Dr Paul Wharin and the Clinical Director of BTMAT, Prof Peter Hesseling, visit Cameroon biannually. As is their usual pattern they worked at all 3 Baptist hospitals in November and made two calls at Cameroon Baptist HQ, Nkwen, Bamenda in order to confer with Prof Pius Tih, director of the Cameroon Baptist Convention Health Board (CBCHB) and to check our charity accounts at Central Accounts Office.
There follow a few excerpts from Dr Paul Wharin’s travelogue:
Thursday Nov. 1st Babessi Parents Group
Prof Peter Hesseling and I travelled from Bamenda to Banso Baptist Hospital today. You may remember an email (May 2012) in which I described how the road had been “regraded” (the potholes filled with soil and levelled), but no tarmac has been laid since that date. Paul Biya, the president has promised that this will be done. Our departure from Bamenda was delayed for over 2 hours because the vehicle scheduled to carry us (and also senior Banso administrator, Joseph Ngum) was needed to winch another CBC vehicle which had careered off road. No CBC personnel were seriously injured – but this makes me all the more thankful for your prayers. When I am asked by children, “What is the most dangerous animal that you see in Africa?” I usually reply “the oncoming driver”.
On the way to Banso we stopped at a village called Babessi in order to meet the parents group formed last year. Babessi is a large village with widely scattered houses. It lies in the Ndop plain which is hot and wet – classic mosquito country with holoendemic malaria and thus a high incidence of Burkitt’s lymphoma. We were warmly received into the house of Mr Moses Mbammu, the secretary of the group – a dark, earth floored, thatched house with 2 rooms. Prof Hesseling and I and Joseph Ngum were given seats of honour (very hard!). Mr Mbammu opened the meeting with prayer. Glenn Mbah, our research assistant nurse declared that all 6 children of these parents were well (and at school). The president of the group, Mr Francis Hambe reported the success of their palm oil sales earlier in the year (raising funds to send “new” parents to Banso Baptist Hospital where free treatment is available).
We were invited to eat outdoors, a meal consisting of coco yams, mackerel and “palm wine”. Mr Francis, the president had climbed one of his palm trees earlier in the day and tapped the sap – it was delicious. The mackerel was a bit more risky, probably S.African with a very dubious cold chain of delivery – but a costly gift from our friends. We gave thanks and ate well.
Sunday Nov. 4th Motorbike Palliative Care at Banso
We have treated over 700 children with Burkitt’s lymphoma at the 3 Baptist hospitals. Over 60% of children treated with Prof Hesseling’s 2008 protocol survive for one year and beyond. These results have been acknowledged as the best achieved in small hospitals in a resource limited setting and this protocol will now be the basis of an international standard which will be used in Malawi, Tanzania and S. America.
However this still leaves 40% of children who have tumours resistant to our chemotherapy. These children need palliative care. We do not abandon them but the majority live far out in the bush way beyond the reach of the 4-wheel drive vehicle used by our hospital palliative care team. A trained African palliative care nurse on a motorbike can reach much further (and travel faster) than the palliative care team in a vehicle. A suitable male nurse has been identified by the senior nursing officer and CMO and this man is now receiving training in palliative care. He will be part of our Burkitt ward team at Banso. Prof Hesseling has used his funds to purchase the motorbike and will cover the cost of fuel and per diem payments to the nurse, but the salary of the nurse will be the responsibility of our small charity (BTMAT). We are helping our Cameroonian Baptist colleagues to fulfil their mission statement “to provide exemplary health care to those in need as an expression of Christian love”.
Monday Nov.5th Ntaba Parent Group
On Monday we travelled northeast to make follow-up visits at Sabongari near the Nigerian border, a journey which I described last May. The dirt roads were in good condition then, but not so now at the end of the rainy season. I saw 2 craters deep enough to swallow a car – very dangerous if they fill with water. At Sabongari Baptist clinic we found a 7-year old boy who had presented with advanced disease in May 2012. We could only provide palliative care. Glenn, our nurse counselled his uncle who appeared to be the only carer. The second patient, a girl of 10 was in complete remission 6 months after chemotherapy for a tumour of her lower jaw. Her aunt gave Glenn a bag of roasted “termites” (an expensive gift) and two large pawpaws. I tried a few mouthfuls of the termites (“flying ants”, I would call them) and found them quite tasty.
On the way back to Banso we called on our second parent group at Ntaba village.
The president of this group, another Paul, is a pig farmer. We bought a piglet (sow) in May and Paul is raising it for us. I can report that the sow is doing well and will be mated in December. Half the litter will go to Paul and half will be sold to raise money for the parent group. They have already sponsored one “new” parent and child on their journey (3+ hours by car or minibus) to Banso Baptist hospital. They are good advocates for our child cancer treatment programme and will tell their neighbours that “This sick is NOT witchcraft. Take pekin na Baptist hospital” – where you get free treatment.
Sunday Nov. 11th An egg a day
Prof Peter and I have just had breakfast in the canteen at Mutengene. Standard fare is pancakes and maple syrup to suit our American colleagues. We usually beg for an omelette.
Food is important in any society but especially so in Cameroon where 85% of people are subsistence farmers. The soil is particularly good in N.W.Cameroon and crops (bananas, plantains, corn, yams, beans and sweet potatoes) grow well. Even so children admitted for chemotherapy are relatively malnourished – and hospitals in sub-Saharan Africa do NOT provide food for patients (OR relatives). We give our children an egg and 200ml of vitamin-fortified F75 (skimmed milk formula) per day for the first 14 days of treatment. We have proved that this reduces early mortality. Colleagues in Malawi have shown that improved nutrition correlates with fewer side effects from our powerful (potentially lethal) cytotoxic drugs.
Parent support is also important. A mother will arrive at the hospital with her sick child only to be told that he /she must stay for 2 weeks. She may have little or no money, several other children and a field (a “farm”) to care for. She is likely to discharge her child against our advice. We call this “abandonment”- a big problem in African medical practice. Prof Hesseling provides 500 CFA (65 pence) plus 3 cupfuls of rice per parent/guardian per day (and also supports transport costs to the hospital). Our Beryl Thyer Trust pays for drugs and all other in–patient treatment costs. Our abandonment rate is almost zero.