Banso Baptist Hospital - My elective (Cameroon)

Member Name: Ric!

Product:	Cameroon
Date:	26/05/01 (1396 review reads)
Rating:

Advantages: Beautiful Country, Welcoming People, Fufu & Jamma Jamma - their traditional food

Disadvantages: In the big cities, people are desparate and will try to con you.

In October 2000, I spent 6 weeks in Cameroon, with a colleague, as part of our medical training called our 'elective'.

It had taken months of forward planning to arrange our elective at Banso Baptist Hospital, in the Republic of Cameroon, followed by four weeks travelling to see some of the highlights that Africa has to offer.

After a pleasant flight to Douala in Cameroon, via Paris, we were greeted at the airport by..... nobody. Our worst fears seemed to be coming true. Here we were, in the World's Most Corrupt Country (1998), and we were on our own. After about 45 minutes, a representative from the Cameroon Baptist Convention finally arrived, but not before we had been surrounded by 5 men and 'heavily' persuaded to part with £10 worth of money. Thankfully this was all the loose change we had in our pockets. The rest was tightly rolled up and zipped inside our travel belts. Credit cards and travellers cheques were to be impossible to use where we were going so carrying money was the only option.

Our representative escorted us to his vehicle - a semi-destroyed ancient Datsun with a cracked windscreen. On route to our first stop, a Baptist Rest House, children came and begged at our windows when we stopped along route. The roads were appalling. We dodged around huge crater-like pot holes, occasionally driving into one of them, and seeing the crack on the windscreen snake across the glass as it got larger. This was it - we had arrived in the Third World, and this was luxury compared to where we would end up. Around the hospital, there was no tarmac on the roads, and burnt out cars and even petrol tankers were a stark reminder how complacent we are about being safe on the roads in the UK.

After spending a night in the Rest House in Douala, we began the 6 hour journey to our next stopping point. But, ten minutes down the road, we were ushered out of the car and put on a bus. We were then left on our
own, with the assurance we would be met at the other side. In Cameroon, the buses don't leave until they are full. So we sat on it for 2 hours before it finally left. To say that the next 6 hours were uncomfortable would be an understatement. What with a baby crying, a woman being sick in front of us and the vomit flooding back to our seats, the sweltering heat, and passing through a police check every 20 minutes or so (remember this is a corrupt country), I can honestly say I have been on nicer journeys. Add to all this the fact that we had an underlying fear in the back of our minds that we wouldn't be met at the other end, and it becomes evident that these first two days didn't exactly get our trip off to the best possible start.

The one thing that made the journey bearable is that at around about the halfway point we started talking to elderly man next to us. I could tell there was something different about him by the way he spoke perfect English. The Cameroonians assume that if you are white and speak English, then you must be American. This has come about from many years of American missionaries in the country. The gentleman we met was most excited to learn that we were from England and he launched into his memoirs about the days when he fought as part of the Queens Infantry, when the English sent troops over to defend the Cameroonians from the French Invasion.

Our relief was immense, upon arriving in the town of Bamenda, when we saw a minibus with the words "Cameroon Baptist Convention" on the side. We knew that for the next 6 weeks, at least, things would be fine from then on. We stayed the night in another Rest House before leaving the next morning for Banso Baptist Hopsital. It would take another 3 hours to arrive there.

Throughout our journey we were struck by the beauty of Cameroon. We would pass through lush green banana plantations, outcrops of rocks with plentiful waterfalls streaming downwa
rds, and all around us were many people, all with wide beaming smiles, getting about their work on their land. We also passed through many settlements along the road side. Dirty, squalid conditions, and run down patchwork homes seemed to be the norm for many people.

We settled in our accommodation that afternoon, and went up to the hospital the next day. We were welcomed with such warmth and appreciation, that it was quite a surprise. After all, we had ASKED to go there for OUR own benefit. Yet it would soon become apparent that we would actually be of immense benefit to the people there.

Banso Baptist Hospital cannot be compared to hospitals in the UK. But it is a very good hospital in Cameroon. It has a reputation as being one of the best. People would travel for up to a day to get there and be seen. Some would even cross the border from Nigeria to consult a doctor. There were certain things that BBH did not offer. For example, certain drugs, like ACE inhibitors, Proton Pump Inhibitors, Amphotericin B and many Chemotherapy drugs would all have been useful. They could be obtained at the Government Hospitals in large towns. However, such was the reputation of BBH that even people in the capital city, Yaounde, would travel for over 10 hours, when the government hospital couldn't help them.

The building was structurally solid, but old. The beds, sheets and equipment on the Florence Nightingale style wards all needed replacing. There were strange concepts we had to get use to. We couldn't admit anyone unless they paid a sum upfront. They also had to have a carer, who could bring them food and supplies (there was no such thing as hospital catering). We couldn't admit someone for a surgical procedure unless they brought at least one other person as a blood donor with them.

We were treated as doctors there. Initially we declined the responsibility. "No, I'm not a doctor, yet. I'm still a stu
dent," we would say. "Ah, okay doctor", would come the reply. After about a week we were expected to conduct our own ward rounds, to do outpatient clinics and to be the only person on call for the whole hospital at night time. This was the only expectation that we really had to put our foot down on, and decline. It was one thing to do ward rounds and out patients clinics on our own. If there was something we were not sure about, we could hunt down one of the qualified Cameroonian doctors and ask their advice. There would always be someone to ask, somewhere on-site, it was just a case of finding them. But we felt it unfair on the patients to do the on-call overnight on our own. This was met with some disapproval. It was certainly made clear to us, in a nice way, that we should be doing it. The American medical students and the Cameroonian medical students always jump at the chance. Overconfidence is dangerous, though, I believe. The Cameroonian medical students even do surgical procedures like appendicectomies and Caesarean sections, which is quite unbelievable. A senior scrub nurse who had been assisting at all surgery for over 20 years had even recently started doing operations as complex as hemi-colectomies on his own!!

We spent our 6 weeks at Banso Baptist Hospital working 6 days a week, from 7am until about 4-5 pm. Our day always started with a ward round in the morning. After this, all the doctors would meet up for coffee until heading to the out-patient's department at about 10:30 to 11:00. Taking a break for lunch at some point, the rest of the day would be spent at outpatients, seeing a phenomenal number of patients each. During our time there we rotated between the Men's Ward, Women's Ward and Paediatric Ward. We also went out in a 4x4 jeep to a clinic where the doctors only go once a month. On that occasion we saw and diagnosed a new case of acromegaly. It was classic text book stuff. A lady with chan
ge in her appearance, increase in size of her tongue and feet, with wide spaced teeth, a deepening of her voice, headaches, hypertension and muscular weakness. We couldn't do anything for her except tell her that she really needed to come to the hospital to get some treatment. It had taken us 2 hours in the jeep, and she would have to walk if she wanted to get there. The only treatment available for acromegaly was the dopamine agonist bromocriptine. Realistically, we knew there was no way she was going to get to the hospital, and even if she could, it would be unlikely that she could afford the drugs.

We saw many interesting cases at BBH. It was a huge learning curve. We felt more livers and spleens at one outpatient clinic than in our entire clinical years as medical students. Soon we became accustomed to the most common presenting complaints. Tuberculosis, HIV, and Malaria were among those that we encountered most frequently. We learnt to recognise other tropical diseases, too, particularly filariasis. With 50% of the inpatients being HIV positive, many of them presented with HIV related diseases. The vast majority of the TB cases were HIV positive. Cryptococcal meningitis was quite a common presenting condition, and we saw several cases. While we were there some results of the India Ink stains on CSF came back surprisingly negative, only to be later confirmed as positive. It turned out the lab staff had been trying to use Parker Washable Blue Ink as a substitute to the expensive India Ink!

The situation with Cryptococcal meningitis was actually quite a hard one to deal with. In many cases, not only did we have to tell the patient that they had been found to be HIV positive, but also that they had a fungal disease which could be treated, but at a cost. There was some controversy here. There was no Amphotericin B, so the only treatment available was Fluclonazole. Unfortunately, this was extremely expensive. Bearing in m
ind that the patient would need 2 tablets a day for 6 weeks, then one a day for the rest of their life, any treatment was going to expensive. However, fluclonazole cost £10 per tablet for the patients. Seeing as their hourly wage averaged about £0.10 per hour, it can be seen that they must work for 100 hours just to buy just one tablet. When you consider they need 2 tablets a day for 6 weeks, that makes £840. This means that many can't afford it, and for others their family must make an agonising choice as to whether to use up all their savings when their loved one has a terminal disease anyway. I was told by one of the Cameroonain doctors not to even mention to the patients that there was a treatment available. I was told it was not fair to make them choose between a loved one, who was destined to die soon anyway, and their savings, which were probably essential to the numerous other family members that they had. However, I believed that it was a patient's right to know that there was a treatment available for them, even though they may not be able to afford it. I still don't know what the solution to the situation is. However, I still haven't forgotten the look on a young man's face when I explained to him that there was a treatment available to give him temporary relief and extend his life expectancy, but that he would need 840,000 CFA (£840) just for the first 6 weeks worth, and then 10,000 (£10) a day for the rest of his life. He insisted he would get the money, but that it would take some time. When his sister came in and heard the news, the look on her face told me that there was no way they could raise that sort of money. It left me feeling bad that I had given him false hope and a sense of despair. But I feel that patients deserve to be told the truth. Why does the hospital keep the drug in stock, if the doctors aren't going to prescribe it and the patients can't afford it? It was important for me that I knew I had
given the patient all the information he was entitled to, and for him to make an informed choice. I didn't want to condemn him to an early death if he did have the money tucked away somewhere.

We encountered these sorts of dilemmas frequently. We saw patients whose family had abandoned them because the hospital bill was too high. Take thecase of two tetanus patients. One had been in hospital for 6 weeks. His bill was £180, and he couldn't pay it. So, one day, he absconded and went back to his small village far away. The hospital sent a security guard on a 12 hour return journey to bring him back. When we left BBH, he was sitting on Men's Ward, staring into space. He is not ill anymore, yet he is acquiring more bills from being back at the hospital, with no prospect of paying the original bill, let alone this new one. The second tetanus patient had a broken leg. His family had abandoned him at the hospital when the bills got too high. He was then put on a side ward. He couldn't abscond because he was hobbling around on crutches, yet he had no family around to bring him food. He was literally starving in the hospital. He would beg us for food every time we passed him. Eventually, we took the whole side ward a large bag full of fruit to share. It had only cost us 50p. But we just had to come to terms with the fact that this was their way of life. We couldn't help everyone. Just because we were "white doctors" from a "rich country", we couldn't change everyone's life, and sometime it felt like patients expected us to.

Several months before going to Cameroon, we had written to various drug companies, medical suppliers and bookshops, asking for any donations they could spare, that we could take to Cameroon. The response was good. We received medical text books, pens, sutures, IV lines, dressings etc. It amounted to about 4 large boxes full. Air France had said they would take an ext
ra 10 kilos free, and we were going to pay for the rest ourselves. But then we had another email from a medical suppler saying that they had some sterile gloves we could have. This seemed like a good idea. We knew from the Wards at St. George's, just how expensive they were. "Do you really need to use those sterile gloves - £1.12 per pair, compared to 12p for non sterile gloves," as the sign says on many a wall. We communicated by email for a while. It emerged that an anti-oxidant in the latex had turned the gloves pink and thus they were unable to be sold. However, this had not affected the quality of the gloves. This sounded all very good, until they asked us how we planned to transport the gloves. I emailed back and said I would pick up the gloves myself in my car and take them on the plane with us to Cameroon. The response to this was shocking. The amount of gloves they were prepared to donate was over 100,000 pairs, taking up 21 cubic metres and weighing 4 tonnes, worth over £100,000.

With so little time to arrange anything, and our written finals fast approaching, we were torn about what to do. This really was simply too good an offer to turn down. As we were to find out later on, at BBH, they actually wash, dry and reuse gloves, so these were to be of immense benefit. With assistance, we arranged for a container to be sent on a ship from England to Cameroon, containing the gloves. It was arranged through a charity, so we got preferential rates on the shipment cost. The charity transported the gloves to the container themselves and filled up the rest of the space with wheelchairs, crutches and second hand clothes. As things went, we left BBH a few days before the container arrived. However, it all arrived safely and the hospital were extremely grateful for our efforts. We were guests of honour at one of their evening meals and they bought us traditional West African attire to wear and keep.

All in all, it wa
s a brilliant time. We felt valued and appreciated and we certainly weren't expecting that. We had gone there for our own reasons, and as it turned out we had actually done some good. If we weren't there, many of the patients in outpatients would not have been seen at all. It was a valuable learning experience for us. Before we left, one of the surgeons, an American missionary said to me, "You'll be back. This place has a magic about it." I know she will be proved right. We will definitely go back.

The time I spent in Africa has been the most rewarding time of my life. In some ways it has been a life changing experience. My values and priorities in life have altered somewhat, and it is due to the people I met and the places I went to. Cameroon may be a third world country, but the people are No. 1 in the world. Their attitude towards their own hardship can only be admired.

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