I thought you might like to see the main Medical Staff Conference Room. It serves two basic purposes. The first is a place for the mid-morning "tea" break. From around 9-11 am each morning, coffee, tea and a snack (usually including a fried bread item of some sort) are served here for the physician staff. It is a nice time to talk to other physicians about the day and discuss patient issues. Another function of the room is a location for meetings and lectures. Every Thursday, the General Surgery Department spends 3-4 hours here for their academics. This includes a textbook chapter review and written testing, Morbidity and Mortality review, and Bible study. The photo shows me giving a lecture on the basics of ventilator settings for the general surgery residents. A main function of this international rotation is an active exchange of information where we each learn from our own teaching and experiences. At the end of the day, I think I learn from them just as much as they learn from me!
It has been a couple of days since our last blog simply because Kathryn and I have been too busy. That is a good thing!
I thought you might like to get an "inside look" at the x-Ray department at MBH. The waiting room has comfortable benches and is very breezy! The red Christmas tree light reveals when An x-ray is being taken. The x-ray machine has been recently replaced and is even digital! They have a full range of studies available; if it can be x-rayed, they can do it! Contrast studies via catheters and drains can also be done, but the physician ordering the test must be present to inject the contrast. The Department also offers ultrasounds via a portable machine which provides nice images.
There is no radiologist here. X-Rays are read by the ordering physician and the ultrasound technologist writes up a very detailed report which includes images. X-Rays and ultrasounds are relied upon heavy by all departments here.
The next step is a CT scanner. Even a "one-slice" or "four-slice" scanner (too old for use in the U.S.) would be of tremendous use here. The radiology department will be moving into a new addition currently under construction which has the room for a scanner. Financial capability to purchase one depends upon supporters of the hospital as well as availability of an installer and maintenance of the machine. I was told by one of the physicians here that a "one-slice" would cost around $25,000 and "four-slice" scanner around $50,000. It CAN happen!
One thing that struck me about the wards was the amount of friends and family present for each patient. These caregivers are present 24/7 and are very active participants in the patient’s hospital course. Patients are required to have at least one caregiver present at all times during their hospital stay. As a general rule, if the patient does not have someone available to fill this role, they will not be able to be admitted to the hospital.
Caregivers are responsible for feeding, bathing, and ambulating the patients. During the day, the caregivers are always at the patient’s bedside and at nighttime, you can find them sleeping on cots or blankets in between hospital beds.
I thought that it was about time to include some photos from the OR and give a quick report on our experience operating thus far. The general surgeon here, Dr. Jim Brown, and his residents welcomed us warmly and we began operating the first day. The number and variety of cases including major procedures done here in this austere setting is truly remarkable. Kathryn and I have performed many procedures typical for the general surgeon such as hernia repairs, gall bladder surgery, breast cancer cases, and surgery for perforated gastric and duodenal ulcers. In addition, we have performed many surgeries outside the normal practice of many general surgeons in the U.S. These include various procedures on the ovaries and uterus, prostate and sarcoma resections, and several different pediatric surgeries. Finally, the residents here are very skilled in assessing and managing these diverse and difficult cases; at times, I learn as much from them as they learn from me!
On another note, MBH has an excellent oncology service and has numerous chemotherapy protocols including several for patients with breast cancer. We have seen patients with locally advanced breast cancer and they can now receive chemotherapy before surgery which is an option in the States and rarely offered at other hospitals in Cameroon. MBH is continually improving the level of care they offer and it is a pleasure to observe and be a part of this transformation.
The CBC hospital in Mbingo started off many years ago as a Leper’s colony. Gradually over time it became a full fledged tertiary care center taking in patients from all areas of Cameroon. In addition to housing and taking care of patients, there are several places within this hospital that provide items for patients. There’s a place that makes prosthetic limbs, another in which furniture is created, and even a shoe shop.
Dr. Sharpe and I stopped into the shoe shop the other day and were amazed by not only the quantity but also the craftsmanship of shoes that are specifically created for patients in the hospital and school children on campus. Each shoe is created over a period that can take up to three days. A pattern of the patient’s foot is taken and then the sole is created from rubber. Nigerian imported leather is heated and molded and the shoe is lined in assorted materials (basically whatever is available in the hospital). Each shoe is individually designed - the shoe in the photo was designed for a patient who had all of his toes amputated. These shoes cost less than $2 and are free to school children and those patients who can’t afford them. The gentlemen in this photo take an enormous amount of pride in their work and shows in the quality of their product.
I had my first Mbingo clinic experience yesterday and my mind is still reeling…Within an hour, I saw patients with everything but general surgery problems. I took care of several patients with prostate CA, normal pressure hydrocephalus in a 1 month old, trauma patients who were several days out from their initial injury, a 14 year old girl with an imperforate hymen and hematoculpos (I had to google this while seeing her), and even pinworms in a grown man. As the day went on, I began to see more general surgery patients but was amazed by the amount of Ob Gyn, urology, neurosurgery and even ortho that these general surgery residents here take on. To them, that’s just how it is because if they don’t take care of these patients, no one else will…
Initially I was concerned about the language barrier as French is the primary language here in Cameroon. However, the nurses were fantastic translators and were the foundation of the clinic. They did it all- assist in minor procedures (and our definition of minor is slightly different in the states), schedule patients for the OR, kept clinic moving and acted as bouncers for the 100+ patients a day who came to clinic.
The people here are incredibly grateful for any care or help that you give them. They are never demanding and always are very kind and happy- even if they have traveled for several days to see you and have slept outside the clinic door for you to ask them to come back tomorrow after some test results have not come back yet. It blows my mind that these people put so much trust and faith in the health care providers here and never question anything. They are so incredibly patient and trusting. It is an absolute joy and privilege to be able to provide whatever assistance I can here and I feel truly blessed to have this opportunity…
The kitchen at Mbingo Baptist Hospital is like nothing you have ever seen! All food is traditional African meals made in typical African fashion. The open air building, partially obscured by laundry drying, is where all the food is prepared for the patients. A small shed out back is where the cooking takes place. There is no gas or electricity - all food is cooked over wood fires which are lit in holes in the ground! The ladies in the main building were gracious enough to allow me to photograph them preparing the vegetables for today's lunch. The cooks do a great job and patients are very grateful for the meals provided in this simple kitchen.
This is just one of the many things that strike me about this place: They do so much with so little and are thankful and content. Truly a wonderful place to serve.
Today was our first real operative experience on this trip… We had a pretty full day in the OR doing everything from hernias to hysterectomies (Dr. Sharpe even performed a transvesical prostatectomy). Before our day began, however, we were able to unload all 3 suitcases full of OR equipment that was generously donated by the folks at St. Lukes. We had brought a wide assortment of gear - lap sponges, bovies, JP’s, staplers, gowns, ET tubes, LMAs, drains.. the list goes on. Everyone was incredibly grateful and our supplies were in demand even for today’s cases. It’s hard not to reflect on how much we have back home and how everything is so readily available to us. Here, they make do with what they have and find a way to make it work…
Dr. Kathryn Balinger and I are now at the Philadelphia International airport Awaiting the first of four flights ultimately landing us in CAMEROON, Africa, in about 38 hours. After a night of much needed rest, we then travel by vehicle for 7 hours before arriving at Mbingo Baptist Hospital (MBH) with the nearest large city being Bamenda. Although we are not looking forward to these next two days of travel, we are excited about this first rotation for the newly developed "St. Luke's International Surgical Studies" (SLISS) and serving a population in great need.
I invite everyone to visit this site as much as possible to view our experience and see what St Luke's University Hospital is doing through us, and ultimately, you. Since SLISS is funded solely by donations, we rely upon you and your generosity. All funds are used for travel expenses and purchasing supplies; these supplies are carried with us on each trip, as well as sent by international shipping. None of your money will ever be spent on salaries or "administrative overhead"; all travelers are volunteers. My hope is that as more of you support this effort, we will be able to purchase supplies and equipment which will create a sustainable improvement in the level of care offered by MBH. That's the key for international medical missions: make a change that lasts.
We will attempt to post pics, videos and blog daily. Check back often!