It was mid-evening in the quiet darkness around the hospital when I walked to the 24 bed women's ward to meet with the worried internal medicine residents on call. There was a surreal looking tint to the moonlight through the dusty air from the dry season and sand aloft from the Sahara gave a sepia appearance to the mountains around us and the dry highland foliage along my path.. This time of night in the low lit ward, the very quiet background of muted conversations despite the number of patients, many with children sharing the hospital beds, gave a warm homey feeling in the long room with beds on both sides.
There was tension, however, at the 27 year old mothers bedside with two nurses and two residents in attendance. She was admitted to the hospital in the early evening holding her 5 month old baby and having extreme difficulty breathing even at rest. She had very low oxygen levels and her blood pressure was barely detectable. We had been teaching the residents to use their hand held ultrasound device to evaluate the heart. Together we worked to sort out how each of the valves and chambers and cardiac walls were working. She had a classic peripartum cardiomyopathy. (Severe failure of pump function on both sides of the heart that develops a month before delivery or within 5 months postpartum). This zone of Africa is one of the epicenters of the disease. So many young women throughout Africa and especially in this region do not survive this event but if we can get them through the dangerous period, 1/3 have complete recovery and 1/3 have moderate recovery.
Throughout the two training weeks I was at Mbingo Hospital we had three severe peripartum cardiomyopathy patients and all the residents learned how to make accurate diagnosis with the ultrasound device and most importantly the subtleties of when to use certain cardiac medications and the order to start them, usually ending up with the patients on 5 medications carefully balanced. We have all the proper medication here (generics) with the newer versions used in highly developed countries slightly more effective but very expensive. My input and training for these 3 women made a difference and the trip would be worthwhile for these cases alone but most importantly, the residents are now expert in this disease presentation and the multiplying effect as they additionally care for patients and share their new expertise is what we strive for. Below is a picture of this mother and child (with permission for teaching). The other two women did well and were also up walking around the wards before I left. This case represents one of many different cardiac diseases with diagnostic and management teaching opportunities that the residents will use lifelong.
Leprosy village on the hospital grounds from the old days of multiyear treatment, now cured in 6 months of Rx. Housing is mainly used now by hospital workers but we see many people around with leprosy damage.
I was asked "Don't just send pictures on patient's, send some pictures of you guys". This is the guest hostel. I am smiling because I am done lecturing (frequently 2 lectures a day) and done with ward and consult teaching. No Colleen in this picture----this hospital was in a US Embassy no travel zone and no help available for American citizens, so we decided to only have one parent/grandparent on this trip. I started to write up the security events that happened and planned to share the email after I was back, but changed to I'll let you know in person if requested. I have great concern for the Cameroonian hospital leadership l left behind. I was able to debrief and counsel a number of people that were traumatized during those two weeks.
Included below is one of the many houses Colleen has contributed to building for very special nationals with decades of selfless service and no place to stay without rent ( 1/3 of their $80/month pay) or for a pre-retirement home as in this case. The lady in the picture who we have known for 14 years will live here with her daughter and grandson. The small amount that I brought with me will allow her to put ceilings in the house and bring gravity flow water to the kitchen and bathroom and then they will move in.
The three of them have spent the last 20 years in a 12 ft X 14 foot space on the hospital site despite her being the onsite hostel caretaker, cook, and mamma to the visiting nurses, technicians and docs and doing her role with such love and skill. We help many at the places we work overseas in small ways who are special in their roles but not recognized by the hospital for their special and competent roles but only a small group of unique people get partial support to build a house of their own.
The market across from the hospital. Everything you need (except shampoo, diet coke, and potato chips much to my distress!!)
There is enough fresh food and basic items that one could live at Mbingo Hospital and never need to shop in the big city one hours drive to our south.
Lots of stories to share with you, and looking forward to catching up on your lives. I'll be home in a few days. I am in the capital of Cameroon, Yaounde, and out of the embassy no travel zone and very safe.
Much love and appreciation to all, Dad/Ron/Grandpa
