Cameroon # 20
He was very stoic. It was obvious he was badly hurt.
He was an 18 y/o male with multiple stab wounds that
was brought in to our hospital by car from a village
30 minutes away. On his left upper arm there was a
large laceration with shin and muscle missing. This
wend down to bone. His right shoulder was bandaged
tightly and as I loosened it to see the injury he
began to drip blood from this injury. This side also
was a glancing wound with loss of skin and muscle down
to bone. His right middle finger was also dripping
with bone exposed. His abdomen was wrapped tightly
and as I asked about this spot I was told his
“intestines had come out†of a hole in his abdomen.
As I unwrapped this I noted small and large intestine
lying down to the table at his side. At least the
decision to operate on him was a rapid one.
Fortunately for him he did not have a real high heart
rate or low blood pressure. So we started intravenous
fluids on him and took him to the OR. About ∠hour
later the operating staff were there with me and we
started in the abdomen. I went in through a midline
(up and down) incision from the sternum to pubis. I
noted a cut in the liver about 4cm deep and 7 inches
in length. This was bleeding slowly. I examined all
the small and large intestine and fortunately for the
patient and myself no injuries were seen. He had had
his liver sliced and that appeared to be all. I then
noticed with each of his breaths that air was entering
his diaphragm (the muscle from breathing separating
chest from abdomen). I also saw that a rib had been
cut in half and the cut slid along the underside of
the next rib up along the chest wall. I reached my
hand into his chest from the abdomen and swiped out
the clots and felt the collapsed lung. So at this
time I’m even more amazed that his is alive. We
operate here with limited resources, and have no
general anesthetics. I did his entire operation under
Ketamine while he breathed. In the US he would be
intubated with a double lumen endotrachial tube and
his lung inflated. This is not an option here. And
in addition I have no chest tube to help inflate his
lung. So I adapted a urinary catheter for this
purpose. I also don’t have suction I can use to help
inflate the lung with the chest tube either. So I
connected the urine catheter in his chest to a urine
bag, added water to it and flipped it upside down to
make a water seal. I’m sure everyone medical is
laughing now. This is NOT the normal treatment but it
is what I had to work with and I was trying to help
save his life. I then proceeded to close the
diaphragmatic laceration. This was successful after
much struggle and liver retraction to visualize the
laceration. Now the liver was bleeding more because
of manipulation. Fortunately I found some surgical
(helps stop bleeding) and after that the oozing
stopped. So I closed his abdomen. Fortunately for
the patient Dr. Appel and his wife arrived to visit
for a day on their way to some meetings. They helped
me “close†the shoulder and finger injuries and
repaired a finger tendon while I closed the abdomen.
So 4 hours after starting we were finished.
It is now a week later. He has healed his abdominal
wounds and granulating his shoulders. Audrey took out
his “chest tube†while I’ve been gone about a week at
other meetings. God is definitely blessing our
efforts with this patient. We give glory to Him for
what He has done. Later we found out the person who
had done this to him was a younger brother who he had
called a donkey thief. I guess that is a serious
accusation; the brother apparently was also brought in
by the army for more minor wound care. Praise God for
this patient’s life today. We explain this to him
daily. I pray he realizes the reality of this. Thank
you for your prayers for our work here, it IS making a
huge difference in this spiritual battlefield. In His
Grip, The Shanks
Cameroon #21
Oh what a trip!!! I was asked by the Central African
Union to assist in a meeting in Yaounde that occurs
every 5 years. I felt this was not wise as we have
not caught up on the hospital workers salaries yet,
and the hospital was the one to foot the expense for
my travel and stay… but many people thought it was
very important, so I went. It’s a long trip at
minimum. I got on the taxi motorcycle form Koza to
Mokolo, along with Dr. Appel and his wife from Bere,
Chad. They were on their way to the same meetings.
So it was nice to travel together. At Mokolo we got a
local minibus transport to Maroua. We only waited
about 2 hours, which is about average. The bus must
be full before it leaves. So we arrived in Maroua at
about 7PM. One of my new friends met us there and
took us to find a room to stay in. After checking the
Baptist Mission for rented rooms we were able to find
two at the Catholic mission. Early in the morning
(5:30) we went to the bus station to catch the first
bus to N’gounderi. After an 8-hour ride we arrived at
the train station there. We had a couple of hours to
spare so we went into “town†and ate at a
“restaurant.†We didn’t know the area so ate where
the taxi motorcycle took us. The “restaurantâ€
definitely wouldn’t have passed standards in the US
and would be immediately closed. Tables had been
cleaned onto the floor and there were food particles
all over the places in piles. In the back, rats were
seen near the bathroom. Flies were everywhere. But
we had a good salad (risky here) and were able to
watch a soccer match on TV in there. So at 5:30PM
(train was to leave at 6PM) we went to the train and
boarded. We were fortunate to get the sleeper cars
and 4 small beds in a room. To be able to sleep the
night and arrive the following day around noon in
Yaounde (the capital). After getting comfortable in
our beds on the train we just sat there. 1 ∠hours
later they said we must deboard. Apparently the cargo
train had derailed part way up the route and 10 or so
cars were turned over. We asked if we could stay on
the train and of course we could not. Fortunately by
this time we had met up with the conference president
and he had some church member contacts there who put
us up for the night. So we spent a lovely evening
with them. The next morning someone went to the train
station to see if it would run that night (only daily
departures). Unfortunately it wouldn’t be. So they
arranged for us to take local minibus transport. Well
comparing this to sleeping the night on the train it
didn’t sound like too much fun. But no other options
and we had to make it to Yaounde for the meetings. So
we were to leave at 11AM and arrive, after an all
night trip, at around 6AM in Yaounde. So we set off.
With in 1kmof the train station we were on a bumpy
dirt road packed 5 wide in the minibus. The chicken
sitting on someone’s lap was squawking and the dust
was stifling. About every 2 km’s we met an army or
police stop to ask for our documents. These are after
just a chance to rip off people and increase their
salaries if not all is in order or you want them to
leave you alone and let you continue on. Cameroon is
noted as one of the top 5 corrupt countries.
Fortunately after about 5 stops there were less for
the rest of the trip. Though there was about 15 in
all. After a couple hours we were covered with dust
and sneezing. A couple hours later we stopped at a
small bus station and changed minibuses. Then a few
hours later the same thing. We passed many scenic
spots. I noticed quite a change in hut styles as we
came down the country. At midnight we stopped at
another town to change buses. They moved all the
luggage to the top of the next bus then we waited… and
waited. After about an hour of waiting people were
getting inpatient. Some started to complain to the
office and were getting upset at the wait (especially
when the bus was already full). So they called the
driver of the bus. He arrived on a taxi motorcycle
and some in the group yelled at him also. So he got
upset and said he would not drive till the morning and
left. So they were even more upset and assembled all
the passengers to speak to the people at the ticket
counter. They did this and threatened to call the
police for leaving them there like animals and
threatened to burn things. Well the ticket office
closed and they came up with the chief of that bus
station, who after hearing all the same threats got
another driver to come. So they transferred all the
luggage to this new minibus and we were off like a
rocket of sardines (packed 5 wide, hitting our heads
on the roof frequently) We were off at 2:30 AM.
With my knees buried in the back of the seat in front
of me and squished on either side. We finally
arrived, after about 5 more stops by police/army, at
about 9:30AM. FATIGUE! So I feel I got the full
African travel experience. I also enjoyed seeing
other minibuses with goats tied to the roof rack with
the luggage traveling down the road. I am thankful
that at least we did not have flat tires, and made it
there safely. Thank you Lord, Greg Shank