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It’s been a hectic last few weeks.  Multiple surgeries each day and the hospital ranging from 50-77 patients (full).  Pediatrics has sometimes had 28 patients in 25 beds.   Also the government had another session of a vaccination campaign.  This time it was for polio, Vit A, and mebendazole (worm medicine).  This is why I have not written in a while.

So Mbaitomou (a nurse) comes to my door and says, Je une cado pour vous! (I have a gift for you) shaking his head.  He describes an old man who was on a motorcycle in Garoua and had an accident.  This resulted in an open tibial fracture in about three places.  He was treated initially at a health center there.  They cleaned out the wounds, then the patient was taken to a traditional bone setter.  He was placed in wood splints and then brought back home to Nguetchewe, a village to our North.  There he was treated by the traditional healer there for two months, with weekly replacing of the wood splints, and “setting” of the fracture.  So they brought him in a pickup because it was smelling bad.  I asked Mbaitomou if he had removed the dressing, “No, but the smell is overpowering, the other patients in the ER got up and went outside when they brought him in.”

It was night so I walked in with my headlamp.  Walking in I saw the eyes of two bush babies jumping through the trees and those of a ring-tailed wild cat.  Also a barn owl catching insects near a florescent light.  Arriving at maternity the smell is powerful.  I see an OLD, thin man laying on a foam mattress with blood and pus dried in pools around his left leg.  Wood splint were visible with cloth wrapped around the splints at two inch intervals up to his knee.  The foot lay cocked at an odd angle off to the side.  As I look closer there are maggots of different sizes moving about the lower edge of this “dressing.”   The man appeared very sick and malnourished.  As I remove the dressing and wood pieces I see exposed tibia from near the knee down to almost the ankle.  Skin attached to the dressing comes off the leg easily.  Two fractures are easily seen on the exposed bone.  Maggots pour from a necrotic area near the knee, the visiting doc leaves the room.

An elastic tourniquet is applied and the leg prepped.  With the help of the visiting doc we amputate the leg above the knee.  The removed part is given to the family for them to bury the following morning.  He is then taken to his room to wake up from the anesthesia.  About two days later he finally wakes up and takes porridge.

The following day was also full of surgeries.  We perform an inguinal hernia repair; explore a woman for an extra-uterine pregnancy, evacuating an huge hematoma; and do an emergency cesarean delivery for failure of progression of labor in a woman with previous  cesarean.

“Lord, give us strength to serve you day by day.”  Greg

MOV02374

Its vaccination week. There was a case of polio up in Kusseri, in the far north. So this spawns a reaction to vaccinate everyone in the north. These are sponsored by the WHO, UNICEF, and World Bank. So for the local population it is free. This time, polio, Vit A and Mebendazole are given to all children up to 5 years of age. Last month it was vaccination of all pregnant women for tetanus.

I head out early to do my supervision of the process early before arriving at the hospital late, around 10AM. It is cold, 61deg. I think that’s the coldest I have ever seen. After supervision I hope to finish rounds, and see the outpatients before 3PM. Then back to the village to verify a cartier or two before the sun goes down at 6PM.

I take the motorcycle out across the main road and head for the mountains. I pass children in blue uniforms heading to school. Some wear simple plastic shoes, others with tennis shoes. Some with baseball caps. One has sunglasses on. They walk in groups of 2-4 it seems. As I go out further, I pass a four year old girl carrying her little sister on her back. Boys run by with a stick pushing an old motorcycle tire. I pass a one year old child playing in the dirt in front of his dirt home. Dust flies up as he pats the ground and throws dirt in the air. I lock up my breaks as 4 goats dart across in front of me. I cross the river and climb the other side. There is a wide area that no one lives on, this is the burial ground. I pass it and when I re-enter the habitable area I nearly run over a chicken that is finding something near the dirt path I’m following. I find the vaccinators passing from house to house. I have to verify that the vaccines are maintained in the cooler with ice packs and are in good condition. I also look at the way they mark the house with chalk, to assure that it is correct. Then on to find another group.

I cross a flat area with dried grass along the path about 2 feet tall. Next I find two women vaccinating a group of children. I check out their cooler and find vaccines and some flat food patties they are keeping cool along with them. I explain why that is not good and take them out. They mark the fingernails of the children to show that they are vaccinated.

I drive on to another section of the village. I pass a group of young boys kicking around a deflated red ball. Another group is using a wad of tape. I pass mothers carrying wood on their heads, babies on their backs. Others have a sac of millet on their heads, headed towards the grinding mill. I verify a few others before heading to the hospital.

I see a few patients in the clinic, then head to the OR. I have a prostate to take out. After the surgery we take the patient to their room and explain to the family how to verify that the irrigation is passing well. I tell them because I’m sure the nurse doesn’t pass real often, especially if there is a delivery. So the family is the eyes I need to watch the irrigation. In the evening I head back to see if the children are marked correctly and they are vaccinated in the cartier they say they have finished.

I arrive at a small building that has three rooms. It is the Kilda health center. It was just opened officially by the sous-prefet. The vaccinators are all sitting around in front of it, wrapping up the days numbers to hand in to the district health department. After talking to them I head to an area with a number of houses. I park the motorcycle and head house to house asking to see the children less than 5 years old. I check their fingers and ask their mothers if they know why we vaccinated their children. Most don’t know and some refuse to have their children vaccinated. I find 6 children non-vaccinated. We have to repass through this cartier. It is now to dark to see and I head home. Home to sit and recuperate from the day. I often wish I had less responsibilities, but I figure many adults wish that. Greg

#139 Shanksteps

I get a call at 6PM that our large order of medicines has arrived from Yaoundé. This means that all the private hospitals are going to meet in the early morning to unload the truck then separate the supplies for the different hospitals. I was planning on taking a day off with my wife who has been sick in bed for a couple weeks. I is nearly impossible to get time away as every day they call for patients. Sabbath my entire day was spent at the hospital. Sunday is our busiest day of the week and the most patients come. Last Sunday was 62 inpatients and 32 outpatients. But instead instead of resting, I need to go to Maroua. So I leave at 7AM to drive the three hours to Maroua.
They have already started unloading when we arrive. I drop off Doudge to start with them as I go in to Maroua to get other things taken care of since it has been three months since I was last there to buy supplies and go to the bank. I buy supplies we need and then return to the place they are separating the items. After packing our pickup full of boxes of medicines and supplies we start home. Today we are “early” leaving at 5:30 PM for the three and a half hour drive back. As we crawl back home over the rocky road we get a call that there is a patient that needs a C-section. I ask them to send her to another hospital. As usual they refuse.
We arrive at the hospital and unload the truck into the stock room. They ask me to see three other patients that came in during the day that the nurses are worried about. A woman has peritoneal signs (signs of needing surgery in her abdomen) that we have been treating for typhoid about three days, another old man has bad pneumonia and is struggling to breath. Fortunately the electricity just came back on so he was just put back on oxygen. The other is the woman they called me about. Apparently she had delivered and the baby didn’t breath. The nurses resuscitated the child and he was doing fine by then.
I headed home to get something to eat, as I had not eaten or drunk all day. Called the nurse to prepare the patient for exploratory surgery, and ate till I could burst. It was millet paste with a tasty sauce, one of my favorites, that really leaves you full.
In the OR: she is grimacing on the table in pain. Not comfortable in any position. We put her to sleep with Ketamine and Diazepam. As we open the abdomen we find pus everywhere. After searching all over we find pus coming from the fallopian tubes. She has a PID, infection of the uterus. We clean out all the pus and finish the surgery.
After seeing a few more in the ER I head home and crash into bed exhausted. Audrey is at least eating and drinking. I find that she has thrush in her mouth (oral-pharyngeal candidiasis). Her entire mouth is white with the plaques. Now I understand why everything has tasted real bad these past few days for her. She has also decided to stop the quinine as the side effects are very bad for her. She has probably already treated her malaria sufficiently anyway. She is slowly gaining strength, but cannot still be up more than about a half hour before she must lay down again.
Keep her health in your prayers, and for me to continue to have strength to do what I need to do. We appreciate all your notes and emails you have written of encouragement. Thanks!
In His Service, Greg

Shanksteps #138
It’s vaccination week for women 15-50 all over Cameroon. Audrey is out on supervision and I’m taking care of things at the hospital. It’s a long day and 95 deg (still the cool season). I make rounds on all the patients in the hospital (55 in all) and see about 14 outpatients, do one Norplant insertion, and open one abscess. I get home about sundown and find Audrey with her head in her hands. It’s the worst headache of her life. She asks me for a Diclofinac injection (very unusual as she doesn’t like injections). It’s the strongest painkiller we have at the hospital, kind of like injectable Ibuprophen. She has just completed a week of treatment for malaria and is still on typhoid treatment. Over night she is relieved a little by the injectable medication but it only lasts about 5 hours till she needs another. Then the itchiness sets in. She scratches and scratches. Takes dexamethosone and chlorphenirimine to help but they only decrease it a little. The next day w
e tell the district health doctor she is unable to help with supervision. She stays home and sleeps, until the pain is to strong to sleep, and the itchiness is unbearable. I get home again late and she seems a little better. Wednesday, Thursday, Friday. all the same things, all over. Injections, temporary relief, itchiness, injection, force down some food, itchiness, and me coming home late.
Friday evening Im still at the hospital. She calls me and tells me to bring home IV treatment for malaria and typhoid, she can’t handle the headaches or body aches or the weakness any longer. I bring home a nurse with me to start her IV. She looks terrible! Finally the IV is started and the Quinine starts in, Ceftrixone follows. She takes another med to help treat malaria along with the Quinine. I’m called to suture up a woman’s head that is bleeding profusely. She and her husband were drunk on millet wine and he hit her in the head with a stick and now she is bleeding. I follow the trail of blood to the suture room. She is talking up a storm to the man who accompanied her. I throw in a few stitches and it stops. No skull fracture. Throughout the night I wake up frequently to check if Aud’s IV is dripping correctly, to help her to the bathroom and at the different times the hospital calls me in to see another patient. At 2AM the patient that I just repaired his f
ractured patella calls me on my phone. “Cest no va pas, cest no va pas, cest fait mal.” I’m tired and he shouldn’t have my number or be calling me in the night. I tell him to NEVER call me again and to tell the nurse. I lay there fuming in bed, unable to sleep. My subsequent thoughts are, did I miss something? As I cannot go back to sleep because of my anger, I go into the hospital. I check out his leg and find he is still mostly toasted from the Ketamine and Valium I gave him for surgery. But he did come to enough to dial my number. I tell the family not to let him call me again. I sleep for a three hours before its Audrey’s next dose of Quinine.
Sabbath I spent the whole day in the hospital. Went in at 8 when they called. Home at noon, called back at 12:30. Home at 3, make something for Audrey to eat, back in at 3:45. Finally home at 7PM. I’m exhausted. Audrey’s IV isn’t working any more. They call me back in to see a patient with potential for Cholera (There is an epidemic in our surrounding area now). I ask the nurse to replace her IV catheter. He is unsuccessful. But she looks better. Her headache is finally gone that has kind of been there for two weeks and really strong for days. She looks good lying flat, but is dizzy when sitting up. She starts oral Quinine. I get called in to open up a large abscess on someone’s thigh. We sleep well finally.
Sunday morning, our busiest day here at the hospital, because it’s market day. Audrey is still too dizzy to stand for longer than about two minutes. She stays in bed. I go to worship at the hospital. See a few in clinic, then head for rounds at maternity and surgery. After seeing 25 there I go to peds. The ward is full about 27. I get done and head to clinic. About 3PM I have one card left and I feel I can soon breath a sigh of relief and finish the adult ward when the nurse brings me about 14 more cards. 32 in clinic today. I finish and head for the adult ward. 32 outpatients, 62 inpatients- 94 in all. I get home late again. Audrey looks better. The malaria is lessening and the side effects of the Quinine increasing. I have to talk loudly for her to hear me over the humming in her ears. She is more nauseous. She can sit up for about 4 minutes before she feels like vomiting and lays down. I feel quite tired. I think a cold shower sounds wonderful then.slee
p.until they call again. Lord give me strength! Need your prayers, Greg