Around the Hospital

Most of this blog is a collection of photos from around the hospital and around town from the past few weeks.  Hopefully it will add more depth to what you already know about Mbingo.

This is from Youth Day just a few weeks ago.  It is a national holiday when all the children march and dance in celebration with their school groups.  The children work for weeks on their group routines and then perform them one after another.  You can see there was a big crowd while this group was dancing.

This is Angela presenting a case at our weekly tumor board conference.  This is a combined conference that involves all the medical and surgical attendings, residents, and students.  Medicine and surgery alternate on bringing a case that crosses the two disciplines.  The case presented this day was a child with sickle cell disease with extramedullary hematopoeisis (blood cells made outside the bone marrow) causing a mass in the liver.  Angela and Simo (CIMS resident) are working on a case report because there is nothing in the medical literature like it.

This is Aaron Bryant and Jacob Stephenson, close friends and recent volunteers to Mbingo.  Aaron is a videographer who came to do a PAACS (surgery residency) and a CIMS (medicine/pediatrics residency) video that we will use to spread the word about Mbingo.  Jacob is a pediatric surgeon that comes to work with us twice a year and is a huge blessing to the surgery department and the many children he operates on.  The videos are currently in production, but Aaron did a few short videos while around Mbingo that are already finished.  The first one is titled "I Am Cameroonian" and is at this link - http://vimeo.com/60505520.  The next one is from the New Hope Village Leper Colony and is at this link - http://vimeo.com/60092039.

This is the future chemotherapy room that is getting close to being finished.  The floors are going in and then the walls will be painted.  After that, we can start giving chemotherapy in a much better environment.  Currently, they have to share a small room with the patients getting EGDs and colonoscopies.  We had to wait a few months to get enough money to buy the floor tiles, but now we are close to putting the room to use.

Electricity continues to be a challenge here.  We rely mostly on the government power company, but they often have low current or cut the power off completely.  This picture is our generator, which has quite a few years on it.  We are in the process of buying a new one, but they are expensive.  As you can imagine, it is a big deal for our patients when the power goes out, especially those on oxygen.  Frequently, the generator is slow to start or needs to be manually started (with prayer that it comes on easily).

This is our version of staff parking.  Most of the hospital employees walk to work, but some have motorbikes.  It is first come, first serve parking and there are no numbered spots.  You also can't get upset about a little ding from the close parking.

This is the hospital kitchen.  Most of the hospitalized patients have their caretakers cook for them, but a few need food provided by the hospital.  Traditional Cameroonian cooking is done over an open wood fire like the one here.  It can become quite smokey in the outdoor kitchen.

This shows the classic African orange sunset that we are blessed to see during the dry season.  The orange color is from all the dust in the air before the rainy season starts.

 

But now, the rains have started!  You can see this storm coming over Mbingo Hill in the distance.  The front side of Mbingo is still brown, but you can see the green already coming down from the top and on the backside.  We really enjoy the rainy season.

Especially Isaac!  Here he is in a fresh puddle with his boots on with Chuck.  This is one of his new favorite activities.  A few days ago, he woke from a nap and the first thing he said was "It's raining...there are puddles out there!"  And out the door he went.

Big News...

As you know, we have to practice medicine far beyond our level of formal training here at Mbingo.  We have told you about difficult tropical medicine cases, making diagnoses with limited testing, and even giving chemotherapy to both children and adults.  Chuck continues to do and teach EGDs and colonoscopies daily, but lately he has been doing more pediatric gastroenterology.  Here are a couple cases...

This is an 8 year old boy who presented with intussusception (the bowel telescopes on itself).  The cause was seen on ultrasound to be a mass in the colon.  Chuck did a colonoscopy on him and found multiple polyps, the largest being over 2 cm and this was the cause of the intussusception.  The polyps were juvenile polyps, but needed to be removed.  At first the plan was for the surgeons to operate.  Then Chuck and Jim Brown (missionary surgeon) decided to try to snare the polyps, even the large one.  This was the first time cautery has been used for an endoscopic procedure at Mbingo and it was a huge success.  All the polyps were removed including the large one and the young boy did not need surgery and was able to keep all of his colon.

In the past month, we have had three children with caustic ingestions that injure the esophagus.  These injuries require multiple EGDs with Chuck needing to dilate the esophagus due to strictures.  The kids have been young too (the youngest is 8 months).  In addition to the caustic injuries, this photo shows Chuck and Jim Brown finding a coin in the esophagus of a child.  It was removed without any complications.

This CT scan shows neurocysticercosis.  This man presented with vision changes and seizures.  He had the CT scan done in another town a few hours away that has a CT scanner.  Neurocysticercosis is a disease in which a parasite (worm) is ingested in the egg form and then migrates to body tissues including the brain to cause cysts to form.  It can take many years to develop, but is felt to be the leading cause of epilepsy in adults in the developing world.  You can see on this CT scan the multiple cysts in the brain tissue and even in the ventricles.  This man was treated with albendazole (worm medicine) and steroids and has improved significantly.

This is Kaye Streatfeild walking on a hike with Isaac.  You can see how brown the grass is from no rain in months.

Despite no rain, we have been able to water our plants due to the hard work of Thom Shotanus.  He is the missionary engineer and general contractor at Mbingo.  Many of you know that last year we ran out of water for most of a month at the end of dry season.  Thom assures us that the improvements he has made to the water supply will allow us to even water our plants throughout the dry season.  This is currently one of Isaac's favorite activities.

Having enough water has also allowed the kids to play in our inflatable pool.  Mostly Isaac just dumps the water out, but he and Cathen enjoy it and it keeps them cool during this warm month.

Yes, Isaac is going down the hill on a homemade slip-and-slide in our backyard.  We bought the tarp in town and put the kids in their bathing suits.  We then put some soap and water on the tarp and sent them down.  They had a blast.

And finally to the big news...Angela is pregnant.  Many of you have already heard this, but we wanted to make it blog official.  She is now 20 weeks and this shows her getting an ultrasound from Christy Lee, our good friend and missionary OB/GYN here at Mbingo.  We are excited and Isaac is already talking about how he is going to help with the baby.  We appreciate your prayers for Angela and the health of the baby over the next few months.

Improvements

We have had a busy and eventful first few weeks back at Mbingo.  One great thing about being back was seeing Dr. Koudjou after he returned from his away rotation at Tenwek Hospital in Kenya.  We recently started a partnership with this famous mission hospital in East Africa.  They now take our residents in their final year to do a 3-4 month rotation focusing on critical care.

This is Dr. Koudjou after his return to Mbingo.  Tenwek Hospital has an ICU and he was able to learn more about shock, resuscitation, ventilators, and other critical care topics than we can not practically teach here at Mbingo.  He also found himself useful in teaching Tenwek some of the things we do here.  He gained a lot of confidence and we can say that he is clearly a better doctor after the experience.  We hope that the partnership with Tenwek continues for many years to come.

This is the new NICU.  The walls have been painted and tiled and the cupboards hung.  The new incubators are in place and there is actually room for a fifth one when needed.  This renovation has greatly expanded our ability to care for premature and small infants.  We even have a visiting NICU nurse, Leigh Greer, here for a few weeks and she is helping to improve the nursing care in the NICU.  Once again, we are thankful for your generous donations to help with these improvements.

Greg Kline, an endocrinologist, is here giving a lecture on hypothyroidism.  He gave almost 15 lectures during his 2 weeks here at Mbingo and the time served as an endocrine rotation for our residents.  Many medical specialists are not sure how God can use them on the mission field and this highlights how we can use just about any medical specialty here at Mbingo.  Greg did not know where God was leading him to come, but was willing to go.  He prayed about it and later that morning had an email stating there was a need for an endocrinologist at Mbingo Hospital in Cameroon.  He immediately started making plans to come.  If you feel like God may be leading you to work overseas in some way, just be listening and He may open a door like He did for Greg.

This is a lumbar spine x-ray showing Pott's Disease, which is TB of the spine.  You can see the collapsed vertebrae is the one that looks like a triangle instead of the more rectangular shape of all the other vertebrae.  This is a fairly common diagnosis for us here at Mbingo, but this was one of the most pronounced x-rays that we have seen.  You can also tell that the physical exam is markedly abnormal with what is called a "gibbus", or sharp angle to the mid-spine.

This is Helen at her shop in the market.  If you remember, Helen works at our house during the week to help with cooking.  Her shop is open on Saturdays, which is the big market day.  She sells onions, peanuts, and all types of beans.  She buys and transports the items from Bamenda in bulk and then sells them in smaller amounts in order to make some money.  There are quite a few shops like hers in the market, but we try to buy from her as much as possible.

As soon as we arrived back to Cameroon, we were able to go to a conference in Bamenda for a few days with all of the other missionaries that work with the Cameroon Baptist Convention.  It was a great time to hear from an American pastor and hear from other people about their ministries around the country.  This picture shows the crowd during a picnic dinner.

Isaac is a runner.  Or at least he loves to run.  It is pretty much all he wants to do when he is outside.  He loves to chase you and be chased.  The other day, he ran almost a mile doing laps in the backyard.  This picture shows his sheer joy at trying to catch Chuck on the sidewalk behind the house.

As always, thanks for following along with us.

Newsletter

We had a great visit with our families for the holidays.  Now we are all packed up to head back to Mbingo in the morning.  Our newsletter for the year is at this link:  Mbingo Newsletter - Jan 2013

Happy Christmas

We are getting into the Christmas spirit here.  The standard expression here is "Happy Christmas" instead of "Merry Christmas".  We start each day at chapel where two groups sing a couple of Christmas songs each.  It has been fun to see all the nursing wards, hospital administration, different doctor groups, and even the carpenters and metal workers up front singing.  The whole month is together called the "Christmas Singspiration".

This picture shows Irene (head nurse), Norah (medical resident), and Alex (nurse practitioner student) on the men's ward.  Irene was inspecting the medicine cart which is used to carry the medicine around to each patient.  As you can see, it can barely make it down the narrow middle aisle when we are rounding.

This is Kamdem, one of the medical residents, working in one of our newer clinic rooms.  The residents round on the wards in the morning and see patients in a clinic room like this for the rest of the day.  The residents all have interesting backgrounds of school and work.  For example, Kamdem did medical school in the Democratic Republic of the Congo and then worked in Cameroon for almost 10 years before joining the residency.  There are very few doctors in Cameroon that have had any training beyond medical school as it is not required.  This is why the CIMS program at Mbingo is such a great resource to improve the level of medical care in Cameroon.  Kamdem is halfway through his 3rd year and he will be quick to tell you how much his medical knowledge and patient care have improved since he started the residency.

This is Keith Streatfeild (anesthesiologist) with a nurse anesthetist student on the female ward.  Chuck was caring for a young girl with severe hypoxia and was unable to give her enough oxygen with our basic oxygen concentrators.  Keith had recently been home to Australia and built a homemade CPAP (continuous positive airway pressure) machine that requires no electricity and runs off the oxygen concentrators that we already have.  This was the first time we used it and it improved her oxygenation from the 40% range into the 90% range.

This is a Fulani man that lives near the hospital.  The pediatricians recently took care of his son and we saw him on a hike towards his house.  He is always thanking us for caring for his "pekin", which is pidgin for child.  Now that we have been here over 10 months, we often see many local people that we know on walks to the market or hikes through the mountains.

With Christmas comes the dry season.  This is good if you don't like rain, but bad if you don't like dust or the color brown.  In thinking about this, it gave us a chance to remember how our yard looked when we first arrived and the changes that have happened since.  This first picture shows Angela hanging up hand-washed diapers (before our washing machine was installed) on our falling down clothesline in our dirt/rock yard.

And this is how are yard looks now.  Grass and plants have been planted and thrived during the rainy season.  The clothesline was repaired and moved behind the house to allow for a bigger yard.  You can even see Isaac's swing hanging from the side of the clothesline.

We also wanted to give an update on the NICU renovations.  The incubators have been built and this picture shows them.  The carpenters built the top part and the metal workers the bottom.  Then the electricians installed lightbulbs below the baby's bed for warmth and a thermometer to control the heat.  They really did a nice job.  The NICU room is almost done and we look forward to showing you the finished product soon.

This picture is from the Christmas Singspiration at chapel when the missionaries sang.  We were led by Kaye Streatfeild and also benefitted from JR Young's parents being here to visit and willing to sing with us.

This is a typical load of fruit after going to the market on Saturday.  Isaac likes to help unload the bags and pass them to us as we wash them all in dilute bleach water.  All part of the routine here at Mbingo.

We are also getting excited about Christmas because we will be going back to the US to visit our families over the holidays for a few weeks.  We look forward to seeing many of you while we are there.

Thanksgiving

Happy Thanksgiving to all of our friends and family at home. This was the first big family holiday that we have missed, but we are thankful for the missionary family and friends that we have here in Cameroon to spend the holiday with. Fitting to the season, we have also had some wonderful successes recently at the hospital.

We had a large potluck Thanksgiving dinner last night.  This shows the spread just as we were about to dig in.  Unfortunately there are no turkeys here in Cameroon, but we ate delicious chicken, vegetables, and desserts.

Now to what we are thankful for at the hospital recently.  This baby was a 7 week old twin who came in apneic (not breathing), cyanotic (blue) and lifeless. He had a severe case of bronchiolitis that his twin unfortunately had already died from. Thanks to one of our pediatricians (JR Young), a wonderful CPAP machine that was donated, and God’s provision, this child was resuscitated. He stayed with us for several weeks and finally was able to make it home.

Baby Victory (aptly named) came in as a newborn with meconium peritonitis and perforation. Stool got stuck in his intestines, causing a hole which stool leaked out of. He was operated on 3 times due to new perforations and leakage. He was only intermittently able to eat. However, he was a strong and resilient baby. He survived all of these surgeries and has gotten up to full feeds. He is still in the hospital due to a wound infection, but he should be going home soon. It is amazing that such a small baby survived so much.

This little one was born at term and expected to be a healthy baby but then we noticed swelling of his scalp, that continued to get worse and worse. He had a subgaleal hematoma (which is a rare type of bleeding that can happen between the skin and bones of the scalp). Babies can lose a lot of blood this way. This baby’s hemoglobin dropped to less than 4. Unfortunately, the hospital at the time did not have the correct blood type to give him a transfusion. We thought he would die overnight, but he held on until we were able to get blood the next day. After the transfusions and some phototherapy this little baby was able to go home with his parents.

We are thankful for our new bedside ultrasound.  This was donated from Angela's dad's office.  We have been using it for quick bedside evaluations, FNAs (fine needle aspirations), and teaching the residents the basics of ultrasound.  This picture is of Chuck and Kamdem finding the mass in a liver before doing an FNA.  Christy Lee (OB/GYN) has even started using it for some urgent evaluations when there is not time for a more formal ultrasound by the hospital techs. 

We are thankful that Isaac really enjoys playing with Cathen.  He is always watching out for her and likes to take her by the hand when we go walking.  Sidewalk chalk is their new favorite activity.  When playing together, he occasionally bulldozes her over, but she is very forgiving.

We are thankful for the new wildflowers that we see on all of our hikes now.  They are a beautiful addition to the landscape, but they seem to signify the end of the rainy season as the rains have officially stopped.

We hope you are as thankful as we are for the blessings God has given all of us.  We continue to be thankful for the support each of you give us here at Mbingo.

Church

We wanted to introduce to the churches around Mbingo.  We primarily go to church a few houses down from where we live, but like to visit some of the other local churches when we can.

 This is Mbingo Baptist Church on a typical Sunday as church is finishing.  We officially joined this church a few months ago, so it is where we go most weeks.  You can see all the people in this picture crowded on the front lawn to fellowship after the service.

This is the inside of Mbingo Baptist Church.  The service lasts 2 hours or so and includes plenty of singing, some dancing, and a sermon from the pastor.  The service is in English, which makes it easy to listen and enjoy.  We have many hospital employees, some patient caretakers, and other visitors attend each week.  It truly is an extension of the ministry of the hospital.

Isaac usually cannot make it through the whole service, so he gets to go outside and play with the other children.  This is him running with two of his Cameroonian friends.  They love to just watch Isaac and touch his white skin and blonde hair.

Some Sundays, we take the walk to the Mbingo II Church.  Mbingo II is the nearby village where many of the hospital employees live.  It takes about 30 minutes to walk there along the path.  This picture is the view as you approach the village.  As you can see, things are still very green here as the rainy season is just now coming to an end.  As we walk through the village, we see many of our coworkers at their houses and greet them.

This is the Mbingo II Church.  It is basic and still under construction, but it has a roof and some chairs and is a truly African service.  You can see all of the produce to be given in the offering outside the door as people head in for the service.

This is the inside of the Mbingo II Church.  The service is in English and Kom (local dialect).  The music is a mix of English and Kom and there is always plenty of dancing.  This usually occurs around the time of the offering.  They are all certainly cheerful givers!

This is what you get when you try to get a 2 year old to pose.  Angela was taking the picture and asked Isaac to smile.  No matter how many times we tried, his "smiles" involved opening his mouth and closing his eyes.  We thought it was funny anyway.

We always look forward to sharing with you all about our lives here in Cameroon.  If there are other things that you would like to know about or have questions, don't hesitate to email us and we can try to add it to the blog.

Thanksgiving

We continue to be stretched daily in our medical knowledge and abilities here, but God has been faithfully providing what we need to care for our patients.

This is the Men's Ward.  This photo was taken just after Chuck rounded on the 32 patients with the team of residents and nurse practitioner students.  The beds line both sides of the room and extend into an extra room at the end of the middle walkway.  Each patient has a family member that serves as a caregiver to provide food, clean clothes, bathe the patient, etc.  The nurses are only able to provide the direct medical care (IV fluids, medications, vital signs, draw blood, etc).

This chest x-ray is from a 24 year old boy with TB pericarditis.  He presented with shortness of breath, chest pain, and edema.  He has a large pericardial effusion (fluid around the heart) that is seen on the chest x-ray and confirmed by echocardiogram.  Chuck did a pericardiocentesis (needle into the sac around the heart) on him and got bloody fluid back.  He was also found to be HIV positive and this makes the pericardial effusion likely to be due to tuberculosis.  We have actually seen quite a few pericardial effusions like this recently and the challenge is making the firm diagnosis of TB in order to qualify for the TB medications from the government-funded treatment program.

Chuck had a big success story from last week.  A 17 year old boy presented to the hospital with severe anemia after having bloody stools for 3 days (melena).  Chuck did an EGD and found an actively bleeding duodenal ulcer.  He had the pharmacy mix up an epinephrine solution and loaded the new injector into the scope.  He then removed the loose clot on top of the ulcer and injected the epinephrine around the ulcer and the bleeding stopped.  Just after the procedure, the boy dropped his blood pressure and had to be resuscitated in the EGD room.  By the grace of God, three days later, he walked out of the hospital with no bleeding and feeling much better.  This photo shows Gideon and Emmanuel who work in the EGD room holding the injector and the scope.

Yes, that is a snake in a bottle.  Lindsay was on call a few nights ago and got the call that a child was presenting with a snakebite to the face.  The family brought the snake in to the hospital in this bottle and Nesoah (surgery resident) is examining it in this picture.  It was decided that it was indeed a green mamba, but that the bite had not released venom.  We don't have many snakebites here so the antivenom is not always readily available, but thankfully it was that night (even though they ended up not needing it).  Green mambas can be incredibly deadly, but they usually like to hide and stay away from humans.

This is Angela with Chuck Miller.  Chuck is an 82 year old pediatrician who came to work for 2 months at Mbingo with us.  He has an amazing story of clearly feeling God's call to the mission field around the time of his wife's death and has been busy doing mission work around the world ever since.  In fact, he was heading to South Sudan just weeks after leaving Mbingo.  We pray that God will continue to use him through caring for children around the world.

This week was Thanksgiving at our church.  It is quite different than what we are used to.  There was a point in the service when people walked to the front to give their offering of money or produce.  Many people at the church have almost no money, but are farmers and can bring their "first fruits" to give to God.  After the service, the produce was sold to other members of the church with the money going into the offering.  This picture shows the "auctioneer" taking bids for this basket of corn.

This is Isaac and Barry playing in a puddle down the street from our house.  Barry is the son of one of the medical residents and is about the same age as Isaac.  They chased each other, picked up rocks, and dipped leaves into the different puddles until they were both dirty and worn out.

Thanks for following along with our adventures here at Mbingo Baptist Hospital.  We thank God for the opportunities that He gives us to serve here on a daily basis.