University Times

From left: Tammy Haley, Rachel Avey, Amy Silvis, Christina Siewe and Patricia Rouse.

Pitt-Bradford nursing professor Tammy Haley is finishing her dissertation for a PhD in nursing and her thesis for a master’s in public health — more than enough to keep her busy over the summer.

Still, when the opportunity arose to spend a month using her nursing skills at a new health clinic in the western African nation of Cameroon, she was eager to go.

As a nurse practitioner with a focus on rural medicine, the mission was a natural fit, she said. “The idea of being able to provide health care, the area of my specialty, made it a unique opportunity.”

Haley, coordinator of Pitt-Bradford’s bachelor of science in nursing program, returned in mid-July from the medical mission. She traveled as part of a five-member group that included UPB nursing student Amy Silvis and Christina Siewe, the wife of Youmasu Siewe, director of the Center for Rural Health Practice at UPB.

The group also included Silvis’s younger sister, Rachel Avey, who recently graduated from high school, and Patricia Rouse, a nurse from Arkansas, where the Siewes resided prior to coming to Bradford in 2009. “It was an interesting mix of people. We all brought different skills to the table,” Haley said.

Siewe, a nurse, founded the Good Samaritan Health Center with her sister through efforts that began about five years ago, Haley said. Information on the clinic is available at www.goodsamaritancameroon.org.

The two-story cement clinic building stands on the site of the sisters’ childhood home in the Ekona district of Cameroon.

That connection, Haley said, “made it personal.”

Haley learned about the clinic last fall through fundraising efforts by Holly Spittler, UPB associate dean of student affairs and director of career services. Spittler attends Bradford’s First Presbyterian Church, which took on the project as part of its mission work after the Siewes became active in the congregation.

Haley, a nurse practitioner, asked whether volunteers were needed. “There were some nurses going but because there were some donations of medications going as well, they needed someone who could prescribe medications. I filled that bill,” she said.

Making the commitment to the month-long trip meant Haley needed to brush up on her family medicine skills. While her background is as a family nurse practitioner, her current clinical practice is in family planning and women’s health. “My practice is very different than this practice. The point was to provide them better health care, so to go unprepared would have been a real disservice.”

She found a mentor in another member of the congregation, physician Anita Herbert. “She gave me the tools and knowledge and really made sure as soon as I committed to this that I was as prepared as I could be.” Haley spent three months brushing up on routine problems that might be seen in a family medicine practice and preparing for treating less-familiar tropical illnesses such as malaria and typhoid.

In Cameroon, along with providing patient care, the volunteers helped put documentation and recordkeeping systems in place for the new clinic, she said. “It was a really tall task.”

A nurse had been providing care but the clinic had been functioning only in a skeletal capacity until recently, when it obtained nongovernmental organization (NGO) status. That made it an officially recognized entity, Haley said. “This was a huge expansion in services for them.” Although additional Cameroonian staff had been hired, they didn’t start working at the clinic until after the U.S. group came, Haley said. Now the clinic has nurses and a midwife on staff, as well as a physician who sees patients there one day a week. In addition to outpatient services, it can house eight patients in four hospital rooms.

The establishment of the clinic makes health care more accessible to some 28,000 people who live in or near the Ekona region. While a government hospital is nearby, “This is closer and more acceptable,” she said, noting that many of the people who live in the farming community are poor and must walk to get medical care.

On clinic days, Haley and the staff saw about 40 patients a day, diagnosing problems ranging from high blood pressure to HIV.

“I diagnosed more HIV there than I have in my practice here, ever,” she said. Although the clinic could provide pre- and post-HIV testing counseling, it was not equipped to treat the disease, so patients were referred to the government-run medical facilities. “It seemed to me that most people that had a diagnosis did get treatment,” she said.

However, most of the illnesses and disorders the team treated were largely a result of poor hygiene and sanitation, Haley said. “It was something that could be addressed in a meaningful way.”

Haley said she had traveled to Africa twice before, albeit not as a health care volunteer. “One of the big things for me that was different in this village than in other villages: Animals run free in the streets.” Pigs, goats, chicken and cattle roam in town, she said, noting that a flock of chickens wandered into the clinic lobby one day.

“When you’re thinking of the impact of biologic agents on health and you have pigs roaming the street and chickens roaming the street … to me that would be something that public health education efforts could remedy or make a difference with,” she said.

Cameroon is officially bilingual — residents speak French or English. Although Haley was in an English-speaking part of Cameroon, “Their English is not our English,” she said, adding that a translator often was needed, especially for communicating crucial instructions, such as how to use prescribed medications, or the importance of boiling drinking water.

“It was really important that a local person provided clinical instructions,” Haley said, adding that a local nurse explained what she was saying to patients. “They had a hard time understanding me sometimes,” Haley said.

She found many cultural differences in the course of providing care for patients in Cameroon. There is no health insurance system, so care is pay as you go. “If you don’t have money upfront for care, you don’t get care,” Haley said.

In addition, in Cameroon there are no hospital meals or hospital gowns. Patients rely on their families to bring them food, clothes and other necessary items, Haley said.

Another difference: “Patients’ medical records were kept by the patient. And they transported their own medical books with them to the provider,” said Haley.

“You write directly in their medical book. Any tests are written directly in the medical book. Then that medical book is given to the lab and the lab writes the results. Then if you give medicines, you write the medicines … and if they needed to go to the pharmacy, they simply took their medical book to the pharmacy and had their medicines filled,” she said.

If prescription refills were necessary, patients would need to return to their provider each month to have them written into the book. Some aspects of the system were convenient. “Some patients brought 10 years’ worth of records,” Haley said. That made it quick and easy to review what treatments already had been tried. But patients who wanted to withhold information easily could “forget” their book, she said.

Although Haley said she would like to return to the clinic, it’s likely that future service there would be in a different capacity. “The need potentially for me to go as a health care provider might not be as great as it was initially,” since the clinic now has a medical staff in place.

However, she sees a potential role as a trainer, given that many of the supplies that were shipped to the clinic from America were unfamiliar.

“Really basic stuff like tape that we use in the hospital,” she said, was completely foreign to the Cameroonian staff, who were accustomed to cutting adhesive sheets called plasters into strips. They didn’t realize that the rolls of tape sitting unused on their shelves could be used in same way, she said.

“It’s hard to expect somebody to utilize all these really great things that we can bring and provide if they don’t have any idea what to do with them,” Haley said.

Reflecting on her trip, Haley said, “I think it’s going to be a really great teaching tool.” Although she has taught concepts of cultural sensitivity and awareness previously, actually facing such dramatic cultural differences provided a new perspective, she said.

“It was good hands-on experience.”

—Kimberly K. Barlow