Highs & Lows

This week has been exciting, at times full of hope, and at other times, seemingly full of despair. However, even when things looked the worst, I was reminded that God has the perfect plan, and thankfully I am not in control.

I attended my first STAT c-section two days ago. It was a young lady with a term gestation, but the baby presented as a footling breech (the baby was positioned legs first, one of the legs was already out, and it was rapidly losing blood supply). We rushed to the OR expecting the worst, and miraculously, within 10 minutes, we had not one, but two healthy, pink, and crying babies on the warmer! Mother had looked more pregnant than anticipated, but given a lack of prenatal care, it was not certain that she was indeed carrying twins. The children survived what could have been a disastrous entrance into the world, and have been thriving ever since. That was a high.

That same evening, one of our late preterm infants who had been making strides towards recovery - a 36 wk old male, now 10 days old, with suspected neonatal sepsis - developed acute respiratory failure.  Despite our best efforts at resuscitation, the child passed. The mother's pregnancy had been complicated by placenta accreta, and she underwent a hysterectomy to prevent fatal hemorrhage at the time of delivery. She wept and wrestled that evening, not understanding why she had been lead to hope, seeing her child's daily improvement, only to have it dashed, and knowing now that she will never have another child. That was a true low.

This morning, I returned to the nursery, and shamefully, wanted nothing more than to avoid contact with the bereaved mother. I did not want to become emotionally engaged, did not feel able to share with her in her loss. She called me over to her bedside when she saw me enter the room. My heart stopped. I took a deep breath and walked over to her. I opened my mouth to give her my condolences, but before I could speak, she said to me: thank you for trying your hardest. You all worked to save my baby. You did everything you could, but it was God's plan.

I often do not understand why things work out the way they do; I have no comprehension of God's decisions. However, I know that God is the God of comfort, and that He is sovereign, and that His plan is much better than the plans that I could make. I am eternally grateful for that.

Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, 

who comforts us in all affliction, so that we may be able to comfort those who are in any affliction, 

with the comfort with which we ourselves are comforted by God. 

For as we share abundantly in Christ's sufferings, so through Christ we share abundantly in comfort too.

- 2 Corinthians 1:3-5

Family Update

Well, we wanted to keep you all apprised of our family while we're off in Cameroon as well. So rather than talk about work, here's a little update on the family.

Cathen is doing great. She is now 6.5 months old, is taking solids (she loves rice cereal and avocados, and should start sweet potatoes in the next couple days), sitting on her own, and coming dangerously close to crawling. It'll only be a matter of weeks before she is completely mobile... we need to start baby-proofing! Lindsay and I are adjusting to being parents in a new home. Lindsay has had the daunting job of being the primary caretaker for Cathen and working part-time on the pediatrics ward, but she has graciously entered into her new schedule, and has been tremendously resilient to the challenges of motherhood and work in an unfamiliar environment. I have been enjoying life at Mbingo: hiking, playing guitar, eating new foods, experiencing new customs, and yes, also working.

Here are some photos from taken in our front yard today:

Culture & Adjusting

Well, after about a month in Cameroon, we have come to "appreciate" some of the cultural differences we are exposed.

1. Today, there was a herd of cows eating our grass and pooping in the front yard.

* this is the same group of cows. Last week they stayed on the other side of the road out of people's yards.

2. Keys: we have a total of 6 doors in our house. We have a different key for each door in the house. We have only 1 front door key and 1 back door key. We have a key for the refrigerator. We have a key for the laundry room. We have a key for the safe. We have 9 keys to make our home functional, and no spares for any of them.

* our keys

3. Phrases:
     a) "Aasha." This roughly translates to "my condolences for your hard work," or "that is rough, keep your chin up," or "I'm sorry for your load." When in doubt, you can always respond with "aasha" and it seems to make sense.

     b) "You're Welcome." If "aasha" seems to fail you, "you're welcome" seems the next best phrase to use when unsure about what is appropriate. We are often greeted in the hallway with "you're welcome!" - much like: "you are welcome to work here, thank you for your time."

     c) "Purging." I finally discovered that "purging" was in reference to diarrhea and not vomit. Many of my patient's stories make a whole lot more sense now.

     d) Stool. Stool is at times called feces here in Cameroon. "Poop," however, has no meaning. More commonly, our friendly four-letter word beginning with an "sh" and ending with a "t" is the common vernacular. This is taking some getting used to. What wonderful things is Cathen going to be saying when we come back stateside?!?

4. Time: Time seems to have little bearing on how things operate... with the one exception of morning chapel, which starts promptly at 6:40 every morning. Otherwise meeting at 11:30 might mean 2:30, a STAT lab might come back the next day and as "O/S" (out of stock), and a chest radiograph might take a week to obtain. However, everything gets done, and everyone works on behalf of their neighbor; but our typical urgency simply does not translate.

5. Fire: two weeks ago, Mbingo mountain was set on fire. We thought it an interesting spectacle, but assumed it was a controlled burn. Apparently it was not. Many people fought the fire overnight to prevent property damage and injuries. Today, after a few days of rain, the entire mountain is green and lush.

* flames on Mbingo Mountain

We are adjusting and learning to live more comfortably in a new environment. Thank you for your thoughts and prayers. More later.

Week 2 Update

We are over two weeks in to real work on the pediatrics ward and the neonatal unit. It has been humbling to say the least. We often have a good idea as to what we would like to do, but sadly are unable to do it due to lack of resources. Other times, we are seeing diseases more common in developing countries and aren't as clear what to do. Thank you, for those of you who have fielded our internet consults! However, we are eager to learn and are excited about our time here at Mbingo.

Perhaps the most exciting thing about Mbingo is that it is a true teaching hospital. Our role here is not only to serve as pediatricians, but more importantly, to train the Cameroonian residents and nurse practitioners. We are also blessed to be neighbors with many of the training staff, and have the opportunity to become friends and not just co-workers. There are a number of small children that live across the road, so Cathen will have plenty of friends to play with as she gets a little older.

In addition to working, we've been trying to get outdoors and enjoy the hiking.

Pathology

Well, one week completed on the wards... and there has been much to see and do. Perhaps the greatest challenge has been learning how best to manage and care for these children with limited resources - to not get frustrated when I know what is theoretically possible, and yet so far removed from what I can currently offer. It is a struggle, but it emphasizes the role of compassion and empathy and reminds me that true healing does not necessarily come from medicines and studies.

What I have seen this week alone (or at least what it appears I have seen... I don't always have access to the true diagnostic study):
1. Necrotizing enterocolitis with bowel perforation
2. Septic arthritis
3. Sickle cell disease with osteomyelitis
4. Chronic inflammatory demyelinating polyneuropathy
5. Rheumatic heart disease
6. Neonatal sepsis
7. Neonatal jaundice with severe dehydration
8. Ambiguous genitalia (query androgen insensitivity)
9. Severe hypothyroidism/cretinism (adult height ~3 feet, myxedema, macroglossia, etc.)
10. Posterior fossa brain tumor (with diplopia, ataxia, proptosis)
11. Pierre Robin sequence
12. PCP pneumonia
13. Typhoid
14. Hydrocephalus
15. Pyomyositis

The list continues... almost everyone has true pathology and needs medical care. There is never a dull moment, never a visit without cause. As Cathen is settling into her new home, Lindsay will be starting up this coming week; and Angela (Chuck's wife) will be starting up on Monday. What a blessing to have partners to run things by. Thank you for your prayers and encouragement. More later.

Rest, Relaxation, and Anticipation

Today was our first weekend. It is also a national holiday - Youth Day. We awoke early, had a wonderful breakfast of coffee (grown, roasted, and ground all within our hospital complex), yoghurt (made yesterday by Angela), honey (locally grown here at the hospital), and fresh pineapple and papaya. After breakfast we hiked down to Mbingo II, the next town down the road where all of the schools in the vicinity were gathered for Youth Day. The day celebrates the upcoming generations of Cameroonian children, and honors the hard work and dedication that they place into schooling and education. There were many people in attendance, and it was a wonderful display of pride in their younger generations.

Below are a few pictures from the event:

I have purposely not posted too many pictures of the landscape on the blog. We are currently experiencing the Harmattan - a strong, dry, and dusty West African trade wind that covers Sub-Sahran Africa with dust during the winter months. When the rainy season comes (about 1 month away now), the dust will settle and the surrounding valleys, plateaus, and vistas will become fully apparent. For the meantime, here is what we are seeing:

Overall it has been a lazy Saturday. We will attend church tomorrow with the local congregation, and then we will prepare for Monday: my (JR's) first day on the pediatrics ward! I am eager to interact with the residents, the staff, and the patients. I just hope that I have something to offer. Please keep us in mind as we learn how best to teach, treat, and care for the people here at Mbingo.

Firsts

This first week at Mbingo has been a week of many firsts for the Young family.

- The day before we left, Cathen first babbled: “dah, dah, dah.”

- Our arrival to Mbingo was an abrupt first introduction to Cameroonian culture and hospitality. The people are gregarious, kind, and genuinely welcoming

- On Sunday, we experienced our first Cameroonian church service

- Cathen’s first sleeping with a mosquito net

- Our first mouse kill

- Cathen’s first guitar lesson

- Cathen's first bath in Cameroon

- Our first introduction to local food: fufu and njama-njama

It has been a busy week, and a week of many new sights, smells, faces and words.  Parenting has been difficult. Cathen, although not yet crawling, still manages to get her hands into everything, and it is a challenge both to appropriately monitor what she gets into her mouth, and to relax and let her grow. We have had our first arguments in Cameroon, our first experiences of forgiveness, and our first time as a family to sit together and give praise for our blessed life here at Mbingo. Thank you again for your well wishes, prayers, and support.

Next week: our first days serving as Pediatricians at Mbingo Baptist Hospital!