Last year when we were in Ghana, our group was asked by Dr. Jacques Kemabia to do an eye mission in Cameroon. He is originally from there but has been working in Ghana for the past 20 years and is one of the most highly respected eye surgeons in West Africa. He did many outreach programs in remote areas in Ghana and in the neighbouring countries, and now he wanted to help his own people. In his words: “I have been in so many bushes, I finally wanted to be in my own bush.”
So we agreed, and he worked arduously on organizing this mission for nearly a year. He suggested that we should go to Tonga, where his family originated from. He used his own vacation time and money to travel there twice so that everything would be in order by the time we arrived.
Cameroon is a country slightly larger than California on the West coast of Africa, with 22 million inhabitants. It is called “Africa in miniature” as it contains much from elsewhere on the continent, from every type of African people to every form of landscape. It has over 275 ethnic groups. Its GDP per capita is $2300, comparable to Ghana, and 1/20th of the USA. Its healthcare is worse than Ghana’s, as there is no national health insurance. It used to be a French colony and became independent in 1960. It had only 2 presidents since, and even that it is officially a democracy, it has many features of a dictatorship, including suppression of opposition parties and widespread human rights abuses. It is also one of the most corrupt countries on the world.
We flew into Duala, a bustling port city of about 4 million inhabitants, the largest in Cameroon. All of our 15 bags miraculously arrived. We were greeted at the airport by Dr Kemabia and his friend, and two self-appointed “helpers” who soon became twenty. There was a pandemonium, everybody screaming, running around, grabbing bags haphazardly and demanding money brazenly. We Americans were upset, confused and intimidated by this scene, but our African friends were laughing: “Welcome to Cameroon!” It was truly incredible that all our bags made it to the car.
We were taken to the house of Jacques’ brother, who was a retired customs officer. It was massive and beautiful, with a guesthouse, servant’s quarters, a large garden and a swimming pool. We were served a delicious dinner by a liveried waitress, with French wine; it was quite an unexpected welcome.
The next morning we drove up to Tonga, a 200-mile drive, which took us six hours. Tonga is a small but lively town of the Bamileke people, with 16,000 inhabitants. The climate is relatively mild, with temperatures in the 90s during the day and in the 70s at night, and there are no mosquitoes or malaria. The Bamilekes are considered hard working and thrifty; they are excellent businessmen and value education highly. In general they are more prosperous than the other tribes.
The Mayor of Tonga, Monsigneur Ola Didier, generously offered us his weekend house to stay in. It was an enormous building with wrought iron gates and fence, a well-kept garden, its own well, and a multitude of rooms with luxurious leather furniture. It was quite absurd and pathetic to have such a house in a town where the majority of the population lives in mud huts, in abject poverty. It is a status symbol in Africa to build a large house in one’s birth village, even though the owner usually doesn’t spend much time there. But the house was rotting from the inside: water was leaking into it from many places and the repairmen could not fix the leak. The air was damp inside with a terrible odor, the walls and beds moldy, cockroaches scurrying in every direction. But this was still the best place we have ever stayed in Africa. The caretaker was a somewhat mentally challenged, friendly, and lonely man called Alinu, who had an elaborate and absurd ceremony of opening the house and the rooms for us, involving several keys hidden in different places. Usually it took us at least 15 minutes to get in. Sometimes we had to climb over the spiked gates, which was a bit nerve-racking at the end of a tiring day.
We arrived Saturday and immediately started to set up the clinic and the operating room (OR). First we had to decide on a location. There are two “hospitals” in Tonga, a Catholic Mission Hospital with three nurses and two midwives but no doctor, and a government hospital, with a new doctor who had arrived recently—there had been no doctor there before. We chose the Catholic Mission Hospital for our work, as it was in a somewhat better condition and they had running water and a generator, both of which the Government Hospital lacked. Around 9 P.M. Jacques suddenly remembered that we had been so busy with the organization that we had forgotten to visit the Chief! He hastily called him and arranged a meeting. It is customary in Africa for visitors to see the local chief upon their arrival, tell him about the purpose of their visit and ask permission to work. So we went, and even though the chief seemed upset about the late notice, he, few of his wives and the village elders welcomed us. In Cameroon the function of local chiefs is more limited than in Ghana. They preside mainly over land disputes. The government provides for the rest of the municipal functions.
On Sunday we finished unpacking and setting up the clinic and OR. It was challenging as always, but after so much experience with so many missions, it went smoothly. We had to deal with the usual broken taps, refrigerators, doors, as well as a cramped working space with very few electrical outlets, missing bulbs, etc. We purchased two fans for the OR as it was hot during the day, but the electric currant could not accommodate these together with the autoclave, which we had to run constantly as we had two microscopes and operating tables. It heated the room up like a steam bath. It was not easy to work in these conditions but we had no other choice. We hadn’t completely unpacked when the patients started to arrive a day early, so we started our examinations then.
Our meals were provided by Jacques’ sister Olga, and the cook, Patrick. We often had to wait an hour or two for our dinner, as Patrick was in town making matches on the internet or playing soccer instead of preparing our meals. But his employers never got upset with him. He was a decent cook, and anyway, what’s the rush? The local vegetables and fruits were excellent: tomato, avocado, plantains, potatoes, mango, pineapple, and banana. But the meat was a bit strange: chicken consisted of mainly bones and skin, and we never got a taste for bush-meat (different kind of animals hunted down in the forest, the main source of protein besides fish for most Africans).
On Sunday we had a chance to meet Jacques’ father who was 93 and nearly completely blind from glaucoma, but mentally intact. He used to be a meteorologist. He once had three wives simultaneously but two were now deceased. Together they raised 19 children and the whole family lived peacefully together.
Monday we started work. Two volunteers, Paul, an eye-nurse, and his nephew, Vincent, who was an optician, screened the patients. They were decent and hard-working people. They were building an eye clinic in Tonga and were hoping to get future patients this way. Jacques examined those who had problems, usually over a hundred people daily, and we saw only the ones he deemed to be candidates for cataract or eye plastic surgeries. Communicating with the patients was a major problem. Most of them spoke Tonga and some French, and we had only one translator, who spoke their language but minimal English. Even the two members of our group who spoke French had trouble understanding the local accent. As a result communication was limited. We never knew how much of the explanation got through to the patients. When I complained about this to Jacques, he said that patients hardly ever get so much explanation (i.e. 2-3 sentences) about their medical conditions in Africa! We had several patients with languages nobody else spoke (in Cameroon there are 160 different dialects), and we usually let a family member come in and hold their hand during surgery to calm them.
The location of the OR was not ideal; the blind patients as well as our group had to pass through the maternity ward each time we entered, where women were breastfeeding their babies, surrounded by their families who were busy cooking and caring for them. Adjacent to the OR was the birthing suite were the fridge stood, and we had to enter several times daily to access it. This did not bother the mothers giving birth, or at least they did not show it. Interestingly, we did not hear a single moan or scream ever from them, only the newborn’s cry. We were told it is frowned upon for women to scream when giving birth.
On the weekend we went to visit the grave of Jacques’ and Olga’s mother. It was in a little sepulcher about 20 miles from Tonga, with the second’s wife’s grave right next to it. We entered, and Olga told her mother about us, what we were doing here, that her son brought the Americans here to help the people of Tonga. Then we just stood there silently for a few minutes before leaving.
Then we paid a visit to the Chief again, this time in his palace in Bandunga. We arrived unannounced, and we found him alone watching TV. His palace was a 1-floor medium-sized house filled with artifacts, mainly presents to the previous chiefs and to him: statues, masks, plates, paintings, leopard-skin, and a large throne. He offered us beer and soft drinks. He told us the story of his chiefdom: He was in his 40s, an established engineer, when his father passed away. His father willed that he became the new chief. The office of the chief is inherited and the chief in power appoints the next chief, usually the son whom he considers the most apt for the job. He absolutely didn’t want to become chief, but tradition forced him to accept the position. In the beginning he performed the functions reluctantly, but with time he got used to it. He had four wives but married only the first one in the Catholic Church, as the church doesn’t recognise polygamy. As a chief he is expected to have many wives; this is a sign of power and affluence in Africa (much like a fancy car or a yacht in the US).
During colonialism the tribal societies were superimposed with centralized governments, but in some instances they have retained or regained partial self-government. The function of a local chief is somewhat different depending on the country, the area and the tribe. Generally it involves decision making in land disputes, judging personal disputes, helping people in need, organizing political gatherings, keeping contact with the government, etc.
On Saturday night we decided to visit the local nightclub of Tonga. It was an unforgettable experience. Young men and women—usually arriving separately—were lined up at the entrance in their best outfits, hair beautifully made up. Inside there was deafening music, a growing crowd was dancing amid mirrors, flashing coloured lights, on an uneven floor which posed quite a challenge. No one seemed really drunk. The heat and the consequent odour of sweat were nearly unbearable at first but we soon got used to it. There were mostly men dancing, the women sitting shyly at tables. The whole place was just brimming with life and energy.
In the second week we continued to screen and operate on patients.
As word got out to the surrounding villages about our work, more people arrived early each morning. First we would see our post-operative patients while preparing the new patients for surgery. In order to maintain a peaceful and quiet environment, all the new arrivals were seated under a tent and entertained by a few of our group singing a few African-American spirituals and any songs that the people wanted to share with us. This is always a great way to “break the ice” and produce smiles in those who had to wait long hours to see us. Later we added a small comedy skit with wrestling, which was even more successful than the songs, and had to be repeated frequently.
Each day we walked through the village of Tonga several times on the way to work or to our meals. We always passed the two town wells, constantly in use, being pumped usually by children. The villagers waited to fill large buckets with water. We also passed by the adobe houses nestled in the surrounding heavily vegetated hillsides. No matter what time of the day or night we walked through town there were always multitudes of people on the streets busy carrying things, hurrying somewhere, selling all kinds of stuff, cooking, eating, drinking, talking, shouting, laughing. There was loud music coming from many stores. It was truly a village teeming with life.
On our last day in Tonga we packed up and bid farewell to everyone we had worked with. On our way to back to Duala we stopped in Bafoussam, a large town to tour the eye hospital and once in Duala we toured the eye hospital there, both of which were superbly run and staffed. It was quite a surprise to see these facilities; we didn’t understand why we had had so many patients if there was good quality and relatively affordable eye-care nearby. We were told that even though cataract surgery costs “only” 100$, many patients can’t afford it, and many don’t trust their own healthcare because of previously poor outcomes.
On our last day we did manage to visit the beach in spite of a sizeable thunderstorm. We decided to take a swim in the ocean, but ran in panic to the shore as a lightning bolt struck right next to us. At the airport we learned that our flight had been delayed by 12 hours so we happily spent one more night in Cameroon.