Africa Adventure 2012: Our last entry

The Mission Hospital at Ngaoundere has approximately 250 beds, meaning that it houses about the same number of patients as most metropolitan hospitals here in America. Yet there are only 8 doctors and about 100 healthcare workers, half of which are nurse aides. It is not one big building like hospitals here, but rather a composite of many smaller buildings spread over a large complex. There is even a tuberculosis ward that consists of 6 patient buildings each filled with 4 to 6 patients. I think to myself, good at least I can avoid this area. But in reality they come out of that ward and up to the Emergency Department to receive their daily medications. So much for that thought.

In this hospital, the nurses round on patients like doctors. They write orders for medications, IV fluids, procedures and lab tests. In some specialty units, a doctor will round on patients daily, but in most other units perhaps once a week. In most cases it is the nurse who decides what the diagnosis is and how to best treat the patient. Now there is a lot of variability in each nurse’s level of training and experience. Sometimes the diagnosis is incorrect and other times the wrong treatment is given. Tests ordered by the doctor or nurse, must be performed by the nurse or nurse aid. If a spinal tap or ultrasound is needed, the nurse must do it. If blood work is ordered, the nurse must draw the specimen and take it to the lab. Doctors complain that the nurses give no care, but the biggest reason for this is that it the nurses are too busy practicing medicine.

In this country the family does most of the cares for their patient and also gives them their oral medications. There is no standard of care and each family cares for their loved one as best they can, but often they do not have the knowledge to do it right. There is no linens provided by the hospital, so if the family does not provide a sheet to lie on the mattress, then the patient will be placed on the bare plastic. The family is responsible for cooking for the patient and for cleaning them up. Most rooms at the hospital have beds for 4 patients, and many family members stay in the room with them the whole time. So in a typical ward in any given room there are usually 20 plus people staying in there. On the hospital complex there are a couple of cooking houses where families prepare food and a water spigot and large rocks for them to wash dishes and do laundry. Definitely not an American laundry mat! Having the family provide the care has been the custom in this country for many decades and I don’t see that changing soon. Our mission there is to help them to better function within their own means. And rather than insisting that the nurse give all of the cares, much can be gained just by teaching families what to do and by telling them what is expected.

There is no health insurance here and before any treatments or medications can be rendered, the family must first pay for it. It does not matter if the patient is near death from a low blood pressure that can likely be fixed right away with IV fluid bolus’s, no treatment can be given prior to the family paying. Nothing is supplied for free or included in the room charge. If it is an IV that is needed, they must buy not only the IV fluids, but also the needle and tubing to infuse it with. It is hard to stand by, waiting and wondering if the family will come up with the money. Sometimes one is just compelled to reach into your own pocket to come up with the few dollars it costs to begin life saving treatment.

This trip although short was very busy and despite the time crunch we were able to accomplish many things. Steph was able to train over 100 healthcare workers in basic life support, helped organize the store room and somehow managed to get them to type out an entire list of the supplies there, trained ambulance workers to be better prepared for emergencies and was even able to go on an actual ambulance run with the crew. She also spent some time working in the Pediatrics ward (can’t keep her away from the kids) and somehow also found the time to help out with the massive amount of burn care we had to perform every day.

I spent most of my time working with and training nurses in the Burn Unit and ICU. In our time there we treated patients with burns, strokes, heart attacks, gastrointestinal bleeds, active hepatitis, malaria, tuberculosis and AIDS. Many of these patients we would be caring for in full body armor at our hospital, but there is no such thing as isolation in this hospital. No negative air flow rooms, no gowns, masks or face shields. Gloves were our only protection. Culturally medical illness is treated very differently in Cameroon. My own practice of preparing families for the worst, yet hoping for the best is not in their mind set. Even though you think it likely that their family member might die in the night, it is taboo to tell them so. Also if a family does not have the money to treat AIDS, then to diagnose the patient with this disease is to sentence the patient to death. So a husband might die with a diagnosis of pneumonia and even his wife does not know that it was AIDS that killed him and that she likely has it too. I haven’t checked lately but I think the average deaths from AIDS in this country are reported at around 17%. That number is likely low due to the appropriate diagnose never being made.

Much of my visit was planned to evaluate how departments we have helped them re-model or build in the past are functioning and to assess the overall operation of the hospital from the ground level. It can sometimes be easy for them to prepare administrative reports that make things appear better than they are. Some things are going well, but many problems continue to exist. Workers are not being paid on time, and sometimes not at all. There are big disparities in how they are paid, and it has little to do with the job they perform at the hospital and more to do with what tribe they are from. Tribalism, like families delivering most of the care, seems likely that it will go on forever. This holds them back in so many ways and I am discouraged because how can they progress if they refuse to move forward.

They lack basic equipment like stethoscopes, blood pressure cuffs and thermometers. Supplies of gloves and dressings are very limited. X-RAY and ultrasound equipment is in poor shape, much of it very used and too old to find replacement parts. More training is needed for nursing staff, managers and bio-medical technicians. Administration tends to deal with any and all problems by shuffling all workers around within the system and therefore it is hard for any of them to become truly good at any specialty. The needs remain great, and so now the next step is to make on going plans for how to best spend time and money and figure out what supplies will best help them in the future.

Plane schedules from the north to get us back to Douala did not work at all with our departure back to the USA, so we had to take a very long, overnight train ride to Yaoundé, then rush to the bus station with all of our luggage crammed into a taxi along with us and then wait for the next bus to take us to Douala. We paid extra to get on one of the supposed nice buses only to find that the air conditioning stopped functioning as soon as it started moving. Another 5 hours in sweltering humidity and heat on that bus and then another taxi ride with all of our luggage to get to the hotel. We had pulled out of the train station at 620 PM the night before and did not arrive at the hotel until after 2 pm the next day, we were wringing wet with sweat and totally exhausted.

After checking in, we celebrated brushing our teeth with actual running water and showered. Despite that our feet were still black, so we decided to go soak in the pool awhile. For sure this hotel looked at least ten times better on the way out than it had on the way in! This was Saturday night and our plane did not leave until one AM on Tuesday. We hired a taxi driver recommended by a former missionary and drove to Limbe to see the black beaches. Beaches created by the active volcano known as Mount Cameroon. Today the mountain is obscured by clouds as it often is, so on the drive, we can’t see the mountain. The sand was definitely black and a sight to see. The amount of garbage being washed ashore was not so pleasant, but hey we found lots of sea shells because nobody seemed interested in picking them up there.

The humidity all along the coast is almost unbearable at least for me, but we made a day of it and saw a lot of the country that I had never seen before. We saw banana plantations and others filled with rubber trees. They are tapped for rubber much like trees around here are for maple syrup. Pretty interesting because I never before realized that rubber actually came from trees. Along the way we also saw sand extractors who took large canoes up the river and filled them with sand, and then brought it back by the boat load to near the highway so that trucks could easily pick it up, Coming from such an industrialized nation it surprises me how much physical labor is required for such common products.

Without question, to perform this mission, we endured many hardships, totally left our comfort zone, faced miserable conditions, unbearable travel and at times dangerous situations, but for certain we grew stronger in our faith. We hold tight to our children, the dogs, and our families, somehow loving them all even more than you did before. We are more appreciative of all that we have and are thankful for the talents and opportunities that we have been given.

The only thing that I can compare it to really is child birth. You somehow forget all that was so bad about it and are left mostly with what was good. You remember the smiles of the people you were able to help, the friends you made, and the beauty of this land located in the midst of so much hopelessness.

We have been back at home for a couple of days now and we take pleasure in all the comforts that we have here. I think I am still brushing my teeth like every 2 hours, just because I can. We have heaters for when we are cold, air conditioning for when we are too hot, fresh water to drink, reliable electricity and internet connections. If we want to go someplace, we need only walk to our car and drive and can be pretty certain that we will get there. If we are ill we can get the best medical care regardless of our ability to pay for it. The differences in our nations are pretty much the exact opposite. They live in the land of too little and we live in the land of too much.

For sure a journey such as this makes one much more appreciative of all that you have and all that you typically take for granted. It opens your eyes to see a world that is so much bigger than just us and helps you to see that coming from this land of plenty that there is more that we as individuals and as a nation could be doing to help others. Whether it be our neighbors that live right next door, or the homeless and hungry right here in our own country or those who are underserved in other parts of the world, we should all try to do something more than just talk about helping out. By suffering very little, there is much that we can accomplish.