Dr. Danny--obstetrician & neonatologist

So here at Mbingo Hospital there are two residency programs—a surgery residency through PAACS (Pan-African Academy of Christian Surgeons), which has been here for a good number of years, and an internal medicine residency, which was started by Dr. David Palmer, the chief medical missionary, only three years ago.  In addition to taking residents into those programs, the hospital also takes on “housemen” who essentially do a year of rotating internship.  Each houseman is assigned to a service for a 2-month block.  There are also 2 other American residents, one pediatrician and one internist, rotating here for the first 4 weeks that I’m here.  Since I’m the only one of the three who’s had obstetrical training, I’ve been assigned as attending on the maternity ward.  Yep, I said “attending.”  That means I’m kinda in charge of the service…scary!  I say kinda because there are nurses and (I think) nurse-midwives who essentially function as mid-level providers on maternity.  So they are a great help and have lots of experience.  We’ve had a number of deliveries since being here, and most of them not too scary.  The more involved ones included a lady who hemorrhaged after delivery down to a hemoglobin of 5, a twin delivery (although she was transferred here from an outside facility after delivery), and a uterine rupture who was taken to emergent C-section at 32 weeks gestation.  The facilities are certainly quite different than those at home, but they certainly make do with what they have.  Interestingly, maternity seems to include the premature babies, so I get to round on the preemies as well.  It’s actually kinda cool as I really enjoyed my time on NICU during second year, but I have to say it’s been nice having Emily, the peds resident (who rounds on the pretty full inpatient peds ward), here to help me out.  Right now we have five pre-36-weekers and two incubators.  Since 3 are in need of the incubators, two of them are roommates!  And yesterday, we found a third roommate in the incubator with the two babies—a large cockroach!  While gross and kinda sad, we had to laugh at the situation...otherwise we would have vomited or cried, I think.

I’m enjoying my time here so far, but it’s kind of hard at the same time.  Things are just so different back home—the wealth of technology available, the ease with which you can have studies done, the lack of concern about cost.  In some ways, it’s actually better as you don’t feel like you’re practicing defensive medicine, doing things just to cover your rear and keep from getting sued, but you also feel like your hands are tied in some situations when you don’t have all the information you feel you should in order to make the choice for the patient’s best interest.  And the attitude of both the patients and the medical staff is quite blasé at times.  They lack a sense of urgency when doing pretty much any kind of patient care.  I think that’s probably one of the most frustrating things for me so far.  In the US, especially in very old or terminally ill patients, the pendulum certainly swings the other way, as we try to keep people alive by any means possible, even if their quality of life or dignity is gone.  But here it seems that even in the salvageable cases—or at least the cases where there is a considerable chance of good outcomes—the lackadaisical attitudes persists.  I guess when you see so many patients die, maybe you get numbed to the idea.  I don’t want to be an ethnocentric westerner who berates anyone who doesn’t do it “our way,” but I also don’t want to neglect the opportunity to teach and improve the patient care to which the people of this area have access.  This is an area where you all can continue to pray for me and my compatriots.  Lord, give us the wisdom to see the proper balance!

Here are a few photo updates:

My room.  They call it the chicken coop, so I was a little concerned at first, but once I arrived I saw it was actually quite nice. 

A view of the hospital compound from atop a hill across the valley

A Falani man was herding his cattle along the trail as we hiked.

View of the ridge along the backside of the hospital land...beautiful!

A family hanging out on the roadside along our hike.  The littlest ones are 5-month-old twins!

The Richie kids (Dad is a general surgeon serving for 6 months) came trick-or-treating to my door tonight.  Good thing I packed some goodies for my trip!

The Journey

Well, first of all I'm glad I finally get the chance to post on the blog.  It took a couple days for us to get our Internet access setup, so I was a little stalled in getting to post.  The journey here was long but fairly enjoyable...except, of course when I lost my passport in Paris.  Yeah!  You read that right--I LOST MY PASSPORT IN PARIS!  Can I just tell you how dumb it makes a man feel to lose his only means of internation travel and identification when doing said international travel?  Well...pretty dumb.  But the Lord is gracious, and he used some fellow traveler, whom I did not get the chance to encounter, in the Parisian airport to help clean up my blunder by turning my wayward ID into the airport police. 

So I had just arrived to the airport in Paris and walked up to the self check-in kiosk to look up the departure gate for my connecting flight.  It couldn't read the barcode on my boarding pass, so I pulled out my passport and scanned it in.  That's the last remembrance I have of my passport at that time.  The screen told me to proceed to gate C87 in the 2C terminal, which was a short shuttle ride away.  When I got there, I second-guessed my memory on the gate number, so I decided to scan my passport again and verify where I was supposed to be.  However, when I put my hand on my passport pouch, I at once could sense that my passport was not where it was supposed to be.  My heart sank.  I checked all six pockets on the cargo khakis I was wearing.  I frantically looked through both the bags I was carrying.  I couldn't imaging I had left it at the previous check-in counter.  At least I knew I hadn't left on the plane.  I decided to go back to the previous terminal, but when I got there, they knew nothing on the whereabouts of my passport.  I returned to 2C, just to retrace my steps and make sure I didn't find it lying on the ground in some corner off to the side.  When I didn't find it on my second journey to that terminal, I decided it was time to get some help.  I went to the police counter and told the gentleman my dilemma.  He took me back to an office around the corner, made a couple phone calls, and told me to wait for a moment while he checked around.  But before leaving he informed me there was no way I was getting on my plane without a passport.  Great!  Even though I woulnd't have minded hanging out in Paris for a day or two in some other circumstance, this was not the time.  About 10 minutes later, however, while he was still gone, the policewoman working in that office hollered and asked me, "What was your name?"  I told her and she said something back across the phone in French.  When she hung up, she looked at me and smiled, "You are so lucky.  They have your passport back in 2E."  Hallelujah!  I was uber-relieved.  Some gracious soul had found it apparently (where exactly, I still am not sure) and turned it into the police over there!  What a gift!  I've always wondered what it feels like to not exist...ok, I haven't ALWAYS wondered...or well, I don't know if I've every wondered that, but regardless, that's kind of how I felt for the 30 minutes I was without my passport.  Needless to say, I've decided that if I have to take passport out, once through, I don't do anything else until it's back in the pouch, safe and sound.

One more story about my travel in, and then maybe this weekend I can tell you a little about my first couple days at the hospital.  I was warned my WMM reps and the hospital volunteer coordinator that the porters and people outside the airport can be a little aggressive but that we should just ignore them and keep with the "No, thank you" policy. Waiting around the conveyor belt to pickup my baggage I had several porters ask if they could help me.  I politely declined, and they politely moved on.  I thought that was going to be the worst of it until I moved to the customs line...or customs mob, I should say.  A tall Cameroonian gentleman caught my eye and asked if he could help me. 

"No, thank you," I replied. 

"You have camera?" he asked

"I'm sorry?" I asked, politely trying to skirt the question, not sure where he was leading.

"You have camera, you have to pay.  They inspect and find camera, you have to pay least 50 dollars."

"That's OK, I'll let them search like I'm supposed to."  I said, wanting to take my chances with the official-looking customs agents rather than this questionable-looking individual.

"Fine, go 'head."  About then, his even shadier-acting cohort sidled up beside me and said, "No, you have camera, you have to pay.  You give us $20 and we make them go away.  They won't even look."

I continued my inching up the customs line, repeating my refusal nicely but not really sure how long they were going to persist.  As I got close, I noted the customs agents weren't even looking in every bag...and some people were just going right through without inspection.  Just then the second gentleman, the more seedy-appearing of the two, motioned from right in front of one of the customs agents.  "Come, put your bag here.  He will search." 

I looked at the customs agent, probably about my age, and asked, "Do you need to search my bags?"

He turned his gaze away and didn't respond.  I took that as a no and tried to continue inching toward the exit.  I saw my "friend" move in on the customs agent and say something unintelligible to him under his breath.  It was interesting--the customs agent looked more awkward and intimidated than I felt at that point.  Finally, the young agent indicated toward me, "I need to see that bag."

"You need to search my bag?" I verified.  He motioned for me to come near, and I placed two of my bags on the counter.  The first contained some snacks, my electrical converter and outlet adapters, and the gifts for little kids Na Neltner had sent with me.  Nothing interesting for him apparently, as he brushed right over it and went to the second bag.  Therein was mainly dress clothes and some medical books.  He muttered something as he started to zip the bag closed.  "I'm sorry..." I questioned.

My "friend" chimed in again, "Where is your camera?"  I obviously hadn't shown the valuables he was expecting. 

"I don't...what do you mean?"  I played dumb.

The customs agent halfway whispered to me, "Just pay him something..."

What?!  This customs agent was advising me to pay the guy just to get him off my back...and likely off his back as well.  No, thank you.  "Do I need to pay something?" I asked him directly.  His gaze turned off to the side, and he didn't answer.  "Ok, thank you."  I kinda pushed my way through the rest of the crowd, feeling a small sense of victory as I walked out into the hot humid air outside.  About ten steps ahead I met George, the volunteer coordinator for the Cameroonian Baptist Convention, and we were quickly to the car.  We spent the night in a guest house (hostel of sorts), had a delicious breakfast the next morning of omelets, fresh-baked bread, and fresh pineapple (Mmmm...), and then made the 7-hour drive up to Bamenda and Mbingo Hospital.  I'll save the details of the first couple days at the hospital for next time.  Hope everyone is doing well.  Talk to you soon.

Danny

T-20:00

Tomorrow is departure day.  I'll be heading to Mbingo Hospital in Bamenda, Cameroon for the next six weeks.  I got back into Greenwood early this afternoon after a great weekend at my friends' wedding (congrats Dr. and Mrs. Dr. Wilson!), and have been feverishly preparing for my exit from the country since--washing several loads of laundry, going through my checklist, getting my official paperwork together, and of course, stocking up on the store of goodies at my work desk so that my coworkers aren't deprived of sweets over the next 6 weeks!  I'm pretty excited about this venture but also a little nervous.  I'm sure a bunch of the medical issues I'm gonna encounter will be novel experiences for me, having never treated things like malaria or typhoid fever before.  But that's also part of the excitement!  The learning curve will be quite steep, I'm sure.  I'm also excited about getting to experience yet another culture.  This will be my first time to an African country, and from what several friends and mentors tell me, it's like no other place.  Sadly, I won't be using much of the little Spanish that I know at Mbingo.  Too bad I couldn't brush up on some French over the past few weeks.  I'll try to keep you guys updated from time-to-time.  Thanks to everyone for their prayers.  I know the Lord's gonna teach me a lot during this time, not only through the medical experience but also through seeing His people and His Spirit at work in another part of the world.  Talk at you all soon.