“Oh Buea! (boy-ah)” -Kristen

Today I was at the Muea Community Health Center. It is a clinic turned hospital meant to serve basic needs of the people of 3 different villages (Muea, Mutengene, and another that I have never heard of)
When Sarah and I first arrived, we were directed to sit on a bench to wait to speak to the physician. We ended sitting for  good amount of time, but we made lots of good observations and saw a lot of neat things. First thing that was noticed was that there were roosters wandering around and walking down the wards. We laughed at the thought roosters and hens walking up and down the sterile looking hallways at the Cleveland Clinic.
Another thing we noticed was the mass amount of pregnant women. Later I asked my nurse, and she said that they were so busy with pregnant women, the ward didn’t even have enough beds (even after they added more). We saw at least 15 pregnant women! They were there today to register and pay for future services (when they are ready to deliver). Then they all went to the maternity ward to wait in  line to be examined by the physician. Tomorrow they are “booked” which means they have labs drawn and further preparations for delivery. Such an interesting way of handling things!
After watching all of this and briefly meeting with the physician (there is only one regular doctor there, a general practitioner), I sat in on consultations with the nurse. This is where patients come in when they are not feeling well. The nurse see’s them first and takes weight, blood pressure, temperature, and complaint. Then she can choose to send them home or to see the doctor. However before the patient can even have a consultation with the doctor, they must go pay for the consultation.
The nurse also takes emergencies, so in a way it is like a doctor’s office (with sick calls) and also an emergency department. It is a way to improvise with such low resources.

Muea Health Center courtyard

 Once all the morning consultations were done (we were swamped at the beginning because it was Monday morning), the nurse told me to take  lunch. So she ordered me plantains and fish, it wasn’t bad!

boiled plantain and grilled fish with njangsa sauce

 After lunch, the nurse told me she did not have any work except logging and paperwork, so I wandered on over to the lab. Part of being a good healthcare working is looking outside of just your scope of practice!
The lab techs were very kind and welcomed me. They had a lot to show me! There was a table with lots of specimens, testing for Malaria, and 2 types of worms that is commonly found in the villages. Gross stuff on those slides!

specimens!

They also do prenatal labs, so tomorrow is going to be a very busy day for them! I was able to look at some slides under the microscope, and although I couldn’t even begin to name what they were, the lab tech could riddle off every scientific name. Impressive!

looking at slides

They were a great group of people and I learned a ton about lab work here in Cameroon.

Our heads were cut off because the person taking the picture was unsure of how to use the camera :)

Since their resources are so low, they improvise a lot! For example, one of the most common tests they do is the rapid HIV tests. Instead of using the automatic pricker (like we use for blood sugar tests) they just use a 22 gauge syringe needle. The number of HIV tests they do is crazy!
The lab tech said they find 3-4 people a month with HIV, which to be honest doesn’t seem that bad to me!
In order to get the full educational experience in the lab, they went ahead and showed me how to do an HIV test.. by testing me!

rapid HIV test

I’m happy to report my test was negative :) I guess that is the benefit of putting yourself in the patient’s shoes! The lab tech was sure to show me that he was using a new needle tip. He said he does this for everyone, because in the past there has been discrepancies about reusing needles. It was nice to know that they are really working hard to ensure safety!
I was also impressed with the sharps box. It was actually an empty soda bottle, but he did say that the clinic burns the sharps when finished. This is a definite improvement from what we saw done with the sharps at the regional hospital (they throw them in the trash.)
My two comrades, Kristen and Lydia were at the regional hospital again. Lydia said she had a pretty slow Monday (nothing wrong with that right ;-) ), because there were no surgeries. Kristen didn’t have any laboring mothers or births, however she had fun holding babies all day! We love babies!

Kristen and her baby!

After clinical, Emmanuel (the tailor) dropped off something for me. It’s a surprise for someone at home, so I cannot elaborate. But it is so neat to have clothes made!
Then we had sandwiches from the bakery and plantain chips. Now I’m mostly packed and ready for my last day. CRAZY!
Africa has been great to me! I will be leaving with infinitely more knowledge!

One last picture, I stole it from Kristen’s camera card when getting the picture of her and the baby. It is from the other night when we all had dinner at Amilia’s. Such nice people!

Our group and Amilia's family!

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“This is the biggest meal ever!!”

Lets rewind to last night! NIGHTCLUB!
Kristen and I went with Hans to further immerse ourselves in the culture!
The nightclubs here are actully not that much different from those at home. First you sit and visit and have a Soda or drink.

Nightclubbers :-)

There was a band with live African music. We requested about the only song we know, known to us as “the wife song.”
Seriously, this song is a mystery! Everyone knows it! But nobody has any idea who sings it, or what the title of the song is called. Apparently it is the singer’s first big hit. But really, it is heard EVERYWHERE!
As soon as we requested it, practically the whole restaurant got into it. We even got to sing into the microphone, cultural immersion at its best!
After this, off to the dancing club it was!
 

Hans has this thing about going early..

We were one of the first one’s in there, because Hans likes going before it is crowded to get a good couch seat. The one thing that Kristen and I found totally amusing was that guys in particular would stand in front of the wall of mirrors and just watch themselves dance. They would even stand in a line and watch themselves. Funniest thing ever!

some guy watching himself dance

We were pretty tired, so we left pretty early, but not until after we heard a Beyonce song, we were outta there! Home and to bed!
 
This morning all 4 of us woke up for church. We still go to the Catholic church on campus. The first two weeks we have gone at the wrong times. This is because that during the break there is only one service, at 7:30am. We have been told the last two weeks that because classes are starting up again, the times switch the 6:30am and 8:30 am. So third time’s the charm right… wrong! Once again we were there at the wrong time!
 
Didn’t put a damper in our spirits though. At least we were up and ready for the day earlier than if we would have slept in! We came back and did various things like homework, naps, showers, then we headed out to get some SUYA!
 
Another cultural thing we are learning, shops along the street do not stay long! Apparently the council orders them to leave at random times, so they must close up and move or else risk losing all of their goods. This means that almost all of the shops along our street are disappearing. Much to our dismay our favorite grocery spot, and two dress shops (with dresses we had our eyes on) have all closed! Even some restaurants!
However, Chocolate City still had their stand out there, so we didn’t go hungry.
After lunch, Kristen and I ran to the Muea market so that I could get one last present for someone at home before I leave on Tuesday (can’t believe I’m already leaving!)
With Hans’ cool bargaining skills, I found just what I was looking for! We also went with him to quickly say hi to his family down the road. We were immediately welcomed into their home and greeted by the children!
 
Then tonight, we headed to Vivian’s home for dinner. It was delicious! She has been with us since day 1, and it is such a great experience to be welcomed into her home, and for her to serve us the way she did. I hope someday we can repay her for all she has done for us!

Amid the chaos of food

We had roasted chicken, gari and eru, both ripe and green plantain, tomato stew, rice, soup, fish, pineapple, dodo (pan fried plantains), wine and fanta! So much better than any restaurant food!

Tomorrow is a new week! I am in the community health center for my last two days! Kristen heads to the Maternity ward, and Lydia to the theatre!

Have a great sunday night!

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Saturday!

Finally able to sleep in this morning! I think we all needed it! We awoke to no electricity though! This is not all that uncommon here in Africa, but it was out all day!
 
Kristen and I also watched  a little parade outside our window (Lydia was still sleeping :-) )  It was funny, because as soon as the people saw us from our window, they started cheering and waving at us. I think they liked the cameras too.
 

Parade down out street! complete with the marching band in front

People waving at us

After everyone was awake today, we headed to the suppo market down the road. Tuesdays and Saturdays are their big days. It was PACKED! I honestly felt very uncomfortable, because I do not like when people grab me to come look at what they are selling. I did manage to snag a gift for someone at home though, I won’t say what it is here! We also met two other Americans from Texas. It is really funny to us when we see other white people, because it is very uncommon. We stopped and talked to them for a little while. They are here with an ITS company helping to build infrastructure for students. Very nice people!
After the market, we headed home, and then to Deso’s house. He said I am not allowed to leave without first coming to his home! His home sits almost at the bottom of the mountain, and he had a great view of Mt. Cameroon! We enjoyed some cookies, peanuts, and the best white wine I have ever had! We also talked a lot about our research project and his thesis, which he defends in December (good luck!!)
Then it was time for dinner! We went to a nice restaurant called OIC, and the 4 of us splurged for the “full course.” This included carrot and cucumber salad, an entree (we all had chicken and potatoes/rice), watermelon, and cake! It was delicious, but we are stuffed now!

After getting back (power finally came back on!!), our nursing student friend Muriel came over for a little visit. We are planning on getting together tomorrow, and possibly a Limbe trip!
Now Kristen and I are getting ready to go to a nightclub with some friends, and trying to convince Lydia to come!

Also, as promised..

My dress!

(and me being a ham :-) )

Hope you’re all having a great weekend! I am enjoying my last weekend in Cameroon!

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Ironic that the operation room is called the “theatre”

Guess where I was today… back in the Theatre!
Because I really only had one good day in there last week (due to our crazy schedule) I went back today to make sure I got the full experience. Kristen was in there as well, and I believe we saw  total of 7 or 8 surgeries. By far the most complicated was the hysterectomy (removal of the uterus.) There is  photographer in the theatre who the family can pay to take pictures of their loved one’s surgery. He also was taking pictures with mine and Kristen’s cameras, but do not worry I will not post any of the gross ones- and trust me, there are plenty of very graphic pictures he took.
Kristen and I are in the navy blue.

At least one of us was paying attention to the surgery (Kristen looking at the camera) :-)

 Then we went for a “quick” lunch at the Canteen!..

mmm hospital food. This is fish stew and kwakoko

Kristen, Lydia, and I at lunch

Some friends at the canteen

One interesting thing I learned today: Because there is such a shortage of surgeons at the hospital, sometimes the general practitioners are trained to do minor surgeries (like hernia repairs). Yet the way they do their “minor surgeries,” is still a lot more invasive than the way it is done by a surgeon in the U.S. I attribute this to the fact they do not yet have the resources here to do laparoscopic surgeries. So all surgeries are invasive.

Another interesting observation. The number of appendectomies performed here is crazy! They make up a good percentage of the surgeries performed. Out of ~8 surgeries today, at least 4 were appendectomies. I often talk to the patients before they go in, and not one has seemed sick to the point of appendicitis. I am not at all suggesting that patients have unnecessary surgeries just so the doctors have something to do. Rather, I am exploring the thought that in the case of “abdominal pain” or other generalized symptoms, if an appendectomy is the “cure-all” surgery, even if there is no clinical indication. Another point, the infected appendix I’ve seen here, are definitely not the size of the ones I’ve seen removed in America. If the rate of unnecessary appendectomies could be reduced, this would also reduce the rate of infection.

Tomorrow we are headed to the market! But first we all get to sleep in!!! It is currently 8:51pm here in Cameroon, and I have been ready for bed since 7:30pm. We were planning on going to the nightclub tonight with some friends, but that has been rescheduled for tomorrow.

Goodnight! I promise a picture of the dress tomorrow! :-)

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Lets all do the HOKEY POKEY!

What an exhausting day/week! And it’s not even over yet!
I was in the Pediatric ward for a little bit this morning. 3 of the 4 patients were in for Malaria! The other was the little boy from yesterday with nephrotic syndrome. However, there was not much going on, and I was glad when someone sent for me from the Maternity ward to tell me a woman was in labor!
It was her first child, and wow what a long and painful looking labor! She was given no pain medications, only Pitocin (to induce labor)
All births here are completely natural with no pain medications (except c-sections). Some of the nurses had never even heard of an epidural when I mentioned it today. It was funny though to me because the nurse I was with kept saying, “Americans have painless births!” Some of the perceptions here are so skewed! ;-)
I know that pain management during birth is somewhat a topic of debate. On one hand why give meds? Women have been having babies without them for millions of years! On the other hand, why not?! If it does not harm the mother or baby (another debate) why not make it a little bit easier?
I would love to elaborate more on the birthing process, and the aftermath, but I really do feel that it is not appropriate for an online blog. There are so many similarities, yet so many differences! The miracle of watching a baby being born is really quite the process!
 
These are the babies I cared for while in the Maternity Ward. Shots shots shots!
The one in the blue is the one I witnessed into the world =)

my babies! :-)

 Such wonderful people at this hospital!

Maternity nurses and nursing students

Pediatric nurse and I :-)
 

Christian (another nursing student) and I.

Thanks for all the help!!

After work, we went to our friend Amelia’s house to meet her parents and for dinner. It was delicious! We had chicken, ndole, white yams, plantains, potatoes, bananas, and pampo (?) (a tropical fruit). Then we visited and talked. We also sang the hokey pokey compliments of Sarah!

Doing the hokey pokey!

These are the gifts Amelia’s parents surprised Sarah with. A beautiful African dress (that her mom made) and a map of Africa made of out different materials from here. They also said they were making us dresses!

Sarah was presented with a dress and map of Africa! So sweet!

 ..speaking of dresses! Emmanuel dropped mine off this morning, all fixed! I love it! I have not yet taken a picture in it, so I will either tomorrow or Saturday for sure!
I’m really excited because I love the color, and I have some leftover fabric which I have a secret plan for using ;-)

I just found out I am back working at the hospital again tomorrow (thought today was my last day there), so check back for that! Us 3 girls are also pumped because Hans is going to take us to a nightclub tomorrow night. We are going to make sure we experience the full range of the culture!
Can’t believe my time here is almost up!
Goodnight!

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Happy Wednesday

Pediatric Unit today! There were 4 patients (it’s a small hospital):
18 day old with Bilateral pneumonia
32 day old with Malaria
3 year old with nephrotic syndrome
5 day old with jaundice there for phototherapy

I was hanging with the young crowd today!
This morning I listened to the Pediatrician do rounds with the nurses, and medical students. One point that really stuck out to me was when the Pediatrician was talking about the FBC (we call it CBC in America) of one of the patients. He said that one of the challenges of healthcare in Africa, is that the “normal ranges” are set according to the research done on white Europeans. What he means by this, is that in an ideal world, there would be standards of normals set for each race/ethnicity. Obviously this is not a perfect world though, so one must be intelligent enough to understand that what is not “normal” on paper, may be completely normal for the patient. I think this could definitely be carried into nursing care in America, because we care for such a wide variety of races/ethnicities. It’s the holistic approach to look at how the labs were trending, versus what the paper says is within normal range.

After rounds, one of the medical students gave a small presentation about seizures, and then the Pediatrician went into a long lecture about seizures and Epilepsy.
Sorry for all you non-medical minded folks out there. I hope by now you have learned to just skip to the pictures =)
Lydia and Kristen spent their day in the ER. They had a fun time trying to take temperatures with a mercury thermometer, weights on a very touchy scale, and blood pressures with cuffs that were too small or too big.
The pictures are compliments of Kristen’s camera :-)

Sarah and the patient she visits everyday

 
 
 

The hospital with the ocean in the backround, it has to be a really clear day to see it!

Tonight:
We went and got some soya (sp?) for dinner. That is the African name for roasted meat and plantains. Then our tailor Emmanuel brought over mine and Sarah’s dresses! We both had them shortened and tightened in some spots. He ended up coming and going 3 times, and messed mine up the 3rd time. So he is going to work on it tonight and meet us in the morning before clinical so I can pick it up. Cross your fingers he fixed it! It was almost perfect before!!

Fayn nayt! A go slip mi di! ( “goodnight, Im going to sleep” in Pidgin)

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Babies and Engagements!

Today started off with a trip to the theatre where I found Kristen! One of the mothers in the Maternity ward went for a c-section. Kristen and I both got to stand in on it. I was there with the midwife, so I was mostly behind the table working on the baby.
At first the baby (a boy) was not crying, limp, and had very low apgar scores. But after some oxygen (thanks to the AMBU bag), and stimulation we got him crying and clearing his lungs! Once cleaned up, olive oil was applied head to toe. This was a new thing!
Then we wrapped him up, but him in his little carrying basket, and took him to the nursery.

This is where we took his wt (2.85kg), length, head/abdomen circumferences, and gave him his Vitamin K injection (for clotting factors). Baby was doing MUCH better!

 Unfortunately I did not see a natural birth, and I am in the Pediatric ward tomorrow. However, the two wards are right next to each other, and if there is a laboring mother, I am not far!
The nurses in the maternity ward are a blast and so helpful!

Maternity nurses

 Also, here is a picture of Lydia with a baby she cared for last week. We just got permission today to post pictures =)

Lydia and baby!

 Notes about today:
-The mothers are put completely under for their c-section. This means they do not see the baby at all before it is whisked away to the nursery.
-No family in the operating room
– No identifying information on the mother or baby to match them to each other. However, the awful thought of having a baby taken seems to not be of any concern here at all. (which is good)
– The midwife knew that leaving vernix on the babies is actually good for them. Yet she said that they still clean it off and bathed the babies in olive oil, because the families think they are dirty otherwise. Family education maybe?
– The use of the metric system really does make so much more sense. America needs to get on board!

I have also been looking into providing materials on Kangaroo Care for the nurses. This is when, after birth and the following days, the baby is placed skin to skin on the mother’s (or father’s! :-) ) chest for a certain amount of time. The research shows so many benefits to both the mom and baby, and it takes no resources at all. This is something practical that, with a little education, can be fairly easy to implement.
If you are un-familiar with the concept of Kangaroo Care, read on:
From Wikipedia:
Kangaroo care seeks to provide restored closeness of the newborn with mother or father by placing the infant in direct skin-to-skin contact with one of them. This ensures physiological and psychological warmth and bonding. The kangaroo position provides ready access to nourishment. The parent’s stable body temperature helps to regulate the neonate’s temperature more smoothly than an incubator, and allows for readily accessible breastfeeding.
http://en.wikipedia.org/wiki/Kangaroo_care

A funny thing that has been happening a lot lately to me is inquires about my “engagement.” I did not know until yesterday, but wearing a ring on your left middle finger signifies that you are engaged, and then once married, you move it over to the ring finger. The ring on my middle finger is in fact my late grandmother’s ring.

My grandmother's ring!

This really gets me thinking about how simple gestures have different meanings in different cultures. For example the “okay” sign is okay is America, and Cameroon, but in some South American countries, it is seen as offensive. The same goes for eating with your fingers. Here it is completely acceptable and a part of any meal. In the United States, it can be seen as impolite. We are all well aware that differences exist, and discovering new ones everyday. These must also be taken into consideration when in healthcare and dealing with what we perceive to be sensitive subjects.

Goodnight!

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