July 25, What happened?

In the hospital, a young 2 ½ y/o boy had come in with sepsis. The story was that he had a swollen right leg and a blister on his right medial foot that the grandmother had tried to drain a week ago. He now had a taut, swollen right thigh, moist cough, and very distended abdomen with a heart rate of 144 and pox of 75%.  I wasn’t sure that he was going to make it through the night. His lungs were coarse and there is only one oxygen concentrator for all of the medical wards, which works when there is electricity, which is sporadic at night. His right upper arm was slightly swollen; we couldn’t feel any abscesses in his swollen thigh; his abdomen was distended and he hadn’t passed stools for the past week; he also had an altered level of consciousness in which he would not focus his vision on you or anything, just kind of stared off into space, and had a sardonic-like smile.  Over the next few days, with antibiotic therapy, nursing care, and a lot of prayers, he is getting better. The swelling in his arm has dissipated, his cough is less (pox 93%), his belly has softened after enemas and paraffin tx, and the swelling of his thigh has reduced enough to reveal multiple abscesses. Probably for an incision and drainage soon. Thank you for your prayers.
 

Just a little FYI: The language they speak here are Pigeon, Kom, and English. Pigeon has many English words in it with different organization of expressions. For example: If you’d like for the patient to sit on the examining table, the term is, “Climb for bed”. If you’d like for them to lay down for an abdominal examination, you say, “Sleep for bed”.  Have you lost any weight is “Is your body small for skin?” If you’d like them to take deep breaths, you say “Breathe deep.”  Diarrhea is “posh”, vomit is vomit, cough is cough. Tuberculosis is “Strong cough”. Fever is fever, or “Is your skin for hot?” Pain is “hot”. For example, when checking for dysuria - “Is it hot when de piss?”  And by the way, just when you think you have the pronunciation down right, you’ll say it in your best American Pigeon, and they still won’t understand you. Our translator still has to sometimes repeat exactly what we’ve said, but with familiar accent and then they understand.

In Kom, it is a little more foreign. “Lay down” is “Ninyi”. “Sit up” is “Lolli”. “Deep breathe” is “Z’usa”.  “Say ahhh” is “Zese ahhh”.  “Where is the pain?” is “Fos ia de hot?”.  “Goodmorning” is “Tulima,” the response is “Aye, Wulime”. Or, “How did you sleep?” is “Aye wachima junga?” and the response is “Aye, machime”, which means you slept fine. And I always sleep fine because if I didn’t sleep fine then that would lead to a whole explanation that I am nowhere near translating!! “I’m sorry” is “Asha.”

This morning, a young lady came in comatose, pupils fixed and dilated, no doll’s eyes. The story was that she was fine yesterday, had some had not been ill, no history of headache. Last night she had some problems sleeping (unclear why) and this morning she awoke and told her mother that her head hurt, and collapsed.  They tried to give her some traditional medicine to wake her, but it did not help and so they brought her to us.  We placed an NG, oral suction, and placed her in what they call “cardiac position” (HOB elevated).  Within a couple of hours, she passed. SAH? Ruptured aneurysm? I suppose we’ll never know. God rest her soul and be with her family…

Today Milan felt the pain of teaching. The usual instructor that teaches grammer and reading was not there as he had a funeral, so Milan taught math (division of fractions) for 4 periods today and was exhausted. The children seem to be catching on to the concepts, but it has taken time. And of course on their break, Milan plays a mean game of futbol with them.  He says that they are really good, especially one young boy is superfast.

July 20, Reaction?

Well, today was quite an emotional day from the very, very young, to the older.

There was a woman who came in today with right anterior and posterior cervical and supraclavicular  adenopathy. Multiple firm nodes approximately 2cm.  She was married to a first husband that died and they had 3 children. With his death, she was given to his brother, with whom she had 3 more children with. It is with this 2nd husband that she had suspicions of HIV and thus got herself tested without his consent. She is positive for the virus and her last CD4 count in September of 2010 was in the 100s. She has not begun antiretroviral treatment because her husband will not allow her and he himself will not get tested.

Another woman came in this week and for 3 years, her husband never revealed his positive status to her. Now she learned that she also is positive and she is very upset. Not because she has the virus, but because he never told her.  This situation reminds me of a movie I once saw called “Yesterday”. If you get the opportunity, watch it.  I think it is a pretty accurate depiction of some lives here.
I don’t see a lot of upset amidst those who are newly diagnosed. I was a bit disturbed about what I perceived to be a lack of reaction and I thought that I needed to understand my perspective.

I spoke with a counselor who works with newly diagnosed patients and asked for some input.  They have worked hard to decrease the stigma associated among the people about the virus and so this has helped in better acceptance and coping. The counselors also do both pre and post test counseling that is very thorough in which they explain modes of transmission, prevention methods, lifestyle, diet, staying healthy, and prompt referral to the clinic when feeling ill.  Some of the modes of transmission are detailed as what we in the States already know, and in addition here in Njinikom, unclean blades used by traditional medicine providers and unclean blades/knives used by barbers.  For the most part, partners stay together, even if one finds they are positive and the other is negative.  In the case that one is not coping well, the counselors are very good at following up and giving individuals the chance to go through denial or anger, their own process of acceptance. They also foster partner and family support when the patient consents which provides great help to the patient’s adherence to medications, lifestyle changes, and overall wellness.

Prayers for a little one…
We have a little one, a beautiful 4-day old girl, which was born with Spina Bifida. We were hoping that she would be transferred to a hospital not too far away, where an American surgeon specializes in this surgery, however last night, the little one developed a very high fever. Please keep her in your prayers. She is a very tiny body and soul trying to fight.

El Professor Milan.
Milan is doing great in the “summer school”. How would you like it if the same teacher who was giving you instruction in math (means, mixed fractions, improper fractions, etc.) then took you outside on break and taught you how to play freeze tag?  Well, that’s Milan. He seems to enjoy it and it sounds like the kids enjoy him as well. Some of the other things he’s into now is “pen spinning”. There is actually a website, videos, and “pen spinning forum” on the internet. So in the evening he morphs my pens by removing the ink, putting weights on the ends, and using electrical tape to secure it. They all have a different weight and feel to the spin. I’ve tried the spinning, and I seem to be a little better at it than yo-yoing.  Ahhh… maybe I am morphing into a cool mom.

July19, What Did You Take?

We seem to be having a surge of hypo and hyperglycemia this week.

One woman has 3rd CN palsy that is beginning to resolve with her sugars once over 600, now under control. We have Metformin here and a drug called Glibencamide, as well as short-acting, long-acting, and mixed insulin solutions.  A young gentleman presented with ataxia, slow mentation, confusion, delayed verbal response, and uncoordinated movements. We were thinking some kind of tumor or encephalopathy, but many of his tests were coming back clear, except the history of recent traditional medicines. With no history of diabetes, his blood sugars were high and he was progressing to renal failure with weak respiratory effort. After almost 2 weeks, he is sitting up, eating and conversing with family. Another 2 patients, an 18 y/o and a 60 y/o came in comatose, with sugars in the 45 range after taking traditional medicines for stomach upset. It is frustrating because we often do not know what the traditional medicine is, only what it is doing.  I am sure that there may be some traditional medicines that do help symptoms, these are just not the ones that we are seeing. Both are doing fine now, sugars back to normal, up and about.

By the way, our gentleman with tetanus who was having full body spasms and inability to open his mouth… he is now recovering
well, off the diazepam drip and on po diazepam bid.

We lost a little 3 y/o girl last night… she was wearing a shiny pink satin dress. She came in with respiratory distress, grunting respirations, and pox of 69%, and only localizing pain. My stomach turned over as soon as I saw her. She had been sick for the week and they had tried traditional medicines as well. We don’t know if this was progression of the original illness, or aggravation by some traditional substance. My heart goes out to her and her family. May she be surrounded by all God’s angels.

In the clinic we had a 14 mo/o with breast tissue and galactorrhea; a fractured femur and ankle; cough for 6 months progressed to hoarseness; malaria; hyperglycemia; generalized body weakness; “scrofula” TB adenitis; chest trauma on a motorcycle. By the way, the motorcycles here are used as taxis. We do not ride them as it is very dangerous, but this is how some people get around. Taxi cars are also used here and they can be filled beyond capacity.

July 17, Sunday, My Birthday

Well, the morning began with the sun shining bright and mass at the church. I video-taped the mass that day and the Gospel reading and homily were very strong. The reading was about the good seeds being planted with the bad seeds and whether we should separate the bad from the good or just get rid of the bad altogether… Fr. Dominic’s homily asked us why, why did the Jesus let them grow together? Why don’t we just get rid of the bad and just have all good people? The answer was that the good need the bad and the bad need the good. It is our responsibility to be an example for those who are walking down the wrong path in life and it is those who are walking the wrong path to keep us alert in staying close to God.  We need each other. In our daily lives, when we have a husband or wife, sister or brother that is not good, it is our responsibility to love them and work to sanctify them. This reinforced God’s message of patience and unconditional love. He never runs from us, never avoids us, never gives up on us no matter how many times we have failed. It was a very nice birthday gift.

My next gift was the smiles of the little ones in the pediatric ward. Milan and I took balloons and began playing a game of ‘keep the balloon up’.  Soon many of the mothers were helping us to keep the balloons up as well! And of course, the lollipops are almost always a guaranteed smile.

Gift number 3 was the smile on Milan’s face after he beat me twice in the game Draft.  No mercy!

Gift number 4 was the beautiful day with no rain, a rarity here in Njinikom during July and August.

Gift number 5 was the 4 hour mountain climb to almost the bottom of the valley behind the orphanage.  It was like a bit of heaven, sitting on the hill and taking in God’s beautiful handiwork.
How the many hills gathered downward to one point in the valley, almost like a folded hand fan, the ones you make from folding paper back and forth. And then there was a long stretch of a green plateau that curved to the right in the distance. Trees dotted the hillside in groups here and there. The sky was powder blue with soft white clouds. There was a small stream that flowed over and between large rocks. We packed a lunch and hot tea, and this is what we did: had chamomile and peach tea, plain bread, tartina spread, and some trail mix.  Naturally, the red ants wanted to join us, and they let us know it. The climb back up was a great workout, and my hamstrings felt it. Milan pretty much ran up most of the hill, unlike me, huffing and puffing.  I think it’s the altitude?

The day came to an end with a movie at the orphanage – fittingly Madagascar. All the kids joined in the playroom and watched the little laptop as the zebra and giraffe danced across the screen. Even the toddlers and babes were entranced by the colors and music.  For movie night, there was no popcorn, so we had chinchins and pixie sticks. There were many blue tongues!! It was great to be around all the little ones. And the older ones started a few dance moves when “I like to move it, move it” came on!

A surprise visit came from the Sisters when we had retired to the house for dinner. They came and sang Happy Birthday and brought these wonderful cookies with bit of coconut. We have them with tea in the evenings after dinner.

And lastly, we hadn’t seen any stars in the sky since we had arrived, but that night, I wished that I was an astrologer… The sky was full of stars! Tim thinks he saw the Southern Cross. There were so many stars, it was just like someone pasted the sky with glue and threw a box of glitter up there. How it was sparkling.

Although I was away from family and friends in Pennsylvania, especially my aunt Maria, with whom I share her name and birthday, it was a very nice birthday. Tim and Milan were great and their company made the day special, especially on the mountain. The best part of the day was the embracing birthday hug that I got from Milan before we went to bed.

Thank you everyone for your birthday wishes and prayers… God really sent them my way on that day.

July 16, Saturday

Well, I thought today was going to be a beautiful day to go to the mountain after clinic and see the calves, and while it started out that way, right after I stepped out of clinic, the thunder rolled and within a half an hour came the dark clouds and heavy, heavy rain.  July and August are supposed to be the heaviest months for rain.  I can see why.

Yesterday, Milan had his first day in the local school. During the summer, they have half-day classes to prepare the students for the next school year. Fr. Evaristas asked Milan if he would teach and he agreed. So Friday, he taught math (algebra) from 8-12 to 14 students. It sounded like he had a good time with it. He said they were “blazing” through most of the problems.  He would bring them to the board to work out a problem, and if the student got stuck, he said that other students would be whispering the answer and he would be “Shhhhsh”ing them.  It sounded like he had a good time with it. I was happy for him. He will be teaching them next week from 8-12 all different subjects: algebra, writing, reading, and grammar.  I am excited to hear this goes.

Last night we went to visit Rosie and Bet, the ladies that are working with Project Hope. During the day I had an opportunity to sit in on one of their meetings for a bit, and I learned about the women and their perceptions of health problems.  About 8-10 women were given a camera to use and were asked to capture photos of what they viewed as health problems for women in their community.  The photographs and stories that went along with them were very poignant. Some of the women farmers were injured working on their steep landscapes. The rock/mudslides (due to heavy rain) have thrown rocks at one ladies leg rendering her with the loss of her left lower limb. She had an ill-fitting prosthetic and so could no longer farm, but managed to knit and work around the home a bit.  The mentally challenged and mentally ill are sometimes at a great disadvantage, some abandoned, but it does seem that for the most part, extended families try to keep them and care for them.

Today, Milan was at the orphanage and played mostly with Louise. He has discovered that Terrence and Dzuran are exceptional at drawing, so they do a bit of that as well. For lunch, we are out of the Pseudo-Ramen Noodle Soup, so I tried my hand at some homemade macaroni and cheese with the Laughing Cow cheese that we had.  Milan loved it. Said that it tasted French… ha, I am morphing into ze chef in Njinikom!!  So far we have learned how to properly eat a mango, coconut, and avocado. Next on my list is the pineapple.  I’m not sure how they cut it so nicely, but I will find out from Felicitas!  I hope to try making banana bread here, but we’ll see.

Little Souls

The small, 2.5kg baby was discharged yesterday and doing well, and today we had a new little girl with spina bifida, skin intact.  There is an American surgeon in Mbingo who specializes in this type of surgery so we are hoping that the family will be able to take her there in the next week. It is nice to see so many little babies in the maternity ward…

A few days ago, we had an otherwise healthy lady (with a history headaches), found unresponsive after a fall. After investigating more of the story (there had been no immediate witnesses), it appeared that she most likely had a massive stroke and then fell.  Her eyes were fixed and dilated; there was no gag or corneal reflex, GCS 3.  We had her on mannitol, but there was little more that we could do. She passed away the next day. God rest her soul and bring comfort to her family…

We had another non-diabetic, young lady who was found unresponsive with a sugar of 56. She had been walking around with a septic knee for 3 weeks. Aspirated and cx for MRSA. She is healing well.  We’ve had young infants with hemoglobin’s <6, laryngotracheobronchitis with inspiratory stridor, bronchiolitis, gastroenteritis, malaria, sickle cell crisis, and a bulging fontanel. This week we also had a young child with auditory hallucinations, occasional confusion, 4+DTRs. We ran every test on her that we could to find any other explanation. Everything has come back normal. The family is concerned that she is possessed. The patient always asks us to pray for her. The only antipsychotic we have here is haldol… Please keep her in your prayers.

A couple of days ago at a daily mass on Thursday, Fr Evaristas gave a very nice homily that has stayed with me over these last few days.  It was the Gospel of Matthew 11:28-30, and Jesus spoke, ”Come to me all you who labor and are burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am meek and humble of heart; and you will find rest for yourselves. For my yoke is easy and my burden light.” Father Evaristas shared with us about a poster he had once seen in which a younger brother was carrying his older, bigger brother on his back. The poster said, ‘He is not heavy, he is my brother.’

July 13, 2011

In the hospital: A young gentleman, looks like metabolic encephalopathy of some sort – ataxic gait, slow, delayed mentation, no other neuro-focal deficits…waiting on labs, reading up on neuro; one with a left knee effusion – septic arthritis; malaria; gastroenteritis.  One of our little ones from the orphanage is in the hospital with fever, vomiting, and herpetic stomatitis. 

July 12, 2011

This past week has been interesting. Milan has put his yo-yoing on hold for the moment to construct a bow and arrow from wood, electrical tape, and feathers of a bird. It worked very well, the arrow actually stabbed a hole in one of our curtains, until it broke.  Then I came to pick him up from the orphanage one day and he and Terrence looked like they were doing some complex Ninja/Karate dual with bamboo sticks…  And a few days ago, I heard about the “wet-towel snapping” game (thank you Uncle Johnny.) that he was teaching the boys.  There were all running around trying to escape him! Terrence is doing better with the spintop… he now has it spinning on his own hand.  We hope to have Terrence prepared for class 3 in September.  We are trying to get the school books so that he can have a headstart for him in math and english/reading.

Today Milan went with Sr. Hilda for a bit to play with the baby calves and watch the milking of cows. Then it was back to the orphanage where he taught Terrence, played “copycat” with Moses and Louise, and fed Moses lunch. Milan has been doing well. We stopped by to visit with Bet, one of the ladies that is working with Project Hope. She was sharing her experience of working with the children and using child psychology. She and Milan had a good conversation of ways to assist Terrence with school preparation.

At the clinic, there was a woman who came in, and probably had the same story that many others share. She is married and I suppose had some suspicions of her husband’s infidelity. She came in for an HIV test and found that she was positive. There was a long conversation that took place in which she shared her anger and was asking “why me?” My heart ached for her… I pray for her and for the many that share her suffering.  Another little 3 y/o boy came in with Ricketts and rectal prolapse.  A 4y/o girl with a history of snoring, sleep apnea, and adenoid facies in need of an ENT consult.  A 15 month old girl with inspiratory stridor.  A young girl with an 2cm fluctuant abscess on her posterior head that contained purulent matter and necrotic subq tissue. Numbed, incised, and sent home on antibiotics.  And an older gentleman with Parkinsons who had been paying 4,000 francs (8.00 US dollars) for 10 pills of Sinemet and needed to take 6pills per day for relief.  He had to cut down because he couldn’t afford the cost. Now he only gets 30 minutes of relief three times a day, otherwise shakes the rest of the time.  It is very frustrating for him. Can you imagine having to consolidate all that you needed to do with steady hands into 30 minute time slots, 3 times a day.  And he is a farmer.

We have a young gentleman with tetanus. About a week or so ago he stepped on his machete and obtained a wound on his foot that healed well. He presented with trismus and generalized muscle spasms.  We have him on a diazepam drip to help with the spasms and are vigilant over him for any autonomic dysfunction. So far he is able to swallow, but there is some constipation beginning.

Upon repeated oropharynx exams, I have learned that it is common for people who have a tonsillectomy, to also have their uvulas removed.

We had a young 8y/o boy with partial seizures and left hemiparesis. Finally after over 2 weeks we have been able to send him home. He was slapping me “five”; up high, on the side, down low, TOO SLOW!! It is a game that I learned growing up and shared with him. He had a good time with it and it helped encourage movement and coordination with his left arm/hand.  He has gained some gross motor movement and is walking with help.  On his last day he was smiling from ear to ear… It felt good to see him improve and I was thankful to God for His guidance and to Tim for his knowledge and watchful eye.

It is a Moslem custom here that when a woman gives birth, she leaves her husband and lives with her mother for the 1st 2 years of the baby’s life while the husband usually comes to visit frequently.  Well, we had one patient who had lost a significant amount of weight over a 3 year period, anorexia, nausea, vomiting, and fever.  Well, her H-pylori and typhoid came back positive and so we treated, however, the weight loss was very concerning. Later we discovered that this patient had stayed with her mother for the 1st years of her baby’s life, but the husband never came to visit, and hasn’t been heard of since. The child is now 3 y/o.  We tried Citalopram and it has made a world of difference.  I feel for her in these last 3 years that she’s suffered, and I was thankful to God… my heart overflowed to see her finally smiling and a light in her eyes.

And I had my first neonatal sepsis. A one-day old with a fever of 40.6, born 37 weeks gestation, with 2 days of prolonged labor (unknown time of ruptured membranes).  Ampicillin and gentamycin. She is taking the breast and her suck is strong. No further fever. Thank God.

So this evening we pray for a friend of ours in the States who is having a surgery today. God be with you.

God bless all of you back home…

July 6, Wednesday

Day at the orphanage: Made beds, folded clothes. Invented a playtime that Milan has named “Mariokart” in which he put each child in a little wagon and pulled them around the building. The little ones loved this.  I have seen Milan work with Terrence and I am very proud of them both. Milan has an immense amount of patience and Terrence has a persistence and resolve to learn.  Terrence is now doing large number multiplication and is learning division for the first time.  He is reading better and better each day. Later, Sr. Hilda beckoned the boys for some help. Sr. Hilda is the nun that Milan affectionately calls “Sr. Francis” because she is so good with the animals. The cows come when she calls them and the 2 shepherd looking dogs (Apollo and Shepherd) follow her everywhere. Anyway, Sr. Hilda needed wood brought up from down the hill for the orphanage. The three boys and Sr. went down this very steep hill and 2 more hills down and brought firewood up. It was there that Milan found a beautiful view of Njinikom. That same day, he took me down there after clinic, and the view IS breathtaking. I could just sit there and adore His creation. Milan has been there every day so far.  In the afternoon, he fed 3 little ones because none of them would hold still, they would come and go, easily distracted.

Listening to a fetal heart with a pinard horn

The Clinic: A gentleman with a posterior fracture dislocation from a year ago, hoping for surgical intervention. And different patients with a hydrocele, fever, abdominal pain, back pain, typhoid, and urinary tract infections. They had adoration in the clinic chapel today. I managed to get there for a ½ hour and sat there praying for the patients, Milan, our family and friends back home, caregivers, and all those suffering.  I talked with one staff member to gain a better understanding of why patients would default on HIV medication. Their opinion was that often times, even though the medication is free, they didn’t have the money to even get to the clinic. Some have to come from hours away. Some have to wait for their husbands to give them money. Some choose to go to traditional medicine where they may be told that they don’t have the disease or that they can heal them of it. It is these I pray for as well…

July 5, Tuesday

This week mass has been at the church. The church is very big and beautiful. Everything is wood. The kneelers are hard, there is no cushion, and each time I kneel I feel the pain on my knees. It is only a very small suffering that I can share with God, but I am happy to share it.  It reminds me of how comfortable things usually are in my life at home, and how I not only take this for granted, but on the other hand, how I try to avoid pain, avoid maybe doing things the hard way – when there may be a grace waiting for me through the suffering. The suffering reminds me of those who suffer and have no choice. Those here in Africa who are suffering from HIV, all the orphans left behind, disfigurement, poverty; and in the States, those who are suffering from diseases, cancers, loneliness, poverty, and bullying.  So often I am comfortable and going through my everyday life, that it’s not until I experience pain and reflect upon it, rather than just concentrating on the fact that I am hurting, that I remember those others who suffer daily. The hard, wooden kneelers in church...

Note to self – Never put your feet on the kneelers. That is an understood rule here.

Milan’s day at the orphanage: weeding the grass in the yard, played soccer with Aday and rode her on bike. Sr. Natalia gave Milan some biscuits for the little ones so that they would gain trust with Milan and come to him to get them. These have been affectionately named the “trust biscuits”. And Sr Natalia also makes a small biscuit called “ChinChins” that Milan loves and I am requested to make once we get home. The recipe is flour, egg, margarine, sugar, lemon rinds, nutmeg and are fried. After Milan’s day in the orphanage, he went up to the surgical ward and played 6 games of Drout with Julius. Won 2, Draw 1, Lost 3; getting better… and taught them blackjack.

Our 2 week old at 2kg...now 2.5kg!

There were sick, sick kids in the hospital with seizures, malaria, respiratory tract infections, gastroenteritis, marasmus, Kwashiorkor, and TB; adults with bowel obstructions, metrorrhagia, CHF, weakness, pneumonia, and pelvic abscess. In the clinic: a child that was 2.2kg at birth and now at 2months weighs 2.5kg. Malnourishment, loss of periorbital fat, club foot – mother does not want to admit the child. We are praying hard for this little one. 

Another case of parotiditis and one girl who is very tall and slim, walked pigeon-toed, with a history of pains in her ankles and knees, and whose feet would “freeze” in place 2x year requiring hospitalization. One young gentleman with symmetric polyarthralgias rendering him with a limp, and pronounced cardiomegaly with mitral regurgitation, mitral and aortic stenosis. All need your prayers and donations as you can. One young lady had herpes zoster that had resulted in a secondary infection of both her eyes, swelling one eye completely closed. She wanted to leave the following day because she couldn’t afford both the hospital stay AND the medication acyclovir. We explained to her how the IV antibiotic treatment was critical for the secondary infection for now and the acyclovir is next. It is patients like these that your donations help to heal.

4th of July

Not.  The only sparks we saw were from a fuse box, and then it was repaired. Oh well. 

Today Milan  had his usual day at the orphanage. He taught Terrence, folded clothes and made the crib beds, and fed Moses. Later they had (in the words of Milan), an “epic” game of tag.

July 3, Sunday

The one day that we can sleep in, we can’t. Our bodies are now on schedule, with the help of the 5am rooster here!  

On Sundays, Milan and I take balloons and sweets to the kids in the pediatric wards and visit with them. Sometimes Milan will give them a yoyo show or we’ll hit the balloon back and forth to get some smiles.

July 2, Saturday

Some of the type of patients that we have seen this week: a 4 year old girl with ricketts of both upper and lower extremities; an 8 year old girl with polyarthritis - once we got the swelling down in her joints and limbs, many pus-filled lumps were visible on her anterior left lower leg, she went for incision and drainage and is healing in the surgical ward; a 2 week old baby that weighs 2kg, finally taking the breast; a gentleman in his 30s with cold and allergy symptoms, wheezing, with a family history of asthma. (I felt like I was seeing you Mom!) 

the "veterans"

In the evening, Father Dominic had invited Milan to play soccer, but it poured rain. While he didn’t get to play, later we did get to watch a championship game played by 2 teams. In fact, Milan got to do the kick off!!  It was Athletico (teens and 20s) vs. Veterans (older, some gray). Wet and muddy! Great, long kicks across ½ - ¾ of the field. Lots of heading! And a few times they did great getting the ball across the field with kicks or heads the whole way. The ball never touched the floor.  We couldn’t stay for the whole game, but I must tell you that the Veterans scored the first goal. Did I expect anything different? For us ol’ foggies!

July 1, Friday

Milan playing drought

A typical day goes like so: 5am wake up/shower and 6 am mass. I wake Milan at 6:45 for an omelet and toast and then we head out. I walk him to the orphanage and then I walk back up to the hospital to round with Tim until somewhere between 10-11. Tim and I then see patients in the clinic. At noon I leave the clinic and bring Milan to our house to give him lunch, and he is ecstatic that we found something very similar to Ramen noodle soup here. That small finding has made a world of difference, go figure. After lunch we head back out and I go to the clinic while he heads up to the surgical ward to play a game called “Drout” with some of the younger patients. Drout is very similar to checkers except you can jump people backwards as well. Other games they have is Ludo, which is like our game Trouble, and a card game played with regular playing cards that is like our Uno.  

One particular patient named Julius who has been there for 2-3 years has befriended Milan and is teaching him the games. After clinic, which is until the last patient is seen, usually around 3, Tim and I will re-round on some of the more critical patients or the ones who had pending labs/Xrays. Once we return home, we usually read up on the diseases we saw or issues with the patients while Milan uses the internet. Tim takes calls from the hospital and goes down to admit any patients or check any patients that have issues. 

Dinner is prepared by Felicitas and Priska, and around 4:30-5 we all 3 eat together. Following dinner Tim, Milan, and I play Uno, read, or just chit-chat.  Our last conversation was about all the different pets we have had. I was happy to meet another adult who enjoys the ferret! Shower time is about 7-7:30pm for Milan and we read till about 9pm (he is a fan of the Redwall series). That’s it.  We haven’t really deviated from this, but we do try to get creative and take different paths on our walks or I’ll try to yo-yo which is not very exciting as I can only go up and down.  Rain is pretty much guaranteed each day, sometimes a pour down. Usually many clouds, little sun. The corn harvest is happening soon and I am excited to see this.

July 1, 2011

Well, this morning I have a bit of time to write. Milan and I are going to Bamenda today to do a little shopping for some household items (tea, Maggie-a soy sauce, a lighter for the stove because the matches are as Milan would say, a “fail” here).  I’ve gone through a full box trying to lite the propane stove to heat water for tea.  Milan seems to have better luck, but we still go through a good 15 matches before a lite happens, if at all.  And of course, wouldn’t you know, that since I haven’t really cooked in years (with school, work, and Milan), I would come to Njinikom, in Cameroon, Africa and have to try to conjure up a meal.  There are 2 ladies that prepare a wonderful dinner for us 6 days a week, but breakfast and lunch is up to me. So, for someone who doesn’t cook in the first place, this has been a bit of a challenge. I have managed to make toast over the skillet and scrambled eggs or omelets with chopped yellow/red pepper, onions, salt, and pepper. Milan seems to like it, and loves the toast. I just realized that I might be able to conjure up french-toast (please don’t laugh for you advanced chefs). We drink tea a good bit and lunch is usually Tartina (hazelnuts mixed with chocolate-Nutella) on bread for Milan and I usually have a banana and protein bar.  

Milan is still doing okay in the orphanage. It is sometimes tough for him to stay motivated, but I try to give him some direction.  He continues to teach Terrence reading and math and each day tells me who he has fed, how they ate, and who he played with. Each little one has some sort of personality quirk that he shares with us. And when I come there after clinic, I usually try to play a short game of hacksacking the soccer ball with him and the older ones. I only get a max of 3 hits, 2 knees and a foot while the other boys and Milan keep it up for 6+ hits using their head, chest, foot behind their back, knees, etc. Yes, I am a hacksacking soccerball fail.
 
Our kitchen sink broke at the beginning of this week (today is Friday, July 1st). Milan was washing his dish and must have turned up the pressure too high, then I hear this “Mooooom!” from the other side of the house and run to the kitchen and see water squirting straight out at him and all of the kitchen.  We couldn’t figure out how to shut the water off, and couldn’t see a ring to turn or something, so SOMEHOW, we got the knob back on and turned it tight to the left and it seemed to stay, although it had a leak, it was better than spurting across the kitchen. Now it just went down the sink.  So this has made washing dishes a little complex.  There is a big bowl in the sink that catches the leaking water, so this is where I wash the dishes.  Then I take the tea kettle to the sink in the bathroom and bring water back to heat on the stove to boil and wash/rinse the dishes.  It’s just a little system that we’ve developed… they are supposed to get a part to fix it in Bamenda, but things around here get fixed when they get fixed. Transportation and money is not plentiful and so patience is a virtue.
 

I am unsure of the peoples’ mentality towards HIV.  People take their medications when they can or want to. Essentially they are hurting themselves with this method because once you stop taking the medications more than once, your body will develop a resistance to the meds and it won’t work to reduce the viral load. Some of these people go months at a time without taking their medications. Then they start to develop a rash, or get a cough, perhaps because their CD4 is so low (we’ve seen as low as 6 here), and it is then that they come for medications. This is very frustrating because the only thing left in their future is AIDS… there are no 2nd or 3rd medications to try here.  Now, the medication is FREE, but every 6 months, you have to have lab values drawn to check and see how the medication is working and whether it is hurting your liver. These lab values cost 15,000 francs, which is the equivalent of $30.  Now this is a large sum for them, but they are not required to get the lab values, but this is the reason they sometimes give for why they couldn’t pick up their medications.  It is very frustrating because you see the epidemic and how many default, and we’re not sure why. They see what HIV can do to someone once it becomes AIDS… why wouldn’t they want to avoid that?
 
There is a group here from England that are part of an organization called Project Hope.  Their purpose is to help educate about HIV/AIDS, prevention, treatment, and decreasing the stigma.  We met a woman here, Rosie, who has come to help establish some organization within the project houses around Njinikom.  Another lady from Uganda, Bet, is the roommate of Rosie, and she works with the children who have HIV.  Her job is difficult because she encounters young children who are not receiving their medications. She is hoping to start a youth club for them so that they many have a place to share and receive support.  We are hoping to attend one of these group sessions.
 
(evening of July 1st, 2011)
Well we returned from Bamenda and brought a few groceries, one of which were something similar to Ramen Noodle Soup. Milan was happy!  We also brought a coconut and snacked on that. I had never eaten one before and you pretty much eat the whole thing. Bamenda is a busy town. Lots of traffic and outdoor markets, like a continuous fleamarket. There are many taxis here as well, both car taxis (they’re all yellow) and motorcycle taxis. The terrible thing about motorcycle taxis is that there are very few that wear helmets and there are many babies and children on them. These have lead to some very horrible accidents.  Another thing that I learned is that there is no inspection required of vehicles. Some businesses or missions may require inspections, but for the vast majority, there is no requirement. So for some, failing brakes may have only been discovered after the fact.  I’m not that great about keeping up with my inspection sticker, in fact, it’s usually a family member that sees it’s overdue and reminds me.  But there is a good reason for inspection. I have seen it firsthand.

June 30, 2011

Today was a good day in the clinic and orphanage. Milan got Camerika to smile a few times and he helped to feed Louis, although today I heard he was quite distractable and so this made it a very messy encounter.

I discharged a few from the hospital and followed up on some patients with Tim. One young lady consulted a “chemist” (one that sells drugs on the streets) for the herpes zoster pain on her right back. He gave her 3 shots in each anterior thigh which rendered her unable to ambulate, or even stand. Worst part is that we don’t know what she was injected with.  We started her on acyclovir for the shingles. As for the thighs, these were now another source of pain. Sensation was intact but movement was initially minimal. Over time with some watchful waiting, she is beginning to regain strength in her thigh muscles. Not standing or walking yet, but improving.  

Another lady came in with “dizziness for 9 months” and inability to walk.  Her neuro and HEENT exam was essentially negative with a conjugate gaze and no nystagmus, however her eyes could not follow our finger on the vertical and horizontal gaze. Over the past few days, her extra-ocular eye movements have improved but not completely and she still cannot walk without assistance.  We are wondering about a supranuclear lesion and have sent her to see the opthamalogist. Other patients have been admitted for issues such as uncontrolled hypertension, fever of unknown etiology (sometimes accompanied by nausea, vomitting, and/or diarrhea), stroke, esophageal candida, typhoid, meningitis, and malaria.

This evening was completed with a “Welcome” dinner hosted by the Sisters in their convent. It was lovely and the food was delicious. I think Milan had 3 helpings of their mashed potatoes!! Their hospitality was warm and affectionate. They shared pictures with us and told us stories of themselves. Father Dominic joined us as well and spoke of his hopes to start some sports groups within the congregation to help inspire the youth. He is so full of energy. This Sunday there is a futbol game from 2-4. Milan is planning to play… I am excited. But I didn’t bring him sneakers. L We’ll see if this will still be doable.

June 29, 2011

Today we had our 1^st death. A 25 y/o young lady with Stage 4 HIV, encephalopathy. She had presented to the clinic about a week earlier in a wheelchair, unable to walk. She was HIV+ but was not on ARTs, she would only use traditional medicine healers. She was a very pretty young lady. 

My heart aches for her and her family…

June 27, 2011

Today is Sunday.  What to do on a Sunday in Njinikom?... 

Well, we had attended Saturday evening mass within the hospital chapel with many patients and that was very nice. It was like a complete circle of why we are here. The Sisters, Priest, patients, and caregivers, all of us… celebrating and glorifying God together. It was very special to me.  I have made many mission trips before, mostly with non-denominational groups, and the experience has been just as great. To share God with those of different faiths is a unique experience in which there is openness, curiosity, and a variety of spiritual expression, while still together sharing the commitment to loving God and loving others.  

This mission is one in which we are praying together in a familiar faith. Sharing morning mass in the convent with the Sisters is a blessed experience. Their voices are like angels, the songs express their tender love for Jesus and Mary with a beautiful rhythmic beat from their traditional instruments, and just being in their presence… which carries a fragrance of devoted love to Christ.