Blog from 3 days ago-- no internet, unreliable electricity

Slept like a rock last night. We really lucked out because we are staying in a house recently built by some long term missionaries, so it’s really comfy. Still with creepy crawlers and fickle electricity, but pretty nice overall. The hospital here is huge. There are tons of surgeries, as well as specific wards for ulcers, TB, Leprosy, orthopedics, maternity, ophthalmology, HIV, and pretty much anything else you can think of. There is also a large outpatient area where patients travel for days to be seen for sick visits. The patients’ families sleep outside on the grass and they are in charge of making their own meals for their sick loved ones. There are two major teams of residents- CIMS (internal medicine) and PAACS (surgeons). There a couple semi-permanent attendings, but most come and go as needed. They are desperate for pediatricians, so they tell me that they are going to keep me very busy. They have asked me to precept the residents here and run morning rounds, which is a little intimidating since the residents are much better versed in the likes of malaria and parasites and exotic tropical diseases. We will see how this goes—I’m sure I will learn a lot in a very short amount of time. It is really varied about what the hospital does and doesn’t do. There are no ventilators, so they do all major surgeries with ketamine. No blood cultures. Lots of LPs- looking at cell counts only. Will probably have to get pretty good at physical exam skills. The day starts with chapel at 6:40am and then a quick breakfast, morning report, and rounds ~8am. The day ends early, around 4pm. I won’t be starting to work on the wards until next week due to all the work that needs to be done for our research study out in Bamenda. There are a couple other residents here from the US right now- an internal medicine resident from Alabama, general surgery resident from somewhere else in the south, two general surgeons- one from Oregon and the other from Nashville, an ICU PA, and a family medicine doc from Chicago. They’re all really nice and cool- we take all of our meals together (when not in Bamenda), so I think I’ll be getting to know them all well. This morning they called us to the front of the whole congregation (it’s huge) and introduced us to everyone. The leader said, this is “Dr. Brittany, also from New York” and then I had to say something on the spot, so I ust said “Nice to meet you all…I feel blessed to be here…I’m looking forward to meeting your children.” I wasn’t quite ready to talk in front of the masses, it was 6:45am and I hadn’t had coffee yet.

This morning for breakfast we had a boiled egg, watermelon, and a piece of bread. For lunch, we went into town in Bamenda and were treated to a ton of traditional Cameroonian food. I’m not sure exactly what everything was that I was eating. I tried chicken gizzards which are apparently a delicacy, but I think it must be an acquired taste. I ate all three on my plate because I thought it would be rude to waste them, but it wasn’t easy. They also eat a ton of starch here, very little meat. Their staple food is something called Fufu which is ground cornmeal into mush that you break with your hands and use it to pick up other foods like Okra or other mystery dishes. We had Fufu wrapped in a banana leaf for dinner with another dish that reminds me off collard greens and some beef cubes. The fufu sits in your stomach like a ton of bricks. One of the missionaries was saying that his 7yo son ate two large servings of fufu and then drank a bunch of water and his abdomen became so distended that they had to take him to the emergency room. After getting the history, the doctor said, “oh he just has fufu belly”.

I’m going to briefly explain our project, as we don’t currently have any electricity and I am typing on a word document before my battery runs out. The study that we’re working on has been going on since 2011 and it involves a cohort of ~1000 women and infant pairs with/without HIV/AIDS. Much of the work in this study has been looking at metabolic outcomes secondary to antiretrovirals and most has been done on the internal medicine side. We are now following the children at the 6 wk, 6mos, and 9-12mos visits—following parameters such as living situation, hospitalizations, breast/bottle feeding, comorbidities, mortality, HIV meds, PCP prophylaxis, HIV status, and anthropometrics. What I’m interested in is taking out all the HIV-infected children and looking at morbidity and growth parameters in the HIV-exposed children versus the unexposed. About 50% of studies done in sub-Saharan Africa have shown a statistically significant difference in mortality/morbidity among the HIV-exposed uninfected population when compared to their unexposed counterparts. There are a lot of different theories about why this exists. One such theory is that lower rates of breastfeeding may be putting these babies at higher risk for poor growth and higher morbidity/mortality rates. The WHO recommends exclusive breastfeeding by HIV positive mothers for the first 6mos in resource poor countries, due to the greater risk of death from diarrheal disease secondary to poor drinking water. In everywhere else in the world, breastfeeding is contraindicated in breastfeeding mothers. This sends mixed messages to the women in many areas of sub Saharan Africa, who often end up doing a little of both. Their babies not only lose out on the full immunological benefits of breastfeeding, but are exposed to more dietary pathogens than they would otherwise. But there’s lots of theories. What we’re doing right now is not so exciting, basically a lot of data cleaning and crunching, between electricity outages and transportation issues. But so far so good.

Okay, enough of that for now. Tomorrow is Youth Day, I hope I can make it to one of the parades that are performed by the schoolchildren—depends how much work we have, but hopefully I can sneak away. I hope everyone back home is good. Cameroon is good, things are great, I think I have fufu belly.

Rural Cameroon, View from our back door.

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