MissionDocs.org

Cameroon #13 09-28-2005
“Where’s the mother of this 7 day old infant?” I said
as I entered the room.  This is a continuation of the
story of last time.  “She said she went to the river
to wash.”  Three hours later she was still nowhere to
be found.  Only the child was on the bed without
anything but the hospital sheet around him, now laying
in his own vomit.  The nurse cleaned him up at my
request and it was decided at that point that the
child had been abandoned.  His intestines still
haven’t started working yet so we cannot start working
on formula yet.  So we started new things with the
child since we cannot start an IV.  We placed a
subcutaneous catheter and are infusing it.  This
gradually will replace the fluid lost/ dehydration.
This raised a few eyebrows but is working.
(A few days later)  The child started to move his
bowels and everything appeared to be starting to work.
We purchased a bottle and used some of the donated
formula for the child.  I was starting to get hopeful
that the child would actually make it.  The following
day we entered to see him and he was distended and
breathing terribly.  His incision had opened more with
the distention.  He looked terrible.  So the ethical
question was: do we start an IV again and give him
antibiotics for the very small chance that this would
help, or make him comfortable for the inevitable?
After much discussion we made him comfortable.  Audrey
held him for more than an hour.  And he was comforted
some.  We had to continue with work and the child died
a few hours later.

Ohh, the smell was awful.  Before me sat a 50 year old
man with a tumor on the side of his face the size of a
basketball but not as pretty.  He had had a small
lesion under his chin ever since he was 15 but in the
last two years it had grown to this.  Unfortunately
people were covering their faces when he was near or
leaving the room.  He had wrapped a shirt around it to
cover the sight and to catch the drainage of pus.  I
was amazed in many ways.  How could he live like this
these past two years?  I felt sadness, suspecting how
he must be scorned.  Intrigue on what should I do with
him.  Dream of a pathologist once again!   Fortunately
my own nose doesn’t work real well and I was glad for
that at this time. (Later you may see pictures on the
website in about a month when I can get them back to
the US.  www.missiondocs.org) We continue to go well
beyond anything we have been trained for.  At times we
wish for the more straightforward US pathology and
excellent diagnostic techniques, at others we are
happy to be learning still more, entirely different,
medicine.  In the mean time I think that Burkett’s
Lymphoma is most likely or a salivary cancer.  Either
is difficult to do anything with here.  He however
doesn’t want to go back to the village.  He says if he
goes back that the people will all be talking about
how even the doctors have no hope for him.  He has
chosen to stay here and wait for me to try to find a
solution.  I will continue to try to find a
pathologist to be able to send a biopsy to.  I will
also try to send a picture to my ENT colleagues in the
US to see if they have any ideas.  I guess the good
thing about seeing all we see here is that it teaches
us to depend more on God.  Only He can lead us in the
things we have never seen before.  We are constantly
praying for His guiding and wisdom.  God is blessing
this hospital.  We started with about 15 inpatients
when we came and currently have more than 50.  Today,
Sunday, is our busiest day.  We admitted about 10
people and saw another 6 in clinic today.  God is
blessing!!  Please continue to pray for wisdom and
patience for us as we continue to work for HIM.  We
miss you all.  Also whenever any of you want to come
to Cameroon and visit you are welcome.  We do have
some extra room in the house for visitors and would
love to have more visitors.  God bless you also as you
serve Him in the US!
In His Grasp, Shanks

Cameroon Shanks steps of faith #12
9-25-05

He’s three days old and ate well the first day then
has had vomiting and his abdomen is very distended.
His mother says he has not had a bowel movement yet.
So I examined the child and found an imperforate anus
(an anus without a hole to have a bowel movement). So
for this child this was an emergency. I asked if the
patient had urinated that day. Mom said she thought
he had never urinated. This raised suspicion for me.
Especially since this malformation occurs frequently
with other problems. I have only read about this, but
unfortunately have never seen or operated on someone
like this. And the nearest pediatric surgeon is
possibly in the capital 800 miles away or further. So
I began to tell the family about the problem and that
it required surgery. Their first question is how much
it would cost. The nurse said probably 100000CFA.
Well this was a bit exaggerated an I didn’t know if it
would be only a small covering of skin over the anus
or anal atresia (inadequate development of the anus or
rectum) So I couldn’t tell how much surgery was
involved. I could tell by their faces they were
considering not doing anything. So I convinced them
to let me see if I could at least do the “small”
surgery and if more was needed I would talk to them
before proceeding. So this child was taken to the
operating room. We have no preoperative studies
available to see how far down the rectum and anus are
open (x-ray or other studies). So without studies I
figured I should be able to put a needle into where
the anus should be and if only a skin was covering it
I should be able to aspirate meconium (baby stool). I
attempted and could not. So I figured it must be anal
or rectal atresia (malformation up higher). So the
child needed a colostomy (bringing out the colon to
open on the skin of the abdomen). So I discussed
things over with the parents telling them this was
necessary for the life of the infant. Well they said
I should do whatever I think is best. So I continued
on with the surgery. Upon opening the tense belly the
intestines spill out onto the table as they are very
distended and trying to escape the confining space. I
choose a site to bring the intestine through the
abdominal wall and then attempt to close the incision.
This is very, very hard, as the intestines don’t want
to be confined to the small abdominal cavity.
Eventually with much effort we get them back in and
suture the ostomy in place. When opened it pours out
stool. The large intestine was about 10X normal size.
It took a lot of Ketamine to put the child to sleep
enough to do the operation. So during the middle of
the operation the child stopped breathing. I notice
the bowel getting purple instead of pink and ask the
nurse if the child is breathing. He says “yes” just
fine. I look for signs of respirations and there are
none. They start doing CPR on the infant, which is
ineffective. So I break sterility and bag the infant
myself. He pinks back up and starts breathing slowly.
I bagged him about 15 minutes then continue with the
operation as the nurse bags him. I believe this is
the medication we have given him are the cause. Dr.
Hamza who is operating with me thinks it’s the
distended abdomen. Again with difficulty I try to
close the abdomen, the bowel turns purple and I bag
again. Finally I am able to finish the case while the
nurse bags the child. I continue bagging the child
hoping he will live for another hour. Finally he
starts breathing on his own. I stay with him on the
operating room table a few more hours. Only the
on-call nurse has been with me since the end of the
operation. I know the child may not live. I remember
what the mom said about the urine so I attempt a
urinary catheter, it doesn’t pass. So there IS a
problem with the urinary system. I place a needle
into the bladder through his belly. I get 30ml of
urine (large amount for 6 pounds infant). He is
finally breathing well enough I feel ok with leaving
him with the “nurse”.
The next day the child is doing OK and the ostomy is
putting out a lot of stool but the child is crying
constantly. I place a catheter through his abdomen
into the bladder. He tolerated it well.
Now here we are 3 days later. Nothing has been paid
by the family but the husband has gone to sell his
grain supply to get money to pay for the
hospitalization and all we have done. It will likely
not cover the price of it all. The child’s intestines
still haven’t woken up and he is vomiting. I place a
nasogastric tube into his stomach and get many cc’s of
bile. He is dehydrated and his IV fell out overnight.
The nurse is now asking me, if they haven’t paid
anything should we continue with the catheter and
continue to do all this things when he is likely not
to live. If he does live with the urinary catheter he
will have repeated infections and more surgeries… and
more that the family like this will not be able to
support either here at our hospital or even frequent
treatment at dispensaries. I would not make the
decision on what to do. These decisions on whether or
not to continue are easier when I know there is no
chance of survival. But in a child who CAN live I
can’t make the decision on whether to stop treatment
or not. That is the families place not mine. For me
“First do NO harm” (In the physicians oath). So we
placed the IV tonight to rehydrate the child and await
the fathers return. We have seen so much death that
the chance of a life saved even if very sub optimal is
great. I don’t mean to say that we haven’t had
successes with Gods help, but there is enough death to
be very discouraging. Mostly because they come in at
such a late date, and are in bad shape when they
arrive. But also some young (example 14yo girl) who
come in and look just kind of sick but then have a
release of malaria trophozoits in the blood stream and
then decline rapidly. These are also hard.
Fortunately that is rarer, its harder to deal with
mentally because they don’t look like they are ready
to die like the others when they come in. But such is
the life of physicians working in this part of the
world. (Se la vie)
I think what is necessary as in everyone’s life is to
trust in God more. We are not here for our purposes,
or the patients, or hospital workers. We are only
here, because this is where God wants us! I do
believe it is to help the patients and hospital
workers and teach those who do not KNOW GOD about Him.
This is the most important. With some patients it is
easier than others. Also with some hospital workers
it is easier to show God’s love than others. But
that just reconfirms our need to become closer to God
and rely on Him more to be able to deal with these
people as God would and not as we feel like treating
them.
God please help us treat our patients like your
children. Help us to work with the employees who
betray us as you did with those who betrayed You.
Give us your strength as you promised in Isaiah 40:31.
Give us wisdom as You promised in James 1:5 when we
do not know how to treat your children best and what
medications to give them. As in
Psalms 62:2 be my rock and salvation, my stronghold,
and I will not greatly be shaken. Thank you for all
your promises in the Bible to comfort us in the times
of distress and disappointment and ignorance. And
thank You most of all for sending your Son as a
sacrifice for my sins that I can one day be with you.
Thank you Lord. The Shanks

Shanks steps in
Cameroon #11
Hi! Sarah here. The reason I’m writing because
we’ve gotten a few letters asking about me. Thus, I’m
writing.
Lot’s of things have been happening. The
highlight of my kid brain is the fact we found 2
hedgehogs. We kept them in a little box and fed them
bugs. Pierre (Our guard.) caught big inch long ∏ inch
wide bugs for them. Now, I’m not a girl that gets
grossed out by bugs, but when you see a can full of
big wiggling hopping bugs, you can get a little
grossed out.
I ended up letting the hedgehogs go.
Unlike my mom and dad, I have no great medical
stories. I don’t like the hospital for multiple
reasons. One, I think blood is cool! But 1 part of my
brain disagrees. I faint. I can’t explain it! I like
seeing blood, really! But I just get faint.
The other reason is because babies’ cries make me
nauseas. (I never really liked babies.) Trust me,
there are lots of babies in the hospital.
And the other reason I don’t like the hospital
is because seeing people so sick also makes me
nauseas.
Mostly, I do the staying home and praying part.
My day is made up mainly of home school, (Where
I teach myself until Mom gets home.) reading, and
drawing. So unless you want to hear that 109,786
divided by 10 = 10,978 r6, I’ll skip that part of my
life here.
I’ve made a few friends here even thou I can
only speak some French. I have learned that they like
Duck- Duck- Goose a lot. The 3 year olds to the 19
year olds play it with us.
Mainly the boys play with us. I think the girls
are shy, or they are just doing too much work. The
little children do very interesting jobs. Like the 3
year olds taking care or a big herd of cows, all with
horns at least 5 inches long. It’s kinda funny seeing
a boy 2 feet high hitting a cow with a stick and the
cows’ 5 feet high!
Many other funny things you see here are goat’s
tide to the tops of mini buses as they speed past. Big
satellite dish tied to a motorcycle ( Moto’s as they
say here.) with the man sitting in it as he drives by.
Bulls walking past our house. And ducks, goats, sheep,
donkeys, and an occasional horse in the road. We know
a man with 50 children! True story. There is only one
way describe Africa. Crazy.
One of the biggest problems I have here is not
enough books. I go through books fast. I read 315 page
books in 1 day! I’m so desperate for books that I’m
ready to read that one book I found here from the last
missionaries, The Basic Fundamentals of Golf.
The other draw back is not enough cheese or
chocolate. Sigh… Chocolate…
I like chocolate. Who doesn’t?
Africa is a different world. The mountains,
animals, plants, houses, weather, electricity, sand,
customs, cloths, weather, music, illnesses,
treatments, languages, food, bugs, people, all are so
different. Life here is more interesting than you can
imagine unless you’ve been here. We have been here for
about a month and are not yet settled down. We miss
every thing we left behind. Please pray we do well
here and start feeling comfortable.

Sincerely,

Shanksteps #10
16-9-05

C’est le main gauche. Oh no, not again. This was the
third delivery with “hand presentation” in as many
weeks. What is it with Cameroonian women that the
hand comes out before the head? She started to have
contractions this morning in a nearby village and went
to the local medical personnel. When they checked to
see how dilated she was, they felt a foot and pulled.
Unfortunately it was not a foot, but a hand. So they
sent her down the horribly bumpy dirt road to Koza for
us to take care of. Greg and I ran down to the OR for
yet another C-section. This hand was a bit different
than the others though as the skin had already started
sloughing. We feared what the rest of the baby would
look like. The operation went well but the baby was
dead, and had been for quite awhile as evidenced by
the amount of decomposition. Mom has done well.

She’s eight months pregnant, delirious, with jaundice.
Why? Three days ago she had been fine, they tell me.
I search my brain, Williams Obstetrics text, Current
Medical Management text, and Manson’s text of Tropical
Medicine. We perform the labs we have, only to find
out that mom’s blood is Rh- and her husband is Rh+(so
baby could be Rh+ also). Could this be some form of
blood incompatability reaction? One of the nurses has
seen Rh problems before and said they looked similar.
I go to check on mom again and her heart rate is now
170. Her breathing is irregular and she is thrashing
about. I wonder if mom’s reaction against baby has
been so severe that the baby has died and mom is
becoming septic; I wonder about hepatitis and
encephalopathy; I wonder if this could be a weird
presentation of eclampsia and HELLP syndrome (we had
one earlier in the week). I never found a fetal
heartbeat, but that’s not as surprising using just a
stethascope. All I know is that if the fetus is
causing the problems, we need to get it out. Another
c-section. Baby was dead and mottled. Mom’s vital
signs started to level out once the baby was removed.
I still wasn’t totally convinced that that was the
whole story. Late in the evening Greg was told that
this patient wasn’t doing well. She had Kussmal
breathing (end of life breathing) and altered mental
status. Several hours later she was dead. Why??? At
our morning worship and patient sign-out the next
morning we get an answer. One of the patient’s
neighbors came to the hospital to tell the rest of the
story. The patient had not been feeling well for
about a week. 3-4 days prior to coming to the
hospital she had gone to a traditional healer who had
given her a potion to drink. She did and immediately
fell to the ground and started acting strange. The
family kept her at home like this for 3 days, then
finally brought her to the hospital as a “last ditch
effort”. Unfortunately I do not have a traditional
medicine textbook to refer to. Tribal potions was not
on the differential diagnosis for jaundice in my
medical text. (It will on my personal differential
next time though.)

So many patients wait until the last minute before
coming into the hospital. They go to the market to buy
(prescription) meds; they go to traditional healers
for potions, cuttings, burnings and spells. By the
time they come to us they are in very serious
condition. If we are able to help, very often the
family doesn’t want to pay for the medications and
care and will take the patient home before they are
ready, especially the women and children. Some days I
just want to come home and cry for all the death we
see, and the seeming indifference to it. I feel that
the difference we make is so miniscule that it doesn’t
really matter. But then I remember that we are not
here for us. We are here in Cameroon because God
called us to be here. He has plans for us that we
know nothing about. I have been out of my “comfort”
zone since landing on Cameroonian soil. I have felt
inadequate medically, culturally, spiritually,
emotionally, physically, in language, understanding.
But God is not done with me yet. He continually
reminds me that “My grace is sufficient for you, for
my power is made perfect in weakness.” (2 Cor 12:9)
He has a lot of weakness to work with…
Please continue to pray for our hospital and it’s
spirituality. Please pray for our strength to keep
working for HIM through the life and the death. We
feel your prayers as we are given boosts of energy and
have the privilege to see miracles throughout the day.
In his service,
Audrey, Greg, and Sarah

Cameroon Shank steps #8
At times we are up, at others we are down.  It seems
our emotions are like the rivers here.  At times dry
and other times of the year flowing.  A lot of the
feelings depend on whether we feel like we have helped
someone that day or whether someone has died.  As
mentioned before it seems is very much a part of life
here and accepted very differently.  But for us with a
western mindset it’s sometimes harder than it seems
for some of the family members.  I had another child
die in front of me yesterday.  Many children are
brought in by parents very late in the malaria process
when the child is already worn down by repeated
malaria and also malnutrition.  In children like this
even a few days may be too much.  Their hemoglobin may
be very low and they bring them in when there is
difficulty breathing from the anemia and they seem to
die often before or while the blood transfusion starts
running into them.  This is one of our most common
difficulties to deal with.
The other is the constant strain of insufficient
money.  Again this month the workers were paid only
1/3 of their salaries because the hospital doesn’t
have enough to pay them.  We ran out of Quinine today.
This is one of the essential, most used, medications
for treating malaria.  Nearly every patient in the
hospital and clinic receive this.  Today the
“pharmacist” came to us saying they were out.  And of
course the nearest place to get it is 3 hours away in
Maroua.  So the hospital ends up sending patients to
surrounding dispensaries to fill the necessary
medications.  Not a good move to have to take.  But
since we just paid the 1/3 salary we don’t have enough
to buy today.  We may be able to buy a few essential
medications tomorrow after seeing some patients and
discharging others.  It is also hard for us to hear a
worker say “It’s hard to treat the patients well when
you’re hungry”.  Or “My family hasn’t eaten in 3 days
because the salary is late.”  The needs here are very
real and at this time of insufficient funds, are
amongst our staff too.  Often it is more common
amongst those without jobs or income who are waiting
for their crops to produce.  But now since the
hospital is behind a few months the crunch is real and
also amongst those with a job.  Our administrator has
just had a baby boy in the hospital in the capital of
Cameroon.  He hasn’t been able to travel there now for
a week because of lack of funds to go.  Unfortunately
some parents and husbands also make medical decisions
based on cost.  We had a child who’s father took them
home today with cerebral malaria because he was
worried about the bill getting to high for him to pay
so he paid and left.  Another mother came in with a
child with a broken tibia and fibula (leg) and when
the nurse mentioned the child should be hospitalized
and casted she left with the child.  So along with the
joys of working for Him in this place amongst these
very friendly and hospitable people there are real
challenges.  Please pray for us and for this hospital
that we may grow to be the people and institution that
God wants us to be and that we will some day have the
ability to provide more care and aid to those here who
really need it.
We are still not able to use our ham email yet.  We
are waiting for the permit to use it.  Also pray for
this that we may get it soon so that we can stay in
more constant contact with you all.  Unfortunately it
is hung up in the telecommunications department here.
When it is rough I am reminded of the Bible text:
Isaiah 40:28-29, 31 “Do you not know?  Have you not
heard?  The Everlasting God, the Lord, the Creator of
the ends of the earth does not become weary or tired.
His understanding is inscrutable.  He gives strength
to the weary, and to him who lacks might He increases
power.  V 31. Those who wait for the Lord will gain
new strength:  They will mount up with wings like
eagles, they will run and not get tired, they will
walk and not become weary.”  God is giving us the
strength to do what He has called us to do.  We praise
Him for this.  We serve an awesome God who is
interested in each issue in our lives and has
experiences the same difficulties that we have.  I am
very thankful for a God who understands our
difficulties and is interested in each aspect of our
lives.

Shank steps #9 9-13-05
One of the hospital workers sons comes in three days
ago with severe facial pain on the left side. He had
been in a fight and hadn’t won. He could barely open
his mouth for me to examine him. He had severe pain
over his left cheekbone and left jawbone. I was
unable to get further exam on him. At our daily
worship that morning his father emphatically said that
he would not pay for the injury as it should be the
assailant who is to pay. Unfortunately, as director
of the hospital, this left me having to talk to him
because he shouldn’t be saying such things to all the
hospital workers and it is his responsibility. The
issue between him and the assailant is not hospital
business, but his. So after examining the patient
and not getting very far I decided to wait a couple
days till the swelling went down, then reexamine him.
After a couple days it wasn’t much better so I decided
to examine him under anesthesia (Ketamine). But
yesterday the power had been out for a day and a half
and without light would not be able to evaluate him
well. So I put it off till today hoping that the
electricity would be back. Fortunately it did come
back on this morning and I was able to look at it
today. He DID have a broken jaw and a couple of his
teeth moved separately to demonstrate the location.
We had gotten one facial x-ray but this was unhelpful.
Then as Murphy’s Law would have it we were out of
x-ray films, so no more films till there is more money
(that should only take a few more months…sarcasm…) so
when I was able to demonstrate the fracture I decided
to wire his mouth shut so that it would heal
appropriately. I did this wiring periodic bottom
teeth to the periodic top teeth in such a way to pull
the fractured site together. Of course as he was
waking up from the anesthesia he was flailing all
around and hallucinating and trying to open his mouth
stretching the wires. So I had to sedate him to keep
him from tearing apart what we had just done.
We had a rude realization this week. The power had
been off about 24 hours then our water ran out. I was
surprised because I had been told by someone that when
the power was out that the water lasts about a week
when the water tower is full. Well 24 hours after the
power was out no water. Also the reagents in the lab
and vaccines were about ready to go bad also because
of warming up. So we were running low on water and
many other problems. So we needed to start the
generator. This poses a few problems. 1: we don’t
have diesel – we need to buy it (available locally)
2: the oil has not been changed in more than a year
and it was seizing up last time we ran it- thus we
need to change the oil before starting 3: It will need
to run about 5 hours minimum to cool the refrigerators
to keep the lab and vaccines from going bad and to
pump water to the tower. 4: the ever-present shortage
of funds. Well, praise God, as I was trying to figure
out what to do the power came back on, and all is
avoided temporarily.
I believe we are starting to be blessed. The
hospital made a priority of paying tithe this month.
It has not done so for some months. It seems that
when things are tight with individuals or institutions
that they cut out tithe paying because they feel they
can’t afford it. I believe it keeps God from blessing
them like He would like if we only gave Him back his
10% like he requests. So we paid it yesterday and
today was very busy, and I believe God is able to
bless us. I encourage any of you who have found it
difficult to pay tithe to God to do so now. He only
requests 10%, but it is our duty to give it to Him,
then He can bless us when we are faithful to Him.
Liz, nurse practitioner student, is leaving tomorrow.
The people here have been very thankful for her help
and we pray God uses her in a mighty way in the
future.
Please keep the hospital in your prayers and us as we
continue to serve Him in Cameroon. We think of you
all often and cannot wait till we have email access
here by ham radio whenever the permit comes through so
we can stay in better tough personally. Until then it
will be every few weeks. Thank you for remembering us
in prayer. In His Service, Shanks

Cameroon Shanksteps of faith #7
She was 8 months pregnant and seizing. We were
called to come and evaluate. She had eclampsia. This
is a fatal condition if not treated aggressively and
the baby delivered. We had to rush her to the
operating room. It was the middle of the night. So
the guard set off on bicycle to round up the operating
room staff while we established intravenous fluid and
treated her seizures. About an hour later we were
able to start the cesarean section. We got a healthy
baby, which cried vigorously. Next as we were getting
ready to sew up the uterus we realized she had a tear
through one of her uterine arteries that was bleeding
badly. At this time the power went out. Fortunately
I had remembered my camping headlamp that day. So the
nurse put it on me and we went on repairing the uterus
in the semidarkness. God blessed this woman and she
and her baby are doing well.
Have you felt like you have a large task that needs
to be done but you are afraid of what may happen if
you do it? I felt that way this week. The Chief of
Koza came to see me in the clinic last week with his
4-year-old son who had a hernia he wanted repaired and
a circumcision. Well a hernia is fine with me, the
chiefs son isn’t. I feel it would be much better to
operate on these high profile people far in the future
when the kinks have been worked out and things are
running “smoothly”! Well we did not have the
appropriate suture for this surgery, well for most
surgeries. So I told the Chief that I would like to
postpone it a week to allow us to get the equipment
that we needed. So he agreed to come into the
hospital this week. We were able to find the
appropriate suture in Maroua. Unlike the states I
brought the child in the night before to obtain some
labs and make sure he stayed without anything to eat.
I decided to do it with Audrey and fortunately she was
back from Maroua that day. We started in the morning
after staff worship. The IV line was difficult to
obtain and the child was poked many times. Then off
to the operating room. Using Ketamine for anesthesia
Audrey and I explored the groin and found a very
adherent, septated hydrocele. What happened next? You
probably guessed it, the power went out. We were
trying to find the base to tie it off. We continued
on by flashlight. Fortunately about a half hour later
they were able to find a car to jumpstart the
generator so we had power once again. This is the
usual problem with the power going out. We end up not
having labs, and operating by flashlight and oil lamp
because we either don’t have diesel for the generator
or a vehicle to jump-start it. Well the child has
done well other than not being able to urinate the
first day. God has blessed us with the chief’s son
doing well.
There have been times of gladness, when we were able
to help someone in a critical condition, and others
when we do all we are able to do and they die in front
of us. Sometimes for things preventable. We pray for
the appropriate equipment for the hospital and for
knowledge to use what we have to the maximum, and to
know when excess effort is fruitless. We find our
peace in knowing that we are here on His mission and
not ours. As “The Purpose Driven Life” book says:
“It’s all about Him.” It’s NOT about us but His
purpose for us being here. Please continue to pray
that we stay willing to go in whatever path God wants
us to take, to be open to His leading at every step.
Thank you for your prayers and support.
In His Service, the Shanks

Dear Family and Friends,
Come quick she just delivered and now is pale and not
looking well. So started our first Sabbath here.
Audrey went in to check the woman. She checked her
and she looked like she was alert but not doing well.
She checked the baby who was doing OK. Then back to
mother, who now had stopped breathing. Since we have
ambu bags and no masks, Audrey did mouth to mouth
though a gauze but without avail. She had
exsanguinated. She was suppose to have gotten blood
two days before from her husband or family members or
they were to call on me to give some, as I am able to
give to most people. They didn’t do any of the above
and we left the next day for Maroua to get some
hospital supplies and food for our house. We got back
in the evening and I went to the hospital to check
things over. There were a couple issues I attended to
and there was “nothing else” that needed to be
addressed. So I went home. Then we woke up to this.
She was 18 and this was her third child, she hadn’t
bled much because she didn’t have much to loose.
Audrey was very shaken as can be expected. Later on
that day…
We have an urgent problem: a woman is 8 months
pregnant and convulsing. We went in and she had been
seizing for “3 hours”. She was in eclampsia. We
arranged for an urgent C-section. Using Ketamine as
the anesthetic, only what is available here, we did
the operation and the baby came out limp. Audrey
again did a valiant effort and did CPR on the infant
for 30 minutes and finally revived the 2.5 kg infant,
again with gauze as a barrier. Oh how I wish we had
the appropriate equipment. It is hard to leave the
land of “plenty” for the land of famine (equipment
wise). We pray our container of medical equipment
arrives as fast as possible. (4mo instead of 2 years
like some) And still later that day…
“This boy was out watching the cows when a bull caught
him with his horn. He has a laceration of the scrotum
and a testis hanging out.” He also had a cut on his
abdomen. So I took him to the OR for repair.
Now today, a week into our stay here in Koza we have
another. A woman is brought here from 40 km away who
has been in labor when they noticed a hand as the
presenting part. They brought her here. She ended up
being a transverse lie. The infant was not moving and
limp and blue. Audrey did CPR for 35 min. without
success. Is it Ketamine? was it the child? what could
we have done different? We are plagued by questions
that we search our minds and books for answers. Some
are answered some aren’t. We hope we are making the
difference that God wants us to make. We are only a
week into it and are taxed. The mental anguish is
more than the physical. Our schedules aren’t bad but
we are very tired by the afternoon. I pray we never
become calloused to the pain and suffering around us.
The people here seem to accept death, where as we have
been taught to fight it at all costs. We pray for
constant direction from HIM(God). Please pray for us!
Serving Him, the Shanks

Shanks
Hopital Adventiste de Koza
BP 53
Koza, Extreme Nord
Cameroon