Barbara Hotelling recently traveled to Cameroon in Central Africa to provide birth doula training to locals. Through journaling, Hotelling gave an account of her eight-day adventure. Read on for an abbreviated version of her experience:

Day One

Hotelling traveled from Raleigh-Durham International Airport on a Saturday evening and then arrived in Cameroon at 5:30 p.m. their time. The country is six hours ahead of eastern standard time. After dealing with some transportation issues when she arrived, her evening ended on a high note with a great meal of rice, stew and a portion of meat in the home of Dr. Tobias. She was even able to enjoy a good night's sleep in a bed.

Day Two

Every five minutes in Cameroon a woman and/or child dies in childbirth, so Hotelling's first assignment would be critical to improving care. Approximately 100 potential birth doulas came from all over Cameroon for her birth doula training. Something that Hotelling took seriously since globally the major factors leading to death are: anemia, diabetes, hypertension, and postpartum hemorrhage. With this knowledge and the donated books, stethoscopes and blood pressure cuffs in hand, she was ready to educate these doulas on ways they can support pregnant women in building their iron levels, detect early signs and symptoms of hypertension and hyperglycemia and teach them fundal massage when post birth bleeding is too heavy.

As she prepared for the training, a nurse spoke of an event where a pregnant woman came to her hospital with abdominal pain. The woman was diagnosed with a ruptured uterus but because her husband was not there with money, she could not be treated. This nurse even gathered some money and pled for them to treat her knowing she needed a stat cesarean and could die on transfer. They wouldn't wait or listen and transferred her anyway. Unfortunately, the nurse didn't know the outcome.

After a tour of Tobias' clinic, Hotelling settles in the home of another family as she continues to prepare for her upcoming training sessions.

Day Three

​Hotelling awakes to the sound of children's voices, roosters crowing and someone singing. The children would have been in school but the teachers had been on strike for two months seeking more pay and better teaching conditions. She spent the day meeting with Tobias, his medical partner Fritz and other members from the local health care community in order to prepare for the upcoming training sessions. The first would be an opportunity for local women to hear about the project and to be trained as doulas without the expense of going to Youande.

Day Four

On her trip to Youande, Hotelling notices similarities to Guatemala. Women and children everywhere, transportation mostly by motorcycles and taxis, dirt paths with no clearing done, vendors along the road near communities, and people standing in the middle of the roads trying to sell tissues, fruit, etc. Youande, the capital, didn't look any better than where Tobias and his family lived. According to his daughter Kelly, it's a shame. Dirt and trash everywhere, people trying to survive on whatever they can sell, and yet the government lives well.

While in Youande, Hotelling stayed in the home of Tobias' assistant Pastor Solomon. She settled in and prepared for the upcoming training that afternoon. The event was expected to have 100 people with 35 to 40 super enthusiastic about the project. The attendees represented the 10 regions the group had hoped to get.

The planning team spent some time talking about patient care and how family members (doulas) were kept outside the gates of the hospital so the woman has to labor and birth alone. And when a woman protests the lack of support or anything else, there is a warning that the nurse will hit her and is usually followed by the hit.

Day Five

​Hotelling finds out that instead of one training with the large number of attendees, she would be teaching two sessions: a morning and afternoon session. She showed the attendees birth videos, which they enjoyed. They even remark that the nurses in the videos are so nice to the mothers. Hotelling learns that in their hospitals (public) everyone has suffered from the nurses and physicians. It helped them understand the difference between giving birth with lots of support and oxytocin and giving birth in sheer terror. They were eager to change this.

While there, Hotelling helps the group set up a new Facebook page only for the doulas: Cameroun Birth Doulas. She ends her night in the home of one of the heads of Cohecf where she partakes in a meal of huckleberry (greens) and plantain.

Day Six

Hotelling arrived for the next day's training to only two students. However, within 30 minutes more students started to arrive. Before the training began, the group took time to teach Hotelling some African dances that were a lot easier than her style of dance.

The group spent the day organizing the regions and deciding on regional co-chairs. One man worked as a project director for projects that improve maternal child health. At the end of the day, he came up to her, held her hands and promised that he would work to see the program model successfully implemented over Cameroon and then to neighboring countries.

The day began with watching a video of a pregnant woman who had been refused care and left to die outside the hospital walls. Another woman came along, saw fetal movement and performed a cesarean to save the babies, but unfortunately they were already dead. This video put into perspective what the doulas were up against.

The training started off with evidence-based birth using the Lamaze Health Birth Practices. They then started on the pregnancy work the doulas would do to save lives. Hotelling then taught the group how they can prevent anemia by placing a clean iron nail in their cooking pots. She also taught them to take pulse rates and on hypertension and blood sugar. The group then learned about fundal massage to prevent death from postpartum hemorrhage.

Attendees left energized by the possibilities of the project. Hotelling and Kelly then took the four to five hour journey back to Duoala and then another bus to Limbe. Once she arrived home in Limbe, she enjoyed a fine meal, a cold shower and a good nights sleep.

Day Seven

​Hotelling prepares to teach in town to another potential group of doulas. She talked with Tobias about the difference in care between Yaounde and the smaller villages of Douala and Limbe. He advised that the government doesn't care about the people in Yaounde and will not hire anyone who doesn't speak fluent French. They do not offer many jobs and the capital doesn't attract business because of the trash and dirt. Limbe is the cleanest town in Cameroon.

She went to Newtown to teach that afternoon. There were fewer participants than expected but each one was passionate about saving mom and babies' lives. Mrs. Tobias attended the training session so she could continue to train birth doulas after Hotelling leaves.

Day Eight

Hotelling finished packing in order to prepare to return to the United States. She finalized training details with Kelly and Evelyn to ensure that they would be prepared to keep training doulas. She later said her farewells and headed to the airport. Unfortunately, her 11:55 p.m. flight was delayed until 2 a.m. Nevertheless, she made her Delta flight home and prepared herself to return to work the next day.