Opportunity and Challenge at the Protestant Hospital in N’gaoundéré, Cameroon

Many of you are reading this are following along with Courtney and I’s day to day travels and experiences in the hospital. We will continue to post those stories on future blogs. But I want to take the time to speak to opportunities and challenges to those who are planning on travelling and working here at the hospital and those that may contemplating it. I also want to speak to anyone who wants to help in other ways. Please see the ‘how do I help section’ at the end of this blog.


First, I will speak to the challenges. First and foremost is the language. Although, in theory, Cameroon is a bilingual country with French and English being the primary languages, this can be misleading. English and French sections of Cameroon are well demarcated and N’gaoundéré is French speaking. So I would strongly suggest really learning basic French or having at least one translator; preferably more for large groups working in the hospital. Courtney and I made a valiant effort in this regard but it does take a good deal of uninterrupted time. Even if one knows French, many natives speak in tribal languages which further complicate communication especially in the healthcare field. This can be overcome by developing relationships with local doctors, nurses, and healthcare staff; which brings me to my next point.

Language isn’t everything. In my short stay here, my feeling is that many of the Cameroonian people working in the hospital feel like they can take care of their own with what resources they have. Some might even feel threatened or resent that Americans have come here “to save them.” It is analogous to a foreign doctor coming in and telling your long time family physician that his treatments had been inadequate. Not an easy situation by any means. Carolyn Brown, a nurse and the wife of the head surgeon of PAACS Jim Brown, said it took here one year before she felt like she had develop the rapport to teach the other nurses. When Dr. Jim Brown took over, there was essentially no documentation system and it was anybody’s guess if the doctor’s orders were performed by the nurses. He has spent the last 1.5 years attempting to change the system and it has only recently been working with few setbacks.

Lastly, and maybe the most obvious problem, is finances. Many people simply have very little money and the resources they do have go to food and shelter. Jim and Carolyn have set up a benevolent fund for emergencies and surgeries deemed necessary. People pay out of pocket for everything. People have to purchase manually all the treatment they will receive in the hospital. This includes IV fluids, medication, and surgery before anything will be done. Recently, we had a woman unable to immediately pay for an urgent treatment in the ER and she was not treated overnight because of her financial issues.

OK, now onto the positive points. With the caveat of what I wrote above, much is needed here and much can be done. In regards to healthcare personnel, an anesthesiologist or nurse anesthesitist would be huge help. The anesthesia staff is overwhelmed with the volume of surgeries and need help with the quick turnaround often needed in surgery. Secondly, medical supplies, basic sanitation equipment, and medications are sorely lacking. Moreover, any doctor or nurses willing to make the trip would be a help. Specifically general surgeons, OB-GYN docs, and Internal Medicine specialists and nurses experienced in these fields would be of help. In regards to specific donations, donations to the hospital for infrastructure I think we be the best use of money. Infrastructure may be the largest problem facing this hospital. The hospital is simply nowhere near where it needs to be in many areas.

We will be posting a “how can I help” section that will be continuously updated with contacts and specifics on how to go about making a difference here.

-Brent Brown

Medical Student Frustration

Well, we’ve been at the hospital for almost a week now, and things are not quite how we expected them to be. I think we came in to this experience with the expectation that we would be an invaluable addition to the hospital and would get to experience and participate more than we would in the US. We thought that I would be working mostly in Obstetrics and some Gynecology, and that Brent would be working in Internal Medicine and rounding in the hospital. And, we thought we’d be some of the only “extra hands” in the hospital.


Some of the above is definitely true. We have seen some amazing cases that we would be unlikely to see anywhere else. We round every morning on surgical patients and are very helpful in assisting with wound care and chart documentation while our attending hurries to see all 40 patients. I have seen several Gynecology cases already.

However, a lot is different. First of all, we have pretty much only been working on the surgical team. Dr. Jim Brown, the attending, is American and therefore speaks fluent English, and is extremely nice and welcoming. As Brent and I have attempted to branch out to other fields, we have not been very well received and have a difficult time explaining who we are and why we’re there due to the language barrier. Therefore, we’ve been feeling much more comfortable and welcome with the surgery team. Secondly, there are 5 other medical students besides us here at this very moment. Some are coming and going, and one has been sick with malaria, but 7 total students makes for a very crowded service. And we are still only students. We are working with an American attending and his residents (1-2 at a time), which leaves us in the “student” position, giving us very little, if any, autonomy. This also leaves us with a lot of time to sit around and do nothing, waiting for a moment to be useful. Finally, we are still in the mix of the competitiveness between medical students. We are all vying for the good surgeries, the future obstetricians all want the C-sections, and we all want to give off a good impression to our attending.

I know that this experience is unlike any other and that I am truly lucky to be here, yet some days it is frustrating that we can’t be more help. Dr. Brown needs more surgeons, more hands, and more time. He does everything by himself and is on call every day of the week. I only wish I could take some of the load off of him and truly give back. I find I am feeling the same as I have throughout the fourth year of medical school: I want to more and I feel I have the ability to do more, but I am not yet at the point in my training that I am allowed to do more. I suppose that is frustrating both in American and in Africa.

Courtney Steller

An Easter to remember

As expected, Easter Sunday was not the same this year. Even thousands of miles across the country, however, we still were able to celebrate.


The day started with the goal of attending a sunrise service at Mount N’gaoundere, the largest “mountain” around. We piled in the car at 5:30am to drive to the mountain, expecting a large group of worshipers to meet up with, but instead we found no one. We decided to just climb the mountain by ourselves and do some personal reflecting. The gathering consisted of Dr. Brown, Kim, Magdalena, Marit, Lauren, Jacque (one of the PAACS residents), his wife, Deena, and us. The hike up didn’t take too long as we traversed the mounds of rocks and attempted to find a trail. By the time we got to the top, the sun was just rising. We stayed there a while, meditating and snapping a lot of pictures. We were able to see over all of N’gaoundere from the top, from the train station, to the cathedral, and almost to the Protestant Hospital. As we relaxed, enjoying the mildly cool breeze of the early morning, we were suddenly surrounded by hundreds of Cameroonian “athletes” who use the mountain as their morning exercise. They bounded up and down the hill, jumping from rock to rock, as we attempted to keep our balance and avoid tumbling down the hill during our descent. Brent noted that they were hiking similar to the way they’ve been driving: fast, reckless and without “rules.” By the time we made it to the bottom, we found the original gathering that we were supposed to meet for our service. Our car was on the other side of the mountain. Oh well!

We drove back to the Mission where Carolyn had a beautiful Easter brunch prepared for us, complete with colored eggs!! She had made some cinnamon buns, chocolate zucchini bread, and fruit salad to celebrate the day. It was amazing and we were again grateful for our gracious hosts here.

By the time we finished brunch it was only around 9:00am, so we decided to walk over to the Millenium Church to see what their Easter service looked like. The church is gorgeous! We listened to (and tried to sing along with) the band and attempted to understand the baptism and the sermon.

For a while we were able to relax in the afternoon, until Dr. Brown came knocking at the door, letting us know there were some emergency surgeries going on. We dashed up to the hospital to join him. For those interested in the medicine, Courtney was first assist on an 18 year old girl with a ruptured ectopic pregnancy, on whom we did a unilateral salpingectomy and a couple ovarian cyst drainages. Brent then was first assist on an incarcerated hernia repair. Finally, Courtney performed a curettage on a woman who had miscarried (technically an incomplete abortion) at 6 months gestation. Whew! By the time we got back, we were hot and tired. We forced ourselves to make a quick dinner and then went to sleep.

Like we said, not your typical Easter.

Courtney and Brent

Day #2 N’gaoundéré -First day in town

Courtney and I were able to get away and go into the city after our first trip to the hospital. Lauren, who had been in N’gaoundéré for 5 weeks and spoke fluent French, was our guide. We walked the 45 minutes to downtown from the mission with great pleasure as we had been feeling a bit cooped up. We strolled all around town and saw all the little restaurants and shops. This was no easy task. In order to move we had to navigate through mobs of people, motos (motorcycles), and cars, through a cloud of dust, and with the local youngsters yelling “Nassara, Nassara!” (meaning “hey, white person…”) from every direction. That being said we had a lot of fun. We eventually made our way to the petite marchè (small market) which is ironically larger than the grande marchè (large market). Lauren showed us the fine art of haggling a local seller at the market; which is actually, we found out later, a large part of the Cameroonian culture and West Africa in general. We were able to snag an ‘authentic’ Cameroon World Cup soccer jersey and a ‘real’ African necklace. After that we went to Courtney’s dad’s favorite restaurant when he stayed in town: The Plazza. Unfortunately the cooks weren’t there and the waitress didn’t know when they would be back. All they had to offer was drinks, which was not going to be satisfying enough. So we wandered to another place where the cooks were there. However, they only could offer about half of their menu. Despite the limited options, we were very happy with the meal, especially since we got some fried plantains (a delicious substitute for French Fries!). We then got the Cameroonian version of ice cream, ice flavored with vanilla and chocolate extract, which was actually pretty good and thoroughly refreshing. We got a taxi home to the mission feeling full and content Now we were ready for a great Easter Sunday.


Brent and Courtney

Day #2 N’gaoundéré-First hospital day

We had settled in on Friday and were ready for anything. On Saturday morning we volunteered to go in for rounds at 0730. We made our way out of the mission and into the hospital compound close by. Dr. Brown led rounds through the various wings of the hospital without hesitation as if he were back in the US. He seemed unaware of the conditions around him. Courtney and I were not. Everything was hot, humid, and dirty. The rooms were often full with four to five patients per room and their entire families with them. Dust settled on the floors, bugs crawled on the walls, and flies swarmed around patient’s wounds. But the amazing part was the staff at the hospital. From the janitors to the doctors everyone seemed to be doing the best with what they had. Dr. Brown seemed to lead the charge in this regard. Dr. James Brown, the leader of PAACS (Pan African Academy of Christian Surgeons) seemed to tap into an inner strength and faith few people have ever possessed.


Once we looked past the conditions we attempted to focus on the patients. From the child with a snake bite causing a permanent deformity of his arm to the women who had burns over 25% of her body from boiling water being thrown on her the patients were truly shocking. Patient after patient would come to this little hospital in N’gaoundéré from sometimes miles away with horrific injuries just for a shot at hope. Perhaps more depressing was witnessing a very treatable disease in the US being either horribly mismanaged or ignored by the patient or family until it was too late. Even if they were there in time and treatment was available at the hospital often times the patient had so little money the hospital would have to eat the cost.

We realized quickly where the need is in this community resided. The need for basic medical supplies and medication was a constant issue. The facilities all badly needed upgraded.

Courtney and I were finished with the hospital by the mid-afternoon for that day. But we realized the importance of bringing our story back to the United States for the never ending fight for quality health care around the world.

Brent and Courtney

04/02/2010 Arrival to N’gaoundéré and Day 1

We had finally made it to N’gaoundéré. As we exited the train and prayed our bags made it with us (they were thrown into some other car by the porter), we couldn’t help feeling excited and a bit nervous. With our appointed porter, we eventually found our luggage in the midst of a huge crowd. Carolyn Brown, wife of Dr. Jim Brown was waiting patiently to pick us up at the station with yet another medical student from the US! We all drove into town and made our first most important stop: lunch. We ate at this little restaurant called “The Coffee Shop” and tried out the local fish, Capitain, with some fried plantains (yum!) and the Cameroonian soda, Djino. Once we were sufficiently full, we made a quick trip to the grocery store, a bakery, and finally to the EELC Mission. We were met by Dr. Jim Brown, who is one of the most talented, hard-working, dedicated and kind-hearted people. Once we introduced ourselves and tried to figure out who we were “officially” meeting at the hospital we were assigned to our different mission houses and left to get settled in.


The houses here are pretty comfortable. Courtney has a two bedroom/one bath house that is right across the way from the house Kim and Magdalena (the two girls on the train) share. It has a kitchen, a dining table, a living area, hot water, and electricity. Brent lucked out with a three bedroom/one bath “mansion,” with a huge living area and a fire place (for all those cold nights…), a large kitchen and huge storage areas. Overall we are quite pleased with our living situations.

Once we got settled and cleaned up a bit, we visited with the other students since there was nothing going on at the hospital (as it was Good Friday). Two students, Marit and Lauren, are from the University of Minnesota. Marit is originally from Duluth and there is a strong connection between St Mary’s Hospital in Duluth and the Protestant Hospital here in N’gaoundéré. Through some contacts back home, she and Laura were able to come out here to work. Kim and Magdalena are from Danville, Virginia, where Dr. Brown used to practice. Through his connection, they were able to set up a rotation here. It was amazing to talk to these other students from across the country that ended up here, at the same place at the same time. The others had been here for 5-6 weeks and were very familiar with the area and with the hospital, which eased our nerves and helped get us oriented quicker.

The evening was spent having a nice pizza (made with fresh picked mushrooms!) at the Browns. We talked and ate and got to know one another. We felt extremely welcomed here and were excited for what the journey brings us next. Rounds at the hospital in the morning….

Courtney and Brent

The train ride 4/1/2010-4/2/2010

Finally the day of the long awaited train ride had arrived: Thursday 4/1/2010. We had made our reservations for the train on Monday but we had to still go to the station in the morning to purchase the ‘real’ tickets. Ann and Willie had to go into town so they were nice enough to drop us off at the train station and direct us to the proper line to wait in. Unfortunately, when we got there, nobody was working the ticket line. We discovered that this is not an uncommon occurrence in Africa: unscheduled “breakfast breaks” can happen at any time. While in line (for a mere 2 hours), we met two other Americans girls, Kim and Magdalena, who were heading to N’gaoundéré to the same mission! In fact, they were also medical students! Not just medical students but osteopathic medical students from Virginia. One of them, Kim, spoke French and was able to get us all in the same “wagon” (aka cabin). After getting our tickets we went back to Anne and Willie’s to eat lunch, take some final pictures, and say our goodbyes. That afternoon, Felix, our trusted taxi driver took us to the train station one last time for our voyage. Arriving at the train station was mildly overwhelming as several Cameroonians approached us offering to carry our bags in exchange for a fee. These men are known as “Porters” and are common to find at any travelling station. We proceeded to the first class waiting area, which seemed completely out of place, complete with nice seats, air conditioning, and a flat screen TV with hip hop videos. After waiting another couple hours, it was finally time to board the train.


We proceeded to get on the train now with our new medical student friends. The cabin was small but had 2 bunk beds. We tried to lay as still as possible to avoid any more heat production as the heat and humidity descended on us and we were unable to open the majority of the windows around us. After sweating through our clothes the train gloriously started to move. With a sudden and forceful jerk we were finally on our way to N’gaoundéré. We read some books via the lights that were hanging on by a thread and slowly drifted off to sleep as it became darker and darker. At one of the stops, a couple innocent-appearing flies made into the cabin. Then about 500 of their fly-friends flooded in, all swarming around our light. Courtney was swatting at the flies with her flip flop and hiding as far in the corner as possible. We searched around frantically for the light switch but were unable to find it. When we really thought there was nothing more we could do, a maintenance man came around with some bug spray. We dashed out of the cabin while he sprayed like crazy, shut the window, showed us how to turn off the lights, and closed the door to fumigate the unwanted insects. We went back into the cabin ten minutes later cleaned the dead flies off our beds and breathed a sigh of relief. We drifted back to sleep and woke up around 6AM as the sun rose. Although the train was supposed to take about 12 hours, Courtney and I had now gotten used to “Africa time” and were not surprised as we rolled into N’gaoundéré around 11AM. We had made it!

-Brent and Courtney

 

Cockroach

Alright, so I had my first run-in with a very large, very disgusting (albeit harmless) insect, and I admit, I may not have handled it with much grace…


Since arriving in Cameroon, I’ve had the distinct pleasure of waking up each morning at 5:30am for no apparent reason. Maybe it’s the incessant crowing of roosters everywhere, maybe it’s the prayer signals from the nearby mosques, maybe it’s the slightly uncomfortable beds or the slightly uncomfortable heat. Whatever the reason, I’ve continually been waking up at this unnecessarily early hour. So I wasn’t surprised when Thursday morning, at Ann and Willie’s, I woke up again at 5:30 and found myself unable to go back to sleep. I decided that perhaps if I took a quick bathroom break, I would have an easier time returning to my pleasant dreams.

As I headed to the bathroom, I remembered that there had been a dead cockroach in the corner by the door for the past day (I had previously confirmed with Brent that it was truly dead), so I cautiously avoided that. Then it happened. As I shut the bathroom door, a huge, evil looking, squirmy, gross creature crawled rapidly the other way, out of the bathroom. As my heart skipped a beat and I stared at the floor stunned, I decided that it was out of my way for the time being and that I could briefly go about my business. But then came the hard part… leaving the bathroom to go back to bed. Praying that the insect had gone on its merry way, I start slowly prying the door open. There it was again, and I swear it was looking at me! It started coming back toward the bathroom, close to where its dead friend resided. Quick to think, I jumped up on the toilet so it wouldn’t be able to get me (as dangerous as it was…). Staring and the floor and attempting to figure out my next plan, I saw its little tail tentacles move under the door, so I did the most logical next step: yelled for Brent.

As Brent slowly arose after realizing I wasn’t in any grave danger, the cockroach decided to play a fun hiding game. As I swore to my fiancée that the cockroach was real and was “right there,” he searched and searched and found nothing. He somehow was able to convince me that I was delusional, get me down from my perch on the toilet and calm me down enough to go back to bed.

What do you know, as I was lying there in bed, I heard a quiet, “Courtney, you should get up.” Thinking it was some kind of April fool’s joke, I almost ignored him, until he advised again, “Really, you should get up!” Turns out that sneaky cockroach was RIGHT next to my bed and was making its way to my head, and who knows what kind of horrible plans it had in mind! I ran to the highest place I could find: the top of my suitcase and waited there until the roach was gone. Luckily, Brent is faster than a cockroach and was able to take care of it. Whew!

Now that that’s over, I think I’m ready for anything. The next giant insect that comes along I think I will be able to handle much more gracefully :) … perhaps.

Courtney

Brent's biggest surprises (last post till N'gaoundere)

I have been pleasantly surprised by a couple things already on the trip. First and foremost, I have realized the food is wonderful here; different but very good. The coffee at the hotel was very strong (sorry weak coffee people) but had a rich aroma and flavor that really was incredible. While at Anne and Willie’s we have experienced the local fruit. I may take some flak for this but it was better than anything I have tasted and that includes you Southern California :). Also, don’t tell anyone but Courtney agrees with me at least about the mango. From the mangos to the pineapples to the tangerines everything was superb. For dinner today, we had spiced beef with peanut sauce, plantains, cassava, and pineapples for dessert. What is cassava you might ask? The cassava root is long and tapered, with a firm homogeneous flesh encased in a detachable rind, about 1 mm thick, rough and brown on the outside. Cassava can be used in flour preparations, tapioca, dumplings, or as an accompaniment to meat dishes. Cassava is the third largest source of carbohydrates for human food in the world. But I digress……….


*Note: Courtney and I are stilling following all the proper travel precautions when eating the local cuisine so no need to worry.

The second biggest surprise is the touches of Americana that have reached Cameroon. From your obvious Coca-Cola and Coca-Cola light,for you calorie counters, to a place called “Mac Donalds” with no trace of the American version except they ironically serve greasy french fries and hamburgers. Possibly less obvious was the completely up to date versions of hip hop songs from the US in English on the radio. The most touching piece of American culture we expereinced was Yaoundè’s best known street: Kennedy Avenue.  The street is complete with a bronze bust of JFK himself.

I feel truly honored to be welcomed so graciously by the Cameroonian people and the contacts made by Pastor Luther and LCI.

This is the last post before we head on a train tomorrow night for our final destination: N'gaoundere. We will arrive on Easter weekend. We are looking forward to a great celebration.

-Brent Brown

Anne and Willie (and Micah)

So...now for something completely different!  After spending a day with not much to do or see at the Hotel le Tango in Yaounde, we were able to get a hold of some missionary contacts that live here in Yaounde, Anne and Willie.  Anne is originally from Montana in the States (so she speaks perfect English!) and Willie, her husband, is native to Cameroon (in the northwest region, I believe).  Both work for the Lutheran ministries and have a beautiful home in Yaounde with their 23 month old son, Micah (spelling could be wrong). 

After speaking to them yesterday, it turns out they have just returned from a trip and graciously offered for us to stay in their guest house for our last night in Yaounde.  Willie picked us up in the morning and we said goodbye to the Tango (in a little bit of a fluster after finding out their VISA machines were broken...).  We drove around the city some more, this time more in the center of the city, where street vendors were surrounding us and traffic was horrific!  (I'm not sure how anyone gets anywhere around here, but I am certainly glad I don't have to drive.  Even my Chicago driving skills wouldn't stand a chance!)  Eventually we made it to their house.  Their home is beautiful, with an expansive and gorgeous view of the city.  Their guest home, where we're currenly staying, is apparently much like the houses we will stay in when we're in N'gaoundere.  We had a fabulous time visiting with the family, we sat through a huge rain storm, ate some lunch, and now are relaxing and making good use of the faster internet connection :) 

It has been great to visit with Anne and Willie, who are truly kind-hearted and generous individuals.  We are certainly lucky to be able to stay in this guest house for the time being!  We will post pictures soon!  Only one more day until we're finally on the train to N'gaoundere!

--Courtney