Every seven years, physicians in my clinic are given the option of taking a 6 week sabbatical, which can be spent however one desires. It was perhaps a mid-life or mid-career crisis that prompted me to consider spending this time living and working in a third world country. I had assumed that I would find a place where I could work within my specialty of urology. I became aware of a short-term program with MDA in Njinikom, Cameroon and was very interested in this based on what I had heard from others who had been there. The biggest drawback I saw was the fact there would realistically be only minimal need for a urologist in this rural mission hospital. If I was going to be busy and provide any benefit to the local people, I would have to be prepared to practice medicine well outside the realm of urology. Although I was initially intimidated by this prospect, I eventually became intrigued and excited by this challenge.
When I was first planning this trip I was advised that the purpose was to fulfill a need within me, not necessarily a need in the local population. This was very true. I recognize that the people there got along fine without me before I arrived and will continue to do so long after I left. Of the many people I treated there, probably only a small minority really benefited from my presence — those with specific problems that could best be evaluated and treated by a urologist (and there are precious few in the country). The majority of my patients would have been well managed by the three experienced docs already there. My being there did result in shorter wait times and a lighter work load on the local docs. I was very impressed with the broad knowledge base these doctors had. I hopefully improved their understanding and ability to treat some common urinary tract diseases and at the same time I learned much from them in terms of management of many tropical diseases in an environment with limited resources. I also personally benefited by being able to do things there that I could never do in my practice back home.
I was encouraged and expected to treat patients with conditions that would are considered unusual or even exotic in America (e.g. malaria, amoebiasis, typhoid) as well as more common everyday medical (e.g. HIV, peptic ulcer disease, diabetes, HTN) and surgical (e.g. c -section, hernioraphy, bowel obstruction, D&C) problems which I’d never see back home since they are outside the realm of urology. The other challenge, sometimes fun, sometimes frustrating, was to practice medicine without many diagnostic and treatment tools that are taken for granted back home. Improvisation proved to be a necessary and valuable skill. I would encourage any specialist considering a short-term medical mission to take advantage of the opportunity to practice outside your normal comfort zone. Two books I found invaluable in preparing for this were Oxford Handbook of Tropical Medicine and Surgical Care at the District Hospital.
From a distance, Njinikom appears as a quaint mountain top village nestled within lush tropical forest and fields. However on closer inspection, there is abundant poverty, hardship and misfortune. In spite of this, the people here are probably the most friendly, warm and welcoming that I’ve ever met anywhere. I am embarrassed to imagine how any of these people would be received if they were walking down one of our streets back home.
My experiences in Cameroon made me appreciate being born into a family and an environment where hard work and discipline were encouraged and rewarded. Unfortunately, hard work and discipline by talented, intelligent and motivated people in Cameroon is met with little promise of reward or self advancement.
I believe I’ve returned home a better person and a better doctor as a result of my time in Cameroon. It was a rewarding experience in many ways and I look forward to participating in other short-term mission programs in the future.