I would just like to make it known that since my arrival 6 months ago, two of my friends have become pregnant, a third friend will have her baby in the fall, another four have gotten married and two have gotten engaged.
Keep praying people...
Sunday, July 20, 2008
Friday, July 18, 2008
My Day
Today started like any other, I woke up, got dressed, ate breakfast and headed out the door with my bag of books. I got set up in my office and began to receive patient charts.
Patient #1 was a young widow with complaints of lower abdominal pain. During our time I found out that her husband died of an unknown, mysterious illness. We ordered a number of exams including an abdominal echo and an AIDS test. We found that she has a large ovarian cyst that requires surgical intervention, and that she was positive for HIV. We spent a while talking about her upcoming treatment, we prayed together and she left.
Patients #2 and #3 were a married couple who came in for evaluation of their infertility. They conceived two children, both of whom passed away. They have not been able to conceive for the past 6 years. They have undergone a number of tests and treatments already in N'Djamena, Chad, but chose to come to our hospital for a second opinion. We discussed their options including lab exams, imaging studies and medications. They will talk about this info together and possibly return in the future.
Patient #4 was an elderly gentleman who was waiting for me in the hallway. He has lost quite a bit of weight and has been coughing up blood. After a 2 week course of antibiotics he felt better, but the exams showed that he was positive for TB. In addition, during another revision of the lab exams, we determined he may need his prostate removed. He was referred to the surgeon and the TB dept. It was tough to convince him of his need for further treatment, he has a large family and wanted to return to them as soon as possible.
Patient #5 was young woman who also came with the complaint of weight loss and chronic cough. Her lab work was positive for both TB and HIV. We prepared the appropriate referral paperwork for the TB department and her upcoming ARV (antiretroviral) treatment, prayed together and she left.
Patient #6 was a skeletal 3 year old girl. She was so weak that she urinated on my office floor. She was coughing uncontrollably and her mother stated she had suffered from diarrhea for months. I picked the child up and carried her to the pediatrics ward as the mother followed with a second baby on her back and a large bag of belongings in her arms. I ordered a number of lab exams and left, reminding myself to return to check the results.
Patient #7 was a middle aged woman with complaints of pain and weakness in her legs. She stated she was simply “not feeling well” However, during physical exam I found no problems with her legs, but discovered that she was feverish and had a widespread rash over her whole body. Her test results revealed a bacterial diarrheal infection, urinary tract infection, malaria and HIV. I prescribed a number of medications, attempted to explain all of them, prepared the referral letter for her to begin ARV treatment and prayed with her before she left.
I was just about to take a look at the results of patient #8, a pregnant young women with asthma, when our accountant from the hospital called to let me know I needed to meet him in Maroua, the nearby city that afternoon to complete paperwork for my residency card.
So, I shuttled my remaining patients to other workers, changed my clothes (since I had already been urinated on that day:-) and went to the entrance of the hospital where my director hailed a taxi. I crawled into the backseat which smelled strongly of either dog or goat and headed out.
The roads are quite an adventure during the rainy season and I held my breath as our little compact car navigated a number of deep puddles. However, it was a beautiful day, and I enjoyed the ride. Everything is green now, including the mountains. The skies are full of enormous, fluffy white clouds which cast impressive shadows. The riverbed is no longer dry, since the most recent rain, there is water spanning about 1/3 of it's width. Children swim and play, and people wash clothes.
The local neighborhood restaurants were hopping, and vendors were selling their plethora of used clothes by spreading them out on the sidewalk or walking down the road with them on their heads. Little boys ran together down alleyways pushing metal rings with their sticks and riders on moto taxis waved to one another. I recognized carts full of manioc and peanuts and huge bunches of bananas lined the road.
A group of old men were sitting together selling bundles of something that looks like grass and I made a mental note to ask someone what it was. The road was absolutely full of bicycles, motorcycles, cars, chickens, push carts, pedestrians and children. The whole city is in a state of controlled chaos, everyone going their own way, yet fitting together somehow.
We arrived at the police station and I hopped out, met up with our accountant and entered the building. I was greeted by a cloud of cigarette smoke, dirty walls and a blaring radio program, conducted in French. We waited patiently as my paperwork was finished, payed the correct amount, moved to another room where I was fingerprinted, then moved to yet another room where I was photographed. I had to remove my head scarf for the pic... I inevitably looked like a serial killer...as I do in all passport/formal photographs:-) Voila, I am now an almost legal resident of Cameroon, West Africa.
Our trip back home was uneventful, except for a couple of near misses with a rooster, a chicken and a baby duck. Upon arrival at the hospital, I headed back to work on the hospital wards. In pediatrics I found the little girl I admitted sitting up and eating, which was promising, however a review of her lab results shows that she was positive for malaria and HIV. We consulted with the mother, who has been wonderfully cooperative, and we decided together to wait and test the rest of her children and herself after her husband arrives and gives permission. A positive diagnosis of HIV carries with it accusations and blame, and testing is often quite a delicate matter. We started the little girl on treatment, I will be visiting her this week.
I then made my way to another bed containing a 14 year old patient I saw just yesterday. He returned with his mother that morning and underwent incision and drainage of a huge abscess of his right thigh. The contents of the abscess were a little suspicious and I asked the nurses to send a sample of the drainage to the lab to check for TB. This bacteria can take up residence in many different areas of the body. In the meantime, this young man, who has been suffering with a hot and swollen thigh for a month and who just underwent surgery that very morning was in the process of making his bed when I left him. His strength is amazing.
As I was sitting at the nurse's station, writing up treatment plans in the charts I heard screaming from the far end of the room. A little boy of about 7 was undergoing a dressing change for his right thigh which is almost 50% burned. This is an exquisitely painful task. His mother, baby strapped to her back, was all alone except for the nurse performing the procedure. She had to leave the room to escape his cries. I walked to the bedside and sat next to the boy, stroked his head and back and talked softly to him. The mother returned and sat next to me, she was so tired. As the nurse was placing the fresh bandages, the little boy actually remained perfectly still, holding his leg up in the air in order to help the nurse. I was once again struck by the strength and resiliency of these people and in particular, their children.
My work in pediatrics done until tomorrow, I headed for the women's ward. I looked in on a patient that just recently had her thyroid removed, another older women with heart failure and significant fluid accumulation in her abdomen, and lastly a patient that just underwent a second surgery for a non-healing femur fracture.
The work completed, I headed home. It was an unusual, yet interesting day. My coworkers wave their goodbyes and wish me a “happy weekend” ...I am looking forward to it:-)
Patient #1 was a young widow with complaints of lower abdominal pain. During our time I found out that her husband died of an unknown, mysterious illness. We ordered a number of exams including an abdominal echo and an AIDS test. We found that she has a large ovarian cyst that requires surgical intervention, and that she was positive for HIV. We spent a while talking about her upcoming treatment, we prayed together and she left.
Patients #2 and #3 were a married couple who came in for evaluation of their infertility. They conceived two children, both of whom passed away. They have not been able to conceive for the past 6 years. They have undergone a number of tests and treatments already in N'Djamena, Chad, but chose to come to our hospital for a second opinion. We discussed their options including lab exams, imaging studies and medications. They will talk about this info together and possibly return in the future.
Patient #4 was an elderly gentleman who was waiting for me in the hallway. He has lost quite a bit of weight and has been coughing up blood. After a 2 week course of antibiotics he felt better, but the exams showed that he was positive for TB. In addition, during another revision of the lab exams, we determined he may need his prostate removed. He was referred to the surgeon and the TB dept. It was tough to convince him of his need for further treatment, he has a large family and wanted to return to them as soon as possible.
Patient #5 was young woman who also came with the complaint of weight loss and chronic cough. Her lab work was positive for both TB and HIV. We prepared the appropriate referral paperwork for the TB department and her upcoming ARV (antiretroviral) treatment, prayed together and she left.
Patient #6 was a skeletal 3 year old girl. She was so weak that she urinated on my office floor. She was coughing uncontrollably and her mother stated she had suffered from diarrhea for months. I picked the child up and carried her to the pediatrics ward as the mother followed with a second baby on her back and a large bag of belongings in her arms. I ordered a number of lab exams and left, reminding myself to return to check the results.
Patient #7 was a middle aged woman with complaints of pain and weakness in her legs. She stated she was simply “not feeling well” However, during physical exam I found no problems with her legs, but discovered that she was feverish and had a widespread rash over her whole body. Her test results revealed a bacterial diarrheal infection, urinary tract infection, malaria and HIV. I prescribed a number of medications, attempted to explain all of them, prepared the referral letter for her to begin ARV treatment and prayed with her before she left.
I was just about to take a look at the results of patient #8, a pregnant young women with asthma, when our accountant from the hospital called to let me know I needed to meet him in Maroua, the nearby city that afternoon to complete paperwork for my residency card.
So, I shuttled my remaining patients to other workers, changed my clothes (since I had already been urinated on that day:-) and went to the entrance of the hospital where my director hailed a taxi. I crawled into the backseat which smelled strongly of either dog or goat and headed out.
The roads are quite an adventure during the rainy season and I held my breath as our little compact car navigated a number of deep puddles. However, it was a beautiful day, and I enjoyed the ride. Everything is green now, including the mountains. The skies are full of enormous, fluffy white clouds which cast impressive shadows. The riverbed is no longer dry, since the most recent rain, there is water spanning about 1/3 of it's width. Children swim and play, and people wash clothes.
The local neighborhood restaurants were hopping, and vendors were selling their plethora of used clothes by spreading them out on the sidewalk or walking down the road with them on their heads. Little boys ran together down alleyways pushing metal rings with their sticks and riders on moto taxis waved to one another. I recognized carts full of manioc and peanuts and huge bunches of bananas lined the road.
A group of old men were sitting together selling bundles of something that looks like grass and I made a mental note to ask someone what it was. The road was absolutely full of bicycles, motorcycles, cars, chickens, push carts, pedestrians and children. The whole city is in a state of controlled chaos, everyone going their own way, yet fitting together somehow.
We arrived at the police station and I hopped out, met up with our accountant and entered the building. I was greeted by a cloud of cigarette smoke, dirty walls and a blaring radio program, conducted in French. We waited patiently as my paperwork was finished, payed the correct amount, moved to another room where I was fingerprinted, then moved to yet another room where I was photographed. I had to remove my head scarf for the pic... I inevitably looked like a serial killer...as I do in all passport/formal photographs:-) Voila, I am now an almost legal resident of Cameroon, West Africa.
Our trip back home was uneventful, except for a couple of near misses with a rooster, a chicken and a baby duck. Upon arrival at the hospital, I headed back to work on the hospital wards. In pediatrics I found the little girl I admitted sitting up and eating, which was promising, however a review of her lab results shows that she was positive for malaria and HIV. We consulted with the mother, who has been wonderfully cooperative, and we decided together to wait and test the rest of her children and herself after her husband arrives and gives permission. A positive diagnosis of HIV carries with it accusations and blame, and testing is often quite a delicate matter. We started the little girl on treatment, I will be visiting her this week.
I then made my way to another bed containing a 14 year old patient I saw just yesterday. He returned with his mother that morning and underwent incision and drainage of a huge abscess of his right thigh. The contents of the abscess were a little suspicious and I asked the nurses to send a sample of the drainage to the lab to check for TB. This bacteria can take up residence in many different areas of the body. In the meantime, this young man, who has been suffering with a hot and swollen thigh for a month and who just underwent surgery that very morning was in the process of making his bed when I left him. His strength is amazing.
As I was sitting at the nurse's station, writing up treatment plans in the charts I heard screaming from the far end of the room. A little boy of about 7 was undergoing a dressing change for his right thigh which is almost 50% burned. This is an exquisitely painful task. His mother, baby strapped to her back, was all alone except for the nurse performing the procedure. She had to leave the room to escape his cries. I walked to the bedside and sat next to the boy, stroked his head and back and talked softly to him. The mother returned and sat next to me, she was so tired. As the nurse was placing the fresh bandages, the little boy actually remained perfectly still, holding his leg up in the air in order to help the nurse. I was once again struck by the strength and resiliency of these people and in particular, their children.
My work in pediatrics done until tomorrow, I headed for the women's ward. I looked in on a patient that just recently had her thyroid removed, another older women with heart failure and significant fluid accumulation in her abdomen, and lastly a patient that just underwent a second surgery for a non-healing femur fracture.
The work completed, I headed home. It was an unusual, yet interesting day. My coworkers wave their goodbyes and wish me a “happy weekend” ...I am looking forward to it:-)
Tuesday, July 8, 2008
Blood Donation!
I don't know what possessed me to wait and proceed with my first blood donation upon arrival in West Africa, but that is precisely what happened. You'd think I would have done a practice round on my home turf, but nothing doing...let me just say they didn't give me a cookie and orange juice afterward:-)
Upon working with Dr. Jacqueline Koster at the beginning of the week, I met a young woman with prolonged and probably fatal liver failure. She was hospitalized and found to have a significant anemia. A few days later, while pursuing her records, I noticed that a donor had not yet been found. There is no blood bank here, and multiple patients have been sent home with dangerously low blood counts due to the lack of blood for transfusions.
Wouldn't you know it, we had compatible blood types. I could not ignore her need. I proceeded to the lab for the initial screening exams. We had to swat away a few flies, but the lab technician was an expert, I barely felt the needle.
Upon arriving on the ward for the donation, the nurses joked with me saying I looked a "little pale" and was I sure I wanted to donate? (pale...I'm white...get it?) I told them I had plenty of blood and hopped up onto the table with a courage I did not feel. A mere 15 minutes later, a bag of my blood was ready and waiting for Aissatou. During the procedure the patient's mother was called as a witness to the source of the blood. Mistrust is understandable in a country with an AIDS epidemic.
The next day, the mother spotted me and called me over. She took me by the hand and pulled me into Aissatou's room where she proceeded to give me a bolt of fabric used to make a pagne, the outfit commonly worn here. She and her daughter were very appreciative and while I would have been happy to remain anonymous, I was touched by their gratitude.
I don't know if Aissatou will survive. The odds are certainly against her. I can only hope that my action brought her comfort during this time of great illness.
Upon working with Dr. Jacqueline Koster at the beginning of the week, I met a young woman with prolonged and probably fatal liver failure. She was hospitalized and found to have a significant anemia. A few days later, while pursuing her records, I noticed that a donor had not yet been found. There is no blood bank here, and multiple patients have been sent home with dangerously low blood counts due to the lack of blood for transfusions.
Wouldn't you know it, we had compatible blood types. I could not ignore her need. I proceeded to the lab for the initial screening exams. We had to swat away a few flies, but the lab technician was an expert, I barely felt the needle.
Upon arriving on the ward for the donation, the nurses joked with me saying I looked a "little pale" and was I sure I wanted to donate? (pale...I'm white...get it?) I told them I had plenty of blood and hopped up onto the table with a courage I did not feel. A mere 15 minutes later, a bag of my blood was ready and waiting for Aissatou. During the procedure the patient's mother was called as a witness to the source of the blood. Mistrust is understandable in a country with an AIDS epidemic.
The next day, the mother spotted me and called me over. She took me by the hand and pulled me into Aissatou's room where she proceeded to give me a bolt of fabric used to make a pagne, the outfit commonly worn here. She and her daughter were very appreciative and while I would have been happy to remain anonymous, I was touched by their gratitude.
I don't know if Aissatou will survive. The odds are certainly against her. I can only hope that my action brought her comfort during this time of great illness.
Observations
During my past 4 months of work in the clinic, I have made certain little observations. Life is so different here, I try not to take anything for granted.
I have become a pro at pronouncing most of the names of my patients, such as Fadimatou, Ousmanou, Fatime and Aissatou. I also know that “Mht” is a very convenient way of abbreviating “Mohammet” and that Hamadou indicates the eldest son of a family.
I can now distinguish Cameroonians from Chadians on sight based on their clothing, personal belongings, height and the color of their skin.
I am familiar with the fact that many Chadian women come in multiple layers. They often wear shorts then a slip then a skirt plus blouse plus a head scarf and top it all off with about 3 yards of extra material which wraps them up like a present:-) It often takes a few minutes for them to disrobe in preparation for their examination.
One of the most common health complaints here is pain. When the patient sits down with his translator and begins to point to his head, shoulders, back, stomach, hips, knees and feet in rapid succession I know I have my work cut out for me:-) Last week we met a man who believed he had been poisoined when someone shook his hand and a woman who after 6 years of amenorrhea, came to us convinced she had been pregnant for that entire time and requested we remove the baby.
When asked, most women will reply that they have given birth to about 10 children and that approximately 5 of them are still living.
The following excerpt came from a thank you letter I recently wrote to a church in my hometown;
"One of my favorite things about life here is watching the family members of our patients. Often they will come with their sick relative, spread out their mats and cooking supplies and carry on with life in one of the many hospital courtyards. The children will play, the mothers will feed their babies or cook a meal, the men will sit together and talk. Clothes hang from the trees to dry, people nap, women wrap and re-wrap their “pagnes” or skirts as they bend to pick up a load of wood or a bucket of water and proceed to place it on their heads:-)
And so they move in...and move out, and life continues to flow in and around the hospital of Meskine. I cherish my time here and am so grateful for all of you who have shared in this experience with me. God bless."
I have become a pro at pronouncing most of the names of my patients, such as Fadimatou, Ousmanou, Fatime and Aissatou. I also know that “Mht” is a very convenient way of abbreviating “Mohammet” and that Hamadou indicates the eldest son of a family.
I can now distinguish Cameroonians from Chadians on sight based on their clothing, personal belongings, height and the color of their skin.
I am familiar with the fact that many Chadian women come in multiple layers. They often wear shorts then a slip then a skirt plus blouse plus a head scarf and top it all off with about 3 yards of extra material which wraps them up like a present:-) It often takes a few minutes for them to disrobe in preparation for their examination.
One of the most common health complaints here is pain. When the patient sits down with his translator and begins to point to his head, shoulders, back, stomach, hips, knees and feet in rapid succession I know I have my work cut out for me:-) Last week we met a man who believed he had been poisoined when someone shook his hand and a woman who after 6 years of amenorrhea, came to us convinced she had been pregnant for that entire time and requested we remove the baby.
When asked, most women will reply that they have given birth to about 10 children and that approximately 5 of them are still living.
The following excerpt came from a thank you letter I recently wrote to a church in my hometown;
"One of my favorite things about life here is watching the family members of our patients. Often they will come with their sick relative, spread out their mats and cooking supplies and carry on with life in one of the many hospital courtyards. The children will play, the mothers will feed their babies or cook a meal, the men will sit together and talk. Clothes hang from the trees to dry, people nap, women wrap and re-wrap their “pagnes” or skirts as they bend to pick up a load of wood or a bucket of water and proceed to place it on their heads:-)
And so they move in...and move out, and life continues to flow in and around the hospital of Meskine. I cherish my time here and am so grateful for all of you who have shared in this experience with me. God bless."
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