January 26, 2011

January 26, 2011

Wednesday.
--We said good bye, and then followed the students’ bus till it turned off to Mangamba. They’re going back to clean the house and gather mousquitaires and leftover medical supplies which they’ll distribute to Mbanga hospital, Kotto Up school, other places and people, follow-up Michael’s surgery and discharge plans. Tomorrow morning they’ll leave Mangamba forever, visit a leprosarium in Douala, and shop for fabric and curios in the afternoon. Friday they’ll write their final paper and leave a copy for Ruth to submit to the Department of Health, and they’ll fly to Paris that night for a long weekend and then home to Portland.

--We loaded our luggage and got in the 4-passenger, 4-wheel drive Toyota truck with Njoke and Npho and drove away, heading for Limbe where we’ll stay for two nights and visit the surrounding sights.
--We crossed the ---------- River Bridge, the boundary between former French and British protectorates that caused today’s Francophone and Anglophone Cameroon. In 1961 France granted Francophone Cameroon independence, but Britain’s position was that their region was not yet developed enough to govern independently; they required Anglophone Cameroon to join Francophone Cameroon under one government, the Republic of Cameroon. As in the American South, tensions between the groups are unresolved and occasionally there are serious uprisings. Five years ago this bridge was blown up; it was replaced and facilitates nonstop heavy commerce.
--The river banks and bottom under this bridge are very sandy, a material needed for construction. The banks are lined with dugout canoes filled with loads of sand that workers got by paddling out, diving to the bottom to collect a bucket of sand, swimming up to the canoe to dump the bucket, diving back for more sand. When the load in the canoe lowers the sides just above water level, the worker paddles to shore where another man waits to shovel the sand out. The banks are steep, so another worker shovels the load up a few feet, then another worker moves the load up another level, until it is on the high ground where a waiting dump truck is filled and then hauls it away to a construction site in Douala or elsewhere. This seemed like a don’t-miss photo opportunity.
--We stopped, walked down the beach, watched, talked with a worker, took a lot of pictures. A man appeared, gesturing angrily. Another man came, we were the center of a gang of angry men, yelling at us. Njoke handled this well. We were escorted to a guard shack where a man in military uniform told us this has happened to other visitors - this area is not posted that photos are forbidden - we’d have to surrender the cameras. They agreed to watch Njoke and Joe delete the photos of the sand divers. The uniformed man’s superior arrived and wasn’t satisfied. We showed our passports and talked about why we’re in Cameroon. Njoke sent us to wait at the truck. After 10 minutes he returned, poorer by quite a bit.
--We drove on to the town of Tiko, then turned down a dusty bumpy road through miles of banana plantation that is owned by the Cameroon Development Corporation and leased to Del Monte Foods until we entered the headquarters clearing where Njoke had arranged that we’d meet the plant manager and have a tour of the plantation. We waited and waited, a message arrived via Njoke’s son-in-law who works there that the plant manager apologized for a conflict and he couldn’t meet with us. The son-in-law answered a lot of questions and told things we didn’t think to ask. It was fascinating to see hundreds of stalks of bananas that had been cut from their respective trees in the orchard and hung on a trolley that delivers them to a shed where a protective blue plastic bag is removed, the bananas are inspected and washed, and sent on to a packing shed to be boxed for shipment to foreign countries.
 
--Back on the road it wasn’t long till we were in Limbe. We were here two years ago but until today we had little concept of the size of this old city – certainly not a sleepy little town, and Njoke knows his way around well. Alfred Saker, a German Presbyterian missionary, arrived in 1885. His work was accepted well – today the Presbyterian church is firmly established and very influential in Cameroon. Less savory, in the 18th and 19th centuries this natural port was the site of very active slaving and ivory export trade.
--We spent a few hours touring the Limbe Botanical Gardens – created in the late 1800s by the German occupants, it has survived political and governmental ups and downs – today it is renowned for tropical plant research and the beautiful grounds. Predictably, Joe enjoyed examining and identifying many of the trees and plants. It is serene here, and we took good advantage of the unhurried experience, savoring the peace and beauty.

--We then walked over a knoll to a seaside restaurant where we had a late lunch/early supper of rice with red sauce, fried plantains, and fried chicken, and of course we washed it all down with good beer. We sat and visited until twilight, then to the hotel.

--This off shore oil rig was installed sometime in the last 2 years.  Like neighboring Nigeria, Cameroon has off shore oil and is beginning to develop this industry.

January 25, 2011

January 25, 2011
Tuesday. Still no power, water – the whole group bussed to Njombe for breakfast, then we spent the day doing the last health education and health assessments in a very hot, crowded and noisy classroom at Njombe school.  We all were tired - its been an amazing time, and there's so much to ponder and digest.  We've seen more hardship here than any of the other places we've been. 

House with gravesite.

Young crippled woman crawls and protects her hands with flip-flops.

--One of the Njombe WEH kids has captured everyone's heart.  He is 15, post-polio, dirt poor, very bright and positive.  Two years ago the students helped him with a physical examination and new crutches. Now he's a lot taller and his crutches needed adjustments.  The bolts had rusted tight, so a student and Joe went with him to a welding shop to loosen it and adjust the height correctly. 
-- Isabel was there today and surprised me with her good English-speaking ability – she’s been keeping a secret! I’ll stay in touch with her and Kassafro, and do what I can.


 --Back to the Luxor Hotel for a shower!, cold beer on the porch with David and Joe – and then Njoke arrived with our driver, Npho!  Today marks the end of our journey with Linfield, and the beginning of our 4-week tour of Cameroon. We’ll leave early tomorrow morning to start our month long tour of Cameroon.

January 24, 2011

January 24, 2011
--Power is still off, everyone is hot, uncomfortable, wants a bath, and without refrigeration our meals are uninviting and repetitious. I can’t find my camera – I wonder if I left it in the SUV on Friday afternoon? At the Titis? At any of the 3 department stores we went to for a razor for Joe? Or?



--Penja. Isabel became my heroine when I learned about her 3 years ago. Despite her own serious health issues, she has acquired the resources to operate a home for throwaway people with AIDS in her community, Penja. She somehow does a lot with very little - there is never enough for everyone’s needs. Nonetheless, she is kindly strong and very determined.
--Most of the children living at Kassafro are WEH kids. We did our health assessments here today – 4 stations in a small room packed with people, and a hoard outside pressing loudly to get in next. We gave out vitamins and intestinal worm medications liberally, lots of paracetamol (Tylenol), cough medicines, and occasionally antibiotics. I had some time to meet with Isabel and talk about her work and the support group that I lead at home for people living with HIV/AIDS. She needs money for her own labs in order to continue to be eligible for her medications.

--We made a quick stop at the Luxor Hotel in Njombe to make our reservations for us and Njoke tomorrow night. Then back to Mangamba where the power is still off. We’ve packed and we’re ready to take all our belongings with us tomorrow morning.

January 23, 2011

January 23, 2011
Sunday – Sam has been increasingly excited – he was invited to preach at the Titi’s church this Sunday, so he’s been preparing his sermon and worrying how he’ll be received. Sam’s sermon was incredibly well-received, and he’s relaxing now, happy and relieved.

Schedule of Sunday services - traditional Douala at 9 am, French at 10:30 am

Rev. "Papa" Sam Hosler

Ruth and Raphael at church

Ruth and her sister Doris

--After church we sat down to a lovely dinner; the guest list was heavy with clergy – Carol, Sam, and 3 pastors from the Iglese Evangelique du Cameroon. The afternoon flew by – suddenly it was late afternoon and we’d had a 5-course meal and lively discussions. Linfield students began to appear – they were here for supper. The table was cleared and reset, Ruth’s amazing kitchen staff put another meal on, and served them.
--We tried again several times, unsuccessfully, to phone Njoke. Hopefully he’s received the e-mail that I sent Friday evening saying to find us Tuesday evening at the Luxor Hotel in Njombe.
--We joined Linfield on the bus and headed out of town after a stop for ice cream at Goody's. The pastry side of this shop is like a French bakery, and the ice cream side served Italian gelato! Joe was beside himself when he found they had a soft serve ice cream machine. Just a couple of blocks from the Titis’, this is a hopping upscale place to meet and be seen. Back on the bus hawkers tried to sell models of the Eiffel Tower!
--Reportedly, Friday night’s debriefing was long and very, very productive. They’d learned that none of the patients they sent for testing had been tested. The woman complaining of flank pain had negative results for her tests that cost nearly $80 and she was released with instructions to continue the medications that we’d given her, and later that day students saw her walking very normally through markets doing her shopping; they felt she had “taken” them so she could get a ride to town. Their agreement is that for the remainder of the trip, when any students wants someone seen at the hospital they will seek evaluation from their faculty or me to confirm the findings and plan. Only then will a patient be given information and promise for assistance. The student who told me about the debriefing said, “we’re all wiser now, this was a hard lesson that we needed.”
--Just after Dibombari we realized there were no lights in any homes or businesses, and we only saw lantern lights along the way all the way back to Mangamba where there was no electricity or water and the town water pump outside our gate wasn’t working. The house, closed up tight for the weekend, was very, very hot for those who opted to sleep indoors.

January 22, 2011

January 22, 2011
Saturday. Late in the morning Carol, Sam, Ruth, Raphael left for Limbe. We stayed behind to read, relax, get some laundry done, hopefully meet the seamstress to have our measurements taken and choose styles for dresses and shirts, to catch up with the blog, e-mail and the church website.
--We tried to call Njoke – a message repeatedly said the number is not in service – YIKES! But its not time to panic yet.

January 21, 2011

January 21, 2011
--Friday. Still no power, water, phones. Frustrating start for the day that culminated with an invaluable learning experience.
--Due to misunderstandings, miscommunications, and poor coordination yesterday, several people were told to come here this morning for a ride to Mbanga hospital to have filiaria (parasites) and malaria testing and treatment, and also for HIV/AIDS testing. The flank pain woman presented herself saying she was “a little better” but wanted to go to the hospital - I re-examined her and told her to go home to give her meds time to work, but I was over-ruled by students who wanted to hospitalize her because they’d have a terrible weekend worrying that if she’d worsened, they wouldn’t be available to help her. Because there wasn’t enough room for everyone in the vehicle that was going to Mbanga Hospital, the students were asked to prioritize which patients should travel today and which should be postponed. They couldn’t come to agreement, so today’s assignments and schedule were rearranged necessitating more travel time and significantly delayed arrival at our primary destination. All the patients, students, WEH staff, and supplies were loaded on the bus the other SUV, and we delivered the patients to a junction where they were all given money for taxis, a meal, and their estimated medical expenses - they were to take taxis north to the hospital and then home to Mangamba, and we turned south for our rendezvous with Bekoko Primary School.
--Bekoko Primary School is small and rural. The children are active and bright, and their teachers are committed to the educating them well.  I was charmed with variety of braiding styles among the girls' hairdos.

--Half the school was crowded into one classroom for the First Aid and Malaria presentations.  One teacher had a big stick that she pointed at children when she called on them.  From their responses, we suspect she used it to correct them, too. The groups rotated and the presentations were repeated. One of the WEH volunteers, Danielle, is the daughter of the village chief. The chief and the senior chief were there to observe and to welcome us.
--During the 2009 visit I had seen one of the WEH orphans, 14 yo Michael, and examined his tender and enlarged scrotum. At that time he was not given priority, so medical attention was not funded. Today I invited one of the students to examine him with my supervision – we found he was still tender and enlarged, with what we presumed was an egg-sized hernia. Arrangements were made for him to be evaluated at Mbanga Hospital on Monday, and the students will pay for his care and probable surgery. We’ve learned that hernia repairs cost about $200.
--We did health assessments with all the WEH children and several others. 

--Despite the chaos this morning resulting from poor collaboration, after finding that we did not have the means to transport a mother and child for hospital evaluation, a student privately gave money to them because she felt that her assessment overruled others’ and indicated a medical emergency. This decision was not discovered by the group until the debriefing.
--After finishing at Bekoko School, Joe and I rode to Douala in the SUV, and the Linfield crew returned to Mangamba for the night and then to Limbe for the weekend.  Its good to be in town again, to see Ruth and Raphael, Carol and Sam, and to catch up with the CNN news. We walked to the internet café to catch up with e-mail, and to finalize our plans to meet Njoke on Tuesday.

January 20, 2011

January 20, 2011
--Today’s starting plan was to spend the morning here at the house doing health assessments and treating Mangamba’s adults, old folks and preschoolers, and for the afternoon we'd go 7 km up the road to another village school. We didn’t make it to the school because the logistics became too complicated – lunch arrived at 3 pm, delayed due to a fender bender in Douala, etc., etc. We spent the whole day here and were busy with patients, without a break. It was another very hot and humid day.
--We were ready shortly after 9 am starting time – dozens of people were eagerly waiting to be seen for their myriad concerns, especially malaria symptoms. The oldest ones had arthritic aches and pains from their lives of daily hard manual labor, age- and lifestyle-related vision problems, and chronic stomach upsets. The young children presented with fever, runny noses, cough, nausea, vomiting and diarrhea.  A triage and vitals station was set up down stairs, and upstairs we did assessments and treatments - this worked well because here we were next to our pharmacy and supplies.

--A young man, Coco, had a seriously infected hand from a work accident with his machete – we dressed the wound, gave antibiotics, and arranged for him to return tomorrow for a recheck.
--We were concerned because last week’s 15 year old boy with the abscess on his hip did not come today. A middle-aged woman complained of severe flank and one-sided pelvic pain, and decreased urination with blood - she was given antibiotics and education about her care and sent home with plans that we’d follow her outpatient, but a few students feared she’d worsen and really wanted to hospitalize her – transportation was not available so she did go home and we’ll see her in the morning.

--Our meals have been and continue to be interesting and somewhat problematic.  Ruth is doing her best to assure that none of us get sick, so all our food is prepared by her chef in Douala and driven to us, usually twice daily and sometimes 3 times.  The cost of gas is horrendous, and its been difficult to deliver the meals on anything like a reasonable schedule. We’re really enjoying the French-influenced African foods, French cuisine, and some American foods, too.  We do appreciate the efforts and the good flavors. Lots of fresh tropical fruits – papayas, bananas, pineapples especially – we’ll never tire of any, they are so-o good.
--Joe and I will not miss our foam mattress because it absorbs body heat, making it hot to lie on it. But we will miss the coziness and romance of sleeping under the mosquito net – its filmy and pretty, and we feel very close when we’re tucked inside, just us and our magnificent adventure.