I spent my elective in St. Martin de Porres Catholic Hospital in Njinikom, Cameroon. St. Martin de Porres Hospital is on a Catholic compound that also contains a convent, orphanage, schools and outreach programs. At the hospital, there are currently 2 married American missionary family physicians, Dr. Brent Burket and Dr. Jennifer Thoene, a Cameroonian general practitioner, Dr. Eugene, a Guinean OB-GYN, Dr. Dabo, a Cameroonian general surgeon, Dr. Foku, and a Cameroonian orthopedic surgeon, Dr. Lazare.
Brent and Jennifer, with whom I primarily worked, moved to Cameroon in August of 2013. Prior to living and working in Cameroon, they have worked and lived in Ghana and Guatemala. They have 4 children (2 biological and 2 adopted - one from China and another from Ethiopia). They work through a Catholic organization called Mission Doctors Association.
Njinikom is a small town in northwest Cameroon. The majority of people in Njinikom speak Pidgen English or the local dialec, Kom. Some people speak and understand English, fewer speak and understand French. Njinikom is in the hills. I landed in Douala after 26 hours of flying and the next day spent about 9 hours driving past banana, plantain, pineapple, and papaya plantations to arrive in Njinikom.
The most common diagnoses seen for inpatients were malaria, typhoid, pneumonia, stroke, diarrhea, tuberculosis and complications of HIV. Diagnoses were difficult as we were limited in the labs that were available (electrolytes, blood count, malaria antigen, Widal test, stool O&P, HIV), in how reliable those labs were, and in the imaging available (ie. chest x-rays taken with patient's in prone position, EKG, portable ultrasound that was brought by Brent & Jennifer from the US).
My last week, I worked with Dr. Dabo, the OB-GYN to get some OB experience. Brent & Jennifer, Dr. Dabo, Dr. Foku, and Dr. Lazare rotate who is responsible for cesarean sections. While I was there, Brent and Jennifer were unfortunately not scheduled to be responsible for OB, so I decided to work with Dr. Dabo. It was a little difficult because his primary language is French and being from Guinea, he doesn't really understand the U.S. medical training system so it was hard for him to understand what a 2nd year resident would know. We rounded on post-cesarean section patients in the morning and any antenatal complications.
The normal vaginal deliveries were all managed by midwives. The midwives deliver all vaginal deliveries including breech presentations. and only call the doctors for complications such as hemorrhage, need for induction or augmentation, etc. I scrubbed for 4 cesarean sections while in Cameroon. I assisted in all 4 cases. Two of them were primary cesareans (one was done by Pfannenstiel by Dr. Foku and one done by Joel-Koen by Dr. Dabo). The other 2 were repeat cesarean sections and were repeat vertical incisions. Dr. Dabo did a lot of ultrasound in clinic (GYN and OB). We saw a lot of infertility consultations and many of the women had been exposed to Chlamydia. The only test available was an antibody test, therefore, it was difficult to know if Chlamydia was truly the cause or if she had only been exposed prior, therefore, most women got treated.
Overall, Njinikom was a great experience. It was my first time on the African continent and it was the most resource-poor area I have ever visited. I encountered diseases that I've never seen and had to stretch my thinking and get creative when medications or tests that I was used to weren't available.
Brent and Jennifer were wonderful mentors and hosts. I lived just below them and ate dinner with their family every night. They truly were my family during my stay as I spent Christmas, my birthday, and New Years in Cameroon. I would recommend the experience for people who want to see what it's like to work in Africa in a resource-poor area. There is not a lot to do in and around Njinikom tourism-wise, but medically I learned a lot.