Shanksteps #95
There was a small hole in his upper back about 1cm from the spinal column. He was spitting up blood and otherwise felt OK. He was drunk on the local millet wine and couldn’t remember what the dispute had been about, but knew that his neighbor had done it. He said it was a thin piece of metal that was about a quarter of an inch across and imbedded about 6 inches in his back. They pulled it out immediately. He had some blood coming from the stab but it was slowing down. For me it was a diagnostic
difficulty. He needed to have a gastrograffin swallow to evaluate for esophageal injury. A CT scan with contrast to evaluate for any large vessel injury. And a bronchoscopy to evaluate for tracheal perforation. He had a normal pulse and blood pressure. I do not have the tests that he needed. And if I were to try to refer him elsewhere, they wouldn’t either. There is a CT scanner in Yaoundé (about a 3 day trip and 800km away). This is not feasible for the local population regardless of how
sick they are. It would take their years income, to just arrive down there. So I needed to treat him where we are. So I decided to treat him with antibiotics and wait and watch. If he became infected then I would have to explore his chest. That would cause other difficulties as I do not have a chest retractor, or good assistance, or general anesthesia… the list could go on and on.
We prayed for him daily and gave him IV antibiotics and he took nothing by mouth. We continued this treatment for a week. After about 5 days the spitting up blood stopped and his pulse and BP remained normal. He never developed a fever either. After a week I advanced his diet slowly and eventually he began a full diet. We praise God for healing him and that he did not get a mediastinal (central chest) infection.
We often have diagnostic difficulty in many patients we see. We have limited tests, plain xrays and ultrasound (thanks to your donations). Often I feel God prompts us on what to think about and how to treat some patients.
We are thankful for His healing. Greg