Entry #2: Working in the Out Patient Department

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Sunday November 3, 2013

Today marks a time of transition.  Poised on the cusp of a new week, a new month, and a changing season, I find myself settling in to a new normal; traversing that liminal state that exists between the borders of tourist and resident.  The last few weeks have been chock full of new experiences, new faces, and cultural adjustment, but by now much of that patina of “newness” has given way to an accustomed familiarity that can only come with time.

In the short time I’ve been here I’ve seen several babies delivered, including two C-sections, I’ve witnessed a handful of funeral processions (the mortuary is a stone’s throw from my house), and I’ve endured some grueling cab rides with eight or nine people crammed into a five seat car (this is the norm for rides to the large town of Bamenda two hours away).  I’ve successfully done my laundry twice without a washing machine, I’ve attended a few masses in Pidgin, toured Medicines for Humanity (MFH) project sites on the back of a dirt bike, made friends with the cooks, learned the handshake, sampled the nightlife, played some soccer for the hospital area team, and held a chimpanzee.  In addition to the new experiences, I’ve grown accustomed to the scenery, to the pace of life, and I can now enjoy a mutual recognition with most of the hospital staff and regulars.

Shadowing the doctors in the Out Patient Department, has been my primary point of contact with the hospital thus far.   Doctors Brent and Jennifer (from America) staff the OPD along with Doctor Eugene who is a Cameroonian.  The American doctors’ fast talking ebullient style of practice contrasts Doctor Eugene’s more deliberate pace. Each has provided a unique perspective on the practice of medicine.  For the most part, I sit quietly observing as the doctor, whether it be Brent, Jennifer or Eugene, examines the patient and decides on a course of action.   Oftentimes the flow of conversation is facilitated by an interpreter and punctuated by the doctor digressing to explain certain observations to me.  Clothed in scrubs and sporting a stethoscope, I look much more official than I feel, but nonetheless I’ve been allowed to take vital signs and participate in examinations.

A menagerie of Muslim herders, school children, poor farmers, and businessmen come through the OPD, some with a relative to assist them and others alone.  Some speak English in varying degrees of fluency but many speak Pidgin instead (a broadly used African language that blends English French and native dialects).  Many of the older people speak only the local language called Kom.  As I alluded to earlier, the American doctors sometimes need a translator to accommodate the Pidgin, but other times they’re able to soldier through the language barrier which, because of Pidgin’s closeness to English, can make for some interesting exchanges.  Many of these exchanges relate to describing bowel movements and rely heavily on hand gestures, and unavoidably begin to border on the comedic.  The doctors, and frequently the patients, have a good sense of humor about this but the comedy of the situation often belies the seriousness of it.

Typhoid, diarrhea, malaria, AIDS, and gastritis are the most common occurrences, with a fair share of hemorrhoids, fungal rashes, diabetes, TB, and high blood pressure.   The drugs and procedures are cheap by western standards, but for many people treatments must be reconciled with cost considerations.  However, the value of the hospital is clear, as many of the patients come from far away, electing to forego treatment at nearer locations.  The burden of HIV on the population is painfully evident and the burden of poverty more so.  It’s tough seeing some of the cases, especially the older people that come in alone, knowing that their options are limited.

Poverty is not the only obstacle that the hospital is up against.  Many of the medical problems we see result from avoidable things such as poor knowledge of basic sanitation policies, lack of clean drinking water, and stubborn adherence to backward traditional medicine.  In one case a mother brought her young son in to have his swollen and painful leg evaluated.  Large scars above the knee revealed the work of a local healer who had tried bleeding the leg after the kid had fallen and likely sprained his knee.  Doctor Jennifer ordered an x-ray to confirm her suspicion that the femur was infected and concluded that he would need surgery to properly address the infection otherwise he may lose the leg.  More common occurrences are the cases of diarrhea that result from contaminated water or improper washing of food.  These are all issues that MFH is addressing with their programs here.

MFH has helped fund the establishment and maintenance of forty-five clean water sources in the Njinikom area alone.  These community taps are a boon to villages that would otherwise need to trek very far through mountainous terrain to gather water from possibly contaminated sources that often times run dry in the dry season.  Young kids are especially vulnerable to waterborne diseases and the reduction of illness allows them to attend school on a regular basis.

Clean water is only a part of the story.  MFH’s core initiative of reducing childhood and maternal mortality hinges on the work of community health workers.  These are local people that are trained by MFH to help educate the population on important health concerns and refer people to a local clinic or hospital if need be.  The community health workers help identify pregnant mothers and make sure they come in for pre and post-natal care.  By keeping tabs on the community, they’re able to ensure that children follow through on their vaccinations and that people in general turn to the clinic and hospital for treatment instead of relying on traditional “country medicine.”  The net result is a huge portion of the avoidable illnesses and problems that have traditionally plagued this area are being addressed and the needle is moving continually in the right direction; lower mortality among pregnant mothers and children under five, increased birth weights, lower HIV transmission from mother to child, and fewer waterborne infections.

There’s much more to say but I think I’ll leave it for my next post.


Drew is pictured here with one of the Tertisary Sisters of St. Francis Nurses.

Drew is pictured here with one of the Tertisary Sisters of St. Francis Nurses.

About the author: Drew Fink is a graduate of University of Wisconsin where he was a pre-med student. He travelled to Cameroon to do a 3 month internship at the St. Martin de Porres Hospital in Njinikom.

The hospital is managed by MFH in-country partner Sr. Xaveria Ntenmusi and the Tertisary Sisters of St. Francis – Cameroon. These are entries from Drew’s journal about his experiences in Cameroon.