MissionDocs.org

9-24-06

Sabbath, our day of rest and communion with God. Well
NOT TODAY!

I woke up in the morning and knew I had a few patients
that I had operated on the last few days and that I
wanted to see how they were doing. So when I woke up
I headed into the hospital. It was about 7:30 and the
workers had just changed shifts. As I checked on them
at maternity, another woman arrived in a pus pus (a
push cart that carries wood, grain sacks, or really
sick patients). I let the nurse figure out the
history while I checked in on the new patients in the
ER. I admitted one 5-year-old boy with malaria and
convulsions at home. Another 3-year-old girl with
convulsions while I was examining her (cerebral
malaria), and another with pneumonia and malaria.
Guess what season it is? Malaria, malaria, malaria!
Then they called me back to check on the woman again
in the delivery room. She had had one child at home
and had another one that wasn’t coming out. When we
examined her we found a hand sticking out of the birth
canal. This usually means the child is lying
transversely and will not come out. She was having
real strong contractions. But with him transverse
there was absolutely NO progression. Also when I
examined here I could not figure out the presenting
part next to the arm bulging out with it. I decided
to try an internal version. The is almost never
successful because the uterus is contracted and the
child cannot move. Fortunately I knew by now that
there was no heartbeat and we would have a stillborn.
(after delivering the first at home she went to a
dispensary and they “worked” on her a few hours.)
God really relaxed her uterus and I was able to find
the head and pull it down next to the arm and then was
able to do a forceps delivery of the stillborn.
After finishing that I saw a couple more in the ER
for malaria and for dysentery. Then I went back to
maternity to try to teach a young mother of a
premature 7-month child how to give formula via the
nasogastric tube. I needed the nurse to translate
for me but he had just received another patient who
was having contractions. He said he better stay with
her as it was her 7th child and may be fast. I was
able to find another mother who knew some French to
translate for me. After explaining how to do it I
went back and the other woman had already delivered.
They also showed me another child who had very wide
set eyes and skin very tight all over and nearly no
nares that were open. I mentioned to them that to
save the childs life that we would need to do a
tracheostomy to keep him from aspirating but that I
felt his prognosis was poor. The mother decided to
take him home rather than go the aggressive route.
Very sad but I understand.
I went home as church was ending. Ate some breakfast
and relaxed for about a half hour before being called
back to someone who was bleeding a lot. I went in the
room to find a mom who was pregnant to 6 months with
pools of blood all over the floor and bed. She was
going to die in front of me I was sure! I convinced
the family to be tested for blood and they went off to
call the lab tech. They were able to give one unit
only. She needed more. I went to work on getting
out the already dead child that as I found out was
breach. Since she was almost fully dilated I thought
I would have no problems. I found both feet and
pulled him out. But the head got stuck. Oh it was
terrible. She was bleeding like crazy and I have the
head stuck. After working a long time I finally got
the child out and was able to get the placenta out and
stop the hemorrhage! They had found another person to
donate and we were very happy that her life was saved.
Another one came in just after that for obstruction
of labor. I found out her pelvis was too small for
the child she was trying to deliver. I performed a
symphisiotomy and pulled out a screaming child. This
is a huge relief. Especially after a couple
stillborns.
To finish off the day and kill the night we had been
watching another woman in the ER who I thought might
have pre-eclampsia. This is a disease that the only
help is to deliver the child. She had come in with a
BP of 130/80. This seems normal except everyone here
is much lower. Her pressure came down then went up to
150/90 by evening. She had a hemoglobin of around 5
gm/dl. Normal is about 12-15. So she really needed
blood before we operated on her. So finally another
family member arrived from about 2-hour bike ride away
and she was able to give blood. The woman who had
pre-eclampsia also started to have foot swelling,
headache, epigastric pain, and visual changes. All
signs that convulsions are near. I decided to give my
blood to her also so that we could proceed with the
surgery that she needed, a caesarian delivery. I
gave, and off we went to the operating room. During
the surgery all her bleeding was like running red
water. The child was still born and had been dead for
a while. Just at the end of the surgery her oxygen
saturation dropped. She had crackles over both sides.
She had gone into pulmonary edema. I bagged her with
oxygen, then intubated her. Initially her oxygen came
up to 94% then over the next two hours of bagging it
gradually dropped. Cardiac arrest followed. It was
now 1:30 AM. I was very tired. I saw one more
patient in the urgence (ER) before heading to bed.
We have been praying for our hospital to have more
patients so that we can continue to pay our workers
salaries. God is answering our prayers by bringing
the sick of the surrounding area in. We also thank
you for your prayers. As you saw in my last letter
there are many frustrations. I believe God is helping
us grow. I wonder for what? Please continue to keep
us in your prayers, In His Service, Shanks

“When life gets tough, when you’re overwhelmed with
doubt, or when you wonder if living for Christ is
worth the effort, remember that you are not home yet.
At death you won’t leave home”- you’ll be going home.
p. 51 The Purpose Driven Life by Rick Warren

9-16-06
Dear Family and Friends,
This is a different letter than the past. Today is
Sabbath (Saturday). For those of you who are unaware,
it is the day of rest and communion with God for our
church. A time spent with God and family, with a goal
of drawing closer to God. Today has been very
difficult for me and I, for some reason, feel the need
to share the difficulty.
I am a surgeon; I love surgery and the art of
medicine within the surgical realm. As you have seen
from my past letters I do much more than just surgery.
I feel that surgery is enough for me and it is my
interest. But being here I am the director of the
hospital, surgeon, family practitioner, gynecologist,
respiratory therapist, physical therapist, chief
nurse, and chief of lab, of grounds…and on a larger
scale, a representative of our global church to our
hospital in Northern Cameroon. So being the Director
is not something I’m trained in or have a real
interest in doing. I was well aware that it would be
part of my job here before I came. However having not
been trained in it did not know all that is entailed
in it. (though when God chose our location, I would
not have changed anything). I have a good
administrator who takes care of many problems but
there are still ones that come I need to deal with.
It seems like since I’ve been back that there has been
no lack of problems for me to deal with. This last
week dealing with personnel problems is very tiring
and difficult, and not something I am very good at or
experienced in.
Today as it is Sabbath, and the day I attend church,
I went to church. However the problems of the week
follow me wherever I go. They intrude my thoughts as
I worship God, as I pray, as I work at home or at the
hospital, as I do surgery. Today was like no other in
that regard. At church ,at home, as I read my
uplifting book, these thoughts enter. And questions
start. What decision should be made? What’s best for
the hospital? What will be the workers reactions?
When will I not feel all alone? When will the strife
end? When I awake in the middle of the night, they
start again. When I’m called into the hospital the
same! What would God do in this case? Is there
anything in the Bible that addresses a similar issue?
Then so many are unclear still and I struggle what
should be done.
I am very fortunate to have a woman of God as a wife.
Today she suggested we pray together and ask for Gods
wisdom. No lightning bolt of wisdom hit us but peace
is there. We need to continue turning things over to
Him. This is His hospital, regardless of whether or
not the workers are working for Him or their wallets
or their status.
I guess what I really want and need is an incredible
love for the people. It’s hard to love people who are
difficult. It’s easy to love those who love and
respect us. Very hard to love and minister to those
who do not.
So today and every day that you remember, please pray
for us! Pray that we have understanding, wisdom to
deal with all the situations we are not used to and to
show Gods love even though we do not feel it. Also
that God’s love be put in our hearts that we can do
His will, follow His plan, minister as He would
minister, practice medicine and surgery as He would
practice it, direct the hospital as He would direct
it. Have patience when needed, have tact and firmness
when needed. But most of all as in 1 Corinthians 13
have love! Please pray for us to have LOVE! Please
add us to your prayer chains and your family worships.
We appreciate all that are already praying for and
supporting us. God bless each one of you. God’s
servant, Greg

Shanksteps #44

9-4-06
Please come to the hospital I have a number of
patients for you to see (as translated from French).
It was Sabbath morning and I was trying to sleep in.
I went in to the hospital and found a “few” patients
(nine!) in the ER. This is the season when all the
things from last year, mainly onions and peanuts, are
sold at high prices just before the new crops start to
develop. Onions buy for $14 a large sac and at this
season sell for $40. So this family had sold their
onions this week and had “made” about $2000. Wow that
was impressive! What we suspect is that people
watching these transactions and noted which family
made a large sum of money, then told their Nigerian
friends who came an robbed this family. So the
robbers showed up in a vehicle, shot a gun in the air
to scare all the neighbors from helping, then brutally
beat up the family till they handed over the money.
So they all arrived together, penniless and with many
injuries.
- wife #1 severely beat on head, loosing
consciousness, with multiple cuts from the stick
hitting her head
- wife #2 with the same injuries
- father of house, multiple cuts over head from
beating and cuts on hands from defending himself
against a knife, contusions over shoulders, back,
face, arms
- Son with loss of consciousness from severe blow to
head, I could not determine if he had a skull fracture
or not, seemed to be slow of speech.
- One neighbor had the guts to help, man severely beat
on face with zygomatic arch fractures, as best I could
see on the x-ray- nondisplaced
- Son with contusions over thigh and probable medial
maleolus fracture they refused to let me x-ray.
- worker of family with small finger fracture at base
and contusions everywhere
- worker with facial contusions
- young boy with minor contusions
It took us about 4 hours to suture all the cuts, look
at all the films they allowed us to take, and
prescribe medications.
I went back to the ER to see if there was anything
left to do and two new were in the ER. One was 17 you
girl with an acute abdomen (surgical abdomen). She
had been seen in Maroua and said she had a hernia and
needed surgery but the surgeon left for Yaounde. I
think they have more surgeons there so it not all
clear to me. The other one was an old woman with
complete bowl obstruction for 3 days, also needing
surgery. The younger girl I operated on after getting
something to eat and drink. She had perforated
appendicitis with pus everywhere. Her father is
influential in Mokolo and could give good or bad
publicity for our hospital. After finishing her I saw
a couple more children. One with malaria and
convulsions, and another with dysentery and malaria.
After admitting them I headed for home. I ate supper
and headed to bed. Just after crawling in bed there
was another knock! (Not what I wanted) Audrey was
already asleep so I headed back in. I found another
convulsing child with what I suspected was malaria and
another child who had a cough. Father demanded a shot
of Ampicillin and to go home. Because that always
works for a cough. By then I was not feeling very
amiable so I told him he needed to be admitted because
I thought he had epiglotitis (infection of the throat
and epiglottis) but he refused so I gave him oral
medications and they left. I got home about 3AM and
had difficulty falling asleep. Strange how one can be
so tired and not be able to sleep.
Sunday is our busiest day. We saw a number of
patients in clinic. At about 10 AM I finally
convinced a man to let me do surgery on him. He had
refused for 4 days of complete obstruction. Finally
he felt so bad he let me. He had ruptured
appendicitis and fortunately I only had to take his
appendix. Then the old woman was not being
decompressed with the nasogastric tube so I convinced
her family to let me operate and the government
official of that area agreed to pay. I found a pelvic
tumor blocking the large intestine. It had already
spread so performed an ostomy to relieve her
obstruction. She looks 100 and is very malnourished.
I pray she survives the insult. I finished her about
7PM. I went home and dropped dead from exhaustion.
The first couple weeks we were back things were slow
and now they are picking up. I guess God was giving
us time to get our internal clocks set back to
Cameroon before we picked up a lot of work. We are
thankful for the work as it helps our hospital try to
run in the black. And we thank God we have the energy
to keep up. Please keep us in your prayers as we
serve Him here! Shanks

Shanksteps of faith #42
8-25-06

We’re Back…
It may be hard to believe for those of you who have
traveled in Africa, but we had an essentially
uneventful trip back from the states. As you may
remember, on our first trip here, we missed every
plane, train, automobile, and motorcycle. I think
that God was really pushing for us to get back to Koza
quickly as the hospital went without doctors for
several days. (The couple that replaced us at Koza
were told that they only had one day that they could
fly out of Cameroun or they would have to stay until
September. They chose to leave Koza a couple of days
before we returned so that they would be able to leave
the country.) We left Charleston WV on Aug 11th (the
day after the terrorists were arrested) slightly late
and arrived into Cleveland OH with just enough time to
catch the next flight. (I have to add that we had 8
bags (allowed 6) and they were all overweight, but the
agent never charged us one cent – a miracle in
itself.) We left Cleveland a bit late but arrived in
Newark NJ with just enough time to make the flight.
We were kinda hoping that we wouldn’t make the flight
in Brussels so that we would be “forced” to spend a
couple of days with our good friend Steve in Germany,
but God had other plans. We arrived in Brussels,
deplaned and arrived at the next gate as they were
boarding. We got into Douala, Cameroun at around the
time planned and fortunately there were people from
the church to meet us there. (We did however lose 2
bags, only one of which has been found.) We spent the
night in Douala at a hotel and traveled the next
morning to Yaounde. In Yaounde we found that the
airline we were supposed to take back up north was not
running, and hadn’t been for over a week. The
Kettings (the doctors that replaced us in Koza) faced
the same problem and were forced to travel to Yaounde
by train. So, we were able to spend a day with them,
debriefing. We found that we were not able to catch a
train back up north for 4 days – and were feeling very
frustrated. But, again God is in control. Our
Administrator Yves had traveled to Yaounde with the
Kettings, and he dealt with the people at the train
station all day to get us tickets. At 4:30 on the
14th he called and said, “Get to the train station
quickly, I got us all tickets.” So, we left our
baggage in Yaounde and got on the train. We spent 19
hours on the train, and then 7 hours in a minibus.
The next part of the trip was definitely a miracle
because we really just wanted to get home to Koza, but
there is no transportation at 10:30 at night which is
when we arrived in Maroua. As we were driving into
Maroua, we passed a bush taxi that was headed to
Mokolo. Our driver turned around and flashed down the
taxi. We were able to squish on board to travel the
hour to Mokolo. At 11:30pm in Mokolo we found one
motorcycle driver who was willing to take us the last
1 ∏ hours to Koza. He found two friends. With the
driver, Sarah and me on one moto, Greg and driver on
the 2nd, and Yves and driver on the 3rd, we headed to
Koza. My moto taxi had fuel problems, and only had
lights about half of the way. Greg’s moto got a flat
tire about ≤ of the way there. So, Greg, Yves and the
driver finished the trip on one motorcycle. Sarah,
myself and our driver on the 2nd, and the third driver
limped along with a flat tire. We got to Koza around
12:45 in the rain, and as there are only dirt roads
here it was all mud. I looked over to Greg and Yves,
and they had slid right over and all three and their
baggage were sitting in mud. Fortunately, the mud here
is soft and they were going slowly, so no one was
hurt, only a bit muddy. The three moto drivers spent
the night on our porch to fix their motos in the
morning and then left for home. We were sooooo
thankful to be home. Isaiah and Pierre were both here
to greet us and we stayed up until around 2am talking.
We’re happy to be back but sad to leave our families.
We are extremely grateful to the Kettings for running
the hospital in our absence. Everything was running
smoothly when we returned, and all salaries had been
paid through the worst time of year. (Last year when
we arrived, salaries hadn’t been paid for almost 3
months due to lack of funds.) This in itself is a
miracle, and we have God and the willingness of the
Kettings to thank for that. Thank you all for your
prayers – they are much needed and appreciated. We
love to hear from you. We were hoping that our ham
radio/e-mail would be up by now, but it is not yet
working. We’ll let you know once we get it going.
God Bless,
Aud, Greg, and Sarah Shank

Shanksteps #41

So we are back in Cameroon. We will tell you about
our journey next time.

So what do you think of babies being born in taxies
on the way to the hospital, in ambulances…? Where do
you think a hospital workers wife would deliver?
I was at the front of the hospital when one of the
nurses pushed in a poos-poos. (this is a hand
pushed/pulled cart with two wheels used to carry
anything heavy) He headed for maternity. I called
after him to see if he needed me there. (Normally the
nurses here deliver all children in the hospital
unless there is a complication) He said no things
were fine. I questioned further as I saw a woman in
the cart. This normally means a very, very ill person
because they cannot walk, thus the poos-poos. He
said, no, it was one of the workers wives and she
already delivered. She had gone to visit his home and
the baby “came out”! I guess the cord and placenta
were still there so he was taking her to maternity to
wait for the rest to be done.
After being gone for nearly 2 months Koza is still
the same. Other than coming back to one MAJOR
personnel issue it is nice to be back. We are very
grateful for the octogenarian couple, Drs. Ketting,
who covered the hospital while we were away. All the
staff and population have great respect for both of
them and very much appreciated the work they did here.
Also we are very grateful that the generator is
really fixed this time. Dr. Ketting made it possible
while they were here to obtain a good mechanic from
Maroua and got it fixed. So our generator need is
fixed. He also started a “fuel fund” so that we do
not need to operate or work in the dark. As diesel
fuel is expensive $4/gal. I’m sure we will have many
more dark nights but at least when we need the lab
working or the OR running we will be able to start it
up. I am also very grateful for a gift that was given
to me from my previous surgical director. It is a
rechargeable headlamp that is really bright. If you
surgeons are interested check out www.enovamedical.com
Very good for the mission field. We also want to
thank each of you that have sent donations to my
father or our church. I was able to bring it back to
Koza with me. We have started with replenishing
medications that were low and have started measuring
broken glass windows so as to replace them. This will
diminish risk to patients and us… We thank you so
much for your help to the people of Koza.
For those of you who plan far ahead, we plan on being
back in the US in July and August again next year. We
were very happy to see those of you that we could and
hope to see more next year. Please continue to keep
us in your prayers as we work here for HIM (Christ).
In His Service, Shanks