Weekend Outings

Saturday, we adventured into Bamenda to do some shopping and to see the sights.  It takes about an hour to drive there on the no rules, everything is legal and fair roads.  The drives are always an adventure in themselves!!  We took one of the PACS residents, Treasure, with us who was looking to get out of Mbingo for a bit and “see some people that were NOT SICK”.  It was great having him with us.  We enjoyed his company and stories of his life and work in Liberia and the DRC.  He is one of the many heroes that worked through the Ebola crisis (B has a separate post on that).  He also helped us navigate the shopping and made sure we didn’t get charged too high of “white man price”.  In town, we ventured to the main market (which is complete craziness in itself!) so that Joe could get material to make a shirt, then we went to the supermarket to grab a few snacks for the upcoming week.  Toby wanted a haircut, so Treasure took us to his barber and Tobs got an official African buzz with a little decorative flare.  We hit a couple of artisan shops so that we could bring home some treasures and then we had lunch before heading back to Mbingo.  Our lunch was at a restaurant recommended to us by another Dr. volunteer.  It was one of the “nicest” in Bamenda.  It was very fancy, with full place settings and all.  The kids were very happy because they could get a cheese burger and fries.  The men all ate goat dishes with yams and fries.  The staff took excellent care of us.  But, I was quickly reminded that we were still in Africa, even at the nicest restaurant, when I asked to use the restroom, I was sent outside to a toilet in a separate building that had a half door and a bucket of water that you had to dump into the toilet to flush it.  The sink did have running water, but no soap or towels or napkins, and definitely no sign that read “Employees must wash hands”.  Next to the toilet building was the staff laundry hanging up to dry on a clothesline and there were chickens running around oblivious to the fact that they were the next order off the menu.  We left full and happy, it was a good day.

Busy Saturday market

Coffin store/funeral supplies

If you can zoom in on this one, you can see it is a butcher shop.  All meat is butchered outside in open air markets.

The meat on my salad was chicken stomach.  It is traditionally reserved for the chief of the village to eat.  I tried it, but passed the rest to Joseph, our driver.  He got to be chief x2 that day!

Sundays are one of my favorite days in Mbingo.  It is inspiring to witness the depth of the Christian faith that so many of the people here have.  The praise music, full of emotion and adoration for our Lord and Savior, coupled with the beat of the African drums nearly brings me to tears.  I love watching the faces of the people around me, I have never experienced a church service like the ones here in America.  It definitely stirs the spirit in me.

Worship service in Mbingo Baptist Church

After church, we packed a picnic lunch and headed out for a hike.  As usual, it quickly turned into another typical “Ipsen adventure”.  About 30 minutes into the hike it started to rain, and not just sweet gentle rain, it was torrential, drenching rain.  We were, of course, on one of the steepest parts of the hike.  The wind blew so hard that my umbrella flipped and broke, but it was ok because I was worried about it getting caught on the barbed wire fence the was about a foot to my left.  All this while trying not to lose my footing and slip on the extremely slick packed wet clay, that would cause me to plummet down the steep hill about a foot to my right.  This is the same path that the locals climb every day, with a skip and a hop, and usually with something on their head.  I am so impressed (and embarrassed for my lack of balance) watching them gracefully navigate these steep, slippery, and difficult paths, with a baby on their back, something on their heads, and often in nothing but flip flops.  Asha for me!  By the time we made it to the top of this first peek, I was a soaked jungle rat.  But we all rallied and powered on in the rain, we were too far to turn back at that point.  We made it to our destination just about the time the rain let up and were able to have lunch and enjoy the beautiful view of Mbingo.  On the way down from the peek, I came two feet from stepping on a snake, which in the last day has become quite the buzz around the hospital.  Apparently one of the most venomous around and most of the people haven’t even ever seen one of this kind.  If you know me at all and know my snake phobia, you would understand the anxiety that this has brought me.  It’ll take a lot of convincing to get me to venture into the jungle again any time soon.  But even with all the excitement, it was all worth it to see the view from the mountain top, God’s beauty at its finest. 

Some of the houses on the path along our walk.  Electricity in the house, but no running water inside.  There is an outhouse, a cook/smoke house where they cook, and an outside communal faucet.

Ran into a soccer game up in the hills, barefoot in the mud, between corn fields.

 We returned home to find Grace working on her “house plans”.  She has spent hours drawing out our house here and rearranging the furniture to make it just perfect for when she moves here permanently.  She even included a guest room…” for when you and dad come to visit”!  I guess I can say that homesickness isn’t hitting her as hard as it did last time we were here.  At least she is keeping herself entertained.

Besides our adventures, I have so many pictures and stories that I still want to share with you all.  Stories about all the things that make living life here hard, that are the things that we take for granted.  And about all the wonderful people that we have met.  There is just not enough internet here to do it.  It saddens me that the people here have such a hard life.  At the same time, it saddens and embarrasses me to think about the state of affairs back home.  Let me just say about home…no one should complain about anything…not work, or school, or healthcare, or ailments, or about what they don’t have, or how they are oppressed, or how life isn’t fair.  What we consider to be not fair is nothing compared to the way the people here have to live every day.  I was thinking yesterday about sweet Justine, who I met on our first visit.  Sitting in her dirt floor mud hut, watching the hospital counselor perform a rapid HIV test on her two babies.  It has been experiences like these that have changed me and my perception of life and people.  It has humbled me and has made me more and less tolerant all at the same time.  I can’t wait to see what this week has to bring.  Please continue to pray for healing and strength for the people here that B is operating on.  God is in this place, I know his people here are guarded by his mighty hands.  And every outing we take and every encounter we have opens our eyes to the glory and beauty around us, right here in the heart of Cameroon. 

Tricked into Hot Hot

Cameroonians’ often describe their pain as “be hot”, when you ask them where it hurts, it gets translated into “Where be hot?”  But it is also seemingly a term for difficult or challenging, I would guess because you get “hot” doing them.   I had discussed with the team, starting with a “cool” or easier spine case first since it had been several years since we had worked together.  We had classified them into being cool, hotter and hottest cases toward the end of my stay.  To my surprise, the first patient I had seen, one of the hottest of the hots with a severe and stiff curve is who was readied for surgery today.  WAWA, jump into the fire and try to make God’s people better. It was tough, challenging and overall good.  I ended up having to cut screws to get enough short ones to do the cases, something I’ve never done, nor would ever consider in the States.

We’ve had some great fellowship with the other volunteers we share meals with.  There is an Interventional Cardiologist teaching Venous Ablations for treatment of venous stasis ulcers.  There are two head and neck reconstructions surgeons, one who we had meet years ago as a resident, who has returned from Portland, and his colleague who practices in Hong Kong here to teach the Head/Neck (ENT) Fellowship they are running now.  A general doctor from Denmark who is always entertaining to speak to has been enlightening as well.  We were discussion civilizations, government etc..  He was speaking of how long Denmark had been civilized and how relatively “Young” America was, and described us as “A global teenager carrying on and such,” interesting perspective. 

Meet an interesting young woman from Birmingham, AL who is here trying to get their EMR started before she returns to medical school in the states, and her perspective on working in “low resource environments” such as Brazil, Eastern Europe, but that this blew them all out of the water for being scarce of resources.  

Mbingo has grown dramatically in the 3-4 years since I was here last.  They have increased the operating theatres, built a three-story hostel to house visitors, two stories duplexes to house all the resident doctors and their families. Below is new hostel and the sleeping mats the patients family stay on around the grounds when waiting for their families care.

The interesting dynamic of Cameroon being a dual linguist country both French/English, and the struggles between the two are ever present here.  Speaking with our driver coming up, and again with Dr Nana (Local Ortho Surgeon) their children have not been in school for an entire year.  Based on some political issues and essentially a strike/work prevention no children have been to school all year last year.  They are hoping that they get to go back in September but no one still knows.  Children just sitting at home for a year in the two English speaking provinces.  Riots early in the year caused them to have the internet to these provinces shut for three months as well, and again you count your blessings for a free and democratic America.   We were also visited by a young Fulani man, who had extended friends/family murdered in the north of the country recently in a battle between farmers and cattle men.  ALMOST 100 people killed and burned, villages burned, cattle slaughtered, and it’s aftermath is right in front of you.  

The coarseness/brutality of life is in the forefront as well.  The surgery resident with me this month came in this morning stating he was tired… He had to perform 4 amputations overnight.  3 severe road traffic accidents and a case of gangrene.  4 more disabled Africans with too little resources and very little likelihood of becoming successfully integrated back into life.   3 legs and a taxi driver who lost his arm when it was hanging out the window and struck another vehicle.   Trauma here is really bad trauma and a lot of it, a whole lot of it, with very little resources to follow once it happens.  From having to ride on a moto with an open broken leg, or sharing a taxi with a ruptured organ and a bumpy road to get here, it’s tough from beginning to end for trauma patients.

So, on a great note, we performed two spine surgeries on the same day for the first time on Thursday, then bested that by performing two instrumented spine surgeries on the same day on Friday.  This was necessitated by the fact that 4 people showed up Thursday evening, got admitted for surgery on Friday and when we rounded Friday morning there were 4 women expecting to be operated on.  Needleless to say, A Fulani woman and another woman are waiting all weekend for Monday and Tuesday to be fixed.  There are so many cogs in the wheel here, and some of them don’t function very well and it sabotages the entire process.  Some Pics from the OR.

Trying to explain to people what it is like to operate here is difficult.   No, its actually very difficult not just to explain, but trying to operate, even the easiest cases are hard.  It is taxing, draining even the simplest procedures in the States, just suck it out of you trying to make them happen here.   Nothing comes easy here, the power goes out several times a day, suction is reused, so it is leaky and not very strong.  Gowns are cloth, hot and brutal to be in very long.  Piecing together one spine instrument set a few years ago was a real accomplishment to be able to start doing surgery here, so Wednesday when they asked if we could split them in half so we could do two cases in a day, I was like “Sure????”  For those who know how many instruments I usually use will be surprising, but I did two decompression surgeries with essentially a 12 instrument set, total.  Friday, we opened the screw set up, took out the few screws I thought I would use, enough of the equipment to be able to perform the surgery and left the rest of the instruments, open, sterile and covered in the corner of the room waiting for the second case… Pic is of the washed and reused disposable suction tubing/cauteries.

Both went well, I’m waiting on x-rays to pass along.  Our two decompression/discectomy patients from Thursday both are doing great and went home today and our big scoliosis girl from Wednesday is getting up and around.

We ended up getting a driver and adventuring to the Market in the regional Hub of Bamenda today. Continued to get to know one of the residents who traveled with us, his story will follow in a separate post.  Toby got his first African hair cut from a local barber for 1,000cfa/$2.00, couldn’t talk Joe into one, though he did find a hat he thought looked good on him.

The Whoo Whoop heard across Mbingo

I don’t feel like I have anything too exciting to report as it has been a quiet week for the kids and myself.  A couple of factors have kept us indoors the first few days and we have not gotten out to adventure around.   The boys (especially my near teenaged, Joe) has had a hard time adjusting to the jet lag and time change.  The kids basically spent most of the first three days sleeping.  But I think yesterday we finally got over that hump.  Grace has not been feeling well, she has also been a bit lethargic and has had upset stomach for the last few days.  I think she is also adjusting to the changes of being here (ie…the lack of sushi for her extra sushi stomach).  But she too has made a turnaround today and is back to her normal chipper self.  The rain has been pretty consistent every day from about 1pm to whenever it decides to stop in the evening, this makes it hard to want to go out much because you get wet and muddy.  The house that we are staying in this time is on a different side of the hospital grounds and unfortunately there are no kids nearby for our kids to play with.  Last time the local kids were right behind us and always ready to play.  These things have kept us inside most of the days thus far.  Don’t get me wrong, it has been nice to hang out with the kids in a way we don’t at home.  We have played Rummikub, Farkle, and cards more than I can count.  We have each finished reading a book (including Joe) and to my surprise the kids haven’t been at each other’s throats.  They have, for the most part, been getting along really well.  Toby is fighting more with Brian over what he is going to eat then he has with Grace and Joe. 

Sample of some of our meals...

Curry chicken, plantains, and boiled cabbage (with something else in it that I don't know what it is)

Beans and avocado (I added ranch to make it a little more tasty)

So, yesterday we decided that it was time to get out of the house and get some fresh air.  We all put on our kicks and took a little hike.  The boys have gone out with Brian a couple times, but this was the first for me and Grace.  I was a little nervous because earlier in the day I ran across a man at the hospital who was selling “jungle meat” outside of the ortho clinic.  I can now visualize where the “bush meat” sold on the road side came from.  They were RATS…and not just everyday Missouri rats.  They were the size of a cat.  He had six of them laid out on the concrete stoop selling them, the same place people sit and eat their food.  I asked if I could take a photo and they all laughed when I said I did not want to buy one (it musta been the look on my face).  So now knowing these varmints exist, makes me a little more anxious about hiking.  I just kept envisioning that scene from The Princess Bride when Wesley and Buttercup get attached by the giant rats!  Not how I want it to go down in Africa.  Luckily, no rats or any other surprises on our treck up the mountain.  I also encountered this ginormous beetle like creature yesterday.  It was in our duplex neighbor’s house!  Yikes, so glad it went under their door and not ours!  The spiders and crickets are enough for me.

Speaking of hikes, Tuesday the boys tackled Mt. Mbingo in between rain showers and made it all the way to the top.  B posted a few pics the other day.  It is a pretty intense hike because it is very steep and with the rain I knew it would be very muddy and slippery, so Grace and I decided to stay home.  So, there I was…laying on my bed reading my book when I heard a “whoo whoop”!  For those of you that know our family, you know that that is our family call.  Anywhere, anytime we hear a “whoo whoop”, that means one of us (more than likely daddy) is close by or trying to get our attention.  I though surely, they weren’t coming back already, so I went outside to investigate.  Nope, not back, they were on the top of Mt. Mbingo.  One “whoo whoop” and with the clouds hovering low the entire valley got to hear our family call.  I sent one back and they heard me on top of the mountain.  It was crazy…or the people around us probably think we are crazy!  

Mt Mbingo from our front porch

Grace at base of Mt. Mbingo looking up

Those little specks are my boys...zoomed in ALOT!

Even in Africa I get field flowers when the boys are out hiking, 💗💗💗

 Today we had to venture out, I was starting to get stir crazy and I thought it would help the kids (Grace) feel better.  Grace and I started at the hospital, we delivered blankets to the maternity ward for the babies.  They were very happy to get them, but also very busy so I couldn’t take a snap.  Then we went to visit with one of the permanent missionaries and their family.  He is a pediatrician and she is a family medicine doc.  They have two kiddos ages 4 and 2.  It was nice talking to them and hearing their story.  It inspires me when I talk the full timers, it is such a big adjustment for their families to be here.  I am not sure I could do it full time.  They truly have a heart for Jesus and serving His people!  We then went and retrieved the boys to see if we could get a soccer game started.  It didn’t take long to reunite with a few of the local kids and find some new ones.  Here is a few pics of the houses that they live in and the kids playing.  Grace made friends with Endurance (yes, they still have names that are words of strength and inspiration; Comfort, Confidence, Lovely, Courage, Blessing). 

Margaret keeps us well fed and always has a beautiful smile on her face.

Makes us feel at home.

Grace and Endurance

After we had lunch, Grace still had her camera and ran into a few people who wanted their picture taken.  They love to have to take their pictures taken and then look at themselves.  Next trip I need to remember to bring a little printer so that I can print them off for them. 

A kiddo chillin' with his mom after having an external fixator put on, they watched the boys play soccer

This man has been working really hard every day learning how to use his new prosthesis

Back at the house, the boys have taken up a new hobby…walking stick whittling in preparation for their next hike.  Daddy told them last night that they needed to “listen to the stick” when they are carving it.  So, Toby found an “eye” on the side of his and added a mouth.  Joe made a spiral on his because his had had a vine twisted around it when they found it.  Creative juices flowing, let’s just hope that we don’t end up needing stitches!  Since it is raining and we are literally in a cloud right now, it is chilly and dark, so Grace decided to do what she does best…build a fort.  Her and Tobs hung out inside for a while, texting and playing with Legos.  It warms my heart that she still has moments when the little girl in her shines through. 

Joe making some awesome hiking sticks,

Grace's fort on a rainy afternoon

Tomorrow we are headed into Bamenda to do some shopping.  We are hoping to grab a few snacks for next week and treats to bring home.  I’ll let you know how that goes. 

Good night y'all...sweet dream!

The Worst of the Worst

It’s crazy when you’re gone for a while that you forget how severe and how bad things get here in Africa.  Things that never make it that bad/involved in America.  Day One in the clinic started with a bang.  Patient after patient with severe spine deformities, and it continued throughout the day.  They had 72 patients waiting to be seen on Monday (both spine and general ortho)

We surprisingly got through 72 people and a few surgeries before 3:00.  It’s amazing when you chart only for the bare necessities how rapid you can move patients in need.  As I have said in the past, it is crazy that their lives often come to a halt, travel here for days, wait on the lawn to be called, and then wait some more, just to be seen. 

General Ortho Trauma hasn’t disappointed either, worst of the worst.  It’s always hearting to see the healing power of the human body and the resilience and perseverance of the human spirit.  Huge volumes of “Moto” (Motorcycle) accidents.  There were three thoracolumbar fractures and a cervical spine fracture waiting on me, but based on several things none that really needed surgical care, either too far out, or not surgical in nature.  Several Open tibia fractures just make you gulp and say, “Holy Crap”, but thankfully there is a plastic surgeon here now to give a glimmer of hope of saving these legs with flap coverage.  First picture is of a patient who had been treated Elsewhere since November and finally came to Mbingo for care, and still a mess.  The second had been treated here, had coverage over the bone, but the local witch healers had taken over care when he left, and returned with a wound that looked like this because of the concoction they had been rubbing on his wound, with severe tissue loss now.

The following pictures shows the Orthopaedic “A Ward” which moved from my last visit and is split between men on one side and women/children on the other side with a nursing desk in the middle.  Everything is similar on the wards, other than they now do electronic x-rays and have a PACS system and have to look at x-rays on the computer.  They also just launched their own electronic medical record this week which will be a huge advance, as previously patients were responsible for carrying their own charts (Little pink, blue, rainbow  Notebooks) everywhere, which acted as a medical record, anywhere in the country, and often lost.  They have truly advanced themselves which such a significant endeavor, and will really improve patient care by being able to keep track of previous labs, diagnoses, treatments and care.

Day 2 started slower than I hoped, you come here hoping to do as much as you can, knowing the need is great, and the time is ever enough, but as Mama Cindy says, WAWA (West Africa Wins Again) and you must roll with the punches. My instruments were delayed in arriving to Mbingo so I was unable to do any surgery today, so spent part of the morning organizing the spine sets here and getting them ready for our first big operation tomorrow.  I think it’s because they don’t store/save as much crap as we do in Western civilizations, but it can be a challenge to get them to understand keeping a certain number of and a certain amount of screws ready, available and then replaced with the same sizes so they are ready for the next day.

There were more severe scoliosis patients waiting for me in clinic this afternoon hoping to get onto the “Program” (be fixed) before I leave, but it is already filling fast.  This young lady had been being treated by a local witch doctor who had been practicing what my wife calls “Chicken Scratching” cutting to try to let the “evil” that is causing the bump in her back which is actually severe scoliosis.  It can be seen in the picture all the little scars in her low back from the cutting.

Made it by the prosthetics shop where they were making a leg prosthesis and gave some donated children’s AFO braces they were super excited to receive.

The boys and I have been able to get some hiking in the last two afternoon/evenings, and is gorgeous as always, this is later in the year than several of our previous visits, so is rainier than before, so its muddier, slicker and trickier to try to miss the pop up rain showers.  We hiked up to top of the hill, Joe helped fix some fence and saw some local Cameroonian cows.  Today we hiked up Mt. Mbingo, which the last time I did, Toby was 3 or 4 years old, cried most of the time and I had to carry him both ways.

Joe and I are again amazed at the beautiful color of even the dirt roads you walk up.

Joe also thinks they know how to grow corn, but their cows are too skinny.

By the time we made it to the top, the clouds rolled in and was hard to see or get good picture of hospital, but parts can be seen in the photo.  Joe was excited because he became the “Goat Whisperer” as he tamed the goats who let  him pet them.  For those who haven’t climbed Mt Mbingo, it’s a legit hike, and steep/slippery.  I’m really proud of the boys who are already asking where we are hiking to tomorrow.  I’m just happy with how much easier it was not to have to lug Toby up, and that he did it all on his own.

To bed I go, surgery in the morning, and I keep waking up at 1:30 in the morning for a few hours for no reason.