Why?

Sometimes we ask why.  Why was the child born to an HIV infected mother?  Why did the woman who seemed to be improving from meningitis suddenly worsen and die?  Why did the cancer that was treated aggressively with surgery and chemotherapy recur?  Why do the patients at Mbingo have so many less medical resources than we have in the US?  At these times, we are reminded that although medicine has given us answers to some questions and the ability to treat many diseases, we are far from having all the answers.  Only God does.  Although we have sad stories of poor medical outcomes, we also have medical success stories.  We see that even in this poor remote area, we are seeing childhood cancers like Burkitt's lymphoma, Wilm's tumor, and osteosarcoma cured.  We see patients with HIV and TB get put on medicines that will allow them to live longer and healthier lives than they ever expected.  We see patients in need of an ICU walk out of the hospital just days later after receiving antibiotics for an infection.  We also see miraculous stories of how God clearly stepped in when we had no answers to what was causing a disease, no idea how to treat it, and yet healing still occurred.  We also see souls that are healed during their short time at Mbingo and that is always a blessing from God.

 This is our morning chapel service.  It starts at 6:40 am each morning and all the hospital workers attend.  It is a 20 minute service with singing, a devotional, and prayer and a great way to start the day.  It is led by the chaplains that work at the hospital.  The hospital has 9 chaplains that have many roles including leading services, counseling patients, praying with patients, and social work.  They are a vital part of the work of the hospital.

Many of our patients have complicated neurologic problems.  We are frequently struggling between diagnosing infections or malignancies or other neurologic disorders.  One adult patient had a cranial nerve abnormality and strange weakness pattern who ended up having a brain tumor (she actually went for a CT scan).  Another 10 year old girl had horizontal nystagmus (rapid uncontrolled eye movements) and was sent for a CT scan.  The only way to get a CT scan is to have them drive 6 hours to Douala and pay for one there (they are expensive).  It is rare that our patients can do this.  The longterm plan for the hospital includes having a CT scanner here, but we are years away from the infrastructure being able to support that.  In the meantime, we are often forced to make clinical decisions based on the physical exam findings, the labs, and ultrasound with a healthy dose of prayer.

Water.  We are running out.  Rainy season was supposed to start March 15th, but we are still waiting.  Even after the rains start, we will have critical water shortages for another 2 months while the water catchment areas fill.  This past weekend, we went 24 hours with no water.  Many days we have water early in the morning, but then it runs out until late in the evening.  This is a picture of us slowly filling our water container to use during the next outage.  Despite our difficulties here with water it can be much worse for people in the villages that have even less water than us and depend on the rains for their crops and livelihoods. 

You all know Helen from a previous post.  She invited us to her house this past weekend to meet her 6 week old grandson.  Her daughter Becky (white t-shirt) is also in the picture.  It was neat to spend time with her and her family at her house.  She made fufu and njama-njama, the local Cameroonian favorite, for us as we chatted around her table and held her grandson.

Chuck went horseback riding this past weekend with Sara and Christoph (Swiss couple finishing up a 2 year stay at Mbingo) and Jacob Stephenson (visiting pediatric surgeon).  We borrowed Dennis Palmer's horse Chocolate and 3 other horses from the Fulani people in the area.  The man in the front of the picture is a Fulani, a traditionally nomadic people group throughout West Africa.  Riding horses is natural for them, so I think they enjoyed watching us with less experience try to ride.  They don't even use saddles and we often see children less than 10 years old riding alone through the mountains.  I guess it is like a bike for an American child.

Please continue to pray for the patients at the hospital that they would find healing for their bodies and souls.  Please pray for us as we allow God to work through us to accomplish this.

Happy Birthday

This has been a better week than last.  There have been more encouraging stories from the hospital in the midst of difficult medical cases.  The positive attitudes that patients demonstrate despite the trials they experience teaches us to be more grateful daily.  Some of the more interesting diagnoses that we made this week were: myasthenia gravis, bulbar ALS, benign rolandic epilepsy, and every type of TB imaginable.

Happy Birthday to Angela.  Helen made a cake for her and we took it to our Bible study.  The people in the picture include hospital administrators (Mrs. Gabe, Mr. Nji, Joseph), physicians from the US (the Palmers, the Bardins), visitors from the US (Hugh, Jerry, Andrew, Dave), and our physical therapy teacher (Jayme).  It was fun to celebrate Angela's birthday and we already mentioned how good Helen's cakes are.

As part of our teaching roles here we also give regular lectures to the residents and other trainees.  This picture shows Chuck giving a lecture on heart failure.  Medical training is different here.  Most of the Cameroonian physicians go to medical school and have little to no practical experience seeing patients until after they graduate.  At that point, they often are sent to work at clinics where they have little supervision or support. This makes the residency program at Mbingo unique. We do regular teaching rounds on the ward and 2 conferences a day (just like an American residency). When these residents finish here, they will be some of the best trained in the country in internal medicine and pediatrics.

Some of you may wonder how childcare is going. Currently, Angela works the beginning of the week, Lindsay works the end of the week, and they are splitting weekends. Watching a toddler and a new crawler makes home time very busy as well. Thankfully, Isaac loves Cathen. As you can see from this picture, sometimes he loves her too much and too vigorously. Cathen is very easy going and usually finds the attention funny. 

Last weekend, Professor Pius Tih (pictured here) invited us to come to his country home where he grew up for lunch and a hike. "Prof Tih" is the head of the Cameroonian Baptist Convention (CBC), which is the organization that runs our hospital and multiple other hospitals, clinics, churches, and schools throughout Cameroon.  He came from a small village and ultimately received his masters in public health from Boston University.  He is unique in that he effortlessly moves between western academic culture to the poorest areas of rural Cameroon.  We also appreciate that the CBC is run by a local Cameroonian.

This is the beautiful crater lake at the end of the hike. We ate "country chop", which is local food, while looking over the lake. Not a bad view.

Since it is March Madness, we had to put in a little UNC plug. Also, we wanted to show you one of Isaac's new and favorite activities....wearing our shoes around the house.  Go Heels!!

Please continue to pray for us to have the strength to face the challenges at the hospital, both in medical diagnostics and treatment and continuing to love and care for each patient.

Tough Week

In some ways, this has been a tough week.  We have had more deaths at the hospital, especially in the pediatrics ward and the newborn nursery.  Many of the babies and children are brought to the hospital too late and are already too sick.  We try to take comfort in knowing that we are doing all we can for the patients that come to Mbingo and even when we can't heal them, we try to treat them and their families with dignity and love.

This is Angela leading rounds on the pediatrics ward.  She is working this month with Comfort (next to Angela) and Stephanie (across the bed with the chart).  They have seen some tough cases this week from  disseminated TB, massive ascites, and osteomyelitis to severe burns, Wilm's tumors, and sickle cell disease.  Angela diagnosed the sickle cell child at 8 years old (this is found at birth in the US on the newborn screen).  One child in particular made a big impact.  Her name was Grace and she was being treated for PCP pneumonia and was only 4 months old.  Angela, Lindsay, and JR had gotten to know her family while she was admitted.  She died this AM.  Situations like this are rare in the US and common here, but it is never something you want to get "used to".

Chuck continues to round daily with the residents on the busy female ward.  It seems that no matter how many patients are discharged one day, the beds are all full the next day.  During rounds just one morning, Chuck had 3 patient's results come back positive for active TB.  The rate of TB is higher with HIV infection and about 1/2 of the admitted adult patients have HIV.  This picture is a chest x-ray of one of the patients with active TB with positive sputum stains for AFB.  One of the other patients had TB diagnosed from a lymph node biopsy in the axilla.  TB can be a difficult diagnosis to make and is almost always on our differential.  Fortunately, we have a great pathologist here who helps with the diagnosis and an HIV and TB treatment team called M+ that follow the patients after they leave the hospital to give them medications.

Chuck is doing EGDs now.  This picture shows him working with Immanuel who keeps the EGD room running.  Chuck started about 2 weeks ago and has already done 25 solo EGDs.  Dennis Palmer has been teaching him, but he mostly operates on his own at this point.  He has seen many gastric and duodenal ulcers.  He has biopsied masses and has evaluated acute bleeding.  Probably 1/2 of the EGDs have significant findings which is much higher than in the US.  By the end of the month, he will be in charge of teaching this procedure to residents so he is trying to get plenty of practice!

We are excited to introduce you all to Helen. Helen works at our house to help with cooking and cleaning during the week.  She is one of the main reasons that our transition has gone as well as it has.  She is an amazing cook and makes everything from scratch.  This includes baking, killing and plucking the chickens, bleaching and scrubbing the vegetables, and even making salad dressing. Cooking here is definitely a full time job.  You have to try her chocolate cake, it is delicious!  She has also started to become part of our family and we could not be happier.

This picture shows the bottom part of "Paradise Falls".  We hiked there from our house last weekend with the plan to actually get in the water and swim up to the base of the waterfall through the opening in the rocks.  However, just as we arrived the rains came and it got a little too cold.  We can't wait to do this so we will try again soon.

Isaac continues to be a hit with the local kids.  This was just after church and everyone wanted to lead Isaac around by the hand.  We have been so proud of how he has adapted to life here, especially all the attention that he tends to get.  We are thankful each day for him and all the joy he brings to our lives and the lives of those around him.  Thanks again to all of you for the prayers and support that you send our way.

Come Greet Me

We can hardly believe that it has been over a month since we said goodbye to our families and our life in Nashville to move to Cameroon. Part of living in a different country is gradually trying to learn some of the customs. One custom in Cameroon is that whenever you see someone you know, you should greet them. This means shaking their hand with your right hand. This reflects their people-oriented culture where relationships are highly valued. Even the small children will greet you.

 Isaac had been a little shy and averse to greeting people, but last week he started getting the hang of it. This was a group of kids hanging out in front of the church that Isaac went up and greeted, but at first he used his left hand...

...but then he learned.  There, that's better.  Always shake with your right, Isaac.  The local kids love playing with Isaac and everyone in the village knows him. There is a deaf boarding school here at Mbingo, which serves deaf children all over the country. The deaf children often play in front of the church and like to come over to have Isaac greet them.

We have been trying to develop relationships out of the hospital with some of the residents and other trainees.  We really see this as an area where we can make not just a medical impact, but a spiritual one as well.  We and the Youngs have started hosting some of them at our house for dinner and we serve American food.  This is a picture with Doris, Tumi, John, and Nestor with our families. We had fajitas that night which none of the Cameroonians had every had before. It was fun teaching them how to make them, fold them up, and eat them.

 We are also sampling Cameroonian food. We have started eating at least one Cameroonian meal per week. This is fufu and njama-njama and pineapple. The njama-njama is similar to a cooked collard green. The fufu is a ground meal that makes the staple of the Cameroonian diet. It was pretty tasty, but we are not ready to give up American food yet.

For those of you who have contributed to us financially we wanted to let you know where some of your money will be going. One immediate need at the hospital that we found was a lack of reliable blood chemistries. This means the ability to check sodium, potassium, creatinine, and a lot of other electrolytes. For the non-medical folks, these tests are integral in being able to diagnose and monitor the progress of our patients. The hospital's current machine (here in the picture with Joseph) is only intermittently working and sometimes is not accurate and the reagents are expensive and difficult to obtain.  We will be donating to buy the new machine (which does over 30 tests) that will be able to service the hospital's lab needs for years to come and the reagents can be purchased cheaply here in Cameroon.  If you would like to contribute to this project, please look to the side of our blog for ways to give to our Samaritan's Purse project fund.  We look forward to sharing stories of the impact the new machine will make here at Mbingo.  Thank you all for the gifts that you have already given and the gifts you will give in the future.