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“For My thoughts are not your thoughts, Neither are your ways My ways, declares the Lord. For as the heavens are higher than the earth, So are My ways higher than your ways, and My thoughts than your thoughts.” Isaiah 55:8-9 I do not understand, when my view is so finite. Mounagui died the day after surgery about 12 hours afterwards. Though I do not understand, I like Job in the Bible, I choose to follow Him even though I do not understand here on earth. I look forward to knowing in Heaven when I can ask Him face to face. Praise to our Saviour! Greg

I recently heard from our friends Gary and Wendy Roberts who lost their son to malaria in Chad. Please pray for them, as this is going to be the hardest time of their lives. May they, like Job, choose to honor God in spite of what has happened.

So there seems to be a trend in injuries. Some people say that medical things come in three’s. To me this is superstitious, and I do not believe it. But last week we worked on the man with an epidural hematoma. I.e. burr hole with much nibbling leaving a larger hole and a drain.
The following day a boy came in who had been hit by a soccer ball on the side of the head and was unconscious, agitated, and only moving one side of his body. God healed him, for today, one week later, he was laughing, playing, talking and moving all extremities. This brings us to last night:
Many things have been going on and I have had a hard time going to sleep at night this last week. I lay there and mull over the things I need to do or try to solve some of the day’s problems. Audrey tells me to stop moving. She says I’m thrashing about in bed. So I turn over and try to go to sleep again. I toss and turn for a while then I hear a knock at the door. I feel groggy like I must have just fallen asleep. It’s midnight. Mbitomou tells me that there is a ten year old girl with a head injury she sustained after falling from a tree, and that he hesitates to even bother me as she has brain matter all over her head. She fell during the day and lives in a village very far away. He thinks she has broken her skull in a large area. So he takes me to the hospital on his motorcycle. This gives me a minute to think of what I will do on physical exam. She is laying on a gurney, the right side of her head rather flat. She has a skin wound about 5cm long with brain ma
tter bulging from it and smeared across her black kinky hair. She flops back and forth using only her right arm. She doesn’t respond to sounds and doesn’t say anything. Her pupils are both reactive and small. I palpate her head and I feel what I think is a large depression; blood is coming from her nose. The family says she has lost a lot of blood, and she looks pale. I describe to the family my findings, and tell them her only chance is to operate on her, and that her chance is small. The father says he has no money. I reinforce that this is necessary for a small chance of helping her. He agrees to surgery saying that he brought her all the way here to see if we could help her.
In the operating room I call Audrey and Ganava. After shaving her head and prepping it, I incise in a huge semicircle. I see many fragments of skull, brain and dura all in different levels. The skull has been fractured in maybe 7 pieces. The fragments sit at strange angles to each other. I free up the dura from beneath a few and raise out some large pieces. The dura is torn with blue brain matter below with pieces of skull down in it. I debreed the material from the brain. I see an area of subdural hematoma, so I open the dura over that to evacuate it. I repair the dura. Next I use some periosteum to create a dural patch. It seemed more accessible than fascia lata, though I had prepped the leg. One fracture went behind the ear and down to the base of the skull. Blood started welling up from this area. Nothing seemed to stop it and I couldn’t get under the brain enough to find it. So I elevated the head of the bed and it subsided, Praise God! I set the bone fra
gments back in place and sutured the skin closed. She stayed stable throughout the case regardless of her condition.
Before leaving work this evening, she is moving her right arm slightly. Pupils are still reactive. I’m praying for a miracle. Please pray with me, for her. Her name is Mounagui. Greg

It has been a while since I’ve written. We have been quite busy. The rains came for a couple weeks and now it has not rained for a month again. No one is planting yet. we look forward to being home and since January we have not found a physician to cover the hospital during our absence. God has provided every year. Last year it was 5 days before leaving. I’m sure he will provide again. We were hoping to have peaceful sleep, the Friday night. The power is out because 9 power poles blew over on Thursday. I suspect we will be out for more than a week. So I was getting ready for bed. Where to sleep. It’s 94 degrees inside. A little breeze near the kitchen table, the bed is to hot, the trampoline outside is a good spot but I don’t feel like mosquito repellent tonight. So I lay a sheet on the concrete floor and sleep for about an hour. I am awakened by itching and buzzing around my ears, Mosquitos! So I go for the bed. I take a bucket bath (no power = no running w
ater) to cool off and don’t even dry off. I just drip to bed and evaporate while laying there. I’ve just fallen to sleep when there is a knock at the window. There is a problem at maternity. Jonas is calling. I slowly walk into the hospital and wake up enough to talk to Jonas. A woman has been in labor since yesterday but is not progressing. I do a vaginal exam and get meconium on the gloves. The baby is stressed. i tell the father that we need to do a C-section, and surprisingly he directly agrees with whatever I think is best. I go and start the generator and head to the OR. I do a c-section and pull out a screaming baby. Praise God, the last two were still-born. It’s very frustrating to do a c-section and know the baby is dead. I finish up her surgery. I slowly go home as to not be my muscles hot. I take a shower and drip to bed.

An hour later the hospital guard is at the window. This time it is someone who was drunk and got hit in the head. He had done Ok and then became unconscious. He is laying on the ER bed wet and smelling of urine and bili-bili (millet wine). I rub his sternum to arouse him and he doesn’t really do anything. Checking his pupils demonstrates that the one is working fine but the one on the side where he was hit is dilated and non-reactive. He needs a neurosurgeon. Let’s see, the nearest one is in Yaounde aprox. 1000 miles away. You may recall Shanksteps #73 that Audrey wrote about my job description. Well, let’s add one more- Neurosurgeon. Dr. Gary Marais had brought us out a drill and a few instruments that could be used for a burr hole. So I took these with me to the OR. Reviewed cranial anatomy, sliced open the scalp, dissected up the periosteum. And found a hole punched in the skull with blood clots bulging from it. As I evacuated the hematoma, he seemed to react
more. We put him more asleep. I found he had an epidural hematoma. I evacuated this. Picked pieces of bone from his brain matter and then closed the dura. But he kept bleeding. I tied off the meningeal artery, where it was bleeding and then held pressure 20 min. I left a drain and at the end of surgery his eye was reactive again. Praise God he is still alive. I am anxious to see the end result. There is never a dull moment in the mission field. I pray that God heal this man and that he be able to go home without deficits. Thank you for lifting them up in prayer too. Greg