Bell

The children’s day begins, at school, with the ringing of the bell and ends the same.

What happens between these two times changes day to day.

What we learn, who we meet, how we see God working throughout our lives day to day.

We cannot change when the bell rings but we can see how God is calling us to be.... between those two rings.

A world of help.... Thank You!

September was expected to be a busy month and it was!

Dr. Dabo, the obstetrician, went on a much needed vacation for the month and Brent was in charge of the Obstetrical Service.  This meant Jennifer was in charge of the house, children and working in the Outpatient Department.  Dr. Eugene covered the Medical Wards and Pediatrics. Surgical Services were covered by Drs. Lazare and Foko.

There were 62 deliveries and of these 24 were cesareans and three sets of twins.

The love and support provided by the staff, Sisters and patients was very humbling.
Brent had a world of help and one case exemplifies this.

A young lady who is HIV positive presented with rupture of membranes but without contractions. She was not sure how far along she was with the pregnancy.  The baby was anywhere from 28-32 weeks old (normal 37-42 weeks).  There were many questions on what to do for the baby and the mother. The longer the baby stays in mom, the better for lung maturity so it can breathe on its own when it is born, but the longer the rupture of membranes the greater risk of HIV transmission to the baby and the greater the risk of infection entering mom's uterus.

We contacted US based Obstetricians, a Family Doctor, Perinatologists, a Neonatologist, consulted with Dr. Eugene and even called Dr. Dabo!

In the end we gave medicines to help mature the baby's lungs, antibiotics to prevent/treat infection, and HIV medicines to prevent transmission of the virus to baby.

After about a week we gave mom medicines to induce her labor. Baby delivered without difficulty and weighed 1500 grams (3 lbs 5 oz). The baby spent the next three weeks in the "incubator" and has grown to over 2 kg. It has been receiving expressed breast milk via a tube and nursing some. The baby will stay in the hospital until it can breastfeed and/or feed with a cup and maintain steady weight gain. We hope to be able to discharge the baby within the next month.

Maternal Mortality

Cameroon has a very high maternal mortality. There are approximately 600 maternal deaths per 100,000 live births. Comparing Cameroon maternal mortality to other countries, we have worked in, it is the highest we have seen.

Countries Maternal Mortality comparison:
USA = 24             Ghana = 350        India = 230
Guatemala = 110  Kenya = 530        Malawi = 510
http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf

Here is some additional information from WHO
http://www.who.int/mediacentre/factsheets/fs348/en/index.html

Key Facts

• Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. 
• 99% of all maternal deaths occur in developing countries. 
• Maternal mortality is higher in women living in rural areas and among poorer communities. 
• Young adolescents face a higher risk of complications and death as a result of pregnancy than older women. 
• Skilled care before, during and after childbirth can save the lives of women and newborn babies.
• Between 1990 and 2010, maternal mortality worldwide dropped  by almost 50%

The other night exemplified the challenges facing the developing world regarding education and appropriate available obstetrical services.

Mareline was 9 months pregnant when she presented urgently to St. Martin De Porres Catholic Hospital, from a referring hospital, with bleeding. She had had some bleeding a few days before, at home, but did not think it was of concern.  When she arrived, her clothes were soaked with blood and her Haemoglobin was = 6 (normal = 12-15) . We were able to perform an emergent C-section and found a complete placenta previa.

 A Placenta Previa is when the placenta grows over the cervix and when the mother's cervix begins to dilate, during labor,  the mother can exsanguinate.

 Mareline and baby are doing well!

Orphanage

St. Martin De Porres Hospital has an orphanage that presently has 16 children.

The ages range from 3 weeks to 5 years old. We have visited them a number of times to play with the kids.

The orphanage is different from what we experienced in Guatemala. These children are from families that cannot take care of them at their young age, for various reasons.  After the child reaches 3-5 years old, family members (usually extended family) come and take the children back to their homes/villages.

Sister Nathalia is in charge and notes that she has been there for the last three years.

The orphanage was started in 1953 and is run by the Tertiary Sisters of St. Francis of Assisi

Beautiful

We are fortunate to be in one of the most beautiful spots we have ever been to. The hills are lush in many shades of green. Sometimes the hilltop where the hospital sits actually becomes engulfed in a giant cloud that touches the ground and then quickly disappears. The earth is red clay and slick when wet. The rain is daily now, sometimes all day, and at times torrential. The temperature is mild, good sleeping weather, but usually no need for a sweater. Goats roam freely and the pygmy goat babies are very cute.  Nicholas’ goal is to touch one. There is very little garbage on the ground which may be the work of the many goats.

Food and the Market

We have been very fortunate in Cameroon so far as there is a cook assigned to us who has been cooking most of our meals. I found that one of the most unexpected gifts for me during our months home in the States this past summer was that I wasn’t obsessed with thinking about food. Even though the food was plentiful in Guatemala and there was a lot of variety, there were no grocery stores in Santiago, some items were only available on certain days of the week or only if one got to the market early, and some items were scarce and/or expensive, for example, cheese and peanut butter. I did careful meal planning and a little rationing (my family would call it hoarding) of special foods. It ended up that I spent a good part of my days thinking about, buying, and preparing food in Guatemala.

So, here in Cameroon, even though I will be able to ease into 

the meal preparation, I did want to see what the market had to offer. There are tomatoes, onions, carrots, okra, garden eggs (a small form of eggplant), and bananas available daily. At times, I have seen green peppers, celery, green beans, potatoes, yams, avocados, and pineapple. There is bread, rice, pasta, black beans, pinto beans, soy beans, and dried fish, plus eggs, flour, oil, vinegar, and salt. Dried corn which is ground into corn flour and made into corn fufu is plentiful as corn fufu is the food that everyone eats daily. The market day is every 8th day and on those days the market also sells fabric and new and used clothing and shoes. I saw tomato paste in sachets and canned sardines. There is groundnut paste (passable for peanut butter), Ovaltine, milk powder, and something similar to Nutella, which has been a sweet treat. Only live chickens are available. We’ve received homemade cheese as a gift from one of the sisters at the convent and that has been a treat.

First Few Weeks

We have been spending the first few weeks shadowing the doctors at St. Martin De Porres.

Dr. Tim and wife Sheila have been helping us to settle in and we have really enjoyed their camaraderie and wisdom from their years of mission work. 

We are seeing many of the common illnesses we saw in Ghana.
AIDS, Malaria, Typhoid, Meningitis and the various obstetrical complications.

One of the big differences is that the people with HIV are now being treated with medications.  This was not the case in 1990s. Now there is hope and acceptance (or at least more so than we experienced before)

Dr Tim and Sheila leave this week and the Obstetrician leaves for vacation (gone for a month)  in September.  The kids will begin school September 2nd so we are gearing up for a busy September!