Blessing

 Terry and I have so many things to be thankful for this Christmas Season.  We feel so blessed to be part of Mission Doctors Association.  This would not be possible without the prayers and financial support directed to MDA.  Your financial support to MDA has allowed us to set up an account here at the hospital to pay for tests and medications when patients can not afford them.  I would like to share with you how your financial support can affect an individual on this end. 

Blessing is a young mother who has been in the hospital the last 6 weeks.  She was found to have HIV and had a series of secondary infections which have kept her from recovering and going home.  During her hospital stay she found out her husband has had HIV for some time and has been on treatment but failed to let her know about his illness and the risk to her and their 1 year old son.  To make matters worse her husband literally walked out on her and their son a month ago.  She has been in the hospital without a care giver and has been getting food from other patients and care givers to survive.  She has had to continue nursing her son even though it poses a risk of passing on her HIV but she has had no resources to buy food for him.

 
We were able to use donor funds to pay her medical bills and provide money for her to travel back to her family which lives hundreds of miles away.  Your generosity allowed Blessing this special Christmas gift and knowledge that there are people in the world who care about the less fortunate and are willing to do something about it.
 

Blessing and Poukline

Terry and I join Blessing and her son to thank you and wish you a Blessed and Merry Christmas.

Still a Killer

Malaria is part of our lives here.  If a patient has fever there is a good chance that there is malaria.  With few exceptions we treat for Malaria whenever fever is present.  Malaria medications is one thing we have not run out since I have been here.  While people may be very ill with Malaria they almost always respond to treatment and usually are much improved by the next day.
 
This weekend we had a reminder that Malaria is still a killer.  A 16 year old girl was admitted over the weekend with a fever of 105 and a decreased level of consciousness.  Despite treatment with  our 2 strongest medications she never regained consciousness and died 3 days later.  

The World Health Organization figures still show over 1 million deaths annually from this disease throughout the world.  We are keeping this girl and her family in our prayers this week.

Christmas Early

Happy with their straight legs

A team of orthopedic surgeons from the Netherlands was here one month ago.  In eight days they operated on 80 children straightening crooked legs.  They have been coming to St. Martin de Porres Hospital for years delivering this wonderful service.  The children remain here for three months and when their cast are removed they go to Bafut, a rehabilitation hospital also run by the Franciscan Sisters.  

Terry and I have enjoyed interacting with the children as they recover.  They all have big smiles admiring the straight plaster casts covering their legs.  

They and their families are enjoying this special Christmas Season!                                                                                                                                                                                                     

Making a Difference

Today, I was walking by the lab and I ran into Anita and a passel of kids.  Anita is from Germany and is working for an NGO in a nearby village.  She was bringing a group of children in for HIV testing.  The children she brought in were from situations where a parent had known HIV or were at high risk for it.  Hopefully, all the tests will be negative. 

I have been fortunate to meet quite a few young people from the US and Europe who are working in this area of Cameroon for several NGOs.  It is evident to me there are many people doing God's work serving the poor here.  Working together we are making a difference.  Keep us in your prayers.

Additional Hazards

Last evening I was called to the hospital to evaluate a snakebite.  There was a large crowd of people outside of the ward.  They had accompanied 2 children. 

Earlier in the evening Grandma had prepared a meal for her grandchildren, 2 year old twins and a 5 year old girl.  A black cobra had apparently entered the house and one of the twins sat down on it.  She was bitten along with her 5 year old sister.  The 2 year old died on the way to the hospital and the 5 year old was vomiting.  The older sister is doing well this morning while the family mourns the loss of her sister. 

There are so many additional hazards to life in a developing country that take their toll.

Update on Oliver

Last month I wrote about Oliver who arrived confused after having severe headaches for 1 month. 

He was diagnosed with Cryptococcal Meningitis and HIV.  He responded nicely to medications and was able to go home after 2 weeks. 

He returned for follow-up feeling well and looking great.

These success stories are wonderful to witness.

Christine

Christine and her daughter

Christine is a 52 year old lady admitted this week.  While we see many interesting cases her's is more unusual than most.  

4 months ago a banana tree fell and hit her in the head causing complete paralysis.  After spending 1 week in the hospital the family took her to a Traditional Doctor.  Over the last 4 months she slowly regained movement, first in the arms and then in the legs.  She began walking with assistance just a few days before coming in. 
 
She came to the hospital because of persistent shock like paraesthesias shooting from the base of her neck into her arms and legs.  Her x-rays suggest a fracture of T-1(just below the neck).   I have begun a seizure medication which will hopefully reduce her pains.

Victorine's Checkup

Yesterday found Victorine coming in for her monthly followup visit.  She is  the lady with HIV and TB who had the hemoglobin of 2.5. 

Victorine 3 months ago to weak to get out of bed

Her prognosis 3 months ago was grim.  She has gained 30 pounds since her discharge 2 months ago and has now completed her 6 months of TB treatment.

She feels great and is planning on returning to Yoaunde next month to resume her work doing clothing design and running a retail business.  She is a wonderful reminder that HIV treatment is working to extend people's lives and allowing them to be productive members of their community.

Victorine today

Ahijo

This week Terry and I ran into Ahijo on the road to the hospital.  Ahijo is a Moslem man who registered the Out Patient Department patients when we were here in 2004.  He no longer works at the hospital but I have seen him on a couple occasions the last 4 months.  We had heard that his 4 year old child had recently died so we expressed our condolences to him.  When I asked him what happened he responded, "Incompetence, pure incompetence".  

The child developed fever and he was away from home so he told his family to bring the child to the clinic the next day.  Instead the family took him to a traditional doctor and 2 days later he died.  You could feel and hear the anger in his voice but he quickly settled down and said everything was OK now.  The people here seem to accept bad fortune quickly and then move on with their lives.  

Our prayers this week are with Ahijo and his family.

Jacqueline's Story

Sunday

Terry and the Babes

Friday evening I got called to do a C-section for a lady with 34 week gestation twins and failure to progress. 

I had not done a C-section in 2 months so it was exciting to do one. 

All went well and healthy 5 pound girl and 4 pound boy are now with mom who is recovering nicely.

Today, while doing rounds Terry had to temporarily adopt the babies!

Underestimated

The last week has found the majority of my hospitalized patients having HIV related illnesses.  Yesterday 11 of the 14 ladies in Ward 1 were HIV positive and 5 of them also have active TB.  

There are days when I think the number of HIV patients in Africa is underestimated based on the numbers I am seeing in my small slice of the continent.  The good news is that more HIV patients are receiving education and treatment.

Oliver

Last Friday evening I was called to see Oliver, a 32 year old man.  He had been having headaches for a month and had been seen at another hospital on 5 occasions for these headaches.  He had been treated for malaria, typhoid and migraines, but the headaches continued.  Friday afternoon Oliver became confused and began throwing up.  

His family then brought him to St. Martin de Porres Hospital.  I did a lumbar puncture  and Oliver had Cryptococcal Meningitis along with HIV.  He was started on medication Saturday and became oriented by Monday.  

Today, he is feeling much better with some mild headache.  He is doing amazingly well for a bad combination of illnesses.

Patience and Harrison

It is nice to see patients who are doing well as opposed to those with protracted illnesses who finally come in after the traditional doctor has not affected a cure.  

Today, Patience and her son Harrison came in for their HIV medication refills.  Harrison is 3 years old and doing very well.  He was very inquisitive and like most 3 year olds really liked to give you "five".  Mom likewise was doing well and visits like these are nice to remind us that all is not lost.  

HIV can be managed with education and medication. 

Treat the Patient

David's x-ray with depression top left

David is a 19 year old who was referred from a hospital 100 miles away with a diagnosis of "depressed skull fracture".  He was cutting down a tree 2 days earlier when it fell and hit him on the head and shoulder.  He was seen the next day complaining of both headache and shoulder pain.  X-rays were obtained and a depressed skull fracture was present and he was sent to our hospital because we do orthopedics. 
 
David appeared quite well and I could only find some minor scratches on his head with no swelling.  His mother could not remember him hitting his head when he was younger.  I elected to obtain a lateral skull x-ray since I could not find a depression on his skull to go with his x-ray finding.  The additional x-ray also showed the depressed skull fracture.  By then David's father arrived and remembered David had fallen out of a Mango tree as a young child.  

David with Parents

Conclusion:  Indeed David had sustained a depressed skull fracture, but as a child and not 2 days earlier from the falling tree.  

David's case is a good reminder to treat the patient and not necessarily the lab or x-ray finding.

Sunday Rounds

I believe I previously talked about Sunday rounds.  Prior to my arrival they never happened.  There are only 2 nurses working on Sundays in the medical wards compared to the normal 3.  I am now able to do rounds on my own with the help of Terry on Sundays which has eased the concern of the nurses.  I now see all my patients on Sunday so if Mondays in the Out Patient Department are too busy I can limit rounds to the sicker patients and those going home.  

It is actually more relaxing doing Sunday rounds and I have a chance to visit with patients and their families.

Many Hands Working Together

The Belgian Team

New Physical Therapy Department

Sister Xaveria has cultivated relationships with many people and organizations around the world.  The last 2 weeks there has been 5 volunteers from Belgium working at the hospital.  2 nurses and a pharmacist worked on the medical and surgical wards.  They instituted a new system to distribute patient medications and worked on improving hand washing policies.  
 
A medical equipment technician installed new lights in the operating rooms and worked on other equipment in need of repair.  The physical therapist was very busy and opened a physical therapy staffed by 2 hospital employees.  This group sends a team here every 6 months and it was enjoyable working with them.  We look forward to their return in the future.  Their presence illustrated how God's work is being carried out by many hands working together.

Dick and Jane

Dick Talbot and his wife Jane Fehrenbacher arrived last week.Dick is a Dentist and Jane is an MDA veteran having done a long term mission in Zimbabwe in the 1960's.  Dick has been extremely busy at the Dental Clinic since his arrival.   He is working with Dorothy who has been staffing the clinic for many years.  Dorothy has had no formal training and Dick will certainly be able to enhance her skills.  She has been looking forward to his arrival for some time.
 
Dick was able to secure a large number of dental supplies from Direct Relief based out Santa Barbara.  Mission Doctors Association also procured some necessary supplies.  It was like Christmas here last Friday when Dick was unpacking the supplies for Dorothy, Sr. Relindis and Sister Xaveria.  Terry and I are enjoying their company.

School Days, School Days.

Eager Learners

 School has been in full swing for nearly two months. The students have settled into the routine of boarding school and classes.  As the enrollment has stabilized, class rosters are being finalized.  I am anticipating receiving class rosters for each of the forms by the first of next week.  

Quiz Time

In many ways school is the same here as it is in America.  Some students are eager to learn, others resist.  However, classrooms look very different.  Class size is best described as open-ended.  My Form 3 class is the smallest  with 37 students.  Most of these students fall in the Junior High age group.  So when was the last time I thought a class of 37 students would feel small---Hmmm, never!!  Perhaps it seems small as my Form 1 class has 60 students.  Now that is a classroom full and more.  I am grateful that the principal was not able to find anymore "late enrollees" for Form 1.  

I shall keep you updated on my survival with that many students.  

All prayers are welcome!!!

Two per desk

 

Cookhouse

When you are hospitalized at St. Martin de Porres you are provided a bed and the Nurses monitor the patients and distribute medications.  A family member or guardian provides your meals and assists with your personal care needs.  The family can purchase prepared food at the hospital canteen but most cook the meals at the cookhouse which is located next to our house.  The food is cooked over open wood fires in the cookhouse.  Sometimes the smoke is so thick it is hard to imagine being inside long enough to prepare a meal.  It is the system here and it works.

Mattyl and Janette

While doing rounds today I was informed that Mattyl had died this AM.  She was the 7 week old with HIV and multiple Staph abscesses.  Yesterday, at her dressing change she had lost 20% of her skin already.  It was amazing she had survived this long.  

As one door is closed, God opens another.  

A few minutes after receiving the news of Mattyl's death I ran into Janette.  She was the 7 year old who I sent home 2 months ago after recovering from meningitis.  Her older sister Doris was admitted at the same time with meningitis and had not survived.  Janette was only able to sit with support when she left.  Her parents with big smiles reported she has fully recovered and has no limitations.  

Janette is a reminder that our efforts at the hospital are usually productive.  Mattyl makes us thankful for the blessings of good health God has bestowed on our family at home.

Marietta and Brenda

Marietta Snoozing on Mom's Back

Marietta is a 2 year old with HIV who spent the last 2 weeks in the hospital with Marasmus, malnutrition.  Marietta never got used to the white doctor poking at her and screamed bloody murder whenever I walked into the Peds Ward.  She was started on HIV meds and mom returned today with Brenda, her 5 year old sister.  Marietta immediately screamed at the sight of me and unfortunately Brenda tested positive for HIV.  

Brenda

Hopefully, Mom will stay motivated to bring the girls in for their monthly visits.

Hope

Today, a 20 year old pregnant lady was referred to the clinic.  She was found to be HIV positive during her first pregnancy 2 years ago.  Her husband refused to allow her to take meds preventing transmission to the baby and has not allowed the baby to be tested or mom to have any follow-up.  After this not so wonderful man took another wife 2 months ago mom decided she had enough and came into be placed on medication.  Hopefully she will be able to get her first child in for testing.  

Most men here seem to have a good grip on the HIV situation but today's case illustrates how some remain very ignorant of the disease and the available treatment options.  

Project Hope and others have made great strides regarding education but more still needs to be accomplished.

On Call

I was called this evening to see an  unconscious 7 year child.  The child was started on HIV meds in January and was doing well so mother stopped her medications in April.  She has been ill the last week with fever and a swollen thigh.  She became unconscious today.  

The child is covered with Kaposi Sarcoma lesions and the left thigh was swollen to twice the normal size with a large open ulcer.  Her hemoglobin is 7.3.  She will hopefully respond to antibiotics and malaria treatment along with a blood transfusion this evening.  Then onto her HIV and probable osteomyelitis of the femur.  Noncompliance to long-term medications is a continuous problem here but is more difficult to deal with when an innocent child is the victim.  

Pray for this sick little girl and her family.

Tumbu Fly

Reaction on the back of Terry's hand

Terry and I had noticed we both were getting significant reactions from bug bites this week.  

We consulted Sr. Xaveria outside the Chapel yesterday morning about the bites and she quickly expressed a fly larva out of Terry's hand.  The Tumbu fly lays its eggs on the laundry when it outside drying.  Everything is then ironed to kill the eggs.  If that does not happen your body heat hatches the eggs when you wear the clothes and the hatched egg burrows into your skin.  The larva then feeds on you until is ready to emerge as a brand new Tumbu Fly.  

Tug of War

Sister came back to the house and with the aid of a safety pin extracted 8 more worms from Terry.  

Yesterday afternoon Joe got to operate on me and add Tumbu Fly extraction to his surgical repertoire!  We suspect the power went out while Prisca was doing the ironing and the iron was not hot enough to kill the eggs.  

Rice, Larva and Matchstick

If this is the worst malady we experience here we will have a healthy mission experience.

Dancing Jim

It is tradition here at St. Martin de Porres Hospital to have a farewell gathering as the time for a short-term doctor to leave is near.  The sisters and many of the hospital staff are guests at the party.  Just such a celebration took place a few weeks ago, when it was time to say good-bye to three of our dear friends, Elise Frederick from Mission Doctors Association, as well as two surgeons, Dr. Bill Walsh and Dr. Magued Khouzam.  Typically, the entertainment includes traditional music and native dancers.  As the native dancers entered the hall, their group had grown by one not-so-native dancer. 

It seems that Dr. Jim had been called up to the ward a bit earlier for an emergency.  Timing is everything. He could not resist the opportunity to 'join in the dance', much to the delight of everyone.  It is difficult to know who enjoyed it more Jim or all the rest of us.

Whirlwind

Yesterday was a whirlwind.  I saw 50 Out Patient Department patients including 11 new admits.  We had so many kids with pneumonia that one of the women's wards was turned into a second Peds Ward.  

Today was nearly as busy and it was nice to have Joe here as he was able to take care of a lady with a thyroid nodule for me and then later a man with a surgical abdomen.  The 33 year old man has had increasing abdominal pain for 4 days.  To everyone's surprise he had a gangrenous gall bladder with about a gallon of pus in his abdomen.  

Hopefully his young age will help him pull through.