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.