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!

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.