Mary Buckler’s Blog

First Post!

The year is 1952. You are in the African country of Cameroon, in search of a piece of land on which to build a hospital for the care of people with leprosy. After being turned down many times, you finally acquire a piece of undeveloped bush property in the northeastern province, an hours drive from the nearest major city. The remote location is, in fact, ideal to isolate this dread disease from the rest of society.

Now, more than fifty years later, what originally began at a Leprosy Settlement is now one of the largest hospitals and referral centers in Cameroon and the West-African Sub-Region. Once, 150-200 people with leprosy were pushed far away from the rest of society to be unsuccessfully treated and to die. Now, with successful treatments for this once-dreaded disease easily available, there are only approximately 20 “lepers” still on site, living in their own independent community with services and care-providers allocated to them as needed.

Greetings, all! I type this on a borrowed laptop, from the African country of Cameroon. This weekend was the three week anniversary of my being at Mbingo Baptist Hospital as well as the three week anniversary of my first time overseas. I have not written sooner since it is rainy season and internet time has been unreliable ann few-and-far-between. The above “narrative” was part of my orientation to the hospital…

“Of course we have a new leprosy, you know,” Dr. Dennis Palmer said to me the afternoon I arrived. “HIV & AIDS.” Dr. Palmer is the director of the new Internal Medicine residency program beginning here next month, and he and his wife (a cultural anthropologist and mother of three grown sons) have spent much of their lives working to help craft and empower a sustainable Cameroonian-run-system here. Even before I saw their huge book collection (complete with “The Quotable Lewis” which I must admit I had been missing already), I had developed an enormous admiration and respect for these two people. (I’ll be writing more about them but, for now, I’ll just point out that, “incidently,” Dr.Palmer is co-writer of the “Handbook of Medicine in Developing Countries” along with Dr. Catherine Wolf in Haiti, with whom some may be familiar.) I apologize ahead of time for the length of this email, and hope to keep it shorter in the future.

Medically:
There are many “sensational” and “tropical” presentations that would be much-acclaimed in the U.S., but here are run-of-the-mill. One man came in with a red, swollen left hand and forearm, palpable epitrochlear lymph nodes, and what he soon informed us was a “viper-tooth” remnant sticking out of a puncture wound in his second finger. In this country where (as I learned later from Dr. Palmer) over 90% of vipers are venomous, this man had been bitten, decided to first pursue “country-medicine”, and finally presented to us five days after the “event.” Since the first 12 hours are the most deadly as far as viper-venom is concerned, there wasn’t actually much for us to do other than give antibiotics for the ensuing cellulitis. I recommended removing the viper-tooth (the “remove the source of infection” mantra I remember from med school), but am not sure if it was ever done. The Cameroonian doctor I was working with did give him a lecture about how he “should not use country medicine,” but like in many of the doctor-patient lectures I have heard given in the U.S., the patient looked neither apologetic nor persuaded.

HIV is indeed as common as they say, and opportunistic infections (”OIs”) abound. I feel confident in diagnosing by sight Kaposi’s sarcoma in an AIDS patient, can recognize the fever curve of typhoid fever, and am comfortable including “Cryptococcus” and “toxoplasmosis” on a typical meningitis differential. I have been directly coughed on by a patient who was later found to have TB (positive AFB in sputum), and look forward to seeing whether or not my PPD will convert upon my return to the U.S. in six months. I was a bit surprised by the lack of malnutrition in this part of Africa, but my roommate, Mbong, tells me that Cameroonians will go without many things before they will go without food. Equally surprising, however, was the incidence of newly diagnosed leprosy – though effective treatments have been around for a few decades, there are still some people who put off coming to the hospital until after they have already lost several fingers and/or toes. Sensational though these things may sound, they seem to be as normal to the doctors here as diabetes and hypertension are in the U.S.

Other things, however, are surprisingly close to home. Antibiotics are as overprescribed here as in the states. Unneccessary lab tests that have no effect on the treatment plan are ordered in abundance – another familiar frustration. Philosophical conversations on the value and ethics of placebo treatments pop up from time to time. Women present for infertility workups without their husband, though they have had children by other men and the husband has not (and yes, just like in the states, the woman’s workup is ten-times more expensive). And, from the little time I have spent so far in this culture, I have come to the conclusion that physician-patient communication is a challenge that spans all cultures.

Day-to-day:
I love being here! I feel in many ways more rested than I have in the last four-years of med-school. People get up early (4 or 5am), go to bed early (8pm), and walk slowly (something I may never be good at). It is not uncommon to hear a staff-member or patient spontaneously “bursting into song,” followed soon by the entire ward joining in – in full, glorious harmony! It is rainy-season, so five out of seven days we have rain that is so loud on the tin-roofs that we have to shout to have conversations. I love falling asleep to the rain (reminds me of home in Portland, Oregon). I love waking up to the exotically melodious birds that sing so loudly they could be in the room with me. Outside my door is a panoramic view of the Cameroonian cloud-covered mountains. And you will hardly believe I’m writing from Africa when I tell you that the temp hasn’t gone above 70degrees.

My first week I had a room to myself, and was actually thankful that my luggage hadn’t arrived yet. There’s nothing like being vulnerable to help you get to know people, and “where could I find some _____(insert any awkward personal-hygiene item)” is a line that, now from personal-experience, I can guarantee will secure even the most socially-anxious person some instant Cameroonian friends (people here love to help).

With the start of my second week, came my luggage…and a roommate! Mbong (prounounced like “mmmmm-bong” with the “mmmm” being silent) is a Physical Therapy student from Boston, here for one month. Her parents are both from Cameroon, so although Mbong was born and grew up in the U.S., she has many relatives here, some of whom I’ve gotten to meet. We have many things in common, including our age, having big feet, a love of hiking, exploring, and ice-cream, not being afraid of getting wet and muddy, and enjoying getting to know the people here as well as the various visiting doctors and missionaries that pass through. I am so surprised and thankful for her presence here for this first month, both as a sister in faith and as a friend with whom to share the everyday experiences, struggles, and joys!

Personally:
I love being here, am enjoying becoming friends with some of the Cameroonian physicians, am getting the hang of the hospital system somewhat, am developing an intense admiration and respect for the docs already here, and am constantly amazed at the conversations that come up and how “at home” I feel in so many ways. So far there has been minimal culture shock, and I am glad to know that people are people everywhere – humanity is a constant, no matter what the culture. Reminds me of a quote I once heard–”it may be a third-world country, but they are first-world people.” There have been a few lonely moments, but they are surprisingly minimal – and it’s hard to be lonely in a culture where everyone knows my name, and would even if I WASN’T one of the few “whites” on the premises.

Many things are sad and angering, but many other things are amazing and joyful. Some things about the “system” here appear wrong, unjust, and uncompassionate to me, but there are other things I have a great admiration and respect for (more details to come). Many things are different than at home in the U.S., but many things are surprisingly similar. Mbong is wonderful at reminding me to not “pass judgement” too quickly. Above all else, there is one constant that has stuck with me — from the moment I stepped off the plane into the humid air of rainy-season in West/Central Africa, I was filled by the sense of having “come home.” At first I diagnosed this as part of the “honeymoon/infatuation phase” of culture shock. But later, as the sense of “coming home” persisted even when I have felt some of the classic “culture shock” symptoms (withdrawn, angry, lonely, etc.), I have begun to wonder if it may not be a more permanent condition, and one that is healthy instead of pathological.

Culturally:
Upon arrival, I was given an orientation by a 30-ish-year-old woman named Joy. Joy has a degree in cultural anthropology. When I asked why, she said “because people have reasons for doing what they do. We may not always know why they do it – but there is usually a reason.” Poof—Instant friend! Other Joy quotes: “People like promises here. If you say you’re going back to visit someone, then do it!” and “We consider visitors to be a blessing, like rain…(on the importance of hospitality).”

From day one I have seen how people in Cameroon are more people-oriented than task-oriented. Even the most focused among them are quick to stop whatever they are doing to greet a visitor (”good morning!” or “good afternoon!” or “good evening!) and extend their right-hand. On the flip side of this hospitality-emphasis, many of the missionaries have commented how difficult it can be to have privacy. Even Joy mentioned that privacy is not necessarily an “African” concept. We then proceeded to have a discussion around the terms “introvert” and “extrovert,” and whether or not they are even applicable or relavent in this culture…I suspect many of you may have more insight into this than I.

“For I was hungry and you gave me something to eat,
I was thirsty and you gave me something to drink,
I was a stranger and you invited me in,
I needed clothes and you clothed me,
I was sick and you looked after me,
I was in prison and you came to visit me…
whatever you did for one of the least of these brothers of mine, you did for me.”

(Latest theological discussion passage with Dr.Palmer, on the famous topic of the interaction between works and faith, from Matthew 25…thoughts?)