It's Saturday afternoon. I am not in the hospital today and it actually feels like a sort of typical Saturday, going to the market with Hans and Martha, doing laundry, downloading the latest podcasts of This American Life to listen to later.
Hans and Martha Aas have been coming to Ngaoundere (phonetically pronounced Gowanderray) for 12 years or so. Martha was the first to come and she was by herself and was the person who got the relationship going between the Protestant Hospital and St. Mary's Duluth Clinic (SMDC). They are both retired physicians; Martha is GYN and Hans GI. They said this morning that they feel like they are coming home, and the way they are greeted by people, it's obvious they are family here. Karen, the woman I am sharing a guest house with, is also from SMDC, and is a retired nurse who worked in nursing and medical education and management. Karen is so energetic and fun to hang out with. Karen came for 6 weeks about 7 years ago, and she is here this time to work with the Nurse Majors (Head Nurses) on staff management and professional development support. The 4 of us are having pizza together tonight. I may break out the 5 Crowns cards if they're game.
I feel so lucky to be here, to be able to have this experience, to be out of my comfort zone, but in a good way.
Saturday, February 5, 2011
Friday, February 4, 2011
Another completely different day than I have ever had in my whole life
My day from start to almost finish:
3:30 AM when the call to pray for Muslims begins. This is done over loudspeakers around the city. Although I am staying at the ELCA Missionary Compound, it is located in the primarily Muslim part of Ngaoundere. Between the lingering jet lag and my now awareness of the distant, but constant barking of dogs, I am awake until about 5AM.
6:00: My alarm goes off. Have to meet my Palliative Care colleagues, Remi and William, at the chapel for morning service and our welcome to Protestante Hospital. When in Rome....
8:00: Chapel is over, and Remi and I walk about a half a mile to visit an elderly woman in her home who needs a dressing change to her groin and inner thigh. An elderly man emerges from behind a curtain who does not look well. Not sure if he's her husband. He's had symptoms for the past several weeks but won't go to the doctor because he can't afford treatment. Both of them are so gracious, shaking hands, "Bon jour, merci, enchante."
A recurring theme here is payment for medical care. There is no health insurance program other than a discounted rate to some employed people who's employer has an agreement with a particular clinic or health system. But if you live in Ngaoundere and get sick in Yaounde, you pay the whole bill. There are women with their babies who have been in the postpartum ward for over a month because they had to have an emergency C-section and will not be released until their families pay the bill. A sort of debtor's prison. I don't share this to say, "Oh how awful this is." This is reality. The hospitals struggle as it is to have adequate revenue to pay staff and buy drugs. If they didn't insist on families scraping the money together, they probably would never get paid, and then how could they serve anyone? See more below about how this situation impacts "choices" (a word we LOVE in the US health system) for medical care here in Cameroon.
9:00: We join medical rounds at the hospital. In the next 3 hours I will see:
- a 17 year old man, HIV + since birth who is losing the ability to walk due to severe peripheral neuropathy. His mother is in the room with him. Although she is not an "official" patient, she has several obvious health issues going on.
-a 27 year old man who runs a grocery who "suddenly" was unable to walk at the end of January. He is literally like a rag doll, albeit a skeletal rag doll. He has to use all his strength and his torso to swing his arm around. He cannot sit up without help and his head hangs heavily. He has no hand grasp. He is being treated for pneumonia, I would expect he got because he has no ability to take a deep breath. I speak with him through William and ask him if he had been losing weight (duh) more to get a clearer sense of just how "sudden" this change was. Several months ago he weighed 70 kg. He now weighs 40 kg. He needs an MRI and an EMG, but his family is unable to transport him to the closest city, Yaounde, that MIGHT be able to do these tests. Yaounde, is a 16 hour train trip and even if they could manage the trip, they wouldn't have the money to pay for the tests. The doctor shrugs his shoulders and says to me, "What can I do? There is nothing else I can do." MS? ALS? Probably won't ever know.
- an elderly gentleman that has been in the hospital for many days, who is very thin, weak, nauseous. They suspect a head and neck cancer but he has not been evaluated because his brother and son had to drive back to their village to get money to pay for it. While he waits, he has become sicker. It is likely that he has progressed to the point that not much can be offered anyway.
- a 24 year old man, HIV + with widespread Kaposi's sarcoma. He has lesions all over his arms and legs. (The doctor doing rounds kind of ran me through a test by telling me to don gloves, look at the lesions and tell him what I thought it was. Thankfully, I was right, although I have never seen KS to this degree.) Again, this man has not sought medical care earlier, in part because of the stigma of being HIV + and in part, the money issue. He is beyond the point where they think chemo would help and he couldn't afford it anyway.
OK, that's enough of that. You will probably never log in again if every entry is such a downer.
So, just when I think I'm gonna open that Guinness I bought yesterday, there's a knock on the door and my neighbor Jacqueline has stopped by to see if I want to walk into town with her. It's about 2 miles and I need the exercise and I am way too chicken at this point to do something as brave as that by myself. Jacqueline is a nurse and pastor who is here to learn French and then move to the Central African Republic to work. She is in her 50s, has 2 kids and 4 grandkids state-side and she has boundless energy. We stopped and talked to so many people she has gotten to know, she got me safely across these crazy streets with motorcycles whipping by constantly, she gave me great instructions on what to buy where, and taught me how to properly wash produce so I don't get sick. She is going to take me on a hike on Sunday to the top of Ngaoundéré Mountain. I learned that Ngaoundere is a composite word in the Mbum language meaning Navel-Mountain. I think the mountain actually looks more like a breast or this is one really big outsy belly button. She is fun and fearless and I am glad she's my neighbor.
Signing off!
I found this picture on Wikepedia, but it is exactly what the walk into town looked like, and you can see the navel (or breast) mountain in the background.
3:30 AM when the call to pray for Muslims begins. This is done over loudspeakers around the city. Although I am staying at the ELCA Missionary Compound, it is located in the primarily Muslim part of Ngaoundere. Between the lingering jet lag and my now awareness of the distant, but constant barking of dogs, I am awake until about 5AM.
6:00: My alarm goes off. Have to meet my Palliative Care colleagues, Remi and William, at the chapel for morning service and our welcome to Protestante Hospital. When in Rome....
8:00: Chapel is over, and Remi and I walk about a half a mile to visit an elderly woman in her home who needs a dressing change to her groin and inner thigh. An elderly man emerges from behind a curtain who does not look well. Not sure if he's her husband. He's had symptoms for the past several weeks but won't go to the doctor because he can't afford treatment. Both of them are so gracious, shaking hands, "Bon jour, merci, enchante."
A recurring theme here is payment for medical care. There is no health insurance program other than a discounted rate to some employed people who's employer has an agreement with a particular clinic or health system. But if you live in Ngaoundere and get sick in Yaounde, you pay the whole bill. There are women with their babies who have been in the postpartum ward for over a month because they had to have an emergency C-section and will not be released until their families pay the bill. A sort of debtor's prison. I don't share this to say, "Oh how awful this is." This is reality. The hospitals struggle as it is to have adequate revenue to pay staff and buy drugs. If they didn't insist on families scraping the money together, they probably would never get paid, and then how could they serve anyone? See more below about how this situation impacts "choices" (a word we LOVE in the US health system) for medical care here in Cameroon.
9:00: We join medical rounds at the hospital. In the next 3 hours I will see:
- a 17 year old man, HIV + since birth who is losing the ability to walk due to severe peripheral neuropathy. His mother is in the room with him. Although she is not an "official" patient, she has several obvious health issues going on.
-a 27 year old man who runs a grocery who "suddenly" was unable to walk at the end of January. He is literally like a rag doll, albeit a skeletal rag doll. He has to use all his strength and his torso to swing his arm around. He cannot sit up without help and his head hangs heavily. He has no hand grasp. He is being treated for pneumonia, I would expect he got because he has no ability to take a deep breath. I speak with him through William and ask him if he had been losing weight (duh) more to get a clearer sense of just how "sudden" this change was. Several months ago he weighed 70 kg. He now weighs 40 kg. He needs an MRI and an EMG, but his family is unable to transport him to the closest city, Yaounde, that MIGHT be able to do these tests. Yaounde, is a 16 hour train trip and even if they could manage the trip, they wouldn't have the money to pay for the tests. The doctor shrugs his shoulders and says to me, "What can I do? There is nothing else I can do." MS? ALS? Probably won't ever know.
- an elderly gentleman that has been in the hospital for many days, who is very thin, weak, nauseous. They suspect a head and neck cancer but he has not been evaluated because his brother and son had to drive back to their village to get money to pay for it. While he waits, he has become sicker. It is likely that he has progressed to the point that not much can be offered anyway.
- a 24 year old man, HIV + with widespread Kaposi's sarcoma. He has lesions all over his arms and legs. (The doctor doing rounds kind of ran me through a test by telling me to don gloves, look at the lesions and tell him what I thought it was. Thankfully, I was right, although I have never seen KS to this degree.) Again, this man has not sought medical care earlier, in part because of the stigma of being HIV + and in part, the money issue. He is beyond the point where they think chemo would help and he couldn't afford it anyway.
OK, that's enough of that. You will probably never log in again if every entry is such a downer.
So, just when I think I'm gonna open that Guinness I bought yesterday, there's a knock on the door and my neighbor Jacqueline has stopped by to see if I want to walk into town with her. It's about 2 miles and I need the exercise and I am way too chicken at this point to do something as brave as that by myself. Jacqueline is a nurse and pastor who is here to learn French and then move to the Central African Republic to work. She is in her 50s, has 2 kids and 4 grandkids state-side and she has boundless energy. We stopped and talked to so many people she has gotten to know, she got me safely across these crazy streets with motorcycles whipping by constantly, she gave me great instructions on what to buy where, and taught me how to properly wash produce so I don't get sick. She is going to take me on a hike on Sunday to the top of Ngaoundéré Mountain. I learned that Ngaoundere is a composite word in the Mbum language meaning Navel-Mountain. I think the mountain actually looks more like a breast or this is one really big outsy belly button. She is fun and fearless and I am glad she's my neighbor.
Signing off!
I found this picture on Wikepedia, but it is exactly what the walk into town looked like, and you can see the navel (or breast) mountain in the background.
Wednesday, February 2, 2011
Some early observations on how things are different here
It was yesterday at the train station in Yaounde, which is absolutely crazy busy with hundreds of people walking around selling their products and this one guy is walking with a stick with a string tied to it that has 4 or 5 dead rats and mice tied along the string. He was selling rat poison of course, and was demonstrating just how effective his product was. Now that's not something you see down at the Farmers Market!
One of the highlights of today was meeting Remi and William, the nurse and social worker on the Palliative Care team here at Protestant Hospital (take note my own team members--they have a social worker). They actually came down to the train station to welcome me--I was so touched.
Training in Cameroon
Good morning/good afternoon,
I arrived at my final destination, just getting settled at the Compound. Walked in the kitchen and a 6 inch lizard went running by me. OK then....
The train trip, though long, hot, noisy, and jostling, was worth it for the experience of the sights and sounds. I woke up at 6 am to look out at a grey, misty, African landscape, like a picture in National Geographic. Sweet.
These are some pictures from the last 2 days.
The little boys come from their village to the train when it stops to collect empty water bottles. They reuse them to store water, honey, gas. These guys were total hams, dancing and hopping around.
More later....
I arrived at my final destination, just getting settled at the Compound. Walked in the kitchen and a 6 inch lizard went running by me. OK then....
The train trip, though long, hot, noisy, and jostling, was worth it for the experience of the sights and sounds. I woke up at 6 am to look out at a grey, misty, African landscape, like a picture in National Geographic. Sweet.
These are some pictures from the last 2 days.
 |
| The first morning in Yaounde, looking out from my bedroom at the Shiloh. |
 |
| The view from the upper veranda of the Shiloh, looking out over Yaounde. |
 |
| Bananas |
 |
The Shiloh--I stayed here my first night in Yaounde |
 |
| People farming |
 |
| A small village by the train tracks, with a mom and her kids waving at the train as it goes by. |
 |
| From the window |
The little boys come from their village to the train when it stops to collect empty water bottles. They reuse them to store water, honey, gas. These guys were total hams, dancing and hopping around.
More later....
Tuesday, February 1, 2011
What day is it?
It's my first full day of not being on a plane. We got in last night and by the time we got through luggage, it was dark, so I am just taking in Yaounde while I sit on the veranda at the guest house I'm staying at, the Shiloh. 3 of us, including Paul, our guide and navigator and guardian angel, will be taking the train to Ngaoundere this evening, and I'll arrive at my final destination about 10 am tomorrow.
Paul hired a driver, Felix, to take me and Jarred, a med student from N Carolina, around Yaounde today, to give a quick tour and to exchange money. This is one reason why Paul is an angel. Besides knowing his way around and speaking French, he knows how to not get ripped off and how to stay safe. Part of staying safe is having a good driver and Felix is exceptional. There are no stop lights, no street signs, just a general knowledge of the rules of the road and the ability to pass other cars with about a centimeter's distance between metal. Felix's car even has seat belts!
Paul is from Cameroon but got his degree in business at Augustana in Sioux Falls, so he knows the Midwest. He works for the Lutheran church Ngaoundere and has a wife and 5 children.
It's hard to really describe what I see and I don't want to judge. It's just so different, unlike anything I could imagine. I'll post pictures soon.
But just wanted to say I got here safely. Love you all!
Paul hired a driver, Felix, to take me and Jarred, a med student from N Carolina, around Yaounde today, to give a quick tour and to exchange money. This is one reason why Paul is an angel. Besides knowing his way around and speaking French, he knows how to not get ripped off and how to stay safe. Part of staying safe is having a good driver and Felix is exceptional. There are no stop lights, no street signs, just a general knowledge of the rules of the road and the ability to pass other cars with about a centimeter's distance between metal. Felix's car even has seat belts!
Paul is from Cameroon but got his degree in business at Augustana in Sioux Falls, so he knows the Midwest. He works for the Lutheran church Ngaoundere and has a wife and 5 children.
It's hard to really describe what I see and I don't want to judge. It's just so different, unlike anything I could imagine. I'll post pictures soon.
But just wanted to say I got here safely. Love you all!
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