Hello Friends,
This message is from my friend Dr. Appel who is visiting Koza for a week or
two. I hope you enjoy
In many ways, being in Cameroon is like a vacation. I came down from
N’Djamena with Dr. Roger and Dr. Solomon, our two congolese doctors
who’d just joined us in Chad but were chased off by the psychopathic
behavior of our local District Medical Officer who threatened to throw
them in jail the first day they arrived if he saw them in the
hospital. It’s been 6 weeks of running around trying to meet all the
requirements he’s listed despite the fact that the local Regional
Medical Officer (his boss) and the governor gave the docs the ok to
start practicing. Finally, since the Koza Hospital in Northern
Cameroon has been without a doc for 3 months, I brought them here
where we have been welcomed with open arms by all the local
authorities, the hospital staff and the local church who all keep
thanking God for answering their prayers and providing them with
doctors so they don’t have to refer c-sections an hour away over bumpy
mountain roads to the nearest public hospital which is sketchy at best
if they don’t die en route.
So, I’ve felt an oppressive load fall off my shoulders, a load I
wasn’t even completely aware of until I was in an atmosphere where
people were happy to have me and do everything to help rather than
menace and threaten and coerce and intimidate. All in all, it’s been
embarrassing because in 7 years in Chad it’s the first time I’ve ever
had a real problem with a Chadian, and to have it happen when I
finally find some young doctors willing to come and help me, it’s
discouraging as well. But, then again, Koza has it’s own difficulties
as well.
I walk into the surgery ward the first day in Koza. A young boy had
fallen out of a tree 3 days ago and cut open his upper lip. I take
off the bandage and see that the nurses have done an excellent job of
suturing what seems to have been quite a complex laceration. I notice
that besides his swollen face, the boy is favoring his right arm which
is wrapped in some rags with sticks tied together in a splint around
the entire forearm.
“Does he also have a broken arm?” I ask the nurse who rushes over to
look.
“I don’t know what that is, some traditional bone setter must have
snuck in here last night. It wasn’t there yesterday.”
The boys’ father, a short, man standing straight with a white skull
cap and a dirty blue robe smiles pleasantly and confirms the nurses
questionings.
I unwrap the arm to take a look. The arm slightly swollen and tender
over the distal radius. It seems to be reduced well. A simple
fracture.
“We can put a short arm cast on it for three weeks and it should heal
fine.” I get ready to move on, but the father says something harshly
in Mafa, his mother tongue. I don’t understand a word and look
questioningly at the nurse who looks sheepish.
“He says, no plaster. He’s had it once on his arm all the way to the
shoulder, but he didn’t bring the kid here for the broken bone, just
the cut lip. The bone setter says that in two weeks he’ll take off
the sticks look at it and proclaim it healed so he prefers that. No
plaster.”
“Did the cast work for him when he broke his arm years ago?” The
nurse translates for the father who smiles and nods while moving his
arm briskly in all directions and flexing to show he has no problems
as he spouts off some shotgun sentences in Mafa.
“He says he has no pain and can work all day in the fields for
years…but no plaster for his son.”
I spend about another 15 minutes trying to reason with the man who
just keeps smiling and refusing the nice doctor who just doesn’t have
a clue about broken bones and how fast they can heal in the hands of
the right witch doctor. I move on.
That evening I go to the ER to see a pregnant woman with high blood
pressure. She says she is 8 months pregnant and has swelling in her
legs. In fact, her legs are extremely edematous and she is hugely
pregnant. I examine her belly and while she doesn’t have pain or
bleeding, i feel the fetal presenting parts so well I’m afraid of a
ruptured uterus. She says she has been having contractions for 3
days. I bring out the ultrasound and find that there is no ruptured
uterus, but rather two healthy twins at term. With the added
complication of twins, the fact that they are at term and her pre-
eclampsia, I decide the best thing is to do a c-section, take out the
twins with as little risk as possible and treat the pre-eclampsia as
well by removing the pregnancy.
I calmly call over the woman’s mother and explain. She is
categorically against it. She says they have to wait for the father
and the husband. The husband is in Nigeria and the father is in the
village 10 km away. I nurse asks her is she has a phone number. Yes,
but her phone’s battery is dead. I borrow a phone and try to call the
husband. No answer. The nurse calls the father. No answer. I
recommend the mother go get the father so we can operate tonight. 10km
on a moto taxi is not far. She refuses. Says it’s dangerous at
night. I have them sign a paper saying they refused treatment and go
home to sleep.
The next morning I see the woman and her mom. She says she went to
the village but didn’t bring back the father. Soon the husband shows
up. He seems educated and understands my reasons for wanting to do a
c-section but says without the father’s ok, he can’t agree to it. The
mother told the nurse last night she doesn’t understand why we want to
operate. Her daughter is walking, eating, talking and doesn’t seem
sick. When asked why they came to the hospital then, she had no good
answer.
Finally, later in the morning, they take the girl home. I find out
later that they must have thought I was an idiot since I tried to show
them the edemas and blood pressure to show that the girl was really
sick. Apparently, one nurse told me that night at the house, the Mafa
know that if you have edemas, it’s because you’re going to have
twins. So I was trying to tell them the edemas were caused by a
sickness when they knew perfectly well it was just the twin pregnancy
that caused that and that obviously I didn’t know a thing and couldn’t
be trusted.
That same night, I see a 13 year old girl with classic symptoms and
signs of acute appendicitis. I sit the father down on a bench in the
ER in front of the nurse who translates as the girl writhes in pain on
the bed behind me. The father listens attentively and then tells me
that she has worms, maybe tenia, and that she needs some good bark or
roots. I explain again. He says, ok, just give her some pills
tonight and we’ll see how she does tomorrow. I’d already started an
IV and I pointed out that she was still in obvious pain. He countered
with the fact that it was probably because she was sneaking off with
some boy getting pregnant or something. Another wasted half and hour
later and I go home as the father insists that the nurse take out the
IV and let them take her home where she can get some appropriate
witchdoctor cure for what ails her.
At least one story has a happy ending as the next morning the other
family members bring the girl back saying she was crying all night
long and they want her to be operated on which we do without
complications and send her off to a hopefully speedy recovery as we
hope and pray the young pregnant girl somehow either delivers ok at
home or comes back before the twins are dead or she’s in a coma or
seizing.
But at least they all like me here…so far…