True Religion?

The Mass readings these weeks have been from the book of James, who has a lot to say about what it means to live our Christian faith.  One of the things that is inescapable in Shisong is the degree to which religion (not only Catholicism) permeates the culture, and the fervency and apparent joy with which it is observed.  One of the visitors that I have spent time with in Shisong doubted the faith of many of the people here.  This individual felt that much of the fervency and enthusiasm expressed in the Catholic community was based on the culture and behavioral expectations rather than true love of Christ or belief in God.  In her country, the cultural aspects of faith have largely disappeared, but she feels that those that practice their Catholicism are sincere because those without faith simply don’t bother.

Being here for 5 months certainly does not make me an expert on anything, and I am not inclined to judge the faith of individuals or a community in any case.  However, it could be interesting to share a few observations.  I think that nominal faith and participating in a faith community for social reasons exists everywhere and in every faith and philosophy.  Even in countries where there is severe persecution it is possible that people seek martyrdom for the wrong reasons, although you might suspect that there is less “acting” in a community where the faith costs much.  In Shisong, the Catholic community is served by Capuchins (Franciscan friars), as well as diocesan priests from Kumbo.  I have heard teaching at high levels to general audiences (homilies and instructional settings) on Christian living, the differences between superstition and sacramentals, the tension between one’s Christian faith and the traditional practices of one’s community or position, Christian sexual morality, and care for the poor.  The Mass attendance for the hospital weekday Masses on Wednesdays and Fridays is high; for some it is certainly that they are attending to say they have attended because they work in a Catholic hospital.   However, the level of participation within the Mass is high and I think it would be unreasonable to suspect the motives of most of the people.  In any case, it is much easier for people to be exposed to Christ and to come to a true knowledge of Him in this setting than in a secular setting where Christianity is routinely disparaged, misrepresented, or absent.  A tailor I have worked with does not work on Sundays and leaves early on Saturdays to go to Bible study (and yes, she is Catholic).  Some of the nurses in the operating room belong to various men’s groups that study the faith together as well as serve the community; these activities take a great deal of time – more than activities in America usually expect.  Obviously the sisters dedicate significant time to prayer, study, and service, feeding not only their own faith but also the faith of others.

On the downside, one of the most disturbing stories I have heard came out of Central Africa on the BBC.  The BBC has no love for Christianity and may well have been trying to present “Christians” in the worst possible light.  There have been stories of extreme generosity and Christian heroism from the CAR as well.  However, in this story, people identified by the BBC as “Christians” were participating in clearly un-Christian behavior.  All Christians choose wrongly sometimes, but only rarely is the wrong behavior intentionally identified with our Christianity.  I do not know if the men in the news story identified themselves as Christians, or if to the BBC reporter, any non-Muslim could be identified as a Christian.  These men were seeking revenge against a Muslim man for atrocities committed against Christians by other Muslims (not this man).  Not only did they desire revenge, but they identified it as an obligation.  Additionally, they were described as wearing amulets which would protect them from harm.  In no aspect of the story did God or Christ have anything to do with their behavior or their motivations.  It is possible that these people had had some exposure to Christianity, but clearly their behavior in this story was not related to their Christian lives.  It would be better if the BBC would simply describe “ethnic violence” rather than to portray this as a religious war.  There are true Christians suffering in the CAR, and probably there are people of traditional religions suffering in the CAR, and there are a few Muslims remaining who are suffering in the CAR, and many refugees from the CAR in other places.  Please pray for all of them; I see little of this in the American news, although if you are praying for Syria you can just add the CAR.

The press has a tendency to present Catholicism as ridiculous.  If I learned about the Church and her doings from the New York Times I certainly might think that the Catholic Church is ridiculous.  It is important not to learn about Christianity from the mainstream press, which has its own agendae (primarily selling advertising, but there are others).  There is much rich and beautiful writing to help us understand the life Christ offers and the grace found through the Church.  In much of Africa, books and the internet are not readily available, so people learn about and celebrate Christianity in many other ways, including cultural practices and beauty.  It is not easy, or necessary, to judge.

From Today’s Liturgy:
I will recount all your wonders, I will rejoice in you and be glad, and sing psalms to your name, O Most High.  Ps 9:2-3

Clinical Judgment

In the beginning of medical school, we learned the scientific and humanistic foundations of medical practice.  It isn’t far into medical school, however, before students are introduced to “clinical judgment.”  I think of this as the decision-making process used to decide on a course of action based on the information available, which is always incomplete.  Even within well-studied conditions, it is not possible to know with certainty to which population of patients the person in front of you belongs, and even if the diagnosis is certain, the response to treatment might not be.  Add to this the necessary cost-analysis and the inherent conflicts of interest, and the practice of medicine can suddenly become quite challenging.  Usually within one’s own practice, a physician becomes accustomed to the various considerations that are required, so that only the rare patient is enough out of the ordinary to require extensive additional concern.  In the US, it is likely that your patient is actually in a population that has been studied, that any relevant guidelines apply to him or her, and that if you are wrong you will have an opportunity to follow through with another decision.

Although western physicians have contributed greatly to the care of the poor in developing countries through mission teams and individual efforts, I have always found this judgment issue to be quite challenging in a new location and culture.  It is difficult on a short-term basis to know what options the patient has available, what the risks are in that patient for the procedure or treatment that you want to give (given the differences in equipment, sterilization, and so forth), and how complications will be addressed.  Here in Shisong, we have the opportunity to provide, in many ways, “first-world” medical care to cardiac patients on a long-term basis; yet the judgment issues remain challenging and the uncertainty, while not paralyzing, is disconcerting at best.  In western countries, rheumatic heart disease is not defeated but it is rare, and to see severe rheumatic disease in a very young person is nearly unheard of.  [This is the point at which the issue of prevention is usually raised.  Everyone who treats advanced rheumatic disease in developing countries is aware that the problem should be preventable.  How to prevent it in this cultural setting is less obvious, and in the meantime it does not seem appropriate to refuse to treat the patients in whom the disease has not been prevented.]
 

Dr. Mve Mvondo and I have written an article for submission to a journal which addresses the issue of repair vs. replacement of diseased mitral valves in sub-Saharan Africa.  Although the article addresses primarily the treatment of mitral valve regurgitation, several of the concerns are general.  I outline a few of them here for your understanding (for my non-medical readers, some of these are not unique to Africa and apply to the decision-making process in our own lives in the US, especially if you have faced a rare disease or a treatment not covered by insurance).  Most of the patients who present for surgery are young (between 10 and 30).  Patients who are young who require valve replacement almost always receive a mechanical valve, because their durability is much better than current tissue valves.  There are several issues associated with living with a mechanical valve, but the most important one is the need for anticoagulation.  Lifelong anticoagulation is necessary to prevent strokes and to maintain valve function.  In the US, this is a burden because of the need for on-going monitoring as well as the risk for bleeding.  Athletes and people with high-risk jobs occasionally refuse this treatment rather than change their lifestyle.  Although there are modern valves which might require less anticoagulation, it is not yet certain that it is safe to forego anticoagulation in most circumstances.  Here in Cameroon, there are numerous additional considerations to subjecting a patient to lifelong coagulation.  First is the understanding of the patient that this is a necessary commitment.  It is not uncommon for a patient to stop their medication because they decided that it was unnecessary.  Another consideration is cost; neither the medication nor the monitoring is free, and most patients do not have insurance or much money.   The need for many patients to travel long distances to get their medication and monitoring also impedes successful therapy for many people.  Even where there are roads, most people do not own cars, and travel is also not free or easy.  Pregnancy is an important issue for many of these patients.  It is possible for many women to safely bear children, but it requires intensive prenatal care, careful drug management, and hospital delivery because of the risk of bleeding as well as the underlying poor cardiac function present in many of these young women.  This is a culture in which bearing several children is desired and expected.  Recommending against this is difficult, and in many cases impractical, so even if a patient agrees with all of the recommendations it is unwise to assume that she will follow through.

The alternative, then, in the case of mitral valve disease, is valve repair.  Although this is not meant to be an extensive discussion on mitral valve therapy, I will point out two important issues.  The best methods of valve repair in the setting of inflammatory disease, especially mitral stenosis, are controversial, and in western countries this is not routinely attempted.  Secondly, a failed valve repair here is even more of a problem than in the west.  Many patients will not return for follow-up, most patients cannot afford a second operation, and the risk of repeat chest surgery in this setting is significant given the limitations and costs of blood products, monitoring, and advanced supportive therapies.

An additional consideration here that is somewhat different than my practice in the US is the advanced stage of disease at which most patients present.  There are evidence—based guidelines in Europe and in the US recommending the stage at which the benefit of surgery will outweigh the risk.  Even if the risk of surgery is slightly higher in this setting (and I am not sure that it is), most patients present well past the recommended time of surgery.  Even if they come for consultation early in their disease, they wait a long time for surgery due to fear, lack of support, and financial considerations.  And of course, the options that Americans and Europeans have of heart transplant or artificial hearts are not available at all without travelling abroad.

One final area that looms large, that I have mentioned above, is cost.  In the US, cost is something of a general issue, and we do not often consider it as a deciding factor in the treatment of individual patients.  At the cardiac center, we can overcome the cost issue for the in-patient care of many patients.  However, this does not make the issue go away.  Some patients have co-morbidities or suspicion of co-morbidities, and additional evaluation could be beneficial.  We do not have a CT scanner in Shisong (although hopefully that is coming), so if a patient has a problem best evaluated by CT scan, they must travel several hours and pay for the CT scan, and bring the results back to us.  There is other testing and treatments for which patients must travel and pay additional fees, and we must decide whether to proceed without the tests or not.  In the US, there is always a point at which further testing is not cost-effective, but that moving target is even more difficult here.  From an anesthesia standpoint, deciding to proceed now versus advocating waiting until different drugs or supplies are available is not something that often applies in my practice in Rochester.

In the US, we often over-test, over-treat, still fail to have optimal outcomes, and assume that someone else will pay for all of it.  Here, the answer is frequently, “you can’t have that,” and we are still left to make decisions with the information that we have based on our discussions with the patients and hope to honor their trust and dignity.  I am confident that we always act with good will and that the personal conflicts of interest are minimized.  The rest remains difficult.


From today’s liturgy: “They ate and had their fill, and what they craved the Lord gave them; they were not disappointed in what they craved.” (Cf. Ps 78:29-30)

Ending the week with Jesus

So we had a busy (and successful) week with our local team.  The patients are doing well and one has left the ICU.  Unfortunately, they are young patients who required valve replacement for rheumatic heart disease.  Many thanks to the generous sponsors who make it possible to help these young, otherwise healthy people. 

On Monday, the operating theatre staff finally had our Christmas party.  It had been delayed for various reasons.  Each staff member drew a name from a dish of a coworker to pray for during the Christmas season and to give a gift at the party.  Of course, there were speeches before the gifts were presented and food afterwards.  I presented my gift first, so I do not think anyone had started taking pictures yet.  Here is Mr. Benoit receiving his gift from Mr. Ralph:

 

One of the things I try to do is to attend evening prayer with the sisters (I will write about the community that I spend time with in another post soon), so today we finished in time for me to attend.  As usual, I forgot that it was Friday and that there would be Exposition and Holy Hour, and tonight was a special treat.

Some of the readers of this blog know that one of the central aspects of our Catholic faith is the Eucharist.  We believe that when Jesus said “This is my body” that he meant this and not something else, that he has the power to make it happen, and that the priest at the consecration during Mass makes present the sacrifice of Christ and the body of Christ under the appearance of bread.  This means that later, the body of Christ remains and if reserved in the tabernacle that His sacramental presence is ongoing; it is then appropriate to adore Him in this form.  Usually the host is placed in a monstrance and placed in a prominent location.  This, then, is what was available to me this evening to end my week.  (Well, almost end, anyway.  There are still patients in the ICU.)  Sister Mary Charles, who was assigned to organize the prayer times this week, began with several minutes of reflective praise songs.  Although the community is very small (especially since people are away), there are multi-part harmonies and drums.  A reflective and focused (recollected) atmosphere reigns and it is easy to be aware of the presence of God and the love of the sisters, even with the children of the orphanage in the next room.  Evening prayer consists, of course, of “Evening Prayer” from the Divine Office or Liturgy of the Hours, and also the Angelus, the De Profundis (Psalm 130), a prayer for the sainthood cause of Sr. Maria Huber, the foundress of the TSSF, and sometimes some other prayers.  The holy hour generally concludes with Night Prayer (from the Liturgy of the Hours).

From Evening Prayer:

We ask you to remember tonight those who are in great difficulty:

give new heart to those who have lost their faith in man and in God, to those who seek the truth but cannot find it.

Njinikom

Last week I was able to go to Njinikom for a visit.  Njinikom is near and dear to my heart for several reasons.  Njinikom was the first place that I went to in Africa, and the first place that I was sent by Mission Doctors Association.  When I arrived at the airport in Douala in January of 2010, I was met by Sr. Angeline Wongbi.  Sr. Angeline was a nurse anesthetist at St. Martin de Porres Hospital in Njinikom, having attended nurse anesthesia school in Nigeria 10 years prior, when formally trained nurse anesthetists were even more scarce in Cameroon than they are now.  She was so pleased to have an anesthesiologist visiting (“doctor anaesthetist”), and to consider my ideas in the context of other teaching that she had had.  I spent the entire month with her before I learned that she was 70 years old!  I was blessed to return to Njinikom in January of 2011 while she was still there.  Unfortunately, Sr. Angeline died in the summer of 2012 after a difficult illness.  I miss her dearly but will always be grateful for the time that I spent with her.

  

The anesthetists in Njinikom are now Mr. Julius, Sr. Martha, and Mr. Eric.  Mr. Eric is the newest, having completed his training in Yaounde this past August.  It is always a pleasure to be able to spend time with these anesthetists and to understand their practice patterns, look at their equipment with them in case there is any way to help, and consider options for anesthetics.  This visit, they had received some new equipment, including new anesthesia machines, via a container from Holland.  The current problem faced by all the hospitals that I have visited is that bottled oxygen is very expensive to purchase, and this is required to drive most mechanical ventilators on anesthesia machines.  Supplemental oxygen for spontaneous or manual ventilation can be provided by oxygen concentrators as long as electricity is available, but this will not drive a pressure driven ventilator.  Some new options for pressurized medical gases may be available soon; another option is electrically driven ventilators (useful when there is electricity!).

The matron at St. Martin de Porres Hospital, for a few more months, is Sr. Xaveria.  Sr. Xaveria is one of these people that just makes everyone feel needed and wanted, and exudes energy and organization.  She has worked with Mission Doctors for many years and shepherded many missionaries through their assignments in Cameroon.  All of the sisters in Njinikom, like the sisters in Shisong, are friendly and welcoming and greet me like I have been there forever even though I only spent 2 months there.

While I was in Njinikom I was able to attend the festival for the 20th anniversary of the reign of the Fon.  A Fon is a traditional ruler and the Fon of Njinikom is in Fundong and is Fon Vincent Yuh II.  The celebration consisted of Mass, speeches, and some traditional celebrations including a “fantasia” in which men on horses approach the Fon in formation and the horses dance and “bow”.
  

 

Currently serving a 3-year term in Njinikom are Drs. Jennifer Thoene and Brent Burket, there with their four children.  I had not met them before and so it was a joy to spend the weekend with them.  Since I do not cook here (and do not cook all that much anyway), it was a great treat to have Jennifer’s cooking for a few days.  It turned out that most of the Lay Mission Helpers from the region (the Hornes, who I have shown here before, and the Martins and the Newburns all serving in Bamenda) were also visiting Njinikom for the weekend, along with a family medicine resident (Connie Leeper) from Ventura, California there for a rotation, and a guest of the Hornes, Sara Tuzel. All told, there were 15 American children and 11 American adults in Njinikom last weekend.  St. Martin de Porres has a lovely guest house for the visiting medical teams as well as space for missionaries, and the views are spectacular.  Sunday morning we all attended Mass at St. Anthony parish, and I am sure we made quite a sight.  You can find all of the blogs at www.MissionDoctors.org and at www.LayMissionHelpers.org.  Of course, you can also find information there about serving as a missionary.
 

On Monday I was able to visit Mbingo Baptist Hospital.  This is one of the hospitals run in partnership with the Cameroon Baptist Convention.  They have a nurse anesthesia training program, an Australian anesthesiologist there until July, and a number of ex-pat physicians there for various periods of time.  Mbingo is one of the PAACS sites (https://paacs.net), whose purpose is to help address the need for well-trained surgeons at mission hospitals in Africa.  They have made great progress in their new ICU and recovery areas, which will hopefully open within the year.  One of the realities in mission service is the “siloes”.  There are many reasons for this, but I feel like keeping the lines of communication open can help to advance the goals that we all have to share the love of Christ and to grow medicine in Cameroon.  It is exciting to see these hospitals working so hard with their donors to upgrade both equipment and training.  Additionally I was able to hear resoundingly positive feedback about the Northwest Region Anesthesia Conference held here in Shisong on December 7.  The anesthetists were pleased to have had an English language conference and to be able to discuss issues of interest to them.  They, along with the anesthetists in Njinikom were very much looking forward to the next conference.

One of the most exciting parts of the trip was the progress made on the roads.  The trip from Shisong to Njinikom, which used to take 5-6 hours can now be made in about 3 hours.  This is also better for my neck, but not as good for the workout of my core muscles.

For those of you awaiting spring, I saw this blooming today.  It reminds me of forsythia which is beautiful in Rochester in the spring.
 

From todays’ liturgy (Feast of St. Hilary):
January 13, 2014
“It was not you who chose me, says the Lord, but I who chose you and appointed you to go and bear fruit, fruit that will last.” (Cf. Jn 15:16)

Happenings

On December 7 the first Northwest Region Anesthesia Meeting was held here in Shisong.  It was well attended and well received by English speaking anesthetists from the region and beyond.  If there was a flaw, it was in trying to do too much but there was a variety of topics and speakers.  The organizers are to be congratulated and I am sure that more conferences will be held in the future.

On December 9 I attended the horse races in Tobin, the administrative center of Kumbo.  They even had ice cream (or some sort of cold treat).

 Valentina is an Italian physician who remained in Shisong after the San Donato mission to do some database work at the cardiac center.  Before she left, she and Dr. Charles and I had a cut-throat Ping-Pong tournament.  I will not say publicly who won.

 On December 15 I traveled to Yaounde with Sr. Jethro, Brother Boniface, and Sr. Terese to extend my visa and pay some Christmas visits to various offices in Yaounde that work with the Cardiac Center.  While there, I met Maria and Brad Festen who work with SIL International in the Central African Republic.  They are in Cameroon due to the current troubles in the CAR and they generously hosted all of us for dinner.  We also took Sr. Terese on her first elevator ride and visited with Sr. Apollonia who is in Yaounde working on a communications degree.  I promised I would not post her picture in her kitchen-work clothes so instead I am posting this one of Sr. Jethro crushing pumpkin seeds with a stone.

 

After returning from Yaounde, of course, it was time to prepare to celebrate Christmas.  There is a large Catholic population and a significant Protestant population here in Kumbo, and the non-Christians also wish everyone well at this time.  The ICU staff had a Christmas party at a local hotel, which coincided with the Cameroon Cup championship football (soccer) match, so in addition to good food and drinks, we were able to celebrate the win of the Bamenda team over the Yaounde team.  The hospital also held parties for numerous groups of staff complete with Christmas caroling.

 Christmas trees look a little different here but the idea is there.  I’m sure that Logan and Eric did eventually decorate their tree!  I went there to help but had to leave before we actually hung anything on the tree.

The novices of the Tertiary Sisters put on a Christmas play on Christmas Eve before Mass.  It was very well done, beginning with Adam and Eve and their choice to reject God’s love, then walking us through the (very enthusiastic) prophets, and taking us through the birth of Christ with (very enthusiastic) angels and shepherds, one reluctant goat, and wise men visiting a conniving Herod.  A newborn from the maternity ward played the part of Jesus.  All of this revelry was followed by a beautiful Christmas Vigil Mass and a celebratory Christmas Day.

 

Following Christmas Kumbo holds a “Cultural Week.”   The palace, villages, and family groups participate in traditional dances and other activities.

End of year giving

For those who were looking for a review of how to support this work, here are four options:

1)  Make an unrestricted gift to Mission Doctors Association.  This will not support the project I am working on directly but will support the missionaries and work of MDA.  This gift is tax deductible.

2)  Make a directed donation to Mission Doctors Association (www.missiondoctors.org).  This option is tax deductible and 10% will go to MDA to support their work and administrative expenses.

3)  Make donation to the Cardiac Center and indicate that you would like to support a patient surgery (or just donate to the Cardiac Center). (http://shisonghospital.org/wordpress/donate/)  The entire donation will go to the Cardiac Center.   We are not a 501c3 organization so I do not believe this donation is tax deductible. 

4)  Send a donation to Mi-Do (www.mi-do.org).  This organization allows you to choose a patient to support, but I do not think that you have to.  I believe that the entire donation will go to the purpose that you choose.  The donation options are in euros, but they do not have a problem processing American credit cards.  They are not yet a 501c3 organization either.

For those of you not looking for end-of-year-giving options but want to see pictures, I will work on uploading them and sharing more about Shisong and Yaounde soon!

Belgians (Happy Sinterklaas)

There are two teams in Shisong currently from Belgium.  The first team arrived last week.  They are sponsored by an organization through their hospital called LUMOS.  They have a website, but not an English one (www.LUMOS.org).  If you read Dutch you can learn all about them.  Over the years they have provided significant support to St. Elizabeth’s.  This year’s team consists of an anesthesiologist, a biomedical engineer, 2 physiotherapists, and two nurses.  Of course, the work of the team that I was most interested in is that they brought a capnograph for the main OR of the hospital and provided training for it, they provided monitors for the PACU, and Frederic, the engineer, fixed the monitors in the OR that were not working. 

The second team is a regular team that performs congenital heart surgery.  This team, also from the University Hospital of Leuven, has committed to provide a team to the Cardiac Center each year.  This team was here while I was here last year, although only two of the team members are the same.  Many of the others, including the surgeon and intensivist, were here two years ago.  They have performed cases including repair of Tetrology of Fallot correction of supravalvular pulmonary artery stenosis, and repair of interrupted aortic arch.

Below, you see the newly repaired gas concentration monitor (for measuring the concentrations of inspired and expired anesthetic gases and carbon dioxide), Benson displaying his new nerve stimulator (used for monitoring the activity of muscle relaxants), and the Belgian cardiac team climbing down the rocks at the Shisong waterfall.

The LUMOS team left today along with 2 Belgian midwife students who have been here on clinical rotations since September.  The cardiac team leaves tomorrow, so as far as I can tell there will be a complete absence of Belgians in Shisong for a while.  There are, however, still Dutch nursing students so there will not be an absence of Dutch spoken here.

Today is the feast of Saint Nicholas, celebrated in Belgium as Sinterklaas.  For me, this meant that there were Belgian chocolates wrapped in foil decorated as St. Nicholas.

Check back soon to learn about Mi-Do and their activity in Shisong! (www.Mi-Do.org)

Christ the King and His Rain

Sunday was the Feast of Christ the King, which is also the last Sunday of the liturgical year.  In this region, it is common to have Eucharistic processions to celebrate.  Here, Sacred Heart Parish in Shisong had a procession from the parish to the cathedral.  

Below, you see Maribel encouraging the young people to sing about the kingdom of God as they walk and dance, and the priest carrying the Blessed Sacrament in a monstrance.
 

 

 

I have been getting lots of weather reports from home.  It seems that it is unseasonably cold and there is an expectation of snow.  I thought I would include my own weather report, since there is not much weather available on-line for Shisong.  It is currently the dry season.  Usually this season is aptly named, as I have never really seen rain here when I was here in the dry season.  This year there is rain.  On Sunday after the procession, the skies opened up with heavy rain, thunder, lightning, and even hail.  This keeps the dust down and of course is good for growing things and for the water supply, but not good for those trying to do dry season activities such as build (which often includes making bricks from the local soil) or travel.  Oh well.  I do not get to order the weather.  Here are some picture’s of one of the convent gardens (“farms”) which is benefiting from the rain but also from diligent watering by the sisters, as well as the nearby hillside which I find to be particularly pretty. 
 

Feast Day and Feasting

Sunday November 17 was the feast day of St. Elizabeth of Hungary.  Here in Shisong there was a celebration on Saturday to celebrate this patron saint of the Tertiary Sisters of St. Francis.  St. Elizabeth was a princess of Hungary who married into a German noble family and developed a great dedication to caring for the poor after being introduced to Franciscan friars of her region.  The feast was complete with Mass (including offertory processions from all of the groups of the hospital), followed by speeches, a skit of the leper who returned to give thanks for his healing presented by the patients of Surgical 2 (ward), traditional dances, and of course, food.  

Two of the patients on Surgical 2 and their guardians have been here for over 6 months.  A "guardian" is a person, usually a family member, who takes care of the patient's non-medical needs, including providing food and doing laundry.  They stay at the hospital with the patient and often sleep on a mat next to or under the patient's bed.

On Sunday, the important activity was to watch Cameroon defeat Tunisia in the World Cup qualifier match that was played in Yaounde.  The victory was decisive, 4-1 so everyone could be happy on Monday.  At least in Cameroon.

Day by Day

When I was in high school attending youth retreats, our retreat leader used to play a mix of music during the morning while we were eating and getting started.  I still remember this mix as being uplifting and relaxing, while motivating me to participate in the day.  One of the songs in this mix was “Day by Day.”  The song was from Godspell, but it is based on an ancient prayer.  The words of the chorus are:

     Day by Day

     Day by Day

     Oh, Dear Lord, these things I pray:

     To Know Thee more Clearly

     To Love Thee more Dearly

     To Follow Thee more Nearly

     Day by Day

It is still a good prayer.

Possible, but difficult

On the last night of the Italian Mission, Drs. Giamberti and Cirri shared the story of the beginning of the mission.  They were always cognizant to try to speak English if Falan or I were present, even if they were primarily speaking to their own Italian-speaking group.  Early in the relationship between San Donato and St. Elizabeth’s, patients would be transferred for Italy for surgery.  There was a desire to perform surgery on these pediatric patients here in Cameroon.  The first year they decided to operate on 3 patients with patent ductus arteriosus.  For my non-medical readers, this is a condition in which a structure that is necessary for fetal life fails to transition to life in which oxygen is provided by the lungs instead of by the placenta, creating too much blood flow to the lungs, and too much work for the heart.  If it does not close spontaneously shortly after birth, it can be closed surgically.  The reason that this procedure was chosen to begin heart surgery in Shisong is that it can be done without the use of the heart-lung machine.  Dr. Giamberti said that they wanted to show that it would be possible to perform cardiac surgery here in Shisong, but that it would be difficult.  They then proceeded to share the adventures that occurred during this first mission.  Although we laughed at how silly the problems seemed and marveled at the genius of some of the problem-solving that occurs here in Cameroon (this is not so different than occurs when we look at the history of medical advances in the U.S.), the fact of the matter is that many barriers remain to high level care here in Africa.  It remains true that it is possible, but it is difficult.  The Italian mission organizations have built a beautiful, modern facility for the delivery of high-level cardiac care.  We do not have to worry about having to cancel an operation because the operating room is full of butterflies, as happened during that first year.  There are automatic generators to provide constant electricity so that the perfusionist (the specialist who runs the heart-lung machine) does not have to choose between keeping the patient alive and providing the surgeon with suction, as happened during that first mission because the person whose job it was to start the generator was not immediately available.  There is water, and commercial scrub solutions, and sterile instrument pans for each case.  What is keeping patients from accessing necessary heart surgery today?  Today the problem was a lack of blood availability for a patient with A+ type blood.  There is a volunteer donor program, but it is still in its infancy.  The patients must bring family members with them to donate blood.  This blood might not be appropriate for the patient having surgery, but it is expected that they will contribute to the blood bank.  The blood bank will go out on Sunday to the surrounding villages to encourage blood donation and have what we would call “blood drives.”  The blood bank is also establishing a component program.  Currently only whole blood is available.  The component program will allow us to be more selective with the way that we use blood, and reduce exposure to antibodies in patients who only need red cells, as well as treat coagulopathy (bleeding) more effectively.   I have already described the financial problems that many patients face in preparing for surgery.  Soon I will describe another organization that is raising funds specifically for these patients.  I am hoping that they will soon have 501c3 status in the US, as well as a US donation website.  In the meantime, I would like to encourage my readers who pray to continue to pray about these issues and particularly if there is a way to support these needs.  For my readers who don’t pray, you can still think about whether there is a way to support these needs, and if you are thinking about giving prayer a try again, here is a place to start.

In the pictures, you see Mr. Thomas who is the director for the blood bank, and the chairs for the volunteer blood donors.  There is also a small lounge where they can have snacks and drinks after donating.