November 2009

08NOV2009 The photo below shows the Lutheran church in town, one week ago. It is a much smaller church than the one in Meskine that we usually attend. We did appreciate the service quite a bit, though it was a touch more formal than the other church.

Yesterday I took a bicycle ride from the hospital up to the mountains. This was done with Carsten and Scott. We took off at 6 am, rode for two hours, and went nearly 20 miles. It was over dirt road, and so mountain bikes were imperative.

I think the natives were more puzzled about us than we were about them. You can see their standard home structure, with a cluster of Boukarous and mud walls enclosing the village.
The Meskine missionaries invited a priest from the Anglican church to come to give meetings for four days.  He was heavily influenced by the teaching of the Toronto Blessing, which is a form of Pentecostalism. There were many “words from the Lord” and talk about healings. Some basic doctrines of the faith, such as the doctrines of Christology, were brought into question. My feeling was that though the missionaries wished for “revival”, a revival of emotions without a revival of the primacy of God’s word is doomed to failure, frustration, and a worse end than if nothing at all occurred. You are left momentarily with the haunting notion that maybe there is a form of Christian faith, a technique or belief structure, that will magically transform you into somebody that can heal on command, read minds, and hear God directly. Unfortunately, there is no magic, but there are the Scriptures, with God speaking about as plainly as imaginable. So, our doubts about missing a “higher blessing” are relieved by knowing that attendance to God’s word alone gives the highest blessing.
That evening everybody went out to dinner, and we had sauerkraut. It wasn’t the best sauerkraut that I’ve ever had.

Today, we attended the main church in Meskine, partially skipping out of the healings and words from the Lord. It is quite a dramatic event, and so I include a short portion of the video. The natives here are excellent musicians, and Betsy and I both enjoyed native African beats with Christian songs.
MVI_2014
There is general singing, mostly in Fulfulde, but also in French. Then, various sub-groups will get up to sing in their particular dialect. When it came to the time for us Western folk to sing, it was just Carsten’s family and Betsy and I, so we had Betsy sing “Amazing Grace” as a solo. It was well-received. Sermons and more singing occurred. The entire service lasts 2.5-3 hours. As you can see, the worship is quite animated, and there is more body movement than in Western churches (except for the Pentecostals, of course!).
13NOV09 Time is quickly coming to an end. Having felt light-headed soon after arrival in Cameroon, I solved matters by cutting my blood pressure medicine in half. I am already on the lowest dose possible, so now I am just about taking naturopathic doses for the last 4 weeks. I measured my blood pressure during the stress of a busy surgical day, and it was 100/60. I am beginning to draw further conclusions as to the probable cause and treatment of my hypertension. I just wonder what my weight and cholesterol levels are doing. We are preparing for a trip to Roumsiki with the Kretzschmar family this weekend. It is a small resort town located on the Cameroun/Nigerian border. There are supposed to be some interesting volcanic formations, and it is known as one of the more beautiful parts of the country. Though it is only 80 miles at most away, it will take us about 4-5 hours to get there, since the road is anything but ideal. More on that later.
I showed up at the operating room this morning, and the techs invited me into their own room for brunch. They were sitting around a bowl of what they called “soup”, and sticks of French bread, which they would break off, dunk in the soup, and then eat. It was quite spicy and tasted great. I suddenly realized what had occurred at the Lord’s supper, as I joined into the common pot.

The brunch was served with Cameroon tea, which was quite sweet, and tasted just like lal cha from Bangladesh. That will be one of my more memorable experiences, and it really touched me that the techs would honor me like what they did, inviting me to join with them.
17NOV09 We have just returned with the Kretzschmars from Roumsiki, one of the few resort towns of Cameroon.

It actually was very nice. We stayed at a resort that is maintained by a Swiss man and a native Cameroonian lady. The resort has the comforts of a typical Western hotel, including a swimming pool.

The area is known for its volcanic granite rock formations, that are seen throughout the horizon.

We took a hike one day down into the valley enclosed by these formations, and actually entered Nigeria. The path, though steep, is heavily traveled by donkeys bearing large loads of goods from Nigeria, as well as ladies carrying massive volumes on their heads.

The donkeys are essentially the Cameroonian equivalent of large transport trucks. We were also able to step foot into Nigeria. Here is Betsy and I in Nigeria.

The next day, Carsten and I tried to climb Roum, which is the mountain around which the town is made. He did okay, but I was slipping too much from poor shoes, and decided to opt out of the very last few hundred feet. This the mountain to which the Kapsiki speaking people escaped to from the Muslim terrorists-I mean, invaders. You can see caves where they hid out.

We later went to visit a house of an animist. Each of his many wives has their own home, while he has the biggest, close to where the goats are kept.

Afterwards, we realized that Betsy was having a high temperature, and quickly realized that she was having a bout of malaria, so got her going on Co-Artem.

The ride home was a little difficult with sick Betsy and sick children, since, if you look at a map, it looks like a major thoroughfare, but in actuality, it is dirt road of the worst possible condition.

Diane, if you are reading right now, look closely, as it’s not a cow nor a horse, but a donkey.
19NOV09
Over the last few days in Meskine, the morning temperature has dropped as low as 73ºF, and many people, nationals and ex-pats alike, are wearing heavy jackets and wool hats. Babies are bundled in extra sets of thick clothing. It has become very cold for people accustomed to living in 110ºF weather.
Last night, I did prayer rounds with Martin, one of the evangelists at the hospital. 6/8 people we prayed for were Christian. It is amazing how many Christians are in this mostly Muslim area. The missionaries and many of the native Christians will make rounds on every hospital patient each Tuesday evening, and that has been an interesting way for me to see the patients in a totally different light from that as a physician. It is especially delightful to be able to spend time with the Natives. My pre-conceived conception of them as being a tad bit primitive, living in mud huts, etc., is entirely wrong, and I am amazed at their wit, intelligence, and awareness of world events. Most people have cell phones. Most Natives speak at least two languages, many as much as 4-5 languages fluently. It is not loin-cloth jungle savages barely commanding what lays a few yards beyond their existence.
23NOV09 We are finally home, with a moderate case of jet-lag. Yet, we are thankful to see family, and to touch base with our home and surroundings, while sustaining good health. I now have a laundry list of chores to do before I go back to work on 07DEC. Before then, I’ll probably publish some reflections on the past year, which will go unannounced by e-mail. So, stay in touch.

21OCT2009 – Please also read “First Days in Cameroon”. I tried publishing blog updates from Cameroon, and it would not go through, so, the trip to Cameroon will be a series of several blogs. The above photo shows Sadjo and Carsten in the OR. Sadjo is Muslim, though a most friendly person, and most intelligent. He was one of the first employees at the hospital, brought in when he was a young man, and trying to earn a living as a tailor. He now spends most of his time sewing people.
Today, I did an oophorectomy/hysterectomy on the Pyles cat. This was performed in the quiet of their back porch, using Ketamine as the anesthesia, and Kalabasoo helping with the surgery. It was a bit floundering, but the cat seemed to survive our ordeal. At 1700, Carsten dropped by for our first bicycle ride. He rode out into the fields surrounding Meskine, noting that cotton and Millet were the main crops. Both seemed to be doing well. There are mountains surrounding Meskine, and several have large monkey populations. Our hope is to have a little more time to ride further. Since it gets dark at 1800, we were limited to about 20 km ride today. You must use mountain bikes, since the roads are dirt, and are not in terribly good shape.
I am still doing a lot of operating, and fortunately, able to give Carsten a break more often. This has been good for him. We have also been discussing ways to help Meskine get back into general orthopedics, like bringing the SIGN nail to Meskine. This is an intramedullary nail that you run down the middle of a long bone in order to stabilize a fracture. They are then able to return to function much quicker. Carsten has been absolutely delightful to be around, and we have been able to work well together. I think that I need to learn better German in order to communicate with him and my other German relatives and friends.
On 23OCT, I did a D&C, today a cystolithotomy (removing a stone from the urinary bladder), as well as herniae repair and abscess drainage. The types of surgery seem to be rapidly expanding. It has been an enjoyable experience in the OR. I am still frustrated by the inability to perfectly communicate with Carsten, but fortunately, he is moderately patient. Simple things are easy, but when trying to describe precise details of an operation or procedure, I don’t have the vocabulary in either French or German to adequately communicate.
27OCT, no changes. It rained yesterday, and the temperature fell to 80ºF. It was the first night here where we slept without the air conditioner running. I’m working feverishly on my French, so that I may communicate a little better.
30OCT, our time seems to be winding down. This AM, I went to the hospital 15-minute prayer service, opening with the songs “How Great Thou Art”, and “To God be the Glory”, in French of course. It was interesting to see how joyful the Africans were, in that they could not even sit down to sing these songs. They tend to be far more animated than Western folk. I compare that to the woeful sound of the call to prayer heard 4-5 times/day over loudspeakers in the village mosque next to the hospital grounds. Islam is such a sad religion compared to Christianity. Later, Scott Pyles and I went to do a reading to a young Muslim man showing some interest in the faith. This is similar to a reading that Betsy went to a week ago, where a missionary will go to a Muslim house and will have bible stories, that they will read. In this instance, it was a bible story of the tabernacle in the wilderness, written in Arabic script, but using the Fulani language. All in all, it was a very pleasant experience.

The bottom photo shows some of the students of the person we went to read to. They learn to read and write by writing the Koran out on a large wooden board, which they are displaying. Once they have one page memorized, they erase the board and put it on the next page. This person lived in a one-room house, inside a large compound of about a city block, housing several hundred people, including 90 children, many barnyard animals and goats. His wife had just had a child, and the tradition is for the wife to stay with her mother for forty days after the first child, in order to learn how to raise the child.

Diane, it’s not a cow! It’s a goat!
Though missionaries may be chided for trying to “sell” religion, I would remind the dear reader that coercion or force is never used by the Christians like the Muslims, as many Muslims would readily convert if the societal pressure and intimidation were not so great. Also, the missionaries are almost always the first to form languages for remote peoples and to teach them how to read and write. Contrary to M. Mead who would love to “preserve” ancient cultures, those ancient cultures all desperately wish to move into the 20th century like the rest of mankind, and Islam, unlike Christianity, is doing absolutely nothing to assist in mankind trying to improve their lot. I show a child trying to learn the Koran. Though many children might recite the Koran in Arabic, they have no clue as to what it says or means, as they do not understand Arabic. It would be like Christians insisting that one recite the Scriptures in Latin in order to find favor with God. Fortunately, our God is multi-lingual.
03NOV09 Today, I turned into a Urologist. We had a patient who was thought to have a vesicovaginal fistula. We could not find the fistula by instilling blue dye in her bladder but noted serious urinary incontinence. So, we happened to have some bladder suspension kits, and I had seen it done several times, and went ahead and did it. In spite of that, we still noted a small amount of urine persistently coming into the bladder. So, I suggested we wake her up, do an IVP, and assess the problem. That would be true in the US or Europe, but not here. We proceeded to open her bladder, searched hopelessly for a fistula, but noted that there was absolutely no urine coming out of the left ureter. Again, I suggested a workup. Sadjo suggested otherwise. We opened her up and found a markedly dilated left ureter, and much scarring surrounding the most distal ureter. So, our decision was to simply re-implant the left ureter into the bladder. This we did in a standard fashion, Sadjo paying close attention since he will not only repeat the surgery someday but probably do it better next time. It’s quite incredible working with these guys. As mentioned above, Sadjo was nothing but an ambitious young tailor, hired on for the hospital 17 years ago, fluent in Fulfulde, French, English, Arabic, and some German, now in his mid-forties, owning a large cattle ranch, working evening in the tailoring business, as well as pursuing his love for surgery. He and Barbar are a total joy to work with.
The weather is cooler now. It was only 85ºF last night, which now seems cool to us. This time of year, winds from the north commence, causing a red dust to fill the atmosphere. The surrounding mountains no longer appear crisp, but a blurry red. This causes the temperature to cool down but also leaves dust everywhere. I now remain a touch more congested and am constantly sneezing from the irritation of the dust.
Just a little mention of all those who have made our stay memorable.

Sadjo and Barbar are the two main techs. Sadjo is Muslim, Barbar Christian, and totally opposite personalities, Sadjo being quiet and thoughtful, Barbar expressive and impulsive, always saying “Ah cha cha”.

Tijani and Walko, are quiet workers, Tijani’s uncle is chief of the village, and Walko is a tech that does much of the minor things in the operating room, as well as much of the anesthesia.

Saido,Roger and Falkamo also do anesthesia. It is usually spinal (rachidienne) or ketamine. All are absolutely superb. They can also do general intubation, but the OR is not well set up for that.

Vadera and Wome also do a lot of minor activities like wound debridements and rapprochements (wound closures).

So now I turn to the missionaries that we have met. We loved all of them. Each one has become special to us in their own way. So, let’s start with Scott and Lee. They, along with Danny and Frances, started this place. It was their vision and hard work that led to the founding of Hopital de Meskine, and it continually shows. Scott is responsible for the main leadership, and possesses an uncanny sense of wit and humor about him. He is always able to break a tense situation with a word or comment that leaves a smile on others. Lee is amazingly hard-working, and keeps everything in the surgery end of things running well.

David and Patsy have been most special. David runs the informatics side of things and keeps communications going. They are more quiet workers but always possess a gentle loving spirit. Their hospitality will always be remembered. One day, Betsy was commenting on her bad back, and the next day, David dropped by a special chair that was very comfortable on her back. That really touched us, just the caring for little things in another person’s life.

Andrew and Kari have had two young adopted children to care for and so we have not had the opportunity to get to know them nearly as well as the other missionaries. They are also a bit newer, and so are working on learning the languages and becoming effective on the mission.

Carsten, Annette, and their children Rabea, Lucas, and Aaron (here, shown with Betsy and Marike in Roumsiki) have become quite well known to us. I have spoken more about Carsten in other places since I have been working with him in surgery, but their entire family remains special. Carsten and Annette grew up in the former DDR in Leipzig. He and Annette are both very musically inclined, and he happens to like Bach, which makes them very much true friends. I truly hope to visit them in August in Leipzig, if the Lord wills.

Carsten and Annette have a young German girl named Marike (here shown with Rabea) from Baden-Württemberg helping out with teaching the children, and also working in the hospital, since she would like to eventually go into Medicine. She has been very special to us, since she has been able to help us better converse with Carsten and Annette since she is fluent in German, French, and English. Her maturity and love for the Lord has been especially noticed by us.

Me with Josephine, Melissa with Aisha, Sarah, Kari, and Ruth. Josephine is a general practitioner from the Netherlands, Melissa a short-termer from Louisiana, and Sarah a PA from Michigan. I’ve not had much of a chance to interact with Josephine, but have really appreciated getting to know her. She is very sweet, is fluent in Dutch, German, English, French, as well as Fulfulde, and also a superb, caring doctor. I don’t know how she does it. Sarah has been wonderful to have. She is a real take-charge person, very industrious, and very capable in the tasks she has at the hospital. She rarely makes bad decisions and has been a joy to work with. Kari is a physical therapist, whom I haven’t had the ability to get to know well. I appreciate her sweet temperament, as well as her loving demeanor around natives and patients. We had just gotten to know Ruth, who is working mostly in Chad, and is quite fluent in Arabic.