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# 31 Cameroon
3-17-06
So what do you get when you pray for more patents in
the hospital and more operations. Well you get what
you pray for. Over January and Feb. we had had a
decrease in patients down to about 25. While this is
great for our family time and other interests it is
not good for paying salaries (still a month behind).
So last week we prayed for more patients and more
operations. God heard us and we now are averaging 48
inpatients and I have done 5 surgeries this past week.
We do not want more people sick, just that when they
are they come here. So yesterday I did three
surgeries. First was a woman who had broken her water
about 48 hours before being referred here by a local
dispensary. She had meconium coming out (a sign of
fetal distress). And when I listened to the baby’s
heart rate it was not normal. So we took her for an
urgent Cesarean section. Fortunately Audrey was able
to be there to revive the child. Both mom and baby
are doing well.
The second one was one planned for a couple days. He
has had stool coming out with his urine. I know all
you non-medical people also know this is not good. So
I took him to the operating room. He had a large mass
in his pelvis and it was unresectable. So I diverted
his colon to his abdomen. This allows him to have a
more quality life rather than having obstruction in
the near future. But this causes one new problem. We
have no ostomy supplies. We have a few OLD sacs but
they fall off before leaving the operating room. So I
modify a glove and tape it in place. Not real
effective either.
Finally Audrey and I make it home about 6PM. I then
get a call at 10:30PM for someone who was stabbed.
(our third like this). I feel fortunate there are not
many guns around here. So not many gunshot wounds.
So he has a stab wound in his left upper abdomen. No
other injuries found. So I take him to the OR. I
explore his abdomen and find two holes in his colon
near his spleen. Stool is everywhere inside. He is
also hypotensive (low blood pressure). So I decide to
make him a diverting ostomy and resect the contused
and injured area. He remains hypotensive in spite of
fluid and not much blood loss. So normally in the US
there are a number of medication drips that are
possible to deal with situations like this. Here we
have one medication that can help. Epinephrine! So I
give him some that helps for about 5 minutes.
Fortunately we have received our donated stuff in the
container. We have dynamaps 2 that were donated to
us. So I know have one in the OR. So I can get
regular BPs and Heart rates. And I can see the
result. No more asking the nurse constantly. I
cannot leave the decisions up to him because he does
not know enough. They just accept SBP 60 as
acceptable and chalk it up to him being tired or meds
received. Well with the hypotension we are getting
frequent BP’s and all of a sudden there is an
“electrical burning” smell and the Dynamap quits. So
we are back to manual. So I had started a “drip” of
epinephrine on this patient while I finished the
operation. We did manual BP’s to adjust the drip.
Also the power went out. But just as the nurse was
getting my flashlight it came back on. Wow,
electricity makes such a difference. Fortunately when
our last student missionary was here she gave me her
headlamp that works better, so I use that now. So
when the operation was done we sat there for about 2
hours until he woke up enough and his BP rose. He is
doing well today.
God answers prayers! We are busy and doing surgeries
again. We now pray for a slow Sabbath to rest. We
are slowly installing monitors and equipment donations
we received before leaving the US. It all arrived in
our container. We are very blessed. We also hear
that we have more donation money and a dermatome,
arriving with the next student missionary. Thank you
all so much for all of your prayers and help to the
people of Koza. We pray God’s blessing on you for
your help to His children here.
In His Service, the Shanks

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Shanksteps #30

Fever
When you think of fever, what usually enters your
mind? For me it means that someone’s whole body is
warm to the touch, often feels cold, is usually sick
(often here with malaria, typhoid or other sickness),
and often can be treated with Tylenol or Ibuprofen.
Recently, I found that fever does not mean the same
thing to all people. I realized this when I asked a
man from Nigeria (in English) how long he had had
fever. He answered 8 years; every day; all day long.
Then I asked if when his wife or family touches him if
he is hot to the touch. Oh no, never that. So, what
do they mean by fever? To this man it means hurting
all over. To others it means sickness or warmth in a
certain area (ie. He has fever in his mouth…). One
woman had fever of the feet – she believed she had
fever because her feet were sweating.

History and Physical
For those of you medical types, learning to take a
good History and Physical is one of the earliest and
most important things you learn in medical school.
You use these skills throughout the rest of your
career. However, when you move to a new culture, you
must adapt these skills to the new environment. I’d
like to give you an example of the type of H & P we
have to do here. Remember, everything is translated
at least once, sometimes up to three times.
I walk into the ER to learn that there is a 1 ∏ year
old male with fever, headache (I’m not sure how the
parents know this, but EVERY child comes with
headache), body pain, abdominal pain, and vomiting.
How long has he had these symptoms?
*1 day (even the kids about to die, that have
obviously been sick for a long time).
I see that he was seen a week ago for similar
symptoms, has he been sick for several weeks?
* Yes, it started 1 day before we went to the
dispensary. He isn’t better yet.
Has he taken any other medications than the ones given
at the dispensary?
* No, and since he wasn’t better after one day, we
stopped giving those meds
Have you been to a traditional healer?
*No.
Have you given him any traditional medicines or roots?
* No.
Have you had his uvula cut?
* Yes, 2 days ago.
For what reason?
* He was coughing.
Where did you have it done?
* I don’t know the man’s name, but he cuts our
neighbor’s hair.

On Physical Exam, I find a severely anemic child,
breathing horribly and very fast, very hot to the
touch, with a distended belly and a very large spleen.
When I look in his mouth I find what look like burns
around his lips, and back of his mouth. Similar burns
are around the anus. Across the chest are numerous
cut marks that look to be 2-3 days old.

Again I ask:
Where did he get all of those cuts on his chest.
* The traditional healer.
For what reason?
* His heart was beating fast. It releases the
sickness.
Did you give him any roots or traditional medication
in his mouth. Some roots are more potent at this time
of year and can burn.
* Yes, we gave him roots to help dissolve his uvula.
But we gave the same to his brother last year and he
didn’t have any problems.
Has anyone massaged his belly recently.
* Yes, the traditional healer did because he was
having pain, and his belly was getting bigger.

So, this is how I put together the story. He got sick
with malaria and became anemic from the malaria; had
his chest cut due to the fast heartbeat from anemia;
was coughing from malaria and therefore had his uvula
cut; was having respiratory difficulty after cutting
the uvula and was given roots to burn the rest away;
inhaled and swallowed some of the root and therefore
burned his esophagus and trachea causing further
respiratory and now swallowing problems, and probably
contributed to the vomiting; had a large spleen from
malaria untreated and therefore had it massaged by the
healer. (Normally you have to be very careful with a
large spleen for fear of rupture – and I have seen
kids die of ruptured spleens after having them
massaged by the traditional healer.)
So, now a simple malaria has turned into a nightmare
and probably death for the child. He needs treatment
for malaria; transfusion of blood for anemia;
antibiotics for the infection in his throat and mouth
from cutting the uvula and chemical burns; tetanus
shot and serum antitetanus after having the uvula cut
with the same razor as is used in the community to cut
hair; HIV testing in 6 months; Neosporin on his chest
wounds; oxygen; and LOTS AND LOTS OF PRAYER!!!

Although this story is a mixture of several patients,
it is all true and happens here on a regular basis.
Some of these kids die, many have long expensive
hospital stays. There is NO preventive medicine here
and very little education. Even when I try to educate
parents, usually they trust tradition much more than
the white doctor. It’s very sad, so much is
preventable.

Please continue to pray for our patience, and
patients! Some days are very frustrating, and many
are medically challenging. Pray for our patients to
understand what we are trying to do and teach. Pray
for continued miracles here. Thank you for your
prayers, encouragement and love.
In His Awesome Service,
The Shanks

#29 Cameroon

Have you ever felt like a millionaire while living
near the US poverty level? We do, and especially now.
Our container arrived in Douala at the beginning of
November. Well it took a while for the Union to get
onto it and two weeks ago we got word it was getting
out of port and was going to be shipped to Yaounde and
there put on the train to Ngaoundere (half way up the
country). I received word that my truck is able to be
brought in with IT status. This means that I cannot
sell it in country but also I do not have to pay
taxes. Oh what a blessing, especially since I have
heard that the import tax is 80%. But still cheaper
to bring our truck with all of that than to buy one
here (3X as expensive). Also I wanted it taken out of
the container before shipped up here because we have
no truck ramp in Koza to offload it. Well apparently
it was felt that if they opened the container in port
that many things would be stolen so they decided not
to. Also there was a sudden push for being quick
(after 2 of sitting in port). So it was shipped. Our
administrator was asked to go meet it in Ngaoundere.
He faithfully did this.
Over the next 4 days tried to arrange for truck
transport of the container to Koza. Oh was this a
headache. Finally he found someone but they were REAL
expensive. He then a couple days later found another
who agreed for about half the price. The following
day if finally made it there and was loaded on the
truck. They said they would leave that night because
traveling at night was much better than the heat of
the day. That night they had decided to leave the
next day to do a few “maintenance” items. Does
“maintenance” include engine overhauls? Apparently it
does here. I guess he had money in his pocket and the
next day the engine was all out on the ground and
being overhauled.
Our administrator was not very happy. They promised
to leave the next morning. Well by the next evening
they were finally ready and they left for Koza. It
had to be cleared again by customs in Ngaoundere for
the trip from there to Koza. Well over the next two
nights it traveled up to Mora, arriving Friday morning
in Mora. This is a town 1 hour north of us by
motorcycle. They asked the administrator to meet them
up there to show them the way. He went up there and
found out that the customs officials in Mora would not
accept the papers it had traveled all the way up in
Cameroon with and wanted the originals that were in
Douala. Oh the corruption is incredible. Every one
seems to want something to “pad the pockets”. So he
had to go to Maroua to solve the problem. Finally
after all day in Maroua it was permitted to leave Mora
for Koza. It traveled that night and then arrived in
Koza early Sabbath morning. I went to the hospital
and got a call on the radio, “eeeekk, there is a
container pulling in our front yard!” Oh what a
blessed sight that was. We have been waiting for this
for many months now. All of our things and many, many
hospital donations, and our pickup. That evening
after Sabbath was over we broke the lock, cut the pins
and cut open the metal band holding it shut. We swung
the doors open and what did we see. Our truck,
perfectly protected.
During the last week our guard and I, and one of the
hospital workers had dug a huge hole in our front yard
to drive the back of the container down into to
hopefully get the container to a level where we could
get out our pickup without much difficulty. We had
dug it about 4 feet deep and about 12 feet wide. And
with the pile of dirt at the end our truck drove off
without much effort. We then repositioned the
container in front of the house and unloaded
everything into our front room and dining room. It
was all rather obnoxious. To think that the people
here have at max what could fit in one box.
Fortunately we were a little consoled that about half
of what was there was for the hospital. We had
received many blessings from many hospitals and
individuals. We made a number of trips into the
hospital with truckloads of things over the next 5
days as we went through things. We are truly blessed.
This helps give us confidence when we still haven’t
caught up on our back salaries yet. We see Gods
blessing and know we will eventually make enough to
pay our workers what is due them. We thank you for
all of your support and prayers. Please keep my truck
papers in your prayers and this will greatly help the
hospital get medicines instead of sending all the
saline and meds on motorcycles (expensive too). Also
remember my ham radio license too. We are a year now
and still do not have it and would love to be sending
emails from home. Until then we do it whenever we get
to Mokolo or Maroua (once every 2-4 weeks). We miss
you all and can’t wait to be back in June for a number
of weeks. Until then… In His Service, Shanks

Cameroon #28 2-18-06
Oh Im glad your back! We had just been on a couple
days of relaxation before Dr. Hamza leaves for good.
We had spent a few days in Rumsiki, an expensive,
beautiful tourist spot a couple hours by motorcycle
from here. Dr. Hamza came by to get me. The power
was out but someone had come in with a stab wound to
the right abdomen with intestines hanging out. He
needed to be operated on. So I grabbed my flashlight
and headed for the hospital. We still have no way to
start the generator and wait for our container for a
possible solution, so it would be done again by
flashlight. At least it’s better at night because my
eyes adjust to the darkness and then the flashlight in
the surgery seems bright. If it’s during the day it
seems very dim as some light enteres the windows of
the operating room but leaves the insides of the
patient to dark to operate. When I examined the
patient, I found a hole in his right side and large
intestine sticking out. He had fought with someone
over a girl and was drunk with millet wine. Drunks
are hard to operate on generally. They either take
very little anesthesia or a WHOLE LOT! He was as most
in the WHOLE LOT group. We gave him the Ketamine and
Valium and gave more and more then finally we were
able to start. Fortunately our electricity had not
been out so long that our water was gone, so I was
able to scrub properly. I operated with the help of
Dr. Hamza. We found a near transection of the large
intestine and seven other holes. The small intestine
also had a couple holes to fix. It took us 5 hours
with hand suturing each hole. Then we brought out a
proximal ostomy (an area where the intestinal contents
empty out on the abdomen). This is my first ostomy
here. I don’t know how it will be received overall.
They will not be able to afford ostomy bags for three
months while I wait to repair this with another
surgery. So he will have to devise some other method
of dealing with constant drainage on his abdomen. We
also have a very limited supply of these anyway. Not
something we can buy, only something that was donated
a long time ago. So about 4AM we finished. He is
stable so far. I am praying he doesn’t have any
problems with the repair that I did.
As I mentioned above the other doctor who has helped
us is leaving now. Today was his last day. We will
greatly miss him. He has great patient care and
interactions with the hospital workers. He is moved
by the government to another place for payback for his
education for 10 years. We will then be on our own.
24/7/365. Please pray for our stamina and also that
we are able to teach the workers as to be able to
leave them for a day or two with good results so we
can have a break at times. We know we are where God
wants us to be and also that He will give us the
stamina to work. Please continue to keep us in your
prayers. Also I again want to thank you who are
donating to the Hospital. We are in the process of
getting a dermatome that will help with skin grafting
the burn patients. Hopefully we will get this out to
us soon. Thank you all!
In His Service, Shanks

Shanksteps

Marie, age 14, was in a coma when her parents brought
her into the Koza ER. They said that she had only
been sick for 2 days. She had complained of headache
and nausea and they had given her some type of
traditional medicine. By the time she arrived at the
ER she had already had 4 or 5 seizures. As this is
the season for meningitis, a spinal tap was done,
which revealed pus in the spinal fluid. She was
started on high dose antibiotics. I saw her the
following morning, still in a coma. She had been
convulsing on and off all night, but the nurse hadn’t
called any of the doctor’s to see her. Her father had
smeared some type of traditional anti-seizure root all
over her face, lips, eyes, ears and who knows where
else. I gave her a full exam and was very troubled to
find that the pupil in her right eye had no response
to light, and that her right eye didn’t seem to move
at all. The pupil in her left eye was sluggish. I
was very worried that at best she would lose sight in
the right eye; at worst she would die or be severely
brain damaged. When I looked at her parents my heart
sank. They had just lost a child last month at the
hospital after a long hospital stay. They had no more
money and were very discouraged. When faced with the
possibility of a large hospital bill again, the father
decided to take her home to die. I was very upset, as
this family had done everything possible for their
little son in December, and I could feel their
anguish. I immediately got on my knees with the nurse
next to me and prayed for this family; for the child;
for healing; for miracles; for understanding and
wisdom; for patience. The family decided to let her
stay one more day.
The next morning before rounds, my nurse and I prayed
for all of the patients, and especially for the
families to understand what we are trying to do, and
that they would all see the love of Christ in us.
When we got to Marie, her father didn’t even argue
about continuing medications or staying in the
hospital. He was obviously discouraged, but willing
to continue care and prayer. Again I prayed for
miraculous healing. The following day (after first
praying with my nurse – we have decided that it is
crucial before starting rounds) when we got to Marie,
she had started moving her arms and legs, but had not
yet woken up. On day 4 she was awake, but immediately
I realized that she had serious problems with her
right eye (by now she had some reaction of the pupil,
but very irregular). She would look around but her
right eye would not move at all. I did a fundoscopic
exam (to look at the retina) and saw that 2 of her 4
arteries had no blood in them, and a 3rd had very
little. I was sure that she had lost sight in this
eye. In addition, she still had no movement of her
right eye. She also had not yet started talking.
During the next several days the nurse and I prayed
with her every morning for a miraculous healing.
After one week in the hospital, she was finally
responding to people around her. I checked her vision
and she was completely blind in the right eye. Every
day I checked her vision and did a neurologic exam.
Several days later I noticed that her eye had started
to move. She was able to see shadows and grab at very
large objects. After two weeks in the hospital she
was off IV antibiotics and outside walking around,
although with limited vision in her right eye. Her
parents realized that a miracle had taken place in
their daughter, not only for her life, but also in her
vision. By discharge she was able to grab items the
size of a flashlight (only using her right eye). When
I looked at her retina, I was able to see all four
retinal arteries and veins – and they all looked
normal!
That is not the end of the miracle though. Unlike
other “bush” hospitals, we will admit patients without
prepaying their bill, but we do require them to remain
with us until their bill is paid. I spoke with our
chaplain about the difficulty this family was facing
after the last hospital bill and a fund was set up
with the hospital employees to financially help this
family. They were able to leave the hospital debt
free after we set up this fund. We are hoping that
once the hospital is running well that we can start a
real fund for patients with great financial need. (We
would gladly accept donations for this fund as well…)
But the story doesn’t end there. Several weeks ago I
saw Marie on a follow-up visit. She is back in
school, not having any learning difficulty. I did a
full neurologic exam on her and she has NO deficits.
Her eyesight is 20/20 in both eyes and her retinal
exam is completely normal!!! The ONLY way I can
explain what I have seen is by God’s miraculous
healing. Fortunately the family also agrees with this
conclusion.
Since the time that this took place we have
experienced a meningitis epidemic. The nurses here
say that they haven’t seen anything like this for 20
years or more. We have had 15 admissions of children
with meningococcal meningitis over the past 2 weeks.
They are all from the same village and same school.
Unfortunately for every child that is brought into the
hospital, I am sure there are several others that die
at home. We have had 2 deaths from meningitis
(unfortunately from the same family) but I believe now
after having all the information that the deaths were
probably caused more by the abundance of traditional
medications given to the children before bringing them
into the hospital. Both were already in a coma by the
time they reached us.
Another hazard has also been brought to my attention
recently. A 7-year-old girl was brought in with
meningitis last week with extreme irritability. She
(like Marie) had no response in one pupil and no
movement of the eye. I discovered from her family
that when she first complained of a headache that they
went to the local market (the guy on the bike) to
purchase something for headache. There is now in our
market a pill made in Nigeria that is sold for
“extreme headache”. This pill consists of Tylenol
500mg (adult dose) and cocaine (unknown amount). She
was given several “doses” of this in addition to
regular adult strength Tylenol prior to admission. To
make matters worse, she drinks wine on a daily basis.
I was very, very worried about here. I left her
bedside at 3am and when I got home I realized that I
had forgotten to pray with her. So, I prayed all
night for her. I woke up every 30 minutes or so and
prayed and prayed. When I came in the next morning
and looked in the emergency room where I had left her,
the bed was empty. My heart sank. I asked the nurse
who had been on what happened, obviously thinking the
worst. He explained that early in the morning she sat
up, started talking and asking for food. She had
already eaten breakfast and been moved to the
pediatric ward. She too has full vision!!! God is in
the miracle business here. Please pray for miracles-
healing both physical and spiritual. Pray that this
epidemic will stop without more loss of life. Please
pray for the health of our nurses and ourselves as we
are in contact with many very sick people. Prayer is
an incredible privilege that God has given us to talk
to Him directly.
In His Incredible Service,
Aud, Greg, and Sarah

Dear Family and Friends,
What a last few weeks this has been. I am reminded
of a verse in Psalms 34:19 which says “Many are the
afflictions of the righteous, But the Lord delivers
him out of them all.” Well I’m not very righteous but
it seemed to fit.
Our Cameroon Visas were 6 month visas and ran out
Jan. 20th. So about a month ago they started working
on our resident permits in Yaounde (the capital).
Well come about Jan 10th it was still not going real
well. They were having some difficulties. Then they
decided we could do it up here in the north. So we
went to the chief of immigrations office. Well he
said we needed a work contract signed by the minister
of employment (which usually takes about a month). We
were told this the 18th, two days before the deadline.
And just as we were going in that day we heard him
tell another missionary he had to be out of the
country tomorrow. I think this is true, technically,
but they are searching for a bribe and it is easy to
get an extension then to stay in the country while
other paperwork is being done. So we were worried.
We called down to Yaounde to church headquarters and
they immediately got on it. It was a total answer to
prayer when that night we had a faxed copy of the work
contract signed by him (one day).
So we arrived in the immigration office the next day
and unfortunately gave the paper to the secretary.
She was not at all thrilled because she thought a
bribe was coming. So she outright asked for one.
English translation “So, what will you give me to
drink?” I acted as if I didn’t hear her and continued
on. Then she told us to wait. The chief was just
replaced that day and we didn’t know what he looked
like. So he ended up leaving to a meeting right past
us and we didn’t know it. So then she came out and
said he was at a meeting and we would have to come
back later. We asked her when. She said she didn’t
know. Then I asked her when would I get the visa
done. She said, “I guess that depends on me!”
Nothing subtle there! So we waited a few hours. Then
they told us to come back in three days. So we went
back in three days, traveling without any papers, and
they said “Oh he was just called to Yaounde and is not
here.” Finally I convinced one of them to give me
their number to call them. Finally, two days ago I
called and he said to call yesterday. Well I had a
feeling that he was back so we went in. Sure enough
he was, we could see his car. So we meet with the
secretary and he signed some papers for us to go to
get our pictures taken and pay an equivalent of about
$300. When we got back he was gone. The people in
our office told her in another language to sign them
and help us but she refused because we had not paid
her off and she was mad at us. So she told us we had
to come back today. So we stayed the night near
there.
Today we went back and as we arrived they had just
started a 30 min meeting. Well about 4 hours later
they were done. Fortunately the chief was there
again. She had us wait some more. Then as the Chief
came out she hurriedly called us into her office. She
had already had the papers signed before but was just
making us wait. We eventually got the papers we
needed. And as leaving we finally meet the chief. I
believe she was trying to keep us from meeting him as
that would take away any chance of a bribe for her.
Well he found out I was a physician and asked if I
would consult him. I said I would and plan on being
back there next week to meet him. I hope this starts
a good working relationship.
So unfortunately corruption is very obvious in many
parts here. Please pray for our continued patience
and to know what to do in these situations. We thank
God our paperwork is done for now.
In His Service, Shanks