Jo Weddle, M.D., recently completed her surgical residency at Baylor University Medical Center at Dallas. She is currently on a medical mission in Africa, where she is researching the impact of trauma on patients, families and physicians at Mbingo Baptist Hospital. This is one in a series of blog posts by Dr. Weddle.
After seven long hours, including torrents of rain, we arrived at Mbingo Baptist Hospital from Douala.
The scenery is breathtaking. The hospital is at the base of a ridge that is covered with waterfalls because of the rainy season, which is no joke. It has rained every day since I have been here, frequently all day.
Mbingo, Cameroon, is well known for the hospital and people come from all over the country to be treated here. The road from Douala, where I stayed my first night, to Mbingo is paved nearly the entire way, but it has frequent potholes that threaten to swallow cars and motorbikes whole. Largely, people seem to follow the taxis and snake through the pavement the same way they go.
The hospital compound is rather large and there are about 400 beds. As I anticipated, the health care system here is quite different from the United States. No patient is to be admitted without a caregiver (family or friend) because the nurses are so overwhelmed and are only able to distribute medications and take vital signs. They also do occasional dressing changes, but the best bet is for doctors to do them on our own.
The beds are about six inches apart and the surgical ward has between 65 and 75 patients, depending on the number of stretchers parked in the hallways. Patients do not leave the hospital compound until their bill is paid, even if that means they and their caregiver must stay to work for the hospital in a sort of trade position. You might think this would cause discharges to come to a screeching halt, but in fact people come and go rather quickly.
I started in the surgical ward with Dr. Jim Brown the day after I arrived. He runs the Pan-African Academy of Christian Surgeons (PAACS) surgical program and has been here two years. There are 10 surgical residents, from multiple surrounding countries, including Cameroon, Congo, Sudan and Uganda. They do a five-year program, with a much heavier emphasis on urology, gynecology, and orthopedics than U.S. programs.
When I initially started, the variety of cases was a bit daunting. My first day included prostate surgery and hysterectomies. After the initial shock, I have started to settle in and am quickly learning a lot of new skills.
Each day starts with chapel in the morning, followed by rounds. Then it’s on to the operating room for cases.
Each day has about 20 or so general surgery cases divided between two or three rooms, depending on the availability of anesthesia. Patients are rarely intubated and we move quickly through the schedule each day.
There is one other mission surgeon, who also just graduated residency, so it has been helpful to compare notes with someone else who is in my same boat. We frequently find the same challenges in the day-to-day work flow.
Some of the most difficult challenges have been with a lack of functional equipment, including things as simple as a pair of scissors that cuts without falling apart. Gowns are cloth, which is difficult in the rainy season, because there is no dryer so things must dry outside. For messy cases, such as perforations or cesarean sections, a butcher apron is recommended to keep your scrubs clean.
I started taking calls earlier this month and I am working on organizing the intensive care unit space, so my hands are full. All of the residents are interested in research as well, so we are running multiple brainstorming sessions every week and we are working to organize several proposals.