Mary Buckler’s Blog

Post - August 8, 2008

August 29th, 2008 Posted in Uncategorized

Empathetically injured

Mbingo Hospital has “chaplains” that round in each ward and are around to provide spiritual and emotional counseling and support as patients request. Today the female-ward chaplain-in-training showed up to morning rounds with an oversized-trauma-neck-stabilizing-collar around her neck, looking fairly uncomfortable. At the inquisitive looks on our faces, she explained: “This is our day to learn what it feels like to be a patient – I have to wear this for the next twenty-four hours. So when I say “Ashiah” to the patients, I can REALLY empathize.” The chaplain-instructor then proceded to tell a story of how, last year, the chaplain-in-training who had the full-led-cast for a day got stuck in a bathroom stall and had to call for help getting out. THAT, I think, is a level of empathy that few health-care workers attain. Ashiah.

Ashiah

My favorite Pidgin word. It cannot be translated exactly into English, but the nearest approximation I have heard so far is that Ashiah = “I share,” or “I empathize with you.” It can be used when walking by someone working in a field, as an acknowledgement of their effort. It can be used as a general greeting and will be received as a gesture of kindness and good will. Patients say it to me when I go on rounds. I have taken to saying it everyday to the nurses, chaplains, caretakers, and patients.

The long-termers here tell me that most people passing through like this word. One MK (missionary kid) expressed to me how much she actually disliked the word, from hearing all the short-term-visitors talk about how much they liked it. In either case, I know when I leave Cameroon I will miss having such a beautiful verbal expression of empathy.

Pidgin

I am no linguist, but I think most people would agree that the African dialect known as “Pidgin English” is an interesting linguistic phenomenon. Most languages may sound amusing to outsiders who do not speak it very well; to the native speaker, however, the various sound-combinations are usually not intrinsically humerous. Not so, however, with Pidgin! Those who understand and speak Pidgin fluently laugh at it as much if not more-so than the foreigners who are first introduced to it, perhaps like I might smile at a gangster’s slang or a thick southern accent. Perhaps it is because people here can turn it on-and-off. In either case, because of this insight into the humorous-ness of their own language I have decided that African culture, at least linguistically, has much to teach us about having a healthy ability to laugh-at-oneself.

For the linguistically inclined, here is a page from Joy’s “cultural orientation” packet:

A Simple Guide to Pidgin English

Verb tenses
Present, “di”
“I di go” = I go, “I di sing” = I sing

Past, “done”
“I done go” = I went, “I done sing ” = I sang

Future, “go”
“I go go” = I will go, “I go sing” = I will sing

Far Past, “bi” or “I bi go”, “I bi done” or “I bi done go”, Used in telling history or Bible stories

Helpful Pidgin Words & Phrases
Ashiah = Sorry; shows empathy
Dash = Small gift. “Dash me something” = Give me a present
Pekin = Child
Sabi = to know or understand something. ‘No sabi’ = I don’t know
Na whati? = What?
For saka whati? =Why?

Prepositions: “For” is commonly used for nearly all prepositions. “Carry dis book for table.”

Expressions of feeling may be followed by “say.” “Think say” = think; “He done talk say…” = He said; “feel say” = feel.
Expressions of distance of nonspecific, going from “near plenty” to “near,” “far small” to “far” to “far plenty.”
Medical personnel will soon learn that “four-letter words” related to bodily functions are not vulgar in Pidgin; they are normal. “You di shit wata-wata?” = Do you have diarrhea?
Some English words have different meanings. “Skin” means body. “my skin no well.” = I am not well. “Find” = look for. “I di find my shoe” = I am looking for my shoe.
To make a word plural, add “dem.” “Pekin dem” = children. (Frequently in church they mention “di pekin for God” = Son of God, or “we di be pekin-dem of God” = we are children of God.
There is no “th” sound in most of the vernacular languages, and in Pidgin. “This” sounds like “dis.”
“Done” sounds almost like “don’t” without the “t.”

 

Walking tour of Mbingo

My first night here at Mbingo, I found myself locked out of my room for a few hours. While waiting for my room key, I decided to stroll the walkways of the hospital. I call them walkways instead of “corridors” because the concrete pathways connecting the various wards and building are all outside (under tin roofs, a construction for which in the current rainy season I have frequently been greatful). Outside the various wards are many mats and foam-pads and on them lay sprawled various men and women. Some are eating fu-fu and “njama-jama” with their thumb and forefingers (the traditional method of eating which I am becoming fairly adept at). Others are sitting in circles chatting or playing card. A few are sleeping, supine forms covered with sheets or “wrappas” (the one-or-two-yard blocks of fabric that the women use as wrap skirts). One pair of men is playing checkers with a few onlookers.

Who are these sprawlers? Sometimes they are newly-discharged patients, loitering for a few days until their family brings money to pay their bill. In the afternoon a few of the less critical patients may be seen out-and-about on the lawn. But the vast majority of these persons can be identified as the “caregivers,” those family members or friends required by the hospital to stay with each patient. They are the functional CNAs of the hospital. It is their job to prepare all the meals for the patient, assist them with toileting, help with washing and clothes-changes, and sometimes alert the nurses to things that would otherwise go unnoticed. As a general rule, no patient will be admitted to the hospital without a caregiver. Oftentimes different family members will take turns every few days. Some people have to take off work for weeks or months at a time.

Coming from the western approach to inpatient-hospital-care, I am more familiar with a scenario where a family drops off the patient at the doors of the emergency room, sometimes not to return for a few hours or a few days. It was not uncommon during my medical-school clinical years to round on a patient everyday without ever speaking with or interacting with their family. Being familiar with all of the problems of this model, therefore, I was at first enthralled with this African way of providing hospital care in a way that not only includes family in the treatment plan, but actually requires it. Since then, I have of course seen a few problems or “kinks” that have resulted from the required-caregiver policy, but overall I admire and appreciate the approach.

That first night I met many such “caregivers,” shaking hands with them as I passed and sitting to chat with a few who were more interested. Cameroon has ten provinces, eight of which are French speaking. Mbingo Hospital is in one of the two English-speaking provinces, on the border of Nigeria, a fact that I have been very greatful for as I know next-to-no-French. As long as I do not “rap” (the Pidgin English word for talking quickly in straight-English), most people understand my English and are amused at the few pidgin phrases I am able to throw in. One woman I met that first night, Vera, proceded to greet me everyday whenever I passed by her mat: “Hello, my friend!,” “Dr. Mary good morning!” or “Hello Mary, mother of Jesus,” to which I would respond with the friendly-right-hand-shake and “Hello, my friend!,” “Good morning Vera,” or “I love Jesus, but I am not his mother!” (the last phrase of which usually brought about a few hearty laughs from surrounding loungers). Although she spoke only Pidgin, I was able to elicit from Vera that she is Catholic and had been there for three months taking care of her sister who was finally discharged two weeks after my arrival.

Next to woman’s ward (where I spend most of my time) is the ulcer ward. It contains 50-60 beds, most of whose residents have been there for many months and have many more to go while their chronic wounds gradually heal. There is almost always a game of checkers going on outside, with bandaged-footed-men taking turns to push the rough-hewn-plastic-fragments around. Whenever I walk by, I slow down my fast-clip to ask “who is winning?” to which they usually respond with a shrug or a pointing finger. One checkers-regular was very excited to hear I had lived in Wisconsin, as his son is a doctor in Minnesota and he has other family living in Maryland and California.

Continuing past the ulcer ward and then children’s ward, I reach the xray department which consists of two main rooms, one for xrays and one for ultrasound. The xrays dry on a rack outside on the walkway (check out the right lung in the front, below!) There is no CT scanner, a diagnostic tool I am getting used to living without. A few hosptals in the capital city have one, but oftentimes they don’t know what to do with their findings and send the patients to us, CT scan in hand.

Next we pass children’s ward and men’s ward and come to the pharmacy and lab. I am getting more familiar with the available drugs on the formulary, as well as what to substitute when I see the “O/S” (out-of-stock) written in the chart next to my orders. I am getting to know a few of the pharmacists, and most mornings one tries to round with the doctors on every ward. I was surprised to find that they function very much like pharmacists do in the U.S. – checking our orders and doses and offering recommendations. Some of their recommendations are helpful, and I appreciate their “why” questions (keeps us doctors on track), but Dr. Palmer cautioned me the first week to always double-check things with my own resources.

Laboratory here is limited but does a good job with basic electrolytes and WBCs with diffs, as well as CSF fluid analysis, LFTs, urine analyses, etc. In a few weeks we are supposed to get some sort of machine that will radically expand our lab’s capabilities and enable us to check TSH (thyroid hormone) and other endocrine hormone levels.

From lab we go to OPD (out-patient-department), the clinic part of the hospital. There are no appointments, so oftentimes a patient may wait the better part of a day before being seen. Mondays are the worst days, and the usual disorganization is drastically worsened with the increased patient load.

Past OPD is maternity, the orthopedic “accident” ward (with its assortment of traction beds), the new private ward (where only the more wealthy patients can afford to have their own rooms like we all do in the states), and the “theater” and surgery-wards. All in all, the hospitals has around 200-250 beds in addition to an eye-department and opthamologist training program, the PAACS program (Pan-African-Academy-of-Christian-Surgeons) residency program with seven residents currently, a Physical Therapy department, and the “GoodHope village” for lepers a few miles down the road.

There is no E.R. or ICU (“yet,” says Dr.P). If you were a patient arriving to the hospital in a critical state, you would pull into the turn-around, be placed on the stretcher (stored outside by the map), and brought into OPD to be assessed. There is a reception-room off the turn-around that is open 24-hours, there is someone in the pharmacy 24hrs a day, and someone from radiology and/or lab can be called in in the middle of the night if necessary (though, just like in the U.S., they are not very happy about it.).