Shanksteps Bere 2017 #11

I’m sitting eating supper with Olen and kids. The nurse calls to ask a doctor to see a person in the ER with Tetanus and another on peds with paralysis. I head on in to see what’s going on. I go to the third bed in the ER. There is no light in this area of the ER and I think, well it may be good for this patient. He has had a wound on his knee for about a month since an accident. It has obvious gensin violet all over it making it a deep purple color. I touch his leg and he doesn’t seem to react. So I think he must not have tetanus. Then I touch is abdomen. He goes into a full body contraction. His chest, abdomen, and legs are rigid for about 10 seconds. I shin the light in his face and it happens again. As I talk to the family there is a little louder sound outside the window and he goes into a grimace and spasm again. Guess he passes my tetanus test. It’s a terrible disease that I’m glad we are vaccinated for, usually. There are many diseases that we can see in Africa that could be avoided if there were adequate vaccinations. It also makes me think again, why do some in the US not want their children vaccinated? These diseases kill! I order some tetanus immunoglobulin and some Valium to sedate him and hopefully not set him in to spasms as often. It reminds me of a man in Cameroon that we had at the hospital that had such severe spasms that his spasms broke his own femur.

Next I go and see the little girl. She is about 10, and lying under a lot of blankets with a fever. Sweat on her forehead. They say she has a wound on her leg and has been sick a month. Her leg was swollen till about two weeks ago when it burst behind her knee seeping out the liquid inside. I try to figure out if it was pus, and we cant communicate well enough to figure this out, even with the nurses help. I pull back the covers and the girl starts to cry she’s scared as to what I’m going to do to her. I see two thin legs that are contracted at the knee and cannot be straightened. She apparently hasn’t walked for a month. I feel her knee, then she really cries. Her knee is swollen and warm. I think she must have a septic joint. The father says it’s much better than two weeks ago. I guess she could have osteomyelitis or septic joint, become an abscess in her thigh that then spontaneously drained into the back of her leg. I ask the nurse to get me a syringe, and alcohol swab. I warn the girl what I’m going to do and poke her knee. She doesn’t move much, and doesn’t cry. She was ready this time. I poke her with a larger needle and still get nothing. So either I’m getting in the wrong spot, which I doubt, or the liquid is so thick that it’s not coming through the needle. I decide to treat with antibiotics and have Olen try to get a sample tomorrow, if he agrees that it’s needed. I head out of the hospital and talk to Olen for a while and now am heading to bed.

Now the following evening, it’s around 7:30 and I’m eating supper. Today has been an eventful day. After staff worship and sign-out I started rounds till the first hernia patient was ready. The spinal was in and the sterile pack of instruments unwrapped from its’ cloths. Rollin runs in and says he has a woman who is in labor and has a cord prolapse. There is still a pulse in the cord, meaning baby is still alive. He asks how long till I’m finished? My patient is a man who has had a hernia repair on that side and now has a hernia again with a hydrocele (fluid around the testicle). I expect it to take me 1-1.5 hours. We decide to take my patient off the OR table and do the woman first. Unfortunately no one speaks the male patients language, so we just lift him to the rolling stretcher and wheel him back out to the prep room. Just then the stretcher with the woman bursts through the door. I see that no one is holding the head in. (when the baby’s cord comes out first, as the head pushes through the birth canal the head of the baby cuts off the blood flow to the baby by pinching off the cord. This kills the baby! EMERGENCY!!!!) Rollin wants someone to hold the baby’s head in till he does the C-section. No one moves, so I grab a glove and insert my hand to push the baby’s head back inside to free the cord so it can have blood flow. As I squeeze the cord between my two fingers I feel a pulse in it that is fast like normal. A live baby. As I’m pushing the head in with all the force I can with a couple fingers, meconium flows out. This means the baby is in distress and not doing well. I get down close to the patients knee and duck down while I hold the head. They splash betadine on her and drape over her and me. Meconium and urine flow down my arm to my elbow and drips off the edge of the OR bed onto my leg and shoes. The mom is given a whiff of ketamine (enough to make her not remember the surgery, but not enough to make the baby sleep). A cut is make and I hear her cry out in pain. (I’m thinking, good she was given the small dosage that we won’t have a non-breathing baby). In about 30 seconds I feel Dr. Rollins hand against mine as he grabs the baby’s head to deliver the baby out of the uterus. My back is kinked and I’m very hot under the drapes. It feels good to stand up. They pull out a crying baby, and all of us are grateful for crying babies! I head out to the sink to wash all the bodily fluids off me and am thankful for intact skin! My fingers ache for a short while. They finish up the surgery and I hang out for the next one.

The next is back to the man who had been ready for the hernia patient. They replace another spinal and it takes about 1.5 hours for the surgery. Next is a patient for a prostatectomy. He was up in the capital, had urinary retention and got a suprapubic catheter. Next someone else took that out and put in a regular urine catheter. Now he is here because he needs his large prostate removed. The spinal is placed and he is prepped and draped. I cut down through the area of scar from his previous suprapubic catheter. With a little effort I identify the bladder and free up the stuck area. I open it and feel a large prostate. I pull out three large lobes of the prostate, put in a couple stitches to slow the blood loss and put in the large urine catheter and close up the bladder. His urine runs out clear, well brown, with betadine. I guess someone looked into what to do with the irrigation and betadine in the water seems to diminish the infection rate.

After a few more difficult surgeries, I head over to Johnathon Dietrick’s place to see what he’s doing with his printing work. He is apparently printing tracks in the local language and some books as well. He also passes out little solar powered players that play a passage from the bible. So people that can’t read can hear the Bible. They cost about $20 each and last about a year. They last a year because after playing them every day for a year the buttons and other things wear out. He’s been printing materials for the local union and also to give out the those locally who can read their language. He also gives out Bibles too. He is printing the Sabbath school lesson for the local union too. He has his printing stuff in a container and has cheap mattresses on the walls for insulation from the outdoor heat that makes some of the electronic parts not work. I remember to tell him about the organization that we are a part of, Life Impact Ministries. We and the other members of Life Impact Ministries, take care of missionaries and pastors in our homes. I hope he will be able to visit us when on vacation some time. He is able to come back every 2-3 years. I hope back on the motorcycle and head back to the hospital. I find that my headlamp is much brighter than the headlight on the motorcycle so I leave it on. Dust is swirling around my head as I travel. Periodic smoke from someone’s cooking fire, burns my eyes. I get lost and end up at what looks like a “main” road. I ask a kid at a nearby “stuff” stand where I should go and he tells me how to get back.

For those of you missionaries who are interested in a place to rejuvenate or those interested in supporting that type of work, look up Life Impact Ministries. We are the Safe Haven Oasis. We would love to have missionaries or pastors stay with us! It is a non-denominational Christian organization.

Shanksteps Bere 2017 #11

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