The Package

Hi there. Now that we have been here almost a year, we are finally becoming more culturally savvy. This, however, was not always the case. I wanted to take a moment to reminisce on an interesting experience that occurred back in August. The following is an email that I sent to my parents after a very memorable experience regarding a package. Life simply moves at a different pace here in Cameroon. Many parts are endearing, and others are a little frustrating, but if you can smile and laugh, it all works out pretty well.

Today was an ordeal... I rounded early this morning to make my way to Fundong (about a 25 km drive north or the hospital), where there were reportedly 5 parcels waiting for our pickup. The odd part about all of this is that I knew y'all had sent three packages in May, and I was not sure where the other two were coming from, or why I was picking up packages in the end of August that had been sent in May... The other oddity was that I had received word about 4 weeks ago that the packages were in Bamenda (which is the biggest city on the northwest province, boasts about 500,000 people, and is a "teeming mass of humanity," as I like to call it). However, when George Ngwang (our go-to guy at the CBC headquarters in Bamenda) tried to retrieve the packages, the Post Master was absent from his station for 2 weeks straight, and then the packages were mysteriously transferred to Fundong... which means that the packages took a 35 km trip from Bamenda, right past the hospital, and continued on another 25 km to Fundong, without ever stopping to drop off the packages. However, neither here nor there… We will never quite understand why things work the way they do. 

But that being said, I was very intrigued to go and retrieve the parcels and to find out what was in them. This was supposed to be an easy trip - 30 minutes there, 10 minutes in the post office, 30 minutes back. We left at 0930. The first warning was the fact that the car had neither seat belts nor mirrors. My driver told me he did not think this vehicle was typically used for carrying passengers, but it was all that was left, so we would make do. We took off on a beautiful morning with golden rays of sun shining in the windows and casting an emerald glow on the grass covered rolling hills. It was absolutely breathtaking! 25 minutes later, after lots of windy roads, beautiful vistas, and long, cascading waterfalls, we passed through Belo, and then Njinikom, and then the car broke down on a rather large uphill climb about 5 km outside of Fundong. The hood was smoking, the car smelled of burning electrical gear, and the driver quickly discovered that one of the main electrical cables running from the battery had eroded through as was flaming. We got out of the car. 

At this point, I was loaded into a local taxi (car made for 5 people max), that already had 6 passengers in it. I was the fourth person to sit across the back row that seats 2 comfortably, 3 at max. I sat there, with my rear purchased in the air, one cheek on the armrest of the door, the other on the lady's thigh next to me. We rode 10 km like this and I lost all feeling in my lower extremities. The lady on whose lap I was seated had purple hair and was singing hymns in broken English. We safely arrived at the post office - a large, mud and brick building with a tin roof and three fluorescent light bulbs inside, one of which worked. The front steps were covered in moss, and I was the only customer there, and there was one lady working at the office. She seemed like she had been expecting my arrival and quickly produced 5 packages addressed to Dr. Young. I did not bother to ask why they had made this long journey from Bamenda to Fundong, right past the hospital front doorstep without being dropped off. I paid a small tax for the arduous journey the packages had taken and then tried to call my driver to get an update on the car. 

He answered. He assured me that all would be well - "please just wait for me, and I will be there shortly." 45 minutes later I began to walk in the direction of the broken down car. He later "beeped" me - meaning, he called me but hung up before the call was connected so that he would not be charged any minutes. He informed that perhaps I should take a taxi to the car, and by the time I arrived, perhaps he and the electrician would have it figured out. I continued to walk, was passed on the road by 5 motorcycle taxis and 3 car taxis before a young gentleman honked and pulled over to add me to the car - I was again the 7th passenger in car that holds 5. We made short time to the broken down truck, and the electrician had yet to even arrive. So, my driver instructed the taxi driver to take me to Mbingo. About 3 minutes later, the heavens opened up and I was very glad to be inside the taxi, despite not having any room to sit. It was an absolute downpour, and I was afraid that we were going to have to pull over, as the road was not visible. However, the taxi driver skillfully made his way to 4 stops to offload passengers and pick up new ones before finally arriving in the town of Belo (en route to Belo, we dropped off an elderly gentleman with 2 large, smelly frozen fish; a middle aged couple with 3 potato sacks of gear; and a young man with a roller suitcase). Once in Belo, the taxi driver informed me that I needed to change cars as he had to drive in the other direction with his remaining passengers - so he passed me off to another taxi driver, gave him part of my fare, and wished me well. I was the 8th passenger in this vehicle. This car was also having significant mechanical issues, and we were forced to pull off the road on two occasions. However, we finally made it back to Mbingo after dropping off 4 of the 8 passengers, and picking up an additional 3 passengers. 

I finally got back to the house at 1:30pm. Once home, I opened the packages! Thank you for the plastic bags, the bibs, the skirt, the books, etc. It is wonderful, and will all be used when Lindsay and Cathen get back in just two days!

Who knew what it would take to get a package from the US to its correct destination in Cameroon! It was a journey, but it was worth it. 

Love you guys!

JR

-       ps: as far as I know, the car is still smoking on the side of the road. I informed the administration that their driver was stranded, needed assistance, and that the car needed repairs. They assured me he would be fine, and apologized for any inconvenience. This is life in Cameroon.  

Comfort

December was a tough month. Work was busy. Acuity was high. Our friends, the Barriers, were home for the holiday. Praise God that my parents were here with us. It was such a blessing to have them here for Christmas, to not be isolated from family and friends. And equally important, Mom was able to watch Cathen while Lindsay and Dad and I worked at the hospital. We would not have been able to take adequate care of the patients without their help. Also, what a cool experience to be able to work side-by-side with my Dad at the hospital. Not every son has the pleasure of working alongside and learning from his father.

Mom and Dad have gone home, and the Barriers have returned. Cathen is thrilled that Isaac is back. The hospital has also slowed down, but the acuity of the inpatients still remains high. We’ve lost a number of patients these past few days. One in particular stands out:

A 7-month old little girl showed up with a history of recurrent bloody stools. She had been seen about a month previously at an outside facility where they gave her a blood transfusion because her hemoglobin was ~5. She then came to Mbingo because she was again having profusely bloody stools. A quick exam was enough to show me that we were not able to save this girl. She showed all the clinical signs of liver failure – massive abdominal distension, ascites, jaundice and scleral icterus, caput medusa, coagulopathy with bloody stools, and esophageal varices with hematemesis, and hypoglycemia. She had an ultrasound that could not identify the biliary tree – likely biliary atresia, a congenital disorder that has minimal success with surgical correction, and typically requires a liver transplant. That is not an option here in Cameroon.
 I talked with Mom, explained that the girl was born with a very serious problem and that we could not heal her. She asked to be discharged home to be with family when the girl finally passed. Before leaving, I asked to pray with her and for her daughter, Leila. I asked that God would provide both the girl and the family with comfort, that she would not suffer, and that their last minutes, hours, even days together would be a sweet time. The mother expressed her gratitude for the prayer. Our Pediatrics ward chaplain, Elias, was there with me, and as I was leaving, he asked me to look up Isaiah 57:1-2. He told me that this was a verse he liked to share with families suffering an early and unexpected loss of a child.

“The righteous perish, and no one ponders it in his heart; devout men are taken away, and no one understands that the righteous are taken away to be spared from evil. Those who walk uprightly enter into peace; they find rest as they lie in death.”          - Isaiah 57:1-2

I do not understand why things happen the way they do. Dealing with death has been one of the biggest struggles of working here in Cameroon. Too often I know that if we were home in the States, we could prevent a death. If we were home in the States, the child would have presented months earlier and avoided morbidity and even mortality. However, God, in His wisdom, sometimes takes them home “to be spared from evil.” There is great comfort in knowing that our God is all-knowing, that He is love, that He is sovereign, and that His plan is always best. Praise God that we are not in charge, and the we can always rely on His perfect plan. 
 

Giving Thanks!

We recently celebrated Thanksgiving here at Mbingo Baptist Hospital. Our American holiday is not well known in Cameroon, and I often forget that Thanksgiving on the fourth Thursday of November is indeed, a US holiday. As such, it is equally unrecognized and/or unobserved by our other expatriate friends here at the hospital coming from Canada and Australia. However, this past week, we had a wonderful celebration of thanks with our expatriate friends here in Cameroon, about 25 of us in total. It was a great chance to share with one another, to express gratitude for the incredible opportunities we've been given, and most of all, to thank our Lord & Savior for his precious gift of life.

Thanksgiving Potluck

Here are some of the things that we have been thankful for here in Cameroon:

1) Our family here at MBH:

Mbingo is a fairly large hospital, and we have many volunteers that come and go during the course of the year. These volunteers in many ways are vital to the success of the hospital - they offer a tremendous amount of manpower, bring new ideas and teaching, allow the permanent people a respite, and bring new enthusiasm and vigor. We are grateful for all of them. However, we are equally thankful for our more permanent family here at Mbingo. Specifically over the past 6 months we have grown very close with the Barriers, the Bardins, and the Streatfeilds. They have become our family away from home!

 We came to Cameroon with Barriers, and have been friends since medical school. Their son, Isaac, is Cathen's best friend; and Lindsay and Angela job share, always allowing one of the ladies to be home caring for the children. It really is an ideal set up, and we are incredibly thankful to be sharing this experience with them. 

 Isaac & Cathen: getting ready to walk to the Thanksgiving feast

The Bardins, Rick & Debbie, are our mentors here at Mbingo, and have been such a wonderful source of support and wisdom. They have been long-term missionaries here and in Nigeria for many years, and are a wealth of knowledge and are our surrogate parents.  Cathen has also grown very fond of both "Noni" and "Popi," and is always excited to spend time at their house.

Keith and Kaye Streatfeild, are from Newcastle, Australia, and are an amazing couple who also have been dedicated to long-term missions for many years, serving in India, Ethiopia, and now Cameroon. Kaye leads our weekly Bible Study, and she and her husband are incredible witnesses of God's grace and love. They too have become family here in Cameroon, and so eagerly share God's love and compassion with us. 

From left to right: Rick & Debbie Bardin, JR & Lindsay Young, 

Keith & Kaye Streatfeild, and Chuck & Angela Barrier

 
2) Family and friends at home:

Obviously one of the most difficult things about moving abroad is leaving behind family and friends. However, we have been blessed to have relatively easy communication through Skype and FaceTime and even letters. Written reminders of home are cherished, speaking face to face keeps un in touch with our loved ones, and we are incredibly thankful for the unceasing prayers and support. 

3) Our health:

We weren't too sure what type of environment we were moving to in Cameroon when we left the US. There have been some health challenges - asthma control for JR in the dry season; vivid dreams for Lindsay while taking mefloquine for malaria prophylaxis, and adjusting to raising an infant in Africa - but God has graciously brought us through them all. Lindsay has been able to transition from mefloquine to doxycycline, and her sleep is greatly improved. JR, although struggling at times with his asthma (and therefore with the diabetes if requiring steroids), has been generally very healthy and able to avoid any serious problems with his diabetes. Cathen gave us a scare when she suddenly was refusing to bear weight on her right leg, but she has since returned to health and there is no further indication that anything was wrong. 

Admittedly, both JR and Cathen are a little ill while we are writing this post, but God has been and will continue to be faithful. So we are anxious for their fevers to go, and for their health to be restored. We are thankful that we have a loving Father who has it all worked out. 

4) God's mercies in the hospital

The hospital continues to amaze. We have had many sorrows on the wards, but there have also been many positive stories for which we give thanks. We had a twin male admitted with respiratory failure. He is the first child whom we have successfully resuscitated and brought back to life. He is also the first child to successfully use the heated high-flow oxygen delivery system that Keith brought back from Australia for use on the pediatrics ward. The infant was apneic and bradycardic when he arrived, and he is now home with his mother. The wonderful success is tempered by the death of his twin sister during the same admission, but his life is a tribute to God's grace. A teenage male presented to the hospital with massive right leg swelling, and was found to have a DVT secondary to Burkitts Lymphoma and associated venous stasis. His cancer was rapidly progressive, but he is now status post his chemotherapy and is walking around the hospital with no residual leg swelling. We had a 37-wk female born with severe intrauterine growth restriction (birth weight of 1.2 kg), who thrived in the nursery, and is now home with her loving mother after a successful transition to the incubator, and then an open crib. Although snake bites are not incredibly common here, we did have a young lady admitted with a possible green mamba snake bite. We are incredibly thankful to say that the bite did not envenomate her and she lived with minimal morbidity from the wound. These are just a few examples.

 Burkitts Lymphoma and DVT

 Many of the cases we see we are unable to intervene in a way that will restore a child to full health or to prevent death. However, seeing God's hand at work and saving these children who conventionally should note have survived is a tremendous honor and privilege.

5) Mark and Chloe coming to visit:

Last of all, we are anxiously awaiting the arrival of JR's parents, Mark & Chloe, who are coming to visit during the Christmas holiday. We are incredibly excited to have family out here to see and experience our day to day life, and to share with us during this celebration of Christ's birth. 

Thank you for taking the time to share with us. We love you and miss you. Thank you for your prayers and support.
Blessings,

JR, Lindsay, & Cathen

Thanksgiving Day: JR, Lindsay, and Cathen

The latest...

Greetings! It has been a while since our last post, and a lot has happened since then. To briefly catch you up to speed, here are a few highlights:

1. I was a bachelor for the month of August as Lindsay and Cathen returned home to the US to celebrate Rory’s wedding with Mike Ruma. Their arrival was a surprise to the entire Sallach clan (except for Bob – who did an excellent job of keeping it secret)! They had a great time with the family, were able to take part in the beach wedding, and also spent time with my parents and many of our friends who live back in North Carolina. It was a long month here in Mbingo, and even though I missed them terribly, I am glad they were able to be there to celebrate with Rory and Mike and to catch up with family and friends.

Rory & Mikes' wedding

2. After almost eight months in Mbingo, and only four trips off the hospital compound, we finally took a family vacation. Shortly after Lindsay and Cathen returned from the US, we took a weeklong trip to Kribi, a beautiful beach town in southern Cameroon. We went with the Barriers and had a blast. It was a much-needed break from the hustle and bustle of the hospital. We were blessed to have two pediatricians and a family practitioner here to cover the wards in our absence and to continue the resident education. 

Kribi: enjoying the waves with Mommy & Daddy

3. Cathen is growing up fast! The month that she was back home with Lindsay her walking and talking took off. She is all over the place now, and is gaining new words daily. She is also broadening her culinary selection but thankfully, still loves the fallbacks – avocado and papaya. Most recently, she has become a big fan of Cynthia’s shepherd’s pie and potato soup.

Taking her animals (courtesy of Uncle Brett) on a walk

4. The pediatrics ward was interesting the last few weeks leading up to our vacation. We had fewer patients than typical, but the severity of illness was stunning. Again, dealing with the reality of death here in Cameroon has been a difficult transition for all of us.

5. We currently have three new isolettes/incubators under construction for use in our neonatal nursery. We were hoping to build a new building for the nursery to move into, but after reviewing the building schematics, we will likely reallocate and reorganize space within the current building. We are also excited that a neonatologist will likely be coming out to visit and help with modifying/improving our algorithms and with teaching. There is a lot of work to be done, but we are getting there.

6. Our newest member to the team, Dr. Christy Lee, an OB-GYN, arrived a few weeks ago as part of the Samaritan’s Purse, World Medical Mission, Post-Residency Program (the same program we are here with). We are thrilled to have another colleague here and a partner to work with in the maternity ward.

Those are some of the highlights of the past month. We are all safely home together and have now restarted work on the wards and in clinic. Betty, Angela's mother, has been with us for the past two weeks as well, which has been excellent.

We plan to post some other photos of the past month on Shutterfly, and we will include a link on the blog in the next few days if you are interested.

Thank you for your prayers and support. Blessings,


JR, Lindsay, & Cathen

When all else fails...

About a month ago, a young boy arrived to our outpatient department (OPD) in severe respiratory distress. He was gasping for each breath, and we were fairly certain he was going to die. Based on the initial history (a few days of URI symptoms), he was immediately placed on oxygen and treated as an asthmatic (he had essentially no air movement and a prolonged expiratory phase). However, despite a full court press (back-to-back and then Q1-2H nebs, SC epinephrine, IM magnesium, IV dexamethasone, and aminophylline), we made almost no headway. He persisted to have essentially no air movement. A few days into his course, he became acutely more distressed and developed massive subcutaneous emphysema and a large left tension pneumothorax, requiring an emergent needle decompression on the floor, followed by placement of a chest tube. Once the tube was placed, we could finally hear some air movement, and we were able to hear a fixed, monophonic wheeze emanating from the trachea. He had a foreign body! We rushed him to the OR for a bronchoscopy... and no foreign body was found. At this point, one week into his stay, he had shown no improvement with asthma treatment and although he clinically looked like a foreign body, there was no foreign body on direct bronchoscopy. What was the next step?

He was presumptively placed on antibiotics with risk for super-infection, and then we waited. Our ENT was out performing surgeries at a different facility, but was due back in town in a few days. So we weaned down on our asthma medications, but continued high dose dexamethasone to prevent further airway edema. When our ENT returned, 3 days later, he went back to the OR for a second look. This time, we weren't even able to pass the vocal cords because of the edema and inflammation. What was our next step? On repeat history with the family (which, by the way, is next to impossible to obtain), we "confirmed" our suspicion about a foreign body as mom indicated he had been eating peanuts (called "groundnuts" here) prior to the onset of respiratory distress (although this was the fourth completely different history obtained in as many attempts).

We continued the steroids and antibiotics and removed the albuterol, and waited for a third attempt to localize the foreign body. He made small improvements with the steroids, but a few days later, he again acutely decompensated, becoming cyanotic and struggling for each breath. Our ENT, who had again been out at surrounding facilities performing surgeries, had just come back to Mbingo about 10 hours prior, and was called to take him back to the OR at 4am. This time, he found what we were looking for - numerous pieces of groundnut in both mainstem bronchi. Once the pieces were out, his respiratory status stabilized, and the patient rapidly recovered.

We did everything we could for this patient: we treated him as best we were able given the history and the clinical presentation, but despite our efforts, he didn't improve. Even though we knew the underlying problem, we were helpless to effectively intervene. Then when the patient was seemingly making small steps towards improvement, he acutely decompensated and almost died. When all else failed, however, God came through. It was no coincidence that our ENT had just come back from working at outside facilities in time to rush him to the OR. And even though the vocal cords were too edematous to pass previously, Dr. Acha now had clear passage to remove the pieces of groundnut. Princewill is alive now not because of what we did, but because God decided to intervene and saved his life. When all else fails, God comes through. Thanks be to God that despite our limitations and bumblings, He is able to bring healing when there is seemingly no solution.

Princewill - post the third bronchoscopy and removal of the groundnuts

Provision

The past few weeks have been full of mountaintops and valleys, and have truly highlighted the ups and downs of medicine and life. Lindsay and Cathen flew back the United States to attend Rory's wedding, which provided an awesome opportunity for them to see family and celebrate. Of course, being here alone without my two ladies has been difficult.

We had an incredible recovery of a young boy who had aspirated a groundnut (peanut), and a teenage girl who presented with a massive anterior mediastinal mass and SVC syndrome is responding to her chemotherapy (and we were able to make an "official" histologic diagnosis of Burkitt lymphoma by sending pathology slides to Dr. Bardin to review while he is on vacation in the US). These were tremendous highs.

Those successes have been tempered by the busiest week of our 6 months here in Cameroon - while the hospital is short-staffed (we are currently missing 6 of our 10 expatriate physicians), and feeling helpless as patient after patient gets admitted to the ward and we are unable to diagnose or treat the problems. We have had more deaths in the past week than in the past two to three months combined.

The constant swing of emotions begins to take its toll, and the last couple days have been difficult. However, I was greatly encouraged last night as we were reading in Luke chapter 9 at our weekly Bible Study. After being sent out on a mission to heal the sick, the disciples return and Jesus takes them off to a desolate place to rest and recover. Rather than rest, however, they are swarmed by the masses. Jesus' response was that he "had compassion" on the crowd and "healed their sick" (Mt. 14:14). The disciples ask Jesus to send the people away to go and find food, thinking logically and knowing that they were unable to provide for them. Jesus instead replies - "You give them something to eat" (Luke 9:13). The feeding of the 5,000 ensues and what appeared a disastrous scenario turns into something miraculous.

The last week has beaten me down and I have felt unable to provide for the barrage of patients. However, even when the disciples knew their inability to meet the needs of the crowd, Jesus provided. He had called them there, and He would not let them flounder. Likewise, we've been called here for a purpose, and although I often cannot provide for my patient's various needs, God can.

Thank you for your prayers and support, for encouraging me, and for joining us as we try to bring healing to the sick.


Here are some photos that we took shortly before the girls left town:

Cathen & Gracia

(Gracia is Dr. Francine's daughter)

My Two Ladies

Marching Ants