Today I was cleaning out my kitchen cupboards, to see what I need to use up in the remaining 6 weeks at Mbingo, when Fervent arrived at the door. I told him to scoot, because I was busy with work, getting ready for going to Canada. About half an hour later, Godlove came tearing across the compound, shouting “Auntie, auntie, Fervent says we’re going to Canada – when does the plane arrive?” I guess they were expecting it on the airstrip any moment, and Goddie was already packing up for the journey. This was one of many visits from children today. The first was from Goddie who at 6am, just as I opened my eyes, began to shout “Auntie, auntie” at my window. Who is going to do that in Canada? Maybe I should take them with me.
The last 5 weeks have been a sort of nightmarish, never-ending story of shingles. Life has consisted of pushing myself through class each morning, staying in recovery room with the students as long as I can manage (trying for noon at least), and a great deal of sleep. Today I did have a bit more energy and actually got a few things done. There’s a vaccine against shingles – for any of you of my vintage, I can’t recommend it too highly!!! It would be WELL worth getting.
The students are doing pretty well, despite the lack of attention from their teacher. They do well in recovery room and are a huge help to the anaesthetists who really could not get through the day’s work without the speeding up that recovery brings. As well, most patients are going back to the wards stable, and with good pain control, so this course has been well worthwhile.
Rains are becoming less, in both frequency and in amount. I had forgotten, but as dry season comes, the haze over the hills increases – to my disappointment. The lovely clear views of the hills that we quite often had during rainy season are no more. Last rain should be about November 15. Already the sun is very hot at midday – but the evenings and mornings are cool. The locals are complaining of cold, and wearing jackets and sweaters more.
Two weekends ago, I went with Dorcas to her farm, where she had allowed me to help her plant the corn. That was 2 months earlier - and now the corn is well above our heads. Her farm is on a very steep slope, but the soil must be fertile as both the corn and the beans planted amongst it look very good. She is happy.
Today I had the energy to visit Bruno, a longtime hospital employee who among other jobs, prepares the coffee. He has been around the whole compound, picking the coffee beans off the bushes that grow here and there. Down at the hospital farm buildings, he has a large concrete pad where the coffee is drying in the sun. Then it has to be shelled, roasted, and ground – all of which I saw this morning. Then it is carried across the highway to the provision store – where I was able to buy another ½ kg this morning. I love the Cameroonian coffee and will miss it.
Sonel, the national electrical company, did not supply NW Region for over 3 weeks, because a new transformer was being installed. For my students, all of whom live “in the bush” – i.e. off the hospital compound – this was a real frustration because there was no light for them to read in the evenings. During last week Sonel began to function again, but in its usual erratic way. For 3 nights this week, there was not enough power reaching my house to fire up the fluorescent bulbs. They would either do nothing at all, or flicker endlessly in a manner that made me feel like I was about to have a seizure. It was probably good that I felt so sickly, as about the only thing to do was go to bed – my eyes are long past the age when they can read by candlelight . Last night, thankfully, after a weak start, the lights did come on – and tonight seems to be ok too. Running the 2 generators here for over 3 weeks will have cost the hospital a huge amount, as well as being so much work for the electrical techs – but it was sure nice for us living here to have such consistently good electricity.
Have been off work for the past week, which has been largely a blur of sleep and getting up to take large anti-viral pills every four hours. From Oct 5 on, I did not feel good and had an odd headache – unusual I realized because it was only on the left side of my head. On Saturday, I began to break out with the rash of shingles on my forehead, and from Sunday until really yesterday, Thursday, I have felt quite miserable. Tonight though seems a bit closer to normal, so I hope the progress continues. Thank goodness for the antiviral being readily available here (because of all the AIDS patients, I’m sure) and that I realized early what I had and got on the drug – the rash subsided without ever blistering, and my eye was never troubled. But with sleeping 18 hours a day, I did not accomplish a whole lot.
There are signs that dry season is coming – more wind, and we have gone a couple of days in a row without rain during this past week. The week before, it poured buckets every single day, and we only saw the sun parts of two days. My garden looks good – great cabbages coming along – and I am eating my own beans now. It’s great.
One of the previously trained nurse anaesthetists from here is now in medical school in Ghana – Ernest. Ernest had been reading this blog, unknown to me, and saw the photo of three of my current students, and realized they were his good friends. So he phoned Faith, from Ghana, to greet them all (he and Faith had been ward auxiliaries here together a number of years back). I thought it was such a neat story. Greetings, Ernest, when you read this! And know that you are held in very high esteem back home here in Mbingo.
The OR has been extremely busy – complex cases, long hours. My anaesthesia students / interns are really struggling with the amount of labour being demanded of them, and I can understand. The OR would not run without them though. The number of surgical residents continues to increase every year, without a parallel increase in OR staff, or ward staff – and it does not work very well.
The recovery area though is helping a lot. Patients are moved out of OR a lot faster, and then are properly recovered, and given pain medication adequately, so they go to the ward usually quite comfortable. I am very happy with my RR students, but also with the general team attitude between them and the anaesthetists. I cannot say enough good things about these people – they are team players, cooperative, collegial, with real commitment to good patient care. It is such a pleasure to work with them. I forget how the saying goes, but it essentially that in any business, what matters is “who gets on the bus” – and we definitely are blessed with the right people on the anaesthesia / recovery room bus at MBH.
A week ago, last Friday, we had a very heavy day. Sometime well after 2pm (the official end of shift), I sent my RR students home, and stayed to recover a little boy who had had a big abdominal surgery. He took forever to waken, so while I was sitting there, David who was on call for the night wheeled a small howling boy in for me to “babysit”. It turned out I knew this little fellow, Bryan, from recovering him a few days before, after surgery for severe Hirshsprung’s disease (absence of nerves in the colon which therefore does not function properly). Now he was having obstruction again, and was hot and very sick – and very unhappy to be taken from his mother. I remembered him from the first time for his beautiful smile – and indeed, once I got him comforted, and more comfortable with a little morphine, the smile returned. Then he began to take quite an interest in the other little boy. Bryan is 6, the other child, Bolshi was 8. Unfortunately Bryan is francophone only – and I Anglophone only – so our communication was charades, but it was a pity because he obviously a very bright observant little boy who was making many comments about things. He was fascinated by the NG tube that was draining Bolshi’s stomach – and not frightened as you might expect. And then he reached out to touch Bolshi. I pushed their stretchers together, and Bryan reached over and took Bolshi’s hand to greet him, as any good Cameroonian should do. It was incredibly sweet to watch. In a bit, Bolshi did finally surface, and was able to realize that another child was there, greeting him, and to respond, before I sent him to the ward. The next day when I went to see how Bryan had fared with his surgery, he gave me his beautiful smile, and pointed a few beds down the ward to where Bolshi was. I now have not seen them all this past week, but think I will feel good enough to go over tomorrow. I just hope they have both done well.
Goddie’s little brother did arrive – his name is Rooney and he is just a beautiful baby. I am so thankful he arrived while I was still here, so I have been able to see the newest small Middle Quarter neighbour.
Time is flying, and I am way behind with news from here. We are already at the end of week 3 of the PACU nurse course – ¼ of the way through. My 5 students are experienced nurses, even though a couple of them have had only 3 months of formal nursing training. They are hard-workers (one of the main criteria for choosing them), and committed to their job, and they are a pleasure to teach. I find I’m having to translate all the physiology into very practical terms, rather than present it academically – but that is not a bad exercise for me either, and really rather fun, especially when I see comprehension come across their faces as they realize the “why” of something they have been doing for years. Interestingly though, they are being given a very bad time by other nurses on the ward, who are jealous because this group are being given more training. I am inclined to go and tell the persecutors that their behaviour is precisely the reason they were not chosen for the training! But so far I am just teaching the class for an hour each morning, and then taking either 2 or 3 of them at a time into OR to work in the recovery area, while the others go to work on surgery ward.
The nursing supervisor has been very helpful in already ordering work to start on a few renovations to an area of 4 beds on surgery ward which will become our “high dependency unit” for the sickest pre- and post-op patients. I hope I get to see it functioning before I leave, but if not, at least it will be underway, and the anaesthetists can take over its supervision.
The beginning of week 2, we had a graphic example of why a recovery area is needed. A woman who had had a hysterectomy, done as usual under spinal anaesthesia, dropped her blood pressure about 15 minutes after coming to us in recovery area. Her spinal was still very high, so at first I assumed that was the cause, but when she did not respond to the usual treatments, I called the surgical resident. Fortunately he is our best, and listens, and with a little prodding from me and from the head anaesthetist, he took the patient back into OR and found 2000ml blood in her abdomen, from an artery that had come unsutured. In the four weeks between the end of the anaesthesia course, and the beginning of the PACU course, there was no functioning recovery room because of inadequate anaesthesia staff; this woman would have been sent directly from OR to the ward, and almost surely would have died, because nobody on the ward would have recognized her distress until she was almost dead. It certainly impressed my students that their role was critical (I was impressed too). We have also had 2 young children die in the past month during the night after their surgery – why, nobody knows, only that they were “found dead”. Clearly the HDU is also badly needed, with better staffing and more knowledge and more monitoring, to prevent these needless deaths.
There has been an influenza epidemic here at Mbingo the last few weeks. I was flattened last week for a few days, which I guess is one reason there has been no blog. Several of my friends had been sick, and all said they had malaria, and had taken the appropriate treatment. When I began to have chills and the aches, I wondered if I was going to have my first dose of malaria after 4 years in Africa – but soon realized that the respiratory symptoms were a true influenza. Some of the surgeons were talking about this, and said that in fact flu feels for all the world like malaria, with which of course every African is only too familiar – the headache, joint pains, fever and chills, GI upset, general malaise – they call malaria the great imitator. The drugs to treat it are apparently diabolical too – usually people say the treatment is even worse than the disease. How bizarre it is, that billions have been spent on HIV in Africa, and hardly anything on malaria, which is the biggest killer of any disease worldwide.
There was a wedding in church 2 Sundays ago. The bridal party came in at the beginning of the service, then the church service carried on as usual, but with an interlude in the middle for the saying of the vows. At the end there were the usual wedding things – speeches, presentation of the cake with all its symbolic colours (green for growth, purple for nobility, gold for eternity, white for purity, etc) and the shared “first chop” as the couple fed cake to each other, and finally the celebratory gift-giving as everyone sang and danced in a long line to the front of the church. And then of course there was FOOD. Weddings here are really fun, a truly joyous time in what is otherwise a pretty humdrum life.
School is finally starting to settle in, I think. My vegetable lady has still been in Mbingo market, but said she was starting work at her school this week. A few kids are coming to me with school work. Felix is a boy in class 6, the son of a single mom who I suspect cannot read herself – he needs lots of help with reading, way more than I have time, or skill, for. Salamatu, my little Fulani friend, is also in desperate need of reading help – she really has hardly a sniff even about sounds of the letters and she is already in class 4. Much of this is because she speaks no English at home and receives no help. And Norrin and Becky who live behind me in Middle Quarter started coming this week for help with English; they are in form 1 (like grade 7 at home), and actually seem to be doing well. They are attending the government secondary school that is 2 km from here, and it is interesting hearing how things are done there. I helped them last May with spelling and English and they seem to have made progress since then and seem much more grown up, even though they are only 11. They were laughing at my accent – they have been taught with a good British accent, and even when I try to use a Cameroonian accent, they think I sound really funny – which I do. They are fun to be with – the other kids are hard work!
Stephen’s wife who attended teacher training school last year did not get a job at Mbingo 1 as she had hoped. So yesterday she went down the road to the small government school in Muguh, and was given the 14 students in class 3 and the 14 in class 4 – for which she will be paid 15,000cfa (about $35) a month!! She is happy though, as this helps her keep up her newly learned skills, and will give her an in at getting a government job next year.
Goddie has developed a fixed idea that he wants to be a whiteman. He and Fervant and I skyped Auntie Jan on Saturday, and his greeting to her was “Auntie Jan, I want to be a whiteman so I can come to Canada and help you!” We are trying hard to convince him that we like him very much just as he is and that he most definitely does not need to become a white man to come to Canada – but so far, we don’t seem to be convincing him. His new baby brother or sister is due to arrive any day now, so maybe that will distract him from the whiteman idea!
School began this week – and suddenly the neighbourhood was a lot quieter, just like everywhere in the world. I spent all week working seriously on the next class – for recovery room / high dependency area nurses – which is starting tomorrow morning.
Monday morning last week was about as dismal as it could be – just pouring rain. I felt so sorry for the kids, walking miles in some cases to get to school. It was altogether a very wet week – no sun at all until Saturday. On Friday afternoon, we had almost 5 cm of rain in just over an hour. It was just as the kids were heading home from school, so 5 took shelter on my veranda, where I planned to leave them…..but then the wind started and the rain began to travel horizontally – so in they all came, along with one adult who was also stranded on my veranda. After a while, two more small heads appeared at the window – two drenched small boys also came in. They were all kids I know well – so I got out the “twister” game and it turned out to be quite a hit, and filled in the hour until the rain was gentle enough that I felt not too mean in throwing them out to make their way home. That evening, about suppertime, the rain hit again, this time with even worse wind. Rain on the zinc roof makes a horrendous noise, and with the wind too, it sounded like the storm was going to come right through the roof. By morning the total in the rain gauge was 11 cm!! Thank goodness this soil seems incapable of being saturated with water – or we would all drown. September is the month of really heavy rains storms – less total rainfall than July or August (when we get about 30 inches a month), but it comes in bigger cloudbursts – so it is the month of landslides. I can believe it after Friday night.
The way the school system functions here is quite something for a westerner. Last Saturday in market, my vegetable lady Esther was still waiting to hear if she had obtained a government teaching job (she trained 3 or 4 years ago, and has been applying ever since for a job). This Saturday, Esther was not in market – another woman had her stall (and less nice vegetables, alas!) – and she tells me that Esther was assigned to a school, far away. You can only imagine how prepared those teachers are to start teaching! The government way of doing things has a major effect on a privately run school like Mbingo 1 as well. Many teachers seem to apply for the government jobs, because of better pay (although reliability of payment is rather questionable). We have 9 teachers here, and this year, 5 of them got government postings – this news came on Tuesday, the day after classes began. I met the headmaster that day, and he was very disturbed, and said his head was just hurting, trying to plan what to do for all the youngsters who were already coming. But today I saw him, and they have other applications, and he thinks they will be able to have a good group of teachers in place shortly. He himself had written the government entrance exam for nursing assistant training (even in government schools, teachers are paid badly compared to nurses), and he passed. But he also had his name in for a government teaching job, and he got that too. The nursing training costs almost $1000 Canadian for the year – an astronomical sum for anyone here – so he has decided to go with the government teaching job. And thankfully, it looks like he will be assigned to Fungeh school, which is just a 20 minute walk from Mbingo, so he will be living here and can advise the teachers at Mbingo 1 school, and, he said, maybe even help with some afternoon classes for the final year (grade 6) students. Sounds about as good a situation as we could have hoped for. But still – what a difference from home, where my teaching friends have been setting up their classrooms and making teaching plans for the past month!
Yesterday my Fulani friends appeared. I had arranged for Salamatu to come to Mbingo 1 school this year, and wondered where she was. It is Ramadan though, so that may be a factor - but she and her small brother Osmanu are going to be starting in class tomorrow. They stayed here while their mother went to market - we played the Memory game, and considering Osmanu knows very little English, they did pretty well. Kids here have no games of the sort we have - so it takes them a while to catch on - but once they do, they LOVE to play, and it is lots of fun to get them going and then watch them. Some of the older kids want help with school work now. There are not enough hours in the day - or energy in the body, alas!
I have just killed the biggest spider I’ve ever seen. He must have been 3 inches across, all black and hairy. Ughh! He was on the kitchen wall, up above the cupboards, so fortunately I was able to grab the Raid, jump up on a chair and get a good aim at him. The joke here is that Raid bought Africa actually kills bugs – but this fellow took a lot of sprays before he succumbed. He fell into a wicker basket on top of the cupboard, but kept trying to climb out and get away. At last he became semi-comatose and I was able to get the basket – and him – out the back door and squish him on the back step. The unquieting thing is – how on earth did he get into the house? Until 6 weeks ago, I had no screens on my windows, but now I would have thought the house was fairly bug resistant. Ah well – I am extremely happy that I sleep all enclosed in my cozy mosquito (or spider) net.
Last Thursday I went planting corn with my friend Dorcas on her farm. The farm work is so much a part of every woman’s life here – even for the women who nurse or do other jobs at the hospital. Salaries are too low, and food costs too high, for any family to manage without growing a substantial amount of their own food. Dorcas has a plot of land that belongs to the hospital but is leased to her. It is down in a deep small valley, with a little stream running down the center – and the land itself is on a steep slope. Her rainy season corn had been harvested, and she had had a woman clear the land for her, and make the ridges of earth, about 2-3 feet across, into which the corn and beans are seeded. The ridges keep the seeds from washing away in the heavy rains (which will continue through Sept and Oct) and allow some drainage of the land.
We made our way through some dense bush (mostly bamboo and elephant grass) down a slippery little path to the farm. There were four of us – Dorcas, me, Doris the housegirl, and Dorcas’s niece who is 14 and has lived with Dorcas since infancy. We each took a pocketful of corn kernels, and each took a cutlass to open the soil – and in went 2 seeds to each hole. It is quite a lot like planting potatoes is for us. The girls all went barefoot, and I probably should have too, but there were a lot of ants, of the biting type – so I just let my running shoes get muddy. We worked from 8 until almost 12 when it began to rain, but fortunately it was just as we finished seeding all the mounds of earth. The girls had brought the beans too, which are just planted in amongst the corn, but seeding those was left for another day.
The rain started to really pelt down, making the steep little narrow path out of the farm really slick. Dorcas was wearing flip-flops on her feet, and was carrying a big stick of wood that she was taking home for her fire – but she put the bag of beans on her head, leaving one hand free to reach back behind her to pull me up the path!! These people are amazing.
It was a great morning. I felt honoured to be allowed to go with them to plant, and they were very gracious to let me actually work. I hope I got the seeds in right – it is so important that the corn grows and that the crop is successful. In a couple of weeks it will be time to weed the field, so I hope I can go along with them for that as well. Dorcas says that maybe the corn will be ready so I can eat some before I leave in December. People here are very fortunate that they can grow two crops a year. The rainy season corn and beans, and groundnuts, were planted back in April, and have now been harvested – and now people are planting even more things, corn, beans, yams, plantains, and so on. It is constant work, but many of the poor rural people do not really need to buy much for eating beyond what they can grow.
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