Catching Up

Our internet was down for a few days, which allowed for some time to catch up on life. A lot has happened since we last posted, so I will try to give an overview in brief snippets:

Graduation: the culmination of many years of hard work came to fruition for two of our fine residents a couple weeks ago with our first CIMS (Christian Internal Medicine Specialization) graduation. Drs. Divine Jam and Francine Kouya are the first two graduates of the four-year program, and will be serving at Banso Baptist Hospital and continuing training in South Africa in the field of oncology, respectively. The graduation ceremony was well attended by members of the Cameroon Baptist Convention in addition to the expatriate medical missionaries that are training the residents here at Mbingo. It was an honor to be part of the ceremony, but more so to be part of the training that is occurring here at Mbingo Baptist Hospital (MBH). We are excited to continue to work on the pediatrics curriculum (the CIMS program is ~ 15% pediatrics training) and to further the education of the residents.

Dr. Divine Jam & Dr. Francine Kouya with the Attending Physicians
(Chuck Barrier, Rick Bardin, Angela Barrier, Dennis Palmer, Divine Jam, JR Young, Francine Kouya, Kaye Streatfeild, Lindsay Young)

Ward Changes: nursing here at MBH works on an antiquated system where rather than assign nurses to individual patients, each nurse on duty manages a particular skill set for the shift – vitals, oral medications, IV fluids, etc. We have found that with the current system, the comprehensive details surrounding each patient sometimes get lost. As such, we have spoken with the head nurse of the hospital and are hoping to try a pilot of sorts, revamping nursing on the children’s ward to have each nurse care for about 5 individual patients. The hope is that we will be able to have a more complete picture of what is occurring with the patient when both the resident and the nurse have ownership of individual patients. Change is never easy, but we hope and pray that we can really improve patient care by implementing this change on the children’s ward. If all goes well, we will then promote change on the other medical wards as well.

Comings & Goings: many of our friends and colleagues have recently left for furlough. The Palmers (Dennis created the internal medicine program here, and his wife Nancy, is the administrative head of the program and a doctor of psychology) have gone home to the US for 5 months. Keith and Kaye Streatfeild (anesthesiologist and internist, respectively) have returned to Australia for 10 weeks. The Sparks (Steve heads up the PAACS [Pan-African Academy of Christian Surgeons] program at MBH) have returned home to the US for 6 months. The Bardins (Rick is our pathologist and Debbie is a nurse working in the HIV Clinic) are leaving in July to return to Nashville and Colorado for one month. In addition to the faculty that have returned home to raise support and to reunite with family, we have graduated our two senior residents, and two of our house officers (essentially interns) are transferring to other CBC facilities. In their absence, we are all filling in as best as possible and trying to divvy up the workload. Pediatrics (which was created just 5 months ago here at MBH) is now the best staffed of the services with three attendings! We will miss our friends and colleagues, but we are excited that they have the opportunity to return home, to relax with family and friends, and to raise support so as to continue their work here in the coming months.

Fortunately, we are blessed with frequent visiting physicians to help lend a hand on the wards and to teach. We currently have two wonderful couples with us: Robert & Melissa (Neurologist and Pediatric Nurse) and Dorothea & Drew (Psychiatrist and Anesthesiologist). They have been a wonderful addition to the team and have really helped to smooth things out with many of our colleagues out of town.

The crew - up early on Saturday morning before rounds to go hiking

Chickens: our first batch of chickens have grown up, fattened up, and already appeared on our dinner table… chicken pot pie, Banso chicken stir fry, fried chicken, chicken fajitas, etc., etc. The chicken coop was a huge success, thanks to Chuck, and now that the first four chickens have been eaten, we have a new batch of chicks for the kids to enjoy until they too become dinner. Chickens are rather pricey here in Cameroon (not to mention quite chewy), so raising them on our own is cheaper and it provides entertainment for the kids (and the adults when the chickens escape from the coop – one of the ornery chicks got out three times just during a recent evening’s dinner!).

The chicken coop

Hiking: it had been almost three weeks since I'd been out for a good hike, so Chuck and I got up early last Saturday morning before rounds and took a 3.5 hour hike up the mountains on the east side of the hospital. We ascended just under 2000 feet and got an incredible early morning panoramic view of the surrounding countryside. It was phenomenal, and a great reminder of the beauty that surrounds us here.

Looking back at MBH

Panoramic facing southeast

Medicine: In the past week alone we have seen a barrage of pediatrics cases on the wards and in clinic. Some of the more interesting cases included:

-       Suspected congenital adrenal hyperplasia in a 5 week old

-   Disseminated MAC 

-       Pseudomonal infection of crush injury

-       Cerebral malaria x 2

-       Gram-negative meningitis (likely H. flu)

-       Bilateral retinoblastoma, presenting with an exophytic mass (extending ~3 inches from facial plane)

-       Burkitt’s Lymphoma presenting with intraoral mass, sepsis, acute renal failure, and right cranial nerve 3 palsy

-       Hepatic mass with obstructive jaundice and ascites

-       Inflammatory bowel disease

-       Osteomyelitis with sequestrum
-       Suspected adrenoleukodystrophy

We miss you all and cherish your prayers and support. Thanks for following along. Blessings.

Picture Quiz: Does anyone know what this is? This is really random…

 

Destiny

Maybe we should have seen it coming. They really were two of a kind: rebellious but sweet, always demanding what they wanted, and succeeding in obtaining their demands. He had those rugged good looks with longish, scruffy hair that flowed in the wind, and a way with the ladies. She was somewhat of a tomboy, with short, scraggly hair and trousers as her favorite garb. And her smile – it could win your trust in a moment, and break your heart the next. He showed up one day on our side of the compound, engine blaring, with a huge smile on his face. He was courteous enough to ask, and with his charm, somehow convinced my wife that this was a good idea. Our daughter was enamored to say the least, and without a moment’s hesitation, she jumped on the back of his revved up mustang, and they drove off into the distance. They looked happy, and he was truly affectionate in his care of her… but we keep asking – “aren’t they too young to be riding off together like this? Should we have done something to prevent this? Or are they simply destined to be together… destined to ride?”

    Rugged good looks                                                        Tomboy

   

    The Asking                                                                     Jumping at the offer

   

    Enamored                                                                      Loving

   

    Destined to ride

Starring: Isaac Barrier and Cathen Young

Praises

We have settled in to life here in Mbingo. Work is steady, at times hectic, challenging, exciting, frustrating, and rewarding. We are seeing a much broader scope of infectious diseases here than we did back home, but we are also seeing first hand just how remarkable a recovery a child can make - even when we do not specifically know what we are treating. We have had a handful of children who presented altered, somnolent, and in status epilepticus - likely secondary to a viral meningoencephalitis - who have made remarkable recoveries and walked out of the ward.  We currently have a 13 yo with cryptococcal meningitis (despite being HIV negative) who presented comatose and is now asking for his older brother. God is the healer and we have seen His miraculous hand at work over and over.

Boris: 2 weeks post-operative                                                                                     Boris: heading home

The most poignant example that comes to mind is Boris. Boris is a 5 yo who came in after being hit in the head with a piece of rebar. He progressed rapidly to mental status changes and signs of increased intracranial pressure, and was rushed to surgery where they found a frontal lobe abscess. The surgeons were able to debride the area but in doing so had to resect the entire right frontal lobe. 2 weeks later, he is being discharged home looking and acting for all the world as if nothing ever happened (other than a nice surgical scar). God is good!

The recoveries like Boris' and the teaching keep our spirits up. However, the constant nagging of not truly knowing the diagnoses, of not having access to the studies and tests we would like, and feeling inadequate for the task make it hard. In the absence of cultures we are simply treating all of these patients empirically - what are the common bugs, and what are the bugs that could rapidly kill them, and what can we give to cover those processes. However, we are reminded that it isn't the medicine that matters. We don't have to have the right answer or the cure with each patient, and in fact, we cannot. Our role here is just as much to show these patients and their families that we care, to give our best effort, and to let God intervene where we clearly fall short. Thankfully, He is a great God, and He succeeds where we cannot.

On another note (and to give room for some more photos) Cathen is now a little over 9 months old. She is growing like a weed, and is active as a bunny rabbit. We are ever-thankful for the health and safety that she has been provided. Here are some new pictures that we took in our friends' garden:

Nursery

In addition to the goal of training local residents here at Mbingo, one of our main projects is to get the neonatal nursery up and running. There are many challenges to this goal, including space and equipment, as well as lack of formal training, but we are hopeful that this will become a reality while we are here. Currently there are two semi-functional incubators that can be used for premature babies that need help with temperature control and evaporative water loss. However, the thermostats do not function well, and we are having great difficulty maintaining normal temperatures for the babies (which in turn makes it difficult to assess for infection, as fever is one of the primary criteria). Despite the setbacks, a well-organized nursery would be a tremendous asset to the hospital, providing life-saving treatment to late pre-term infants who otherwise would not survive. We hope to raise some monetary support to build incubators to get things jump-started (it turns out that building simplistic, but sturdy incubators is easier than trying to maintain a new incubator with all the bells and whistles). We are also using bubble CPAP (continuous positive airway pressure) here in the nursery for babies with respiratory distress (we do not currently have the ability to intubate and ventilate neonates), which has been a great addition to the practice. The CPAP was actually started by Dr. Sara a couple of months before we arrived, and is being continued as it is an excellent adjunct to care as it offers respiratory support for babies who are otherwise well, but just need a little extra help to make it through the first week or so of life.

As an update, we recently had our first true nursery success stories: an ex 31-wk premature infant and an ex 32-wk premature infant - both of whom had respiratory distress requiring CPAP, neonatal sepsis (one with necrotizing enterocolitis), and feeding difficulties - were recently discharged home after greater than one month in the nursery. The children look great, have gained excellent weight, and are now stable without additional respiratory support or temperature control. We hope to expand the nursery and obtain more incubators to be able to provide these life-saving measures to additional children. Thank you for your support.

JR and the two premature babies and their mothers on the day of discharge

Our current incubators... which work some of the time. They are rather temperamental and do not hold a steady temperature for the babies.

Creechied!

Well, we have officially been welcomed to Cameroon, or at least that is what we have been told...

There is a small insect known as the Rove Beetle that is endemic to Cameroon (as well as a few other places across the globe), that reportedly has the most poisonous venom known to man - 12x more potent than cobra venom. It does not typically cause problems, unless you unwittingly smash the creature on your skin, causing the toxic liquid to squirt out all over you. Well, we have both been creechied. I received the bug juice on my arm (which spread to my upper arm and torso), and the infection got super-infected with Staph, so I am now on an oral penicillin as well as topical steroids. Poor Lindsay, in addition to the intense burn and then itch, developed a severe id reaction to the mess (a systemic inflammatory response that results in small red, itchy bumps and small vesicles all over) and has been frightening her patients away!

All that being said, the itch is improving, we are on the mend, and we will hopefully be off of medications within the next 2 weeks. Yikes!

JR's arm: the area spread for the first two days and became edematous as well as intensely pruritic. The actual dermatitis eventually resembles a burn wound as the toxin is so strong.

 Lindsay's id reaction

Sleep has been difficult because of the itching, but systemic steroids work wonders. Thankfully once the initial insult was over, we are not able to spread the rash to our patients, although we have had a lot of explaining to do so that they are not afraid!

Love you all.

Happy Mother's Day!

Good morning to all, and Happy Mother's Day to all the moms! I hope that you are able to take some time off and enjoy family this very special day. We have had a nice mother's day here at Mbingo. Chuck and I were able to get up early and take care of the kids to let Lindsay and Angela sleep in; and we made omelets and mango/pineapple pancakes for a celebratory breakfast. It was a feast!

 Breakfast out on the veranda before church

Lindsay and Angela, along with their friend, Jamie, made cookies for the missionary moms here at Mbingo and distributed them door-to-door this afternoon to celebrate mother's day in the absence of their children. Jamie came up with the idea, and it was a wonderful surprise and a heartwarming gift for the moms.

Angela, Kaye, Lindsay, Jamie:

Kaye is a physician from Australia, here with her husband, Keith, who is an anesthesiologist. 

Jamie is a physical therapist who has been here at Mbingo for the past 2 years. 

We also took the opportunity to get Cathen dressed up in some of her new 9-mo clothes for an impromptu photo shoot!

Cathen and Mom in the front yard

Cathen in her new outfit. She'll be 9 months in just 4 days!

Mommy and Cathen

 

Daddy and Cathen

Thank you, Moms. We love and cherish you.

Bringing it home... taking a break

Well, we have all managed to catch colds over the past few weeks. First it was Angela, then Lindsay, then Cathen and Isaac. Chuck held out strong for a while, but eventually succumbed as well. I thought I was in the clear... but am now also battling the sniffles and an asthma flare. We seem to be doing our best to pass it round and round and round... but hopefully we'll clear it soon. This is just one of the joys of working on the pediatrics ward... lots of sniffles and colds.

Separation of work from the home is challenging, especially here at Mbingo, which is a small, rather insulated community. We live only three minutes from the ward and the clinic! However, other than the obvious need to not bring germs home, more importantly, is a mental separation from what we see and do on the wards, and not letting disappointments and defeats creep into home life. Maintaining a positive outlook on things when work seems bleak has been more challenging here than back in the US. Perhaps it is our close proximity to work, maybe the lack of diversions. Whatever the case, it has been challenging to stay positive on the wards, remain empathic towards our patients, and to not allow disappointments from work enter life at home.

However, we are fortunate to have wonderful friends and fellowship here, and a few things in particular help to keep us sane when things are tough:


1) Beautiful views & hiking:

Breathtaking!

These two photos are actually panoramic shots from the Sparks' backyard: one in early morning, and the other just before sunset.

2) Weekend retreat:
Our friends, the Sparks (Steve is a PAACS Surgeon here at MBH), offered for us to stay in their guest house for the weekend. They live about 10 minutes from the hospital and have a ridiculous view of the surrounding landscape.

 Cathen's 8-month photo shoot in the Sparks' backyard

3) Sunday night praise & worship:
We have started gathering together every other Sunday to play guitar, sing songs, and fellowship. This has been a much needed respite and a wonderful time to relax and enjoy time with friends away from the hustle and bustle of work. 


4) Baked goods, home made ice cream, and fresh coffee:
Although we have all lost weight since moving here (we thought this might happen... but don't worry, we are not wasting away), we are blessed to have a wonderful friend, Cynthia, who enables us to work at the hospital by helping us as a fantastic cook, and we are enjoying daily meals (local fare and meals from home); weekly cinnamon rolls, banana bread, and cakes. We have also borrowed an ice cream maker for the weekend. Then of course, there is the coffee - locally grown, freshly roasted and ground, and brewed to perfection every morning with our french press (thanks to Chuck Larson for bringing the press!). It is excellent!


Again, we miss you all, and wish you were here. Shoot us an email if you have a moment - we'd love to hear how you are doing. Blessings!