Dear Family and Friends,
After an exasperating experience of writing a long, detailed report, it disappeared into cyberspace, to be retrieved...nevermore. Oh, how I dislike computers!
However, since my work today was lighter than usual, I will try to muster up the stamina for yet another report! Usually, I spend six days a week at the hospital, reminiscent of my days of residency when I was much younger! School has started here in Cameroon and the costs of sending children to school and buying supplies are deterents for people to see the doctor, so there were fewer patients today.
The experience here is very different than anything I experienced in medicine in the US, but I expected this to be different. Each day I learn something new! I see rashes that I have never seen or heard about before and know less how to treat, diseases that I had only read about in books, and assist in procedures that would be rare for family physicians in the States. When women's health issues come up, I feel that I know more about what I am doing, but most of the time, I feel inadequate to handle the things that appear in our clinic here. At times I feel like a medical student!
There are many patients who wait in the "waiting rooms" which are breezeways with straight, backless wooden benches with the chickens and the roosters ambling about. They do not get upset with the wait and are happy when you see them. Such graciousness and politeness are amazing. They speak Pidgin English, so even though it is English, I need a translator!
Even the children are patient but look at me like I am from Mars. For many of these children I am the first white person they have ever seen so I have to try to establish some rapport with the goodies I carry in my pockets! I am the first American volunteer doctor in Mutengene Hospital, so everyone refers to me as "the white doctor".
News travels fast and I have already had patients come from towns away from here "to see the white doctor". This further scares me because the black doctors are better equipped to handle these things than I, but Africans have longed believed that white doctors know more!
That's not comforting! Ha!
Malaria is the most common problem here and I have definitely learned to diagnose that rather quickly and have memorized all the options for treatment. (So if any of you think you might have malaria, you can call on me when I return to the States!) We see many of the things one might encounter at home: anxiety, depression, colds, gastritis, weakness, dizziness, abdominal pain. Here, however, the complaints engender other differential diagnoses, and that's the part that is challenging!
Never have I seen so many pregnant women in one place!! Children are still a status symbol in this culture, and the family size (sometimes up to 15 in one family) is one contribution to the vast poverty we see everywhere here. The Africans have been very active in establishing programs of education to try to make some impact on family planning here. Our hospital has a weekly clinic, led by midwives and nurses, which focuses on family planning. It is generally well-received, but some believe that their own people are trying to impose on them western practices. The unstable infrastructure of the government and the oppressed position of women also contribute to this poverty, among other things. We have met many young women in their 20's and 30's who are making important changes by becoming educated and finding paying jobs, but progress is slow!
All general surgery is done by family physicians in the hospital, so all day on Tuesdays we are in surgery. The OR is nice enough, but we have no EKG machines, no BP monitors (except for a nurse who sits at the patient's head and periodically takes the BP), no ventilation to keep the air clean and pure, outdated instrumentation. There is one suction machine for the entire hospital and no X-ray equipment except a very modern ultrasound instrument, acquired for them by an American). That is our life saver, especially with post-term or ectopic pregnancies. They have no cautery to help them stop the astounding bleeding we see. Having said all this, I am in awe of the skills and giftedness of the African doctors, and I feel privileged to work alongside them! They remain calm under adverse conditions!
Abdominal surgery and gynecologic surgery is very difficult because of the immense adhesions distorting the anatomy, a result of the high incidence of sexually transmitted diseases and pelvic inflammatory disease. I will spare you the gorey details of what we see in those abdomens, for I am sure it would be hard for some of you! We scrub with a bar of soap and rinse with rain water, flowing from a pitcher held by a nurse! But all the gloves, gowns, etc. are very sterile, so they rarely see post-operative infections! Our patients recover well and can be discharged in 3-4 days! Amazing! The wards have about eight beds or more, so forget a private room! I wish some of you who are acquainted with the neonatal ICU's could see ours here. There is one wooden incubator and our little two-pound preemie, born yesterday, is doing so well that he pulled out his NG tube and his IV last night!
HIV is of course rampart. I have learned more about the complexities of this disease and how well it is treated with the limited drugs available here. I saw a patient with Bell's palsy and never thought of HIV. My colleague said, "I think we should check HIV," and that's exactly what it was. She had been negative two years ago. The astonishing thing is how thoroughly these patients are counseled and supported immediately!
Living in the Baptist Health Complex, (which headquarters some of the health programs, has a pharmacy school, and is the pharmacy distribution center for the mission hospitals and health centers of the Cameroon Baptist Convention, as well as housing the CDC of West Africa!), has given us the opportunity to associate with some of Cameroon's brightest researchers and staff. The CDC director is an American woman, but all the rest of the people involved are Cameroonian. Just as a bit of history, the Baptists first came to Cameroon eons ago from Germany and the US and established health centers and gradually built hospitals, all of which have the highest reputation of any in Cameroon. People are referred here from all over. It is easy to be amazed!
Today the director of the PMTCT/AIDS program (Program for Mother To Child Transmission of AIDS/HIV) took Manfred and me on a tour and explained some of the ways they are fighting the expansion of HIV in this country. The program was initiated in 2000 with the staff approaching 1000 pregnant women, testing them for HIV, then following them and their husbands/partners with counseling. This year that number has risen to 140,000 women who were contacted and tested! Now the CDC cooperates with them, along with some government organizations and many denominations here (Baptists initially, now Presbyterians, Methodists, Lutherans, and Roman Catholics). Since these poor women have no money, the CDC has even found funding to pay for the expensive HIV testing! A miracle of God's work in the world!
I have kept you long enough, but I wanted to share with you this once-in-a-lifetime experience that Manfred and I are having. We are daily enriched by what we see and are allowed to do, the people with whom we work, and the joy of being able to serve in this needy place.
The poverty gnaws at our hearts as we drive through the muddy, horribly pot-holed streets with the little shacks with no covered doors or windows, no running water or plumbing, and with many children playing often naked outside in the mud, and inside parents struggling to buy the next meal, but at morning prayers they sing enthusiastically: "We love you, God, because you are so good to us!" A humbling experience!
Please remember us as we do each of you!
Marjean
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