The Association for Clinical Pastoral Education, Inc.
THE CPE PROJECT OF THE REVEREND NDONGDEH GODLOVE KWAIN
MBINGO BAPTIST HOSPITAL, NORTHWEST PROVINCE, CAMEROON
JANUARY/FEBRUARY 2008
CONSULTANT'S REPORT - written by ACPE Supervisor, PETER HOLLAND
It was my privilege to go to Cameroon and launch the CPE center, participate in student training and experience Godlove's Doctor of Ministry Project unfolding.
BACKGROUND TO THE PROJECT
During 2006 - 2007, The Reverend Ndongdeh was a student in supervisory training at the Avera Health ACPE - CPE Systems Center in Sioux Falls, South Dakota. He advanced his credentials by appearing before three CPE committees, the first affirmed his readiness for Supervisory CPE. Another committee confirmed him as a supervisory resident in the Avera Health ACPE - CPE System Center. Then after a period of training he submitted materials to the North Central Region ACPE Certification Committee and was granted his request to become a "candidate" in Supervisory CPE. As a candidate in the United States he observed one program and had supervisory responsibilities in another. The establishment of a program in the Cameroon Baptist Conference involved two steps. While still in the United States, Godlove arranged to have his program listed as an InternationalAffiliate of ACPE. That affiliation came through in January 2008 as he executed the second step, which involved establishing the program itself (The Doctor of Ministry Project).
As part of his training in America, Godlove not only worked with students, but also functioned as a chaplain in the Behavioral Health Unit of Avera McKennan Hospital. That gave him a chance to work with a program of treatment unavailable in Cameroon and it fostered Godlove's interest in a training program for counseling ministry in Cameroon.Scholarship funds to facilitate my travel, visas, vaccinations and insurance were received from the North Central Region - ACPE History and Research Committee who offered a grant of $3000. A proposal was submitted to the ACPE to cover some program costs for the launch of the program in Cameroon. The "Center for Clinical Pastoral Education and Social Services" at the Mbingo Baptist Hospital received a grant of $4700 from ACPE beginning February 2008.
After Godlove returned to Cameroon in fall 2007, his plan to complete the D.Min. Project involved promoting the program within the Cameroon Baptist Convention by publicizing the program, recruiting students, and persuading his administrators of its necessity and efficacy. Godlove had thought through the milestones before he returned and those were reflected in his prospectus for the degree. Each milestone represented a considerable amount of work, but Godlove was committed to starting a program and that began at the time planned.
The question of whether CPE would work in Africa has been raised over the past 30 years by several ACPE inspired CPE programs in Africa . Would it be best to begin a program using American supervisors? Should ACPE undertake the training of potential indigenous supervisors? Should a specific CPE center sponsor a program on another continent? These approaches had been tried with limited long-term success. Godlove opted for a hybrid of all three. He was open to ACPE trained supervisors working in his program, he wanted to further his own training in the United States to give his supervision an air of legitimacy and he was looking for sponsorship from a particular institution. He chose the Avera CPE Program in which he had trained as a co-sponsor of his international affiliate program. The challenge of maintaining a program outside the United States could be illustrated by four examples. Godlove had participated several years ago in an introduction to CPE training at his hospital, by a non-resident chaplain who had no Chaplain Supervisory credentials. Several years ago in Kenya an ACPE trained supervisor from that country had started an indigenous program. Soon after the program started the trained supervisor was recruited for an administrative position in his denomination, but CPE has continued in some form without a trained supervisor. Currently the ACPE has a relationship in Zimbabwe in which volunteer American based supervisors provide supervision. The Advocate Health System in Chicago has provided financial assistance to programs in India and for a period of time an inter-hospital relationship flourished. So, the long-term success of CPE in a non-American setting presented a risk and an opportunity.
Godlove's ambitious project involved supervising CPE at various sites and hospitals sponsored by the Cameroon Baptist Convention Health Board. As he was head chaplain in the Mbingo Baptist Hospital, so his plan for CPE began at that institution, but was part of a larger strategy to bring pastoral counseling training, social work training and CPE to his convention. Mbingo Baptist Hospital was chosen partly because Godlove lived on campus, but also because as an institution with 260 beds it provided a unique opportunity for students to get good quality clinical practice.
Founded as a leper colony in the 1950s, the hospital remains in a rural community in a mountainous setting about 25 miles from Bamenda. Thus, students resided in the institution during training. One of the logistical difficulties of trying to setup this program was to provide housing for students on site. Another difficulty was finding students who could spend three months away from home or from seminary. By using their extended family network, the recruited students, who were all married, found a way to get family support for their children and the necessary support to provide them with a stipend to pay for the class and accommodation during training.
Hospital Campus from Mbingo Hill
CPE Student Emelda bathes her youngest
As part of the additional preparation Godlove procured hundreds of books on pastoral care and counseling for a training library. When fully catalogued, this library of 3000 books will be the best pastoral care library in Cameroon . For example, the Presbyterian Seminary in Yaoundé had only a couple of dozen books to support their Pastoral Counseling training program.
CPE Student Mildred cooks in her room
MY PARTICIPATION
As consultant I participated in preparations for the program and corresponded through e-mail during the fall of 2007 as the preparations advanced. The CPE group started in the first week of December, and when I arrived at the end of December, the students were on a Christmas break. In order to get a feel for some of the difficulties of instituting CPE in Africa, I found the Douala arrival intimidating. The airfield and terminal looked a drab imitation of their bright American and European counterparts. Learning to wait as a virtue was first encountered on arrival. I had briefly been arrested for illegal photography. However, Godlove had a contact in the airport security office so was able to meet me in the tumultuous baggage hall and facilitate customs clearance. Judging any institution in Africa should not be made by appearances, nor should the impossibilities of improvisation in the face of obstacles be underestimated. Godlove understands both problems in setting up CPE.
It is evident that the makeshift nature of Cameroonian cities suggested immediately that CPE might be irrelevant to an emerging nation trying simply to survive. The Cameroon Baptist Convention Health Board has planned for the future and thrived in this relatively chaotic atmosphere.
My first night was spent at the Mutengene compound of the CBC central distribution site and Center for Disease Control Research. The denomination had organized and prepared itself to tackle the difficulties of health care in Africa with a modern Western approach. I later learned about its radio and TV ministry. CPE training for chaplains would be consistent with their approach of bringing the best of Western medicine to Cameroon.
The Gate House of the Mutengane Compound
With a good car, and a determination not to stop, the trip from Douala to Mbingo could take four to five hours. Douala on the coast has a tropical climate and Mbingo in the mountains of the North West Province, a dry and cooler one. The journey to Mbingo requires passage from a French-speaking area to English-speaking regions of the Southwest Province and then the Northwest Province. Bamenda, the largest town near Mbingo, looks peaceful and neat from the road descending into the town, but it proves a busy trading crossroads of about 500,000 people making a living on its dusty sidewalks, navigating random traffic patterns on unimproved roads under a background of central government neglect and even suspicion.
Part of the Market in Bamenda
It is the central communication point for all who travel to Mbingo. Few here own their own cars, even though a revolution has taken place in the last five years in the ownership of motorcycles and cell phones and communication to the outside world through the internet. Toyota diesel taxis, largely imported from Europe after their useful life there ended, have become the preferred means of transport. To the locals, the distance between Mbingo and Bamenda is 800 francs (two dollars) by over-crowded taxi. After I left Cameroon a central strategy of a general strike and protest in the country involved shutting down taxi services along with protest marches and some violence.
Typical Heavy Traffic in Bamenda
THE TRAINING INSTITUTION
The Women's and Hansen's Ward Mbingo
The institution of Mbingo Baptist Hospital provides a CPE site reminiscent of the old state hospitals in the USA and the National Health Service hospitals in Britain circa 1950s. The ward system packs in patients in close proximity. Students visiting need familiarity with several languages, especially where patients have been brought to the hospital from other parts of the country for specialized treatment. For example,as the only treatment site in Cameroon Hansen's disease patients still come from all over the country even though the disease itself is in decline. The hospital also provides residential schooling for deaf children from different provinces in Cameroon . They learn American Sign Language principally.
School for the Deaf Children Signing
Thus, the hospital necessitates having language proficiency to engage a variety of patients. In the US only few hospitals in the United States might share that need. Here French and English are the official languages, but the principal spoken language is Pidgin English. The local area language is Kom spoken by about 200,000 and the Muslim patients speak their own language, Fulfude, (language spoken by the Fulani).
Falani Men at Mbingo Hospital
Some of the staff chaplains are able to communicate with nearly all those groups and the French-speaking students often worked with patients who had been sent to the hospital because of its specializations.
Many patients had road accidents and others had been diagnosed with HIV. The quality of treatment varied, but in general the students had to deal with people who suffered a lot more than in American acute care hospitals. However, patients like their American counterparts have the pain of paying bills. A lack of money means that many patients seek help from the hospital as a last resort. Thus, students encountered Cameroon specific problems. For example, one student presented a case study of a woman who earned a living as a sorceress and was having marital difficulties in a polygamous marriage. In order to sire children her impotent husband had designated his cousin to impregnate the wives and carry on the family name! This patient had an ovarian cyst. However, despite a mixture of culturally specific differences, this patient's anxiety about her future benefited from the sympathetic approach of the student chaplain just as it would in the United States. In Cameroon and America the chaplain's response would be most helpful if he or she approached patients with curiosity about the patient's story. Listening to the patients' hopes, anxieties and energies are tasks chaplains perform the world over. Godlove's doctoral paper discusses the significance of the universal similarities and specific differences in pastoral care experience revealed. In general, CPE challenges chaplains to become conscious of their cultural assumptions and to address cultural variability in patients through an open curiosity, but it also reminds them that emotionally people are similar. Their task involves trying to help the patient mobilize their inner resources.
Daily Staff Chapel Service
The typical day for patients, staff, chaplains and CPE students began with a half hour chapel service with as many as 300 present. Student chaplains lead this service in rotation in Pidgin English affording a visibility among staff few US CPE programs could match. Students acted competently and confidently in this large congregational setting revealed a familiarity with public speaking. Theologically they related to the people and they spoke well enough to be understood by everyone present. However, it took me a while to get basic Pidgin to follow the sermons. While the culture is an evangelical Baptist one, that raises a longer-term question about sustaining CPE's ecumenical emphasis. Although Godlove values recruiting students from other denominations this hurriedly organized first group had two students from other Protestant denominations. These students spoke French more easily than English and so CPE was conducted in a manner that accommodated to the language of the participants. The students enjoyed the opportunity to practice and to learn about the other languages that surrounded them as I did too. Although all had proficiency in English, they helped anyone stumbling over words in a non-judgmental, warm encouragement. Students in North America might take a common language for granted. I brushed up my French, and was tutored in Pidgin.
THE CPE PROGRAM
CPE Students Break from Evaluation Session
The material students presented at the beginning of the program suggested they thought chaplains only read Scripture and offered prayer. Even though that satisfied the patient at some level, nevertheless the conversations showed that patients had other unmet needs. The students, to their credit, quickly saw the problem and became open to the pain and suffering patients expressed. They showed willingness to try alternative ways of approaching patients. As the weeks went by the students became more proficient in this task and they also understood as a form of pastoral reflection that the task did not just involve technique, but also included their ability to sustain a relationship based on how they felt engaged with the patient and their problems.
The CPE experience took place in a hospital located in a rural community treating patients for both acute and chronic diseases. For example, the campus housed a school for the deaf, a colony for “orphaned” Hansen's Disease patients ostracized by family, a farm, staff housing, family housing, a VIP ward, a hostel for those who had not paid their bills!, a community Baptist Church and an elementary school.
School for the Deaf and Garden
New Hope Village Hansen's Patients Colony
The Hospital's Farm and Market
Rich and almost overwhelming opportunities for engaging a community with strong religious ties awaits any prospective student in this center.
When I read student admission's materials I compared their applications to those of students I had interviewed in North America, concluding that students presented more harsh and raw experiences than their American counterparts. For example, a student married to a journalist husband who spent three years as a political prisoner had a uniquely Cameroonian story.
CPE student Emelda's Family
Fortunately, his plight and that of other political prisoners was brought to the attention of Amnesty International which eventually led to his release. Abortion and Suicide are illegal in Cameroon, and can be treated in a humiliatingly public manner. One of the students who did visit a patient who had had an abortion found a patient who naturally felt suspicious of the chaplain's ministry at first and assumptions needed exploring before a bond of trust could flourish. I saw a news program in which a woman who had had an illegal abortion was singled out by a reporter, and also a suicide was photographed as grave diggers created a shallow grave below the tree from which the man hung. Tradition holds that burial must occur where the act occurs. Therefore, the challenge of working with cultural differences is in being sensitive to the way in which those traditions affect the people concerned. The Baptists held a strong taboo against polygamy, so the pastoral task in Cameroon as in the US was to become more aware of one's own prejudices in order to explore differences and offer pastoral support. Godlove had been writing about Narrative Theory in his materials and using the concept of narrative, found his students resonated to approaching culturally unfamiliar situations with curiosity. CPE's questioning approach to experience helped students bring to consciousness a person's cultural perspectives and common assumptions of everyday life.
As few formal agencies for dealing with psychological problems exist in Cameroon , students received a rudimentary understanding of counseling. Not only do doctors make referrals to chaplains to deal with major disorders, but problem staff, fall into the chaplain's lap through referral from frustrated department heads. For example, a young man diagnosed with Bipolar disorder and treated with Valproic acid was referred to Godlove for counseling. He agreed to stay on the campus of the hospital for several weeks and gradually grew in acceptance and knowledge of his condition through the counseling process. This case example points to the possibility of CPE as a training method in residential work with mental illness. Generally, hospitals in Cameroon do not treat major psychiatric disorders. Godlove plans to train counselors, together with his responsibilities for the social work program in the hospital and to suggest that a unit of CPE might routinely become part of their social workers' training. One of the new social workers joined the CPE group during the program and social workers participated in CPE didactic seminars.
In some of the early verbatim presentations I witnessed, the students dealing with cases where the specifics differed from those encountered in America. For example, the patient living in a polygamous marriage whose gynecological exam revealed a reversible prognosis about her infertility serves as an example of difference. Her husband's impotence, the use of a surrogate family member, the pregnancy of the first wife and the declared occupation of the patient as a fortune teller opened up the possibility of an interesting seminar discussion. The student shocked by polygamy found it difficult to support the woman who felt angry because the husband had excluded her from decisions and abused their relationship. Although the specifics were Cameroonian, the feelings were universal. Could the student for example explore the patient's interest in the future (she was a fortune teller) in application to her own life?
In the same way a second case concerned a patient who had been in the hospital for three months and had wondered how to pay his bill. The hospital had a system where people with unpaid bills would live in a ward for "Bill Penders." The student found the patient's state tremendously frustrating. Students opened their minds to think about the injustices of this system through questions Job asked. Another case concerned a doctor patient relationship turned bad when the patient placed a leaf with supposed magical powers on his injury and had refused the doctor's advice to exercise because it caused him pain. The patient attributed his pain to enemies within placed there by an evil spirit. The student felt challenged about the doctor patient relationship as he did about exploring how the patient stood up to the enemies in his head. Feeling like a victim of fate proved a common and familiar trait among patients as it can among American patients.
On more than one occasion when students dealt with difficult cases after a good meal, they felt sleepy as they placed excessive effort to explain a problem they could not solve. The students witnessed each others sleepiness and delighted in photographing their sleeping colleagues.
Another exciting seminar in CPE
At the next post lunch seminar they predicted a similar fate. Having named the problem, it didn't happen. The surprise provided a learning opportunity in this Interpersonal Relationship Seminar. The students had been taught the theory of System Centered Training devised by Yvonne Agazarian which made them practice their abilities to recognize dynamics within the group. When their "sleepiness" got explored it kept everyone awake. It led them to talk about their frustrations about being in the hospital and also as it happened other interruptions occurred during that session. These would normally be frustrating but the theory deals with such experiences by naming them. The shorthand term for interruptions is "noise" and students were grateful to give it a name so they could stay focused on the heart of what they wanted to talk about. Supervision held up "noise" to help students focus on their feelings rather than the distraction of their intellectual constructs, and the need to act out frustration. Supervising students in conjunction with Godlove allowed me to experience the similarities and differences between these students and their American counterparts.
THE PROGRAM LAUNCH
Godlove also wanted my presence at the official program launch ceremonies slated for January 22, 2008.
Hospital Choir at the CPE Program Launch
A committee formed to steer this occasion and the chief social worker took on the job of mastering details. The planning committee met several times, arranged for the speakers, the invitations to the officials, the meal, and for the Baptist Press to attend the ceremony. Almost everyone invited turned up, except seminary representatives from the Baptist seminaries with teaching responsibilities, and the Catholic bishop. Other seminary representatives from different denominations came. The Fon of Kom, the traditional tribal leader of the 200,000 Kom speakers came. He deeded the hospital all its lands. He made a traditional colorful presence in the Chapel that day. About 500 people attended.
CPE Students at the Program Launch Ceremony
Along with government officials the President of the Cameroon Baptist Convention gave a talk. The chaplain of one of the hospitals preached. It was my privilege to launch the program and some speeches have been included in the D.Mn project. Surprisingly, (unprecedented in the US, as far as I know) the local press and TV had the occasion on their news. The Cameroon Baptist Convention TV Channel worked to develop a documentary about CPE and Godlove and I went to Bamenda a few days later to conduct an interview which they were going to include in the program. DVDs of the occasion are available.
The day began with the uncertainty of when precisely to begin. Although 9 a.m. was my target time, the 40 or so strong choir that had rehearsed for the occasion began singing outside the Chapel at about 9:30 a.m. The chaplain preacher had traveled overnight on the bus from Mutengene. He was ready too. Gradually one side of the Chapel filled and I took my place along the back wall of the stage which filled with about 20 other invited guests, government officials, hospital and system administrators as well as some clergy and persons from the seminaries. Even when the ceremony began some dignitaries had not yet arrived. However, the press came with video cameras. People spoke warmly of the need for trained chaplains in the hospital. Professor Tih Muffih spoke of the specifics of CPE and the role of the hospital system in the community. I discovered that his pointed statements were made to the Fon of Kom who had recently been given information to the detriment of the hospital. The occasion provided an opportunity to build a new bridge to this influential tribal representative. The Fon entered during Chaplain George's sermon. First an entourage arrived bringing a folding chair draped with a colorful blanket along with two of the Fon's wives. Then a large man in traditional orange colored dress walked slowly down the aisle to take his prepared seat.
The Fon of Kom
His dark glasses and still posture suggested a mysterious air as he positioned himself with his hands firmly on his wide apart knees. He was recognized by the leader of the service and his assistant spoke for him. It seemed incongruous that a royal personage, the Fon of Kom should participate in the launch of a CPE center.
At the end of my speech I declared the center launched which brought cheers and a round of applause from the gathering. The students appointed a speaker too and the ceremony ended with a benediction, a procession and a tour of the hospital. At the large luncheon prepared for the dignitaries instructions were given in Pidgin where food was referred to as "chop." In all the ceremony lasted four hours assuming the start was 9 a.m. One of the ambitious plans described during the ceremony included a CPE building housing a dormitory for CPE and social work students, classroom space, and possibly spaces either for the training of pastoral counselors or the use of some of the space for patients receiving psychotherapy. I have come to expect that sometimes electronic presentations get undermined and on this occasion a power cut prevented the company present from receiving all the information on this the most ambitious aspect of the program.
Godlove's Office
THE PLACE OF CPE IN CAMEROON
After supervision and ceremony, the third leg of the stool on which my visit to Mbingo stood concerned the help I would provide Godlove in getting his materials together for his Doctor of Ministry project. The project, to establish the CPE program had gone well, but it proved a challenge to bring all the materials together to do justice to such a large project. Similarities between US programs and this one in Africa were striking; but the details of arranging the program varied considerably from what it would take to get a CPE program in the US started. For example, ACPE conforms to the United States Department of Education Standards; Godlove neither could nor should meet their specifics. So the Cameroonian CPE Handbook kept only those details specific to Cameroon. A revised copy in light of this CPE unit appears in the project appendix.
The next unit of CPE would start in the summer. A couple of the admission's interviews for that program took place in my presence in Yaoundé, the capital.
Peter, Godlove, Emil's student and Emil
Our trip to Yaoundé provided the opportunity to review a pastoral counseling program instituted by the Presbyterian Church. Its founder Jean Emil Ngassi met us with two of his students at his house. While there Emil contacted his sponsoring counseling center in Richmond, Virginia and we had a discussion about applying counseling issues in Africa . For example, one of his students commented on the cultural divide between Africa and the US over acceptance of homosexuality. He described both the denial of its presence by the general population, while claiming that a dominant male homosexuality was practiced widely in high government circles. Though our gathering had a lively discussion, Emil was not well and he had been appointed by the Federation of Evangelical Churches in Cameroon as their General Secretary. He also served on a human rights commission so that he could not give much time to the work of training. The counseling center had a building situated midway between his house and the Protestant Faculty of Theology of the University of Yaoundé.
Theological school Yaounde
We had a chance to review the library at the Protestant Faculty and noted that they had about a dozen volumes on pastoral care and counseling. However, the students seemed well prepared for their counseling duties and like Godlove's students; those practicing counseling were eager to learn more and using the international phone connection for consultation. Emil's struggle against the trap of becoming a denominational executive seemed instructive. While in Yaoundé we met a pastor who had graduated from the North American Baptist Seminary with a Doctor of Ministry. By looking over his project we had the opportunity to compare and contrast a Doctor of Ministry project that had taken place in a Cameroonian setting.
Main Clinic in Yaounde
One of the aspects proposed in the Doctor of Ministry prospectus included research into the practices of a traditional healer. Not far from the Mbingo Baptist Hospital, nestling in an isolated valley laid the compound of "Dr. Leki.” Our expedition, Godlove, a CPE student and myself eventually found its location after an hour's walk, asking directions, following tracks through the undergrowth, along the mountainside and around fields. Dr.Leki, an 84 year old Kom speaker, sat in a makeshift walled area with large cooking pots soaking vegetation; and the tools of his trade.
Dr Leki's Surgery
He had collected wall calendars for the past 15 years which decorated the area behind where he sat. This traditional healer had been interviewed by a German sociologist who had written a book about 15 years earlier. We compared the two interviews. No signs remained that the doctor had family members to carry on his tradition, but he confirmed that he started his work after curing his father's stomach problems. He said he learned by experimentation to find which herbs worked and which ones did not. In addition, he offered prayer to block the bad spirits and he called upon a Christian God to whom he prayed for guidance. He had a “pharmacy” on the compound where he brewed his medicines in two large black kettles which through the years had blackened the walls of the building. His clientele included mental patients and some remained resident in the compound, but of the four men sitting outside their house I could not tell which were patients. A large woman sitting on a bench probably had had a stroke from which she was recovering by drinking some of the herbs the doctor had recommended. However, a younger woman in a dark room with paralysis concerned me, because she looked very sick.
Before I left I had a chance to review Godlove's prospectus locating activities he had performed to meet the plans the prospectus anticipated. The overall Cameroonian experience provided an intricate tapestry of familiar CPE experiences in a new setting, which challenged my supervision, but confirmed that CPE has a potentially enthusiastic following in Cameroon.
Harmattan Haze Winter Sun Set
The Reverend Ndongdeh Godlove Kwain can be contacted at: gndongnde@yahoo.ca
The Reverend Peter Holland of Avera Health, Sioux Falls, SD can be contacted at: peter.holland@avera.org
Copyright 2008, The Association for Clinical Pastoral Education, Inc. All Rights Reserved.
