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!

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.