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“For My thoughts are not your thoughts, Neither are your ways My ways, declares the Lord. For as the heavens are higher than the earth, So are My ways higher than your ways, and My thoughts than your thoughts.” Isaiah 55:8-9 I do not understand, when my view is so finite. Mounagui died the day after surgery about 12 hours afterwards. Though I do not understand, I like Job in the Bible, I choose to follow Him even though I do not understand here on earth. I look forward to knowing in Heaven when I can ask Him face to face. Praise to our Saviour! Greg

I recently heard from our friends Gary and Wendy Roberts who lost their son to malaria in Chad. Please pray for them, as this is going to be the hardest time of their lives. May they, like Job, choose to honor God in spite of what has happened.

So there seems to be a trend in injuries. Some people say that medical things come in three’s. To me this is superstitious, and I do not believe it. But last week we worked on the man with an epidural hematoma. I.e. burr hole with much nibbling leaving a larger hole and a drain.
The following day a boy came in who had been hit by a soccer ball on the side of the head and was unconscious, agitated, and only moving one side of his body. God healed him, for today, one week later, he was laughing, playing, talking and moving all extremities. This brings us to last night:
Many things have been going on and I have had a hard time going to sleep at night this last week. I lay there and mull over the things I need to do or try to solve some of the day’s problems. Audrey tells me to stop moving. She says I’m thrashing about in bed. So I turn over and try to go to sleep again. I toss and turn for a while then I hear a knock at the door. I feel groggy like I must have just fallen asleep. It’s midnight. Mbitomou tells me that there is a ten year old girl with a head injury she sustained after falling from a tree, and that he hesitates to even bother me as she has brain matter all over her head. She fell during the day and lives in a village very far away. He thinks she has broken her skull in a large area. So he takes me to the hospital on his motorcycle. This gives me a minute to think of what I will do on physical exam. She is laying on a gurney, the right side of her head rather flat. She has a skin wound about 5cm long with brain ma
tter bulging from it and smeared across her black kinky hair. She flops back and forth using only her right arm. She doesn’t respond to sounds and doesn’t say anything. Her pupils are both reactive and small. I palpate her head and I feel what I think is a large depression; blood is coming from her nose. The family says she has lost a lot of blood, and she looks pale. I describe to the family my findings, and tell them her only chance is to operate on her, and that her chance is small. The father says he has no money. I reinforce that this is necessary for a small chance of helping her. He agrees to surgery saying that he brought her all the way here to see if we could help her.
In the operating room I call Audrey and Ganava. After shaving her head and prepping it, I incise in a huge semicircle. I see many fragments of skull, brain and dura all in different levels. The skull has been fractured in maybe 7 pieces. The fragments sit at strange angles to each other. I free up the dura from beneath a few and raise out some large pieces. The dura is torn with blue brain matter below with pieces of skull down in it. I debreed the material from the brain. I see an area of subdural hematoma, so I open the dura over that to evacuate it. I repair the dura. Next I use some periosteum to create a dural patch. It seemed more accessible than fascia lata, though I had prepped the leg. One fracture went behind the ear and down to the base of the skull. Blood started welling up from this area. Nothing seemed to stop it and I couldn’t get under the brain enough to find it. So I elevated the head of the bed and it subsided, Praise God! I set the bone fra
gments back in place and sutured the skin closed. She stayed stable throughout the case regardless of her condition.
Before leaving work this evening, she is moving her right arm slightly. Pupils are still reactive. I’m praying for a miracle. Please pray with me, for her. Her name is Mounagui. Greg

It has been a while since I’ve written. We have been quite busy. The rains came for a couple weeks and now it has not rained for a month again. No one is planting yet. we look forward to being home and since January we have not found a physician to cover the hospital during our absence. God has provided every year. Last year it was 5 days before leaving. I’m sure he will provide again. We were hoping to have peaceful sleep, the Friday night. The power is out because 9 power poles blew over on Thursday. I suspect we will be out for more than a week. So I was getting ready for bed. Where to sleep. It’s 94 degrees inside. A little breeze near the kitchen table, the bed is to hot, the trampoline outside is a good spot but I don’t feel like mosquito repellent tonight. So I lay a sheet on the concrete floor and sleep for about an hour. I am awakened by itching and buzzing around my ears, Mosquitos! So I go for the bed. I take a bucket bath (no power = no running w
ater) to cool off and don’t even dry off. I just drip to bed and evaporate while laying there. I’ve just fallen to sleep when there is a knock at the window. There is a problem at maternity. Jonas is calling. I slowly walk into the hospital and wake up enough to talk to Jonas. A woman has been in labor since yesterday but is not progressing. I do a vaginal exam and get meconium on the gloves. The baby is stressed. i tell the father that we need to do a C-section, and surprisingly he directly agrees with whatever I think is best. I go and start the generator and head to the OR. I do a c-section and pull out a screaming baby. Praise God, the last two were still-born. It’s very frustrating to do a c-section and know the baby is dead. I finish up her surgery. I slowly go home as to not be my muscles hot. I take a shower and drip to bed.

An hour later the hospital guard is at the window. This time it is someone who was drunk and got hit in the head. He had done Ok and then became unconscious. He is laying on the ER bed wet and smelling of urine and bili-bili (millet wine). I rub his sternum to arouse him and he doesn’t really do anything. Checking his pupils demonstrates that the one is working fine but the one on the side where he was hit is dilated and non-reactive. He needs a neurosurgeon. Let’s see, the nearest one is in Yaounde aprox. 1000 miles away. You may recall Shanksteps #73 that Audrey wrote about my job description. Well, let’s add one more- Neurosurgeon. Dr. Gary Marais had brought us out a drill and a few instruments that could be used for a burr hole. So I took these with me to the OR. Reviewed cranial anatomy, sliced open the scalp, dissected up the periosteum. And found a hole punched in the skull with blood clots bulging from it. As I evacuated the hematoma, he seemed to react
more. We put him more asleep. I found he had an epidural hematoma. I evacuated this. Picked pieces of bone from his brain matter and then closed the dura. But he kept bleeding. I tied off the meningeal artery, where it was bleeding and then held pressure 20 min. I left a drain and at the end of surgery his eye was reactive again. Praise God he is still alive. I am anxious to see the end result. There is never a dull moment in the mission field. I pray that God heal this man and that he be able to go home without deficits. Thank you for lifting them up in prayer too. Greg

Shanksteps #120

The Cameroons

If someone from the Northeast (New York for example) were to travel to New Mexico for the first time, they would have their eyes opened to a completely different climate, landscape, food choice, and people-group. They may feel as if they traveled to a different country altogether.

I was asked by a group from Loma Linda to help out with a Health Fair in Buea, Cameroon. All I knew about Buea was that we had a struggling hospital there, and that it was very far from Koza. To get to Buea from Koza, one must take a motorcycle to Mokolo (1 hour+), a bush taxi to Maroua (1 hr), a bus to Ngoundare (7 hours), a train to Yaounde (15-30 hours depending on derailments…this trip took 15hrs in seats), a share taxi to the bus station (20 min normally, but 2 hours when the Pope is visiting Yaounde…) and a bus to Buea (4 ½ hrs). With all the waiting and haggling, it takes longer to get from Koza to Buea than from Los Angeles to Buea. Anyhow, I agreed to help with the Health Fair, but dreaded the trip. Greg was asked to come to Buea also for a one-day AHI meeting with Dr Hart, so we were able to travel together.

We were told that the best bus company to take from Yaounde to Buea was Musango Voyage. It claims to be a Christian company, and had a bus non-stop to the center of Buea. Just as we were leaving Yaounde, a young man asked if anyone would like to pray for the trip, and a lady in the back agreed. (Even been on a “prayerful” bus?). Well, this started a discussion (more like a small riot) as to whether the Bible says it is acceptable for women to pray in public. The next thing that happened is that this same young man started promoting herbal remedies like ginseng and other “medicinal” remedies. It was kind of like an info-mercial; We were a captive audience. At the first toll booth, he got off to try to sell to another bus going back to Yaounde. When we arrived in Buea, I was amazed by so many things: Everyone had on “western” clothing. The people spoke English. There were huge plantations for bananas, palms, rubber trees, and coconuts. There were fruits and vegetables available everywhere. There were churches everywhere. The climate was perfect: slightly humid, but not very hot. When we started the Health Fair I noticed something else strikingly different from Koza: the people were not only literate, but highly educated. The diseases were distinctly “western” like diabetes, high blood pressure, and obesity. The questions were about mammograms, PAP smears, and weight loss. We were not asked once for money or gifts. For the students from Loma Linda who were putting on the health fair, it felt like they had just entered a developing country, with poverty, inconsistent electricity, water only every other day, and no supermarkets. For Greg and me it felt like we had just arrived in Canaan – a land flowing with milk and honey.

Greg’s meeting on Sunday afternoon went well. We were able to visit with Dr Hart and his wife, Judy for a brief time before they left to visit Nigeria.   Greg decided to stay in Buea to help with the Health Fair. It was a good thing he did, because most of the other doctors they had planned on to help never showed up. Greg and I saw an average of 50 patients a day for free. The LLU students taught the community about oral hygiene, nutrition, HIV, and family planning. We were all exhausted by the time the sun went down each night. On Friday, the 27, Greg took me to the beach for my birthday.  We found a hotel on the beach to stay at that night. It turned out that this hotel was like a resort, complete with a black volcanic beach, a fresh spring water swimming pond, tennis, basketball and volleyball courts, sea kayaks for rent, horses for hire to ride down the beach, or up the volcanic mountain, a restaurant on the beach, a night club, and a very professional staff, (not to mention hot running water and electricity 100% of the time). It was like paradise for us. We have been told that most of western Cameroon (especially the Anglophone part) is like this. It has been amazing to us to see the differences among the different provinces; from north to south, from east to west, and French to English.

I am writing this from a sleeper car. We were fortunate to be able to get a two spots in a 2-person sleeper car for the return trip. I slept almost the whole 17 hour trip and it has been very pleasant. To get back to Koza, we still have to take a bus (mini-van, 5 people in 4 seats) for 7 hours to Maroua, pick up medications in Maroua, and head back to Koza and its 105-110 degree temperatures. Our mini-vacation is over, but we are both recharged for the work that awaits us. This trip has opened our eyes to the differences among people groups in this country, and the potential difference that we can make in the North with education and the love of God. Please pray for the hospital that is just starting in Buea (it is currently just a clinic), and for the American missionary doctor that will be heading out there this summer to stay. Please pray for the people of Koza, that they will desire further education, and will feel the love of God and turn from their previous ways. Thank you for your support, love and prayers.

In His Grip, Audrey

#122 Shanksteps

The nurse called me and said it was urgent.  Audrey is sick with malaria.  Quinine is making her very dizzy and nauseous.  I said goodnight to her and headed to the hospital.  A 20 year old male lay on the examination bed in the ER with a large pool of vomit next to him.  A cloth wrapped around his middle.  The nurses informed me that he had been stabbed in the abdomen by his brother.  They had fought after getting drunk on millet wine and sniffing glue.  This was the second time he has been here
for being stabbed by a family member.  The last time was last August before I returned from my time of recuperation in the US.  He had had a huge gash on his left upper lip extending back to his jaw.  He had run away without paying the hospital bill a few days later.  Now he was back again expecting to be treated.  The nurses knew him, because apparently he is a known thief in the market.  He hits people with a stick and runs away with whatever they had.  Has been in prison numerous times, but is
always let go very soon thereafter.  So I’m thinking what I should do with him.  He needs an operation, I need to ensure payment to the hospital, and he is stable.  So I tell him and his brother that he has two choices: 1: go to another hospital (nearest one is 1.5 hours by motorcycle) 2: come back with the $100 for surgery.  I then told them to send for me if they came with money, and walked away.  The brother went to consult with the family.  He came back with 5000CFA ($10).  The nurse played along
with my pressure on them and said he could not call me if he didn’t come up with the rest.  They (as everyone says, whether rich or poor) said they had no money.  He went away and came back with 4000CFA.
WWJD (What would Jesus Do) is all over America on bracelets, cups, hats, shirts.  In my opinion Jesus was forceful when he felt it was necessary to make a spiritual point.  So my actions were not the same.  I was making a point but not a spiritual one.  I feel responsible to make this hospital function as well as I know how to do.  I am not trained to direct a hospital but need to do it in this location.  So at times I’m very outwardly hard with patients and families.  All, whether wealthy or not,
claim to be poor and want reduced cost, or free meds or care.  Some of you have chosen to give money specifically to help the poor.  For me to determine who is really unable to pay is difficult. They are usually the ones that end up staying here a month or two after they are all better, waiting for the family to help pay their bill.  Often the nurses know who has ability to pay and who doesn’t.  This helps me decide who to help financially and who not to.  So WWJD.  Jesus would touch and heal this
man, in spite of what he deserved.  He had come wanting help and Jesus would have healed him.  As of yet my faith is still growing for being able to pray for healing but God has given me the ability to help the healing process with surgery. So that’s what I did.
He lay on the operating table, groaning.  Something poked out of the stab hole in his upper abdomen.  The table was at knee height because the hydraulics quit working and I need still to take it apart some evening and see why it’s leaking oil on the floor.  So it cannot rise to a normal level for surgery.  So we hoist up the heavy table with our arm strength and prop things underneath to get it to a decent height.  We prep and drape him.  He is put to sleep with Ketamine and Diazepam.  I open his
upper abdomen and then explore.  I find his stomach has been pierced, the colonic mesentery cut, and strangely enough a small bowl tumor.  All else looks normal.  I repair both sides of his stomach with silk sutures.  Surprisingly his colon is not pierced.  I evaluate the small bowl tumor which is smooth and firm.  Since I have no way of evaluating this later if I leave it I decided to take it out too.  I repair the remaining hole and we are done at 2AM.  We clean the OR and head home to sleep for
a few hours.  I am at peace within that I did what was right for him.
“God, help me love people as you do.  Help me to see this man as a lost, and try to win him for your kingdom.  Change my heart that I will want the best for my fellow man in all circumstances.  Fill me with your peace to continue the task you have put before me.”  Greg

Shanksteps #121
She sat down on the bench in my office and grinned, or at least did that motion with her lips.  Something was in front of her teeth.  She was three and her father had brought her in from a far village to be seen.  About five months earlier she had developed a toothache and then a hole started under her right mandible and draining pus from the hole.  The father was away for a few months with some work and her mother was afraid to come in without his permission.  He returned from his 4 month trip and
after a few weeks brought her in.
I look into her mouth and see what appears to be bone in front of her front teeth.  It appears to be coming from the left side and somewhat mobile.  She is calm and so I decide to wait and evaluate it in the OR under anesthesia.  I suspect it is osteomyelitis.  She has a 0.5cm hole under her mandible with foul smelling saliva draining from it.
In the operating room I peer into her mouth and see her mandible exposed with one tooth remaining in the section from the angle of her mandible to nearly where the incisors would have been.   She is asleep with Ketamine and I tug on the bone.  It comes out easily and I have half her mandible in my gloved hand.  God created our bodies incredibly!  Her bone had become infected; her body had pushed up the necrotic bone through the gums and healed behind it.  So she is still draining saliva from the
hole, but no more foul smell.  What I think she needs is a free graft fibula implant to the area! This would give tissue and structure to her mandible and face.  This is apparently done by transferring artery and vein to the carotid and jugular (sounds microscopic).  I suppose this is usually done with anticoagulants that I do not have.
Again, as often, I do not have the expertise, materials, tests needed for this situation.  God help me know what to do!
I was recently showing pictures to the visiting PA students from the south, that are doing a rotation with us.  I am amazed again at the number of peculiar and advanced diseases that we treat here.  We are usually beyond or way out on some tangent to what we were trained to do.  We pray often for guidance when tests and our knowledge are lacking for the patient before us.
Please continue to pray for wisdom, perseverance, ingenuity, and more love for the people we serve.  In His Service, Greg

Shanksteps #119
WARNING: Not for young readers
He was in pain. He had had an infection of his scrotum for about 10 days that had been neglected. The smell in the ER was rank, with pus. His cloths were wet in the crotch and down his pants legs. He was dirty all over and his cloths were torn and ragged. His wife, daughter and a couple neighbors brought him in to the hospital after convincing him to let them bring him in. The nurse said that his testicles were free hanging without skin. So I decided to take a look in the OR where I could
actually debride what I needed to. They wheeled him to the OR and leaving a trail of foul smelling liquid along the way. I put on my mask and cap to help cut down the stench and removed his cloths on the OR table. Every day there are things unexpected or new. Today it was that the scrotum, or what was left of the infected skin, and the penile shaft were all averted and hanging but still attached to the glands of the penis. The testicles that had been denuded in the process and were free hanging,
held on by the spermatic cord and associated structures. I completed the debridement and dressing changes were done daily. This past week he decided to go ahead with the skin graft I have been wanting to do. He sold one of his goats and had enough money to do the surgery.
At this surgery I attempted to place a Foley urine catheter without success. He had a stricture forming mid penis. I used urethral dilators to dilate the urethra. During the process the scarring cracked and the foley exposed mid shaft. I took a skin graft from his right thigh, meshed it to increase it’s coverage and placed it over the denuded are of his pubis, scrotum, and penile shaft. He currently has about 90% take and I pray that he heals his urethral injury so that he is able to have
normal urine flow.
In past emails we discussed an gentleman with the name of Gudaidai. He was the man here at the hospital for about 2 months that all our treatments did not take away his abdominal pain. It was so intense that he stopped eating and went from about 120 lbs to about 85 lbs. He wanted to die and asked everyone to leave him at the hospital to die. His wife left him out of discouragement. We had been praying for him individually. We got a group of the hospital workers together and prayed earnestly
for his healing. God healed him over the next three days and he went home with almost no abdominal pain. He came back to see us again today. He is a new man. He has regained weight and walks with a lively step. He know God has healed him and he is attending a Christian church in his home village. We thank God for his miraculous works amongst us. We are very blessed to see His working every now and then in a very direct way, often when all hope is nearly lost, including for us! We praise Him
for His leading. Please pray that He continue to guide us in very clear ways as it is very hard to live here and continue the constant daily battle with patients, with people, and ultimately with the devil! Thanks for those of you who pray for us daily, we really need it. Greg

We decided to “take a day off” and go to Maroua to look for some personal things. As with most trips to Maroua we decided to check what things the hospital REALLY needed and maybe we would pick that up too. We, of course, came up with a huge list of medications we still have not been able to get and would look for in a few places, also : brooms, squeegee brushes for the floor, rakes for leaves, detergent for the laundry, and try to “repair” a few batteries that were shorted out, fill up a few
gas tanks, buy cloth for sterilizing OR supplies in, and other odds and ends. So off to Maroua we went early in the morning. As you have probably read the road is not the best for the first 1.5 hours. (12 miles). It’s like driving up stairs in places. Slow going and beats up the truck. Since the hospital does not have a vehicle we use our own to pick up medication shipments and carry most things to the hospital. It works well but only the front brakes work for now till I find someone who can
fix a US trucks rear oil seals.
We went the 1.5 hours to Mokolo then hit the good road to Maroua. In Maroua Audrey and Elisa (a good friend and nurse) headed for the market and I went to look for meds. Yves went to look for a solution for visas with immigration and Pierre to find his son to drop off some millet and peanuts for him.
While looking for meds Ganava (maternity nurse) beeped me. I called him back to find out that there was a patient that was 9 months pregnant and was bleeding profusely vaginally, and the baby was dead. As I was three hours away I asked him to send the patient to Mokolo (the road like stairs) as that is the nearest hospital from us.
Of the 35 types of medication we were looking for, 6 were available for us to buy. We were able to purchase all the other things we needed and headed for Koza around 5PM for the three hour drive home. On the way home another nurse (Kalda) called to see where we were. He said the woman’s husband had finally showed up and they were deciding whether or not to go to Mokolo. At that point I was an hour away, she had survived all day, so I told them to wait, and get her ready in the OR. We got home
and changed and went to the OR. The patient was still in the delivery room. A dried pool of blood lay at least a yard wide in all directions. A slower drip had dried about a foot wide and had gradually mounded up with dried blood during the day. She was very pale. We called the lab tech to check the other members that were then present to give blood to her again. (Ganava had given a pint of blood earlier that day when only her husband would get tested and he was not a match)
We started the surgery, pulling out a white, stiff baby, liters of blood and probably 2 liters of blood clots. Blood was everywhere! That was the 4th one in the last two weeks that had abrupt-placenta. And the fifth dead baby removed by caesarean section in that time frame. (the fifth was placenta previa) At the end of surgery I found out that the approximatively 8 women outside had refused to be tested to give blood. One had and didn’t match. So I called Kanas into the OR and gave her 500ml
of my blood.
God had kept here alive till we got back, and while her husband was not there to make a decision to take her to another hospital. We praise God for His goodness to His children, even when they do NOT know Him.