Under Construction

Mbingo Baptist Hospital has grown incredibly over the years.  It started as a small leprosy hospital over 50 years ago with only a dirt road to access it.  Over the years, the services expanded.  Once the road was paved from Bamenda, people could more easily come to the hospital and the number of patients grew quickly.  Then, over the past 7 years, a surgical residency program (PAACS) and a medicine/pediatric residency program (CIMS) were started.  The hospital is now close to 300 beds.

This picture is from 1957.  There was one building for the hospital and a few houses for the staff.  There were also some houses for the long-term care of leprosy patients.  But mostly there was a lot of open land.

This is what the hospital looks like today.  What a change.  The hospital now functions as a referral center for many poor patients from all across Cameroon.  In addition, it is a teaching site for many doctors and nurse practitioners that will go out from here to work all over Cameroon and even across Africa.  God is clearly working here and it is neat to be a part of it.

This is the homemade map that greets patients and families when they arrive to Mbingo.  It is a rough sketch of all the hospital buildings that we have here.  It is not the most intuitive, so we have plenty of people wandering around that we have help guide to the right place.  It does give you an idea of the growth from one building in the early days to what the hospital is today.

The growth has continued over the two years that we have been here.  This is the new TB ward that was completed a few months ago.  It allows us to properly separate our TB patients and those we are concerned may have TB from our other patients on the wards.  As with many of the building projects, much of the money to build this was from outside donors.  Mbingo Baptist Hospital and the Cameroonian Baptist Convention are always very grateful for the generous donations they receive to improve the facilities and care of the patients.

Another project that was recently started is a hostel.  We are desperately short on housing and we have many instances where Cameroonians travel to Mbingo for a conference or teaching course that can last days to weeks to months.  Currently, there is no good housing options for these short-term visitors or even for the nurse practitioner students.  We are always scrambling to find a place for the nurse practitioners to stay that is not too far away for the year they are in training here.  The hostel will provide over 20 single rooms (like a dormitory) to greatly improve our ability to house people here at Mbingo.  This is another instance of multiple generous donations coming together to improve our facilities.

For years this building above has been unfinished.  We use the first level for our internal medicine, pediatric, ENT, OB/GYN, HIV/TB, and chemotherapy clinics.  This second floor was started a few months ago and will house the new surgical clinic.  Currently, the surgeons have to use a single room that is divided into three sections by cloth dividers to see all of their patients (often over 100 in a day).  Many of them have to undress in that setting or even have minor procedures done (suturing, etc.).  This clinic will provide the space the surgeons need to properly evaluate and treat their patients.

A big project that has been underway for about a year now is the surgical ICU.  This picture shows the almost finished main room of the ICU.  There will be beds along the walls with the central nursing station.  Currently we have no true ICU care here because we have no ICU facilities.  This certainly impacts the level of care we are able to provide.  The surgeons are limited in what surgeries they can undertake by the lack of post-operative ICU care.  We expect this ICU will start to change that.  There will also be space for pediatric patients and some medicine patients when needed.  There will be ventilators and proper monitoring.  This is no easy project as bringing this level of care to our setting requires new equipment, new expectations, and a need for a new level of training of nurses.

This is Keith Streatfeild with Ben at our Thanksgiving gathering.  Keith is a missionary anesthesiologist from Australia.  He and his wife, Kaye, are dear friends of ours here.  Keith has been busy training nurse anesthetists since he arrived over 2 years ago.  He is now in charge of training nurses to deliver intensive care in the new ICU mentioned above.  The impact that he has had here is clearly felt and will continue to be felt for years to come both here at Mbingo and across Cameroon.

We recently heard about this thing called "Dinovember".  Basically, each night of this month Isaac's plastic dinosaurs do some activity and he sees it in the morning.  This picture shows them reading books.  They have also colored pictures, built with legos, played musical instruments, folded clothes, and built a train.  He loves it.

Ben is doing great as well.  Here he is hanging out in the grass on a warm December day.  We have been hearing about the cold weather back in the US.  There are some advantages to living in Africa!  However, we do miss our loved ones a lot during the holiday season.  We are thankful for the family and friends that God has provided here.

Sadness and Joy

It has been a tough few weeks at Mbingo.  We have seen far too much sadness.  There has been too much cancer, too many horrible infections, and too many adults and children that are just too sick to be cared for adequately here.  Over these few weeks, we have seen three kids die from rabies.  They were bitten by dogs in other areas of Cameroon, but made their way to Mbingo before dying.  Rabies is a horrible disease that once symptomatic is universally fatal.  Seeing those kids die from a vaccine preventable disease is just another example of the gap in health care and public health between the US and Cameroon.  It is also just one more example of why we are here serving.

The most difficult losses for our hospital were when we lost two of our own this past week.  Gideon was a nurse practitioner student from Nigeria who was 4 months into his 1 year program here at Mbingo.  Until just a few weeks ago, we did not really know that he was sick.  He always worked hard and smiled despite not feeling his best.  In retrospect, we see that he had had undiagnosed chronic liver disease for some time.  This past week, he had an acute worsening and died here at Mbingo.  There was no way to get him back to Nigeria before he passed.  This picture shows the crowd of hospital workers that came to sing and pray as his body was loaded onto the helicopter to be transported back to his family in Nigeria.  We are all still reeling from the loss.  Gideon will be missed here at Mbingo, but we cannot even begin to know the loss that his family is feeling.

In addition, Reverend Mbieng Elias, a chaplain for many years at Mbingo, also died this week.  He had been sick with cancer for over a year, but it was still sad to see such a loved and committed member of the Mbingo family pass away.  This picture was from his funeral service and the chapel was packed with well over 600 people.  We were all encouraged to see the large outpouring of support from the Mbingo staff in response to these difficult situations.

 

As the title of this blog suggests, we have had some joys as well.  This picture shows a young boy that is recovering from Burkitt Lymphoma.  He had a mass replacing his right eye (the picture of that was too gross for the blog) and a large mass in his abdomen.  He received chemotherapy and had his nonfunctioning eye removed.  His mass is gone from his abdomen.  He will finish his course of chemotherapy, but we are very optimistic that he will be cured.  This picture tries to capture the joy coming from him and his father.


This is Victory.  She has a severe esophageal injury from accidentally ingesting a caustic substance.  Over the past year, Chuck and Jim Brown (surgeon) have tried and failed multiple times to dilate her esophagus that is now stenosed (closed from scar).  She has a gastric tube to allow feeding.  Finally we had decided that the only option was to have the visiting pediatric surgeon move a piece of colon up to replace her esophagus.  This is a complicated and risky surgery here, so we decided to try one more EGD with esophageal dilation before proceeding.  This time, miraculously, the wire passed to her stomach and we were able to dilate her safely.  She comes back weekly for dilations now and has a small tube from her nose into her stomach and out her gastric tube to make sure we don't lose that tiny lumen in her esophagus.  It was a great moment of joy when that wire passed and we are thankful that she will be able to avoid the surgery.

Patients at Mbingo deal with extremes of sadness and joy on a daily basis.  This makes us think of the chaplains and how they directly minister to these patients daily.  Every morning in each of the waiting areas, a passage from the Bible is read and a short devotion is given for the patients by the chaplains.  This picture shows one of the chaplains on a busy morning in the outpatient department building.  The chaplains then spend the rest of their day going from bedside to bedside sharing God's love with patients and their families as they try to minister to their emotional and spiritual needs.

Ben had another "born house" a couple weeks ago.  This time he made his appearance at the women's group meeting.  He was passed around from person to person, songs were sung, and the women prayed for him.  He almost looks like he is flying in this picture as he is being passed.  The women's group meets one evening a month.  Each time, one of the women hosts and prepares food, another woman gives a teaching lesson, and another woman shares a devotion.  Mostly though it is a chance for the women at Mbingo to get together to socialize and fellowship with one another.  Ben was a good sport and they all loved holding this "Mbingo Boy".

Chuck saw this frog on the path to the hospital recently.  Very colorful.  Isaac was sad that he did not get to see it in person, but it hopped away soon after the photo.

If you have ever seen an African woman carry her child on her back, then this picture will look familiar.  We tried to replicate their wrapping, but failed.  You can see that Angela is having to hold Ben to keep him secure and what you can't see is that Ben is not happy about being wrapped like this at all.  We will have to get a lesson in the correct wrapping technique because the African women carry their kids around like this everywhere.  We have even seen them on the back of a motorcycle like this with the child happy and asleep.  We will never underestimate the difficulty in getting the child on securely again.

Ben is getting big.  He is a little over 4 months old and is already 17.5 pounds.  He loves to eat.  Isaac is really doing great as a big brother and it is easy to see how much he loves Ben.

Thanks for following along and for your prayers and words of encouragement.

Got Milk?

Breastfeeding is important in Cameroon.  There is often no access to clean water for mothers to make formula and the formula is prohibitively expensive.  That being said, breastfeeding can be difficult and sometimes impossible.  When babies are premature or the mothers are sick, the mother's breast milk can be delayed.  Also, HIV positive mothers often have to decide if there is any way to provide milk for their child other than breastfeeding as this exposes the baby to risk of HIV conversion.  Mbingo has a breast milk bank to provide breast milk to these babies for a short period of time while the mother's milk is coming in or other options are explored.

Angela is breastfeeding Ben and has been pumping in the evenings to get extra breast milk to donate to the breast milk bank for the pediatrics department.  This photo shows her giving some milk to Priscilla, the head midwife of the maternity ward.  Priscilla will take the milk, pasteurize it, put it in 1 ounce containers and freeze it.  The milk will then be used over the next days and weeks for the babies whose mothers do not have enough milk.  Angela has enjoyed being able to contribute to this important program.

Access to milk for babies is just one of many things we struggle to provide due to resource problems both at Mbingo and in Cameroon as a whole.  This photo is of one dose of amphotericin B.  We need this medicine to adequately treat cryptococcal meningitis in our HIV-positive adult patients.  Without it, we have to use fluconazole alone, which is third-line treatment.  We searched Cameroon for a year to get this medicine and finally found a small supply (50 doses).  This ran out in a few weeks as each patient needs a minimum of 7 doses (shortened course for resource poor settings).  Now we are on the lookout for more...

Ok...guess what this is.  If you said "fish bone" you are correct.  We had a patient referred to Mbingo from Douala after getting a bone stuck in his throat 5 days before when eating fish.  Chuck did an EGD and pulled this fish bone from his upper esophagus using biopsy forceps.  The patient immediately felt better and promised to always check his fish for bones in the future.  Douala is one of the main cities in Cameroon, so it was interesting that he left that city to come 6 hours to get the procedure done here.  Many people trust us to provide their medical care even if it is a long trip to get here.  We also deliver the care at a fraction of the cost which is important to patients who have little to no money.

Circumcision Day.  The surgery clinic turns into a circumcision factory for about an hour a few days each week.  They line up the baby boys on a stretcher, wheel them from the newborn nursery through the hospital, and go down the line doing circumcisions.  Gilbert is actually a nurse anesthetist, but has been trained to do circumcisions and is performing the one in the photo.  You can also see how well the mothers bundle their newborn babies.

Sanda is a painter who lives in Ngaoundere in the northern area of Cameroon.  He travels down to Mbingo a few times a year to sell his paintings to raise funds.  The rest of the year, he works with street children who are orphaned mostly from parents that have died from HIV.  He ministers to them in many ways, but also teaches them to paint.  They can then use this skill for the rest of their lives.  We have bought many paintings from him like the one in this photo.  He is a great artist and an even greater man and we like that we can help support his ministry.

Angela's parents have been visiting and helping us for the past couple weeks.  Mike has since traveled back to the US, but Betty is here for another week.  They have been a huge help while JR Young has been back in the US interviewing for a pediatrics emergency medicine fellowship.  Mike worked at the hospital and Betty has been keeping the kids while Angela and Lindsay have both been working full-time.  It has been great to have them here and we will miss them when they are gone.

We used the chance of having grandparent childcare to take a hike without Chuck carrying Isaac on his back or Angela carrying Ben in the Baby Bjorn carrier.  We ended up getting wet from a heavy afternoon rain shower, but views before and after were worth it.  You can see the hospital in the background off Chuck's left shoulder.

Ben is enjoying the Baby Bjorn carrier and we like to take him on walks.  He just got enough head control to sit forward so he can check out the world.  He is a big boy.

Ben loves his mom.  He has been smiling a lot lately and even gave us his first true laugh just a few days ago.  He is growing fast and Isaac and Cathen are often trying to get his attention and make him smile.

Thanks as always for your prayers, emails, financial support, and just letting us know you are following along with us.

Goodness

As we mentioned in a previous blog post, we now have a functioning peritoneal dialysis service to use for acute kidney injuries.  We have the supplies to give 30 days of dialysis for patients that have an acute worsening of their renal function as we wait for it to improve.  Chuck has been managing the dialysis patients since we returned to Mbingo and we wanted to share with you one of the true success stories.

Goodness is a young lady that presented to our hospital severely ill from the complications of malaria.  She had been at another hospital and had not improved and her family brought her to Mbingo.  At that time, Goodness was essentially in a coma and also had renal failure, but was no longer febrile as the malaria had been treated.  The coma was from a mixture of cerebral malaria and uremia from the renal failure.  Chuck decided to start peritoneal dialysis hoping that if we fixed her uremia, her mental status might improve.  The dialysis worked and her mental status started to normalize, but we were still praying that her kidneys would recover so she would be able to stop dialysis.  The options for longterm dialysis here are limited and costly, so if her kidney injury did not reverse, she was unlikely to survive.  At that point, she developed peritonitis (abdominal infection) from the dialysis catheter in her abdomen and this was treated successfully (first case of peritonitis since we started this program).  Then about a week later, she started to increase her urine output and her kidneys recovered!  We took out the catheter, finished treating her infection, and she walked out of the hospital with normal kidneys.  What a perfect name she has - Goodness - to remind us how good our God is to use this program to bring her healing.

One of biggest interventions that the pediatricians (Angela, JR, and Lindsay) have done is with neonatal hepatitis B.  Hepatitis B is common in Cameroon and all across Africa and much of it is transmitted from mother to child at the time of birth.  The child then can become chronically infected with hepatitis B and is at risk for cirrhosis and liver cancer later in life.  If the child is female, years later she can transmit the virus to her children.  The hepatitis B vaccine was only being given in a combination vaccine at 6 weeks of age (outside of the window to prevent maternal to child transmission of hepatitis B).  If you can give hepatitis B alone within 12 hours of birth to a child born to a hepatitis B positive mother, the risk of infection to the child falls dramatically.  They were able to find this vaccine in Cameroon and now this is the policy of caring for these children at Mbingo and in other CBC (Cameroon Baptist Convention) hospitals across Cameroon.

Before we arrived, there had never been a full-time pediatrician at Mbingo despite the desperate need for one.  This need has only been confirmed as the pediatric volume has increased even more since there are American-trained pediatricians here now.  As many of you know, we feel God is calling us back to the United States in late Spring 2014 after our two years serving with Samaritan's Purse are finished.  We have been praying that God would lead another pediatrician here to work.  We recently had the Nordells here - Ben, Isaiah, and Janielle (pictured above).  Janielle is a pediatrician and they are in the process of looking for where God is leading them to work longterm.  They would be a great addition to Mbingo and are seriously considering moving here permanently.  We will be praying that God leads them back!

Some things are just bigger in Africa.  Isaac has gotten bigger too, but we were referring to this giant snail.  He was just making his way across our patio slowly and entertained Isaac and Cathen for a long time.

Ben is getting into the Mbingo lifestyle too.  He has been on 2 official hikes over the past couple weekends.  On Saturday, we took him on his first trip to the back waterfall, also known as Paradise Falls.  It is a four hour hike roundtrip and we barely made it home before the monsoon downpour.  Tired, but dry.

Throughout our time here, we have felt supported by Samaritan's Purse (the organization that we came to Cameroon with).  This has never been more true than over the past week.  Spencer and Annette Nicholl are part of the "Spiritual Care Team" for Samaritan's Purse.  They periodically travel to different areas of the world where there are Samaritan's Purse missionaries working and encourage them, spend time with them, and lead them in devotions and prayer time.  Living and working in a different culture can be difficult on many levels and we all struggle with different aspects of it.  We are thankful for the time the Nicholls took to come out to Cameroon and the spiritual and general life encouragement they brought.  It has been a refreshing time.

Isaac and Ben are getting used to life as siblings and roommates.  They are sharing a small bedroom and Ben is even sleeping through the night!  This photo was a rare chance we got Isaac to sit still and take a picture with his brother.

Ben is growing like a weed.  It is hard to believe that he is almost 3 months old.  The smiles are coming more regularly and he loves to watch Isaac no matter what he is doing (which is usually playing with toy dinosaurs).

Born House

We returned to Mbingo almost 3 weeks ago.  It was good to get back to see friends and get back to work at the hospital.  Everyone here at Mbingo was happy to see us, but they were REALLY excited to see Benjamin.  They can not believe how "fat" he is ... that is a compliment here!

This photo was from our first "Born House".  In Cameroon, the celebration of a new baby occurs a few weeks after they are born and people come to your house.  At the celebration, the visitors ask the baby's name and each person gets a chance to hold the new baby.  The group sings a traditional Cameroonian song, a few gifts are given, and then the group prays for the baby.  This Born House was done by some of the  resident physicians that we are training.  They gave us some diapers and soap/detergent to wash all of the dirty baby clothes - very typical Born House gifts.  We were thankful to be included in this Cameroonian tradition.  There will be another Born House soon with many of the women around Mbingo, so Ben is looking forward to that as well.

We recently accepted a new group of residents into the internal medicine and pediatrics residency program here at Mbingo.  From the left, Dr. Christelle, Dr. Albert, and Dr. Helmine are their names and they are all Cameroonian.  Christelle did her medical school in Russia and worked with us for about 6 months before joining the program.  Albert did medical school in Nigeria and had been working at another hospital in Cameroon for a few months.  Finally, Helmine will officially join the program at the end of the year when she completes her houseman year here at Mbingo and she also did medical school in Nigeria.  We are happy to have these new residents and look forward to working with them for years to come.  Being Cameroonian, they each take pride in the service they are able to offer their fellow Cameroonians by working here at Mbingo.

Pastor Ephesians Nfor has been the head chaplain at Mbingo for years.  He was recently accepted to continue studying theology at a seminary in Nigeria.  We were sad to see him go, but happy for him and the opportunity further study will provide.  He was a close friend and a real asset to the hospital.  He spent time at countless patient's bedsides, helped lead and arrange our morning chapel and other conferences, and truly cared about and gave to those at Mbingo who had nothing to give him in return.  We hope to see him at Mbingo again in the future, but in the meantime, Godspeed Pastor Ephesians.

Access to healthcare is a problem everywhere, but is especially difficult here in West Africa.  People tolerate pain, horrible symptoms, enlarging masses for many weeks, months, or even years longer than we can imagine.  This patient has had this mass growing from his jaw and neck for over 9 months, but did not come to be seen anywhere until a couple weeks ago.  He was quickly referred to Mbingo and we diagnosed a salivary gland tumor.  Giving the extent and size, there is little that we will be able to offer him.  Unfortunately this situation is a common one we see everyday - extremely late presentations of disease that leave us little options for treatment. 

This chest x-ray shows diffuse metastatic cancer from the liver (hepatocellular carcinoma).  This is from a young man with hepatitis B who has had a mass in his abdomen for months and finally made it to Mbingo.  The diagnosis was made by fine needle aspiration of the liver mass, but the chest x-ray shows why he is having shortness of breath.  Medically it is interesting because this is an atypical metastatic pattern for hepatocellular carcinoma.  Sadly, this is another example of someone presenting with their disease late and again we will not have anything to offer him except symptomatic relief.

This photo is from one of the plane rides from the US to Cameroon.  Ben actually did great on the flights.  Angela managed him and Chuck took care of Isaac.  The main trouble we ran into was that because we bought our tickets late, we were never able to all sit together.  This led to it truly being one-on-one childcare.

We really are happy to be back at Mbingo and we have enjoyed adjusting our routines to having two kids.  This photo is after bath time for the boys when Chuck reads to Isaac with Ben resting on Isaac's toddler bed.  We are blessed to have these boys.

Benjamin is liking it here too, can't you tell?  This was him showing off one of his first smiles.  He turned 2 months old just a few days ago!

A few months ago, a photographer and writer from Samaritan's Purse came to Cameroon to do a story about us working at Mbingo.  Samaritan's Purse has a quarterly medical missions newsletter and we are the main story for the summer 2013 issue.  You can see the part about us at Mbingo by clicking this link - Newsletter.  You can also see the entire newsletter by going to the Samaritan's Purse / World Medical Mission website and looking for the "On Call Newsletter".

New Arrival

Even though we are still in the US, we wanted to keep posting about what is happening at Mbingo.  This past weekend was the CIMS (internal medicine/pediatrics residency) and PAACS (surgery residency) graduation.  All of the graduates have spent many years training and passed their final exams.  They will now be sent to different hospitals across Cameroon and other African countries.

These are our CIMS graduates for the year - Dr. Koudjou and Dr. Mbanga.  We are proud of what they accomplished during their time at Mbingo and look forward to hearing how they are doing at their new hospital assignments.  Hopefully they take with them a deeper knowledge of medicine, much experience in patient care, advanced skills in procedures, and a desire to improve the level of healthcare at their new hospital.  Even though they leave us at Mbingo, they will always be part of the CIMS family.

The PAACS residency also had their graduation and this photo shows Dr. Mifila with Dr. Jim Brown (PAACS faculty missionary surgeon) in the operating room.  Dr. Mifila will be going back to his home country of the Democratic Republic of Congo (DRC) to work at a hospital that has incredible needs as well as challenges.  He has been well-equipped and will represent the PAACS program well.  Dr. Ekwin and Dr. Brown also graduated this year and will be serving their people, their patients, and the Lord at their new assignments.  I know I echo the PAACS faculty in expressing our pride in what they all have accomplished.

This was a photo we took of all the CIMS faculty, CIMS residents, house officers, and nurse practitioner students before we left.  This serves as our "class photo" for the year.  Each person in this picture is an important part of the care that is delivered at Mbingo.

This photo shows the administration of the hospital at Mbingo.  From the left, there is Mr. Nji (hospital administrator), Mrs. Gabe (assistant administrator of personnel), and Mr. Joce (assistant administrator of finance).  Although we as missionaries hold positions of leadership at the hospital, we are proud of the fact that Mbingo is officially run by Cameroonians.  They have a difficult job of figuring out a way to offer the highest level of care possible with minimal resources to an extremely poor population.  We are often pushing them to give us more resources in one area or another and we can even get frustrated at times, but it is no easy task that they are dealt.  We are thankful for the wisdom they try to show each day in keeping the hospital running.

This is the Cameroonian M+ team.  They are responsible for providing care to TB and HIV patients at Mbingo.  Dr. William (middle) is the head physician and leads the team.  The government provides TB and HIV medications free of charge, but do not allow any of these medications to be purchased.  That is fine until the government runs out of medications and these sick patients do not receive treatment.  Even a week of missing medication can cause disease resistance to form for a patient making future treatment more difficult.  The team is assisted by Debbie Bardin (missionary nurse) and as a group does an admirable job of trying to balance medication shortages with extreme need.  Please pray that the country of Cameroon does a better job of keeping these vital medicines in stock and therefore make the M+ team's job a little easier.

Health campaigns and official days are popular in Cameroon.  This poster is for the World TB Day which involved teaching on TB for the week, official posters and t-shirts, and a march through the market and hospital grounds.  In addition to TB, there are official days for HIV, diabetes, and glaucoma just to name a few.  Spreading the word to the community is an important part of preventive strategies for healthcare...and where else can you see singing and dancing to spread the word about disease?

Isaac is having a great time in the US seeing family and friends, but often talks about Mbingo and missing Cathen, JR, Lindsay, and his Cameroonian friends.  This photo shows Isaac after church with a couple of the local children.

Introducing Benjamin Kyle Barrier.  He was born on July 5th and weighed 9lbs 1oz.  Angela and Ben are doing great and we could not be happier to have him join our family.  We are enjoying sharing him with our family and friends here and look forward to sharing him soon with our Mbingo family.  We have already sent off for his passport.  After this returns, we will request his Cameroonian visa and then plan to return to Mbingo in mid to late August.