Archive for December, 2009

#142 Shanksteps

Wednesday, December 23rd, 2009

So what happens when God’s people have come together. “…be vigilant, our adversary the devil walks around as a roaring lion, seeking whom he may devour” 1Pet 5:8

I am called to see a teenager that has been stabbed in the head. He is about 18 and has blood all over. His head is wrapped in a cloth. Shirt saturated with blood. He had a 2cm laceration on the back of his head and a knife mark on the exposed skull. He was conscious and had no other apparent injuries.

I go home and am immediately called back, this time urgently. Allah-Hokki (God has given) is at the door. I go to the emergency room.

A 16 year old boy is laying on his back. His right hand is chained to his right leg. He lays on the gurney, thrashing back and forth. His head looks about twice the size of normal, especially the left side. His shirt is covered with blood. I notice blood and fluid draining from his left ear. His head has multiple large hematomas over the left side. As I examine the back he has some large lacerations down to his skull, in these areas the skull seems intact, but based on the liquid, likely CSF, draining from his right ear, he likely has a basilar skull fracture. Some hematomas are present on his arms but I can’t palpate any fractures. I start Mannitol and antibiotics and he heads to the dressing room to get his head sewn up.

I find out from two of our nurses what happened.

Another mission to the north of us, was having a baptism. Apparently this nomadic kid was drunk and was drawn to the sound of the gathering for the baptism. I’m not sure what got him upset but he stabbed one of the church youth in the chest. This youth spit up blood and died on the spot. Then he stabbed the previous kid in the head. The population then chased the boy and caught him when he fell down in the dry river bed. They beat him with clubs and stones. When they thought he would die they drug him back beside the other cadaver. Someone realized he might make it so they took a huge stone and slammed it on his head. Eventually the military came and shipped him to the hospital in the back of a small truck.

The devil is “devouring” many people! He has taken control of some, creating havoc for others. Even now it is not over, now is the talk. “See what this type of Christian does.” “Did you hear about what happened in …village? And they were … Christians!”

As Christians we are far from perfect! I thank God it does not require my perfection to be saved. See John 3:16; I must only believe, for Christ has already paid the penalty of my sin, and yours! PRAISE HIM! Greg

#141 Shanksteps

Sunday, December 13th, 2009

It’s been a hectic last few weeks.  Multiple surgeries each day and the hospital ranging from 50-77 patients (full).  Pediatrics has sometimes had 28 patients in 25 beds.   Also the government had another session of a vaccination campaign.  This time it was for polio, Vit A, and mebendazole (worm medicine).  This is why I have not written in a while.

So Mbaitomou (a nurse) comes to my door and says, Je une cado pour vous! (I have a gift for you) shaking his head.  He describes an old man who was on a motorcycle in Garoua and had an accident.  This resulted in an open tibial fracture in about three places.  He was treated initially at a health center there.  They cleaned out the wounds, then the patient was taken to a traditional bone setter.  He was placed in wood splints and then brought back home to Nguetchewe, a village to our North.  There he was treated by the traditional healer there for two months, with weekly replacing of the wood splints, and “setting” of the fracture.  So they brought him in a pickup because it was smelling bad.  I asked Mbaitomou if he had removed the dressing, “No, but the smell is overpowering, the other patients in the ER got up and went outside when they brought him in.”

It was night so I walked in with my headlamp.  Walking in I saw the eyes of two bush babies jumping through the trees and those of a ring-tailed wild cat.  Also a barn owl catching insects near a florescent light.  Arriving at maternity the smell is powerful.  I see an OLD, thin man laying on a foam mattress with blood and pus dried in pools around his left leg.  Wood splint were visible with cloth wrapped around the splints at two inch intervals up to his knee.  The foot lay cocked at an odd angle off to the side.  As I look closer there are maggots of different sizes moving about the lower edge of this “dressing.”   The man appeared very sick and malnourished.  As I remove the dressing and wood pieces I see exposed tibia from near the knee down to almost the ankle.  Skin attached to the dressing comes off the leg easily.  Two fractures are easily seen on the exposed bone.  Maggots pour from a necrotic area near the knee, the visiting doc leaves the room.

An elastic tourniquet is applied and the leg prepped.  With the help of the visiting doc we amputate the leg above the knee.  The removed part is given to the family for them to bury the following morning.  He is then taken to his room to wake up from the anesthesia.  About two days later he finally wakes up and takes porridge.

The following day was also full of surgeries.  We perform an inguinal hernia repair; explore a woman for an extra-uterine pregnancy, evacuating an huge hematoma; and do an emergency cesarean delivery for failure of progression of labor in a woman with previous  cesarean.

“Lord, give us strength to serve you day by day.”  Greg

MOV02374

#140 Shanksteps

Sunday, December 13th, 2009

Its vaccination week. There was a case of polio up in Kusseri, in the far north. So this spawns a reaction to vaccinate everyone in the north. These are sponsored by the WHO, UNICEF, and World Bank. So for the local population it is free. This time, polio, Vit A and Mebendazole are given to all children up to 5 years of age. Last month it was vaccination of all pregnant women for tetanus.

I head out early to do my supervision of the process early before arriving at the hospital late, around 10AM. It is cold, 61deg. I think that’s the coldest I have ever seen. After supervision I hope to finish rounds, and see the outpatients before 3PM. Then back to the village to verify a cartier or two before the sun goes down at 6PM.

I take the motorcycle out across the main road and head for the mountains. I pass children in blue uniforms heading to school. Some wear simple plastic shoes, others with tennis shoes. Some with baseball caps. One has sunglasses on. They walk in groups of 2-4 it seems. As I go out further, I pass a four year old girl carrying her little sister on her back. Boys run by with a stick pushing an old motorcycle tire. I pass a one year old child playing in the dirt in front of his dirt home. Dust flies up as he pats the ground and throws dirt in the air. I lock up my breaks as 4 goats dart across in front of me. I cross the river and climb the other side. There is a wide area that no one lives on, this is the burial ground. I pass it and when I re-enter the habitable area I nearly run over a chicken that is finding something near the dirt path I’m following. I find the vaccinators passing from house to house. I have to verify that the vaccines are maintained in the cooler with ice packs and are in good condition. I also look at the way they mark the house with chalk, to assure that it is correct. Then on to find another group.

I cross a flat area with dried grass along the path about 2 feet tall. Next I find two women vaccinating a group of children. I check out their cooler and find vaccines and some flat food patties they are keeping cool along with them. I explain why that is not good and take them out. They mark the fingernails of the children to show that they are vaccinated.

I drive on to another section of the village. I pass a group of young boys kicking around a deflated red ball. Another group is using a wad of tape. I pass mothers carrying wood on their heads, babies on their backs. Others have a sac of millet on their heads, headed towards the grinding mill. I verify a few others before heading to the hospital.

I see a few patients in the clinic, then head to the OR. I have a prostate to take out. After the surgery we take the patient to their room and explain to the family how to verify that the irrigation is passing well. I tell them because I’m sure the nurse doesn’t pass real often, especially if there is a delivery. So the family is the eyes I need to watch the irrigation. In the evening I head back to see if the children are marked correctly and they are vaccinated in the cartier they say they have finished.

I arrive at a small building that has three rooms. It is the Kilda health center. It was just opened officially by the sous-prefet. The vaccinators are all sitting around in front of it, wrapping up the days numbers to hand in to the district health department. After talking to them I head to an area with a number of houses. I park the motorcycle and head house to house asking to see the children less than 5 years old. I check their fingers and ask their mothers if they know why we vaccinated their children. Most don’t know and some refuse to have their children vaccinated. I find 6 children non-vaccinated. We have to repass through this cartier. It is now to dark to see and I head home. Home to sit and recuperate from the day. I often wish I had less responsibilities, but I figure many adults wish that. Greg