Voices from the Field Julie Stone Get to know Julie

A Tale of Two Patients

Published on May 11, 2023

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Silas, flanked by Dr. Blessing Chia and
Dr. Antoine Dountsop.

Despite the challenges of travel created by the sociopolitical situation, patients are still coming for care – albeit not in the large numbers seen in former years. One such patient, Silas, had come to us from the capital city of Yaoundé – where he works as a nurse. However, profound anemia had kept Silas homebound for several months. The work-up for his anemia showed evidence of a GI bleed. Yet, despite three upper endoscopies and two colonoscopies, no source could be identified. The team eventually became convinced that his blood loss was originating in the small bowel. Unfortunately, we lack the means to evaluate the small intestine. The bleed appeared to be quite slow, with laboratory parameters indicating severe iron-deficiency – despite Silas having received supplemental iron for many months. It was suspected, therefore, that he might not be absorbing iron sufficiently for red blood cell production. We were hopeful that offering Silas parenteral iron would solve the problem sufficiently to allow him to compensate for slow, chronic blood loss. With this plan in place, Silas was sent back to Yaoundé to the ongoing care of an internist and recent graduate posted to our hospital in that city. This colleague ensured that Silas received regular iron injections while monitoring his blood counts. Unfortunately, despite adherence to the plan, Silas’ anemia was not substantially improved by the time he returned for follow-up. A bone marrow exam showed no problem on the ‘production’ side, so we were again faced with a recalcitrant GI bleed, the source of which eluded us. It was a substantial struggle to know how to help this young man. Phone calls to several colleagues in the major cities of Yaoundé and Douala revealed that the technology for assessing a small bowel bleed is not available in Cameroon. Since one of our graduates had been to India for additional training in Intensive Care medicine, he helped us to explore options there. Some of the literature we review comes from India – where we have appreciated that care is quite advanced, particularly in urban settings. Not surprisingly, India had the necessary modalities to pursue Silas’ work-up. The two residents who had been caring for Silas provided a detailed referral summary. He has now returned home to Yaoundé to apply for a passport and visa. Silas also received instructions about making an appointment online to coincide with the terms of his visa. We have committed this to The Lord and are hopeful that a definitive solution can be found for him.

A second patient recently referred to us, Eunice, is a colleague with whom I worked for many years in Banso Baptist Hospital (BBH). She was referred to Mbingo with severe back and right leg pain. Spinal CT showed evidence of a mild disc herniation. We were very grateful for the expertise of the head of our Physical Therapy Department. Mr. Timothy Fanfon is pictured here with Eunice shortly following her arrival. He provided traction and worked diligently with her to supply exercises intended to alleviate lumbar disc dysfunction.

Timothy pictured with Eunice and her carer after supplying Eunice with traction.

Timothy provides instructions in exercises prior to Eunice’s discharge.

After nearly a month in Mbingo, Timothy thought Eunice had achieved maximal hospital benefit. He advised allowing her to return home to BBH for continued care. Despite substantial improvement in her pain and mobility – Eunice still had residual right lower extremity weakness, which worried us. It was Eunice who reminded us of God’s promise in Romans 8:28. She expressed confidence that, despite a suboptimal response to therapy, she could return home trusting The Lord for the ultimate outcome. Accordingly, Eunice was discharged to pursue the necessary exercises and recuperation in Banso.

Making arrangements for Eunice’s return was challenging since CBC vehicles attached to BBH have not been permitted to ply the road ever since last September. This has equally compelled the suspension of my regular visits to Banso – previously made together with a senior resident (a source of great disappointment). Working under current constraints, public transportation was secured for Eunice and her carer. They safely made it back home, where Eunice is continuing with her prescribed program.

Julie Stone