AMA

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...