SWIMMING UP STREAM

It has been raining CONTINUOUSLY since Monday.  Cabin fever is setting in at the Ipsen house, C3.  Our little house is getting too close for comfort and the tension has been getting high.  Yesterday the kids decided they'd had enough.  They had watched their share of Scooby Doo, couldn't build any more lego designs, and played one too many hands of Go Fish.    The rain doesn't faze or slow down the local kids, life goes on as usual and they don't understand why my kids didn't want to come out (continuous knocking on the door and "Momma Joe/Grace, when can Joe/Grace come outside?  What are they doing").  So on day three of being housebound, it was time to join thier play in the rain.  Volleyball and army men as usual.  I said great, let me send you out with some soap...one less bath this week! 

Brian has still been working hard and trying to make sense of all the crazy advanced medical problems with lack of treatment here.  He comes in and just shakes his head, no words.  It is hard to see him so frustrated.  He is a fix it, get it done, and move on kinda person.  I am too, but he more than me.  So I know his frustrations are valid and great.  I wish that I could convey these to you all in a way that you could truly understand...swimming upstream.  But I think that you really cannot understand unless you've lived it, smelt it, touched it, heard it, and seen it.  The realization that we have a hard time admitting to is that here in Africa, it is what it is.  A recent example, yesterday the surgical staff went home early and today started after 1pm because there were no surgical gowns for the surgeons.  With all the rain, laundry service has not been able to keep up.  The scrubs and gowns are not drying fast enough.  Completely avoidable situation, BUY A DRYER!!  Instead they went to the hospital in a town over and borrowed the needed gowns.  It took four hours today to get them in.  Asha!  We can do our best to help in the ways we can and that is it, that is all we can do.  The docs can heal who they can in the time they are here, they can teach their skills, but they can't change the system and way of life that is Africa.  And not just Africa, I'm sure it's the same in all the places in the world that are suffering from poverty and  like struggles.  Ultimately  there just has to be acceptance of the circumstances and faith in God as THE HEALER and author of the peoples lives here.  He knows better than us and will provide. 

Myself, I haven't minded the rain even though it's a bit dreary. I finished a great book, did some reflecting of our time and work here, and enjoyed the cool snugly days not doing too much of anything (which is a very rare thing for me). There were two downsides to my lazy days though. First, my laundry WILL NOT dry and we will run out of clothes sooner rather than later. Second, I don't have much of anything interesting to blog about! 

  

 So, since I have nothing else interesting to blog about, today you get my thoughts.  Bear with me, or just don't read it if you start getting bored! I don't like to get too serious in my thoughts, but in these rainy days of quiet reflection, all these issues and happenings here, (aka...life in Mbingo, Brian's medical frustrations, Grace's lessons in living as the minority, our longing to feel at home here, find our nitch, and make a difference here, the reality that our life is easy no matter how hard we feel it is) I have decided on one thing.  That is, that all of our expectations cannot be too high.  In all aspects of this journey, I continue to fall back on "it is what it is" and we just have to decide what our role in that is going to be (at least that is what I tell Grace).  Unfortunately, in the end we may receive more than we give or at least feel that way. 

  

What we give...

I have to start with this, an asterisk if you will.  God has blessed our family in more ways than Brian and I could ever imagine or have asked for.  We are here by His mercies, grace, and love.  What WE have to give... nothing, we are just the vehicles by which His blessings are delivered.  That happens where ever we serve.  My prayers here are for the continued healing and blessings to a people and culture that is in our eyes broken and in constant need.  Needs that are greater than we will ever know.  And by we, I mean you too!  We as blessed Americans will never know the misery of life in Mbingo, Cameroon or other places like it.  What we can deliver here is hope, hope that there are people in the world that are able to and willing to lend a hand, knowledge, aid, love, and caring.  Even when it feels insufficient  and insignificant to us.  To take care of the people that are in greater need than ourselves. " For there will never cease to be poor in the land. Therefore I command you, ‘You shall open wide your hand to your brother, to the needy and to the poor, in your land.’"  Deuteronomy 15:11.  When we are willing, the Lord will deliver what is most needed.    

 What we get...

The knowledge and lessons learned here are most valuable and I/we have taken them to heart.  These are the lessons that we will prayerfully pass on.  In getting, we can continue to give.  Most importantantly I hope to teach and give these gifts and lessons to our children.  That is why I am writing these thoughts down, collecting my thoughts for them.  And if any of the rest of you benefit, grow, or learn from our experiences,  gifts, and my thoughts, then as Susan would say..."That it is a good, that is nice"!  When I think about specifics, many scenarios come to mind.  My story and lessons are many.  For instance, the very kind and friendly man who wishes us well every time we see him throughout the day.  His job at the hospital...collecting all the trash (from ground and buckets) and hand separating it into compost and burnable.  Despite this job that disgusts my children, you can tell he has a joyful heart and is thankful for having the job.  One day I hope to see him without his nasty gloves on so that I can hug him!  There are the ladies that hunch over every day with their bent shovels weeding the entire drive of grass and weeds.  They also remove all the moss that grows on the concrete curbs of the drainage ditches.  Such a tedious unending hard task, they do it with a smile when I would just buy round up and be done with it.  It goes on and on.  They are not too proud to do what needs to be done to survive.  I know that I've said it before, life here is about survival.  Surviving, I can't even begin to tell you how I "survive" because I will never know.  No matter how bad life gets for me/we/us, there will always be an opportunity to make it better.  I had a friend of Gracie's ask if she could wash our clothes for us, so that she could make some money.  I told her no, I wouldn't have anything to do then.  Her response, "you can just sit and rest".  I don't want to be the white man that sits and rests.  This brings me back to "in getting, we can continue to give".  My challenge from here forward for all who reads this is that this question be asked, are my needs greater that of someone else?  If no, what am I/you going to do about it?  Then ask, is it ok to say yes to the first and no to the second?  Think about it.  God has commissioned us to love our brother as he has first loved us.  Even if you feel your contribution to the survival of a brother is insignificant.  It still is what it is!  It still gives them hope!  It is still loving your brother!  It is still what we are called to do!  So do it!  Give what you have to someone who's needs are greater than your own.  The giving and getting outweigh the frustrations and challenges.

Ok, my brain is done spewing. 

One funny story real quick to end my madness.  This goes back to too many hands of Go Fish.  (Mom you will appreciate this one!)
So, B and I had a dinner that we attended last night for the graduating residents.  We left the boys under Grace and her friend Becky's charge.  When we got home, the boys were both asleep and in bed.  I went  in the kids'  room to tuck Toby in and put his pull up on.  He started crying in his sleep.  I asked him what was wrong and he said, "I wanted to play Go Fish".  (We play 30 times a day, he LOVES it!)  I said no, you are already asleep.  He sat straight up in bed, cried harder and said, "No I'm not.  Please, I want to play Go Fish".  Fine...We played Go Fish in Toby's bed, then he laid his head on the pillow and went back to sleep.  :)  And then Grace found $20!

Oh, I have to go.  I think I hear the ice cream truck!   -al

Crooked, Crooks and Chicks

So much going on, but lots of the same...

Orthopaedic Ward

Dr Nana was gone again Monday and Today to meetings in Bamenda, so I had to run the clinic and theatre (operating room) myself and it amazes me how many absolutely crazy crooked people are around.  Just person after person after person coming in with one crazy bent, twisted contorted appendage after another.

We have done spine surgery the last two mornings.  Lumbar decompression yesterday and a L1 burst fracture again today.  It was going very good and I was very proud of Dr N, as I really didn't do or touch much and tried to let him do it all.  We then got to the decompression and there were nerve roots hanging out, so the young man is likely to have some permanent nerve deficits.  It kinda soured the end of the case and I pray he will still have a good outcome.  He should hopefully be able to walk, but we will see.  "The nerves be spoiled" as they tell the patients about how surgery went.  We are operating of a chief of a village about 8 hours north of here tomorrow for stenosis/slippage, should be a good case.  Have another scoliosis on for next week and pretty much have a spine everyday till I'm gone. Dr Nana has several spines booked for after I leave as he wants to "stay hot for the spine." He is excited to keep it going which is good.  The case we did today was sent from the biggest general hospital in Douala (5 million people), which is crazy that they don't have the ability to care for that kind of spine injury. 

The boys, Gaudee' (Godlove) and I took a exploratory trip up the mountain yesterday.  We had hiked Sunday down to the airstrip and from there hiked the back way up to Dr Sparks house.  There was some bushwacking, tree swinging over a river involved so Amy didn't appove.  I'm so proud of how good a hikers' I have.  The pictures from the air strip show the waterfalls I'm going to have Amy hike to, the one on the left is the one we went to last year, the big one on the right is the target for this year.  I found a path up a waterline they hand dug in the hillside this spring to follow up to the top. The boys and I sat on the rocks between the two, so now all I need to do is get Amy up there and the final decent to the base of the big falls should be achieveable...Saturday.

View from airstrip of two falls, red is our hike path.

Top arrow is where we sat, lower is where I'm getting Amy to Saturday.

Waterline trail

View from top

We had some excitement this weekend which is where the crook comes in.  During church Sunday an out-of-towner broke into one of the missionary's houses on the other side of campus.  Smartly he knew most everyone would be in church, but, he picked the wrong house though, the head of building/construction for the region and he actually had an alarm on the house, so when it went off, neighbors responded and apprehended the guy.  We knew nothing of it until we went home from church and there was a huge gathering and commotion going on a the hospital reception.  Everyone in Mbingo wanted to see the face of the thief, eventually the police took him from security off to jail.

The last is part of things you only see in Africa.  Chicken in a bag in the hospital waiting area:)

All are good, Grace still homesick and bored,  Boys just fine.  Amy worried about what she is going to wear tonight to the "formal dinner" for the graduating internal medicine and surgery residents.  So I must go as dinner starts in 30 min.

-  Pa Joe  - 

 a.k.a Father of Joey (my name from the neighborhood kids, I apparently didn't respond well enough to Uncle, so they decided PaJoe worked better;)

 Asha!!!

Sorry to leave you all hanging with the blog.  My internet was down again.  I am thinking when I get back to the states I need to look into computer classes.  I hate being at the mercy of this machine that I cannot navigate.

I'm gonna jump right in again with the "crazy things you see in Africa" list...
This is sooo for real, you can't make this stuff up!
--A moto on a moto!
I do think I might have topped this one today though, but didn't have my camera to snap it...
--A coffin strapped into the trunk of a taxi.  Yes, you read me correct.  It was adult size, ratchet strapped into the open trunk.  I did not have the nerve (or desire) to ask if it was empty or not.  I didn't want to think about it, but your guess is as good as mine since it was at the hospital and all, parked outside the cantina.  :)




MOTO ON MOTO!

The kids have still been busy, driving me nuts.  I admit that I did have a moment the other day when I thought about putting all of them on a bus headed to Douala and fly them home.  Then I woke up!  And  told myself that it was only the mefloquine controlling my mind.  (But if any of you get a phone call from Northwest Arkansas Airport...)  It is getting a little harder to entertain them, but we are doing the best we can.  We had movie night with some of the PT students and watched "Prince Caspian".  Susan really liked it and so we hunted down "Narnia" and the girls watched it while it down poured the next afternoon.  The best I could do was my laptop on a table for a tv.  It kept them quiet for a few hours.  Then the boys watched it later, after dinner.  I was really frustrated today when I found out I can only Netflix in the US,  I'll have to track down some other videos for the upcoming 13 days (I'm not counting...really.  That is for all you all who are anxiously awaiting our return!)

Volleyball has become the sport of choice in the most recent days.  The little kids play during the day and after dinner, when the big kids are home, they take over the court.  Nari fashioned a new net together now that they play every day all day. They even dug holes and set "post".  Angela, I was thinking of you when I was watching the big kids play last night.  You would so love to be a part of this game.  It's volleyball Africa style!  Bump, set, spike, arms, head, foot.  They are very serious and very competitive. It is fun to watch.  For me, I think I'll just keep playing with the little kids!

Friday it was very windy.  Much windier than I've seen it here.  So, out came the kites.  It was a hoot watching the kids try to use, control, play, run, detangle, and what not with them.  There was lots of laughing and everyone wanted a turn.  Some of the kids got the hang of it really quick and then there where the others.  Brian and I spent most of our time helping the "others" unwind, untangle, and remove the kites from each other and power lines.  It was all good, and a beautiful windy day.



Grace and I have started making our regular rounds to the children's ward to share the love.  It is so awesome to see these kids (and families too) smile when they feel so crappy!  We've taken bracelets with Bible messages on them, color books with markers, bubbles, and drawing sheets.  Today the kids and I all went and we took Susan with us too.  I think Susan really had a good time handing things out to the kids.  She was smiling a lot too!  My goal when we walk into that ward is to hug or at least squeeze every person in there and let them know that I am praying for them.  My hope is that through this simple goal, they will feel God's presence and love if only for a moment.

Gracie braceleted up!



This little girl is in the Burkitt's room.  For the most part they are very sick and I can hardly ever get them to smile.  She was watching Tom and Jerry when we got there, a kindred spirit to my Joe.

We even share the love with the nurses.  We send our goodies home with them for their kids.  Nurses are special people here in the Ped's Ward.

 
Sunday it was foggier than I've ever seen it.  We literally were living in the clouds.  They were so heavy and lasted most of the day making it kinda dreary.  Church in the clouds.  Yes, here is a picture of the outside of church.  The top third of the walls in the church are open to the outside so to let air circulate.  As we sat in church on Sunday, I first thought that someone was burning something outside and smoke was coming in the open part of the walls.  As it got thicker and heavier I realized that it was the fog.  It was strange in a neat sorta way.

Sunday late afternoon, Brian took the boys on a hike.  It started out simple and, word on the street was, turned into a hike I would not have approved of.  Supposedly Brian made Joey use his Africa tree limb swinging/climbing skills to shimmy across a 10ft deep gorge with river.  Brian then sent Toby over for Joe to catch on the other side.  Followed up by himself monkeying over.  It will be amazing if we make it home without any injuries.  I guess from now on I will not be able to let them go alone, for sure they need supervision.  Though I'm also sure B has a different take on it!

Saturday we decided to get out of dodge.  We needed a change of scenery.  We got one of the hospital drivers to take us out on an adventure for the day.  We headed towards one of Cameroons biggest tea plantations.  It was an hour and half drive, crap roads, Grace got sick, but we made it.  We headed into the tea plant and was given a guide to show us around.  It was crazy to just walk around the plant.  No restrictions, no guidelines or rules, just walk, touch, look at whatever you wanted to.  We learnt about how the tea is grown, harvested, processed, and packaged.  After the tour, we headed a little farther onto the property to see some animals.  The very wealthy man who owns this and other tea plantations, lots of cattle, and lots of property lives close to the processing plant.  He enjoys exotic animals and has some for viewing by his home.  There were monkeys, chimpanzees (which until last week you could play with but one bit a tourist and now they where confined to a pin), pythons (locally captured form the forest of Cameroon), a cobra (in a wood box with a piece of tin and an rock on top!), different kinds of ostriches, and peacocks.  I enjoyed it all except the snakes, much anxiety there.  I will probably need a zanax before our next hike knowing what I know now about their whereabouts. 

After the tea plantation we headed back towards Mbingo.  I wanted to make a quick stop by this pottery place that I had heard about.  We got sidetracked when we stopped for gas and found out that the truck we were in was leaking oil.  An hour later, new filter, oil, and gas we started off again.  We managed to make it to Pres Pot.  This pottery shop was started in the mid '80s and makes all it's pottery out of the clay harvested from riverbank below the property.  We again got a guided tour of the facilities and learnt the process of producing the clay.  Our guide then showed us how they made, fired, and crafted the pots and figurines.  I am such a sucker for quality art that is made by hand from local resources.  We pulled back into the hospital compound just in time for dinner. 

Ok, it's getting late and my words are feeling jumbled so I am going to stop there.  I think that gets us pretty much caught up on what we have been up to since last Thursday.  Brian will have to fill you in on his patients and the African medicine he has seen lately.  Hope all is well back home. We miss you all.

amy lea

You know you are in Africa when...
You put your children's clothes in the sink to wash and within 30 seconds the water is brown!!!!!!!!



This is my before scrubbing and after scrubbing socks.  I am still amazed at the soap here.  I am sure it has something toxic in it to clean so well.  This is dirt even with shoes on.  And I know why locals do not wear socks...ever!



Lights out!

So another busy day, no Dr Nana, so running the Ortho Department by myself again, 5 cases which is alot here. One spine, 3 external fixators and clean out of osteomyelitis of leg bone on a 12 year old boy.

Grace came to visit the OR this after noon, she was pretty bored at home and wanted to see what I was doing. I had her take picture of me operating with the lights out as the power went off for 10 minutes or so to prove that I do at times have to operate in the dark.  I will let her tell you of her feeling about seeing the inside of the OR and clinic here. She didn't get sick, but I think she was pretty repulsed as I get sometime here becasue there is so much more chronic draining wounds, infection and just overall badness here.  The 12 year old boy who's entire tibia was involved with infection would have never got to that point in the states, but here, he didn't come to hospital until he had been treated for 12 months by "traditional medicine healers" which are very much still in business here.  Much different than she would see in JoMo.

Scrub Sink, 2 bars soap,(one blue/one brown) talc powder and brush that has been there since last year! Pretty amazing how low their surgical infection rate is, given the above.

I was amazed when I was thinking about the talent and work being done over here currently. At one time today we had a thoracotomy (open chest surgery) by Dr Brown (full time missionary surgeon with Navy roots), Mandibular tumor resection by Dr Koch (ENT Attending surgeon from John Hopkins) Some Urological case by Dr Whitmore (Urologist from Connecticut) and Spine decompression/fusion by yours truly... pretty good for little mission hospital in the mountains of Cameroon.

Had to show the xrays of the crooked femur from yesterday and the one that was already fixed, 5 osteotomies (cuts in the bone) to get it straight enough to shish-kabob a rod down it...crazy.

Is there a Pediatrician in the House???

I usually hate doctoring on my kids, so was good to figure out why Toby has had diarrhea for two straight days.  He apparently didn't get the memo to only drink the filtered water...
When I came home this afternoon, I saw him drinking from the water spout behind the house that all the homes behind I use for their water...difference is their GI tracts are accustomed to the flora, I guess soon so will his :)

So I've been busy the last two days,  Dr Nana had a episode of PSVT with heart rate in the 170's, pretty fast for the non-medical readers, so he got fixed with the old school fix (carotid massage) which was cool to see and then has been resting at home for two days.  A good and bad thing...I've been clearing house and fixing every broken thing we can find so they are not laying around...

It has been pretty busy though and I again have seen crazy stuff you don't even see in books.  The femoral recurvatum  (curved leg bone) was nuts... It was really that crooked, no photoshop, insane!!! His right leg looked the same before Dr Nana fixed it several months ago, so as you can see they do pretty amazing work here.

The 3 year old, with part of her humerus missing from infection, she would sit there and twist her arm 270 degrees backward... nuts.  Too small to fix, maybe in a year or two Dr Nana can do a bone transport to get her healed.

And the man with severe leg and pelvic trauma strolling around I included mostly for the orthopod followers who would be amazed at the crazy post-traumatic position of his pelvis.  Thats the only intramedullary nail they have, so thats why it was treating a shaft and neck fx that way, best option they have.

I also included a teaching pic...I enjoy teaching the general surgery residents here who often get sent out to other African countries and they are the only surgeon in the region or even entire country.  So knowing how to do basic orthopaedics serves them well.  Often times I think they have to learn just by watching, so they really enjoy when I let them get in there and do it.  I'd showed the team how to do a closed nailing of a femur fracture which I should have bet them some CFA (african money) I could do as they all wanted to slice open the whole leg...we got it done and actually pretty nicely.  I'm learning much from them and its amazing and sometimes sad to see the healing potential of the human body when forced to try to overcome maladies that are never allowed to happen in the States.

Last is the picture from the hill to the northwest which my family hiked to after church on Sunday.  It was a great new perspective on the valley and mountain range.  I've put an arrow on the hill we (Dr Keith & wife Kay, Dr Sparks and I) hiked up on Saturday.  I guess Adamo the cattle herder also helped us up the last ascent as we needed a little guidance on how to reach the summit.  Was a very tough climb, little over 7100ft, and was about 2600 feet in elevation change and several miles, I was working to keep up with the very in shape late 60's year old Australian.  Other arrow is the compound.  Was a real sense of achivement to summit, also told me I need to do more cardio.

More Spine surgery tomorrow so off to bed...


BI

Cordillia is one of our hood girls, she found this very neat bird nest and baby bird on her farm and brought it to show the kids.  I just had to share cause I thought it really cool.  The nest is amazing, very intricately made.  It was very nice of her to share it with us even though unfortunately the bird did not live since all the kids played with it.

The kids have been really impressing me the last couple days with their ability to entertain themselves and others.  Grace is starting to venture out more and we are letting her make trips to the local market or to the hospital canteen by herself.  The boys play from sun up to sun down.  I was really happy when I saw Joe found a sandpit next door and he and the other kids made this really cool army camp.  Daddy fashioned another swing out of a log and rope for the kids.  Now again a popular spot to play.  There are still "football" and volleyball games every day.  I even played volleyball last night with a few of the kids.  They are working today to improve the net.  Actually digging holes and setting the post of the net so that it stands straighter.  Toby has become a fan of the "Go Fish" game.  Today he and I played.  Actually Toby played his hand and played my hand for me at the same time cause I was trying to get the laundry finished and out before it rained and he did not have the patients to wait for me.  It was pretty cute.  He did a really good job keeping it all straight!  And he still added his exaggerated expressions when he got the cards he wanted. 

Daddy worked late yesterday.  Dr Nana was sick and so he ran clinic.  He made them work harder than normal.  I'm sure the clinic/or staff will be happy when Dr Nana returns.

Grace decided last night that she could not let her brothers show her up.  So, Becky and her decided that this morning they were going to hike Mt Mbingo by themselves.  I was a bit reluctant to allow this as I am an overprotective parent, but given Grace's recent attitude about not wanting to be here, I decided that if daddy approved then it would be ok.  It is good to see her with a purpose and plan for the day.  He approved and they made a plan.  Backpack, water, camera, walkie talkies, tennis shoes (Becky does not have any and had to squeeze into an extra pair of Grace's), raincoats, and band aids.  They left shortly after breakfast so to beat the afternoon rain.  I was expecting them to be gone all day.  40 minutes after they left Grace's voice rang across my walkie talkie.  As with the boys the days before when daddy summoned me to the front of the hospital, I thought something was wrong.  The only thing wrong was me...again.  They had already made it to the top!!  I couldn't believe it.  I went outside to find them and sure enough, there they were.  I photoed them, all the kids gathered round to wave at them.  Before they left Nari had told them about the wild dogs that live up on the mountain and attacked people and he said that the girls shouldn't go alone without protection.  I guess they showed him.  No encounters with wild dogs, at least not today.  I think the older boys secretly were impressed by their feat.  All the hood kids wanted to talk to them on the walkie talkie.  They thought it was pretty cool that we could do that.  Although, it was very hard to explain to them how the thing worked.  Some of them I had to do it for them cause they just couldn't get the "press, talk, release, listen" concept.  The girls were proud they made it and headed down.  I think daddy was impressed too that they actually made it all the way to the top and in great time.  Gracie has been in a bit better mood now that she has left the house and started finding things to do.  :)

Quick update on Susan, she was released from the hospital yesterday.  She is back in her room with her dad.  We are all happy for that, she will be more comfortable there.  This morning she walked into breakfast and seriously you would have no idea that she just had major spine surgery. She is walking so good, upright, and it seems relatively painless.  If she is in pain, she is not showing it.  The hard part now will be keeping her from doing too much too fast.  She still has healing before she can travel home to Gambia but she is not a sit still kinda girl.  I am hoping that Grace can keep her entertained without much physical stress. 

B just got home from work, so till next time.

amy lea