Shanks Steps #10

Shanksteps #10
16-9-05

C’est le main gauche. Oh no, not again. This was the
third delivery with “hand presentation” in as many
weeks. What is it with Cameroonian women that the
hand comes out before the head? She started to have
contractions this morning in a nearby village and went
to the local medical personnel. When they checked to
see how dilated she was, they felt a foot and pulled.
Unfortunately it was not a foot, but a hand. So they
sent her down the horribly bumpy dirt road to Koza for
us to take care of. Greg and I ran down to the OR for
yet another C-section. This hand was a bit different
than the others though as the skin had already started
sloughing. We feared what the rest of the baby would
look like. The operation went well but the baby was
dead, and had been for quite awhile as evidenced by
the amount of decomposition. Mom has done well.

She’s eight months pregnant, delirious, with jaundice.
Why? Three days ago she had been fine, they tell me.
I search my brain, Williams Obstetrics text, Current
Medical Management text, and Manson’s text of Tropical
Medicine. We perform the labs we have, only to find
out that mom’s blood is Rh- and her husband is Rh+(so
baby could be Rh+ also). Could this be some form of
blood incompatability reaction? One of the nurses has
seen Rh problems before and said they looked similar.
I go to check on mom again and her heart rate is now
170. Her breathing is irregular and she is thrashing
about. I wonder if mom’s reaction against baby has
been so severe that the baby has died and mom is
becoming septic; I wonder about hepatitis and
encephalopathy; I wonder if this could be a weird
presentation of eclampsia and HELLP syndrome (we had
one earlier in the week). I never found a fetal
heartbeat, but that’s not as surprising using just a
stethascope. All I know is that if the fetus is
causing the problems, we need to get it out. Another
c-section. Baby was dead and mottled. Mom’s vital
signs started to level out once the baby was removed.
I still wasn’t totally convinced that that was the
whole story. Late in the evening Greg was told that
this patient wasn’t doing well. She had Kussmal
breathing (end of life breathing) and altered mental
status. Several hours later she was dead. Why??? At
our morning worship and patient sign-out the next
morning we get an answer. One of the patient’s
neighbors came to the hospital to tell the rest of the
story. The patient had not been feeling well for
about a week. 3-4 days prior to coming to the
hospital she had gone to a traditional healer who had
given her a potion to drink. She did and immediately
fell to the ground and started acting strange. The
family kept her at home like this for 3 days, then
finally brought her to the hospital as a “last ditch
effort”. Unfortunately I do not have a traditional
medicine textbook to refer to. Tribal potions was not
on the differential diagnosis for jaundice in my
medical text. (It will on my personal differential
next time though.)

So many patients wait until the last minute before
coming into the hospital. They go to the market to buy
(prescription) meds; they go to traditional healers
for potions, cuttings, burnings and spells. By the
time they come to us they are in very serious
condition. If we are able to help, very often the
family doesn’t want to pay for the medications and
care and will take the patient home before they are
ready, especially the women and children. Some days I
just want to come home and cry for all the death we
see, and the seeming indifference to it. I feel that
the difference we make is so miniscule that it doesn’t
really matter. But then I remember that we are not
here for us. We are here in Cameroon because God
called us to be here. He has plans for us that we
know nothing about. I have been out of my “comfort”
zone since landing on Cameroonian soil. I have felt
inadequate medically, culturally, spiritually,
emotionally, physically, in language, understanding.
But God is not done with me yet. He continually
reminds me that “My grace is sufficient for you, for
my power is made perfect in weakness.” (2 Cor 12:9)
He has a lot of weakness to work with…
Please continue to pray for our hospital and it’s
spirituality. Please pray for our strength to keep
working for HIM through the life and the death. We
feel your prayers as we are given boosts of energy and
have the privilege to see miracles throughout the day.
In his service,
Audrey, Greg, and Sarah