MissionDocs.org

Shanksteps – Fasting
I had just finished a book by Paston Jentezen Franklin on fasting that morning.  In it he discussed how the Bible encourages us to fast to become closer to God.  I had decided earlier that week to start a fast, and was now on my seventh day without food, only taking water and juice.  It really did make me more “tuned in” to the things of God.  Greg and I woke up early that Wednesday morning because he had to leave to go to Maroua to attend a two day meeting for all the directors of the hospitals in the North of Cameroon.  After he left, I read, and had my worship and prayer time.  During that time I had a “feeling” that a woman would come in that day in need of a C-section.  Now, I want you to realize that that has been one of my biggest fears since arriving in Cameroon; for a pregnant woman to come in distress in need of surgery, and Greg be gone.  I had scrubbed on many c-sections in residency for this very purpose, but had never before needed to do one on my own – as I always “consulted the surgeon” when cases came in needing surgery.  So, that morning, I told God that if He did indeed send someone my way, I would just trust in Him.
The day started like any other, with lots of kids to see.  Fortunately, many of the kids had gotten better and I was able to discharge a bunch of them.  I saw several people in clinic after finishing rounds on the rest of the hospital.  All in all, everything had gone really smoothly.  Right up to the point where the guard for the hospital came and said that he needed the key to the operating room.  I asked him why he would need the key to the OR, but not the doctor, and he replied, “Oh, they need you there as well!”  So, I went, not having any idea where the keys to the OR were.  What I found in the delivery room was a woman who had just delivered a live baby girl, but the hand of the second twin was protruding from the vagina along with the umbilical cord of the first twin –  the second twin was TRANSVERSE!  I called Greg and told him to pray. There was no way of delivering this child vaginally, so we quickly wheeled her to the OR (through the nurses call room – as I still couldn’t find the key).  Just as we got her on the table, Ganava came to assist me (he also had the key to the suture closet).  Kalda gave her Ketamine anesthesia as there wasn’t even enough time to get sufficient fluid in her to do a spinal. As we were getting her prepped, I noticed that she already had a vertical C-section scar.  “Oh great!” I thought, she’s going to be all scarred down, and I’ve never opened vertically.  I called Greg a second time and he said to go in through the old scar and walked me through what to do, and again said he would pray.  We prepped the woman, I said a prayer that God would get us through this ordeal, and started.  I won’t give you all the details, just that EVERYTHING was scarred together.  It was difficult to identify any normal layers.  The uterus, which is usually paper thin, was already contracting after delivery of the first twin, and was almost 2cm thick.  Even after doing many c-sections in residency, I NEVER was allowed to open the uterus (legal reasons), so this was my first time.  I wrestled with my hand inside a contracting uterus, trying desperately to get the baby out.  Finally I could feel it coming, a boy!  A boy that was not breathing and floppy.  I sucked out the mouth and nose, and stimulated the child until I thought I might rub his skin raw.  Finally, the sound every OB enjoys hearing, a cry!  I passed him off to Kalda to clean him up and weigh him.  Now I had to deal with a very thick bleeding uterus.  I put ring forceps all around the edge and did my best to close up the uterus, suturing through as much thickness as I could, realizing after closing the gaping hole in the uterus, that I would need to do a second later to include the true full thickness. Finally all the bleeding stopped.  I then tried to approximate the fascia, but it was almost impossible to identify the layers with all the scarring.  After checking and re-checking, I was finally satisfied with the closure.  Finally, Ganava said he would close the skin for me, and I could write the orders and the procedure note.
When I finally got home, I was more tired than I can remember being in a long time.  I was also very hungry.  I spent a long time in prayer and thanksgiving to God, then ended my fast, on my 8th wedding anniversary, alone, but more at peace than I could remember being in a long time.  I thank God that He once again “gently” showed me who was in control.  Thank you all for your continued prayers for us and the people of Koza. -Audrey

I want to thank all of you for praying for us.  The passports were retrieved the day before we left and sent to Maroua.  As we traveled through Maroua we retrieved them and continued on to Chad to leave.    Thank you so much for your prayers.  Greg

Shanksteps #107
I’m being shaken awake by my wife. “Wake up, get up”.  It was 11PM.  I had just fallen into a deep sleep.  i hadn’t heard the knock on the window.  She had, and had gone into the hospital, finding a 10 month old who’s breathing could be heard outside the building.  “Come in to the hospital, I think we need to do a tracheostomy”.  Well that got my attention.  I don’t have equipment for tracheostomies except a few sizes in adults.  This was a 10 months old.  She had apparently taken some rice grains
and tried to eat them but inhaled them instead, five days before.  Since that moment she had breathed terribly and now was much worse. I crawl into cloths acceptable for the hospital and walk into the ER with Audrey. A small girl is breathing about 50 times a minute.  At every breath her small chest is retracting and all extra musculature is helping her to breath making a LOUD wheezing sound at each shallow breath.  she will not last long like this, I agreed.  It IS necessary.  We had been up since
three the previous morning and were still groggy.  We quickly took him off oxygen and headed to the OR calling for the nurse to come do the Ketamine anesthesia.  She dropped her oxygen rapidly during the transfer to the next building.  The oxygen was replaced and the respirations again dropped from 70 to 50 (a slight improvement, but still very bad).  I selected an endotrachial tube to modify and place as a tracheostomy.  The girls neck was opened above the sternum.  We slowly dissected down, attempting
to make this as bloodless as possible, so as not to drowned the trachea when we opened it.  We made a “U” shaped incision in the trachea.  Immediately, extensive coughing produced a significant volume of pus from the lungs.  After suturing the tracheostomy open I performed a bronchoscopy.  I aspirated pus from both lung bronchi.  then I scoped upwards. It was difficult to see but something moved.  Afterwards I examined the larynx.  There lay a dislodged piece of rice.  Everything was very inflammed
and edematous.  I placed the modified tracheostomy tube into the trachea and sutured it in place.  She was breathing normally at 16 breaths a minute.

After finishing my notes and placing the patient in her room with oxygen I headed towards home.  I fell asleep dreaming of having a respiratory therapist.  One and a half hours later I was awakened by “the knock”. She was breathing difficultly.  I ran in, finding that the tube was nearly plugged with dried secretions.  I suctioned them and she started breathing better.  I told the nurse that if she was breathing badly or desaturating to call me.  OR if it completely plugged and the patient was dying
to cut the sutures and remove the tube.  I was called an hour later.  It was plugged and he had cut the suture and pulled it out.  I arrived to her breathing calmly without a tube.

Today was Sabbath and I have spent much of the day worrying about her and making sure this stays open.  i pray that the swelling in her throat will go down rapidly so she can breath normally from above again.  I’ve tried to sleep but it would not come.  Wasted but unable to sleep, I continue to think of her.  Lord help her live!  In His Service, Greg

Hello all,
I am just sending a short note to request your prayers.  We are traveling to Boston for a surgical conference in 4 days and our Passports have been stuck in Chad for the last nearly 4 weeks.  Please pray that we get them soon so we can travel as planned.  Thanks, Greg Shank

Hernia’s are nothing new.  I do them a little different here than in the US but the result is the same… No more bulging scrotum, No more incarcerated or strangulated bowel, less pain after healing.
I open the skin with the scalpel, control bleeding with electrocautery.  Divide the external oblique fascia.  Then search for the hernia sac.  Today it was very large on the left and smaller on the right.  I dissect it out from the rest of the testicular cord structures.  I open it, then twisting it at the base tie it off.  I place a piece of local mesh into the hole and place a patch of the same as a reinforcement.  I tack it in place.  As I start the left side I hear a commotion.  I ask Ganava to go out and check what’s going on.  He leaves, leaving Lauren to watch the patient and keep him asleep for me.  I am scrubbed for the first time with Allison.  She wants to learn but has no experience, it’s slow at the start.  Ganava comes back and says there is a woman there with a child that is breech (buttocks presenting first) and she’s pushing.  I ask them to call Audrey to evaluate the patient.  She needs a C-section.  I try to hurry.  Audrey pokes her head into the operating room and asks me if I want her to close this patient or start the spinal on the woman that needs a C-section.  Ganava rushs off to start an IV.  I am able to finish quickly and decide to use one of my seldom used staplers, to close skin quickly.  Ganava takes care of dressings and wheels the patient off to their room.
In the other room two feet are protruding from the vagina.  She is prepped and sitting on the feet so I can do a spinal.  I jokingly ask if the babies feet are OK with mother sitting on them.  I ease the needle into her back, clear spinal fluid flows out.  The spinal medication given I quickly lay her back and position the table.  Audrey and I scrub quickly.  Kalda preps and drapes the patient.  I sweep across her abdomen with the blade and her skin lays open.   The fascia is opened.  The bladder held down and the uterus opened.  Meconium (baby’s poop from distress) gushes out, blood is flowing.  I struggle to get the babies feet up to the incision.  Finally one releases after the other.   I pull him down.  The head is stuck.  I twist and the head pops out.  Thick, brown meconium sliming his face.  I suction frantically before he takes his first breath.  He takes a half breath.  He’s blue and floppy.  I suction, rub, tap and encourage him to breath.  Praying that he hasn’t already blocked his airway with meconium.  Finally he takes a big breath, then another.  I rub some more.  He starts to cry.  I am relieved!  I hand baby off to Kalda and continue working on the mother.  The uterus is closed and finally stops bleeding.  Sequential layers are closed as usual.  Audrey and I are happy to have a live baby, and so is the mother, who starts having shaking chills.  Her temperature at the start of surgery was 104”F.  Our medication is finally working and it’s coming down.  We start treatment for malaria and will check the malaria smear in the morning.  We head home to rehydrate after a full day.  Praise God for Life, Greg

Shanksteps – Habiba #105

Like many of the women here, Habiba delivered her baby at home.   Fortunately she didn’t have any problems during the delivery, and the baby was born healthy.   For about a week before having her baby, she had been having bloody diarrhea at home.  She finally decided to come to the hospital a couple of days after delivery to get checked out.  She was found to have dysentery and started on treatment.  After several days of being in the hospital she was still having diarrhea, but now was also found
to be anemic.  Her family donated a sac of blood for her.  We arrived from the US one or two days after she was transfused.  She continued to have bloody diarrhea, abdominal pain, and was still very short on blood. Now though, she was also vomiting and not able to keep food or her medications down.  Greg realized that she was also bleeding vaginally and performed a curettage.  She was transfused a second time and seemed to do better.  Several days passed and she wanted to go home, so Greg discharged
her.
Three days later, she returned to the hospital with the same symptoms; bloody diarrhea, abdominal pain, vomiting, and anemia.  She was transfused a third time and started on a different set of antibiotics. She perked up for a day, but was then very pale again.  After the fourth transfusion, I started to think that there was more to this sickness than just the obvious physical ailments.  I found out that her mother wanted to take her home so that that whole side of the family could perform sacrifices
to their idols and call on their sorcerer.  Her husband (a wonderful Christian man) wanted her to remain at the hospital and asked if we would pray for him to stay strong for her.  He said that if he told the family that he didn’t want them to take her home, that they would tell everyone that he had abandoned her, and that he didn’t want what was best for her.  So we prayed for his strength, for her healing, and for the right decision to be made.  She was allowed to stay, but I realized that there
was very serious spiritual warfare going on.  I heard that same day that the belief within the family was that she had been “spiritually taken captive and was being held in chains in the devil’s heaven.”
If you don’t remember what the “devil’s heaven” is from previous stories, I’ll give you a brief review.  The Mafa people believe that god (small g) is the one that brings both good and bad on people.  You have to keep this god happy or something bad will happen to you or your family.  (Even most Christians and Muslims believe this way about the Mafa god; even if they say that they believe in the God of the universe.)  The Mafa people also believe that there is a second heaven (also called the devil’s
heaven) where only the sorcerers can go.  They believe that it is a real place, set up like a market, where sorcerers can buy and sell anything, even intelligence, sickness, death, and longevity.  If someone goes uninvited, or doesn’t do the correct sacrifice; or if a sorcerer is “employed” to capture someone, that person will remain in chains in the “devil’s heaven” until a sufficient sacrifice is made.    When anyone is a spiritual captive in the devil’s heaven, it is manifested as sickness, even
to the point of death, in “our world”. This is what was believed to be going on with her.
As is our norm, Eliza and I had been praying for and with Habiba and her husband every day since she arrived on our ward.  I realized that this was going to take more spiritual “fire-power” than just a simple prayer. So, I asked all of the workers who had the desire, to come and pray for her in a group.  We surrounded her, laid hands on her and prayed. We prayed for healing; for faith; for comfort; for her husband; and for the bondage of Satan to be broken.  We commanded the bad spirits to leave
her body, and for her to be restored to complete health.  As is normal for Americans, I wanted to see an instantaneous change in her – which didn’t come.
However, when I went to see Habiba the following day, she was a different woman.  She was eating, had no more bleeding, there were no signs of the anemia that had plagued her for days, and most amazing was the smile that was on her face.  She continued to stay at the hospital for the next week, mostly to be ministered to.  She was afraid that when she left the hospital that her problems would just reemerge.  She and her husband finally set a discharge date.  Her one request was that we all come as
a group to have one last prayer with her and her husband.  So, about 15 of us went and prayed for Habiba, her continued healing, and most importantly her continued faith.
I have since heard that she did not go home to the village of her parents, but to the house of one of our church elders for continued spiritual mentoring.  Our chaplain visits her once a week as well to see how she is doing.
We thank God for His healing power.  We thank the willingness of our workers to lay out their hearts in prayer for this tormented woman.  We thank you readers for continued prayers for our little hospital, which we hope will be a light in the darkness here.
In His Grasp,  Audrey (for the Cameroun Shanks)

Shanksteps #104
I went to bed at 10PM after playing some games with the student missionaries.  We splurged with brownies from a box and Kool-Aid.  Knowing today was going to be a “day off” I planned on sleeping in.  I awoke at 6AM as usual, wide awake and couldn’t get myself to sleep in.  It was finally a cloudy day and cooler than it has been.  I made a cup of chocolate with local chocolate powder then went outside to read for my personal worship.  Mosquitoes and wood bees keep me company while I read.  Up high
in the trees dragon flies fly around looking for insects.  I have a peaceful worship then decide to eat breakfast.  That consists of bouille (local porridge made of rice, flour, sugar, and a dash of lemon) and toast (made of white flour and millet flour).  I then go out to take apart my motorcycle carburetor because it has been choking and coughing for the last few days and new gas didn’t seem to do the trick.  I take it all apart and see all kinds of sediment in the bottom.  After cleaning this,
Im replacing it when the nurse from the hospital comes by.  He wants me to see a patient in maternity that has been in labor since yesterday evening, and has stopped progressing.  I finished putting the motorcycle together, and rode it into the hospital.
I find a woman on the bed who is thin and short.  After examining her, I find the pelvis is small and the child has not really descended much at all.  I decided she needed a cesarean (operation) to deliver the baby.  The husband agrees wanting the best for the baby.  I nearly gape in surprise!  This is the first time I have heard a father say that here.  I assure him I think it’s necessary and we will do our best and ask God to be in control.
I slide the knife blade into the handle and after prayer slice open the abdomen.  She bleeds and I control this with electrocautery.  Through the fascia, muscles and peritoneum.  A transverse incision in the uterus.  The baby is hard to get out.  The head is there but it’s not coming.  I ask for forceps and pull it through the incision with them.  He is floppy and blue.  I ruff him up, drying vigorously, the nurse prepares the oxygen concentrator to give oxygen to him.  He finally starts breathing
then yells for all he’s worth.  He’s ALIVE!  I breathe a sigh of relief and thank God for a live baby.  I sew up the uterus, fascia and skin.  I want to escape home but the other nurses have a couple patients for me to see.
One elderly man came in with red urine.  The nurse put a Foley (urine catheter) in him and didn’t get much so took it out.  I feel his abdomen and his bladder is up to his umbilicus.  His is full to overflowing!  Red blood is coming out his penis.  I think the nurse blew up the balloon below the prostate and ruptured the urethra.  With difficulty I put in another Foley and get about 400 ml dark red blood/ “urine”.  He needs a cystoscopy but we don’t have it.  I give him Vit K, to ensure he has part
of the things necessary to clot.  The nurse had already given him Diclofinac which affects the platelets and inhibits clotting.
The other one was a 6 month old chunky boy with meningitis.  He had been convulsing all night.  I had given him the maximum of Phenobarbital without success.  This morning he had finally stopped and even had some breast milk.  His IV had come out for the 4th time.  Yes you DO need to replace it.  He still needs IV antibiotics and treatment for concomitant malaria.
I am finally headed home.  Our helper has made eggplant peanut butter sauce(affectionately know as “acid”.).  I choke it down and take the motorcycle for  a longer ride to ensure it’s working well.  When I get back we head for a hike up the Mawa Mountain.  It goes well but we reach the 2500 ft summit after bushwhacking a path straight up the side to the top.  It is near dark and we’ve been walking for nearly 2 hours.  We start scrambling back down and choose a nearly vertical route.  We stumble,
skid and fall to the bottom and arrive at the village after dark.  I’m exhausted.  We head home.  I check on those same two patients.  They are doing a little better.  I head home for more “acid”.  It is raining and I arrive soaked, thankful to finally be cold once again.  Im falling asleep as I write this and will hit the sack.  Good,  busy day
In His Service, Greg

Here is a message sent out by one of our student missionaries I have the permission to forward on.  It will give you a new perspective on Koza.  We will periodically send some of their messages on.  Enjoy:

Hello!A busy week has gone by. Two Sabbaths ago Mary-cecille, a women from the south preached. The south is known as being more liberal and she has a good husband which allowed her to speak so freely. She preached on how men should not beat their wives and how God had made woman to be man’s helper not his slave! Dr. Shank was translating for us and the next week when the men had the podium again a rebuttal was given. The sermon opened with the verse about it being “better to live in the desert than
live
with a quarrelsome wife”. It is so strange to hear them preaching on issues like beating your wife. This last week was about not using the traditional healers. The sermon topics here deal with issues that are so foreign to me. The people here in Koza are saturated in tradition. The local medicine man is still visited. A sorcerer lives up in the hills and still makes sacrifices, while fishing around in the goat’s guts so as to foretell some event. That’s a bit scary. Most of the people here in
Koza are farmers. If they do happen to get an education there are no job openings for them and when they come back home many go back to the fields. So why go to school? This past week I’ve been working in the emergency room with Kalda, one of the few nurses that speak English, he has been so good about teaching me. I’ve given several depo shot’s (birth control) and wish that I could give out much more. But being fertile here and having many children is almost a sign of wealth. As well as since many
men take more than one wife the woman who has the most children is presumed to be the preferred wife. Well I don’t want to overload you with too much info and I know that life back home tends to be busy so I’ll try to make this a shorter than my last email…But I just have to tell you one more story…Ok, one last story. I just have to share! So last week a woman came in to give birth and Lauren and I got to get in on it. After walking into the room the nurse Ganava handed Lauren the sterile gloves
and said “Do you want to catch the baby?” “umm ok” say’s Lauren a little timidly as she explains she’s never done this before. With a couple quick instructions about grabbing the head and neck “c’est comment ca” which means “It’s like this” if your talking French. Ganava say’s this all while illustrating with his hands how to catch a baby. Lesson’s over the baby’s almost crowing. I’m standing there holding the clamps and scissors all ready to cut the cord when all of a sudden this huge gush of water

projects from this woman’s vagina, spraying all over me as it hits the wall behind me! I hadn’t understood when Ganava has said the BOW’s hadn’t broken… I really need to learn French! So, after Lauren grabs the baby and I cut the cord, we suction out his nose and mouth and wipe him off before weighing him. As they’re weighing the baby I start doing fundal massages to help the placenta come out. Remembering that the birth of the placenta can be a bloody mess I stand at the woman’s side as I continue
to massage her fundus…again not knowing French… Ganava tells the woman to push and with a huge surge of energy, from a woman who has just given birth, the placenta comes flying out in a surge of blood that fly over the woman’s leg and all over my arm in a warm bloody mess!! Did I mention the last time I was helping during a delivery I got barfed on… yeah, just my luck always at the wrong place at the wrong time. I’m never helping again during labor unless I have a full body suit!!! Well I guess that’s
all for now! Just remember birth is bloody. I’ll let you know some more disturbing stories next time. Till then S.