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Shanksteps – What’s in a name?
I found out the other day that Koza was actually named by a Westerner.  The area all around Koza is mountainous and rocky.  As the story goes, a white man came to this area and pointed to a stone and asked what the Mafa people called it.  They responded, “Kwa.”  Then he pointed to a different stone and asked what that was called. The response was, “Kwa za’a.” meaning another stone. Thus the name Koza was born; simple yet descriptive.
The Muslims here have a few names that are used over and over, such as Aissatou, Fadimatou, or Djaratou for girls; and Amadou or Ibrahim for boys.  I have asked what these names mean, but most just say they are names that they like, are Biblical, or have family members with those names.
If you are a female Christian, most likely your name is Marie. Most of the male Christians have a Mafa name, and a given Christian name like Esaie (Isaiah), Jacques (James), or Jean (John). Unlike other African countries, we don’t see many with names like Joy, Peace, and Patience.
Traditional names almost always have a story behind them. Usually a child is named for what the mother experienced during pregnancy or childbirth.  Often the family will wait for a week or longer before giving a child a name – in case they don’t survive.  One of our nurses tells the story of his name.  Apparently when he was born, he was very small and his father didn’t really want to keep him.  His grandmother rescued him from neglect, and he was given the name Kaotem, meaning “neglected”. Or perhaps
you would like the name Tchougui, which means “irritates the home”.  When I first saw a number of children with the name Bonné, I thought, “That’s nice, they named him/her beautiful.”  Then I found out one day that Bonné in Mafa means “suffering”; possibly named for the experience of childbirth.  Or you could be named Guymatakon meaning “the one who causes suffering”.  In fact, the Mafa tribe used to be called Matakon, which in their language means sickness or suffering. There are in fact many men
here named Matakon.  The name Kaldoussa means “thrown out”.  Dougdje is the name of one of our cleaners; his name means “garbage”.  I think that ZaÏna is a pretty name, but I wouldn’t want to name my child “lost”.  I definitely wouldn’t want to go through life with the name Viché, which means “enter into the ground”.
I guess all of these people are in good company though.  A man in the Bible named Jabez, which means “Child of my pain”, found favor with God.  Jabez called out to God in prayer, asking God to bless him, enlarge his territory, and keep him from pain. “And God granted his request.” (1Chron 4:9, 10).
May we never forget that despite the situation we grew up with, or the name we were given, that God can bless us, and do so abundantly.
In His Mighty Grasp, Audrey

106c

A final update on Fanta, the girl with the tracheostomy.  I took out her
tracheostomy tube a few days ago and she is breathing well and I praise God
for her healing.  Greg

#110 Shanksteps
Today started out as most.  Worship at 7:30; nursing sign-out after that.  I then started rounds as usual.  We were down from 65 to 50 patients.   I rounded quickly and was in the office to see outpatients by 10AM.  I saw about 13 in clinic (including one bitten by a rabid dog) then got called by a place we purchase saline in Maroua.  Ours had come in and they had saved it for me, but they would not any longer.  I had to go to Maroua NOW.   So I left for the three hour drive.   The first segment
is along the “staircase” of rocks between here and Mokolo, then on the “paved road” from Mokolo to Maroua.  I often wonder what the (dollar) toll on the road goes toward.  Well, I don’t really have to wonder, I’m sure there is someone making a killing from it.  I got 52 boxes of glucose saline and returned to Koza.  I got a call from Audrey along the way wondering where I was.  She had two patients waiting for me.  It was 7PM:  We unloaded the truck and put all the items in the stock.  Then on to
the patients.
His abdomen was very distended; eyes were sunken in; he appeared like a starvation victim.  Fluid was dripping into his veins, slowly replenishing days, or weeks of slow dehydration.  I had operated on him two years ago for a mass in his upper abdomen.  He was young, 25ish.  And had a scar from top to bottom along his abdomen and another in his right lower quadrant.  He hadn’t made stool for a day nor gas.  He as very tender all over his abdomen and I felt a fluid wave.  I called Allison and we went
to the operating room.  Opening along the midline we entered the abdomen and found a HUUUGE stomach.  It filled his entire abdomen.  The area where I had attached his intestine to his stomach before had scarred with a band across the area kinking off the outlet of the stomach.  While releasing this band I got into the bowel.  A nasogastric tube was placed removing 5 liters of fluid.  I needed to revise this anastomosis. Opening the stomach, it was filled with remnants of food days old.  After re-evaluating
the area we revised the anastomosis between small intestine and stomach and re-sutured the opening.  We closed the fascia and skin.
Next was a woman who had swallowed a fish bone.  We gave her medication to make her sleep and took a look.  Her throat had a faint laceration where the bone had passed leaving its mark.  The scope was withdrawn, the procedure done.  Midnight had arrived.  I went home to my favorite meal here in Cameroon, Spaghetti.  I ate and crashed.  Morning would soon be here.  But not before another call by the hospital for the next to last patient who was bleeding through his nasogastric tube.
We see a variety of issues from mundane to exotic.  God helps us with them all, knowing what is best to do with what we have.  We praise Him for His Love and compassion towards us!  In His Care and Embrace, Greg

#109 Shanksteps of Faith
There was one nurse off, and the student nurses were off to another village for the weekend.  That left two nurses to cover the 55 patients in the hospital.  Audrey was caught in the ER seeing outpatients coming in who needed to be admitted.  I went to make rounds on maternity/surgical ward.  I had just seen 8 patients when we passed a woman on the veranda of the maternity who was in labor.  She had already broken her “water” and had been in labor for about 12 hours.  She went to a dispensary where
they promptly (very irregular) referred her to the hospital.  I performed a vaginal exam and found the presenting part the face.  She had a very small pelvis and there was meconium (a sign of fetal distress).  It was decided that she should have a C-section.  The husband wanted to wait for his older brother, who was “on his way”.  After some discussion we were able to take her to the OR (operating room).  I called Audrey to do the surgery with me.  The one remaining student missionary we called in
to do anesthesia.
IV’s started, urine catheter placed, then spinal placed.  We vigorously scrubbed.  Opened the abdomen, and with much effort disengaged the child’s face from the pelvis of the mother.  The baby was floppy and had no heart beat.  After removing the child Audrey went to attend to her.  CPR was performed many minutes and then finally the heartbeat came back.  The child’s face was grossly edematous, purple, and disfigured after being squeezed for so long.  I realized that the uterus had torn into the
vagina and bladder.  I repaired both and closed up the abdomen.  Audrey sat with the child in her lap bagging her for more than an hour.  There were no respirations and we could not get a normal saturation during that period.  So we decided to stop CPR because it appeared futile and we needed to attend to the other patients that needed our help.  
I continued rounding.  I saw the woman with the snakebite and a necrotic leg;  another woman with a uterine mass and bleeding that needs a hysterectomy; three that had delivered in the last 24 hours; two children with malaria; the man we did a gastrojejunostomy on last night; the little girl with a tracheostomy; and the two teenage girls with breast abscesses that are slowly healing.  Then on to clinic.
Clinic was filled with patients with malaria, typhoid, pneumonia, a hemorrhoid, and amoeba.  I took things out of the stock to resupply the pharmacy, calculated the day’s entry from the cashier to ensure its correctness, then saw a few others in the ER on oxygen or getting transfusions.  Then home to drink fresh made lemonade and eat lunch/supper.
It’s now Sabbath and I long for the rest that God has for me and the time with Him and Audrey.
In His Service,   Greg

#108 Shanksteps – Fight for life
I do not usually yell at parents; especially in French.  In this case however, I made sure that every word I was saying was translated into the tribal language, Mafa.  I think that the nurse translating for me was a bit embarrassed by my actions, and not entirely in agreement with what I was saying.  Guedana had come in two days before with malaria and jaundice. The day prior to my yelling spree, he had been eating and talking, now he was comatose, with eyes the color of a school bus, and peeing
coca-cola colored urine. A very bad sign!   As soon as he started in with the hiccups, I knew it would be a battle.  The belief here is that if a sick person starts to hiccup, that they will surely die.  So, when I entered Guedana’s room and saw that he had the hiccups, I knew I was in for a long day.  The parents were set on taking Guedana home to die, and/or to make sacrifices or try traditional medicines.  In fact, it was the traditional root powder that got him to this point in the first place.
Here the Mafa believe that if your eyes are yellow, and you can vomit enough (bile) yellow stuff, that you will be healed.  Unfortunately, more often than not, the patients I have seen, that have taken this traditional root, have come in with severe jaundice and liver failure.  Did they have severe liver failure first and the root did nothing, or did the drug make a bad problem, worse.  I have no way to know for sure, but after seeing so many people really sick after taking this “medicine”, I sure
believe that it hasn’t helped.  In Guedana’s case, his parents had given him the root two days in a row. When he didn’t get better, they decided to bring him to the hospital.
So, there I was, arguing with the parents’ “rights” to take 3-year-old Guedana home.  I said that I was the advocate for the child.  If I wasn’t going to be, who would?  I told his parents that God loved this child and so did I, and that I would NOT let them take him home knowing that he still had a chance to live.  They insisted that they needed to leave.  I told them that they could leave, but that the child had to remain at the hospital.  I assured them that I would take care of him and carry
him around on my back.  After much discussion, they decided to stay (with the child).  First hurdle overcome.  I wrote the (expensive) prescription for care (and told them I would pay for it), then went off to start the rest of my rounds.  Ten minutes later the nurse came to me saying that when she changed Guedana’s IV catheter, that his blood was very pale, and watery.  So, back I went to see him. We checked his hematocrit and sure enough he was anemic and not clotting at all.  Next hurdle… who
would give blood.  We have no blood bank here, so usually we search for a blood match with the family.  Dad was the same blood type but afraid to give.  He, like many here, believe that each person only has a certain amount of blood, and if we take some from him, it means that he has less and will be weaker for the rest of his life.  We finally convinced him to go to the lab; he went but refused to have his blood taken.  Finally after what seemed like an eternity of heated discussion and pressure,
he agreed to give 200 ml of his own blood to save the life of his child.  In the mean time I gave Guedana Vitamin K to help with clotting.  I left to continue rounds.  Ten minutes later, the nurse came again to tell me that he was pooping blood. I found myself back in his room looking at a mixture of blood and mucous that had just appeared.  With his liver failure as bad as it was, he wasn’t clotting very well.  The nurse had just placed a nasogastric tube that was now filled with blood.  I started
to wonder if the parents had been right in their assumption that he would surely die.  I gave him Cimetidine IV to decrease the acid in his stomach at about the same time as he started to receive the blood transfusion.  I had been praying for him this whole time, but now I found Greg and Ambassador (one of the maintenance men) and the nurse, Eliza, and we had a small group prayer for him, and his parents.  I again tried to finish rounds.  After about 30 minutes, Eliza again found me to tell me that
his breathing pattern had changed.  In fact he was hardly breathing, just an occasional breath every so often.  With everything he had gone through that day, I was pretty sure that this should have been the end.  I carried him to the emergency room where we have an oxygen concentrator.  I had held off giving him oxygen because our ER had been crazy busy for the past week, and they really needed the bed there for the patients coming in.  Anyhow, I put him on oxygen and his breathing started to normalize.
So, there we were, with three different IV bags hanging; an NG tube coming out of his nose; a nasal cannula in his nose for oxygen administration; and an oxygen saturation monitor probe clipped to his toe.  His little corner of our ER was starting to look like an ICU. I prayed for him again and left him in the care of the ER nurse.  I checked on him periodically throughout the day, fully expecting the nurse to say that he had died, but fully hoping that God would show how powerful and loving HE is,
and keep him alive.  
He stayed like that all the next day.  On the third morning, I went to morning report, bypassing the ER because I didn’t want to know yet that he had died.  The report was that he had complained all night that there was something in his nose, and begged his brother to take it out.  I ran to the ER and let out a scream of glee to see him conscious.  He was still very sick, but now didn’t look like he was on death’s door.  Finally, the parents weren’t quite so angry at me for vetoing their departure.
Today, two days later, he was sitting up in bed eating a doughnut.  His eyes are still yellow, but getting a little less each day.  I have been thanking God all day that he has taken this child into HIS care.  This seemingly long week has given us a chance to tell his parents (as well as show them) about God’s love.  Please pray for Guedana and his parents that they will follow God, and not their old traditional ways.
In His Grip, Audrey (for the Cameroun Shanks)

I am constantly amazed by the interest the rest of the world has in our elections.  I was awakened by a text message at 5AM with a worker telling me that Obama had won the elections.  Over the past few weeks we have heard comment that “we” are prejudiced because we haven’t had an african american president.  Now that we have one the word around Koza is that he is thier “brother” because he’s Kenyan.  i then heard it was  his mother.  But some figure it will make their chances of goning to the US
easier if not helping Cameroon more than the US does at this point.  As you probably know, we live in an area with about 100,000 people in the surrounding area and mountains.  Word travels around as if it were only 100.  Word of mouth gets any interesting idea or news out to all very quickly.  Whereas things like when vaccinations or other health related things dont seem to make it out at all.  

We are in the season of bad malaria and much anemia.  We do blood transfusions almost daily.  And have had a number of children die from malaria and its effects.   There are about 65 patients in the hospital.  Pediatrics is entirely full and Adults has much overflow from Peds.   We have seen our first case of meningitis this year.  we have had two die recently from Snake bites.  Another is in house and has had extensive debredement of her leg and is still quite sick.  Please keep her in your prayers.

I am starting a Fund for those patients with Snake bites.  Currently we purchase antivenum for 14000-15000CFA ($28-$30) and we sell it for 14000CFA.  Most people need many vials(5+) and we try to minimize the number to one to three, to not increase the cost for the patients.  Many patients refuse any further after 2 vials as the cost is so hight for them.  I am starting a fund for those of you who would like to help specifically for the snake bite patients.  I would like to give them the antivenum
for a huge reduction so that I feel free to give them as much as I need without thinking about the cost.  So if you would like to participate in this specific area please mark your donation as “Snake Bite Fund”  we use all donations in the way designated.  If there is no designation we have been using the funds mostly for purchasing medications in bulk in Yaounde, to reduce our costs of purchasing meds.

Another long term goal of mine is to reduce the cost of treatment to all patients who come to the hospital.  We are trying to get the agreement with the government so that we benefit from the funds normally given to a district hospital.  This is turning out to being a long process, mostly due to the stalling of the local health district doctor.  If you can think of any other LONG TERM solution I would be happy to know about it.  I want a solution that will last even after I leave or after the donations
dry up.  I would appreciate any input you may have in this regard.

In the mean time we have prices similar to other hospitals in our region but more than the local dispensaries (health clinics).  Most hospitals care for people only as they have money to start treatment, we treat and ask for money at the same time.  some are unable to pay anything for a while and they stay “prisoner” of the hospital till they pay or run away when no one is watching.  wE have about 40 unpaid bills that we are still trying to collect from.  Both systems, ours and the other hospitals,
have difficulties.

Keep us in your prayers as we continue to try to show Christs love in this spiritual battleground.  In His Service, Greg

I just wanted to give you a short update on the 10 month old girl I did a tracheostomy on before leaving for the conference in the US.  When we left we took her to another mission hospital in Maroua. They took care of her for the days that we were gone and when we came back we picked her up and brought her back to Koza with us.  I did a bronchoscopy on her yesterday and her airway is slowly opening up.  she still cannot breath through it well enough to be without the tracheostomy.  Please continue
to hold her up in prayer that her airway will heal in a way that the tracheostomy can be removed and she can grow normally.  In HIS Service, Greg