sunday was the end of the Spiritual Emphasis Week for the CBC (Cameroonian Baptist Convention) in Cameroon.  There were special services during chapel each morning this past week and on Sunday the Mbingo missionaries all went to different churches in the villages around Mbingo.  We went to the CBC Church at Lih, a small village church that you can see in this picture.  Their building is actually quite large, but it is just an open room with dirt floors, mud brick walls, and a metal roof.  It was great to get out and see some of the areas that our patients come from and worship and pray with them during church.

 Marching ants are a problem here.  They are interesting to watch, but deliver a stinging bite if they get on you.  They march in lines with soldier ants to the sides guiding them.  They travel in such numbers that they carve a path into the red clay as you can see in this picture.  They have even been known to pass through a house, but we are thankful that they have not chosen our house yet.

This is Isaac with his friend Godlove.  Godlove had rheumatic heart disease and was very sick with mitral valve disease.  He was able to have a heart surgery at another hospital in Cameroon (Shisong) that specializes in pediatric cardiology.  Now he has a mechanical mitral valve and is living a much healthier life.  He does have to take blood thinners (warfarin), but is blessed to be alive. Isaac loves when he comes to visit and they like taking turns riding on the scooter.

Gigi and Dodad had a great visit with us and now they are safely back home.   The trip was uneventful, but they are missing a few bags, which has become the norm.  They should get them soon.  I guess if you travel to or from Africa, you should pack anything you don't want to lose in your carry-on!

Thanks for following us here on the blog.  We look forward to coming back to Mbingo after vacation energized and refreshed to continue serving God here at the hospital.

Chuck's Parents at Mbingo

Chuck's parents (Charlie and Ginger) have arrived safely and have been with us here at Mbingo for over a week.  They did have a cancelled flight, lost bags, and a change of airlines, but at least they made it safely.  They have been helping at the hospital, at home, and have been pushed in their hiking abilities.

This is all of us on a short hike down to the airstrip.  This was a welcome hike for Charlie after we took him on a grueling 6 mile hike to a waterfall a few days before.  He did well, but did drink almost a gallon of water on returning to the house!  You can see how happy Isaac is to have his Gigi and Dodad here to see him.

Charlie has been working at the hospital with Chuck.  This photo is from rounds on the men's ward.  In addition to Chuck and Charlie, you can see from left: Norah (resident), Alex (nurse practitioner student), Corine (house officer), and Irene (head ward nurse).  Each of the physicians sees half of the patients on the ward and then we have teaching rounds where we can see up to 32 patients on the ward.

 We have been seeing plenty of pathology at the hospital.  As always, TB is present in all its different forms.  This is a chest x-ray showing miliary TB, a life-threatening disseminated form of active tuberculosis.  Angela even diagnosed TB from a rash on a child's face.  We have also had plenty of hepatitis, which is good timing, since that is part of Charlie's specialty of Gastroenterology.

 This is Chuck doing an EGD with Charlie watching for esophageal varices (enlarged blood vessels in the esophagus).  Chuck has been doing some banding (using rubber bands to shrink the vessels) of the varices and was happy to have Charlie check his technique and give him new tips/tricks for this invasive procedure.

 Ginger has been working just as hard at home taking care of / playing with Isaac.  Isaac wakes up at 6am and does not slow down until bedtime, except for his nap.  This photo shows Gigi and Isaac picking leaves from the banana trees just a short walk from our house.

 Ginger and Isaac have also been watching for airplane or helicopters that occasionally fly over the hospital or even land to transport patients to the hospital.  This photos shows a helicopter that recently landed.  Sometimes the prop planes can bring a patient from as far away as Nigeria.

 A visit to our house at Mbingo would not be complete without a trip to get more chickens.  We recently ate our chickens and went to the poultry to get more chicks.  This is Charlie showing Isaac how to put them into the coop.

 As we mentioned above, Ginger and Charlie have been hiking with us too and have been enjoying the incredible surroundings that we live in.  This photo was from a hike to the "Knob" that gives a view of the hospital with the mountains around.  Despite being in the middle of rainy season, we have had mostly nice weather and have not been rained on during a hike yet!

Isaac in the "down dog" yoga position.  Having Chuck's parents here has allowed us to get a chance to exercise more.  Sometimes we do yoga and Isaac likes to copy us.  He has almost mastered the "down dog" position if he can just tuck that head in a little bit more.

We have seen God at work in many areas lately at the hospital.  We are constantly pushed to our human limits, but so often, God then makes his presence clear and provides for us and for our patients.  Thank you to each of you for your prayers and encouragement as we serve here at Mbingo.