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Shanksteps #94

How strong are your beliefs and what are you willing to give up to keep them? A young man came by the house today. And is often the case I first think who is it? If it is someone I don’t recognize I think what do they want. Often its to ask for something. Seeing someone who I didn’t know I asked what they needed. His was a request.
He is in University a full days travel away. He was brought up in a family of animists. While he was young his father didn’t take care of his family or make sure they could go to school. Everyone was for themselves. He made it to high school with the help of other family members. In grade school his father decided to become a Christian and got rid of his extra wives and their children. (Doesn’t seem entirely Christ-like to me) So since that time he has essentially had no father. A few years
ago a Peace Corps worker was here and he helped her a lot and she subsequently helped him get a small plot of land to have a house here in Koza. She has also helped him with part of the schooling for going to University. He has strong beliefs. He is a Seventh-day Adventist. Since he takes his beliefs seriously he has chosen not to go to classes or tests on Saturday, but preserves it as a day holy to God. His first year in University he was able to pass ten out of twelve credits. The two he
failed because he failed to attend the final tests which were on Saturday. The school advanced 160 students of the 400 of the first year. He was also advanced. Now in the second year he is nearing the end and has found out that five of his 13 credits are testing on the Sabbath. So he feels he will not pass this year. When I asked him how many others are in the same situation he said one other. He said most other Christians trample their beliefs while at school, whether it be Sabbath observance
for Adventists, or sexual promiscuity for others, or alcoholism for still others. Sounds similar to many Christians in the US Universities doesn’t it?
He came to see if there was any way I could help him go to a Christian school that did not require activities on Saturday. He said this school generally costs 1.2 million CFA ($2800) to attend per year. 750,000 for tuition, and the rest for rent, food and other living expenses. He thinks he can do it for 1 million CFA. He gets 400000CFA help from his friend, could get 100000 from a younger brother and is asking for help of 250000 a year for three years. This would cover his tuition. He will
work locally to cover lodging and living expenses. All of this to keep his beliefs. How strong are your beliefs? Are you willing to give up critical things in your life for your beliefs.
I hope this story encourages you in your beliefs that those who are following God need to always be firm in the time of temptation to fall to the easy way or to rationalize away your conscious. If any of you are interested in helping a young man please let me know.
In His Service, Greg

He was born this morning. He has six toes on each foot, six fingers on each hand. Short stubby ears, and a wrinkled forehead. He weighs 1.6kg (3.5 lbs). His parents said he was term but that’s not likely. His heart and lungs sounded normal. He was crying and had a cleft lip and palate. But the biggest problem lies at his umbilicus. There was a 3cm wide hole with all of his bowels laying on the table beside him (gastroschisis). [It is an abdominal wall defect that has 14% associated jejunaland ileal malformations, 4% have other malformations, 60% are premature, and there seems to be no associated genetic factors.] Only the grandfather and some other relatives were there. The mother was to weak to come to the hospital they said. The father was away in another village, and didn’t know he had a new baby. I explained to the grandfather that survival was unlikely but that surgery was his only option. We took the child to the operating room. He was making stool, which made me slightly hopeful. Our student missionary and I were able to take all of the edematous bowl and put it back inside. We sweated profuselyas we attempted to do the repair without air-conditioning because the child was already cold. It was 107deg F outside, and just as hot inside, with our gowns on. We have no warming apparatus in the OR. During the surgery the child vomited and desaturated (dropped his oxygen) and I had to unscrub to help the nurse bag the patient. He was not able to raise the saturation. After 30 minutes he was stable enough on max oxygen for me to reenter the operation. We finished the operation and he wasbreathing on the maximum oxygen that we could give (5L NC). We put him in the incubator donated by Parkveiw hospital and warmed him up. He would periodically stop breathing and we would have to bag him up again. We started another operation, a hysterectomy for uterine prolapse, and observed the baby in the OR while we did it. A few hours later after seeing clinic patients a man came in who was stabbed in his left upper abdomen and had omentum hanging out. Blood oozed from his side and he was drunk and talking profusely. He referred to me as a priest and explained he was stabbed with his own knife he was carrying. As we went to start his operation the baby desaturated again and I had to go between roomsto help him. Then the power cut off. We operated in the dark by headlamp donated by the head of surgery at the end of my residency. I could hear the monitor going off because of the low oxygen but could do nothing about it. They went to find someone to start the generator. Finally the generator was started about 5 minutes later and the oxygen for the baby was in single digits (normal is >92%). I was concerned then about brain death for the child. We found a spleen laceration in the stab victim,through and through stomach perforation and a liver laceration. We repaired the stomach laceration and repaired his cut rib at the entry site. The baby was being bagged more often with less success, he was wearing out. He needed to be on a ventilator, but that’s not available here. Finally I decided to stop and turn off the generator. It is often very difficult decisions that physicians have to make on a daily basis. Unfortunately many are life and death decisions. I pray daily at the beginning of each rounds, that God gives me the wisdom to treat each patient that I see, and not harm more than help. It is frustrating not to be able to diagnose problems and even more frustrating to know the problem and not have the equipment or staff to do something about it. Another along those lines is that we are having a measles outbreak now as Audrey wrote recently. We are up to 8 cases now. Children that were apparently already vaccinated against it, for the most part. Very contagious and preventable. We are thankful for our health that is holding up in spite of our surroundings. Thanks for all your prayers and emails. They are very encouraging.

Greg

Shanksteps 92

For you medical people out there: What would be your differential diagnosis for an 18 month-old that presents to clinic with conjunctivitis (pink eye), sore throat, and cough?  What if I told you that her dad had been in the hospital about 3 weeks before with similar symptoms and was still not feeling well?  After 2 days this little girl developed what looked like heat rash on her face and trunk.  Of course your initial diagnosis would be to put her in isolation with the Measles.  How many of you
out there have even seen a case of the Measles?  It was a new one to me.  Fortunately (or unfortunately) some of our nurses have seen several Measles epidemics in their lifetimes and recognized it right away.   So, let’s review the fact about Measles.  It is a virus.  There is a great vaccine against it (that this child, and the subsequent 4 kids that came in, all received).  There is no real treatment for it except Vitamin A and tincture of time.  It has a 90% transmission rate to those susceptible
(not vaccinated/not immune).   It is contagious for 2 days before symptoms appear and 4 days after they disappear.  It is a VERY scary disease because there is really nothing that can be done once the symptoms appear.  We now have 4 kids in the hospital from 3 DIFFERENT villages.  The 18 month-old girl died 3 days after arrival.  The country considers it an epidemic if there are only several cases. But in Cameroun, as in most developing countries, it takes a long time to take action – vaccinate the
whole population in order to stop the spread of the disease.  So, we are presenting all of these kids to God for healing, and praying that HE stops the spread of this disease, and protects not only the family members and neighbors, but all of our employees and patients as well. Please pray with us for healing and protection.  We really need your prayers, as this could be devastating for these villages.
May God bless you all with health.
Audrey and the Shanks