ACPA Pulse - Summer 2019

PULSE ASSOCIATION OF CAMEROONIAN PHYSICIANS IN THE AMERICAS

SUMMER 2019

Editorial ............................................................ 2

INSIDE

ACPA 3rd Annual Conference ......................... 4

ACPA President’s Letter .................................. 3

IMPACT

Medical Mission Update .................................... 7

HEALTH & WELLNESS

Needs-based training of providers on new techniques to improve cervical cancer control in sub-Saharan Africa ............................................. 8 Pre-eclampsia: ................................................... 10 What is it?

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Newsletter Phone Number: 912-584-0163 Email: ACPAPulseEditor@ACPA-CMR.org www.ACPA-CMR.org

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NEWS & EVENTS

ACPA Ladies Workshop ................................. 12 New Members ................................................. 13 Top Ten Reasons Why You Should Join ACPA .... 14

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ACPA PULSE In this summer issue of the ACPA Pulse, the President, Dr. Cassandra Ndiforchu introduces new members of ACPA leadership team and shares her vision for a more active and engaged membership.

The editorial board of the ACPA Pulse joins the president to echo this call for active participation by asking that all members endeavor to sign up for at least one committee. For those who missed the fourth ACPA Annual Conference held at the Atlanta Marriot Northwest Hotel from April 26 to April 28, 2019, we have two articles that capture the highlights of this successful reunion. An important highlight of the 2019 Annual Conference was the offer of 5.5 continuing medical education (CME) hours through the University of Alabama, Birmingham (UAB) office of CME.

Editorial Special thanks to the members of the Publications and IT committee: Dr. Christian Bime, Dr. Alan Tita, Dr. Bertand Fote, Dr. Dione Mbame, Dr. Kingah Pascal, Dr. Denis A. Foretia, Dr. Bekong Daniel, and Dr. Anita Sangong

Cervical cancer remains a major cause of preventable morbidity and mortality in Cameroon and across subSaharan Africa. In this issue to the Pulse newsletter, we present a report of an international collaboration including the ASCCP (formerly American Society of Colposcopy and Cervical Pathology (ASCCP)), the Cameroon Baptist Convention Health Services (CBCHS) and the National Cancer Control Committee of Cameroon (NCCCC) to provide local training for cervical cancer screening. Four ASCCP experts, including Drs. Ajenifuja Keyode Olesegun, David Greenspan, Laura Fry, and Alan Waxman (Course Director), served as course Instructors for this training hosted by the CBCHS Associate Directors, Drs. Thomas and Edith Welty. Read more about this impressive and impactful collaboration in this issue of the Pulse. Special thanks to Dr. Joel Fokom Domgue, a Cameroonian OB physician currently on fellowship training at MD Anderson Cancer Center. Dr. Fokom organizes monthly ECHO teleconferences with the Women Health Program nurses to discuss management of difficult cases and provides ongoing consultation. This is an opportunity to expand on ACPAs medical mission portfolio. As noted by Dr. Nina Lum, chair of the ACPA medical missions committee, this is a critical unmet need for our community.

The ACPA Pulse Newsletter highlights important events and achievements by the organization its members and partners. The ACPA pulse also welcomes submissions from the Cameroonian medical community at large. Contact us at Journal@ ACPA-CMR.org

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ACPA President’s Letter Greetings from California! I Extend a hearty welcome to all of our new as well as re-registered members. And I want to extend concerns and prayers to everyone affected by the recent floods and severe storms. It’s my hope and sincere wish that restitution will happen in a timely and efficient way.

It’s my pleasure to announce to you the formal election results:

PRESIDENT ELECT: DR. SHIRLEY AYUK-TAKEM Dr. Shirley Ayuk-Takem is an ICU physician based out of the Dallas, TX metro area. She is the CEO of Soleil Medical Group and completed her undergraduate studies at the University of Alabama in Birmingham, AL obtaining a BS degree in Respiratory Therapy.

She worked for a few years as a Registered respiratory therapist and continued on to medical school on scholarship at the School of Osteopathic Medicine in Mesa, Arizona where she earned her D.O. degree.

She went on to do an Internal Medicine residency in Detroit, MI and a Critical care medicine fellowship in NJ.

TWO-YEAR VOTING BOARD MEMBER: DR. NICOLE FOBI-NUNGA Dr. Nicole Fobi Nunga is a Georgia based Hospitalist with over 10 years extensive experience in acute care and ambulatory settings. She began her medical career in Berlin, Germany, studying at Freie Universitaet, completed an Internal Medicine Residency in Morehouse School of Medicine and is now a physician with an unrestricted US License and Board Certification in Internal Medicine. She is a preventive care practitioner lending her expertise predominantly in settings such as medical wards, acute and intensive care units and rehabilitation centers.

ONE YEAR VOTING BOARD MEMBER: DR. BONAVENTURE NGU Dr. Bonaventure Ngu is from the Washington/ Maryland/Virginia area where he began his career in medicine. He graduated Magna Cum Laude from Howard University with an Electrical Engineering degree and went on to pursue a degree in medicine from University of Maryland School of Medicine where he graduated in 2000.

He is a board-certified and fellowship-trained Orthopaedic

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Surgeon who is passionate about his patients and his mission to restore mobility to those that suffer from chronic back pain.

Dr. Ngu is currently the CEO of Premiere Spine Institute in Woodlands, TX, in operation since 2012 where he specializes in the diagnosis and treatment of disorders affecting the neck and back.

COMMITTEE SIGN-UPS

Unfortunately, our website continues to offer some technical challenges. In May, I had requested that all members sign up for three committees. The instructions were to do that through the website. Everyone who did sign-ups then, please accept my “Thanks” for your commitment and due diligence. At the same time, however, I must apologize for requesting you to now do the sign-ups again. If you have not submitted your committee choices up to now, please do seize this opportunity to let us know.

Instructions are below.

TIME IS NOW OF THE ESSENCE

The chairs for your committees need to contact you before June is over. Let me remind you that ACPA needs your ideas, your thoughts, your involvement-even if you’re only able to attend a few of the committee meetings. The fortunate thing with our ZOOM meeting site is that several committees can hold sessions at the same time. What that means is that you can spend a portion of your time in 2 committee meetings that are going on simultaneously.

So, do not be concerned about potentially conflicting schedules.

I also want to again point out/remind you that some committees will not hold very many meetings during the year, while others will have a more lively schedule.

ONGOING FINANCIAL SUPPORT

ACPA has ongoing costs and financial obligations beyond the Annual Conference. You can make a difference-AN ABSOLUTELY PAINLESS DIFFERENCE- through your everyday Amazon purchases. ACPA will receive 0.05% per qualified item purchase cost. Now, this may not seem like a lot, but it is additive over time per individual. And if more than one member participates, additive becomes multiple…

Please go to https://acpa-cmr.org/donate-pay and follow the hyperlink to sign up.

Please be sure to correct the Charity listed at the top to our full name: Association of Cameroonian Physicians in the Americas.

By the way, there is also an opportunity to make an outright donation at this same hyperlink. Remember, every penny counts.

Better still, why don’t you do both! Thanks for all you do for ACPA. The organization has many resources so please feel free to reach out to us as you see fit.

Have a great week!

Your President,

Cassandra J. Ndiforchu MD, MPH, MBA, FACOG, FACS

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3RD ANNUAL CONFERENCE

A Resounding Success ACPA held its third annual meeting from April 26th - 28th, 2019 in Atlanta, GA. The theme of this year’s meeting was “Wellbeing of Cameroonian Physicians: Focus on Mental Health.” In keeping with this theme, the discussions were rich in content and substance. Attendees are already looking forward to Charlotte 2020.

The weekend started with an exquisite welcome reception hosted

by Mr. and Dr. Mrs. Nunga at their residence. ACPA members were treated to a delicious variety of fine Cameroonian cuisine, wining and dining, as the members and potential members caught up on the previous year. The huge turnout with many first time attendees was a fitting testimony to ACPA’s steady growth over the past three years. Following their final meeting, board members joined the crowd.

After an early morning executive council meeting, the general assembly was kicked into session by President Bertrand Fote at 9:00a.m. on Saturday morning. A line-up of seasoned speakers left meeting attendees with a wealth of information and a great variety of applicable resources to take-away.

Mr. Enyi Kanu, financial expert and founder and CEO of Kanu Wealth management, gave an animated talk on “Coupling Tax Minimization Strategies with Comprehensive Financial and

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Estate Planning”. He focused on how ACPA members could utilize basic strategies to reduce their tax liabilities. He re-iterated a challenge that President Fote had made to ACPA members in his last monthly message before the annual meeting, calling on ACPA members to consider creating an endowment fund to help fund ACPA projects. Mr. Kanu explained how members could utilize smart tax minimization strategies to fund this endowment without spending any more money out of their pockets than they currently spend in taxes. ACPA members were given and interesting concept to ponder moving forward.

Following the financial discussion, Dr. Moses Ambilichu, the keynote speaker, gave the first of his two presentations on the theme of the event. With his extensive experience as a renowned psychiatrist, evident in the eye-opening talk he gave about mental health in our community, Dr. Ambilichu addressed mental health and well-being for Cameroonian physicians in a thought provoking yet insightful manner.

The focus then shifted to academics. Dr. Marilyn Feh gave a powerful presentation of her research on the unique challenges of informed consent and effective drug safety reporting; highlighting the benefits derived from clinical research on HIV/AIDS for pregnant women and infants in sub-Saharan Africa. She called attention to cultural and other barriers, which pose significant

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challenges to medical research in Africa, particularly on HIV/ AIDS.

signing up as consultants and reaching out to physician colleagues in Cameroon to lend their services as referring physicians.

Drs. Clarence and Kyra Clark, both residency program directors in Surgery and Medicine respectively, followed with an enlightening talk on the current perspectives in residency training. Even though they covered different fields – medicine and surgery – their presentations had some common themes, which shed light into the residency matching process. This illuminated a hot topic for the many students and FMGs who attended the meeting. They were thoroughly engaged and pressed the conversation further with a battery of questions and conversation, with the Clarks, during lunch.

The chair of the Education and Scientific Research Committee, Dr. Efua Leke-Fonlon, led the next agenda item. She gave an update on ACPA’s Community Impact Project, which addresses mental health in our community. She presented data collected from an ACPA survey, whose intended goal was to provide key information needed to fully develop the project. She reaffirmed her committee’s pledge to see this project through to its implementation. She concluded with an apt call to attention for the crowd; to address mental health in our Cameroonian communities across the US, through presentations, symposiums and other direct impact means, as often and as efficiently as possible.

Following the break, the new topic was on health missions and healthcare opportunities in Cameroon. There was a panel discussion, which featured Dr. Henry Nkumbe, who joined the event from Africa via Zoom conference, Dr. Ekokobe Fonkem, and Dr. Denis Foretia. Dr. Nkumbe, an ophthalmologist and the medical director of MICEI- Cameroon, talked about the continued efforts of his Eye Institute/Clinic for patients in the region and across sub-Saharan Africa. Dr. Fonkem presented the humanitarian work in Cameroon from his Healing Beyond Horizons Foundation. Dr. Foretia highlighted the strides taken by the Foretia Foundation to improve healthcare delivery and policy in Cameroon. Delegates were moved by the opportunities presented and the standards set by these organizations/foundations for Cameroon. In fact, Dr. Vanessa Ngakeng, an ophthalmologist ACPA member, was so led by the conversation that she pledged to do volunteer work at the MICEI Center upon her next visit to the country.

The panel discussion was an exemplary precursor for an update on ACPA’s Medical Missions Committee and their flagship, Telemedicine Program. Committee chair, Dr. Nina Lum could not attend the meeting in person, but was no less present as she joined via video conference. She called on all ACPA members to get engaged and ensure the success of the Telemedicine Program, by

After an enriching day of presentations, President Fote opened the ACPA business meeting, set to focus on pertinent topics affecting Cameroonians and Americans in the mental health arena and the daily struggles of this difficult and often awareness poor disease.

He concluded the speech and set to administrative matters starting with Dr. Shriley Ayuk-Takem accepting her nomination for President-Elect, and Dr. Bonaventure Ngu and Dr. Nicole Fob-Nunga accepting their nominations to serve on the Board of Directors. The DC Metro area was also selected as the site for the April 2021 ACPA Annual Meeting, with a marginal win over Seattle, WA. Later that night, delegates and guests were treated to a classic soiree at the 3rd Annual ACPA Gala. It was a time to relax, network and stay mentally engaged with a featured keynote address given by Dr. Moses Ambilichu, focusing on the theme of the meeting. Mr. Alain Fokam and his Kizomba dance class partner also treated gala attendees to an exquisite Kizomba dance (an Angolan native dance) performance. Mr. Fokam is married to ACPA member, Dr. Vanessa Ngakeng. The pinnacle of the evening took form in a thoroughly entertaining musical and dance solo performance by ACPA’s new president – Dr. Cassandra Ndiforchu. She took the stage for the first time as ACPA President after the ceremonial passing of the imaginary gavel by outgoing president, Dr. Fote.

President Ndiforchu gave a passionate address and shared her vision with a call to all ACPA members to work together for the continuous growth of ACPA. The Ladies’ Breakfast and 3rd Annual ACPA Community Health Fair on Sunday were an esteemed conclusion to the meeting. They culminated the theme of the event with camaraderie and active involvement in the local community and all its visitors. More on these are addressed elsewhere in the Pulse. Briefly put, Atlanta 2019 was a resounding success. The Atlanta team, led by the indefatigable Dr. Nicole Fobi-Nunga and her lieutenants, exceeded expectation throughout. The stage is now set for Charlotte 2020 with the bar set very high indeed.

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The medical missions committee at ACPA is an ever-evolving group. During the Atlanta meeting it chose to shine the spotlight on the use of telecommunication technology as a means of assisting our physician partners at home. At the Atlanta meeting, our medical missions chair, Dr. Nina Lum, presented a status report on ACPA’s telemedicine project.

The pilot project was launched in 2018 at the Houston meeting, with the goal to bridge the gap in providing specialty advice to our physician colleagues in Cameroon. From its inception to date, ACPA has provided consult services to five unique patients. Consults were in the disciplines of pediatrics, internal medicine, rheumatology, endocrinology & gastroenterology. These were cases where members of ACPA rose to the occasion and offered expert opinion to patients being managed in diverse parts of Cameroon by primary care providers.

One significant hurdle our telemedicine services faced, was the lack of acceptance and utilization of the service by physicians located in Cameroon.

This could have been caused by various environmental factors, such as its complete dependence on internet capability and the required direct patient care time lag in order to complete. That notwithstanding, the medical missions committee has identified that additional advertisement of the service, along with guided tutorials, will go a long way in publicizing ACPA’s readiness to provide this much needed assistance, and hopefully mitigate the barrier to entry for this type of service. With globalization, by way of the Internet, we believe this to be a worthwhile investment opportunity for our growing organization.

At this time we have 34 members registered on the following online platform hosted by Collegium Telemedicus https://www.collegiumtelemedicus.org/ ct/index.php. This includes 4 coordinators, 11 referrers to date (located in Cameroon) and 19 consultants (ACPA members).

As we continue to build towards the possibility of an ACPA sponsored medical relief trip to Cameroon, we anticipate an increased engagement from ACPA members for the following year as demonstrated by the enthusiastic feedback from those who attended the Atlanta 2019 session.

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ACPA PULSE Needs-based training of providers on new techniques to improve cervical cancer control in sub-Saharan Africa:

insights from the Colposcopy/LEEP course organized by the ASCCP and the CHCBS in Cameroon in April 2019 Although preventable, cervical cancer remains a leading killer from cancer among women in Africa. While screening and management of cervical dysplasia is a highly effective cancer prevention strategy (in addition to HPV vaccination), a large majority of women in Africa have never been screened. This is mainly attributable to the lack of resources, including a well-trained workforce to establish and maintain effective cervical screening programs.

As most African countries, Cameroon is in the early stages of exploring the best strategies for successfully implementing socially appropriate, affordable and scalable cervical cancer screening and treatment programs. Considering the limitations of cytologybased screening in resource constrained settings, alternative tools for cervical cancer screening must be considered. Options include low cost HPV testing assays and visual methods (visual inspection with acetic acid (VIA), visual inspection with lugol’s iodine (VILI)).

The Cameroon Baptist Convention Health Services (CBCHS) is a not-for-profit, faith-based healthcare organization that has provided medical services in Cameroon for over 50 years. In response to the large number of cases of cervical cancer seen in its facilities, the CBCHS founded the Women’s Health Program (WHP) in 2007. Since its inception, this program has provided cervical cancer screening to more than 100.000 women in 7 of the 10 regions of Cameroon, making WHP the largest “screen and treat” cervical cancer screening program in Cameroon.

In a setting where highly skilled specialist physicians are poorly accessible, the WHP is staffed by nurses who have been trained to use visual methods to provide cervical cancer screening and to treat cervical cancer precursor lesions. With this nurse-led approach, WHP has been able to offer affordable preventive services and

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establish strong links with the population. Despite the success of this largely self-sustained program, the need for WHP providers to update their skills and knowledge has emerged in a context of speedily growing technologic improvements. Moreover, physicians and providers from various public and private organizations who are facing a high demand of these services in their practice, have requested high quality training that will allow them to properly detect and handle pre-invasive and early invasive cervical disease.

This includes the appropriate use of new portable devices to perform colposcopy, and new techniques for cervical screening with lower cost HPV assays and for treatment of cervical dysplasia with battery powered thermal coagulation. Indeed, accuracy of visualization methods (including colposcopy) is highly variable, depending on the quality of personnel training, experience, and supervision, and the option to use adjunctive quality assessment tools such as digital cervicography (DC).

In the light of the foregoing, the ASCCP (formerly American Society of Colposcopy and Cervical Pathology) collaborated with the Cameroon Baptist Convention Health Services (CBCHS) and the National Cancer Control Committee of Cameroon (NCCCC) to organize for the first time, a high-quality comprehensive course on HPV, cervical cancer prevention, colposcopy and LEEP in Cameroon. Held from April 17 to April 26, 2019 in Douala, this in-depth training consisted of up-todate lectures on HPV epidemiology, cervical cancer screening and management, and colposcopy; combined with hands-on clinical experience (on actual patients) with punch biopsy, LEEP, and colposcopy. Four ASCCP experts, including Drs. Ajenifuja Keyode Olesegun, David Greenspan, Laura Fry, and Alan Waxman (Course Director), served as course Instructors for this training hosted by the CBCHS Associate Directors, Drs. Thomas and Edith Welty.

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ACPA PULSE Forty three (43) doctors and nurses from three countries (Cameroon 38, Nigeria 3, Sudan 1) participated in the three days of classroom teaching that used lectures, interactive case presentations and simulations in colposcopy, LEEP, and thermal coagulation.

Dr. Greenspan lecturing during the classroom teaching The program was patterned after ASCCP’s Comprehensive Colposcopy Course. This was followed by 5 days of hands-on colposcopy and LEEP training in a clinical setting for 15 of the participants (Figure 2).

Dr. Waxman with students at the hands –on training Overall, 54 pre-screened women with presumptive diagnoses of HSIL, based on VIA, VILI and digital cervicography, were recruited and offered free evaluation and treatment as part of the training. The hands-on trainees included a near equal mix of Ob/ Gyn physicians and women’s health nurses. Most of the nurses had previously undergone LEEP training, and each had experience with LEEP prior to our training. The doctors were mostly from Nigeria or Cameroonian health systems other than CBCHS, and most had little LEEP experience. Patients were evaluated and treated with close supervision by the 4 ASCCP faculty. Each faculty member proctored 3 or 4 students. To facilitate this, mobile ODT digital colposcopes were used with images displayed on a video monitor.

In total, 44 patients received LEEPs, 9 had biopsies, and one was scheduled for a hysterectomy.

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Trainees baseline knowledge, and knowledge gained about cervical cancer prevention was assessed with a pre- and post-test.

At the end of the course, a debriefing was held with the course participants and their comments were overall positive.

A certificate of completion of the 2019 ASCCP training course in Douala, Cameroon Certificates of completion (Figure 4) were distributed to all participants.

Dr. Tom and Edie Welty, ASCCP Faculty and some course participants In summary, the success of cervical screening programs in Africa depends not only on the feasibility of the approach implemented, but also on the quality of care provided to women and their satisfaction with the services they receive from providers. Thanks to this high quality training, many women in Cameroon, Nigeria and Sudan will benefit from adequate cervical cancer preventive services, which will contribute to the elimination of cervical cancer in the region.

This summary was prepared by Joel Fokom Domgue, MD, MPH under the supervision of Drs. Welty and Waxman.

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ACPA PULSE PRE-ECLAMPSIA:

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– What is it?

DEFINITION Pre-eclampsia is a condition which can occur in pregnant women after 20 weeks of pregnancy. It consists of new onset persistent high blood pressure (systolic BP greater than 140 mmHg and/ or diastolic BP greater than 90 mmHg) along with the presence of protein in the urine and other signs of damage to other organ systems. In pre-eclampsia, due to the effects of high blood pressure, you will have protein in your urine more than 0.3g/24 hours. Essentially, think of your kidneys as a sieve (“sifter”). A properly functioning kidney should not allow any large molecules (like proteins) to pass through and be excreted in the urine. Thus, a healthy kidney should be a sieve (“sifter”) with very tiny holes to block all the protein and other molecules from passing through.

You can also see other signs of the kidney not working properly like elevations in creatinine (a sign that your kidney is not filtering properly). Other things like liver injury (elevated liver enzymes), right upper abdomen pain, a decrease in the number of platelets in your blood and neurological complications, like seizures and the poor growth of your baby, can also be indicators.

TYPES OF PRE-ECLAMPSIA According to the American College of Obstetricians and Gynecologists (ACOG), pre-eclampsia can occur with or without severe features. Mild to moderate pre-eclampsia is diagnosed in women with blood pressures 140-159 mmHg/90-109 mmHg who also have proteinuria of 300 mg/24 hours or more, or a protein/creatinine ratio greater than 0.3 mg/dL. Severe pre-eclampsia is diagnosed by systolic blood pressure greater than 160 mmHg and/or diastolic blood pressure greater than 110 mmHg and proteinuria (300 mg/ 24 hours) or a protein/ creatinine ratio greater than 0.3 mg/dL. This would occur on at least 2 occasions taken at least 4 hours apart while the patient

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is calm and resting. Conclusive tests can also be derived from a patient with an SBP greater than 169 mmHg and/or a DBP greater than 110 mmHg (tested on 2 occasions at least 6 hours apart while calm and at rest) and without proteinuria, displaying results such as low platelets, kidney damage, liver damage, fluid in the lungs (pulmonary edema), difficulty seeing or problems in the brain.

Other laboratory findings which can be seen in women with preeclampsia include having the serum creatinine be greater than 1.1 mg/L or a doubling of the normal serum creatinine without a prior history of kidney disease and the type of liver injury represented by liver enzymes, increasing to twice the normal levels. Further indicative characteristics of the disease can be pulmonary edema (fluid in the lungs causing trouble breathing), headaches or trouble seeing.

SIGNS AND SYMPTOMS Symptoms seen in women over 20 weeks pregnant include high blood pressure, nausea, vomiting, headaches (which remain even after treatment), upper abdominal pain (usually on the right side), swelling (especially around the eyes and on hands), trouble seeing (flashing lights, blurry vision, seeing spots), racing heartbeat, seizures, difficulty breathing, difficulty urinating, hyper-reflexia and/or clonus (a twitching/jerking like movement). The baby would also experience reduced movement in the uterus and possibly poor growth. In severe cases, women with pre-eclampsia may progress to having seizures or a cerebrovascular accident (stroke).

HOW IS PREECLAMPSIA DIAGNOSED? Pre-eclampsia is diagnosed based on blood pressure assessment and evaluation of the urine for protein. The tests done to diagnose pre-eclampsia include urinalysis (urine test to check for proteins), complete blood count, liver function tests, kidney function tests, blood clotting tests, fetal ultrasound, fetal biometry (to see if the fetus is growing), fetal cardiotocography (recording the fetal heartbeat and the uterine contractions), umbilical artery Doppler

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WHAT CAN CAUSE PREECLAMPSIA?

HOW LONG DOES PRE-ECLAMPSIA TAKE TO GO AWAY?

Pre-eclampsia usually resolves after delivery of the placenta but can last for up to a few more days. In certain cases, even after delivery, the symptoms are still present and the risk of complications may remain. It can be associated with an increased long-term risk of developing diabetes mellitus, high blood pressure or strokes.

Several things can increase your chances of having pre-eclampsia such as a prior history of pre-eclampsia, family history of preeclampsia, obesity, 35 years of age or older, first pregnancy, multiple pregnancies, history of diabetes, autoimmune diseases, kidney disease, high blood pressure, or 10 years or more in between births.

COMPLICATIONS OF PREECLAMPSIA. Complications of pre-eclampsia include eclampsia (seizures and/ or coma) and HELLP (Hemolysis, elevated liver enzymes, low platelets) syndrome, both of which cause damage to other organs such as the liver, the kidney, the brain and can also cause the fetus to develop poorly.

HOW IS PRE-ECLAMPSIA TREATED? Treatment of pre-eclampsia depends on whether you are stable or unstable. If you are stable (i.e. no seizures) it could involve medications meant to lower blood pressure and close monitoring of patient and fetus. In an unstable situation (i.e. dangerously high blood pressure or seizures) the decision has to be made to treat the high blood pressure with intravenous magnesium and lower the blood pressure with medications, plus a firm course of action to deliver the baby after blood pressure has stabilized. Delivery of the baby is the only definitive treatment for pre-eclampsia. The mode of delivery (cesarean section versus vaginal birth) is made on a case by case basis. IV steroid administration can also be used if the pregnancy is under 37 weeks to help the fetal lungs develop in the case of an anticipated early delivery. Close monitoring of fluid intake and output is also recommended along with monitoring of blood pressure and consistent follow up with a medical doctor.

TYPES OF MEDICINE USED TO TREAT PRE-ECLAMPSIA Medications that can be used to lower your blood pressure include Labetalol, Nifedipine, Hydralazine and Methyldopa. If severe preeclampsia or eclampsia (preeclampsia complicated by seizures) is present, then IV magnesium can be used.

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TAKE HOME POINTS:

✓ Monitor and record blood pressure closely when pregnant and if higher than the numbers above, let a doctor know promptly

✓ Get routine blood work as recommended when pregnant; make sure that liver and kidneys are working properly and

that blood is clotting properly, if diagnosed with elevated blood pressures during a pregnancy.

✓ Get a fetal ultrasound done to make sure that the baby is growing properly. ✓ Avoid excessive salt and water intake when pregnant as this will increase blood pressure ✓ Know the warning signs listed above and contact a doctor if they are present ✓ Go for prenatal checkups and see a doctor regularly. If you don’t have an Ob/Gyn, there are several well qualified Ob/ Gyns that are members of ACPA. Go to the ACPA webpage for contact information if you want to be put in contact with them.

✓ Remember you are the number one advocate for yourself and your baby, so don’t panic.

AUTHOR: Shirley Ayuk-Takem, DO REVIEWER: Efua B. Leke MD, MPH REFERENCES: American College of Obstetricians and Gynecologists (ACOG)

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ACPA PULSE ACPA LADIES Workshop

TITLE: RE-INVENTING YOURSELF BEYOND PAST CHALLENGES DATE: APRIL 28TH, 2019 FACILITATORS: DR ASEH, DR YEMBE

“Life isn’t about finding yourself. Life is about creating yourself ”.

George Bernard Shaw On Sunday April 28th, 2019 twenty-five ladies met for the 3rd annual ACPA Ladies workshop.

At that workshop, we had the rare opportunity to meet and discuss ways to reinvent ourselves. What unfolded was a truly enriching and transformative experience for the ladies.

Pulling back the curtain and making ourselves one with others was a strenuous feat. Female physicians, in particular, find it difficult to be vulnerable. As the “fixers” in our professional and personal lives we are unaccustomed to seeking camaraderie and advice for our deepest challenges.

On that Sunday, however, we filed into the room bright and early, with minimal expectation. Nervousness, self-doubt and concern for criticism slipped away as each sister testified.

Time rendered useless, we sat transfixed as we heard what the stories revealed. We bore our souls and felt and supported each other. Most importantly, we gave each other permission to be honest.

Each tear, smile and outburst of laughter brought us closer and at the end of it all, strangers emerged as sisters. In this “sacred” space, we gave birth to a book, a captivating tale of finding success.

BEYOND CHALLENGES: SURVIVAL STORIES OF AFRICAN IMMIGRANT PHYSICIANS ON LIFE, LOVE AND THE PRACTICE OF MEDICINE. Despite hectic professional and personal lifestyles, in six short weeks, fifteen of these ladies submitted a book draft to a publisher.

This has been an enlightening, collaborative and instructional experience. I am pleased to announce our book will launch in October 2019.

We look forward to sharing more at the 4th Annual ACPA Meeting, April 3rd in Charlotte, NC.

“Not sisters by blood, but sisters by heart” --- Unknown Author: Omerine Aseh MD

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Uninsured To treat or not to treat?

That is the big question.

It now plagues a nation Of unequal ration The poor uninsured! Treat??

To be or not to be?

Morally right and nice Or fiscally unwise?

The physician must size The uninsured shall be!

To fix or not to fix Our health care system’s holes?

As poverty still grows, Is no question for votes But lives! Not politics!

To act or not to act?

As healthcare costs increase While payments now decrease Can make or break our lease And that – my friend- is fact!

To treat or not to treat The poor and penniless Who come to you helpless?

Moral high or fiscal mess?

Puts heart and mind in heat!

To be or not to be A force in this big fight Is privilege or right?

A question of great might!

With lives at stake – Please be!

Bertrand Fote (Sir 4te) Charlotte, NC

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NEW MEMBERS JOIN US IN WELCOMING OUR NEWEST MEMBERS: Dr. Silo Mbame MD/DO

-------------------------------------Dr. Nina Tazi MD/DO Internist

-------------------------------------Dr. Dieter Wefuan Internal Medicine/Pediatrics

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REASONS

WHY

you should join ACPA 1. Professional development while earning CMEs during the annual ACPA conference.

2. Professional networking with other physicians of Cameroonian origin.

3. Participation in physician wellness sessions.

4. Capitalizing on practice referrals.

5. Marketing and promotion of business by advertising in The ACPA Pulse Newsletter/ Magazine and renting a booth during ACPA annual conventions.

6. Access to groundbreaking research opportunities, especially those affecting the Cameroonian community.

7. Participation in the Telemedicine initiative and helping physicians, based in Cameroon, solve complex cases.

8. Involvement in health fairs benefiting Cameroonians living here in the Americas.

9. Mentorship for young Cameroonians during their undergraduate and graduate medical training.

10. Development of practical solutions to Cameroon’s health care challenges. www.ACPA-CMR.org info@ACPA-CMR.org

Newsletter

ACPA PULSE JOIN ACPA WHO?

Are you a physician or medical student of Cameroonian origin or with Cameroonian connections residing in the Americas? If yes, consider Joining ACPA today

OUR VISION:

A stronger Cameroonian healthcare community in North America fostering improved healthcare in Cameroon.

OUR MISSION: •

To foster personal and professional growth of physicians of Cameroonian origin in North America through networking and collaboration.

•

To promote scholarship and facilitate integration of physicians of Cameroonian origin in North America in the healthcare industry in North America

•

To provide a forum for involvement in healthcare delivery and policy in Cameroon through communication and collaboration with Cameroon health authorities.

•

To play a significant role in all matters affecting the health of Cameroonians and provide the forum for debating evolving health issues

•

To encourage the development of practical solutions to Cameroonian health care problems through training and other strategic activities inside Cameroon.

WHY JOIN ACPA?

Here are some benefits to being a member of ACPA • Discount Program: Take advantage of our discount program •

Professional Development: Opportunities for scholarly activity at annual meeting, publications in ACPA Pulse, mentorship opportunities for medical students, observing opportunities for FMGs, CME offering coming soon, leadership opportunities.

•

Professional Networking: Access to online community networking, informative emails, membership directory etc.

•

Practice referrals: Access to membership referrals

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Physician wellness: Access to information and strategies on physician wellness

•

Support the mission and make a difference: Help improve the quality of life of our fellow Cameroonians through community service, supporting efforts to make healthcare more accessible like our Telemedicine program, partnerships with NGOs doing mission work in Cameroon, collaborating to develop sustainable solutions.

•

Member Spotlight:

Knowledge is power but ONLY ACTION SAVES LIVES! Why wait. Join today. For more information, visit our website at www.acpa-cmr.org www.ACPA-CMR.org Newsletter info@ACPA-CMR.org

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ACPA HEADQUARTERS 501 White Tail Terrace, Waxhaw, NC 28173 Phone: 912-584-0163 www.ACPA-CMR.org ACPAPulseEditor@ACPA-CMR.org Dr. Cassandra Ndiforchu, President Dr. Dione Mbame, Secretary Dr. Awungnija Leke-Tambo, Treasurer

www.ACPA-CMR.org info@ACPA-CMR.org

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