Peritoneal Dialysis

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

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

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

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

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

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

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

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

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

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

Hospital Departments

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

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

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

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

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

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

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

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

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

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

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

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

Teaching Hospital

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

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

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

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

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

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

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

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

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

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

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

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

Easter

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

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

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

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

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

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

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

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

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

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.