We have had an eventful week of surgery and Outpaitent Clinic.  Our usual start of each day is to awaken at 5:30-5:45 and begin to get ready.  We make coffee and tea and then have a breakfast of toast and a piece of fruit or sometimes we have scrambled eggs.  We have not seen anything like breakfast cereal or oatmeal. The coffee is grown here in Cameroon and there are 2 varieties of coffee trees.  The Robusta is from the lower elevations and is regarded as the less desirable.  Arabica is grown in the highlands and we are in the highlands so we have the Arabica.  It is very delicious and I like it with my breakfast almost every day.  If it is a surgery day we are in the OR Theater by 7:30 and our first case usually starts by 8 AM.  Prayers are said when the patient arrives in the Reception area for surgery  each AM.  The staff of the hospital usually has prayer service for  themselves and for patients who are ambulatory from 7 AM- 7:20 or so.  If it is not a surgery day for us then we have OPD Clinic that starts about 8:30.  Before that or during the morning we make patient rounds and do dressing changes or wound checks on our patients.  There are at least 5 different wards where our patients are residing.  The entire St. Martin de Porres Hospital here in Njinikom is a series of mostly one story buildings except for the main building that houses OB/Gyn and Pediatrics. quite a few of our patients are of pediatric age but they are staying in the surgical male and female wards with adult patients.  Usually a family member sleeps on the floor beside the patient and is there also to cook the food for the patient as well as do their laundry.

Many of the things we take for granted in US hospitals are either lacking totally or sporadically available.  Sutures and dressing supplies including elastic wraps  are very scarce . We brought 4 large trunks of sutures and dressing supplies, staplers, drains and supplies for anesthesia with us.  If we had not brought them we would not have them.  We also were asked to bring suture for general and orthopedic surgeons to use.  The general anesthesia agent of choice here is Halothane which is also used in many parts of the developing world because it is the least expensive agent available. That agent has not been in common use in the States for 15 or more years.  Our USA hospitals are a dream for the waste disposal people as very little of our supplies are reused.  Here and in other similar countries nothing is thrown away until it doesn’t work anymore. We could learn something from these people about repackaging and reusing items whenever possible.  Most hospitals in developing countries, including here, rely heavily on donations from abroad and from those supplied by volunteers who come to work in the hospital.

Patients here are truly patient and wait for their care often for hours.  There is about one MD for every 50,000 people.  This means auxiliary healthcare personnel are numerous and have more responsibility than in the US.  Often the care a primary care MD would provide is given by a Nurse or medical assistant.  Sadly many well trained MDs including surgeons who are native to Africa seek better conditions and much better salaries working in the Middle East, Europe or the USA.  It takes a really committed physician to stay in their home country or another African nation and work with their people. Most of these individuals who do stay have a very strong religious faith that keeps them committed to their people.

I better sign off now and rest for tomorrow.  Keep us in your prayers.

Man with neck mass excised-1 week post op

Keloid scars from very minor trauma like insect bite or scratch are common
problem

We have now been operating for the last 10 days and our surgeries have been going well.  The local OR crew of RNs and Nurse Anesthetists have done a great job for us.  The equipment we are using is very satisfactory and we also have our own surgical instruments and sutures we brought with us.
There are some things it would be nice to have that are lacking but they are not creating any significant problem.  Medical supplies and sutures are very expensive and often difficult to obtain even if they could be afforded. The staff here has learned to adapt and to make very good use of what is available.  We knew ahead of our coming of items to bring for them as well as for our own surgeries.  Thank God for modern communications that allow for rapid correspondence!  When Rosemary and I first started our volunteer work in Nepal in the 1980's there was only very limited telephone service that was almost impossible and the mail service which took 6 weeks each way.
What a change with the internet today. Even when it is often down or delayed it is lightning speed compared to that. 

HIV is very common here and we see patients here every day who are HIV+ and have already operated on a couple of them.  Of course we are careful to take appropriate precautions so the risk to us is low.  If we did get stuck by a needle we would have to take the antiviral drugs we brought with us as a prophylactic measure.

I will include a couple shots from the "Theater" as they refer to the OR here.

God Bless You All and we appreciate your prayers and support.

Rosemary, Nurse Canisius and me in OR with 4 year old burn patient

Pole stretcher assembly to move patient

Man with huge tumor on back of neck for 15 years

We had a rainy weekend but enough sunshine to be out a few hours each day.

Today we had surgery until noon & then saw new patients in the outpatient clinic as well as on the wards. Many patients have chronic wounds that need skin grafts. Some of the wounds have been open for 2 years or more. Today we saw an elderly man who travelled 9 hours by vehicle to come here because he heard we could do skin grafts & he has 2 large leg wounds from a motor vehicle accident in 2012.  We scheduled him for surgery. Healed burn wounds with severe scar contracture are another common problem. These require a release of the contracture and skin grafting.

We are blessed with a really good OR staff that are very helpful. All the other MDs here have also been helping us get settled in.

Many of the patients can't afford to pay for their care or surgery and we have decided to pay for them when necessary which seems to be often. The average farmer or laborer works a 12 hour day 6 days a week and earns $30/month or less. Nurses here make about $100/month. Very few people have cars. A motorcycle of 125-250cc made in Asia is most common gas powered transportation.     However most people walk for transport or take minibus.

God Bless You All.
Keep us in your prayers.

Our first day of surgery went well & the patients are now in their 2nd post op day doing fine.

Yesterday we went to Saturday Market. That was a great experience with lots of new fruits & veggies to look at and buy. Also it was a great opportunity to see the people in a normal setting rather than in the clinic or hospital. We continue to love the openness and warmth of the Cameroon people.

Today we attended Mass for the second Sunday here. The students were back, all 250 of them & their singing presence was wonderful. The Priest announced that there would be a second informational lecture on Ebola for all who are interested as well as he gave some advice himself. There is as yet no Ebola in Cameroon but it is in Nigeria which is on the western border of Cameroon.  Patients come to our hospital from Nigeria quite often.

It is sunny right now and warm. The day is beautiful.

By the way, we saw glimpses of the Oregon/Wyoming game at Drs. Brent & Jennifer on the internet. Reception here is slow so it was in video "bites" that we saw at least 2 of Oregon's scores. GO DUCKS!!

We have a full OR schedule for this coming week.

God Bless You All.
We appreciate your prayers.

local produce and vendors

Rosemary and Nicholas Burket-Thoene

Shopping for clothes in market

Dr. Brent Burket & Student Sean Igelman of Medford working on HIV Research Project

We are here safely since late last Friday. Trip was long but no problems and all our luggage/supplies arrived with us. It was a long ride from Duala to Njinikom and raining off and on.  Weather here is tropical as expected and not too hot. So far it has rained every day, usually for a few hours.  We do not have internet or wifi, TV, radio or newspapers.

Our phones are useful for texting but it is taking several days for us to receive replies to our texts.  I am using a computer in the cyber center at the hospital and the power goes off frequently and I have to start over.

We have seen patients in the Outpatient Clinic every day this week and have a full day of surgery tomorrow as well as next week.  The Sisters, Doctors, Nurses and Staff are all very friendly, helpful and welcoming. The hospital equipment is quite satisfactory for our surgeries and we are looking forward to working in the OR tomorrow.  Rosemary has met with the OR staff to get acquainted and to go over our routines and equipment needs.  We brought a great deal of the supplies and instruments we will need for our time here.

We were met and welcomed by long term Missionaries Dr. Brent Burket and his wife, Dr. Jennifer Thoene. They have both been of great help to us and have worked with us daily to get oriented and settled.  They are truly a vital part of the Medical community here. Their 4 children are a joy to be around and we are getting to know them well.

More Later. 
God Bless You All
 

View from our front porch

Dr. Jennifer and Rosemary

Hospital Njinikom