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At the heart of general practice since 1960

Practising in the footsteps of witch doctors

Fear of Western Medicine in Cameroon forced

Dr Roxana Whelan to radically rethink the way she practised

was armed with only a stethoscope and GCSE French when I set out for Cameroon to work in a mission hospital. I wanted to get a taste of working as a missionary doctor with a view to working overseas long-term.

After house jobs and an A&E post I found the whole way of working in Cameroon quite different from the NHS. I was in a 40-bed general hospital with surgical facilities staffed by two or three doctors at a time.

We began the day with a ward-round followed by seeing patients in the clinic, being available to the wards, and conducting a round at the end of the day.

We were on-call on a one-in-two or one-in-three basis.

Health a low priority

Some conditions were very similar to those in the West, but I also saw many patients with HIV/AIDS, tuberculosis, leprosy, malaria, typhoid and schistosomiasis.

Patients often presented very late, like the woman with a huge fungating tumour on her foot, indicating health had a low priority on people's agendas.

We saw people with gross nephrotic syndrome, and children with severe heart failure, who inevitably did not survive.

A wide range of presentations had initially been treated by a witch doctor. People came with large blisters or burns, where the witch doctor had tried to exorcise the 'spirit' causing the illness.

Others had taken powders or potions, including one particularly deadly toxin

that caused jaundice, followed by coma and death.

Work was made more difficult because I was unable to do what I knew the patient needed. Pathology was limited to blood counts and microbiology (no cultures).

Monitoring people on intravenous fluids or large doses of diuretics was difficult without being able to measure a potassium level. We had X-ray and ultrasound, but nobody skilled in interpreting ultrasound.

The pharmacy had a reasonable range of drugs, but lacked strong analgesia for postoperative or terminal patients.

Being unable to get a specialist opinion was frustrating.

Language barriers

Language was another obvious difficulty. Staff, and educated patients, spoke French but the local language was Fulfulde.

Some patients did not even speak Fulfulde, which meant a three-stage translation. Subtle nuances of history-taking, describing pain or eliciting a hidden agenda, were inevitably lost.

Sometimes I was very lucky to get an answer to my questions.

Culture was a barrier. There was

a huge fear of Western medicine, hence the use of witch doctors and

delays in coming to hospital.

A review was often impossible because of t

he length of the patient's journey.

Some people refused to come into hospital, sometimes for financial reasons, sometimes because they had no relative to care for them while they were in, or they could not leave the family or the fields.

This was challenging in situations where I felt they would be unlikely to survive without hospitalisation, and even more distressing with children, where there was no recourse to the courts to protect their interests.

Refreshing lack of bureaucracy

After the initial shock of being unable to do things in a Western manner, the cultural aspects became quite interesting. I learnt to work round the patients' viewpoints and expectations. Paperwork was minimal and there was never a need to plead for a bed, or an investigation.

If I wrote 'chest X-ray' or 'full blood count', it would be done. There were no telephones or bleeps. Someone would find me if I was needed, and a nurse or porter would come and knock on my door at night.

There was no threat of litigation. I was free to do my best, within the limitations. Sometimes lack of resources, or patients' refusal of treatment, was demoralising.

But at other times, against all odds, you would see someone pull through and go home after what had seemed a hopeless prognosis.

Most memorable were two young women, one with cerebral malaria, the other with bacterial meningitis.

Both were unconscious, but they slowly responded to treatment and eventually recovered.

After my first three-month stay, I went back later the same year for another three months.

I eventually decided I wasn't cut out to be a missionary doctor, but had nevertheless benefited from and, I hope, contributed to, the work there.

I am still in contact with some missionaries and staff, and recently had the privilege of going back for a three-week visit.

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