Love cannot remain by itself -- it has no meaning.
Love has to be put into action, and that action is service.
--Mother Teresa
We would like to sincerely thank Pastor Luther, the Council, and the LCI community for sponsoring our trip to Cameroon, Africa this past April. It is difficult to know where to begin when describing our experience in Africa. However, it is clear to us that our experience changed our lives forever, and we believe it will be a valuable stepping stone in LCI’s continuing work with the EELC mission and The Protestant Hospital in N’gaoundere.
We noticed from the very beginning of our journey how desperate the situation was in the healthcare system in N’gaoundere, Cameroon. We found a need in every corner. The hospital needs general medical supplies, medicine, nurses, doctors, and, most importantly, proper infrastructure. The patients’ rooms are unacceptable, covered in dirt and swarmed with flies and cockroaches. Patients share their rooms with 3-5 other patients, negating any form of privacy. The operating rooms have just enough supplies to get by. However, at the same time, the Cameroonians do the best they can with what they have. Their attitudes are positive and optimistic, despite the dire situation. They simply need help.
As our mission continued, we found ourselves working in the operating room, helping care for surgical patients and emergent patients, before, during, and after their operations. We experienced some common surgeries that we had seen before in the United States: hernia repairs, cesarean sections, fracture repairs, etc. The only difference was that there was only one surgeon performing all of the operations. This was far too much work for one man, yet he took it in stride and continued to save the lives of the Cameroonians. We also experienced some surgeries that we would never even dream of seeing in the United States, and saw some situations that continue to haunt our memories. We experienced the pain of family members who desired to help protect their loved ones but were unable to keep them in the hospital due to money. We watched as patients bartered for the price of their medical care, unable to scrape together the $50 it would cost for an important operation. We saw children who had resided in the hospital for several months due to horrific injuries and even more horrific complications. We witnessed simple injuries get exponentially more complicated as the patients were forced to travel for days to reach the hospital. All of these events and experiences were new, complex, and eye opening for us both. Seeing the dismal situation of medicine in Cameroon has changed our outlook on our careers and in our lives.
Although a lot of the trip was frustrating and heart breaking, not all of it was this way. We formed deep relationships with strong and inspiring patients and staff. Although the staff of the hospital needed education and some motivation, they put up with serving in the healthcare field with minimal supplies and resources, utilizing an incredible amount of patience and understanding. In addition to the staff, we were awe inspired by the unchanging and ever hopeful will of the patients. Our favorite patients were the “Three Musketeers:” three young boys who were all in the same room for months, all with horrendous injuries, and all with the brightest, happiest smiles we had ever seen. They greeted us every day, saying “Good morning. How are you?” in broken English. They personally rehabbed their injuries (as there was no physical therapy at the hospital). And they survived. Without the work of the hospital, especially the surgeon, Dr. Brown, their injuries would have taken their lives. We also loved visiting the Nigerian man who spoke a foreign dialect that no one understood, but who talked to us and laughed with us every day. He had an injury to his arm and asked every one on our team to help him stretch it out every day in an attempt to heal. And, finally, there was the woman who had a beautiful baby girl, which Courtney delivered. She offered to name her baby “Courtney” out of appreciation, joy and grace. All of these experiences will remain with us forever.
Even with the good experiences, there are still an insurmountable number of problems at the hospital. So, where do we begin to help? First, by sponsoring the work of Jim and Carolyn Brown. Dr. Jim Brown is the leader of PAACS (Pan African Association of Christian surgeons) in N’gaoundere, Cameroon. He is almost single handedly taking on the healthcare needs of the entire area. His wife, Carolyn Brown, is a nurse and educator at the hospital. She also organizes a benevolent fund, sponsored through the EELC and ELCA, which supports care for patients who cannot afford the basic healthcare they require. Instead of denying these patients care, which is what used to occur, they can now dip into the benevolent fund and provide the emergent services necessary. This fund is supported fully by donation. This is a good place to start with simple monetary donations through the ELCA. Donating supplies to the hospital through Jim and Carolyn Brown would also be beneficial. As for more ambitious goals for the church, a few ideas come to mind. Funding a large infrastructure project at the hospital for an extended period of time would have a long lasting impact. This can be accomplished through LCI alone or through a consortium of churches. Sending personnel to the hospital, specifically shifts of doctors and nurses throughout the year, would be invaluable as well. Lastly, spreading out into the neighboring communities with a mobile medical clinic is an ambitious goal worth pursuing. This would provide access to healthcare to thousands of patients who sometimes would travel up to three days to get to a hospital.
As we experienced, these tasks can seem overwhelming and daunting. But what we can also assure you is the rewards far outweigh the risks. This undertaking can serve the Lord by saving the lives of innocent men, women, and children who simply have nothing. When you look into the eyes of an innocent dying child who can be saved from a simple investment, it is heart wrenching. We cannot only save one child, but we can also save an entire community and do it in the name of Jesus Christ our Lord.
Courtney Steller and Brent Brown
Wednesday, May 19, 2010
Sunday, April 25, 2010
Top twenty things we'll miss about Cameroon
20. Sleeping under mosquito nets
19. The 50 year old train
18. Eating lunch in the surgical wing in a wheelchair with medical supplies, ants, other med students, and a mouse
17. No traffic laws of any kind
16. Understanding every 5th word
15. Taxi motorcyles (motos)
14. Loud call to prayer/roosters/goats/screaming children at 5AM
13. Blaring african/middle eastern music till all hours of the night
12. Always having at least one major utility out
11. Sweating through scrubs three times a day
10. 75% of diet consisting of eggs
9. Food and drink for under $2
8. Omnipresent red dust
7. Bartering for everything
6. Plantains served as french fries
5. Adorable children chanting 'nassara'
4. Endless supply of mangos
3. The hospital
2. The spirit of the Cameroonian people
1. Jim and Carolyn Brown
Wednesday, April 21, 2010
The snakebite
It was 6PM after another long day of surgery. Brent went with the resident to follow up on the cases in the ER when the resident non-chalantly says "snake bite....that one is us." The 14 year old boy lay still, as if in a trance, clearly favoring one arm. We found out this boy had been bitten three days ago by an extremely venomous snake in the ring finger. Attempts had been made by the 'traditional healers' to dispel the venom slowly moving its way up the child's arm. The 'healers' put several holes with needles in the boy's arm to no avail. Once the family gave up on the traditional route, they travelled apparently a great distance for a last ditch effort with Western medicine.
When we examined the patient's arm, it was full of dirt, needle holes, and so tense and swollen he barely had a pulse. He immediately needed IV fluid and antivenom. The ER had some generic "African snake bite antivenom" which we immediately pushed into his veins. He could barely move his arm due to the pressure building up in his left arm. In medical speak, this is known as "compartment syndrome" requiring an immediate "fasciotomy." In other words, we had to slice up his arm to relieve the pressure.
We called anesthesia to get ready to perform surgery. We got no response. A half hour later, we decided we were going it alone The medical students attempted to set up the equipment, replace IVs, and get ready for surgery. All the while, the patient was getting worse, much worse. He had virtually no blood pressure, had very little oxygen in his blood, and was dangerously anemic due to the hemolysis likely occuring secondary to the venom.
Courtney looked at the chart and sure enough he was O positive, the same blood type as herself. Courtney, being the fearless person she is, went to give blood without letting Brent or Dr. Brown know. Brent found her giving blood in a back room of the laboratory. He was in awe. There was no hesistation to giving blood in Africa. The child needed blood and Courtney gave it to him.
Anesthesia finally showed up and he eventually stabilized with Courtney's blood. We had saved his arm and his life.
-Brent Brown
The waterfall
On Saturday afternoon, following a half day in the hospital, we decided to take a day trip out to some nearby waterfalls. We grabbed some water, snacks, our tour guide, Yerima, and our four wheel drive, manual Toyota, and we were off on our "safari."
We initially headed outside of N'gaoundere on a back dirt road. Not only was the road a dirt road, it had apparently not been maintained for years. There were giant holes, roots, ditches, and miniature rivers paving the road. Endlessly bouncing up and down and swerving to all sides of the road to avoid the huge bumps, Yerima led us on our way. As we drove, we passed several villages far outside the boundaries of N'gaoundere. These villages would pop up as if from no where. They usually consisted of a group of little houses that looked like huts, with grass roofs or occaisionally no roofs at all. Every now and then we would pass a larger building, which we were informed were schools. We wondered how children got to the schools as they appeared to be in the middle of nowhere with no nearby surrounding village. As we drove further, we got confused stares from the Cameroonians, as well as some children yelling "Nassara."
Finally, after around an hour and a half of driving and some roadblocks by an occasional herd of cows, we arrived at a small hut next to a stone pathway of steps. "We are here," said Yerima. We migrated down the stairs in the sweltering heat to come upon three gorgeous flowing waterfalls. They seemed to have no beginning. They fell into a small lake below, which generally gets much larger as the rainy season progresses. We could stand as close as we could to the falls to feel the cool mist chill our skin against the hot sun. We wandered around the falls, to the back side, and as close to the water as we could get. It was beautiful. After taking hundereds of pictures and relaxing for a little while, we made our trip home.
It was a wonderful short little day trip. We ended the day drenched in sweat and red dust, turning one of Courtney's great little white tee-shirts to a dull orange shade. We had finished our little safari and decided to treat ourselves to a nice fancy dinner at the Plazza Restaurant that evening; a great ending to a great day!
--Courtney Steller
Sunday, April 18, 2010
Dr. James Brown
That quote from Dr. Brown was said after a patient was not being treated in the emergency room because of lack of payment. I think it epitomizes the way he practices medicine. A former Navy surgeon and a practicing general surgeon in Virginia for the last 30 years, Dr. Brown has chosen to end his career in N'gaoundèrè, Cameroon providing quality healthcare to a place struggling to just survive. Dr. Brown is technically providing general surgical care to the Prostestant Hospital and the serves as head of PAACS (Pan African Association of Christian Surgeons). As the head of PAACS in N'gaoundèrè, he instructs two residents leading surgeries and bible studies alike. Dr. Brown also does an amazing amount of surgeries. As the only attending surgeon, he is always "on call." In other words, he never has a day or even a night off. By my count, in addition to his surgical duties, he also works in pediatrics, obstetrics, gynecology, gastroenterology, pulmonology, infectious disease, orthopedics, urology, internal medicine, and family medicine.
You may ask, how can one man do all of this? The answer: the best that he can. He literally taps into energy stores that I don't think exist. I also think his faith plays a large role in how he is able to handle his responsibilities. Whatever you may believe, there is little doubt when you see this man, that a higher power is on his side. He once said "80% percent of what I do here I have never done in the states." This is a doctor who had been practicing for thirty years. Often times he is functioning on a hope and a prayer, and more times than not somebody is alive today because of that.
And of course, there is Carolyn Brown. As they say, behind every great man is a great woman. This couldn't be more true in this case. As a nurse, she handles a lot of patient care as well as education for the other nurses on staff. In addition, she handles virtually all the household duties and is the de facto adminstrator of the patient benevolent fund designed to help patients who simply cannot pay for lifesaving treatment. She is a woman of patience, grace, and dignity.
The next time you think you work too many hours, you hate your boss, you don't get paid enough, you despise your commute, think of Jim and Carolyn Brown. They just may put everything into perspective.-Brent Brown
A day in the Protestant Hospital
We start rounds in Urgance. Urgance is the Emergency Room. It consists of 6 "Boxes" (rooms), which are literally boxes with a curtain hanging in front. The rooms are generally single rooms, although I have seen up to three people in a room at a time. Urgance has access to oxygen and wall suction, and has its own supply of dressings, gloves, etc. When patients present to Urgance they are seen on one of the two beds that are not inside a room, but out in the open. If they are to stay, they will then be moved to a room. Urgance also serves as a place to put post-operative patients, since there is a smaller nurse to patient ratio and the supplies listed above. If patients remain unstable for a while, they may remain in urgance for a very long time. For example, there is a girl we are treating in Urgance currently who presented one week ago suffering major injuries from a moto accident, including an open femur fracture and an open humerus fracture. She was taken to the OR immediately and stabalized, and has remained in Urgance ever since while she recovers.
Our next stop in rounds is to pick up our "dressing cart" (simply a cart with a lot of dressings, tape, gloves, betadine, saline solution, etc.). We usually have to restock the cart before we pick it up because the nurses here don't feel it is their responsibility. Then we make our way over to the private rooms. There are about 6 private rooms offered to patients. They cost 5,000 CFAs a night (about $10) vs the 3,000 CFAs ($6) it would cost otherwise for the entire hospital stay in a non-private room. The rooms are very nice and are usually decorated with rugs, sheets, etc from the family. There is also an extra bed in the rooms for family members.
Next up: Reanimacion (aka Reanimation), which is the ICU. The only reason this area is considered the ICU is because it has access to oxygen, up to 6L at a time (which is not much), and wall suction. It is also more expensive, but often we will have to place patients there even when they do not need to be there due to lack of space in the hospital. The area was originally built to be a burn center, with a donation made from St. Mary's in Duluth. However, the infrastructure was never maintained to continue a burn unit, and it became the "ICU."
Finally we get to the surgical ward. There are about 6 rooms we see patients in on the surgical ward. Each room holds about 5-6 patients. They are stacked up against the walls (which usually have an array of bugs and cockroaches crawling on them) with their dishes, clothes, family members, etc. struggling to find space aroud them. My favorite of all the rooms is the second room. In that room are "Les trois Muskateers," three young boys who suffered horrendous injuries at different times and who have been in the hospital for months, becoming very good friends and motivating each other to get better. They all get really excited when we come see them, giving us high fives and teasing us about our French. They are inspirational in the amount of dedication they have towards their own recovery. Even though they have been here for several months (some since January), they are still happy and never cease to have fun or laugh. Rounds on the floor consist of a ton of dressing changes (apparently this is not something nurses do), and a lot of sifting through the charts to try to decipher whether or not a treatment has been given. Have they gotten their antibiotics? Do they have a fever? Has their Foley catheter bag been changed? Rarely are these important facts documented in the charts, leaving a lot of unanswered questions. We also have several (about 4 right now) patients who are still on the floor even though they have been discharged home, just because they have not paid. The head nurse (the "Majore") will not let the patient leave if they have paid, so they just sit around until they can come up with money.
Our last stop on rounds is Maternatie. We follow up on any C-Sections that we may have had. Finally, once rounds are done, we will make our way to the Bloc (short for Bloc du Operacion, or the OR). There are 2 major operating rooms, each with two tables, and yes, sometimes they have two tables operating at one time in one room. There is also a side room for minor operations and a pre-op/post-op room for patients to wait. There are two sinks to scrub (aka steralize) for the operations with soap and unfiltered water. About 80% of the time, the water is not working in the OR, so there is a bucket filled with water that we use to scrub when that is the case. There is supposed to be one oxygen machine in the OR, but that has not been seen for a while. There is a back storage room, which seconds as a call room/cafeteria, and contains cabinets full of unorganized supplies, both donated from outside donors and bought by the hospital. There are a few sterile instrument trays. There are two bovie (cautery) machines which work about 50% of the time. There is a pulse oximetry for the anesthesiologists, which usually is inaccurate, and a blood pressure machine in each room. And there is suction in at least one of the rooms at all times. (Sorry non-medical readers, that paragraph probably didn't mean that much to you).
Finally, once all of the operations are finished and there are no more emergancy operations that need to be done, we are finished and can go home to enjoy some dinner...most of the time!
--Courtney Steller
Everything is negotiable
As a 'Nassara', or white person, people generally think they can take advantage of you; we learned this quickly. 'Nassara' is literally yelled at you by people as you pass. Sometimes, when yelled by chidren, it feels like you are a white celebrity walking by. Other times, when yelled by merchants, it is like they are putting a target on your back, essentially yelling "sucker!" when you walk by.
The door to door salesman is not dead in Cameroon. With little access to the internet, people aren't buying things off Ebay or Criag's list; they are buying it at their door. We have bought things at our door; which you can really haggle down the prices. We have bought mangos, onions, paintings, and souvenirs from salesman. Often times these are extremely cute children, which can often be endearing. Except, of course, when they constantly harrass you at 545 AM knocking on your window before you are at the hospital for 16 hours.
People even bargain for medical care. We have outpatient clinic every Monday and Thursday where we set up surgeries and treat a lot of non-surgical patients. I would say roughly 1/3 of clinic is going through the prices for surgeries; which are already ridiculousy low compared to the states. For example, a complicated orthopedic surgery in states could run you $30,000 or more. Here, you may get one for 150,000 CFAs (300 dollars).
So if you are heading to Cameroon, put your best haggling face on, and shop till you drop!
-Brent Brown
Wednesday, April 14, 2010
Medical Students
There is one medical school in the country of Cameroon which is based out of Yaounde. The school is, I am told, similar to European medical schools in that they are 6 year programs and students can enroll directly out of high school. I believe they have 4 years of basic science classes and 2 years of clinical rotations. They are required to do at least three months of their clinical training at a "rural" site, which is why Binto is working at the Protestant Hospital in N'gaoundere with us. She is in her 5th year at medical school; her first year of clinical rotations.
She has been a lot of fun to work with and talk to during our time in the hospital. It is interesting to get her perspective on certain things: e.g. she is very impressed by the conditions of the Protestant Hospital and thinks it is one of the nicer hospitals she has been to. When I told her there are about 8 medical schools in Chicago, she was astonished and could hardly believe there were so many medical schools in one city. She also enjoys working with Dr. Brown as much as we do and is very enthusiastic about learning (proving she is not quite in her last year of school!).
Tuesday, April 13, 2010
Things you won't see at a hospital in the USA
Our time in the hospital started off with surgery the morning after we got off the train. It was a fairly routine surgery until we realized the anesthesia was never routine. Patients rarely would be put under full sedation (gas, muscular blockade, IV medication). Our patient was given a lot of IV medication to compensate. Unfortunately her airway was not kept open and she had copoius secretions with no suction. She proceeded to desaturate until her oxygen levels were next to nothing when we had to take over to get her breathing again. This was our induction to surgery in Africa.
We have had several patients who have groaned during operations; some more than others. Although, with the medication they are on they will likely never remember the pain of surgery watching the patients experience the pain in an altered state is still unsettling.
We have seen an extraordinary amount of children with burns; sometimes extensive. Kids often play near fires with little to no supervision as a way of life. The struggle is not the surgery to repair such wounds with skin grafting, etc; the struggle is with wound care management and physical therapy. We round everyday often changing wound dressings with children in agonizing pain. Even with proper managment many of these children will lose function in the hands, arms, legs, etc.
Many children also come in with serious fractures often dirty and old. Many kids develop osteomylelitis (bone infection). When this happens you can treat with antibiotics. They have access to some antibiotics here but not the IV variety they have in the states. So many children are left with multiple operations to remove the infected bone as their only alternative.
We also have seen an good deal of patients related to 'motos.' Motos are essentially taxi motorcycles. Courtney and I experienced an accident on the way to town one day. We performed a basic trauma survey on the side of the road. We had a man stabbed multiple times from someone attempting to steal his moto. Most recently we saw an accident with 3 people on a small motorcycle being struck by a large bus.
Many OB/GYN cases also have bad outcomes. The infant mortality rate here is still very high here; with approximately 5 of our last 10 C sections resulting in dead children. There is little to no prenatal care and often women wait until it is much too late. Compounding many of these problems is the reliance on 'traditional' medicine before seeking 'western' medical care.
Lastly, is a case that will stay with us for the remainder of our careers. Pt X was a 30 year old female who was a UN recognized refugee living in CAR (Central African Republic). She came in with a large mass in her abdomen for an unknown amount of time. The history we got was anywhere from 6 months to two years. We obtained an ultrasound and a pregnancy test. The pregnancy test was negative and the ultrasound confirmed a mass outside the uterus. We were truly confused. She had also developed an abscess with pus draning from her abdomen. She complained of constant itching until a hole opened in her skin. We decided we had to explore and remove whatever was causing this problem. Brent was lucky enough or unlucky enough to have scrubbed in on the surgery. Pus drained profusely as we opened the wound. Then fragments of hair and bone were seen; typical of a dermoid cyst (cyst with hair, tooth and nails; fairly common). We continue to remove debris until we noticed a femur, pelvis, and a horrific smell. We were removing a dead child. The child was either an ectopic abdominal pregnancy or her uterus ruptured and she recovered quickly enough to not bleed out. The child had been dead so long her pregnancy test was now negative. As we grimly removed her unborn deceased child she never knew she had, Courtney was asked to document what we had seen here. She did her best to contain her emotions and her stomach as she took pictures. The whole situation made you want to cry.
I write about these situations not for shock value or as a condemnation on what goes on at a hospital just trying to save whatever lives they can with the resources they have. I write this as a reminder as to how lucky we are to being living in the US where we have access to great care in virtually ever walk of life. I also write this as a plea to continue to keep in your thoughts and prayers the disparity in the quality of life here.
-Brent Brown
Fruits and Veggies
-Courtney Steller
Subscribe to:
Posts (Atom)
