Shanksteps #100 War update
I just wanted to give you an update on our local tribal warfare. I’m happy to say that the bloodshed has ended. The attacking village finally gave up as too many of their men were wounded and unable to cross “enemy territory” to get medical attention. They apologized to the authorities and the enemy villages. Our hospital only saw four of the victims, who are all doing well. My fear remains for those who have not received a tetanus shot; that once all is peaceful in their villages that they willcome down with tetanus. I pray every day for their protection from that horrible disease. Thank you for your thoughts and prayers. - Audrey
Published by admin on June 5th, 2008 | Filed under | Comment now »Shanksteps - Birme’s update #99
Shanksteps - Birme’s update #99Often we are not privileged to see the outcome of hours of prayer, but once in awhile God allows us to see a sneak peek of what I imagine it will be like in Heaven when we meet the people who have influenced us, and those we’ve touched as well. I was given such a gift this week. Let me back up several months to the beginning. For those of you who follow our Shanksteps, you may remember this story.Birme, a young girl from a nearby village came to the hospital last fall with a 5-day history of headache and neck pain. She was diagnosed with meningitis (the first of the season) and started on a long course of antibiotics. During much of her stay she remained in a coma and had several days of severe convulsions. When she finally did come out of the coma she was paralyzed on one side and was unable to talk. Her paralysis finally resolved but as of December when I left Cameroun to go the US,she had not yet uttered a word. Many of us at the hospital prayed for and with her many times throughout the day. Interestingly, every time we tried to talk to her of God’s love (even in English) she ran away and refused to come near us. We spent a lot of time talking with her parents about God’s love and forgiveness. We had four Student Missionaries from the US visiting at the time from Chad. Just before we left, all of us Americans and many of the hospital workers prayed with Birme: for healing- physical and spiritual - for her and her whole family.Although Birme’s family brought her into the hospital for medical healing, they believed that her illness was of a more spiritual nature. For those of you who don’t believe much in the “spirit world”, this will just come across as a weird story. For those of you who truly believe that there is a war raging between God and Satan, please read this and pray, HARD! I assure you, living in a land where the Devil can and does work openly; I have no doubt that we are involved in spiritual warfare. Hereis her story, and the beliefs of her people, the Mafa.In Birmé’s case, she is unlucky enough to have a grandfather (father’s father) who is a sorcerer, an old one at that. As the story goes, her grandfather is becoming more and more feeble and is afraid of dying. Every year, for the past three years, he has sacrificed (in the spirit world) one of his grandchildren in order to “buy” more life. Consequently, in the “real” world, each of these children has gotten sick and died. This year it’s Birmé’s turn. To make matters worse, her mother’s brother”knows” what has been going on, and has threatened that if Birmé dies, he will kill everyone in the grandfather’s family. This 13-year-old girl IS a spiritual battleground.To give you a better idea of the Mafa ideas, and how one can “buy” life, you need to understand their basic spiritual beliefs. I’ll give you the short version. The Mafa believe in what is called a second or middle heaven. Some Mafa Christians call this The Devil’s Heaven. In this heaven is a grand market. At the market, you can find almost anything you want, from special pieces of clothing, to knowledge, to longevity. You can also buy spells to harm or kill people. Only a sorcerer can go tothis market, however many people here are considered sorcerers. (My opinion is that a sorcerer here is just one who has access or is open to this spiritual world.) Apparently Birme’s grandfather goes to this Devil’s Heaven to buy longevity, but the spell only lasts for a year. His payment each year, for the past three years, has been the lives of his grandchildren. This year Birme was the sacrificial grandchild.The follow-up to the story is this:I paid her hospital bill and released her from the hospital right after we all prayed with her. I wish I could tell you that she was healed instantaneously, but God works in different ways than we would hope. She returned home, to the home where her grandfather lives. Within weeks of her discharge, her speech returned and she was completely normal. Both of her parents started going to church again with the knowledge that God’s love conquers all. Her father had once been a Christian but longago left the church to follow the spirit world. Now he is a believer in God’s power and grace. Birme and her mother visited me several days ago as a testimony of God’s love. If God can use me to save just one soul, it’s all worth it.In His Grasp, Audrey
Published by admin on June 5th, 2008 | Filed under | Comment now »Shanksteps #98
Shanksteps #98 The nurse called me to see someone in the ER. The note said he had an arrow sticking out the side of his neck. I see an old man (approx. 65 years old) pulling out on the arrow lodged in his neck. He is pulling it out as they feel if he leaves it the barb will continue working its way deeper and deeper. He is conscious and talks with a little hoarseness in his speech. We went to the operating room where I explored his neck. The arrows path took it through the saliva gland under his jaw, thenpiercing his voice box with the barb caught in his larynx musculature (voice box muscles). I free up the barb and pull out another 1.5 inches of metal, rusty with years of nonuse. Air bubbles up through the blood collecting there. His larynx was pierced through and through. After leaving a drain and closing over the hole, I finish that surgery.In the past the story goes that two brothers were living in the valley. One decided to move into the mountain beside the valley. In doing this he gave his brother the right to cultivate his land in the valley if at the end of each year he gave a portion of the crops to him. Thus the villages of Mauvmi and Oupi were created separate. For many years at the end of the growing season the Mauvmi people have given the Oupi grains and animals for their yearly debt. Two years ago the Oupi people didn’tdistribute the goods evenly and so discontent arrived in that they didn’t receive their share. So last year they were going to fight. The local authorities were able to calm everyone down and a war was avoided. Now this year they decided to claim their land and work it themselves. So both villages are claiming this land as theirs. So they organized a village war. The Oupi have had problems with other villages in the past so others are joining in too. The men would go with their bows and arrowsand stones and fight against the other men. Oupi had a distinct advantage of being on the mountain. Stones and boulders made it difficult for Mauvmi to attack. But some harm was done and some houses burned and some clubbed and stabbed. None arrived at the hospital for the first three days of fighting. Apparently for the Oupi to arrive here the hospital is to go through hostile territory. So they aren’t coming.The second casualty was the next day. He had an arrow lodged in his back that came out on his way to the hospital. Listening to his lungs he had a pneumothorax (a collapsed lung) but was breathing well. He had a 6mm hole in his back on the right side. I decided to watch him but he wanted to leave. He refused anti-tetanus serum and when the guards were changing he snuck out of the hospital.Last night I was called to see a man with an arrow in his leg. He had been shot in the front of the leg in the medial aspect. Fortunately for him the vessels were missed and I was able to take it out within a few minutes of anesthesia.I heard that yesterday they decided to prolong the war for 10 more days. They are now fighting on a battlefield. It’s edges are marked, with two sides opposing. The women and children are staying at home. But may venture into the other village to steal goats, sheep, sacs of millet, or other things. The men enter the fight by selection. They use some magic spells to know who should enter and won’t get shot. Apparently there is a large crowd around the perimeter just watching the war go on.When the deputy or chief of the village go near they try to shoot at them too. I’m not sure why more hasn’t been done by the government to stop it. They have been there some, but when they turn their backs they are right back at it.We hope all this will stop soon. Fortunately its only localized to their area. Greg
Published by admin on June 3rd, 2008 | Filed under | Comment now »Shanksteps #97- War Games
Shanksteps #97- War GamesHave you ever played Laser Tag? How about Capture the Flag? War Games? Paintball? Cowboys and Indians? You know, games where you hide behind bushes and rocks and shoot at your friends…Just 3 miles from here, several villages are playing their own war games, however they are using real bows and poisoned-tip arrows. I know you are saying, “But this is 2008, how can this be?” I assure you that this is the real deal. Greg has already pulled barbed arrows out of a chest, neck, abdomen and thigh. Most of the “warriors” refuse to come into the hospital because it would mean that they miss out on the war. Apparently the initial two villages have been enemies for years. They lasthad tribal warfare in the 1980s. Now again, the village farther up the mountain attacked the village toward the bottom. Why are they fighting? The fight started over a field. One village said that it was their right to plant it this year, the other refused. As fields mean food, and food means money, it is an understandable fight. However this one has gotten out of hand. The chief of the upper village (Wopi) is recruiting all men from the village to fight. When the police or army comes to stopthe fighting, the chief tells his men to shoot at the authorities. So far, the fighting villagers are much braver than our feeble military. A couple of days ago they started burning down houses as well.The interesting thing to me is that there is an accepted “playing field”. This area doesn’t contain any houses. Only certain men are chosen to fight or “participate” as they call it. The surrounding villages have all come to watch. It is almost as if it is all a game - although people are getting hurt and dying (and I’m sure more will die of tetanus). At first, the war was “scheduled” to last for 4 days. Now they keep postponing the end. We are now on day 6, with 10 more “scheduled”.The men that have come into the hospital are begging to go home to re-enter the war. Two have already done so. The first man came in with a hole in his chest causing collapse of his lung. He refused most treatment (including tetanus vaccine) and fled the hospital without paying his bill. (He recently told our guard that he plans to pay the hospital when the war is over, he was just anxious to get back to the fighting). The next man to come in came in with a barbed arrow in his neck through hislarynx. Greg removed the arrow and repaired the damage. He is also trying to leave to go back and fight. The third guy came in with an arrow sticking out of his abdomen. Greg was able to remove it without opening his abdomen. He had no internal damage and did well after watching him for several days. He left the hospital today, begging to go back to the fight. The fourth guy came in with a barbed arrow sticking out of his thigh. This was removed and he is still being treated. There have beenmany others hurt who have refused treatment. I don’t know what the death toll is now, but it is mostly due to overwhelming infection of the arrow entry site.When we hear of all that is happening in the world, we are reminded again that we are in the beginning of the “time of the end” where “you will hear of wars and rumors of wars” (Matt 24:6). Please pray for the fighting to end and that these peoples hearts will be changed by the love of God.In His Grip, Audrey and the Shanks
Published by admin on June 3rd, 2008 | Filed under , | Comment now »Shanksteps # 96
Shanksteps # 96A 60-year-old woman lay on the floor of the Emergency Room. Fear filled her eyes. She was given a medicine cup filled with water. Her eyes grew more fearful and she threw it across the room. She answered questions appropriately, but was agitated with a crazed look on her face. One minute she was lying calmly; the next she was writhing and breathing fast. When asked why she threw the water across the room, she answered that she was “afraid” of it. Her brother was in the corner crying softly(extremely rare to see men or women cry here). We asked if she was bitten by any animals recently, and the response was yes, by a dog a month ago. Rabies! 100% fatal once symptoms start, and death usually occurs within a week. Her brother had died of rabies a year ago after being bitten by a dog. My heart aches, I feel like joining the brother in the corner. I explain what rabies is and what the outcome will be. I pray for healing or endurance for her and the family. I asked the nurse to prayin Mafa, so that she could understand. We pray that she accepts Christ and that she feels peace. Later I ask the nurse that lives near them why they didn’t look for rabies treatment after she was bitten, especially when her brother died of the same thing. He explained the following: It is common belief that only sorcerers die when bitten by a dog with rabies. Other people do not. So if you are not a sorcerer then you don’t need to worry. But maybe you do believe medical recommendations to get treatment, if then you go to get the treatment you are very shamed because all your neighborswill be convinced that you ARE a sorcerer. Here is the pathophysiology of a rabies bitten person based on local beliefs. After the bite a small dog starts growing inside. It is in the early stages that the traditional healers can “treat” it with sacrifices and other witchdoctor things. In the later stages when it already “has teeth and hair” it is too late and cannot be killed and the person will die of the disease. As you can see, it is hard to convince someone that the treatment is necessary when they are bitten. Especially when they are not a sorcerer and our medicines wouldn’t treat something like a dog growing inside anyway. So it makes more sense to go the person that treats these kind of things, the witchdoctor. Continue to pray that we learn how best to relate to the Mafa people that have so many different beliefs and understandings than we do. In His Service, Greg
Published by admin on May 19th, 2008 | Filed under | Comment now »#96 Shanksteps - Selfishness
#96 Shanksteps - Selfishness
How many times does the Holy Spirit have to scream in your ear before you finally give in? What does it take for you to realize that you are self-centered? For us it took the angelic face of a 12-year-old girl who appeared on our doorstep one evening. Her name is Dzaoda. This courageous young girl is the very first female in her village to continue her education past elementary school. Her mother and brother, who are from a village about one hour away by motorcycle, decided to send her to the Adventist Secondary School in Koza. This is her first year here. Up until now she has been living with her aunt here near here. However, last week, four weeks before the end of school, her aunt kicked her out of the house demanding that Dzaoda give her two bags of millet or she couldn’t come back. Dzaoda came to our house to ask if she could hide her books on our porch because she said that if she left them with her aunt, her aunt would throw them away. (The school is right next to our house.) She said that her mother was coming in 3 days to arrange everything with her aunt. We offered that she could stay here until her mother came, and our guard thought it best for her to sleep on our front porch. We gave her a mat and mosquito net, and fed her for the next several days. Now, at this point I know there are some of you saying, how could you leave a young girl outside like that. First, let me say that everyone here sleeps outside during the hot season. You also have to remember that the people here live by the concept that if you “have” and I “need”, it is perfectly okay for me to “take”. Unfortunately, the inside of our house would be too great a temptation for almost anyone, with all of the “American stuff” we have. Even if they weren’t tempted to “borrow” any of it, they would certainly tell all of their friends how “rich” the Americans were. So, to avoid these and many other problems, we don’t usually invite people that we don’t know VERY well into our house. Several days ago we went out and she was crying. After calling our hospital chaplain over to help talk with her, we discovered that she was afraid that we would be angry with her and think she was a liar because her mother never showed up. We assured her that we were not angry and promised to try to work things out for her. Our Chaplain went and talked to her aunt and others who knew what was going on. Well, yesterday morning, we met the Aunt. She said with her mouth that Dzaoda could come back to her house, but with her tone/mannerisms, it was quite clear that she was not welcome or wanted. So, yesterday afternoon, Greg drove Dzaoda to her village to meet with her mother and brother. (Her father died when she was 7.) Greg planned to drop her off, but made her promise to come by our house on Monday morning (to make sure that she was ok, and that she was planning to finish her last 3 weeks of school.) He talked for a while with her mother and brother (all translated, as no one in the village speaks French), and in the end, realized that she had nowhere to stay if she was to finish out the year of school. So, Greg agreed that she could stay at our house until school ended. Last night, we again had Dzaoda sleep on our porch with the idea that we would try to find a good Mafa family to stay with in town. Now, I have to tell you that for the past week as this saga has been unfolding, I have not really felt at peace about her sleeping and eating outside; despite the fact that she was okay with it; despite the fact that it was culturally appropriate; despite the fact that our guard was out there with her. I have been continually rationalizing that it was okay, while in my “mother’s heart” it was not. So, after almost a week of struggling with the voice of the Holy Spirit (some would call it a conscience), we have taken her in as one of the family - rules and regulations included. And finally, my heart is at peace with my head. I also realized that if God wants us to take her in, then he would protect our “stuff”, or make us realize that we really don’t need it anyway. It’s obvious that we are different from the people of Koza, but sometimes I forget how different. I was again struck with how much we do have, and how little the people get by with. When I was showing Dzaoda around the house, I realized that I had to teach her how to turn on the water in the sink, use the toilet, and switch on the light in the room. We are so blessed, and yet unfortunately so selfish with our blessings. Try not to use this reminder to point out how others are selfish, but look inside yourselves to see how you can share your blessings with those around you. In the service of One who is completely unselfish, Audrey (and Greg and Sarah)
Shanksteps #95
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
Shanksteps #94
Shanksteps #94
How strong are your beliefs and what are you willing to give up to keep them? A young man came by the house today. And is often the case I first think who is it? If it is someone I don’t recognize I think what do they want. Often its to ask for something. Seeing someone who I didn’t know I asked what they needed. His was a request.
He is in University a full days travel away. He was brought up in a family of animists. While he was young his father didn’t take care of his family or make sure they could go to school. Everyone was for themselves. He made it to high school with the help of other family members. In grade school his father decided to become a Christian and got rid of his extra wives and their children. (Doesn’t seem entirely Christ-like to me) So since that time he has essentially had no father. A few years
ago a Peace Corps worker was here and he helped her a lot and she subsequently helped him get a small plot of land to have a house here in Koza. She has also helped him with part of the schooling for going to University. He has strong beliefs. He is a Seventh-day Adventist. Since he takes his beliefs seriously he has chosen not to go to classes or tests on Saturday, but preserves it as a day holy to God. His first year in University he was able to pass ten out of twelve credits. The two he
failed because he failed to attend the final tests which were on Saturday. The school advanced 160 students of the 400 of the first year. He was also advanced. Now in the second year he is nearing the end and has found out that five of his 13 credits are testing on the Sabbath. So he feels he will not pass this year. When I asked him how many others are in the same situation he said one other. He said most other Christians trample their beliefs while at school, whether it be Sabbath observance
for Adventists, or sexual promiscuity for others, or alcoholism for still others. Sounds similar to many Christians in the US Universities doesn’t it?
He came to see if there was any way I could help him go to a Christian school that did not require activities on Saturday. He said this school generally costs 1.2 million CFA ($2800) to attend per year. 750,000 for tuition, and the rest for rent, food and other living expenses. He thinks he can do it for 1 million CFA. He gets 400000CFA help from his friend, could get 100000 from a younger brother and is asking for help of 250000 a year for three years. This would cover his tuition. He will
work locally to cover lodging and living expenses. All of this to keep his beliefs. How strong are your beliefs? Are you willing to give up critical things in your life for your beliefs.
I hope this story encourages you in your beliefs that those who are following God need to always be firm in the time of temptation to fall to the easy way or to rationalize away your conscious. If any of you are interested in helping a young man please let me know.
In His Service, Greg
Shanksteps #93
He was born this morning. He has six toes on each foot, six fingers on each hand. Short stubby ears, and a wrinkled forehead. He weighs 1.6kg (3.5 lbs). His parents said he was term but that’s not likely. His heart and lungs sounded normal. He was crying and had a cleft lip and palate. But the biggest problem lies at his umbilicus. There was a 3cm wide hole with all of his bowels laying on the table beside him (gastroschisis). [It is an abdominal wall defect that has 14% associated jejunaland ileal malformations, 4% have other malformations, 60% are premature, and there seems to be no associated genetic factors.] Only the grandfather and some other relatives were there. The mother was to weak to come to the hospital they said. The father was away in another village, and didn’t know he had a new baby. I explained to the grandfather that survival was unlikely but that surgery was his only option. We took the child to the operating room. He was making stool, which made me slightly hopeful. Our student missionary and I were able to take all of the edematous bowl and put it back inside. We sweated profuselyas we attempted to do the repair without air-conditioning because the child was already cold. It was 107deg F outside, and just as hot inside, with our gowns on. We have no warming apparatus in the OR. During the surgery the child vomited and desaturated (dropped his oxygen) and I had to unscrub to help the nurse bag the patient. He was not able to raise the saturation. After 30 minutes he was stable enough on max oxygen for me to reenter the operation. We finished the operation and he wasbreathing on the maximum oxygen that we could give (5L NC). We put him in the incubator donated by Parkveiw hospital and warmed him up. He would periodically stop breathing and we would have to bag him up again. We started another operation, a hysterectomy for uterine prolapse, and observed the baby in the OR while we did it. A few hours later after seeing clinic patients a man came in who was stabbed in his left upper abdomen and had omentum hanging out. Blood oozed from his side and he was drunk and talking profusely. He referred to me as a priest and explained he was stabbed with his own knife he was carrying. As we went to start his operation the baby desaturated again and I had to go between roomsto help him. Then the power cut off. We operated in the dark by headlamp donated by the head of surgery at the end of my residency. I could hear the monitor going off because of the low oxygen but could do nothing about it. They went to find someone to start the generator. Finally the generator was started about 5 minutes later and the oxygen for the baby was in single digits (normal is >92%). I was concerned then about brain death for the child. We found a spleen laceration in the stab victim,through and through stomach perforation and a liver laceration. We repaired the stomach laceration and repaired his cut rib at the entry site. The baby was being bagged more often with less success, he was wearing out. He needed to be on a ventilator, but that’s not available here. Finally I decided to stop and turn off the generator. It is often very difficult decisions that physicians have to make on a daily basis. Unfortunately many are life and death decisions. I pray daily at the beginning of each rounds, that God gives me the wisdom to treat each patient that I see, and not harm more than help. It is frustrating not to be able to diagnose problems and even more frustrating to know the problem and not have the equipment or staff to do something about it. Another along those lines is that we are having a measles outbreak now as Audrey wrote recently. We are up to 8 cases now. Children that were apparently already vaccinated against it, for the most part. Very contagious and preventable. We are thankful for our health that is holding up in spite of our surroundings. Thanks for all your prayers and emails. They are very encouraging.
Greg
Published by admin on April 26th, 2008 | Filed under | Comment now »Shanksteps #92
Shanksteps 92
For you medical people out there: What would be your differential diagnosis for an 18 month-old that presents to clinic with conjunctivitis (pink eye), sore throat, and cough? What if I told you that her dad had been in the hospital about 3 weeks before with similar symptoms and was still not feeling well? After 2 days this little girl developed what looked like heat rash on her face and trunk. Of course your initial diagnosis would be to put her in isolation with the Measles. How many of you
out there have even seen a case of the Measles? It was a new one to me. Fortunately (or unfortunately) some of our nurses have seen several Measles epidemics in their lifetimes and recognized it right away. So, let’s review the fact about Measles. It is a virus. There is a great vaccine against it (that this child, and the subsequent 4 kids that came in, all received). There is no real treatment for it except Vitamin A and tincture of time. It has a 90% transmission rate to those susceptible
(not vaccinated/not immune). It is contagious for 2 days before symptoms appear and 4 days after they disappear. It is a VERY scary disease because there is really nothing that can be done once the symptoms appear. We now have 4 kids in the hospital from 3 DIFFERENT villages. The 18 month-old girl died 3 days after arrival. The country considers it an epidemic if there are only several cases. But in Cameroun, as in most developing countries, it takes a long time to take action - vaccinate the
whole population in order to stop the spread of the disease. So, we are presenting all of these kids to God for healing, and praying that HE stops the spread of this disease, and protects not only the family members and neighbors, but all of our employees and patients as well. Please pray with us for healing and protection. We really need your prayers, as this could be devastating for these villages.
May God bless you all with health.
Audrey and the Shanks
