Final Exam

We were sad to tell Angela's parents goodbye today...especially Isaac.  However, we had a great 3 weeks with them and they did a lot to help us, not just at home, but also at the hospital.  Thanks and we can't wait to see you guys again soon.

Mike rounded on the men's ward while he was here.  That involved seeing about 30 admitted patients with the residents each morning and teaching them in the process.  He saw and treated patients with TB, malaria, cryptococcal meningitis, prostate cancer, chylous ascites, toxoplasmosis, HIV, strokes, and even a young man that presented with a blood pressure of 270/140!  This picture shows him in action with one of the nurse practitioner students.

 Betty stayed busy with Isaac most days, but did make it to pediatric rounds with Angela one morning.  This shows her with Angela and Estelle.  Estelle is a house officer completing her one year internship with us before she goes to work as a general practitioner at another location in Cameroon.  Angela enjoyed showing her mom what it was like in the hospital.

Mike also helped us by being one of the formal external examiners for our final exams for the 2 graduating residents.  Our residents are here for 4 years training in internal medicine and pediatrics and they took a 2 day exam involving written, oral, and practical components.  The picture shows Mike with George Reisz, Jam Divine, Kouya Francine, and Dennis Palmer.  George Reisz is the chair of medicine at the University of Missouri - Kansas City and Dennis Palmer is the director of the residency program here at Mbingo.  Congrats to Jam and Francine on passing the exam!

We also had time to get out into the surrounding country some with Angela's parents.  We took a trip to the Ndwara Tea Estate and as you can see from the picture, the road was bumpy.  This shows Mike and Betty supporting Isaac's head as we get tossed around on the rocky dirt road.

 The tea estate is quite nice and smelled great, even from the front door.

 We were able to take a tour and see how the tea is processed from the leaf to the tea bag.

We also went out into the fields and took in the beautiful views.  The estate is about 1500 feet higher than where we are at Mbingo with many mountains around.  It was amazingly green.

One of the many things that is different about this tea estate in Cameroon is that they also have chimps nearby.  The owner of the estate has chimps, monkeys, ostriches, peacocks, and pythons for visitors to see. We all took turns holding the chimps.  Nobody held the pythons.

Two funny things happened in the process.  This chimp tried to put his hand in Chuck's mouth, which of course Chuck was not too happy about.  After we put the chimps down, one jumped up and grabbed Isaac's shoe off of his foot and was playing with it.  We got it back and even a week later, Isaac still talks about the monkey taking his shoe!

Thanks again Nana and Papa for coming to visit.  We will miss you.  They are actually getting on the plane now, so we will be praying for safe travels back to the US.

Angela's Parents Have Landed

We are happy to say that Angela's parents are here!  They arrived to Mbingo on Monday and are staying for 3 weeks.  We are enjoying spending time with them.  Of course, Mike has been working at the hospital (he is an internist), but we don't think Betty has left Isaac's side!

 This was a couple days after they arrived and we went on a short hike to the airstrip.  It only takes about 15 minutes to get there and the views are memorable.  We are at 5000 feet of altitude here, but Mike and Betty have started to adapt and did well with the hike.

This is Isaac on the airstrip.  Few planes land here anymore since the road was paved about 15 years ago.  This used to be one of the best ways to bring in supplies.  We sometimes have a prop plane land with a patient (even from Nigeria), but mostly it is a nice place to take a hike.  Isaac is here suggesting that Nana and Papa just fly direct next time from Charlotte.

 We introduced Mike and Betty to the market, which is mainly on Saturdays.  We buy all of our supplies for the week and this week we put Angela's parents to good use by helping us carry all of it back to the house.

 As we have mentioned before, we teach medical residents, medical interns (house officers), nurse practitioners, and nurse screeners here at Mbingo.  This week, the nurse practitioners and screeners needed a lecture on the pediatric exam, so Isaac got to go to the hospital to be the "patient".  He actually did quite well as Angela demonstrated and taught how to examine a child.

 We also wanted to share with you guys some of the building that is taking place.  This is the outpatient building that was started years ago.  We are actually working in the part closest to us, but as you can see, much of the rest is still under construction.  The rest of this floor should be finished in the next few weeks and there will be more room for clinics.  At this point, the medicine, pediatrics, ob/gyn, and ENT clinics share about 8 rooms.  After the expansion, the clinics will have more of there own space which will allow us to see more patients and provide better care.

 Teaching is a component of many areas here at Mbingo.  This is one of the head carpenters giving a geometry lecture on an unfinished wall to a group of students.  We stubbled upon this scene, but were happy to see that the teaching is not limited to the medical side of the hospital.  Even the carpenters here  will leave with more skills and knowledge than when they arrived.

This is Darko with Chuck and JR.  Darko is a chief medicine resident at the Mayo Clinic in Arizona.  He was here for a month and did an incredible job teaching many lectures a week in addition to rounding on the wards and seeing outpatients.  He learned how to hike and he also became a friend.  He is on to become a cardiologist but is welcome back anytime.

Thanks again for all the prayers, emails, and support that we receive from each of you.  We hope you enjoy following along as much as we enjoy sharing.

Mothers and Chickens

Happy Mother's Day.  Cameroonians also celebrate Mother's Day at least as much as Americans.  In fact, here in Cameroon we celebrate American holidays, government holidays, church holidays, and quite a few more.  It seems they have time off for a holiday about every few weeks.  We guess this explains why there is a 6 day work week here.

Isaac made this card with a little help from Chuck on Mother's Day morning.  Chuck and Isaac let Angela sleep in and made breakfast for her.  

 We then went to church and noticed that many of the women were wearing the same pattern of material for their skirts and headdresses.  It turns out that it is the "official women's cloth".  Angela and Lindsay will need to buy the pattern soon!

 After church, Lindsay, Angela, and Jayme went to deliver the cookies that they had baked to all the missionary moms here at Mbingo.  Jayme is the physical therapist who has been here for over a year.  She teaches a course to train physical therapists for multiple hospitals across Cameroon.  All the moms enjoyed the treat.

  The hospital continues to be challenging and rewarding at the same time.  One of the most consistently rewarding things we do is teach the residents.  This is Stephanie and Joel.  Stephanie is a first-year resident and Joel is doing his house officer year (one year internship after medical school).  They have been rounding with Chuck on the wards and based on this picture, seem to be having a good time.

Although there has been a lot of sadness in the children's ward, we recently had a huge blessing in the survival of these 2 infants. JR, Lindsay, and Angela have been caring for 2 premature infants born at 31 and 32 weeks. This is baby Lillian and baby Ernestine with JR on the day they were discharged from the hospital after staying with us for 6 weeks. They both survived several rounds of infections, jaundice, trouble breathing, and other problems that go along with being premature. In our setting it is difficult for premature infants to survive, and we know that God has his hand on both of these babies. We really grew to love these little girls and their mothers. 

 We also have an amazing story to share from the men's ward.  Chuck was called in by Dr. Jam (on the left) late one night for a 25 year old boy who was incredibly swollen.  He was so swollen that they could not get a blood pressure, draw blood on him, or give him IV medications.  In fact, when the nurses tried to draw blood, they only got edema fluid in the needle.  Chuck went to the OR and found a central line kit (a small miracle there was even one there) and put in the central line in the ultrasound room with the assistance of Darko (visiting chief resident from Arizona).  As far as we know, this was the first central line put in a medicine patient at Mbingo Hospital.  The amazing thing is that this boy lost 70lbs of fluid over the next few days and was discharged with significant improvement in his cardiac function.  For the medical people out there, we believe he had myocarditis and his ejection fraction improved from 5% to 20% with diuresis.

Our family is growing!  We are now the proud owners of 4 little chickens.  Chuck built a chicken coop and picked up the chickens this week.  This picture shows him putting the final touches on the coop with a little help from one of the hospital workers.

Welcome home chickens!  Isaac is still learning how to care for them, but he likes to check on them each morning.

As always, thanks for all of your prayers and support.  Please continue to pray for the challenges at the hospital.  Please also pray for safe travel for Angela's parents who will be here to visit in less than 2 weeks!

Mountain Views

 Mbingo is an incredible place to hike.  This photo was taken from the top of Mbingo Hill looking down on the hospital and surrounding houses in the bottom left.  JR and Chuck hiked up the hill to get a view early in the morning.  This panoramic really captures the setting where we live.

 This is the start of the hike and it takes you directly up that hill to the left.  You can also see a thatch roofed house at the base.  There are no switchbacks so it is pretty steep and was slippery on the way down, but we made it safely.  If you remember from an earlier post, this was the same hill that was lit on fire just 2 months ago and now is bright green.

 As we got to the top of the ridge we had beautiful views in both directions with just the right amount of cloud cover on the back side of Mbingo Hill overlooking another valley and more mountains.

 This is from the top of the hill looking down on the hospital area.  There is a red arrow pointing to our house.  The front door of the hospital is the roundish white building just left of center.

 This is the view of the mountain range from the Sparks' house just a few minutes walk from our house.  Steve Sparks is the missionary vascular surgeon who has been here for 6 years. There are at least 6 waterfalls in this range, but it is difficult to see them all in this picture.

This is looking down the valley from the hospital area.  Most days start clear and then clouds move in during the afternoon and then we have a late afternoon rain.

This was taken on a hike we did last weekend.  You can see the hospital area in the distance.  You can also see Mbingo Hill (the one JR and Chuck climbed) over Chuck's right shoulder.  The rains have made everything green and the views can often be clear for miles.  We all love the hiking here, but Isaac probably loves it the most.  Who wouldn't want to be carried to these views though?

Three Months

We have been here in Cameroon for almost 3 months. Everyone warned us that most people experience a down time after they have gotten settled for a few months. Initially, you are so busy unpacking, meeting people, and learning the system, that you do not have time to really reflect on the fact that you have left your former life behind.  Still, we had hoped that we would be immune to this particular phenomenon. There are a few reasons for why we are experiencing this now. One is the continued difficulty at the hospital. Some days it feels like almost every patient has a problem we have never seen before and do not know how to treat. Also, one of the lab machines and the pediatric cardiac ultrasound are currently broken which makes treating patients even harder.  Another is that we are missing family and friends and it will be awhile before we see most of them.  Finally, Isaac is starting to have a temper and need discipline which can be hard at this age.

Still, when we really stop to reflect, God is doing a lot of wonderful things around us on a daily basis. This weekend we had a “party” to teach some of the pediatric parents early warning signs of childhood cancers. It was Dr. Francine (one of the residents who is specializing in oncology), Angela, and Lindsay who hosted it. We had the parents and children come to learn, eat lunch and cake, and socialize.

 This is a picture from the session.  The idea is that these parents and families will take this information back to their villages and everyone can learn from them.  Then, we can have these pediatric patients present earlier to the hospital and have a better chance at a cure.  Even some of the inpatient pediatric patients attended.

 This is Comfort (pediatric nurse) and Dr. Francine with Angela.  This is Francine's last year in residency and she will likely be heading to South Africa after that for further oncology training.  Then, we plan on her returning to be head of oncology here at Mbingo.

 We also are happy to report that the new chemistry machine has arrived and is in use.  This is a picture from the dedication of the machine on the first day of it's use.  This will be changing how we care for each patient and we are thankful to so many of you for giving towards this gift.  We are continuing to look for future projects and needs at the hospital to give towards and will let you all know of the next one.

 Another thing that we are thankful for is all the volunteers that come to help us.  We recently had Adam Houser, a 4th year med/peds resident, come from Cincinnati.  He helped in the clinic, attended on the female ward, and gave lectures.  This is him with Chuck and Isaac on a hike in the rain.  With the rainy season here, you can't wait for perfect weather!

 We have also continued to develop relationships with the residents.  This past week we had Dr. Jam, Dr. Koudjou, and their wives over for dinner.  It is so interesting to hear how they ended up together, in medicine, and learn about the Cameroonian culture from them.  It is not nearly as simple as they applied to medical school, got accepted, and attended.  It takes dedication from them and their families to make it happen.

Isaac has also begun to make friends. He often plays with children at church, but recently he has begun playing with our neighbor.  Javasius is a 2-year-old little boy who often comes over. He and Isaac play in the dirt, pick the flowers, and run around giggling together. It is a joy to see.

All of this is to say that God is good. He did not promise us easy lives, but He does promise to be present and support us in the trials of this world. Please keep us in your prayers. Specifically pray that we would feel renewed and energized to tackle another week at work, that we would have patience to discipline Isaac in love, and that we would seek God in all things. 

Happy Easter

We have had a good couple weeks since our last post.  Chuck was actually able to take a week off from rounding on the wards as we have a couple additional volunteers for the week.  This allowed him to focus on some other areas around the hospital.  He continues to teach EGDs and do colonoscopies.  He has now done over 100 EGDs and 15 colonoscopies!  We are also starting to do FNAs (fine needle aspirations) and learning to do bone marrow biopsies.  Angela has been busy with the children's ward and has been rounding more in the pediatric oncology department.  It is actually just a separate room with 6 beds, but department sounds more official.  She has been learning and is now helping guide chemotherapy treatment plans along with some of the more experienced residents.  We continue to be challenged medically with the volume and complexity of our patients that present with such advanced diseases.  We continue to trust God to provide the strength to face such a daunting task when we are limited in diagnostic tests and treatment options.

This past 2 weeks, we have seen new diagnoses of Burkitt's Lymphoma, pediatric AML (leukemia), metastatic Wilm's tumor, many cases of malaria, TB, and meningitis, a child with juvenile inflammatory arthritis, and even a dislocated jaw.  We also continue to see HIV with it's many consequences. Chuck saw a lady with Parkinson's disease that had never been treated and could not even move out of bed.  He gave carbidopa/levadopa and she is almost like a new woman! We saw a 22 year old girl with severe hypertension who presented with blindness from her hypertension.  We were able to control her blood pressure and her vision in her left eye returned completely.  She had been treated inadequately for many years in small clinics, but will now be coming to Mbingo for her care.

It was a good Easter week here.  The church and hospital had some kind of celebration almost everyday of the week leading up to Easter Sunday.  The people here know how to celebrate!  This picture shows a group of us singing during Easter week at the morning chapel service.  We formed a somewhat official choir and practiced our songs and the service seemed to go well.  Angela has been in choirs before and did great...Chuck had to learn how to sing something other than the melody, but ultimately it was a fun time.

 On Easter morning there was a sunrise service on Mbingo Hill.  The group passed our house at 430am and then this is the group coming back down at 7am on their way to church.  We did not make it up the hill this year with Isaac, but we are looking forward to joining them next year!

 The rains have come and it rained 14 days straight to kick off the rainy season.  It rarely lasts more than a couple hours, but can be very heavy.  Our water shortage is improving and we are thankful for that.  Isaac has also found a new activity...dressing in his rain clothes and playing outside...wait, where are your pants??

 Now that it is raining, our views have improved significantly.  This is taken from the hospital, looking back towards our house.  Our duplex is the farthest on the left.  We are blessed to live in such a beautiful place.

 This has also been a week of goodbyes.  This picture shows Mr. Nji giving a farewell speech to Christoph and Sara Berger.  They are a Swiss couple that spent 2 years here and are now heading back home.  She is training in tropical medicine and he is the brains behind our internet setup here.  They were a great asset to Mbingo in all the ways they improved things here and their friendships.

We wanted to introduce you all to Dave and Susie Oviatt.  They are both physicians and have an interesting story.  They did some short-term mission trips (2 weeks) earlier in life and felt God calling them to something more.  They both decided to retire early and now they take extended trips to hospitals in need around the world multiple times a year.  They have been with us for 6 weeks and we will be sad to see them leave on Tuesday.  Susie is a family medicine physician and worked with ob/gyn on the maternity ward and in clinic.  Dave is a hematologist and worked in our chemo/palliative care program as well as rounding daily on the men's ward.  He also made some lasting changes in his updating of our chemotherapy protocols.  It is neat to hear how God used shorter trips in their lives to ultimately lead them to this. We hope God calls them back our way!

As always, thanks for the support you all provide.  Knowing that we have a group of friends and family at home praying for us, following along with us, and keeping in touch with us helps us more than we can say.

Why?

Sometimes we ask why.  Why was the child born to an HIV infected mother?  Why did the woman who seemed to be improving from meningitis suddenly worsen and die?  Why did the cancer that was treated aggressively with surgery and chemotherapy recur?  Why do the patients at Mbingo have so many less medical resources than we have in the US?  At these times, we are reminded that although medicine has given us answers to some questions and the ability to treat many diseases, we are far from having all the answers.  Only God does.  Although we have sad stories of poor medical outcomes, we also have medical success stories.  We see that even in this poor remote area, we are seeing childhood cancers like Burkitt's lymphoma, Wilm's tumor, and osteosarcoma cured.  We see patients with HIV and TB get put on medicines that will allow them to live longer and healthier lives than they ever expected.  We see patients in need of an ICU walk out of the hospital just days later after receiving antibiotics for an infection.  We also see miraculous stories of how God clearly stepped in when we had no answers to what was causing a disease, no idea how to treat it, and yet healing still occurred.  We also see souls that are healed during their short time at Mbingo and that is always a blessing from God.

 This is our morning chapel service.  It starts at 6:40 am each morning and all the hospital workers attend.  It is a 20 minute service with singing, a devotional, and prayer and a great way to start the day.  It is led by the chaplains that work at the hospital.  The hospital has 9 chaplains that have many roles including leading services, counseling patients, praying with patients, and social work.  They are a vital part of the work of the hospital.

Many of our patients have complicated neurologic problems.  We are frequently struggling between diagnosing infections or malignancies or other neurologic disorders.  One adult patient had a cranial nerve abnormality and strange weakness pattern who ended up having a brain tumor (she actually went for a CT scan).  Another 10 year old girl had horizontal nystagmus (rapid uncontrolled eye movements) and was sent for a CT scan.  The only way to get a CT scan is to have them drive 6 hours to Douala and pay for one there (they are expensive).  It is rare that our patients can do this.  The longterm plan for the hospital includes having a CT scanner here, but we are years away from the infrastructure being able to support that.  In the meantime, we are often forced to make clinical decisions based on the physical exam findings, the labs, and ultrasound with a healthy dose of prayer.

Water.  We are running out.  Rainy season was supposed to start March 15th, but we are still waiting.  Even after the rains start, we will have critical water shortages for another 2 months while the water catchment areas fill.  This past weekend, we went 24 hours with no water.  Many days we have water early in the morning, but then it runs out until late in the evening.  This is a picture of us slowly filling our water container to use during the next outage.  Despite our difficulties here with water it can be much worse for people in the villages that have even less water than us and depend on the rains for their crops and livelihoods. 

You all know Helen from a previous post.  She invited us to her house this past weekend to meet her 6 week old grandson.  Her daughter Becky (white t-shirt) is also in the picture.  It was neat to spend time with her and her family at her house.  She made fufu and njama-njama, the local Cameroonian favorite, for us as we chatted around her table and held her grandson.

Chuck went horseback riding this past weekend with Sara and Christoph (Swiss couple finishing up a 2 year stay at Mbingo) and Jacob Stephenson (visiting pediatric surgeon).  We borrowed Dennis Palmer's horse Chocolate and 3 other horses from the Fulani people in the area.  The man in the front of the picture is a Fulani, a traditionally nomadic people group throughout West Africa.  Riding horses is natural for them, so I think they enjoyed watching us with less experience try to ride.  They don't even use saddles and we often see children less than 10 years old riding alone through the mountains.  I guess it is like a bike for an American child.

Please continue to pray for the patients at the hospital that they would find healing for their bodies and souls.  Please pray for us as we allow God to work through us to accomplish this.

Happy Birthday

This has been a better week than last.  There have been more encouraging stories from the hospital in the midst of difficult medical cases.  The positive attitudes that patients demonstrate despite the trials they experience teaches us to be more grateful daily.  Some of the more interesting diagnoses that we made this week were: myasthenia gravis, bulbar ALS, benign rolandic epilepsy, and every type of TB imaginable.

Happy Birthday to Angela.  Helen made a cake for her and we took it to our Bible study.  The people in the picture include hospital administrators (Mrs. Gabe, Mr. Nji, Joseph), physicians from the US (the Palmers, the Bardins), visitors from the US (Hugh, Jerry, Andrew, Dave), and our physical therapy teacher (Jayme).  It was fun to celebrate Angela's birthday and we already mentioned how good Helen's cakes are.

As part of our teaching roles here we also give regular lectures to the residents and other trainees.  This picture shows Chuck giving a lecture on heart failure.  Medical training is different here.  Most of the Cameroonian physicians go to medical school and have little to no practical experience seeing patients until after they graduate.  At that point, they often are sent to work at clinics where they have little supervision or support. This makes the residency program at Mbingo unique. We do regular teaching rounds on the ward and 2 conferences a day (just like an American residency). When these residents finish here, they will be some of the best trained in the country in internal medicine and pediatrics.

Some of you may wonder how childcare is going. Currently, Angela works the beginning of the week, Lindsay works the end of the week, and they are splitting weekends. Watching a toddler and a new crawler makes home time very busy as well. Thankfully, Isaac loves Cathen. As you can see from this picture, sometimes he loves her too much and too vigorously. Cathen is very easy going and usually finds the attention funny. 

Last weekend, Professor Pius Tih (pictured here) invited us to come to his country home where he grew up for lunch and a hike. "Prof Tih" is the head of the Cameroonian Baptist Convention (CBC), which is the organization that runs our hospital and multiple other hospitals, clinics, churches, and schools throughout Cameroon.  He came from a small village and ultimately received his masters in public health from Boston University.  He is unique in that he effortlessly moves between western academic culture to the poorest areas of rural Cameroon.  We also appreciate that the CBC is run by a local Cameroonian.

This is the beautiful crater lake at the end of the hike. We ate "country chop", which is local food, while looking over the lake. Not a bad view.

Since it is March Madness, we had to put in a little UNC plug. Also, we wanted to show you one of Isaac's new and favorite activities....wearing our shoes around the house.  Go Heels!!

Please continue to pray for us to have the strength to face the challenges at the hospital, both in medical diagnostics and treatment and continuing to love and care for each patient.