Mbingo

This entry is extremely long but has lots of details for those who really want to know what Mbingo was like.

On Tuesday, around 2pm, Robbie and I left for Mbingo. We were able to easily find a Toyota Corolla taxi cab that would take us all the way there. Originally we thought we’d have to take a taxi out of Bamenda to a village halfway between Bamenda and Mbingo. Then, from there, we would probably have to find a new taxi to take us the rest of the way. Luckily it was made easy for us, although it wasn’t the most comfortable ride. We had seven adults, including the driver, plus a baby, crammed in a little four door, five passenger Corolla from the early 90s.

I was in the back, with Robbie to my left, and a man, his wife, and baby to my right. In the front was the driver on the left, then two people sharing the front seat, the one on the right shoved against the door, and the one in the middle, half on the seat, half on the center console, somewhat in the way of the shifter. I see multiple people crammed in these little cabs all the time but have never been in one this packed before. It was an experience.

We got to Mbingo around 4 and took a quick walk around the hospital. Robbie stopped in and said hello to nurses and patients he hadn’t seen in a few days. I could see his eyes light up when we got there. It was the same look I probably get when talking about cars and learning about engines. I could tell that working in the medical field was something he really wants to do, just like I really want my own car company. I believe at one point he said being a surgeon would be ideal. He has one more quarter of undergrad school left this year, and then just one more quarter left next year. He’s hoping to take the MCATZ over the summer and he’ll be done with his Bachelor’s degree in December. He may take some time off from continuing school and may not jump right into medical school, but ultimately hopes to be officially trained in the medical field. He has really enjoyed the work he’s been doing in Mbingo.

The hospital is very nice, and much larger than the one in Banyo, even though both are basically funded and owned by the same Baptist organization. It definitely handles more patients, has bigger wards, more operating rooms, more doctors, a bigger library, etc. Robbie said the hospital in Mbingo is a very good one in Cameroon, one of the best, if not, the best. People from all over Cameroon come to it. One of the women I saw operated on today was from hours and hours away. They have multiple surgeons whereas most hospitals in Cameroon have only one legitimately trained surgeon. Robbie mentioned the cleanliness and the quality of machines aren’t up to American standards although I’m sure for a third world country, this hospital is superb.

After leaving the hospital, we went to the Sparks’ home. It’s Cory and Suzanne’s home where the kids from FES went this past weekend (see previous blog). It’s a very nice home and is practically a palace compared to how most Cameroonians live. Although by American standards, it’s fairly normal. It’s in a very nice spot in Mbingo overlooking much of the town. Stephen Sparks, Cory’s dad, is the vascular surgeon at the hospital and was the only person home when we got there. Their two older daughters are away at school right now. I watched some X-files with Robbie, traded some music with him, and ate some dinner. We were both pretty tired and went to bed fairly early, (around 10). It was a good thing because we needed to be up early the next morning.

I woke up at 6:30 and we were out of the house by 6:50. We got to the hospital just before 7. Robbie and I changed into some sterilized scrubs, and put on “indoor shoes”. They have a rack with slip on shoes for use inside the “theater,” a British term for an operating room. When I first saw the word theater at the hospital, I thought to myself, “wow, they even have a theater for patients to watch movies while they wait for their surgery to begin! Sweet!” Not so much.

Robbie introduced me to many of the nurses and doctors in the theater. In this one building, they have three operating rooms, a lounge, and a room to clean clothing and sterilize equipment. I scrubbed up, or rather, did my best to after Rob basically showed me how. He said it wasn’t too critical that I’m completely scrubbed up since I’ll just be mostly watching and observing and won’t actually be doing surgery stuff, obviously. Nonetheless, I wanted to be clean. You have to scrub your hands and arms with soap, and then when you rinse, you start from the tips of your fingers, with them pointing upwards, to allow the germs in the water to drip off your arms. You then always keep your hands elevated above the elbows. We then put on our surgical masks and watched the doctors get to work.

The first surgery was classified as a “pelvic exploration.” The woman came in complaining of pain in her abdomen. Through an X-ray, the doctors were able to tell something was in that area that shouldn’t have been. However, since they don’t have things like a CAT scan, they weren’t able to tell exactly what it was but they figured it was probably a cyst. Robbie mentioned the cyst is most likely the result of an STD. The whole procedure took about 6-7 staff to perform.

It started with two nurses assisting the anesthesiologist in administering the spinal tap. She had to stick a fairly long needle in the spine in order to numb the whole area below the insertion. They then laid the girl down on her back, and gave her some meds to also help her remain comfortable during the procedure. I believe they gave her some ketamine, which is “Special K” in American slang. Ketamine also makes you pretty loopy and you occasionally repeat the same things over and over again during your trip. One day, Robbie was assisting in a surgery where a little boy was on some ketamine. The boy saw Robbie, pointed to him, and repeated over and over again, “White Devil! White Devil! White Devil!” Robbie laughs when he tells the story although I’m sure at the moment it was more a distraction than an amusement.

Then, after the anesthesiologist was done, Robbie used an electric razor to shave any little bits of hair off the woman’s stomach. He used a piece of tape to remove any loose hairs that had just been cut. Then he used iodine to disinfect the area. Then, another nurse carefully placed multiple sterilized cloths around where the incision would be made and then one final large cloth sheet with a hole in the center for the surgery. Then, the anesthesiologist and two nurses plus Robbie stayed on while three doctors came in to do the surgery.

Before the surgeons got to work, the nurses unwrapped a bundle of sterilized smocks and clothes for the surgeons. The surgeons, using their just scrubbed hands, put the smocks on. Before sticking their hands all the way through the sleeves, they used the sleeves to grab the glove packet and opened it. They then very carefully put two sets of latex (or nitrile) gloves on each hand and over the sleeves of the smock. Cleanliness is of course extremely important. Before the whole sterilized smock and glove thing, they put on eye goggles to avoid any blood/fluid splatter.

One doctor did most of the incisions and work while the other two assisted that first doctor by holding utensils in place, provided tools, and soaked up blood using both sterilized cloths and a suction machine. The first incision is done with a scalpel which cuts through the layers of skin. Then the fat and any tissue in the way are cut using an electric cauter. According to Wikipedia, what the doctors used isn’t classified as an electrocauter but rather just electrosurgery.

A cauter is designed to use heat to burn through and slice the tissue you are trying to cut. In the process of burning it, you coagulate the blood in the blood vessels in order to prevent bleeding. It’s kind of like singeing or welding blood vessels shut. Rob described it to me like in the last Star Wars movie. Luke and Darth Vader were battling to the death using their light sabers. Darth Vader managed to slice Luke’s hand off, but Luke didn’t really bleed much. That’s because his blood vessels were singed shut. So by using the electric cauter, you’re basically using a mini-light saber.

This electric cauter the doctors used doesn’t generate heat at the tip, like a soldering iron would which is why it’s not classified as “electrocautering”. What it does is create an electric circuit within the patient’s body that allows the tip of the cauter to slice through the tissue, and coagulate the blood. For anyone that needs a quick lesson in electricity: in order to complete an electrical circuit, you must have a wire coming from the positive side of the power source (a battery, wall socket, whatever the power source is), and you need a wire coming from the negative side of the power source. The negative side is also called ground. In order to use the cauter machine, you have to attach a grounding strap to the patient’s leg. The tip of the cauter gun itself, which looks like a pen, is the positive side. There is a button on the pen you press to complete the circuit and allow electricity to flow.

Electricity then goes from the cauter machine to the tip of the cauter pen, through the person’s body, to the grounding strap on their leg, and then back into the cauter machine. I wasn’t able to find out exactly how much current or voltage was going into the person’s body but the machine’s output was adjustable between 1-500 watts I believe. They had it set to about 20 watts if I remember correctly. Judging by the sparks created between the cauter pen tip and the person’s body tissue, it looked like the voltage was at least 30 volts. It smelled kind of bad but not the worst. It was a combination of the smell of burning plastic and a bad barbecue in my opinion.

They used the cautery machine to cut through much of the tissue in the way and I believe they used a scalpel to actually remove the cyst. The cyst was about the size of a few small garlic cloves. It was filled with a watery liquid, but not pus. The doctors then put everything back in place that they had to move outwards and out of the way, like the intestines and other organs. Then they stitched the opening they made, which looked to be about six inches long. There are two layers of stitching to be done. The first layer is about a centimeter or so below the surface of the skin. The surgeons perform this part using a small, curved hook needle with the stitching thread attached. They used small needle-nose pliers (or whatever the correct medical term for those are, I call them small needle nose pliers) to loop the needle in and out going back and forth from one side of the cut to the other.

Then, the surgeons leave and the nurses do the second layer of stitching in the same manor the surgeons did it. This second layer is done on the skin surface. Both sets of stitching are automatically dissolving stitches. After the stitching was over, Rob and a nurse put gauze and tape over the opening to allow it to heal. We then picked the woman up by the cloth sheet she was laying on, and moved her onto a new hospital bed to roll her out of the room and to the recovery area. A few minutes was given for the doctors to take a break before the next patient came in.

The next patient was an older gentlemen in his 70s with a hernia in his abdomen that needed to be removed. It was more or less the same as the previous procedure. Sterilized equipment, spinal tap, incisions with a scalpel, cautery, removing the hernia, two layers of stitching, move the man onto a different hospital bed and then out to the recovery area. The third patient was a woman who had an abscess in her abdomen (also most likely the result of an STD) that needed to be drained of pus and for some infected tissue to be removed. This was the surgery I got the chance to take pictures of and posted on Facebook. http://www.facebook.com/album.php?aid=2037698&id=1337370415&l=a82aeade57

This was, at this point, the foulest smelling surgery because of the pus. I had to breathe through my mouth several times during the procedure. In all three of these surgeries, the only helping I really did was to move the patient from the surgery bed to the rolling hospital bed by picking up the feet end of the cloth the patient was laid out on.

In between the second and third surgery, and for a small portion of the third surgery, I stepped out of the operating room we were in, and went to the eye surgery room. A man’s eye had ruptured and needed to be sewn back together. I imagine that the whole procedure was a little bit more complicated than just a rupture and there was probably some sort of other problem with the man’s eye but I didn’t catch what it was. There were three people in the room when I arrived. The doctor was performing the stitching through a magnifying machine for looking at the eye up close. A nurse was assisting with giving tools, soaking up blood, and rinsing the eye with saline solution. The third person, who was probably a nurse/student, was observing through the same machine the doctor was using to magnify the eye. The machine had two spots to view what was going on. Perfect for the person actually doing work and someone who needs to learn and observe.

The nurse observing got up to allow me to watch for a little while. It was intense! You’d think seeing a small curved stitching needle no longer than a centimeter or so going in and out of an eye would give me the creeps but it was very fascinating. In it goes with the thread trailing behind. Out it comes. The doctor cuts the stitch, ties the two ends together, cuts the excess, and creates a new stitch just a millimeter or less away from the previous stitch. In the needle goes into the eye, out it comes across the clearly visible ruptured slit in the eye. It gets tied, cut and a new stitch is formed. It was really cool.

I guess that’s more or less what the surgery done on my eyes when I was a baby looked like. I was born cross eyed and had a surgery when I was 9 months old (correct me on this if I’m wrong, mom) to correct it. A few days (?) after the surgery, I started to cry and scream bloody murder. My mom called the doctor and he said one of the stitches in my eye probably came loose and that she should bring me in to the hospital to fix it. Ouch! I’m glad I don’t remember it.

The fourth and last surgery of the day that I witnessed was the hardest, most grueling. A burn victim needed his wounds to be redressed. The man, who is 25, was apparently siphoning gasoline from one container to another, or something like that. It accidentally spilled all over him and somehow got ignited. Almost every square inch on this man’s body had third degree burns. His face was untouched, the bottoms on his feet were okay in some parts, and a few patches of skin on his chest and stomach were okay. Other than that, he had just exposed flesh, bits of blood, and yellow pus everywhere. I breathed in through my nose just a couple times before I made the decision that if I breathe through my nose anymore, I would throw up. I breathed through my mouth the rest of the procedure.

The man cried out very loudly several times and his whole body shook from time to time. You could tell he was in a lot of pain from even though he was very doped up. The anesthesiologist gave him several injections of ketamine to reduce his pain and sedate him. It had been a week since he was burned and Rob said his wounds were much better than when he last saw him. The gauze and bandages covering his body need to be replaced every day.

I put some gloves on and actually helped in this procedure by holding his legs up and removing the old bandages. It was very eerie to feel and hear the gauze sticking to his flesh as it was being peeled away. I felt so bad for the poor man. What a devastating experience. I didn’t help with putting new gauze on, mostly because I wouldn’t know what I was doing. They used gauzes with Vaseline and hypochlorite on them to prevent sticking and infection. Seeing that man was quite disturbing and I hope I never have to suffer from third degree burns ever. They don’t expect the man to live for very much longer and are surprised he has so far recovered as well as he has.

After that surgery, it was almost three o’clock in the afternoon. I needed to get back to Bamenda before the taxis stopped running from Mbingo to Bamenda for the day. I thanked everyone for letting me witness the surgeries and told them how grateful I was for the opportunity. Robbie and I then left, went back to the Sparks’ home, and got something to eat. We then walked back towards the hospital and I got in a taxi, this time with 8 people plus a baby. I was cramped with four people in the front between the two actual seats available in the Corolla. It was like that until we got into Bamenda and my legs were numb for most of the ride but all in all I was fine.

I’m very grateful I was able to meet Robbie and go to Mbingo. It was an amazing experience I probably won’t be able to have again for a very long time, if ever.

Today was a day much like any other. I had algebra class (which Sherri did by herself yesterday while I was in Mbingo) and swimming in the morning and some free time in the afternoon. I played hockey with the kids after school was over for them and graded their math homework after dinner. Tomorrow is the last day of classes and a celebration in the evening for the whole two week program. The Lokkers and I will travel back to Banyo on Sunday.