"Work"

Fundong District Hospital

Laboratory on Monday (4 hours)
o While I felt that my exposure to the lab at the hospital was an eye opening experience (comparing what I know of the efficiency and technology of labs in the US), I felt that I was passing the time waiting for the Chief Medical Doctor to arrive, and he only did as I was leaving for the day. I was happy to be of assistance to Eunice (BFF member) who was handling a large case load all alone on a Monday morning, but it made it clear to me that the need for her to have an assistant is VITAL! Testing hemoglobin levels, retrieving blood from patients and then preparing slides to look for malaria parasites and white blood cell counts under a microscope, and recording all of the information in their patient handbooks (among other tasks) takes a lot of time and thus slows down the process of diagnosis and determining the level of care necessary, by the doctor. As a result of the lack of updated technology and sufficient number of staff in the lab, the process of coming to the hospital here for a consultation can take all day and this really affects the efficiency of the various triage areas of the hospital as well as the patient’s ability to go to school or work that day.

Maternity Ward on Tuesday and part of Wednesday (3 hours over 2 days)
o I was hoping to spend my time in maternity with Beatrice (another BFF member who is the RN in charge of the ward) but she was out because of a burial. I did get to spend a short time with her when she came back to work and found out about her daily routine at work. She has much responsibility taking care of the patients (hands-on), carrying out prenatal exams/consultations & deliveries, and discharging them (and all the paperwork that comes along with that process). There are antenatal and child welfare clinics (for new moms) each week and she, along with her assistant, Madame Achu have a list of about 15 topics that they cover over the course of a few months-very organized it seems. I was unable to observe a clinic at this site but hopefully will be able to in the future. I spent most of my time with Madame Achu, asking her questions, waiting for patients to arrive for prenatal consultations, and reading my own book during down times. No specific appointments are made and so the ability to plan the day accordingly does not seem to occur. Not only that but after doing a consultation, the patient has to go to the lab and get various blood tests done, wait for the results and then come back for a discussion with the results-again too long of a process and too much waiting for both parties. Through observation of a couple of prenatal consultations it was clear that family planning is a theme that the staff has to impart on patients as well as my realization of the need for discussion and a take home handout surrounding iron rich and calcium rich foods for their pregnancy eating plan. This is something I plan to create after truly grasping foods that are easily available and affordable.

Discussion with Chief Medical Doctor & Tour of Hospital Grounds on Tuesday (2 hours)
o Overall, I have to say that Dr Ntongsi is a very motivated Chief Medical Doctor and seems to have the hospital’s best interest in mind, at all times. He himself is a dental surgeon, trained in Russia, but came into this position three years ago, while also maintaining a private dental practice in Bamenda. He discussed with me the various ideas that he proposed to the Cameroonian Government upon taking this position and observing the then current state of the hospital. He had a separate building constructed for the laboratory; he extended the maternity ward, added running water faucets within each room/ward of the hospital, and currently wants to construct toilets and showers for more hygienic practices than the horrific pit latrines that are currently in existence and use. One of the ten additions that he proposed was a demonstration kitchen on the hospital grounds, that which was not given funding or approval. We spent a lot of time talking about this matter after introducing myself and telling him that I am a dietitian (I say nutritionist because it is a more well known term here) in the US. See below for my main project idea where I would like to focus my efforts during my Peace Corps service.

Diabetes Clinic on Thursday (3 hours)
o The first Thursday of each month, Eunice holds a Diabetes clinic which consists of some education, weighing, and the taking of blood pressure and fasting blood sugar. I was very impressed by the turnout, all Type 2 Diabetics ranging in age from late 30s to 70s (side note: average life span for men is 60 and women is 70 in Cameroon). My first observation was that the structure of the clinic could benefit from a slight change. Since I assume these patients have been awake for a few hours prior to coming to the clinic at 8 am and some of them have had to trek a bit of a distance to arrive, the blood sugar and other measurements should be taken prior to education so as to allow them to eat before the end of the clinic, around 10:30 am. Not only will this be healthier for stabilizing their blood sugar levels, but it will also allow for better concentration and retention during the education portion of the clinic. Through some basic counseling with a few men who’s blood sugars were well above normal, even for a diabetic (<200), I came to realize the following areas of INTERACTIVE education that would be necessary in the future, as listed below.
HIV/AIDS/TB Unit on Friday (1 hour)
o Again I was the one asking questions to find out information about how this “unit” functions. I do not really feel that I have a great grasp on HIV or TB statistics (numbers, causes, ages, etc) in the division, but did find it impressive that the hospital has an isolation area where TB patients stay for up to two months, free of charge, for treatment. HIV education seems to only go on in the communities during the week of World AIDS Day as a result of insufficient funds for travel. Margaret does pre and post counseling with couples who come to find out their status and unfortunately I had just missed her doing pre counseling with a couple wanting to get married, but not before knowing their status. Post counseling is confidential, as it should be, whereas pre counseling is something I could have witnessed.

Urban Integrated Health Center

Child Welfare Clinic on Monday (1 ½ hours, 1 hour spent waiting)
o Unfortunately I was only able to observe this clinic for a short amount of time because I was told earlier that morning that I would need to attend a meeting around 10 am elsewhere and because, although the clinic should begin around 8:30 am, it begins when the patients show up. I did some small orienting with Anna (the Chief Nurse) and by that I mean asking her questions because I did not feel she really knew how to orient me to the center and the goings on there. As for the clinic, many mothers and babies finally arrived and the portion of the clinic that I witnessed was baby weighing. It was incredible to see babies hanging in corduroy sacks from a hook that then determines the weight in kilograms above. Some of the children peed while waiting for their weight to be taken (as much clothing and cloth diapers as possible were taken off) and others freaked out at the realization that they were essentially hanging in mid air! The weighing took a long time and wasn’t half finished when I was called to my meeting. Supposedly some education is done after the weighing, but these mothers and babies have to wait a long time, especially if they arrived “on time”.

Antenatal Clinic on Tuesday (3 hours)
o Before the clinic began I was able to observe two circumcisions and had just missed a woman giving birth by about 3 hours. Again, this clinic began after a majority of the woman arrived, but this happened much quicker than the previous day. The women were weighed and one by one were called into the examination room to check if they had edema, to measure the size of the belly, check the position of the baby and to hear the baby’s heartbeat (through a metal, funnel device-I listened and heard a few heartbeats-very different from the technology I am aware of in the US). Anna, the chief nurse, did some small counseling and questioning when necessary and seemed to have a very good rapport with the patients, even if it was the first time meeting them. Each week a different education topic is presented as well. I was very impressed with the simplicity of the checkup, due to a lack of technology, but also how thorough it seemed at the same time. One issue I became aware of while observing the weighing-in was a) whether or not any counseling/discussion is done if they are not gaining sufficiently and b) the amount of unmarried 18 year olds who were attending with their 1st child. Even checking through records, women who were now 25 years old had already given birth to 2 children, the first one being at age 18. This poses quite a problem in this society because girls are still going to school for at least 1 or 2 more years before they take their exam to be ready for university. That means that either the girl is no longer attending school after giving birth or it is asking the mother to take care of the baby and may then prevent the mother from owning a business, going to the farm, etc. As a result, I feel that a teen pregnancy sensitization program is necessary in the surrounding communities, as mentioned below.

Delegation of Women’s Empowerment
(Total time: 5 hours over 2 days, 1 ½ hours spent waiting)

Overall, the two day experience with this delegation was quite a bit frustrating. My first day began after waiting almost an hour and a half for the delegate to arrive. Once he arrived, I initiated questions as to the duties and responsibilities of this delegation to which the questions were well answered. I was told that there were no cases that day and so it would be a day of “rest”. This shocked me, being that this delegation is responsible for many international theme days (i.e. International Women’s Day on March 8th) and in my opinion could be doing some preparation work by looking at the past years events and brainstorming on how to improve for this year’s events, once the theme comes through Yaoundé. Luckily a case came to pass that day and I was able to observe how the Delegate and his colleague carry out counseling. The most striking observation was that the door was kept wide open and that the Delegate sat behind his desk and put in a few words while most of the session was conducted by the other social worker. After the session was finished, I clarified a few points and then sensed that the Delegate had nothing more to offer me and I excused myself.
The following day the Delegate and another member of the delegation were doing a home visit in the early morning. I arrived at 9 am and looked at photos of past events related to this delegation with the secretary. The Delegate arrived after the home visit and stated that he was going home to bathe and I had to ask him if I could look through some cases, as he had mentioned was possible the day before. While the other social worker was off at the market and he was off bathing, I read through some cases and sensed that there was not much else that they were going to offer to me, in terms of information or experience, and I decided to leave. I felt that I received a small amount of exposure to the Delegation but feel that they have much responsibility that may not be time managed for completion and could benefit from more motivation!

Delegation of Social Affairs & Social Centre
(Total time: 4 hours over 2 days, 45 minutes spent waiting)

I spent my first day with this delegation at the Social Centre. Filo and Pola welcomed me warmly. I spent a few hours with Pola, discussing the goings on and responsibilities of this leg of the delegation. She oriented me to the fact that they work to assist people with disabilities or children of a parent with disabilities, orphans and vulnerable children and the elderly. I told her that I have a special interest in the fact that they work with people with disabilities because of my brother’s own disabilities. I was happy to find out that community sensitization is done by the Social Centre to educate about people with disabilities, being that a person in this “category” might be deaf, blind, learning disabled or developmentally delayed. She showed me a disability card and explained that a person who has this card is able to receive education for free and often reduced healthcare costs. Additionally some of her work involves giving monetary assistance to any citizen in the division that applies for the following areas of need: education, medical, those who have given birth to twins or triplets (or more), etc. My second day with this delegation was spent waiting for the Delegate to be available for about 45 minutes and then sitting and discussing with him for about 15 minutes. He essentially told me similar information that I had learned the day prior, including the point that even though the Delegation of Social Affairs is more administrative and the Social Centre is more technical, the Delegation also handles some of the technical work. When I told him that I am a nutritionist, we spent a short time discussing the nutritional needs of the elderly in this division and this helped me to include educating the elderly as part of the demonstration kitchen below.


Ideas for Projects/Work From These Experiences

• Demonstration Kitchen @ Fundong District Hospital
o Cooking Demonstrations
VARIETY
Appropriate intake for condition/age group
Alterations to typically prepared foods
o Taste Testing
o Education
Mothers with Young Children
Diabetics
Hypertensives
PLWHA (People Living with HIV/AIDS)
Elderly
• Diabetes Clinic – 1st Thursday of Each Month
o Education Topics
Food & Drink That Raise & Don’t Raise Blood Sugar
Portion Sizes
Exercise
Meal Variety on A Budget
• Teen Pregnancy Sensitization (and HIV/AIDS Prevention)
o With Help from Anna (@ Health Centre) & Pola (@ Social Centre)
• Handouts for Maternity Ward
(to be discussed with & given to patients during antenatal counseling sessions)
o Iron Rich Foods
o Calcium Rich Foods