Adventures in Residency: Treating Cameroon
Walking into the Banso Baptist Hospital (BBH) in Cameroon for the 11th time, Marilee Cole, MD, DTMH, professor of medicine, expected to see what she had always seen—patients in the hospital, with doctors walking about each ward. Instead, Cole encountered something out of the ordinary: a doctor-less ward for both pediatrics and internal medicine.
Cole, who traveled to the African nation with three residents, was greeted by an extremely gracious and ten-month pregnant doctor —who informed them—that Cole and her residents would now be in charge of the three 45-bed wards.
Speechless and excited about the opportunity at the same time, Cole and her residents sprung into action. Immediately, they began walking the wards, meeting with patients and treating those who were seriously ill. “We were excited to be part of such a large initiative, but I didn’t know if my residents were prepared after such a long journey,” says Cole. “In a normal year, [we] take two days to adjust to the time zone (a six-hour change from the U.S.) and meet with the physicians on staff.” But, if there’s one thing Cole has always taught her residents, it’s to expect the unexpected.
Third year residents Geeta Karnik, Mary Radley and Rachel Kon had spent an anxious year awaiting their trip to Cameroon. To prepare for the month-long journey, the residents met with Cole each month, received vaccinations from Georgetown’s travel medicine clinic, raised funds to cover the cost of the trip, and familiarized themselves with the tropical diseases they would treat. For fun, Cole even created a crossword puzzle about tropical diseases for the residents to complete. “We work extremely long hours to prepare for the trip, so we’re always ‘ready for battle’”, says Cole. And, it’s certainly a battle of diseases the residents were ready to help their patients fight.
At BBH, the residents not only treated neglected tropical diseases, but also HIV/AIDS, which is the most common condition. “Nearly eighty percent of the patients have HIV/AIDS,” says Cole. “It’s an astounding number of patients.”
While Cole, Karnik and Kon first traveled to BBH, Radley went with Georgetown University Hospital HIV specialist, Charlotte Barbey-Morel, MD, assistant professor and director of pediatric infectious diseases, for one week to a smaller campus of the hospital in Mutengene, Cameroon. Both Radley and Morel worked in the pediatrics and internal medicine wards at the sister hospital. During the morning and afternoon rounds, Radley had the opportunity to diagnose and offer treatment options to pediatric patients, learning of many diseases she hasn’t treated before. “I saw many cases of acute abdomens, Burkitt’s lymphoma and Epstein Barr—all things which are common in Cameroon but less so in the United States.”
Radley also recounted a memorable experience she had when she traveled to a rural clinic site in Jikijem, Cameroon. “One day, a lady came into the clinic with what appeared to be masses protruding from her abdomen,” she says. “She told us it has been present for 40 years; we thought it may be a form of tuberculosis or another parasitic disease.” Radley, who did not have the equipment to exam the patient at the rural clinic site, referred the patient back to her colleagues at BBH, who were ultimately able to help the patient. “Upon examination, we found she had a hernia. We were able to successfully repair her hernia, so she could finally walk, and resume a normal life.” The patient was so happy, says Radley, that she was still smiling the next day.
After one week in Mutengene, Radley joined Cole and the other residents at BBH where they had been in charge for only a week and faced many difficulties. Some of the difficulties included limited resources, little access to prescription drugs, a high-volume of patients and language barriers (nearly 270 tribal languages are spoken in Cameroon).
“The hospital had very few medical tests available which makes it hard to diagnose and manage cases,” says Karnik. The opportunity to make clinical diagnosis with limited resources ultimately taught the residents about the challenges of providing health care in a developing country. There to assist the residents was an unexpected resource—the healing power of the family
“I treated a young patient with Stevens-Johnson syndrome, and even though he was in extreme pain, his family never left his side,” says Kon. In Cameroon, patients are assigned a caretaker, usually a family member, who will often bathe and feed the patient, even sleeping underneath their hospital bed just to be by their sides.
“The caretakers are very patient, tend to the needs of the sick family member, and are incredibly proud of the doctors who do their best to help,” says Karnik. “It’s extremely powerful, and motivating.”
Cole says that this group responded to more calls and patients than any other team that has traveled with her previously. “Despite the long hours, and little rest, they were always willing to do more work,” says Cole. The residents are extremely grateful to Cole for preparing them to meet the demands of the hospital. Each of them speak so highly of Cole, it’s no wonder she received honorary titles from the hospital. Cole will return next year for her 12th medical mission with a new group of residents, but will certainly never forget the high standard of performance set by the Cameroon Class of 2010.
By Tressa Kirby, GUMC Communications