Settling In

After 2.5 months, we are finally settling in to life here at MBH (Mbingo Baptist Hospital). Work, although challenging, is more familiar, and we are becoming more comfortable with patient management. The hiking and the views have also greatly improved now that the rains have come. Sorry for the lack of posts, we've been a little busy with work, and Lindsay and Cathen have been fighting colds (I have somehow managed to stay well), so here are a few pictures to catch you up from Easter Sunday to this weekend.

Lindsay and Cathen: Easter Sunday. We are in our front yard, and Mbingo Hill is in the background. There was actually a sunrise service that took place halfway up Mbingo Hill, but the trek up began at 4:30am, and we weren't sure Cathen was up for such an endeavor. Hopefully next year we'll be able to join in the celebration. 

JR & Cathen: Easter Sunday. Mbingo Hill in the background.

The back waterfall. This is about a 90 minute hike back behind our home. There are at least 6 other waterfalls that are visible nearby, but this one is the most fun to hike to. If feeling adventurous, you can actually scramble down the embankment and wade/swim up underneath the waterfall. It is pretty awesome, but not for the faint of heart!

Lindsay and Cathen at the back waterfall. The fall is in actually in front of them from this viewpoint. 

View of MBH from on top of Mbingo Hill

Panoramic view of the back side of the valley from the top of Mbingo Hill. The hospital is about another 90 degrees to the right. The new blog photograph at the top of the page is the panoramic view from the front side of Mbingo Hill. Chuck and I hiked up this morning, leaving around 6am to try and catch the sun as it broke through the clouds. The photos might have been a little better an hour or so later, but I had to scramble back down the mountain to make it to ward rounds! 

View from the top of Mbingo Hill, looking east into the sunlight. The sunbeams are just breaking through the morning fog. 

Another photo from the top of Mbingo Hill. The mountains just ahead in the center of the backdrop are located near the entrance to the back waterfall (shown a few pictures up). Our home lies about 300 feet below the eucalyptus forest on the far right of the photo. The landscape is breathtaking, and the rains have turned this into a tropical paradise.  

On a more serious note, please pray for wisdom in caring for our patients. We have had a number of perplexing cases these past few weeks, and would appreciate your support. Thank you!

The First Two Months

These past few weeks have been busy and have ushered in some exciting changes, but at other times have seemed a little stagnant. It has taken us a while to get back to the blog, so there is a lot to catch up on.

We have been patiently waiting for the rainy season to start. Routinely, the rains begin the second week of March. However, we have been in a severe drought, with our taps often running dry, and having no water for a few days a time. More concerning are the crops that the locals have planted in anticipation of the rains - crops that provide nourishment and a livelihood for the families. However, praise be to God, the rains started yesterday. We will likely still have water shortages intermittently for the next month or so, but with the rains comes a cool breeze in the air, dissipation of the oppressive cloud of dust, and great hope for the new crops.

We have been recycling our water as best as able. This shower water was used for watering the plants.

Work has been steadily increasing. Our numbers have increased dramatically since we arrived. Our ward, which hosts 20 general pediatric beds and 6 oncology beds, is always full, and our clinic workload has tripled since we arrived. Thankfully, we have had great help during these last couple weeks of growing pains. Andrew Kim, a third year pediatrics resident from New York joined us for the past 4 weeks. He was a huge help and great fun to have on board. His patients adored him…Clinton, an 11 year old with right sided heart failure secondary to pulmonary hypertension, told his mother that Andrew was his “best friend.”  This is quite sweet, especially considering that we wanted to surround Clinton with family and best friends during the remainder of his life. There is no treatment in Africa for pulmonary hypertension (not even an option for home oxygen) and his disease will continue to progress. He was discharged home over a week ago, but has been living with his mom in the “kitchen” of the hospital because she couldn’t pay his hospital bill. Friends – you paid for his hospitalization so that he could get home to be with his family for Easter. A precious gift indeed - Thank you!!

Andrew & Clinton

The nursery is an area of great opportunity, but currently much frustration. It is perhaps the area where we can make the biggest impact, but it also needs the most help. Lack of supplies and training are making it difficult to care for premature babies; which is heartbreaking when families arrive anticipating better care because of the new pediatricians that are in town. Prayer for space, functioning incubators, appropriate fluids, and teamwork would be much appreciated.

With the coming rains, we are putting our first parcel packages to good use! We have received letters from family back home containing seeds: carrots, lettuce, peas, tomatoes; flowers; etc. We are excited to get our garden underway. In addition to a small garden around the house, we have planted some larger plants in he backyard along the dirt wall, and hope to plant banana trees soon.

Seeds!

Cathen is thriving. She loves her avocado, banana, sweet potato, and rice cereal. Despite the drought, fresh fruits and vegetables still seem plentiful, and she is enjoying her new foods. She is also wonderfully active – crawling, working on cruising, and babbling with the best of them. Having Isaac (Angela & Chucks’ son) next door is a huge blessing.

Cathen has been well-outfitted by her Uncle Rob. Thanks for the NCSU and Duke paraphernalia! 

Isaac & Cathen

We are having gutters installed on the house and are building a covered patio out back where we can eat meals. Construction is underway and will hopefully be completed in the next couple weeks.

The back patio is under construction, and our plastic yard furniture is ready for action...

There is plenty happening here at Mbingo. In addition to work, we are getting outside and enjoying the countryside. Specific prayer requests for the upcoming weeks:

- Continued rain

- Patience with the rationed water

- Effective teaching of residents and development of pediatrics curriculum

- Making headway in the nursery: space, equipment, and training

- Wisdom in caring for patients

- Safety and health for Cathen as she grows

Cathen and Daddy cooking

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Horseback riding

      

The back waterfall: eating avocado with Daddy

Much love to you all! Blessings.

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.