MissionDocs.org

 There are constantly new ways of doing things when one lives in a rural situation without many supplies.  We order medications and only half of our order arrives.  So we do without medications a long time.  We are forced to make due with what’s available at the time.  There are other medications available through pharmacies in town but the cost is prohibitive to the local population.  Our prices are already to high compared to the health clinics in the area.  Our prices have remained the same formany years but we are still just existing financially.  Even with our “high” prices we can barely pay our workers each month.  The government dictates the salaries of workers and unfortunately as of yet we have not received any financial help from the government to help purchase medications∑  In addition, in rural areas we use what is available out of necessity.  Here are a few examples: This hernia is to difficult to close with only sutures.  “Well we have mesh!” “Mesh?”  “Yes we sterilized it yesterday.”  To my mindset this sounds very strange.  I have repaired all hernias here with only suture since coming to Cameroon.  Now I’m in a hospital in Chad, and they have mesh?  After asking further questions I discovered that the “mesh” was a cut up mosquito net.  I thought, what! a mosquito net?  I guess there have been studies done with using mosquito nets as mesh in impoverishedareas.  So I tried it.  It lay very nicely in the repair.  After the surgery the man was healing well and went home in a couple days.   Another was in prostatectomies.  We have many old guys whose prostates are so large that they cannot urinate well and get urine infections.  And as we do not have sufficient supplies of medications for this disease, in general we treat them for a few weeks and then operate on them.  Well after the prostate is removed they usually bleed a lot and need continuous bladder irrigation.  Some people can afford the regular saline flushs and others cannot.  We have heard in the past some surgeons have usedplane water irrigations.  So we have done this at times out of necessity.  And it appears to work well.  Also the family can add water and if the nurse is busy and doesn’t do it, then at least there is still irrigation running. Another is our treatment of meningitis.  IN the US this is generally treated for a few weeks with intravenous antibiotics.  Here the people cannot afford it.  It takes a great deal to even convince them of a few days.  As soon as the person is awake again they want to take them home.  We generally do 5 days IV and then 2 weeks of oral antibiotics. I think the most important part of our patients health is Gods healing them.  In spite of our inadequacies and in spite if our lack of appropriate medications, people get well at the hospital.  We try to encourage our patients that it’s God that heals them at to look to Him.  Thanks for your prayers and please continue to pray for all those we care for.  We are all His children whether we know it or not. 

 

Shanksteps #75

“I need you to come to the hospital now, he is not breathing well!” As we went to the hospital I found out that a drunk man was run over by an ox cart. It has an axle and wheels from a car or large metal wheels with spokes. On top of that is a wooden box and a “tree” coming out of the front to tie two bulls to, to pull it. He wa sitting on the floor with a lot of difficulty breathing. I listened to his lungs and heard breath sounds on the left but none on the right. He had a tension pneumothorax
(collapsed lung). His right chest slopped of to his arm pit at a weird angle, kind of flat. They said the wheel had come up on his chest. His left side looked OK. I went to the OR and was able to find a chest-tube to put in him. A bit of blood came out but it appeared he would be all right.

Just after that they asked me to see someone that had just come in. They said he was bleeding from his foot. I went to see a man that had been his with a knife 2 weeks ago around the ankle. It had gotten infected and he had gone to a local clinic the day before who refered him to us. Walking in the room, I knew what I would see when I took off the cloth covering his foot. It stunk real bad, and had a puddle of liquid under his foot. After taking off the cloth I saw that he had dead skin from
the base of his toes up to above his ankle. Here things are paid for in advance before treatment is started or given. So he left an ox-cart as collateral on the operation. We debreeded all the dead tissue and basically he had no skin left over this area.

Weve now been in Bere, Chad 2 weeks. I have done about 30 surgeries and don’t know how James Appel can do it alone. Audrey and I are keeping very busy. I hear that he is doing well in Koza since we changed hospitals for a few weeks. We have about 45 patients in beds and about 8 outside under trees because all the beds are filled and some have 2 different children in them. The nurse sees about 30 outpatients a day and we see about 15-20 of those. There are a number of student missionaries and
an Australian couple doing maintenance temporarily. It’s nice to have other missionaries around and speak English. Electricity is on 2 hours a day in the evening via generator. There is running water from a water tower. Food seems to be more expensive. We have two weeks left before returning to Koza, and are looking forward to it but enjoying aspects of life here also. Please pray for James and Sarah Appel as they work in a very difficult situation for one doctor. In His Service, Shanks

Shanksteps Job description of a medical missionary (and hospital director)

The longer we are here, the more involved the job description of my husband: general surgeon and hospital director. When a 35-year-old man comes to the hospital with a painful inguinal hernia, he is a general surgeon. When a pregnant woman comes in need of a Cesarean, he is an OB/GYN. When during the C-section, the baby refuses to breath, he is a neonatologist. When a 5-year-old comes in with a skull fracture after an accident, he is both neurologist and neurosurgeon. When Bouba, a 18 year old
boy, comes in after being stabbed through the diaphragm for calling his cousin a donkey stealer, he is a cardiothoracic surgeon and then pulmonologist. When a 70-year-old man comes in with a huge prostate and inability to urinate, he is an urologist. When a 6 month old comes in with severe anemia from malaria, he is a pediatrician. When a 45-year-old comes in with hypertension and irregular heartbeat, he is a cardiologist/internist. When a 45-year-old woman comes in with VERY advanced breast cancer,
he is both surgeon and oncologist. When the minister of health comes to the hospital to discuss how to prevent another meningitis epidemic, he is a Preventive Medicine doc. When a 2 year old comes in and weighs only 9 pounds, he is a dietician. When our medication is running low, he is a pharmacist. When a 20-year-old comes in with renal failure and our lab tech is away at a meeting, he is a laboratory technician.
When there are employee disputes, financial difficulties, fist-fights between nurses and patients, theft of money and medications, committee meetings, difficulties with the police and army, and new nurses to hire, he is the hospital director. (He is often also a psychologist/counselor in these situations.) When one of our maintenance guys was having problems with his girlfriend, he gave advice and support and acted as surrogate father. When asked to preach, he is preacher (much outside of his
comfort zone).
When our male cat needed to be neutered, he was the veterinarian (on the middle of the living room floor). When the female cat started spraying and needed to be spayed, he was assistant to a visiting American vet. Any time large items need to be picked up for the hospital, he is the driver/chauffer. When electricity goes off in the hospital (but not in the village) he is digging up buried electrical lines and patching them back together, and is an electrician. (He is also an electrician when the
oxygen machine blows up in the ER.) When the voltage regulator catches fire in the lab, he is a fireman. When the oxygen concentrator (a different one) refuses to work, he is a mechanic. When car stops running, he is an auto mechanic. When I’m away or sick, he’s a Jr High Teacher. Every morning he fixes breakfast, and is therefore our cook. When we needed curtains to cover the windows, he was, yes, even a tailor. When the newly opened airstrip in Koza needs to have trees uprooted and holes
filled in, he is a landscaper. When the Acacia trees lining the entrance to the hospital need to be cut down, he is a lumberjack, followed by landscaper, replanting new trees. When the metal grate covering the windows is sawed off by the thief, and needs to be repaired, he is a welder. When the roof is blowing off in the high winds, he is a roofer. When we discovered that there were boxes upon boxes of things donated over the years, all hidden in the garage, he spent hours pouring over equipment
and was a cleaning service. When we suspect that someone has been breaking into one of the houses on the compound, he is the “assistant” guard (armed with machete). When the sink springs a BIG leak, he is a plumber (even when it is fixed with an old bike inner tube). When the hospital latrine falls in, he is in there helping clean up; afterward manually digging a new hole with the other maintenance guys. When our toilet stops working 2 weeks before vacation in the US, and the replacement doc is
staying at our house, he is again the plumber. When he finds out that it has stopped up because the septic tank is full, he is out there manually scooping out 15 years worth of waste. What would you call that? I call him a saint.
At the end of the day, he comes home and is the spiritual leader of our home; and the best father and husband anyone could dream of. Please pray for Greg and the “many hats” that he wears. It is a very difficult position that he holds, but God is supporting him moment by moment, day by day. —Audrey
(Every one of these situations is true :})