9-24-06

Sabbath, our day of rest and communion with God. Well
NOT TODAY!

I woke up in the morning and knew I had a few patients
that I had operated on the last few days and that I
wanted to see how they were doing. So when I woke up
I headed into the hospital. It was about 7:30 and the
workers had just changed shifts. As I checked on them
at maternity, another woman arrived in a pus pus (a
push cart that carries wood, grain sacks, or really
sick patients). I let the nurse figure out the
history while I checked in on the new patients in the
ER. I admitted one 5-year-old boy with malaria and
convulsions at home. Another 3-year-old girl with
convulsions while I was examining her (cerebral
malaria), and another with pneumonia and malaria.
Guess what season it is? Malaria, malaria, malaria!
Then they called me back to check on the woman again
in the delivery room. She had had one child at home
and had another one that wasn’t coming out. When we
examined her we found a hand sticking out of the birth
canal. This usually means the child is lying
transversely and will not come out. She was having
real strong contractions. But with him transverse
there was absolutely NO progression. Also when I
examined here I could not figure out the presenting
part next to the arm bulging out with it. I decided
to try an internal version. The is almost never
successful because the uterus is contracted and the
child cannot move. Fortunately I knew by now that
there was no heartbeat and we would have a stillborn.
(after delivering the first at home she went to a
dispensary and they “worked” on her a few hours.)
God really relaxed her uterus and I was able to find
the head and pull it down next to the arm and then was
able to do a forceps delivery of the stillborn.
After finishing that I saw a couple more in the ER
for malaria and for dysentery. Then I went back to
maternity to try to teach a young mother of a
premature 7-month child how to give formula via the
nasogastric tube. I needed the nurse to translate
for me but he had just received another patient who
was having contractions. He said he better stay with
her as it was her 7th child and may be fast. I was
able to find another mother who knew some French to
translate for me. After explaining how to do it I
went back and the other woman had already delivered.
They also showed me another child who had very wide
set eyes and skin very tight all over and nearly no
nares that were open. I mentioned to them that to
save the childs life that we would need to do a
tracheostomy to keep him from aspirating but that I
felt his prognosis was poor. The mother decided to
take him home rather than go the aggressive route.
Very sad but I understand.
I went home as church was ending. Ate some breakfast
and relaxed for about a half hour before being called
back to someone who was bleeding a lot. I went in the
room to find a mom who was pregnant to 6 months with
pools of blood all over the floor and bed. She was
going to die in front of me I was sure! I convinced
the family to be tested for blood and they went off to
call the lab tech. They were able to give one unit
only. She needed more. I went to work on getting
out the already dead child that as I found out was
breach. Since she was almost fully dilated I thought
I would have no problems. I found both feet and
pulled him out. But the head got stuck. Oh it was
terrible. She was bleeding like crazy and I have the
head stuck. After working a long time I finally got
the child out and was able to get the placenta out and
stop the hemorrhage! They had found another person to
donate and we were very happy that her life was saved.
Another one came in just after that for obstruction
of labor. I found out her pelvis was too small for
the child she was trying to deliver. I performed a
symphisiotomy and pulled out a screaming child. This
is a huge relief. Especially after a couple
stillborns.
To finish off the day and kill the night we had been
watching another woman in the ER who I thought might
have pre-eclampsia. This is a disease that the only
help is to deliver the child. She had come in with a
BP of 130/80. This seems normal except everyone here
is much lower. Her pressure came down then went up to
150/90 by evening. She had a hemoglobin of around 5
gm/dl. Normal is about 12-15. So she really needed
blood before we operated on her. So finally another
family member arrived from about 2-hour bike ride away
and she was able to give blood. The woman who had
pre-eclampsia also started to have foot swelling,
headache, epigastric pain, and visual changes. All
signs that convulsions are near. I decided to give my
blood to her also so that we could proceed with the
surgery that she needed, a caesarian delivery. I
gave, and off we went to the operating room. During
the surgery all her bleeding was like running red
water. The child was still born and had been dead for
a while. Just at the end of the surgery her oxygen
saturation dropped. She had crackles over both sides.
She had gone into pulmonary edema. I bagged her with
oxygen, then intubated her. Initially her oxygen came
up to 94% then over the next two hours of bagging it
gradually dropped. Cardiac arrest followed. It was
now 1:30 AM. I was very tired. I saw one more
patient in the urgence (ER) before heading to bed.
We have been praying for our hospital to have more
patients so that we can continue to pay our workers
salaries. God is answering our prayers by bringing
the sick of the surrounding area in. We also thank
you for your prayers. As you saw in my last letter
there are many frustrations. I believe God is helping
us grow. I wonder for what? Please continue to keep
us in your prayers, In His Service, Shanks

“When life gets tough, when you’re overwhelmed with
doubt, or when you wonder if living for Christ is
worth the effort, remember that you are not home yet.
At death you won’t leave home”- you’ll be going home.
p. 51 The Purpose Driven Life by Rick Warren

Shanksteps of Faith #46

Leave a Reply