The West-African nation of Cameroon is one with limited access to health care, with a ratio of only 1.9 physicians per 10,000 people. Such statistics demonstrate the health care needs of this country; however, personal experience provides a much more striking perspective of such health care disparities. Because of a five-week medical missions trip to Cameroon, I have come to better appreciate the need for health care providers around the globe. During my visit, our team of health care providers, in collaboration with the Cameroonian organization ASCOVIME (Association des Compétences pour une vie meilleure), was able to provide free medical care to over 1,500 Cameroonians from the rural villages of Minkang II, Lomie, Doukoula, and Nditam. These villages warmly welcomed our team, enabling us to provide care through general consultations, ophthalmology screenings, and surgical interventions while being immersed into Cameroonian culture.
After traveling for five hours with five medical volunteers crammed on a four-seat bench in our 17-person van, there was finally a sign of hope: the dirt road that would take us to Minkang II, a village in South Cameroon. For our team,organized by Cameroonian Dr. Georges Bwelle and ASCOVIME (Association des Compétences pour une vie meilleure), seeing this dirt road meant that three more hours remained until we reached the chief’s home. During our travel on paved roads, however, we had faced heavy rains, typical for the rainy season in Cameroon. With this downpour, we began to wonder if we would be able to safely travel down the dirt road. Our hopes of getting food and sleep pushed us to attempt to make the trip, and so we did.
The conditions of the road left the driver unable to keep control. Eventually, the van’s wheels became stuck in the muddy road, leaving the men to push it back onto more solid terrain. With the tires spinning and throwing mud all over the van–not to mention, all over the men– we were able to make it onto solid ground and, eventually, to the chief’s home. Relieved to have finally reached our destination, we began assembling our tent village outside the chief’s home, where village members and the chief, who had been awaiting our arrival, greeted us. Although it was after 12:30 AM, a feast prepared by the village’s women was presented to us, complete with bush meat, rice, and plantains.
Following the meal, the elders of the village performed some of Minkang II’s traditional music and dances for our group. During this feast and festivities, I began to realize that this mission trip to Cameroon would become one of the most formative experiences of my life. Of course, as was planned, our medical team was going to provide free health care, but, within the first few hours at our first village, it became evident that the people and culture of Cameroon were going to give much more to me than I had expected.
With a few hours of sleep on the cold tent floor, we geared up for the day we had so highly anticipated: the first day of our medical clinic. After another feast for breakfast, we began setting up. As we converted near-by huts into departments of our makeshift health care facility, I began to understand the extent of our endeavor to provide health care. Not only was our team ready to diagnose patients, but we were also equipped to distribute anti-helminthic drugs to all village members, perform eye exams, examine pathology samples, administer injections, and perform surgeries. On top of it all, the crowd of village members was growing rapidly as more and more people were arriving, having traveled miles to reach the village center in hopes of receiving answers to their mysterious health concerns.
I could only hope that my knowledge from the first year of medical school, as well as my knowledge of French, would keep me from disappointing these people. I had already seen something of medical care in Africa through an undergraduate study abroad trip to Sénégal. This trip, lead by Dr. Frances Novack of Ursinus College, included my visit to the university clinic at Gaston Berger University in Saint-Louis, an experience that I was quickly realizing was nothing like being out in the bush. Despite my experiences, I became overwhelmed with excitement and nervousness; once the clinic started and each of us was assigned to a specific department, the butterflies in my stomach quickly fled, as there was little time to think about anything but the patient in front of me. Assigned to work with Cameroonian ophthalmologist Dr. Aimé Bang, I shook my head when he asked if I had ever performed an eye exam. So Dr. Bang had a lot to review with me. Quickly, he went over the Snellen eye chart, as well as simple tests I could perform to test peripheral vision and pupil reactivity.
Two minutes of training and reassurance from the ophthalmologist, and we were had our first patient of the day. Spending a mere five minutes with each patient, I began to understand the great need for health care in this village. More than this realization, however, I began to put faces and individual stories on this need. I can recall meeting a 20-year-old woman who had gone her entire life barely being able to see, leaving her unable to work in the fields or learn to sew. Ultimately, this handicap left her withdrawn from the world, as her parents and village elders did not know how to care for her except by keeping close watch over her. With a few minutes of examination and eyeglass fitting, a donated pair of prescription glasses gave her a cure. Immediately, this woman who had never seen the world was given the gift of vision, leaving her full of smiles and words of gratitude for our help. On this day, we were able to see 117 village members for ophthalmologic screening and provide 77 individuals with prescription eyeglasses so that they, too, could finally see.
By the time that the sun had set, I was exhausted. The veteran volunteers and physicians, however, knew that the day’s work was only just beginning, as the surgeries had yet to start. While I had been working in ophthalmology, other departments were consulting patients, formulating their diagnosis and sending patients away with a prescription for medications to be dispensed at the pharmacy department or a physician’s order for surgery.
Since Dr. Bwelle, a native Cameroonian and the founder/president of ASCOVIME, is a trained general surgeon, we were well prepared for any type of case. The only problem was that he, too, had been seeing patients all day and was just as, if not more, exhausted than I. In order to prepare for the surgeries, the operating room was assembled, complete with generator-powered floodlights and sheets covering the hut’s windows. Dining tables from the chief’s home were strategically placed under the floodlights, illuminating the evening’s operating table and the dirt floor which lay underneath.
Thirty-four of our 609 medical consultations had been referred to the surgery department and people had patiently waited for their name to be called to enter the operating room. Throughout the evening, we called out the name of each surgical patient, most of whom had waited for hours. In this village as in others, all of the patients showed a sense of hesitation, despite the great efforts they had made to obtain care. Wondering about this sentiment throughout my trip, I began talking with Cameroonians in an attempt to uncover the underlying reason for this tension.
Many villagers are unsure about the forces ruling their lives, so they ponder the role of their actions or interactions with others and the influence such actions may have. People in rural Cameroon have historically put trust in their family’s elders for advice concerning both their life and health. The family’s elders, who generally had never had any formal medical training, were entrusted to guide their family members, advising them in health matters just as elders of earlier generations had advised them.
During the 1800’s, the arrival of the Germans and, later, the French brought missionary physicians who had sought to provide health care for the people of Cameroon. This desire to provide care was not perceived as such, as the local population mistrusted the Europeans who had colonized them. This distrust, in combination with fear, lay at the core of the hesitancy that our medical team witnessed. For most of our patients, however, the fact that traditional medicine had not healed their pain from a hernia or helped in shrinking the size of the large tumor on their foot evoked an urgency to find a cure, helping them to overcome their hesitation.
A 16-year old girl from the village of Nditam, a village in central Cameroon, had come to our clinic seeking answers about the large mass that had been growing on the top of her foot since she was ten. As with many other Cameroonians, her fears and the fact that her family could not afford to seek medical care kept her from a cure, which eventually limited her activity as the mass became larger. With the mass now the size of a grapefruit, her family worried that the village elders and traditional doctors would never be able to rid her of this debilitating tumor.
News of the arrival of our medical team persuaded this young girl to travel miles on foot to reach our clinic in Nditam. At the start of the surgery, the young girl was instructed to keep her foot still while the first incision was made. She began to squirm, turning her head as far away from her foot as possible in order to avoid seeing the surgeon cutting into her flesh. Discovering that this tumor was a benign lipoma, the surgeon easily removed it, and within minutes, this girl’s fear about her disability was replaced by the hope of leading the life of a normal 16-year old Cameroonian girl, a hope that illuminated her face after she turned to see her tumor-less foot for the first time.
As we had only local and spinal anesthesia to administer for the surgeries, patients endured much more pain than if they had been treated in a hospital. With each patient presenting with a different surgical case, ranging from a routine hernia repair to the removal of fibroids from a woman’s uterus, Dr. Bwelle and our medical team were able to provide relief of pain and discomfort that these patients had endured for years. Finally, these individuals had hope that they could lead a normal life, resuming their daily activities as they had prior to their medical problem. Through these interventions, we were able to demonstrate not only our skills learned through our medical training, but also our passion for helping others.
Planning on a mere five weeks to work in the villages of Minkang II, Lomie, Doukoula, and Nditam, I expected that this trip would have little impact on me, only superficially understanding what it would mean to provide free health care in a third-world country. After seeing over 1,500 patients on our tour of Cameroon, my passion for international medicine was stimulated. Beyond caring for others, I was able to understand the ways that culture is intertwined with health. These Cameroonian villages and their people demonstrated the nexus of culture and health and enabled me see my patients as individuals rather than clinical cases. Just as promised, this trip enabled me to be part of a team providing care to Cameroonians; but, unexpectedly, Cameroon gave me an awareness of human complexities and a passion for global health that will forever affect my practice of medicine.