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.

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.