Monday, October 21, 2013

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.

Tuesday, October 1, 2013


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).