Rebecca Beran

I’m in charge of Maternity Ward!

Dr. Thompson, my supervising American doctor has gone to Banso for a few days (Banso is where there is another Baptist hospital about 3 hours from here) as there is a visiting physician headed there from her medical school. The responsibility for maternity ward is therefore MINE! Of course the surgery team will be doing the c-sections, though I will still be scrubbing for them. And I have full confidence in the wisdom of the midwives to make clinical decisions. Still, I could really use your prayers this week (Dr. Thompson is coming back probably on Saturday, depending on when she can get a ride). Pray that the cases that come in are simple and straightforward and that I will have the knowledge and wisdom to deal with all that I will face.

More photos

Thought I’d add a few more pictures of life in and around Mbingo Hospital.

The other day I went to my room briefly in the middle of the day – and was greeted by a herd of cattle passing by the guest house. Not exactly an everyday sight in Chicago… Beef here is cheaper than chicken!

A typical sight on the roads of Cameroon – baby on the back, large bag on someone’s head, probably going a long distance, as well.

The view from the football field as the sun sets through the harmattan.

Proof that I am actually in Cameroon (I’ve worn skirts more in the last 2 weeks than the last 2 years!).

People can only be admitted to the hospital if they have a ‘carer’ – a friend or family member that will feed them, do their laundry, etc. So there are always lots of people sitting around – and laundry drying on the hibiscus bushes.

The hospital is always expanding. This is the beginning of a new building to hold the outpatient clinic and Mbingo’s future version of an ER. And in the foreground you can see a worker making the bricks that will be used in the construction.

In other news, I’ve been getting the opportunity to do more and more during c-sections. I actually got to use the scalpel today! I opened the uterus, then sewed it up after the baby was delivered. It looks a lot easier to deliver the baby through the incision in the uterus than it really is. Maybe the incision was on the small side? And I need to work on my suturing skills.

Babies Part 2

Here are the promised pictures and some updates on the babies… they’re all doing well except for the one we had nicknamed ‘Amazing.’ Sadly she did not live much past 24 hours old, and the mom is still spiking fevers. I think if we had been in the US, little ‘Amazing’ would have lived. Medicine here is definitely different than the US.

The maternity ward- wing for post-op patients and babies.

A little one born at about 28 weeks, now 6 weeks old. She went home 6 weeks before her due date! Her name is Precious.

Here is the little squished face that is Miracle.

And the two little squished faces that are the twins I wrote about last post.

You gotta love the names here: Precious, Miracle, Victory, Comfort, Patience,  Blessing, etc.

Babies!

It’s almost been 2 weeks since I left Chicago! Time is already going so quickly - especially when there are days like yesterday when I finally got back to my room at 11pm! Babies just don’t always come when you’d like them to, and there were 5 of them yesterday. So far in the 10 days I’ve been here I’ve assisted at only one vaginal delivery, but I’ve been at 7 or 8 c-sections. Yesterday started with maternity rounds, then outpatient clinic, then an OR opened up and we did a nice simple elective repeat c-section (I got to close the first layer of the uterus and tie one tube), I had lunch, then was waiting for one lady to deliver vaginally. She was 9 cm, but the angle of descent was a bit off, so it took awhile. Another lady came in while we were waiting for the Lady #1. Lady #2 had been in labor for 4 days, and had been pushing for a lot of that time. She was exhausted, and the baby was NOT doing well. She went straight to c-section, but I stayed in maternity expecting Lady #1 to go at any time. I have heard that the maternity staff that went to collect the baby from Lady #2 in the OR was ready to give up on the baby, but so far she’s made it. The baby’s face was swollen and her head was badly misshapen. She was breathing very fast, was limp, and making little wimpering sounds. (APGARs were 3, 3, and 6) After some O2, IV fluids, and warming lamps, however, she perked up, and is doing well. (We’ve nicknamed her Amazing)

After ‘Amazing’ came back from the OR, Lady #3 came in. She only spoke French, and so basically handed over her papers (which were also in French). Looking at the ultrasound images in her papers we figured out she was carrying twins! She’d also had 3 previous c-sections, but she was already 8-9 cm dilated, so we attempted to let her deliver vaginally.

Meanwhile, Lady #1 finally reached full dilation. She pushed about 4 times and out came her baby. His name is Miracle (not our nickname). That’s the only vaginal delivery I’ve been at so far while I’ve been here…

After she’d been contracting about 2 hours, Lady #3 was not progressing further, so we decided to take her to c-section so we wouldn’t be doing it at 2 am. At about 10:30 pm Dr. Thompson pulled the babies out - a boy and a girl. The girl was transverse, and provided Dr. Thompson with quite a challenge to get out, but after a little extra effort at resuscitation, she’s doing great, too.

So yesterday was a good day. Today, there haven’t been any new people coming in, so we’re getting some much needed rest. The babies born yesterday are all doing well, which can’t be said of every baby at Mbingo. Since I’ve been here, there’s been one premature baby that died at 4 days from sepsis. There’s been a woman with intrauterine fetal demise at 22 weeks with pyelonephritis. And Monday we worked hard to save the life of a woman who was at term with an anencephalic baby (already dead) who also had polyhydramnios (too much amniotic fluid). In the US, when anencephalic babies are discovered, abortion is usually offered as anencephaly is not compatible with life 100% of the time (anencephaly = no brain. For scary pictures, google it). We attempted to let the mom deliver vaginally, and Dr. Thompson ruptured the membranes around 8 am. At about 11 am we got a call that she was bleeding heavily. She’d had an abruption (the placenta pulls away from the uterus and there is massive bleeding) and was sitting in about 1500 mL of blood, still bleeding. She was in shock (low BP, diaphoretic, altered mental status) - so we took her immediately to the OR (after starting 2 IVs, of course). BUT, all the ORs were occupied… as we waited for an OR to open up, her bleeding slowed, and she stabilized. So we took her back to maternity to see if she could still deliver vaginally (her cervix had dilated 2 cm in 30 minutes), but as her cervix did not progress and she was still bleeding, though not as heavily, we did eventually section her. I had never seen an anencephalic baby before. They look like the pictures. The woman is now recovering well. That was a hard day.  In the US, most hospitals have their own OR for maternity. If that lady had continued bleeding heavily, she could have easily bled out and died while we were waiting for an OR to open. We had all been praying. Laying on the cart in the surgery dept, the woman said one thing - “Papa God” - and I know God was watching over her.

Well, those are the highs and lows of maternity in a third world country.

I plan to do another post very soon with more pictures - hopefully I can get some pictures of the babies!

Mbingo

I took a tour of the hospital today, and met just about every employee here. When introduced, everyone says “You are welcome” (as in ‘you are welcome to Cameroon,’ though I still feel like they’re responding to someone who just said ‘Thank you’). Walking through the hospital people generally smile quickly and greet very warmly. I do feel very welcome here.

I’m starting to get settled into the routine here at Mbingo. Chapel at 6:40 am, then breakfast, then rounds, tea at 10 am, then outpatient clinic until about 2-3 pm, then off for the rest of the day – except that I’m doing 4 weeks of OB, which means that at any time I could be called for a C-section or delivery. So far I’ve been spared because I was still getting oriented, but tomorrow there are 4 C-sections scheduled (unless the one starts bleeding and then she’ll be done tonight). They will be done at the same time as outpatient clinic (I think). I’ve already seen some interesting things in the 2 days of clinic, and Dr. Kara Thompson (a young American family doc who is my direct supervisor) is really great. I’ve taken a few pictures since arriving on the compound and thought I’d share a few of them:

The obligatory picture of the main entrance

Looking down the valley through the Harmattan haze

The rest house where I’m staying

Mbingo began as a hospital for Hansen’s disease patients (leprosy), and there is still a grouping of houses for these patients and their families on the compound. Leprosy is not yet eradicated, and historically has been very debilitating.

There is a school for deaf children on the compound – they are very friendly and VERY excited to get their picture taken!

Last night was the football (soccer) game between Cameroon and Egypt, so I joined people in the waiting rooms watching the game – alas Cameroon lost 4-2.

Yesterday was the celebration of the opening of a school for clinical ministerial care (I forget the official name) – cause for a great celebration with lots of food and singing and people everywhere. The Fon of Kom came for the celebration and stayed overnight. I got the chance to see him today. (The Fon is like the king of people group – this particular one is over about 200,000 people, I think). I gave him greetings from Chicago. Very weird. Never met a king before.

First Impressions

Airports

I’m in Cameroon! Though my flight left Chicago an hour late, we made it to Paris only 20 minutes late, which left me an hour to get to my connecting flight. If you’ve ever been to the Charles de Gaulle airport, however, you will quickly realize that an hour is not very long… before boarding the plane I had to take a bus to another terminal, go through security, and everything in between to get to the gate. I made it for the last call, got on another bus, which took me to the plane. I was not the last aboard, as there was one bus behind mine carrying about 5 people. I arrived on time in Douala. My first impression – HOT and HUMID! I got my passport stamped and then entered the baggage area, which was jam-packed full of people. I had received an email prior to leaving stating that someone would meet me in the baggage area, and I had a picture of him. I almost immediately saw my luggage coming out (PTL!) and the 4 boxes that the North American Baptist Convention had sent with me. After I had dismissed the advances of several porters offering to help me out “for a little money,” the people who were supposed to meet me arrived – they had gotten held up in traffic. After about 15 minutes of jabbering in French to several different customs officials we were allowed to pass through customs without any fees that I was aware of.

Driving Through Cameroon

The Cameroon Baptist Convention (CBC) guest house in Douala was about 10 minutes from the airport and was quite comfortable (air conditioning!). I stayed there Friday night, and Saturday morning was driven the 6 hours to Bamenda. The highway to Bamenda was a 2-lane narrow road dotted with potholes and frequent speed bumps. I had wondered about the government checkpoints, but we just sped past all of them. There weren’t too many other vehicles on the road once we got out of Douala, maybe about the same number of vehicles as a typical busy country road in the US. There were LOTS of pedestrians, however. People of all ages walked along the side of the road, some hitchhiking, some selling things, some hanging out. The people of Cameroon are very beautiful – I loved the colorful dresses all the women wear. We drove through several towns that had their markets along the road – and those were crowded with people and vehicles (but we did not slow down much). Vincent, the driver, makes the trip to Douala at least weekly, so he was an expert at avoiding the potholes, passing every other vehicle on the road, and narrowly missing the pedestrians. He frequently used the horn to communicate. The horn variably can mean “Speed up, you’re going too slow,” “I’m passing you, scoot over out of the middle of road,” or “Get out of my way, I’m not slowing for you” (to pedestrians). The fastest speed I read on the odometer was 110 km/hr, which probably is about 65 m/hr(?). We stopped at a couple fruit stands along the way, and I had some very yummy pineapple and papaya. The area around Douala is very lush. There were large farms of palm trees (for palm oil?), banana trees (with blue plastic bags over the growing bunches of bananas), papaya trees, and other plants I didn’t recognize. Bamenda is at a higher elevation, so eventually we left the valley, and the earth became redder, though it is still very green. It is the dry season here, and winds from the north carry dust from the Sahara into the air, forming a thick, fog-like haze over everything. The haziness gives the landscape a mysterious quality, but doesn’t make for great scenic vistas.

Hopefully when I travel back to Douala in March the haze will have lifted and I’ll get some great scenic pictures. Also along the road are the houses people live in. Closer to Bamenda there were lots of red-earth brick houses, and everywhere are small rectangular houses made of a single layer of boards with a tin roof and no glass in the windows. Yards were red dirt, with garbage in the ditch between the house and road. Occasionally there would be a huge mansion with a wall around it. Some of these appeared new and well-kept, some were being built, so looked as though they’d been abandoned for 20 years, and others looked as though construction had started and been abandoned some years ago. I’ve since been told that these large houses belong to people from the city who often use money gained through corruption to establish the country house to which they will eventually retire. The disparity between these palatial buildings and the common house was quite profound.

The plan

Tomorrow I will go on to Mbingo, where I will be working for the next 8 weeks. (I thought I would be at Banso Baptist Hospital, but I’m actually going to Mbingo Baptist Hospital). Mbingo started as a leprosy hospital, and has grown to be the same size as Banso. The town around it is really only there because of the hospital, but Bamenda (a bigger city) is only 45 minutes away, so it sounds like I will frequently be back in Bamenda. Phone and internet access has been more difficult than I had anticipated, but hopefully once I’m settled into Mbingo I will have more regular access. I would appreciate your prayers as I start work in the hospital tomorrow and adjust to the routine in Cameroon.

Leaving tomorrow!

The day of departure is almost here, and I still have stuff spread out across the guest room… Mostly I feel ready to go. It will be hard saying goodbye to home and all my friends here. I’ll miss you all very much! I have certainly been feeling the prayers that I would have a sense of peace about the trip and packing and customs and everything there is to worry about. Thank you for your prayers, and keep them coming!

Less than one week before departure!

I’m leaving for Cameroon in 6 days. I’ve already got one huge suitcase packed full of medical supplies - gloves, masks, sphygmomanometers (blood pressure cuffs, and yes I had to look up the spelling of that), etc. I’ve gotten all my shots, and started taking anti-malarial pills yesterday. One of the possible side effects of my malarial pills is strange dreams. I’m curious to see what I might dream about… I’ve purchased a new battery charger, electric voltage converter, water purifier, and several skirts in preparation for the trip. In the next few days I have a lot of work to do figuring out how to fit everything into my 2 suitcases! I’m not really looking forward to the looooong flight, but I am very excited (and more than a little nervous) about this opportunity to live and work in Cameroon for 2 months!