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.

Peritoneal Dialysis

We are always trying to improve the level of care here at Mbingo for our patients.  Recently, we were able to start a peritoneal dialysis program for acute renal failure.  This was made possible by 2 years worth of donated supplies from the Renal Research Institute in New York.  We hope this will save the lives of some of the patients that have acute kidney injuries by giving them enough time to recover their renal function - usually days to weeks.

We will be teaching this skill to our CIMS residents.  This was a group photo of the residents that we took last week.  We convinced them all to smile...even though most Cameroonians like to be very serious in photos.  The most difficult part of peritoneal dialysis in our setting is actually choosing the right patients that need peritoneal dialysis and are likely to benefit from it.  We hope to find a way to make the program sustainable here at Mbingo after the 2 years of donated supplies are used. We also hope the residents will be able to offer peritoneal dialysis at the hospitals they end up at after their training is finished.

 This is our first patient receiving peritoneal dialysis.  The sterile fluid goes into the abdomen and "toxins" in the body collect in the fluid.  The fluid is then drained out after 4 hours and the process is repeated.  The "toxins" include electrolytes, acid, and other waste products that our kidneys normally excrete.  This 5 year old girl developed acute tubular necrosis (ATN) after malaria and was making almost no urine and was confused from uremia.  Now she is alert and awake and tolerating dialysis well, but we are still waiting on her urine to increase and kidney recovery.  The nurses, Ivor and Gene, have practiced long and hard to be ready to care for these patients and they are doing a great job.

This is Nancy and Dennis Palmer and Patsy and Bill Lawton.  The Palmers have been here for years and Dennis Palmer is the Director of the CIMS Program.  Bill and Patsy Lawton recently came to volunteer at Mbingo for 2 weeks.  Bill is a nephrologist and helped us get our peritoneal dialysis program ready.  Unfortunately, he went home just before we received our first patient, but he had us all well trained.  Patsy is a physical therapist and helped in our PT department.

This is JR and Angela with Tina Slusher.  Tina is a pediatrician from Minnesota with an incredible amount of global health experience.  One of the things that she identified that needed help here at Mbingo were the bili lights (phototherapy units).  Newborn jaundice is a common problem with potentially serious outcomes.  By using a bili light like JR is holding, the high levels of bilirubin in the newborn's blood can be brought down to safe levels.  We already had bili lights like this one before Tina Slusher came, but we learned how to make it more effective.  In fact, she helped us increase the quality of the bili light to five times stronger than it was before.

Technology has changed the way that medicine is practiced around the world and Mbingo is no different.  Well...a little different.  Instead of computers, smartphones, and iPads at the bedside, we use the older Palm PDAs to look up information on medical diagnoses, treatments, and drug dosing.  Each trainee at Mbingo is giving a Palm PDA and it is loaded with useful medical resources.  This is all possible because we are able to get the older Palm PDAs for such a good price.  As you can see in this picture, a house officer and Dennis Palmer are both looking up drug dosing for this patient at the same time.  This greatly improves our ability to quickly deliver higher quality medical care to our patients.

We are excited to show the new roof being added to the outpatient clinic building.  This has been a long time coming and we are still waiting to complete the other half, but we hope we will have the money to do that soon.  Other than it being a generally good idea to have roofs on buildings, it keeps the heavy amount of rain from causing damage to our walls and ceilings...and it looks a lot better.

JR and Chuck recently did a guys hike to the top of this peak in the picture.  It was quite a difficult climb up with plenty of bushwhacking to make a trail, but the view of all the surrounding valleys was worth it.

A couple weeks ago, the other missionaries at the hospital surprised us with a baby shower.  We had great food, some thoughtful presents, and it was a good excuse to get all of us together on a Saturday afternoon.  Angela is now almost 35 weeks pregnant and we will be heading back to the US this week to have the baby there.  We are then planning on returning when the baby is 6 weeks old.

Isaac will be sad to leave his friends here at Mbingo, but is excited about taking the truck, plane, and car rides home to see his grandparents and then meet his baby brother.  Thanks for your prayers for our work here and now as we travel home and for a safe delivery of a healthy baby.

Hospital Departments

Mbingo Baptist Hospital has many departments other than the obvious medical and surgical ones.  Each is staffed by Cameroonians, many of whom received much of their training here at Mbingo.  We wanted to introduce you to some of these departments.

Pharmacy.  Manasius, head of pharmacy, is pictured here.  He is involved with dispensing medications, keeping drugs in stock (big job here), mixing compounds, and he often rounds on the wards with the medical teams.  He and the rest of the pharmacy team are a huge asset to the hospital.

Radiology.  This group is focused on xray and ultrasound/echocardiogram.  The ultrasound techs have been trained to read the ultrasounds as well.  We do not have a radiologist and this team is able to provide us with good imaging information despite lack of a CT scanner.  We are currently in the process of upgrading to digital xray, which will be a big improvement over the current film model.

 Dental.  They specialize in extractions, fillings, root canals, and other general dental care.  They have patients come from long distances to receive their high-quality services.

 Physical Therapy.  This is part of the PT team showing how to use some of their equipment.  They provide both inpatient and outpatient service for a range of patients.  They will go from working with a stroke patient, to showing exercises for chronic back pain, to helping an amputee learn to use their new prosthesis.

 Prosthesis Shop.  The prostheses that are used at Mbingo are made on site.  It is easy to tell when one is being made because we can hear the loud sound of drills and sanders being used as we walk past the shop each day on our way in to work.  This picture shows a recently made hip/leg prosthesis...a difficult one to make for sure.

 Shoe Shop.  There is no mall or shoe store around Mbingo, so when shoes start to fall apart, you just bring them to the shoe shop for repair.  Shoes take a beating here, but despite this, almost any shoe can be repaired quickly and be put back to work.  They also make special shoes for former leprosy patients.

 Carpentry.  The quality of the furniture here is top-notch.  The wood planks are made from trees in the area and then brought down to the carpentry department.  The planks are then cut to the correct size before the more intricate work begins.

 This board is being sanded by hand prior to adding it to a new desk, exam table, couch, dining table, bookshelf, chair, or any number of other things that are made here at Mbingo.  In fact, all of the furniture in the houses and any wooden furniture in the hospital is made by the carpentry department.  They even made a toddler bed for Isaac from a picture off the internet.

 Metalworks.  This department accounts for most of the other furniture items in the hospital.  This picture shows welding being done to a medical table to be used in the operating room.  We recently had them make two specialized IV poles for the new IV pumps for the NICU.

 The pregnancy continues to progress without any complications and Angela is feeling well.  Isaac continues to be excited about being a big brother...just look at that smile on his face.

BIG NEWS...Mbingo now has an official website and a new and improved Facebook page.   We have put a lot of work into improving Mbingo's web presence and want it to be easier for people in the US to find out what is happening here.  Please check out the website at http://mbingo.org and the Facebook page at http://www.facebook.com/mbingo.baptist.hospital - and don't forget to "like" the Facebook page so you can see any new updates or pictures.

Teaching Hospital

As you all know, a big component of what we do here at Mbingo is teach doctors and nurse practitioners in our training programs.  When we first heard about Mbingo and decided that God was leading us to come here, we did not realize how integral teaching was to the hospital.  It turns out to be one of the more rewarding things about working here.

This picture shows Helmine examining a patient on the men's ward.  Helmine is a recent graduate from a medical school in Nigeria and is doing her house officer year (intern year) with us at Mbingo.  She just joined us a couple months ago and is eager to learn.  The doctors, like Helmine, and nurse practitioner students see all of the patients on the wards in the mornings before rounding with the attendings.  This gives them a chance to evaluate the patients, write their daily notes, and develop a treatment plan for the day.

After the doctors and nurse practitioner students pre-round, we join them on the wards for more formal teaching rounds.  We see each patient as a team with the patient being presented at the bedside.  We then discuss the plan for each patient.  This gives us a chance to immediately evaluate what they know and teach them.  This whole process is very similar to what you would find at an academic hospital in the US.  The main difference is that there are 20-30 patients sharing your "hospital room" with you here at Mbingo.

The official pediatric clinic is now open!  Previously, the peds clinic used a couple of the internal medicine rooms, but now they have their own 4 newly painted rooms with a different check-in area.  This picture shows Angela with Philippa Nana (nurse practitioner) and Doris (peds clinic nurse).  Angela, JR, and Lindsay have been training Philippa to be a pediatric nurse practitioner and she helps them with the newborns in maternity and in the clinic.  She is an example of the success of the teaching programs here at Mbingo.  Doris has been a great addition as well as she is fluent in English, French, Kom (local dialect) and Pidgin English and helps the pediatricians communicate with their patients.

There is also a training program for nurse screeners (a level of training above nurses, but below nurse practitioners) here at Mbingo.  This picture shows Kaye Streatfeild (a doctor who helps with the screener program) teaching Philemon some aspects of the neuro exam before rounds in the morning.

Rick Bardin (missionary pathologist) is currently in the US for his daughter's wedding.  This has forced some of us to learn some basic pathology.  Remedy (pictured) is a pathology technician trained at Mbingo by Rick Bardin.  While he has been gone, Remedy has continued to make pathology slides and either take photos of them to email to Rick or package them to send to a pathologist in the US that is helping us for these few weeks that Rick is gone.

JR has even learned how to diagnose Burkitt's Lymphoma in children.  This is a slide from an FNA done last week.  You can see the atypical lymphocyte in the middle with a large nucleus and scattered vacuoles characteristic of Burkitt's Lymphoma.  It is critical to make this diagnosis quickly as the tumor can grow rapidly and any delay in treatment can worsen a child's chance of cure.

This chest xray is from a young man with newly diagnosed HIV (CD4: 12 cells) and fever.  He also had night sweats, but no cough.  The most notable finding is the mediastinal widening and scattered lung infiltrates.  The ultrasound confirmed large retrosternal lymph nodes.  Initially there was concern for lymphoma, but we did an FNA of the lymph node and made a slide...

that we were able to stain for AFB (acid-fast bacteria = TB).  You can see hundreds of mycobacterium (little red bars) consistent with TB.  We started him on medication and he became afebrile and was feeling better when we discharged him to complete his treatment and start medication for HIV.  We certainly miss Rick Bardin, but we were happy with a few successes in the pathology department in his absence.

This picture shows David Uttley and Gary Martyn.  They both work for Samaritan's Purse and were at Mbingo last week.  David is a photographer and Gary is a writer.  They spent time with all of us taking pictures and getting material to write some stories about what God is doing at Mbingo Baptist Hospital.  We don't know where the stories will end up, but be on the lookout on the Samaritan's Purse and World Medical Mission websites and any newsletters that you may get from them.  We appreciate them making the trip and helping us spread the word about Mbingo.

Isaac is really growing up.  Here he is with one of his favorite truck shirts and his bookbag.  Whenever we go to someone else's house, he brings his bookbag with snacks and books or toys.  It makes him feel like a big boy.

Thanks for following along with us and supporting us through prayer.  We appreciate all of you.

Easter

Easter is quite the celebration here.  We woke up before 5am on Easter morning to the sound of African drumming coming from the church just a couple buildings down from our house.  We then got our clothes on, woke up Isaac, put him in the hiking pack, and joined the expanding group of Cameroonians walking up Mbingo Hill.  The goal is to be up the hill before sunrise, which we easily accomplished. 

This shows the group that did the Easter sunrise service on the hill as we all walked back down toward the church for the official Easter service.  The only downside was the dense fog all morning that actually obscured the sunrise.  However, this did not take away from the celebration of the resurrection of our Savior.  It was a great morning and a memorable Easter.

After the church service, all of the missionaries got together for a potluck brunch.  The food was great and we used the opportunity to take a group photo that includes almost all of the missionaries currently working at Mbingo.  We are truly blessed with a great community of friends here in Cameroon.

After breakfast, Isaac and Cathen joined the other kids for an easter egg hunt.  Someone had a few plastic eggs and then Angela hard-boiled some eggs that were then decorated with stickers.  Isaac collected quite a few and you can see Cathen "eyeing" his basket full of eggs.

In other news, Chuck and JR took part in a teaching course for the nurse screeners that work in the CBC system all over the country a couple weeks ago.  They traveled down to Bamenda and gave lectures and facilitated discussion on pneumonia, asthma, diarrhea, malaria, and sepsis.  Nurse screeners are a step above nurses and function as the frontline in the outpatient clinics that scatter the country.  They hold a lot of responsibility and this course was hopefully a chance for many of them to improve and refine their patient care.

Chuck took this picture from a helicopter over Yaounde (the capital of Cameroon).  He recently helped transport a sick missionary to Yaounde by plane and then got to travel back to Mbingo by helicopter.  It was a unique experience to take a 2 hour flight over the country of Cameroon, starting in the flat big cities and ending in the mountainous NW region where Mbingo sits.  The plane and the helicopter belong to SIL/Wycliffe (Bible translators) and they are mostly used for accessing difficult to reach people groups.

This is Chuck and JR on the top of Mbingo Hill with the hospital in the background.  It is a steep climb, but worth it for the views.

Like this view of the entire valley with the hospital below and the road in and out of town visible.  The mountain ranges here belong in a national park.

This is Angela, Isaac, and Isaac's future sibling posing during a recent maternity shoot we did.  Surprisingly, Isaac did cooperate for a few pictures, but mostly because we bribed him with a cookie.  He does like to talk about how he is going to help with the baby, but we will see if he remains this excited when the baby actually comes!