CAMEROON

<CENTER> <H1>CAMEROON 1995</H1> <P> <HR SIZE=4> <P> <BODY> <H2>Travel Log and Photographs by Scott L. Moats</H2> </CENTER> <BASEFONT SIZE=4> <P> <P> <STRONG> Thursday, July 6th </STRONG> <BLOCKQUOTE> <DD>I awoke to the sound of a rooster crowing. Then, I bathed by bending over a small blue bucked filled with water which had been heated on the stove in a tea kettle. I rounded on Men's Ward (MW) with Dr. Dogo, a Cameroonian physician, and Peter, the Chief Nurse.<BR> <P> <CENTER> <IMG SRC="BBH7.gif"> </IMG SRC> <BR> <STRONG> Nurse's Station on Men's Ward<BR> </STRONG> <BASEFONT SIZE=2> (photo courtesy of Dennis Palmer) <BASEFONT SIZE=4> </CENTER> <P> Tomorrow, Tim Elliot and I will take over the ward. <DD>After rounds, as was the daily routine, everyone met in the conference room for tea and coffee. <DD>After lunch I walked to the market and bought pineapples, mangos, avocados, bread and a few things I couldn't identify.<BR> <P> <CENTER> <IMG SRC="Bamenda13.gif"> </IMG SRC> <BR> <STRONG> Market </STRONG> </CENTER> <P><CENTER> <IMG SRC="Bamenda9.gif"> </IMG SRC> <BR> <STRONG> Market </STRONG> </CENTER> <P><CENTER> <IMG SRC="Bamenda11.gif"> </IMG SRC> <BR> <STRONG> Market </STRONG> </CENTER> <P> <CENTER> <IMG SRC="market5.gif"> </IMG SRC> <BR> <STRONG> Meat Shop </STRONG> </CENTER> <P><CENTER> <IMG SRC="market4.gif"> </IMG SRC> <BR> <STRONG> Souvenir Shop </STRONG> </CENTER> <P><CENTER> <IMG SRC="market8.gif"> </IMG SRC> <BR> <STRONG> Fabric Shop </STRONG> </CENTER> <P> At one point I became lost and followed a road until I came to a taxi pool where several people offered to take me to a town I had never heard of. I declined their offer and told then that I was walking to B.B.H. They laughed but sent me back-tracking in the right direction.<BR> <P> <CENTER> <IMG SRC="Market3.gif"> </IMG SRC> <BR> <STRONG> Taxi Pool </STRONG> </CENTER> <P> <DD>Half-way back to the hospital it started to rain. With two bags of groceries, I lacked a free hand to hold my umbrella. Finally, soaking wet, I sought shelter under a covered porch. There, I met a group of ladies who were eating traditional Cameroonian food; fu-fu and njamma-jamma. Fu-fu is a thick, almost dough-like, form of boiled ground corn.<BR> <P> <CENTER> <IMG SRC="daily7.gif"> </IMG SRC> <BR> <STRONG> Fu-Fu<BR> </STRONG> <BASEFONT SIZE=2> (photo courtesy of Dennis Palmer) <BASEFONT SIZE=4> </CENTER> <P> Njamma-jamma is a type of green, similar to spinach.<BR> <P> <CENTER> <IMG SRC="smallmkt1.gif"> </IMG SRC> <BR> <STRONG> Njamma-jamma </STRONG> </CENTER> <P> The food is eaten by rolling a piece of fu-fu into a ball and using it to pick up the njamma-jamma. It's fun to eat, but not the tastiest of meals. <P> <STRONG> </BLOCKQUOTE> Friday, July 7th </STRONG> <BlOCKQUOTE> <DD>I was sitting in Men's Ward reviewing charts when four men carried in an eighteen year old boy. He was writhing and moaning in pain. He had cerebral malaria. It took four men to hold him down while, with nurse Albert's assistance, I administered an injection of chlorpromazine and started intravenous quinine. Being with the boy, while his family and the rest of the ward watched, was both emotional and frightening. I gained a whole new level of understanding and respect for malaria.<BR> <P> <CENTER> <IMG SRC="BBH7a.gif"> </IMG SRC> <BR> <STRONG> Men's Ward </STRONG> </CENTER> <P> <DD>At one point, Dr. Wheeler called us all to Children's Ward (CW) to see our first case of Burkitt's lymphoma.<BR> <P> <CENTER> <IMG SRC="dis27.gif"> </IMG SRC> <BR> <STRONG> Burkitt's Lymphoma<BR> </STRONG> <BASEFONT SIZE=2> (photo courtesy of Dennis Palmer) <BASEFONT SIZE=4> </CENTER> <P> <DD>Later, I drained pus from the knee of a boy my age. Dr. Elliot opened an abscess on the opposite side of the boy's leg only to discover that the lesion extended a fingers length in all directions. We removed almost 500 cc of pus and debrided until the lateral cutaneous nerve was visible; all without anesthetic. The boy remained unbelievably stoic throughout the entire process.<BR> <P> <CENTER> <IMG SRC="BBH9a.gif"> </IMG SRC> <BR> <STRONG> Out Patient Department </STRONG> </CENTER> <P> <DD>That evening, while walking from the Out Patient Department (O.P.D.) to the Men's Ward I came upon a group of women walking through the wards singing. Their voices were beautiful beyond words. My thoughts of the suffering of these people, mixed with the beauty of the women's voices, brought tears to my eyes.<BR> </BLOCKQUOTE> <STRONG> Saturday, July 8th </STRONG> <BLOCKQUOTE> <DD>Today we visited the Fon of the Nso tribe.<BR> <P> <CENTER> <IMG SRC="palace2.gif"> </IMG SRC> <BR> <STRONG> Road to the Fon's Palace </STRONG> </CENTER> <P> <CENTER> <IMG SRC="Palace1.gif"> </IMG SRC> <BR> <STRONG> Road to the Fon's Palace </STRONG> </CENTER> <P> It is required that when you will stay in one area for a prolonged period of time, that you obtain the welcome of the Fon, or tribal leader. <DD>We walked into an open courtyard which faced a platform upon which sat a carved wooden chair.<BR> <P> <CENTER> <IMG SRC="palace3.gif"> </IMG SRC> <BR> <STRONG> Fon's Palace<BR> </STRONG> <BASEFONT SIZE=2> (photo courtesy of Tim Elliot) <BASEFONT SIZE=4> </CENTER> <P> We walked behind this and into a room which had bells, tarantulas and stars carved into the floor. The walls and ceiling of the room were covered with small strips of wood paneling which had been arranged in intricate patterns. We sat on wooden benches around one side of the room. On the opposite side of the room was a chair covered with worn blue cloth. The Fon entered and sat in this chair. He was about forty years of age and dressed like everyone else on the street. He welcomed us and gave thanks for all we had given to his people.<BR> <DD>When it was time for us to leave, the Fon showed his appreciation by presenting our group with a chicken and a goat. <BR> </BLOCKQUOTE> <STRONG> Sunday, July 9th </STRONG> <BLOCKQUOTE> <DD>At times the sense of adventure and the experience of new stimuli is very fulfilling. Yet at other times, it feels equally rewarding to withdrawal into familiar surroundings and relax. I have had little time to myself since leaving Kansas City. Today, I am trying to withdraw, relax and do the things that are most comforting to myself.<BR> </BLOCKQUOTE> <STRONG> Monday, July 10th </STRONG> <BLOCKQUOTE> <DD>The first HIV positive patient that I had seen on the wards went home today. He was case #594 for the year. That averages out to almost 100 newly diagnosed cases each month. The disease is destroying these people.<BR> <DD>In the Out Patient Department today I saw an elderly man with ascites who had been operated on for scrotal edema secondary to an inguinal hernia. He no longer had scrotal edema but, his abdominal pressure was so great that it had created an umbilical hernia the size of a basketball.<BR> <P> <CENTER> <IMG SRC="BBH10a.gif"> </IMG SRC> <BR> <STRONG> Out Patient Department </STRONG> </CENTER> </BLOCKQUOTE> <STRONG> Tuesday, July 11th </STRONG> <BLOCKQUOTE> <DD>I have just finished my first night on call in Cameroon; and it has been quite an experience. First, I was called to the Out Patient Department to see a man who had sustained a perineal laceration during a fall. Drs. Dogo and Palmer took him to the Theater for surgical repair.<BR> <DD>Next, a man who has not been able to urinate in four days walked into Men's Ward. While I was examining this man, Children's Ward called for me to come immediately; an infant had stopped breathing. It was known that the child's airway was partially obstructed by a polyp of the vocal cords. However, the nurse reported that the child had vomited and aspirated just before I was called. The nurses had tried to suction his airway but, without results. The child was dead when I arrived.<BR> <DD>Next came an emergent call from Men's Ward. An eighty year old man has presented with severe epistaxis and hypertension. His blood pressure was 160/100. I had him sit up, lean forward and apply pressure to his nose. There was blood all over his face, hands and clothes. After a short time the bleeding decreased and the patient appeared more relaxed. Then, the man's eyes rolled back into his head and he fell over. I quickly checked for a pulse but, found none. The family members, all of whom were standing around the bed, began to cry and pray loudly. I felt that the man had died and that there was nothing further that could be done. Yet, when I checked again, he had a pulse and had vomited all over. His "death" was simply an episode of bradycardia from increased vagal tone. He recovered quickly and is now resting comfortably.<BR> <DD>Finally, I found time to catheterize the man who hadn't urinated in four days. He was grateful for the relief and is now also resting comfortably.<BR> </BLOCKQUOTE> <STRONG> Sunday, July 16th </STRONG> <BLOCKQUOTE> <DD>I've just returned from watching Drs. Schmidt and Dogo perform a Cesarean delivery for a breech presentation . Surgery in Cameroon begins with a prayer.<BR> <P> <CENTER> <IMG SRC="BBH10.gif"> </IMG SRC> <BR> <STRONG> Surgical Theater<BR> </STRONG> <BASEFONT SIZE=2> (photo courtesy of Dennis Palmer) <BASEFONT SIZE=4> </CENTER> <P> <DD>Trips to Mbem begin with a prayer as well.<BR> <DD>Dr. Palmer, Tim, a driver, two nurses, an elderly lady and myself climbed into the Land Rover and started for the health center at Mbem; a small village near the Nigerian border. The road was good and the scenery spectacular.<BB> <P> <CENTER> <IMG SRC="road1a.gif"> </IMG SRC> <BR> <STRONG> The Road to Mbem <P> <IMG SRC="land3a.gif"> </IMG SRC> <BR> Cameroon <P> <IMG SRC="Land12a.gif"> </IMG SRC> <BR> Cameroon </STRONG> </CENTER> <P> <DD>At one point, we passed the Ndu tea estate. It had started to rain and the tea gatherers were huddled under a shelter. They waved as we drove past.<BR> <P> <CENTER> <IMG SRC="ndu1.gif"> </IMG SRC> <BR> <STRONG> Ndu Tea Estate </STRONG> </CENTER> <P><CENTER> <IMG SRC="ndu2.gif"> </IMG SRC> <BR> <STRONG> Ndu Tea Estate </STRONG> </CENTER> <P> <DD>Several hours into our journey we slowed to pass a broken-down truck which was partially blocking the road. As we did so, a man ran up to the Land Rover and told us that one of the women in his compound had miscarried and was bleeding badly.<BR> <P> <CENTER> <IMG SRC="mbem1.gif"> </IMG SRC> <BR> <STRONG> The Road to Mbem </STRONG> </CENTER> <P> The man took us to a one room, rectangular, mud brick building with thatch roof and dirt floor.<BR> <P> <CENTER> <IMG SRC="mbem2.gif"> </IMG SRC> <BR> <STRONG> The Road to Mbem </STRONG> </CENTER> <P> Smoke from a small fire on the floor had stained the walls and ceiling black. Laying on a blanket beside the fire, was the girl. She was weak and her conjunctiva were almost white. She couldn't sit up without passing out. As we examined the girl, a small yellow chick continuously walked in and out of the hut; perhaps reporting to the people outside. For, within minutes, we had attracted an audience of almost thirty people.<BR> <DD>We unpacked and repacked the Land Rover before carrying the girl out on a blanket and placing her in the back seat. Her head rested on her carer's lap and her feet on the elderly lady's lap. The two nurses squeezed in with the supplies. Tim and I sat in the front seat, between Dr. Palmer, the driver and the gear shift.<BR> <DD>As we continued, the clay and rock road became more rock than clay.<BR> <P> <CENTER> <IMG SRC="mbem3.gif"> </IMG SRC> <BR> <STRONG> The Road to Mbem </STRONG> </CENTER> <P> I held on with both hands to keep from getting bounced around. There were several places where the road had began to cave away; leaving sharp drop offs no more than two feet from the edge of the Land Rover's tires.<BR> <P> <CENTER> <IMG SRC="road2.gif"> </IMG SRC> <BR> <STRONG> The Road to Mbem<BR> </STRONG> <BASEFONT SIZE=2> (photo courtesy of Dennis Palmer) <BASEFONT SIZE=4> </CENTER> <P> These spots made for a few tense moments. At another point, we were forced to stop while a herd of ox crossed the road.<BR> <P> <CENTER> <IMG SRC="mbem5.gif"> </IMG SRC> <BR> <STRONG> The Road to Mbem </STRONG> </CENTER> <P> <DD>We ascended into the clouds where the light was pale and diffused. It felt as if we were driving along a sharp and precarious ridge that overlooked the entire world; a place no one had been before. We were an odd group of friends, from both sides of the world, traveling what could barely be called a road, just to get to Mbem.<BR> <P> <CENTER> <IMG SRC="mbem4.gif"> </IMG SRC> <BR> <STRONG> The Road to Mbem </STRONG> </CENTER> <P> <DD>We arrived just as I was about to decide that the trip would never end.<BR> <P> <CENTER> <IMG SRC="mbem6.gif"> </IMG SRC> <BR> <STRONG> Mbem Health Center </STRONG> </CENTER> <P> <DD>After a brief greeting, we called for help and took the young girl into the surgical theater. We administered intravenous fluid until her blood pressure had increased to the point that her pulse was easily palpable. Her hemoglobin was less than 4 gm/dl. Dr. Palmer performed a dilatation and curettage procedure. Afterwards, we administered an ampule of oxytocin and she stopped bleeding.<BR> <DD>The next morning, our patient from the night before was doing well. Dr. Palmer spent the day in the surgical theater. Tim and I ran the Out Patient Department. By the end of the day we had seen over seventy patients, including many with onchocerciasis (filaria). Dr. Palmer had performed nine hernia repairs.<BR> <DD>Just as we were preparing to leave Mbem, we met another critically ill patient. She was a young girl with streptococcal pneumonia, bacteremia and meningitis. She was dehydrated, febrile and seizing. We gave her intravenous fluid, penicillin and phenobarbital before placing her in the Land Rover with her carer. She was barely conscious.<BR> <P> <CENTER> <IMG SRC="mbem11.gif"> </IMG SRC> <BR> <STRONG> Mbem Health Center </STRONG> </CENTER> <P> <DD>It had started to rain and we were afraid that the road would be dark and dangerous. Our driver said that he could make the trip, so we began our return trip to B.B.H.<BR> <DD>The ride back was long and rough.<BR> <DD>At midnight we placed our newest patient in a wheelchair and took her to Women's Ward (WW). She received intravenous penicillin and fluids overnight and was doing considerably better the next morning.<BR> <P> <CENTER> <IMG SRC="BBH13.gif"> </IMG SRC> <BR> <STRONG> Women's Ward<BR> </STRONG> <BASEFONT SIZE=2> (photo courtesy of Dennis Palmer) <BASEFONT SIZE=4> </CENTER> <P> </BODY> <LI>Click here for <A HREF="SCOTTCAM3.HTML">PART III </HTML>