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Posted by: Admin on Mon, Jan 9, 2017
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JIM AND CAROLYN BROWN IN CAMEROON
Looking back over the work and activity of 2016, we’re amazed, humbled, and thankful to have been part of what God is doing in Cameroon. In our last newsletter we mentioned plans for an upcoming spiritual retreat for the residents and faculty, a comprehensive Wound Care course for 12 nurses, upcoming COSECSA exams for two of our residents, and going home to see family in October. While it may be easy to fill our newsletter with important events, it is more difficult to describe what we do on a daily basis.
In spite of many administrative and academic responsibilities, Jim’s days are mostly filled with direct patient care and teaching. No day is the same, and still after all these years there is rarely a day he doesn’t see something he’s never seen, or do an operation he’s never done. Every day begins with a schedule, but by early morning most schedules are rearranged as emergencies arrive and must be triaged all day to meet the most urgent needs. Almost half of our surgeries at Mbingo are not scheduled, meaning that we do a lot of emergent and urgent surgery. We have become a referral center for a large portion of the country, receiving difficult and complicated cases that cannot be managed elsewhere. We are doing more trauma, complex pediatric surgery, and oncology cases. About 25% of our surgical cases are operative OB/GYN. As of January 1 we have 13 residents from 7 African countries. Jim shares the teaching responsibilities with two other excellent general surgeons- Dr. Jacques Ebhele, a PAACS graduate from the Gabon program, and Dr. Debbie Eisenhut, a missionary from Oregon. We also have a Cameroonian ENT surgeon, a Cameroonian orthopedic surgeon, and an American plastic surgeon who are part of the PAACS program but run their own services. We rely heavily on visiting surgeons of all subspecialties to supplement our teaching and patient care needs.
Jim estimates that approximately 75% of the surgeries he does in Cameroon he did not routinely do while in the Navy or private practice in the US. There are many examples of this, but three specific areas of surgery he does in high volume are chest surgery (especially related to tuberculosis), pediatric hydrocephalus and spina bifida, and pediatric esophageal strictures related to caustic ingestion.
KB is a 22 year old man with several years history of debilitating shortness of breath and facial, abdominal, and leg swelling caused by a thick membrane (the pericardium) around his heart that prevented his heart chambers from filling normally and limiting his cardiac output. This was probably caused by tuberculosis. At surgery we removed the thickened pericardium, releasing his heart and enabling it to function normally. He quickly recovered his strength, mobilized the extra fluid in his face, abdomen, and legs, and went home much improved. Jim also operates on many TB patients who present with a similar membrane around a lung, trapping the lung so that it cannot expand normally during respiration. Surgery is necessary to release the lung. Other TB patients present with large cavities in their lungs that cause recurrent infections or life threatening bleeding, requiring resection of the involved part of the lung. BB was a 4 day old baby boy born with spina bifida, a condition where the back of the spine does not close around the spinal cord before birth. Many of these babies have severe neurologic problems, but the most urgent need after birth is to close the defect over their spinal cord to prevent infection, which we did for baby BB. Many of these babies also have club feet, or develop hydrocephalus (fluid that accumulates around the brain) and require a shunt to divert the fluid from the brain to the abdomen where it can be reabsorbed. We do a lot of these surgeries. Carolyn has now become involved with these children as their families need to learn to care for their problem with urinary and bowel incontinence. We are just beginning a program to teach families and nurses in this area and plan to work on developing more of a team approach to their care throughout our hospital system in early 2017. AB is a 10 year old boy with spina bifida seen in the adjacent picture with his mother. He walks with crutches and goes to school, but is incontinent of stool and urine and has a chronic wound on one of his feet. After Jim did his spine surgery Carolyn has worked with him and his mother on his other needs.
AC is a 2 year old boy who drank a strong cleansing agent that his parents had stored in a coke bottle in their home. He developed severe scarring of his esophagus and inability to eat. We see many of these children because this practice of storing caustic liquids in non-child proof containers is common in Cameroon. This child required many months of serial dilations of his esophagus to restore it to a state where he can now take food and drink by mouth again. But without this treatment, these children die of starvation or drown in their own saliva. We have begun to address this as a public health issue but in the meantime we have a whole clinic of these children receiving esophageal dilations.
Carolyn’s time at the hospital is spent in the Wound Care Clinic and on the Wound Care Ward, answering consults, teaching nurses, and now following up with the 12 Wound Care Trainers who began their one year course in September. She periodically travels to three of the other hospitals within our system to teach. Ostomy care and teaching is also a large part of what she does at Mbingo. The adjacent photo is JM, a young man who presented with bladder cancer. Jim and the residents operated to remove his bladder and create a stoma from a piece of intestine for the urine to pass out. They were able to get all the cancer, but JM must now wear a sac to collect his urine. An elementary school teacher, he is thankful to be cancer-free and going on with his life. Ostomy supplies are generously provided by FOW (Friends of Ostomates Worldwide).
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