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.