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 an organization called Mission Doctors Association, a Catholic organization. Njinikom is a small town in northwest Cameroon. The majority of people in Njinikom speak Pidgen English or the local dialect 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. My first 2 weeks were spent with Brent and Jennifer on the inpatient medicine service. We were responsible for the male, female and children’s wards and any newborns that were ill. My days on inpatient medicine consisted of rounding on the inpatients with either Brent or Jennifer in the morning, then going to the outpatient department (OPD) once done with rounds. 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). I realized quickly that I didn’t know who was badly sick in this setting. I was called one night as a 26 year old patient was being resuscitated. The patient was admitted for pneumonia and anemia. His hemoglobin was 5 and he had been transfused 1 unit of blood (whole blood donated by a family member) and was on antibiotics. We had seen him that morning and he was talking and in no respiratory distress. We checked an HIV test which was positive. That evening, when I arrived, he was non-responsive, breathing heavily and hypotensive. The night nurse had put him on an oxygen concentrator. I told the nurse to bolus...
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