October 21, 2019
Blessed to be safely back again at M’bingo Baptist Hospital in Cameroon. The scenery was beautiful and the trip here was, for the majority of the time, pleasant. The airline flights are long, but arriving in Douala to be met by the driver Fon, is always a relief. A dinner in the same little restaurant, where I have developed my favorites, and a rest at the CBC Main House is a great way to relax before the long drive to M’Bingo.
The ride to M’bingo is at least 9 hours on a good day. We drove on a Sunday with the first stop at the local bakery to get food for the trip. Wonderful, but I ate all I bought before lunch. We stop for some coffee at a local gas station, Fon always remembers what I need for the trip! The weather was beautiful when we left and the roads were paved and not much traffic. After a few hours we stop at the place Fon likes to get watermelons. several hours we come to the best fruit place, they give us fresh pineapple as Fon picks out pineapples, papayas and lemons to take to the hospitals. I bought a bunch of bananas.
While the drive continues I enjoy the scenery, the small towns, the people sitting outside selling what they have. And how what they are selling changes as we go higher into the mountains. We start with a lot of fruit, then we pass through areas with beans and greens. Next are stands with corn, and then the area with trays of beautiful orange carrots and potatoes. Finally the stop for tomatoes. Along the way a stop at the market where meat is being cooked on big grills. I had Fon buy me an order, I asked what kind of meat, he said it was good meat. I am hopeful it was beef. It was very good.
After about 5 hours, the road quickly deteriorated. There were potholes everywhere, huge ruts of missing dirt. Then the pouring rain. The positive was the rain filling holes helped to see them, that is about all. A couple hours into that driving,we got a flat tire. A new tire and we we back on our bumpy way. We stopped in Bahmenda and switched vehicles and drivers for logistic reasons. Then headed to M’bingo.
This is where I saw the biggest changes left by the recent war against the rebels. The road is guarded and we were let through. The road conditions were bad as they had been, but we only saw maybe 3 other cars passing through the whole hour we drove. Most houses were abandoned although a few people had returned. Our new driver Mark seemed very vigilant, and showed us where the portions of the road had been barricaded by the rebels, and where some had been seen just a few days ago. He explained several times the road had been shut down by the military for protection. It was indeed haunting. I felt sadness that these uprisings caused people to leave their homes and not be able to travel safely.
The hospital has also felt the effects, the patient load has decreased, they just are not coming for care. Staff has left as well.
The positive is that it seems to be improving. Hopefully people will come to have their care and other visiting physicians with their expertise will return. I am happy to be here with my resident to encourage women to come for care, and to encourage the staff that things are improving.
After being introduced in Chapel this morning, we saw a few people in clinic and did our first case. Tomorrow should be even busier. While they do not do much laparoscopy here. SLISS has provided the instruments and we have a few cases to see how it goes. I am excited to bring a few new gynecology procedures here. It is always an honor to be involved.
Dr. Gail Burgey
View from second floor of our housing
October 22, 2019
After a beautiful sunset last night, the day arrived overcast and then with pounding showers of rain. A few people made it to the clinic, and I saw a recurring theme of how fortunate we are to have the basic education and resources for women’s care at home. Even our TV commercials give us more information, maybe too much information, than some of the women have here about their bodies. Someone presented with bad menstrual cramps. There is no Midol and not over the counter Advil. Everything is a prescription here. Someone told her that the cramps were keeping her from becoming pregnant. I tried to explain she gets the cramps with her menses which means she is not pregnant, not the cramps causing anything.
Pregnancy and infertility issues were a major reason for many of the visits today. It is a society where your ability to bear children is very important. Inability to bear a child may lead to a divorce. I spent time just to go over basic female cycles, timing with natural family planning for trying to achieve pregnancy. I finally wrote a brief handout that I could give to others that come with the same concerns.
Then, as happens at home as well, while others struggle to conceive, a patient comes who could not afford contraception and has an unwanted surprise pregnancy. What brief counseling I could provide seemed to make her more distraught and she left. I encouraged her to come back in a week or so, but I am not sure she will.
One emergency surgery that went well ended the day. Hoping more people will come with better weather tomorrow.
Dr. Gail Burgey
Sunset last night
Oct 23, 2019
It is raining, and raining, and the forecast is more rain. I have taken to just wearing the same wet clothes and shoes outside. The weather app said to be careful driving due to “ponding” and the same can be true for walking.
Unfortunately not as many patients come to the clinic on days like this, but we have still seen about 10 a day. We had some babies born today despite the rain. Both of the deliveries reminded me how fortunate it was that this hospital is here, that the staff has worked hard to provide care beyond what is available otherwise.
The one delivery was a woman with the placenta presenting before the baby, called placenta previa. She had come in with bleeding and the ultrasound here found it. She received the same medications she would have in the US to help mature the baby, until today when the bleeding progressed and she needed a cesarean section (C-section). The operating room staff had everything ready for a small baby, and so far, although premature, the baby seemed to be doing well. A lot of the equipment used for the baby were items I recognized we had brought here, donated from SLISS, including the ultrasound machine.
The next patient should show how this hospital is regarded among the rest of other local facilities. This young girl with her first baby was transferred here from another facility, she had been in labor since yesterday. The report was her cervix was completely dilated since 12 midnight, she had started pushing at 6 am. She was transferred her around 5 pm as the baby was not coming out. The midwives here called immediately for us to evaluate, and it was obvious we needed to do a cesarean section. The OR was called and she was taken to surgery right away and had a baby boy. The importance here is that, thanks to very dedicated people, volunteers, and monies/equipment donated, M’bingo Baptist Hospital has an operating room. It is available whenever needed. The staff has been effectively trained. While this may seem as a given in some places, it is a luxury here, a lifesaving luxury, that 2 women and 2 new baby boys, were lucky enough to come to. Even in the pouring rain.
Dr. Gail Burgey
Oct 27, 2019
Not every day is an easy one. Today is dreary..no other way to describe it. It started sunny enough and I had hopes for a warm sun drenched day. We had a case in the Operating Room, a young mother who gave birth last week at a different hospital. She had a tear with her delivery that was stitched, but it did not hold and things were coming out areas they should not, to put it delicately. Her other hospital said to come here. We did a repair and she was recovering well as we walked in the sunshine to the canteen to get coffee.
It is Sunday, and in the spirit of good will we had told the cooks that we would be glad to heat up our own meals if they wanted Sunday off to be with their families. We were dispensed home after Saturday dinner with a glorious basket of food to last us all Sunday. After the surgery and coffee I settled in with some hard boiled eggs, a cucumber and fresh tomatoes. I had scrubbed the tomatoes with hand soap and peeled the cucumber to avoid any gastric bugs. Dr Doucette was happy with a homemade cinnamon bun and a banana. All good.
I hung out some hand wash, then the clouds came. Fast. Then the rain. Then the dreariness.
I was pretty excited about lunch, and when it was time I went and unwrapped a beautiful portion of meatloaf and some pan fried potatoes. Being dreary I was looking forward to some warm homecooked food. There is no microwave. Our little kitchen appeared well stocked and I found a small fry pan and then tried to light the stove. I tried to light the stove every which way, but it did not light. I surveyed the other appliances to see if any of them would warm up some meatloaf and potatoes..a coffee grinder, a scary looking old percolating coffee pot and an iron. I thought quite a bit about the iron. I went to college in very premicrowave days and with some foil and your iron you could make a really good grilled cheese sandwich with bread and cheese liberated from the cafeteria. But I had no foil today. I thought about the iron and my little fry pan. Seemed doable, but seemed like something I could get a nasty burn with.
I could have taken my plate to some houses to ask for a little warm up for my food, but in the pouring rain, I would be not only hungry, but wet, and intruding on others relaxing Sunday.
It only seems fitting then that my dreary day, I had some excellent cold meatloaf and some okay cold fried potatoes. I believe Dr. Doucette had another cinnamon bun and some cheese peanut butter crackers.
The good news? There are still a couple hard boiled eggs and a banana for dinner.
Dr. Gail Burgey
Oct 30, 2019
A beautiful sunny warm day. The number of patients coming to be seen has increased and the mood is upbeat. Nothing much new to report but I wanted to just review access to healthcare. Being in practice for 30 years, I know the struggle my office staff has with getting people in for appointments when they want. There are only so many work hours in the day and appointments need to be staggered and given the correct amount of time per appointment type. Sometimes people feel like they need to be seen sooner than the next available appointment and become frustrated that there are not more available times. Other times people will arrive too late, perhaps traffic or an accident held them up, and need to reschedule. Offices spend a lot of time trying to be sure patients have access to their physician.
Return to M’bingo…clinic is a show up and wait to be seen. Sometimes a physician is available, sometimes they are not. Sometimes the time the physician is able to come is variable. People are always patient and happy to wait their turn. What is the challenge is what they have been through to get here. Currently the towns next to M’bingo have been evacuated as the result of the recent civil war. The next nearest city is about an hour away. The roads to M’bingo are not in good shape. There are multiple potholes, some big enough to lose a small car in, and many edges washed away with some small streams running down the road itself. Adding to this drive is that the edges of the road are also inhabited by some of the rebel army. Whether they are truly part of the civil wars, or just people taking advantage of a bad situation is unclear. They take rocks and branches and set up road blocks to stop cars coming through and demand their money. Many people are carrying the money to be seen, or even have their surgeries. They are stopped and their money taken. The military has increased their patrols to help more patients get through, but sometimes their roadblocks to check credentials can slow the access to the hospital. Our patient with a ruptured ectopic pregnancy this last week was held up several hours at a town up the road as the army and the rebels had some confrontation and traffic was not allowed through for some time.
A few days ago one of the power lines to the hospital was disrupted, presumably on purpose, with some issues with getting it fixed. We are on generator power and all is well, but some energy demands need to be addressed. All of the surgical drapes and gowns are reusable cloth and need to be washed then sterilized. No open and toss away as in the hospital at home. The washing machines cannot run at the same time as the autoclave for sterilization. While they are doing a great job, some surgeries are postponed, while people wait in their hospital bed. Sometimes they can be done later in the day, or need to be done the next day. Patients understand and wait, pleased in general to be somewhere they know they will get care.
We are safe and M’bingo is safe, so I don’t want to worry anyone. I just want some appreciation for what healthcare means to the people here, and what they are willing to do to get it. And perhaps the next time someone, at home reading this, runs into some difficulty getting the physician or other healthcare appointment at the time they want, they can just be kind and grateful they will get there safely.
Dr. Gail Burgey
Bagging the cut grass
Nov 4, 2019
While it continues to be slower than years past, we remain steady in the clinic with some basic gynecology issues. It has been nice weather, other than a few very loud thunderstorms at night. We have used our extra time to get 2 small containers together and equip them with the medications available here for postpartum hemorrhage, a leading cause of maternal mortality. Usually someone would need to run to the pharmacy to get the necessary medications. We purchased 2 see-through small buckets with lids to put the first doses of those lifesaving medications together with the syringes and other items needed to provide care. We included very brief but clear instructions on what to give and when during an unexpected hemorrhage and placed our kits in the maternity ward and the operating room.
Dr. Doucette also has give 2 lectures to the internal medicine residents on evaluation and treatment options for pelvic pain and early pregnancy loss. Both were well received and allowed for a good question and answer period.
We have also tried to weigh in on some options to be put in the developing emergency department ward that would allow for some ob / gyn triage. We have drafted some very basic protocols to allow a non ob/gyn to know what to do next and where to send a patient who presented for care when the clinic was not open..whether they end up being useful remains to be seen as the basic structure of the emergency ward is still being constructed in its new space.
With the nice weather, I have been walking our small hospital grounds roads and noticed a great color variety of reptiles, and I believe at least one salamander that comes running out every time we walk over a small bridge from our walkway to the road. I am sure they are enjoying the sunny weather as well.