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.