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#136a Shanksteps- followup
I sit here at 2AM unable to sleep.  I was called into the hospital to see Baldina as they said he had a low blood pressure.  On the way in I hear the wailing.  He has died.  I go through all we have done on him, all for naught.  He tried to kill himself and then there was hope, now he is dead.  He succeeded.  I hope his last few days were ones he used to ask forgiveness of his family and God, otherwise there is NO HOPE.
At the same time they call me to see another elderly woman who is unconscious.  I had admitted her this morning with epigastric pain and what I suspect is typhoid or malaria.  Tests have no been done yet.  I check her glucose and find it 41.  We start replacing her sugar with the IV but within 5 minutes she is gone also.  Too much death!
I sit here hoping for the day when Jesus will come back to get us all.  Rev 21:4 says: “and He will wipe away every tear from their eyes; and there shall no longer be any death; there shall no longer be any mourning, or crying, or pain; for these things have passed away.”
One day, when Christ comes, we will not have pain, sorrow, or death.  I pray that day come soon.  I’m tired of all the death and sorrow of this planet.
Greg

136b
Audrey here.  After Greg came home (and wrote the above follow-up) we prayed for the families of those who had just died. We reflected on the day, and prayed for sleep to come for us.  Two hours later I was called back in because Baldina’s wife was convulsing.  Apparently she hadn’t slept for about 5 days and had been crying hard for the past 2 hours. If finally took it’s toll on her. I gave her something to calm her and allow her a long sleep.  I too was unable to sleep after returning home. I reflected on the day.  Earlier that day, three children had died almost immediately upon arriving to the ER.  They were brought in about 4 days too late (which unfortunately is not unusual).  Five deaths within 12 hours.  Too much!
The following day was Friday. We had a lot of patients to see, both in clinic and in the hospital. After seeing them all and finally getting ready to go home, I started hearing someone crying outside the window of the ER. I looked outside and heard more wailing coming from the Adult Ward.  I ran over to find out what had happened.  The nurse said that Sali, an old man that had come in that morning with pneumonia, was taking his last breath. The family was wailing even before he was dead.  I examined him as he breathed his last.  I helped the family get his things together and return unused medication. As I was leaving the ward, another nurse asked if I had gotten all of Tize’s things together. I asked what had happened to Tize.  She said that was the man who died and his family was wailing.  He was a young man, around 36, who came in with abdominal pain but was getting better as of about two hours before.   Two deaths within five minutes of each other.  Two hours earlier, ne
ither looked like that day would be his last.  That brings the death count to seven within 24 hours.  Too much death and illness!!!  Greg and I finished up work (which at that point felt like it was never going to end) and walked home in a daze.  We got on the motorcycle and drove into the mountains to clear our heads.
Please pray for the families of these seven patients. Please pray for the emotional state of our workers who have had to deal with all of these deaths in addition to working overtime and covering for co-workers who are sick. Please pray for us to be able to hang in despite the grief, guilt, frustration, and fatigue.  Only God is able to sustain us during times like these. – Audrey

#135  Shanksteps – She dances too much!

“She dances too much!”  That was the reason that Pamda’s son brought her in to the hospital.  He was called by the other members of the family saying that his mother was ill and that he should come quickly.  So, he traveled the 8 hours from Garoua only to find his mother if good health, if not TOO happy.  The rest of the family said that she would be okay one minute, the next she was talking non-stop to people they couldn’t see, and would start dancing and singing.  This had been going on for several months and was disturbing to the family.

Sitting in front of me in my office was a cute little old lady covered with wrinkles from many years working in the sun. When asked a question, she got very animated and talked so fast I wondered how anyone could understand her.  She was obviously still very spunky.  I asked her son if she had been that talkative all of her life and he replied that she had.  I asked her all sorts of questions about her dancing and singing; about her religious background and beliefs; if she saw and heard things that others did not; if she was bothered by what was happening to her.  At first she seemed like she didn’t know what I was talking about. Little by little I guess she realized that she could trust talking with me (or at least that I understood a little of their beliefs) and started to open up to me about what had been happening. She said that although she was a Pagan, and believed in the spirit world, that she never had and never would “sacrifice” any of her friends or family for her o
wn wants and needs.  Someone like that is somewhat unusual to find within the Mafa culture.  Recently she had “unseen” visitors telling her to do some things that she didn’t want to do, and made her feel guilty. They would then tell her to dance and sing or they were going to be very angry and possibly take her life.  She said that she did all of this against her will, but was afraid to stop because she didn’t know what would happen to her.

Fortunately her son was a Christian.  We spent a long time talking about the evil spirits versus the good angels.   We discussed how God is much more powerful than these spirits and that HE could protect her from future attacks.  I reminded them that although we are in an (somewhat) invisible war, that Jesus has already paid the price and won the war.  We pondered over possible avenues that the spirits were allowed in to torment Pamda.  In the end, Pamda decided to trust that God could save her from her tormenters.  Her son considered taking his mother back to Garoua with him so “spirit worshippers” wouldn’t be surrounding her, and so others in his church could pray her.  Before they left, my translator and I both prayed for Pamda and her son to be cleansed and protected from further tormenting.  I don’t know what the future will hold for Pamda, but I have agreed to pray for her continually.  I have asked her son to send news from time to time. Please pray with me that Pamda
finds Peace in the arms of Jesus.
In His Mighty Grip,

Audrey

#131 Shanksteps (of faith)

I was in the shower when I heard someone crying.  I knew that Greg was on the phone with his family so I thought that probably he was instead laughing hysterically. When got out of the shower, I realized that it was true crying; not the kind of wailing that the women do to announce to the village that someone has died, but true, honest, heart wrenching bawling. When I walked into our living room, I was met with a peculiar site. Greg was sitting on the floor with his arm around our nurse Mbaitomo. The nurse’s wife was sitting next to them. Mbaitomo was pouring out his heart to Greg. Mbai is the kind of guy that always wanted a son to carry on the family line.  However hard he tried though, he ended up with 8 girls. Two days ago he found out that one of his youngest was pregnant, and took some kind of traditional concoction to abort the baby.  He found out because she was bleeding all over their house.  After consoling Mbai and his wife, Ruth, we told them to bring the girl in
so we could check on her.  Sure enough, she was pregnant; but not just one or two months like I assumed; not even four months like she claimed; but the baby was almost 7 months along; and now dead (confirmed by ultrasound). To make matters worse, she had already ruptured her sac of amniotic fluid, and the baby was transverse (sideways). This meant that we wouldn’t be able to turn him so he could come out head-first (or even feet first).  What it really meant that this baby wasn’t coming out at all except by Cesarean section.  This was not what Mbai and his wife wanted for their 15 year old (unmarried) daughter.

So, Greg and I took her to surgery.  She weighed about 80 pounds, with a protuberant belly. She had a fever of about 104  F.  The surgery was like any other C-section (with a stillborn) except that we were now doing it on a friend. Fortunately God blessed and we were able to remove the dead fetus without too much difficulty.  We finished at 2:30 am and went home to bed – very sad that her bad choices had to turn out like this.  She is starting to heal but still very sick from an infected uterus. Please pray for her physical, emotional, and spiritual healing. Pray that she will be able to have children in the future. Please pray also for forgiveness from her family.
In His grip, Audrey

Shanksteps – What’s in a name?
I found out the other day that Koza was actually named by a Westerner.  The area all around Koza is mountainous and rocky.  As the story goes, a white man came to this area and pointed to a stone and asked what the Mafa people called it.  They responded, “Kwa.”  Then he pointed to a different stone and asked what that was called. The response was, “Kwa za’a.” meaning another stone. Thus the name Koza was born; simple yet descriptive.
The Muslims here have a few names that are used over and over, such as Aissatou, Fadimatou, or Djaratou for girls; and Amadou or Ibrahim for boys.  I have asked what these names mean, but most just say they are names that they like, are Biblical, or have family members with those names.
If you are a female Christian, most likely your name is Marie. Most of the male Christians have a Mafa name, and a given Christian name like Esaie (Isaiah), Jacques (James), or Jean (John). Unlike other African countries, we don’t see many with names like Joy, Peace, and Patience.
Traditional names almost always have a story behind them. Usually a child is named for what the mother experienced during pregnancy or childbirth.  Often the family will wait for a week or longer before giving a child a name – in case they don’t survive.  One of our nurses tells the story of his name.  Apparently when he was born, he was very small and his father didn’t really want to keep him.  His grandmother rescued him from neglect, and he was given the name Kaotem, meaning “neglected”. Or perhaps
you would like the name Tchougui, which means “irritates the home”.  When I first saw a number of children with the name Bonné, I thought, “That’s nice, they named him/her beautiful.”  Then I found out one day that Bonné in Mafa means “suffering”; possibly named for the experience of childbirth.  Or you could be named Guymatakon meaning “the one who causes suffering”.  In fact, the Mafa tribe used to be called Matakon, which in their language means sickness or suffering. There are in fact many men
here named Matakon.  The name Kaldoussa means “thrown out”.  Dougdje is the name of one of our cleaners; his name means “garbage”.  I think that ZaÏna is a pretty name, but I wouldn’t want to name my child “lost”.  I definitely wouldn’t want to go through life with the name Viché, which means “enter into the ground”.
I guess all of these people are in good company though.  A man in the Bible named Jabez, which means “Child of my pain”, found favor with God.  Jabez called out to God in prayer, asking God to bless him, enlarge his territory, and keep him from pain. “And God granted his request.” (1Chron 4:9, 10).
May we never forget that despite the situation we grew up with, or the name we were given, that God can bless us, and do so abundantly.
In His Mighty Grasp, Audrey

#108 Shanksteps – Fight for life
I do not usually yell at parents; especially in French.  In this case however, I made sure that every word I was saying was translated into the tribal language, Mafa.  I think that the nurse translating for me was a bit embarrassed by my actions, and not entirely in agreement with what I was saying.  Guedana had come in two days before with malaria and jaundice. The day prior to my yelling spree, he had been eating and talking, now he was comatose, with eyes the color of a school bus, and peeing
coca-cola colored urine. A very bad sign!   As soon as he started in with the hiccups, I knew it would be a battle.  The belief here is that if a sick person starts to hiccup, that they will surely die.  So, when I entered Guedana’s room and saw that he had the hiccups, I knew I was in for a long day.  The parents were set on taking Guedana home to die, and/or to make sacrifices or try traditional medicines.  In fact, it was the traditional root powder that got him to this point in the first place.
Here the Mafa believe that if your eyes are yellow, and you can vomit enough (bile) yellow stuff, that you will be healed.  Unfortunately, more often than not, the patients I have seen, that have taken this traditional root, have come in with severe jaundice and liver failure.  Did they have severe liver failure first and the root did nothing, or did the drug make a bad problem, worse.  I have no way to know for sure, but after seeing so many people really sick after taking this “medicine”, I sure
believe that it hasn’t helped.  In Guedana’s case, his parents had given him the root two days in a row. When he didn’t get better, they decided to bring him to the hospital.
So, there I was, arguing with the parents’ “rights” to take 3-year-old Guedana home.  I said that I was the advocate for the child.  If I wasn’t going to be, who would?  I told his parents that God loved this child and so did I, and that I would NOT let them take him home knowing that he still had a chance to live.  They insisted that they needed to leave.  I told them that they could leave, but that the child had to remain at the hospital.  I assured them that I would take care of him and carry
him around on my back.  After much discussion, they decided to stay (with the child).  First hurdle overcome.  I wrote the (expensive) prescription for care (and told them I would pay for it), then went off to start the rest of my rounds.  Ten minutes later the nurse came to me saying that when she changed Guedana’s IV catheter, that his blood was very pale, and watery.  So, back I went to see him. We checked his hematocrit and sure enough he was anemic and not clotting at all.  Next hurdle… who
would give blood.  We have no blood bank here, so usually we search for a blood match with the family.  Dad was the same blood type but afraid to give.  He, like many here, believe that each person only has a certain amount of blood, and if we take some from him, it means that he has less and will be weaker for the rest of his life.  We finally convinced him to go to the lab; he went but refused to have his blood taken.  Finally after what seemed like an eternity of heated discussion and pressure,
he agreed to give 200 ml of his own blood to save the life of his child.  In the mean time I gave Guedana Vitamin K to help with clotting.  I left to continue rounds.  Ten minutes later, the nurse came again to tell me that he was pooping blood. I found myself back in his room looking at a mixture of blood and mucous that had just appeared.  With his liver failure as bad as it was, he wasn’t clotting very well.  The nurse had just placed a nasogastric tube that was now filled with blood.  I started
to wonder if the parents had been right in their assumption that he would surely die.  I gave him Cimetidine IV to decrease the acid in his stomach at about the same time as he started to receive the blood transfusion.  I had been praying for him this whole time, but now I found Greg and Ambassador (one of the maintenance men) and the nurse, Eliza, and we had a small group prayer for him, and his parents.  I again tried to finish rounds.  After about 30 minutes, Eliza again found me to tell me that
his breathing pattern had changed.  In fact he was hardly breathing, just an occasional breath every so often.  With everything he had gone through that day, I was pretty sure that this should have been the end.  I carried him to the emergency room where we have an oxygen concentrator.  I had held off giving him oxygen because our ER had been crazy busy for the past week, and they really needed the bed there for the patients coming in.  Anyhow, I put him on oxygen and his breathing started to normalize.
So, there we were, with three different IV bags hanging; an NG tube coming out of his nose; a nasal cannula in his nose for oxygen administration; and an oxygen saturation monitor probe clipped to his toe.  His little corner of our ER was starting to look like an ICU. I prayed for him again and left him in the care of the ER nurse.  I checked on him periodically throughout the day, fully expecting the nurse to say that he had died, but fully hoping that God would show how powerful and loving HE is,
and keep him alive.  
He stayed like that all the next day.  On the third morning, I went to morning report, bypassing the ER because I didn’t want to know yet that he had died.  The report was that he had complained all night that there was something in his nose, and begged his brother to take it out.  I ran to the ER and let out a scream of glee to see him conscious.  He was still very sick, but now didn’t look like he was on death’s door.  Finally, the parents weren’t quite so angry at me for vetoing their departure.
Today, two days later, he was sitting up in bed eating a doughnut.  His eyes are still yellow, but getting a little less each day.  I have been thanking God all day that he has taken this child into HIS care.  This seemingly long week has given us a chance to tell his parents (as well as show them) about God’s love.  Please pray for Guedana and his parents that they will follow God, and not their old traditional ways.
In His Grip, Audrey (for the Cameroun Shanks)

Shanksteps – Fasting
I had just finished a book by Paston Jentezen Franklin on fasting that morning.  In it he discussed how the Bible encourages us to fast to become closer to God.  I had decided earlier that week to start a fast, and was now on my seventh day without food, only taking water and juice.  It really did make me more “tuned in” to the things of God.  Greg and I woke up early that Wednesday morning because he had to leave to go to Maroua to attend a two day meeting for all the directors of the hospitals in the North of Cameroon.  After he left, I read, and had my worship and prayer time.  During that time I had a “feeling” that a woman would come in that day in need of a C-section.  Now, I want you to realize that that has been one of my biggest fears since arriving in Cameroon; for a pregnant woman to come in distress in need of surgery, and Greg be gone.  I had scrubbed on many c-sections in residency for this very purpose, but had never before needed to do one on my own – as I always “consulted the surgeon” when cases came in needing surgery.  So, that morning, I told God that if He did indeed send someone my way, I would just trust in Him.
The day started like any other, with lots of kids to see.  Fortunately, many of the kids had gotten better and I was able to discharge a bunch of them.  I saw several people in clinic after finishing rounds on the rest of the hospital.  All in all, everything had gone really smoothly.  Right up to the point where the guard for the hospital came and said that he needed the key to the operating room.  I asked him why he would need the key to the OR, but not the doctor, and he replied, “Oh, they need you there as well!”  So, I went, not having any idea where the keys to the OR were.  What I found in the delivery room was a woman who had just delivered a live baby girl, but the hand of the second twin was protruding from the vagina along with the umbilical cord of the first twin –  the second twin was TRANSVERSE!  I called Greg and told him to pray. There was no way of delivering this child vaginally, so we quickly wheeled her to the OR (through the nurses call room – as I still couldn’t find the key).  Just as we got her on the table, Ganava came to assist me (he also had the key to the suture closet).  Kalda gave her Ketamine anesthesia as there wasn’t even enough time to get sufficient fluid in her to do a spinal. As we were getting her prepped, I noticed that she already had a vertical C-section scar.  “Oh great!” I thought, she’s going to be all scarred down, and I’ve never opened vertically.  I called Greg a second time and he said to go in through the old scar and walked me through what to do, and again said he would pray.  We prepped the woman, I said a prayer that God would get us through this ordeal, and started.  I won’t give you all the details, just that EVERYTHING was scarred together.  It was difficult to identify any normal layers.  The uterus, which is usually paper thin, was already contracting after delivery of the first twin, and was almost 2cm thick.  Even after doing many c-sections in residency, I NEVER was allowed to open the uterus (legal reasons), so this was my first time.  I wrestled with my hand inside a contracting uterus, trying desperately to get the baby out.  Finally I could feel it coming, a boy!  A boy that was not breathing and floppy.  I sucked out the mouth and nose, and stimulated the child until I thought I might rub his skin raw.  Finally, the sound every OB enjoys hearing, a cry!  I passed him off to Kalda to clean him up and weigh him.  Now I had to deal with a very thick bleeding uterus.  I put ring forceps all around the edge and did my best to close up the uterus, suturing through as much thickness as I could, realizing after closing the gaping hole in the uterus, that I would need to do a second later to include the true full thickness. Finally all the bleeding stopped.  I then tried to approximate the fascia, but it was almost impossible to identify the layers with all the scarring.  After checking and re-checking, I was finally satisfied with the closure.  Finally, Ganava said he would close the skin for me, and I could write the orders and the procedure note.
When I finally got home, I was more tired than I can remember being in a long time.  I was also very hungry.  I spent a long time in prayer and thanksgiving to God, then ended my fast, on my 8th wedding anniversary, alone, but more at peace than I could remember being in a long time.  I thank God that He once again “gently” showed me who was in control.  Thank you all for your continued prayers for us and the people of Koza. -Audrey

Shanksteps – Habiba #105

Like many of the women here, Habiba delivered her baby at home.   Fortunately she didn’t have any problems during the delivery, and the baby was born healthy.   For about a week before having her baby, she had been having bloody diarrhea at home.  She finally decided to come to the hospital a couple of days after delivery to get checked out.  She was found to have dysentery and started on treatment.  After several days of being in the hospital she was still having diarrhea, but now was also found
to be anemic.  Her family donated a sac of blood for her.  We arrived from the US one or two days after she was transfused.  She continued to have bloody diarrhea, abdominal pain, and was still very short on blood. Now though, she was also vomiting and not able to keep food or her medications down.  Greg realized that she was also bleeding vaginally and performed a curettage.  She was transfused a second time and seemed to do better.  Several days passed and she wanted to go home, so Greg discharged
her.
Three days later, she returned to the hospital with the same symptoms; bloody diarrhea, abdominal pain, vomiting, and anemia.  She was transfused a third time and started on a different set of antibiotics. She perked up for a day, but was then very pale again.  After the fourth transfusion, I started to think that there was more to this sickness than just the obvious physical ailments.  I found out that her mother wanted to take her home so that that whole side of the family could perform sacrifices
to their idols and call on their sorcerer.  Her husband (a wonderful Christian man) wanted her to remain at the hospital and asked if we would pray for him to stay strong for her.  He said that if he told the family that he didn’t want them to take her home, that they would tell everyone that he had abandoned her, and that he didn’t want what was best for her.  So we prayed for his strength, for her healing, and for the right decision to be made.  She was allowed to stay, but I realized that there
was very serious spiritual warfare going on.  I heard that same day that the belief within the family was that she had been “spiritually taken captive and was being held in chains in the devil’s heaven.”
If you don’t remember what the “devil’s heaven” is from previous stories, I’ll give you a brief review.  The Mafa people believe that god (small g) is the one that brings both good and bad on people.  You have to keep this god happy or something bad will happen to you or your family.  (Even most Christians and Muslims believe this way about the Mafa god; even if they say that they believe in the God of the universe.)  The Mafa people also believe that there is a second heaven (also called the devil’s
heaven) where only the sorcerers can go.  They believe that it is a real place, set up like a market, where sorcerers can buy and sell anything, even intelligence, sickness, death, and longevity.  If someone goes uninvited, or doesn’t do the correct sacrifice; or if a sorcerer is “employed” to capture someone, that person will remain in chains in the “devil’s heaven” until a sufficient sacrifice is made.    When anyone is a spiritual captive in the devil’s heaven, it is manifested as sickness, even
to the point of death, in “our world”. This is what was believed to be going on with her.
As is our norm, Eliza and I had been praying for and with Habiba and her husband every day since she arrived on our ward.  I realized that this was going to take more spiritual “fire-power” than just a simple prayer. So, I asked all of the workers who had the desire, to come and pray for her in a group.  We surrounded her, laid hands on her and prayed. We prayed for healing; for faith; for comfort; for her husband; and for the bondage of Satan to be broken.  We commanded the bad spirits to leave
her body, and for her to be restored to complete health.  As is normal for Americans, I wanted to see an instantaneous change in her – which didn’t come.
However, when I went to see Habiba the following day, she was a different woman.  She was eating, had no more bleeding, there were no signs of the anemia that had plagued her for days, and most amazing was the smile that was on her face.  She continued to stay at the hospital for the next week, mostly to be ministered to.  She was afraid that when she left the hospital that her problems would just reemerge.  She and her husband finally set a discharge date.  Her one request was that we all come as
a group to have one last prayer with her and her husband.  So, about 15 of us went and prayed for Habiba, her continued healing, and most importantly her continued faith.
I have since heard that she did not go home to the village of her parents, but to the house of one of our church elders for continued spiritual mentoring.  Our chaplain visits her once a week as well to see how she is doing.
We thank God for His healing power.  We thank the willingness of our workers to lay out their hearts in prayer for this tormented woman.  We thank you readers for continued prayers for our little hospital, which we hope will be a light in the darkness here.
In His Grasp,  Audrey (for the Cameroun Shanks)

Shanksteps
The pediatric ward was full and I was just seeing my last patient.  One of the grounds workers comes running up saying that there was an emergency in the ER. Greg was in surgery.  I grabbed my medical bag and followed him into the Emergency Room.  Before me was a young man, about 20 years old, breathing terribly, flailing from side to side.  The room was full of his friends “trying to help”.  I could not get a straight story from anyone so I decided to try to examine him.  His breathing was labored
but with good breath sounds; Heart rate fast but regular; Extremities cool; Pupils, non-reactive;  Blood sugar – 21!  There was the cause of his agitation.  His blood sugar should be at least 65.  I always keep a ziplock of sugar in my bag.  I place sugar under his tongue with a drop or two of water hoping that he will absorb it quickly.  The ER nurse works on getting an IV in his arm to give him dextrose directly into his veins.  Finally he starts to calm down and I know his sugar level is back
in fairly normal range. I check him again – 82.  He’s now able to answer questions. Between him and his younger brother I find out that he’s been sick for about two months, worse for about two weeks, and in a coma since this morning.  He has complained of headache, body aches, and especially abdominal pain.  He has taken several unknown medications from the market, and I’m sure some traditional medications over the course of the past two months.  In addition he’s a big bili-bili drinker (the local
millet wine).  I examine him again to assure myself that he’s stable, place him on oxygen to make him more comfortable, and then go to write his orders.  I ask the lab to check for malaria, typhoid, dysentery, and liver disease.  By the time I leave the ER, he’s laying comfortably on his side making faces at the baby in the next bed.
I go to make rounds on the adult ward, but realize the one of the patients probably needs surgery so I go to find Greg.  I find him in the ER with the young man who had come in earlier.  He’s breathing terribly and somewhat delirious. Greg thinks he may have a pneumothorax because his breath sounds are diminished on one side.  He inserts a needle, but no air escapes.  He’s still receiving sugar in his IV so I worry less about hypoglycemia.  He sits up and seems to breathe better, so Greg goes to
check on the woman who needs surgery.  Several minutes later the patient sways and lays back on the ER bed.  Now he sounds like he’s breathing through water.  I listen again and his lungs are full of fluid.  I give him Lasix to remove some of the fluid and turn him on his side.  Greg returns to the ER and examines him.  In the mean time look for a mask and ambu-bag in case he crashes and needs CPR.  I find the bag but no mask.  I look all over the ER, tearing through drawers and cabinets.  Before
we left on vacation, there were at least 3 adult resuscitation masks there.  Greg cuts a hole in a rubber glove to do somewhat protected mouth-to-mouth.  I run to the stock room but to no avail.  Fortunately someone had run all the way to the OR and grabbed a mask and bag and brought it back to the ER.  By the time I made it back, Greg was bagging him. He had just vomited a full stomach of some type of alcohol mixed with blood.  I listened for breath sounds and found no heartbeat.  I started chest
compression while Greg bagged.  Every couple of minutes I listened to his chest again, and each time I heard more fluid/less breath sounds.  After about 15 minutes we decided to stop CPR.  He was dead.
About 20 minutes later we get the results of his labs.  Not much malaria, no typhoid, but his liver enzymes we so high they were above the range of our machines. The diagnosis: acute liver failure;  probably due to hepatitis and possibly exacerbated by traditional medications.  I go home that night to read about hepatic failure, complications and management.  What I find out about the initial management is frustrating.  My Medicine textbook says that he could have had kidney failure and I should
assess his volume status with invasive monitoring (NA -none available).  He may have cerebral edema (swelling of the brain) that needs to be monitored if possible (not) and given mannitol to decrease the swelling (NA).  He may have a GI bleed (which he did) that should be treated with antacids (none IV) and fresh frozen plasma (NA). He may have low oxygen due to fluid in his lungs (he did) that would require intubation with special ventilator settings (NA).  He might have low blood pressure that
could be treated with special medications (pressors) (NA). He may have an underlying infection causing sepsis and blood cultures should be done (NA). He may be acidotic and should be given Bicarbonate.  We have Bicarb, but no way to test if he is acidotic.  He may have low blood sugar. This we did find and treat.  He may have low potassium or low sodium.  Thanks to World Wide Labs, we would have been able to test these, but didn’t.  In the end, I read that even if he had been in the best of situations,
his chance of survival was only 10-40%; and the only treatment if it looks like he won’t recover from this attack is liver transplant.
We do the best with what we have available.  And thanks to help from family and many friends we’ve been able to improve the quality of care here considerably.  It’s still frustrating when we know that something could have been done for him had he been fortunate enough to have been born in a different country.  It still amazes me though how many people here do survive, not because of what we do, but sometimes in spite of what we do.  That is the powerful hand of God at work.  He heals our patients
and protects US every day from harm and deadly disease.  For those of you in the US and Western countries, never forget how blessed you are to have access to good health care.  Please continue to pray that God helps us through in spite of our deficiencies.
In His Grip,  Audrey (for the Cameroon Shanks)