Civil War in Western Cameroon
For the first time in 11 years I was unable to travel to Cameroon this autumn. Prof Hesseling with whom I regularly travel had purchased his air tickets and our colleagues from Leeds General Infirmary had planned an itinerary. Six weeks ago Prof Pius Tih, Director of the Cameroon Baptist Convention Health Service contacted us and said, “Don’t come. Travel within Cameroon is very dangerous: we do not want to be responsible for your safety”. We hope to visit the Baptist hospitals in late January 2019.
After World War I the League of Nations mandated control of former German Camerun to Britain and France. The present troubles date from this division, being a dispute between the francophone government and the anglophone West. After decades in which the English speakers in the West have been economically marginalised, the francophone government imposed the French penal code on West Cameroon in 2016. I was in Cameroon at the time. Lawyers protested in the streets . Many were brutalised and put in prison. Teachers went on strike and many schools in the West remain closed to this day. The anglophone secessionists armed themselves in response to violent crackdowns by government soldiers and the armed gendarmerie. In the north west there are curfews and frequent roadblocks by both the secessionists and by government forces. It is difficult for patients to get to hospital or to travel between our hospitals, all 3 of which are in the anglophone West. Prof Pius Tih has banned all outreach activity to protect our hospital staff.
I was last in Cameroon in February 2018. There follows a report for 2018 based around 4 old photos:
6 children all with Burkitt’s lymphoma on the ward of our smallest hospital, Mutengene in 2007
This photo bears similarities to one taken by Dennis Burkitt at Mulago Hospital in Uganda when he was first trying to treat the lymphoma in the early 1950’s. Although the numbers of new admissions of children with Burkitt’s lymphoma (BL) have fallen slightly in the last 3 years 60% of new admissions at our 3 Baptist hospitals are children with BL. We have treated about 1400 children since the programme began in 2003. Our results /outcomes (published) are probably the best in small hospitals in a resource limited setting – but at a cost of approx. £200 per patient as compared with £30,000 per patient in the UK. In the last 2 years our drug costs have increased exponentially - for several reasons, but mainly because one of our principal chemotherapy drugs, vincristine, is no longer donated and because we have treated several children with bone cancers and leukaemia. I met with the executives of our partner charity, World Child Cancer, in September and they volunteered to support us in the next financial year. This is a wonderful answer to prayer!
We have plans to start treating children with cancer at Mboppi Baptist Hospital in Douala, Cameroon’s second city in the francophone south. Our old friend, Dr Julie Stone, the only missionary doctor at Banso has been relocated to Mboppi because of the troubles.
Nurse Comfort Kimbi teaching the early signs of cancer to village practitioners in 2008
This is one of my favourite photographs: nurse Comfort Kimbi, research assistant nurse at Mbingo Baptist Hospital teaching village practitioners about the early warning signs (presentation) of Burkitt’s lymphoma. Until early 2018 we had a vigorous outreach educational programme, reaching small bush hospitals, health workers in rural clinics and village practitioners - but this has all been curtailed by the recent troubles! It is too dangerous for our staff to travel in N.W. Cameroon at the moment.
I have explained before that there is no concept of “cancer” in rural Cameroon. The primary diagnosis of village practitioners is usually “witchcraft”- and it is often the case that a child with cancer will stay with the village practitioner who is officially “qualified” to treat cases of witchcraft. The child may never reach one of our hospitals. Village practitioners have a government-registered organisation and are recognised by Cameroonian law. These three men were certainly interested in what Comfort had to teach!
Ntaba village Parent Group, 2014 Dr Paul Wharin and Prof Peter Hesseling on the back row
The Ntaba village group is one of 5 established parent groups in N.W. Cameroon. Prof Peter Hesseling and I, Dr Francine Kouya and Glenn Mbah, our programme manager, have put great effort into the development of parent groups – but they have not developed in quite the way that we expected (this is Africa, not GB or the USA!). The parents are still our best advocates for the childrens cancer treatment programme. They will say to other parents (in pidgin): “This sick be not witchcraft: take pekin for Baptist Hospital”. There are 4 children in this photo all treated for Burkitt’s lymphoma.
Opening of the We Care Hostel for parents and children at Mbingo, May 2017
Dr Francine Kouya, Clinical Supervisor of our programme is 4th from the left and Mr Glenn Mbah, Programme Manager, 3rd from the left
Over the years we (Beryl Thyer Trust, BTMAT) have contributed to infrastructure at the 3 Baptist Hospitals, most notably with the opening of the first childrens cancer treatment ward at Banso in 2006 and the WE CARE parent hostel at Mbingo last year. This year has seen the opening of a new dedicated paediatric oncology unit at Mbingo. It connects with the old childrens ward. I contributed to the design of the unit (and obtained a promise of finance several years ago!). I hope to see the completed unit in January 2019.
World Child Cancer and BTMAT have invested heavily in further training for our Cameroonian colleagues, especially for our nurses. Glenn Mbah joined us as a young nurse in 2009 - and after completing further training in Cameroon, Utrecht (Holland) and the USA and a Masters in Public Health at Roehampton, London (financed by BTMAT)he was appointed our programme manager. Dr Francine completed 2 further years training in paediatric oncology at Tygerberg Hospital, Cape Town (Prof Hesseling’s hospital), returning to take up her role as Clinical Supervisor of the Cameroon Baptist Convention childrens cancer treatment service in May 2017. Francine and Glenn now take the lead in further developments of the service – and this year they have established formal links with the Chantal Biya Foundation Hospital in the capital, Yaounde , forming an officially recognised Cameroon Paediatric Oncology Group. It is good that we should work together with the government service. Francine and Glenn still need advice from Prof Hesseling, in particular, and the service is dependent on financial support from BTMAT!!
Paul Wharin November 2018