Gambia – May 2018!

This medical mission trip was inspired by my parents, who I lost suddenly a couple years ago. When I was growing up, my parents were heavily involved in community service, so I figured what better way to honor their memory. Although I grew up in Michigan, Gambia is where my parents originated from, and I call home.

Gambia is the smallest African country surrounded by Senegal on three sides and the Atlantic Ocean on the 4th. There are four major hospitals functioning at a tertiary level, 36 health centers on a secondary level, 492 Health posts on a primary level as well as 34 Non-government organization/private clinics. Government Healthcare facilities are free, however, supply is scares, and these locations are mostly frequented by those who cannot afford private clinics.

Most of the medical supply donated for the trip was acquired from Saint Luke’s Warren Hospital, along with two other online nonprofit organizations. Together the supplies weighted approximately 2200 pounds. Some of the barriers encountered during this process include detailed paperwork and international shipping costs, both of which, General Surgeon, Dr Sharpe, played an instrumental role in helping make possible. Through coordination with a local Non-governmental organization in the Gambia, the supplies were successfully transported through airport customs.

During my 10 days trip, over 500 patients were seen and treated, the majority of whom received 3 to 5 months of medication supply to help with continuity. Some of the items include asthma meds and nebulizer machines, blood pressure medications… thiazide diuretics, ACE inhibitors, calcium channel blockers, beta blocker, blood pressure machines, antibiotics, seizure medications, metformin, sulfonylureas, glucometers, blood sugar test strips, wound care bandages, sutures, gauzes, Betadine,, scalpels, intubation trays, IV lines, IV fluids, foley catheters, acid reflux medications, sterile gloves, oxygen tubes, umbilical cord clamps, alcohol swabs, Nsaids, suture removal kits, face masks, gowns, bed pads, casting tape, ankle braces, syringes, medical text books.

As I reflect on this journey, the words of my mom resonated with me, “on your way up the ladder, always pick up somebody else.” This trip has made me a believe that every little bit makes a difference, ringing true to the old African proverb that “When spider webs unite, they can tie up a lion.”

Dr. Naffie Ceesay

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February 2018

 

By Dr. Sharpe

This month’s trip was a little unusual since I was unable to bring a surgery resident, but Chris Cerovsky, a 4th year medical student at Temple University School of Medicine (TUSM), was able to go. We were there for a total of three weeks during a very busy time and enjoyed serving with a great group of medical professionals treating a broad scope of surgical patients. Rather than posting brief blogs of our daily thoughts and experiences, I thought I would take this opportunity to remark on the progress that I have seen at MBH over the last four years since the SLISS trips have been conducted.

First, it was nice to see that the hospital has continued to grow by adding new buildings and capabilities. There is a very large, newly completed three-story building that serves many functions. It houses all of the outpatient clinics as well as the laboratory, X-ray, and endoscopy departments. Additionally, there are much needed conference rooms and administrative spaces to support the daily running of the hospital as well as the Internal Medicine and General Surgery residency programs. One of the most needed and significant additions is their new CAT scanner! Purchased and installed since my last trip, it gets used extensively and relied upon more and more as MBH continues to increase the level of care provided to their patients and those that travel, sometimes over great distances, to receive care there.

It was also nice to see the equipment that the SLISS program sent has arrived there safely and is being used effectively to save lives. Among these are two endoscopy towers, portable ventilators for the ICU, and MBH’s first ambulance!

This trip was like many before; Chris and I assisted in over 50 surgical procedures during many long days and weekends. I am continually amazed at what great things are being done at MBH despite their limited resources and austere environment (by U.S. Standards). The many great physicians and nurses who are there full time, as well as visiting professionals, are doing great things and it is my pleasure to serve with them during these trips. We are continually blessed to be allowed to go there and are always welcomed with gracious and open arms. I am already planning our next trip for the fall of 2018!

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April 2017

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Meet April’s team (left to right): Cory Bond (Resp. Therapist), Heidi Hon (PGY4 Gen SURG resident, Melissa Lam (PGY3 OBGYN resident) Gail Burgey (OBGYN), Franz Yanagawa (Gen surgeon), ABBY Gotsch (MS4)

4/4/2017:

40 minutes from Philadelphia (PHL) to Washington Dulles Airport (IAD) then 7 hours to Brussels, Belgium. At Brussels, we had a little bit of a layover and so we refueled with some coffee and explored the airport shops. It was then another 5 hours to Douala. Upon entering the airbridge, there was the musty smell of body odor which became overpowering. Must be from the long journeys of all the travelers… I could begin to smell myself as well. It was a nice reprieve to stay the night at the Missions House in Douala for a shower and a night’s rest.

-Franz Yanagawa

 

4/5/2017:

The residents from previous years were not kidding when they said that the car trip to Mbingo is long. It’s an 8-hour ride, but I had pictured something much worse. In my mind, I thought there would be dirt roads, dusty and full of pot holes, and that we would be in an open jeep or car without air conditioning for this time. I was pleasantly surprised to ride an air conditioned van with roads that were relatively nicely paved until the last 1.5 hours of the trip. The team arrived tired and ready for a night’s rest before work tomorrow.

-Franz Yanagawa

 

4/6/2017:

I cannot seem to slow down. Dr. Sharpe and my mother have told me to take it easy, but take good care of patients. At first, I was just going to take call with the team, but somehow became case-hungry again and decided to be the attending on call. We got some good cases: Multiple abscesses on the leg of an HIV+ male (I&D), a pan-tenosynovitis with associated button collar abscesses (Debridement and A1, A3, A5 pulley-otomties), a retractile and necrotic right testicle in a one month old (right orchiectomy and left orchiopexy. A good start and I am told it’s standard 36 hour call here.

-Franz Yanagawa

 

4/7/2017:

Sitting, post-call, waiting for the last case to go. The tenosynovitis from yesterday night needs a second look. Its about 7:30 now. At 3pm, I am told that the OR team goes down to 3 rooms.

 

Post-case: I am sad to find that our patient will most likely need amputations of 3 fingers… at least. The palmar arch, superficial, is completely thrombosed. I will recruit the help of our plastic surgeon, Dr. Niles for some advice.

-Franz Yanagawa

 

4/8/2017: An Eye Opener

Today, several of us gathered to go on a hike. Mbingo is about one mile above sea level, but not blaming it on this fact, I realized I am in the worst shape of my life. The climbs are quite steep, but in my youth, I was in such good shape that I would lead the group, often running ahead then running back to check on the group. Today, I definitely kept an eye on the group… from behind.

-Franz Yanagawa

Fall 2016

This trip, I am accompanied by Dr Ronnie Mubang, a PGY4 General Surgery resident, and Mr. Tony XIA, a TUSM 4th year medical student.  Enjoy the posts!

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L to R: Tony Xia (MS4), Richard Sharpe, MD, Ronnie Mubang, MD

 

Sept 2

Some quick captions for the attached photos!

*Here we go Cameroon we come.
*Shout out to Ryan setting out clean water supplies in Liberia. The world needs more of Ryan.
*Why not. Shades all the way lol.
*Transit Brussels. Tired but excited!

Ronnie

Sept 3

(Ditto)

*Thank you sir Brussels for the great movie selection. Everest movie was amazing. Yes Dr Sharpe I said it. Apparently the crew from air Brussels said kingali Rwanda best city to visit y? Because so clean and no plastics banned in the country.
*Respect to other missionaries here in Cameroon. Thank you for setting up the school systems. The world needs you.
*Beinvenue a Douala.
*Feet on soil.

Ronnie

Sept 6

We arrived the evening of 3 September, relaxed a little after dinner, and got a much needed good night’s rest. The next day was Sunday and we spent the day unpacking the four suitcases of supplies we brought with us and putting them into the OR supply room. Most of them were critically needed by the surgery service. I was also able to supply the surgery residents with over 30 pairs of scrubs donated to the SLISS program for this purpose! Tony and Ronnie met many of the residents and they got organized for work the next day. Monday was busy; the residents warmly welcomed us, as usual, and we got right to work operating. It is a pleasure for me to be back here with another team!

Dr. Sharpe

Sept 6

A nice panoramic shot of the grounds from the back balcony of the surgery clinic. The building on the right with the red roof is the chapel. At the daily chapel service, it is a tradition when visitors arrive and depart to introduce ourselves and say our farewells to the entire staff of over 600 people in the hospital. On the left is a view of the mountains of northwest Cameroon where the hospital is nestled.

Tony

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Sept 7

I was happy to find many visiting professionals here this month. Surgeons fellowship trained in ENT, OBGYN, Trauma/SCC and Pediatric Surgery are currently here from prestigious institutions including the Mayo Clinic, Johns Hopkins University and, of course, St. Luke’s. Additionally, MBH has 3 full time general surgeons and 13 General Surgery residents. This may sound like a lot, but there were over 70 surgery patients on the wards to see this morning, approximately 80 will need to be seen in the outpatient clinic and then there are 25 scheduled surgeries to be done not counting the handful of emergency surgeries that seem to be consistently needed every day. It’s quite a busy surgery service! The picture below was from our morning meeting today.

Dr. Sharpe

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Morning Report

Sept 8

Many have asked me about our accommodations while serving at MBH. Since MBH has over 100 visitors per year, they have many places for guests to stay. Single family houses (for groups or families) and two Hostels are able to meet housing needs. For visitors who don’t want the hassle of making their own meals, a small kitchen and dining room provide three meals per day “family style”. I have always found the rooms to be very comfortable and the food excellent. Over the last several trips, I have stopped eating lunch to avoid gaining weight!

Dr. Sharpe

Sept 12

Well, our team just completed our first weekend on call (Friday through Sunday) along with three of the PAACS residents. I’ll let them blog about their impressions, but I was proud of all the work they were able to do and the long hours required. After 72 hrs, Ronnie and Tony are still at it in clinic today and still seem to be enjoying the experience. Here are just a few pics.

Dr. Sharpe

Sept 13

I thought I’d share a success story form yesterday. This 8 yo was suffering from complications of his Tb infection; one complication being restrictive pericarditis. This is a condition where the sac around the heart scars down and literally squeezes the heart so that it cannot function well. The surgery was a removal of the sac around the heart which was done yesterday, but he suffered two cardiac arrests. We were able to get his heart started again and this is a photo after a rough night in the ICU. Big shout out to Cory Bond from Good Shepherd Rehab for the donated vent! Without that the patient would have been “bagged” all night by a family member. After many prayers, the boy was extubated (breathing tube removed) today and is now crying to eat dinner!!

Dr. Sharpe

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Sept 14

The surgeons here in Mbingo take care of patients of all ages with any variety of conditions. This is a 4 month old baby with a patent ductus arteriosus (PDA) causing him respiratory distress. After a technically difficult operation, the team managed to fix his defect and send him safely to the ICU. The first picture shows a red vessel loop around the PDA coming of the child’s aorta, and the second picture shows both sides of the vessel clamped off after it was cut.

Tony

Sept 18

There is no trash pick up here. All trash from the hospital is incinerated. There are two homemade brick incinerators located in a small, separate building. It makes for a fragrant morning, but they work well!

Dr. Sharpe

Sept 19

This is our last week here and, after our first weekend off, we are ready for a busy week. A pleasant surprise happened today. We were told that 18 boxes of supplies shipped from our distribution center sometime last year arrived to the hospital. it was nice to see these much needed items get unpacked and placed onto the OR supply room shelves. Great job St. Luke’s!!

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Sept 21

This is a 67 year old woman who suffered a blunt abdominal trauma and was taken to a
Hospital where she underwent multiple surgeries with severe postoperative complications. She was told there was nothing more they could do and was discharged. She arrived at Mbingo gravely ill aand with little chance of survival. We were able to get her strong enough to undergo yet another surgery and after 2 months of being at the hospital she was ready to go home with no further complications. This was such an emotional trip for her and her family. Thank God for the team at mbingo!

Ronnie

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This is a 60 year old male who had been having symptoms of intermittent nausea and vomiting and unable to eat for for over 4 months. He had been to over 5 hospitals in Cameroon and was told there was no hope for him. Finally, he came to mbingo and was taken to the operating room where we were able to correctly diagnose him and fix the problem. One week later, he was ready to go home and live a normal life! Just another day at mbingo.

Ronnie

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Below is a picture with the nurses from the surgery outpatient clinic. They are absolutely incredible! Each day in clinic we average over 80 patients; speaking many different languages including French, English, “pigeon English” and tribal languages. These nurses translate and keep the entire clinic moving so all can be seen. Thank you so much for all you do!

Ronnie

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22 Sept

Today was our last day here and we had a good day of academic presentations and discussions. We were blessed to have ENT, OBGYN and plastics surgery specialists visiting from such prestigious institutions as Johns Hopkins University and the Mayo Clinic. It was a pleasure to be part of such a talented team this month and I especially thank my friends at Mbingo for their continued warm welcome and making us part of their team.

Dr. Sharpe

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Pictures!

Mbingo Scenery

People

Mbingo Baptist Hospital

 

Bamenda Main Market

MBH OR

MBH Market

PAACS

Getting There!

Agape Foundation

 

Spring 2016

The Kiddos of Cameroon

One of my favorite parts about the trip was meeting all of the children. We performed all of the pediatric surgeries and took care of the children afterwards. There was also a school on the hospital grounds for local children and many children of hospital employees. The energy and spirit of these children was incredible. These are just some of the children I befriended during my time in Mbingo.

The Amazing Residents

The surgery residents at Mbingo Baptist Hospital were hands down the hardest working people I have ever met. Work hour restrictions are non-existent. They are making major clinical decisions and operating independently from very early on in their training. Training to be a surgeon is such a privilege to these residents and they don’t take any learning opportunity for granted. I am forever grateful to my friends and co-residents in Cameroon who helped put things into perspective for me and showed me just how lucky I am to be training at St. Luke’s.

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April 16, 2016

Dr. Mao and I had mixed feelings about this trip before we left. On the one hand, we wanted to come, but on the other hand, we knew two weeks would be too short. We decided to get to work as soon as we arrived at Mbingo and continue to do so until we had to leave. We worked for 12 of the 13 days we were here. Combined, we performed over 60 major surgeries and saw at least 300 clinic patients. Memorable cases were many, but two stuck out in our minds. For Melissa, she will always remember a 3 day old baby born with esophageal atresia. This is a condition where the food pipe is not connected to the stomach. Melissa surgically placed a tube into the baby’s stomach so that she could receive nutrition and get strong enough for a much larger surgery. For me, I will always remember a woman who had suffered for over 10 years with a slowly enlarging tumor in her abdomen. We were able to remove it safely; it weighed over 35 lbs!

Yes, the trip was too short, but we were able to save lives and greatly reduce the suffering of so many in this short time. You can be assured we are glad we came!

Dr. Sharpe

Winter 2016

Blog 1 Feb 2016 pic

Photo (from left to right) Drs Cleve Sides, Shenali Abeysekera, Maggie L in, Richard Sharpe, Gail Burgey, Chineye Nwachuku

February 13, 2016

Our team of six physicians posed for this photo at the Philadelphia International Airport prior to the first of several flights which will land us at the Douala Airport in the evening of 6 Feb. After over 24 hrs of time in the air and sitting at airports, we will be ready for a rest and another day of travel by ground to our final destination, the Mbingo Baptist Hospital (MBH),in Cameroon, Africa. We expect our fatigue from travel will rapidly vanish as we get settled into our areas of specialty and get to know the great people working at MBH and the patients entrusted to our care.

This team includes specialists from orthopedics (Dr.Nwachuku), obstetrics and gynecology (Drs.Burgey, Sides and Abeysekera) and general surgery (Drs. Lin and I).We carry with us many supplies donated by St. Luke’s University Hospital and AmeriCares; these supplies fill some critical needs at MBH.

This page will have numerous blogs from us encompassing all of our specialties and areas of service. We trust you will check back often and thank you for your support!

Dr. Sharpe

February 16, 2016

After a safe 36 hrs of travel, we had dinner at a local restaurant in Douala (photo 1)and spent a restful night at guest quarters arranged for us. The next day,we traveled by van to Bamenda and finally to MBH. The trip was broken up into several stops for fresh fruit, one being ripe pineapple which proved to be quite tasty but a little messy (photo 2). Many photos were taken during the ride as we absorbed a lot of this new and interesting culture. A boy with a pot on his head was selling “bush meat” which,as the name implies, contains any kind of meat killed in the surrounding woods and fields.Not surprisingly, none was adventurous enough to give it a try.The evening was spent at MBH having dinner and getting settled in for a busy week. As expected, we arrived tired but eager to get starting with the staff at MBH.

Dr. Sharpe
Blog 2 Feb 2016 pic3
Blog 2 Feb 2016 pic2

February 16, 2016

The kitchen starts its work early by starting the fires both under the large pots in a shed and in small brick openings that sit under the big cast iron stoves in the general kitchen.  The shed has a place for firewood that is used on all fires and is replenished daily.  Today the kitchen table is covered in freshly harvested carrots, and large bags of beans sit nearby.

Dr. Burgey


February 17, 2016

Gardening here means providing for your family and sales at the market place.  All types of terrain is cleared by hand with raised beds…mountainside, valley, and small gardens near the home.  While the soil appears dusty now, and planting is just starting in the dry season, the depth of the furrows makes for arduous work. The hoes are small shovel blades on a small handle.  As one person digs, the other pulls and clears the brush.  Some small trees are left.  When the planting is done, some tall sticks are placed for the beans to grow up on.

Dr. Burgey


February 18, 2016

Busy week. I am impressed by the type of surgery that this hospital does on a daily basis with the resources it has. I knew it would be a challenge to tackle the cases here, but felt as a gynecologist trained in the times of open procedures I would be up for it. While I feel I have been able to do an okay job, I feel woefully inadequate and admire the cases that they cover as general surgeons everyday. Feeling like the lighting is not good enough, the clamps and instruments are the wrong size and only partially function, the self-retraining retractor doesn’t, and suture type and size is variable. Even a basic case would be challenging. But there seems to be no easy cases. The cases here would be a challenge even in our facility. Being here makes me even more aware how spoiled we are, that we complain about our operating room times…and pout if our favorite piece of equipment isn’t ready. The resources that we have, take for granted, and often waste is a shame is even more apparent to me now.

Dr. Burgey


February 18, 2016

Maternity Ward

The maternity ward is run by midwives with nurses.  There are 7 midwives that all rotate the 3 eight hour shifts.  They handle all the labor patients, deliveries, postpartum and post operative care.  The front room is divided into two sections that look the same, with the nursing station in between.  The left is for the vaginal postpartum patients and the right is for the cesarean postpartum patients.

When a patient is being evaluated in labor, she is taken to a small room with 4 beds in the back.  Her vital signs are checked every 4 hours and fetal heart tones are evaluated every 30 minutes.  The midwives will use cytotec for cervical ripening, and will begin pitocin as needed to augment labor.  There are no pumps so any medicine is given in the drops per minute method.  Everyone must have a caretaker, and that person stays with them throughout their stay.

When the patient is ready to deliver she is taken to the delivery room.  The midwives deliver all the babies, including breech if the patient has had at least  one vaginal delivery before, and twins.  They will repair most lacerations but if it involves any of the rectal sphincter the surgeon will be called and she will go to the operating room for repair.

If a cesarean section is needed, the surgeons are called and the patient taken to the operating room.

Dr. Burgey


February 18, 2016

The busiest week of my life (literally)

Due to a medical conference scheduled a while ago, four of the general surgery residents and both of the general surgeons were gone this week (14 – 20 Feb).  In addition to this, one of the visiting general surgeons could not come leaving me as the only general surgeon here for 7 straight days.  I am 5 days into this experience and can honestly say that I have done more surgeries than in any consecutive 5-days in my professional career.  Add to this the responsibilities of supervising and teaching the 5 residents that remain coupled with over 175 clinic patients in three days and you can imagine that it has been a whirlwind of activity from dawn to dusk (and later).   Many were seriously ill and required ICU level care and attention.  While three of our patients died, many more were saved and countless morbidity averted simply because we could offer surgical care this week.

A significant blessing to me was that our team from St. Luke’s included Dr. Burgey, an OBGYN, and two OBGYN chief residents, Drs Abeysekera and Sides.  Drs Burgey and Abeysekera were able to cover all the c-sections and gyn surgery leaving me free to focus on the general surgery.  Dr. Sides was able to fill a critical need at Banso Hospital, which is about a three-hour drive away, and will be returning to Mbingo today.  He will likely have some great stories to tell tonight at dinner time!

Dr. Nwachuku, the orthopedic surgeon in our group, has literally been operating everyday and has expressed to me his amazement at the type of cases he has managed this week.  Hopefully, we will see some blogs from him soon.  He has some terrific X-rays to share!

Dr. Sharpe


February 19, 2016

Leaving Today

Last day at Mbingo, saying goodbye to one of my roommates, who is usually on the wall, or in the shower stall, until the light goes on, then he leaves…

Having the last cup of early morning coffee from Dr. Sharpe, who kindly made a pot every morning and shared a cup at 0600.  A lifesaver as breakfast wasn’t until 0800.

Not sure what made me want to come, or what I expected to do, or if I expected to find something for myself.  All I know is it was a very humbling experience: to see what people go through here, waiting to get health care that we take for granted, traveling to get healthcare that we have right down the road, the thankfulness for the care they receive and how the physicians and surgeons are able to care for them as well as they do with their limited resources.

I hope I made a small difference, and maybe was able to help some people.  Most importantly I hope I have learned how fortunate I am to have the healthcare and resources available to me, and not take them for granted.  Hoping I will be fortunate enough to come back and do it all again.  Thank you to all who support this project and to my family for supporting me.

Dr. Burgey