MissionDocs.org

ShankSteps #17
Hello. Louie (The civet living in the roof of the
Shanks house) here to narrate: ‘Behind the Scenes of
ShankSteps’! But first, some messages from our
supporters!
(Boring commercials)
Were back with some exciting news! The electricity
has been on for two days now without going out! A
Shank member has noted they were getting used to
sleeping on the floor because it was cooler. Lets go
over and interview Greg Shank, shall we?
Hello Greg.
“Hello?”
May I ask you a few questions?
“What does Louie want to know?”
Yes, well. How do you feel about getting up often
in the night to go to the hospital often? 1:00 and
the like.
“It bothers me less than in the U.S. because at
least the people are really sick when I see them.”
I see. Thank you Greg. Remember folks, these are
the reel responses! None of that ‘make the people say
what you want them to say’ stuff!

Well, wile I’ve been feasting on lizards, the
Shank family has been eating the rations of a siege.
Pore Shanks. Rice and beans, rice and beans, rice and
beans, all the time! Rice and beans! At least they
have a lemon tree out back! Some of which Sarah will
be selling!
Lets move on to the hospital.
Ah. It’s doing better! But, tisk! What’s this?
Almost out of saline bags you say! Such a shame!
But wait! Good news! Sarah has watched a total
of 4 operations! Her response? ‘You’d ‘a thought it
would be more bloody.’
According to Sarah, you can find out where the
different body parts are by remembering these helpful
hints:
1. The intestines are the things that look like worms
located in the area you grab when you say, “Ow! My
stomach!”
2. Your stomach is located above the area you say
“Ouch” when you get a stomachache on the left side.
3. You’re heart is the thing that go’s BOOMB BA BOOM,
BA BOOM in you’re chest.
4. You’re throat is the thing that hurts when you’ve
got a cold.
5. You’re bladder is the thing that feels like it’ll
burst in the morning when you just wake up.
6. And the lungs are the things that go up ‘n down
when you breathe.

That’s just great. Very nice! Now, to the rest
of Koza!
It looks sandy and dusty. Highly populated, and
dirty. But it’s got potential! With two doctors, a
peace core worker, and a little blond girl, my
estimate of time until it becomes some thing great,
is, oh, abooouuut, 234 years. Nah! Just kiddin!
But it definitely needs help! Which is where you
come in! One prayer a day from each of you is a BIG
help!
Well. Hasta le vista! Au revoir! See ya! And
tune in next time for, ‘Behind the Scenes of Shank
Steps!
(Credits role)

#19 Cameroon

I walked into the room and the chest tube is half out
of the chest. She was a thin old woman with a cough.
She had come into the hospital with difficulty
breathing and coughing constantly. She had been
coughing for three months. We checked a test for
terbculosis and she had it. She also had fluid
outside her lung and it needed to be removed. We do
not have the normal tubes for this so I put in another
type of tube, and it drained into a urine sac. She
drained off about 800ml of fluid. This is a huge
amount, especially for a very small, thin woman. So
she went about one week and had a lot of pain at the
site of entry to her chest. After a week she demanded
it out. I did not think this was a good idea as I
knew that with the tuberculosis treatment, which I
suspected was the cause of this effusion, she would
reaccumulate the same fluid. But she was very set and
I warned her that she would need it again. So we took
it out and in the next week be needed another tube.
She refused, but accepted a needle decompression of
the site. So I put a small IV catheter into her chest
and withdrew a similar quantity of fluid. I told her
that the next time she needed it she would get a tube
again. So about a week and a half later she ended up
with the same symptoms. Then she got another small
tube. She has stayed with this for a few weeks.
Every so often when I make rounds on that ward I have
to untangle the macramé she has made of the tubing.
About 4 days ago she was having a lot of difficulty
and so I went to see her. She had swelling of her two
arms and also right side of face and her right chest.
So I figured out that her tube was plugged. So I used
a syringue to suck out the clots in it. We got about
500ml more of fluid. She immeadiately started
breathing better.
So today I walk into her room about noon. And I hear
a sucking sound, suck—swish, suck—swish. I see her
breathing relatively calmly and the “chest tube” in
half with a small portion sticking out of her chest
and the rest laying next to her. The tube making the
sound with each breath. So I immeadiatly think I’m
looking at an open pneumothorax with the tube in place
and the characteristic sound. Now the question is
WHAT HAPPENED? Since she was not in visible distress
I asked her. Through the translation I learned that
that morning she was coming back from using the
latrine and her daughter stepped on the tubing as they
walked and she had intense pain in her chest as it
pulled on the stitch holding in the chest tube. The
tube broke in half and she had difficulty breathing.
So then she went to her room and asked her daughter to
get the nurse. The daughter refused and left the
hospital. I think she must have been scared of what
she had done. So the patient sat there for a few
hours till I came by.
I connected the residual tubing to the tube again but
there was still a huge leak. So I occluded the area
with pressure and was able to use a syringe and a
stopcock to withdraw much of the air out from around
her lung (hopefully reinflating her lung). The next
dilemma was when to get the chest x-ray. I had been
trying to convince her to allow me to get one. She
did not have the money for it and so refused.
Normally I would want one now, when the next chest
tube was in and after it was in to make sure that
there were no tumors in the lung. But I am having a
hard time convincing her of one. So I think I will
wait till she has a hard time breathing again, put in
the chest tube, then after a day get the x-ray if she
will let me. I had hoped that with TB treatment that
this effusion would stop but it has not. I may need
to perform a chemical pleurodesis ( a way to
chemically stick the lung to the chest wall so the
fluid cannot collect), but with what?
It seems each day has something new to amaze,
challenge and intrigue us. We have had a number of
children with huge abdominal ascites that we are not
able to figure out the cause of. We have received
generous donations recently which my dad was able to
bring to us. We have used some of this money for
buying reagents to outfit our laboratory with more
tests to attempt to diagnose these children and also
aid in many other diagnostics. We have already used a
large sum of money to buy medications for our
pharmacy. We now have most of the medications we need
that are available locally. We are looking into
making an order from a company in Holland to be able
to get other medications we need that are not
available here. We will also use some of the
donations for Bibles, so that more people here will
have them. There are very few, as none are available
here and they are costly for the local population. We
thank you all SO much for your prayers and support of
the people here and our working amongst them. We
thank you for you emails. We download them at Mokolo
when we are able to get there and then read them when
we are back in Koza and respond at our next trip.
This minimizes our time at the “internet café” (very
loosely said as there are often animals bleeting
outside and various smells wafting through the musty
air inside.) We thank you all so much and feel your
love in Cameroon. In His Service, the Shanks

ShankSteps of Faith #16
Ooooooh BANANAS! I never thought I’d be so happy to
see a banana. Y’all back in the States might laugh at
these bananas, as they are only 2-3 inches long, but
they are wonderful. AND, these are the first bananas
we have seen since moving up here. So much for living
in the tropics:) Apparently there is a village way up
in the mountains where bananas grow well, but they
can’t sell them up there, so alas, they bring them
down to the booming metropolis of Koza. We have
requested a standing order with the banana lady. Our
food variety in Koza is small right now (tomatoes,
cabbage, occasional eggplant, expensive onions, white
beans, rice and flour) but promises to increase over
the next several months as we are coming into the
harvesting season. What I would do these days for a
good salad bar:)

The past couple of nights here have had a bit of an
eerie feeling to them. Last week a woman who lived in
the village nearby died. For the past 4 nights as
soon as the sun goes down, the drums start. If I
didn’t feel like I was in Africa before, I certainly
do now. The drums (Tom Toms) and tribal singing late
into the night definitely gives this place a different
feel. Greg sat up with our guard one night late
talking about the different ways funerals were
conducted here. Christian and Muslim funerals don’t
use the Tom Tom, so this must have been an animist
funeral. Apparently the drums are used just to call
the village to the home of the deceased for the feast
and fellowship. Our guard (Pierre) said that
Christians don’t usually go to these funerals. He
said that the body is buried on the 2nd day by the
foragers (blacksmiths of the village). Apparently
sometimes the spirits won’t allow the body to descend
into the grave and they need 2 foragers to complete
the task. One of the foragers has to climb into the
grave to pull the body down. Occasionally the body
(spirits) will grab or bite the forager while he
trying to climb back out. For those of you who don’t
believe in this type of thing, the spirit world is
very alive and out in the open in places like Africa,
where spirit worship is a daily part of life. Even
the Christians and Muslims in this part of the world
have a strong belief (and participation) in sorcery.
Almost everyone here wears a cord around the neck
and/or waist with a small pouch of seeds attached.
The seeds are supposed to ward off sorcery and evil
spirits. As I mentioned before, most of our patients
also seek the help of the traditional healers long
before they step foot in our hospital. If the
complaint is pain, often the traditional healer will
make small cuts over the area (often the belly) to
bleed the bad spirits out. Many of our patients come
with numerous scars over previous problem areas. You
may be able to see some of these on our website
(www.missiondocs.org)

Greg mentioned in the last letter that I’ve been sick.
Thanks for all of your prayers. Like most health
care people I am a horrible patient. In fact I
ignored the advise of my doctor (Greg) for a bit too
long before checking labs and starting meds. By the
time I finally checked to see if I had malaria, I
could hardly stand up. I think that because I was
taking prophylaxis that the malaria was just
smoldering. Well, last week it finally won and I was
in bed for 5 days straight. I felt soooooo badly that
Greg was stuck with the patient care all to himself.
God took pity on him and kept the patient load light
(good for Greg, not great for the hospital). I’m
still weak and a bit lighter than before, but feeling
much better now.

Thank you all for your notes of encouragement. Even
the quick “just thinking about you” notes are great.
Some days we feel like we are making a difference, but
other days it gets kinda lonely and we feel that we
have fallen of the face of the earth. We just have to
keep reminding ourselves that we are here to serve the
One who sacrificed everything for us. Please continue
to keep Koza in your prayers.
In His Service,
Audrey, Greg and Sarah

PS: We received this quote in a letter written to us
and it has been very encouraging to us. I hope you
find it the same for you.
From “The Mount of Blessing”
“The road may be rough and the ascent steep; there may

be pitfalls upon the right hand and upon the left; we
may have to endure
toil in our journey; when weary, when longing for
rest, we may have to
toil on; when faint, we may have to fight; when
discouraged, we must
still hope; but with Christ as our guide we shall not
fail of reaching
the desired haven at last. Christ Himself has trodden
the rough way
before us and has smoothed the path for our feet.”

11-7-05
#18 Cameroon Shanks steps of Faith
The other physician asked me to see a patient.
Audrey has finally recovered from her first bout of
malaria. It lasted about a month all and all. Now
Sarah has malaria and profuse diarrhea. So Audrey has
had to stay home a few days, which has been good for
both of them. So Dr. Hamza asked me today to see a
patient with a snake bite 8 days ago. The child was 3
years old. (this story is not for the faint of heart)
I went to see the patient in his office and realized
the patient was outside my office (we have two next to
each other). All his windows were open and the fan
on. I asked why and he chuckled. Well it didn’t take
me long to figure out why. So I decided to see the
patient in the room we change dressings rather than
put him in my office (good choice). So after placing
the IV and starting the antibiotics he had ordered,
the patient went to the dressing room. The smell was
of rotting flesh and pus. I was very glad I chose not
to see him in my office. It was the kind of stentch
that almost makes your eyes water. The child had been
bitten by a snake on the anterior shin region. Huge
areas of dead (necrotic) skin were on the top of the
foot/calf/behind the knee/thigh and posterior leg. I
would say that only about 20% of the leg had good skin
covering it. So I had to talk to the mother. In the
US we would debrede this and skin graft it in a few
days to weeks depending on when it had good
granulation tissue covering the muscle. But we do not
have a dermatome to make a skin graft or anything that
I can figure out to use as one. So I suspected that
if the child was debreded and then eventually healed
in 2-4 months or more that he would likely have
contractures and a useless limb. So I talked to the
mother about the options. One is amputation at or
near the hip (my preference in this child), or
debredement and the long haul for waiting skin to
grow, if it did. She said that the childs father was
dead and she would rather bury the child than cut off
its leg. But there was an old man of her village who
would have to make the decision, so we would have to
await him to make it.
So today I met with him and explained everything to
him. He had not seen the injury so I showed him what
would be necessary for the two options. Explained to
him my reasoning. He chose to attempt to save the
limb and then if it didn’t seem like it was working to
do the amputation. This is actually my preferred
choice, but is not usually an option because then you
incur the cost of two operations and lots of dressing
materials. So I thought he chose wisely. Today with
the help of our energetic student missionary, Krissa,
we debreded all the dead tissue from the leg. It was
quite an undertaking. We removed all the dead tissue
leaving what looked like a denuded chicken leg. (I
will attempt to attach pictures, but if I cannot, you
can look on our website in a month or two to see them
www.missiondocs.org) It was very interesting to say
the least. I have not seen something like this before
except in textbooks. I’ll try to keep you updated on
the progress of this child.
The patient load is back up now. I think God let it
wane a little while Audrey was sick and staying home
about 5 days and Hamza was gone for about a month.
When Audrey was better it started picking up and now
with Hamza here for two more months it has picked up
some more. Today we had 51 patients in the morning.
We have also heard wonderful news from my parents that
they are arriving with a variety of donated medical
equipment and funds. We praise God for each person He
is using to further His cause. Thank you all for your
prayers and support of us and the hospital.
In His Service, Shanks-Cameroon