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Shanksteps #47

Hello Family and Friends,
As I wrote last Sabbath it was crazy. Not a peaceful
day. Many things, one, after another. I had a much
more peaceful Sabbath this week. We were able to go
to church and there was also a baptism this week with
around 40 people baptized. We have a concrete
baptismal tank inset into the ground outside of the
church. So we just cleaned it up and filled it with
water. After the baptism we went home and relaxed and
ate our “Sabbath meal”. This means something not able
to be bought here and from the US. We had vegetarian
“pigs in a blanket”. It was very tasty. And as a
commemoration of every weekend the power went out.
Just about the same time I was called to see a woman
in the delivery room. She was 9 months pregnant and
had significant constant abdominal pain. I felt her
abdomen and the uterus was very firm. She said she
was NOT having contractions and this was her 5th
child. I could not find a heartbeat for the fetus.
So I suspected it was dead. I started to worry about
abrupto-placenta, but have not seen that before, and
she had no vaginal bleeding. I decided to ultrasound
her. I came home and got it and went back. I found
that she did have abrupto-placenta. For those of you
who don’t know, this means that the placenta has
detached from the uterus with bleeding between the
placenta and the uterus. If still partially attached
the bleeding continues, child dies very rapidly, and
mom dies if not receiving enough blood. So since
there is no blood bank or other way to get blood
products other than family, that is what we asked for.
I also prepared to do an emergency caesarian
delivery. I made it in there STAT (about 30 min) and
did the surgery. Stat means immediately, well except
for here, and other hospitals like this. At the
surgery we pulled out a stillborn child and LOTS and
LOTS of blood clots and blood. She looked like she
would have twins by the time we were able to operate
on her. Fortunately her husband gave 500ml blood.
She lost about 2000ml or more. She did remain stable
and is recovering well. The remainder of my Sabbath
was uneventful. We went over to a teachers house and
had millet and different sauces. One was kale based,
another squash based, another okra, and also some
potatoes, and taro. Finally after eating by
candlelight the electricity came back on. We finished
the evening at home. Just about the time to go to bed
I was called back to the hospital for some problems
with our inpatients. Child seizing, another with poor
breathing and then my operated patient with
hypotension. Fortunately these were all taken care of
and I slept fitfully for the rest of the night.
Sunday was busy with about 15 outpatients, one
gastroscopy, one proctoscopy, two ultrasounds
performed, and numerous “fires put out.” We look
forward to Wednesday when we take the daytime for our
family. We thank you for all of your prayers and for
your concern. We are praying that we will get back on
the ham email soon when Cristy (my sister) arrives
with a replacement part. Please keep us in your
prayers, In His Service, Greg

Hi! It’s me, Sarah.
If your wondering why we haven’t written in a while
it’s because we where on a glorious furlough filled
with ice cream!
While I was there our friends and family told us how
much they liked the You Know Your in Africa When. So
I’ve decided to do a You Know Your in America When.

You Know Your in America When…

1.Ice cream

You can’t decide between a soft served, a hard served,
a sunday, or a swerly. Then you must choose the
flavor or your Soft served, hard served, Sunday, or
swerly.

There are 3 different ice cream parlors on the same
block.

As if ice cream isn’t tempting enough! Now they
throw in a free toy!

They make vegetable flavors. Yuk!

2.Cars

You see a minivan driving down the street with only 1
person in it!

The max people in a 12 seat van are 12 people instead
of 18 people (yes it possible, I’ve seen it first
hand).

There are more than 10 cars in 1 town.

Auto dealerships sell new cars that work.

3.The motorcycle aka. Moto

It’s considered ‘cool’ to drive a moto on a dirt road
but not necessary.

Only 2 people are on 1 moto! And they don’t even have
baggage tide to the front with cut up bike tires.

The moto breaks and you bring it to auto repair
instead of fixing it your self in the pitch black at
1:00 in the morning.

4. Whatever’s

You sleep without a mosquito net.

You have the option of two rows of cereal in the
store.

The general public dose not like rain.

Your mother says “eat every thing on your plate.
Remember the starving kids in Africa Even though
leaving food on your plate in Africa is polite. It
means your full and they have fed you well.

You have to pay to see cows walk down the street.

9-24-06

Sabbath, our day of rest and communion with God. Well
NOT TODAY!

I woke up in the morning and knew I had a few patients
that I had operated on the last few days and that I
wanted to see how they were doing. So when I woke up
I headed into the hospital. It was about 7:30 and the
workers had just changed shifts. As I checked on them
at maternity, another woman arrived in a pus pus (a
push cart that carries wood, grain sacks, or really
sick patients). I let the nurse figure out the
history while I checked in on the new patients in the
ER. I admitted one 5-year-old boy with malaria and
convulsions at home. Another 3-year-old girl with
convulsions while I was examining her (cerebral
malaria), and another with pneumonia and malaria.
Guess what season it is? Malaria, malaria, malaria!
Then they called me back to check on the woman again
in the delivery room. She had had one child at home
and had another one that wasn’t coming out. When we
examined her we found a hand sticking out of the birth
canal. This usually means the child is lying
transversely and will not come out. She was having
real strong contractions. But with him transverse
there was absolutely NO progression. Also when I
examined here I could not figure out the presenting
part next to the arm bulging out with it. I decided
to try an internal version. The is almost never
successful because the uterus is contracted and the
child cannot move. Fortunately I knew by now that
there was no heartbeat and we would have a stillborn.
(after delivering the first at home she went to a
dispensary and they “worked” on her a few hours.)
God really relaxed her uterus and I was able to find
the head and pull it down next to the arm and then was
able to do a forceps delivery of the stillborn.
After finishing that I saw a couple more in the ER
for malaria and for dysentery. Then I went back to
maternity to try to teach a young mother of a
premature 7-month child how to give formula via the
nasogastric tube. I needed the nurse to translate
for me but he had just received another patient who
was having contractions. He said he better stay with
her as it was her 7th child and may be fast. I was
able to find another mother who knew some French to
translate for me. After explaining how to do it I
went back and the other woman had already delivered.
They also showed me another child who had very wide
set eyes and skin very tight all over and nearly no
nares that were open. I mentioned to them that to
save the childs life that we would need to do a
tracheostomy to keep him from aspirating but that I
felt his prognosis was poor. The mother decided to
take him home rather than go the aggressive route.
Very sad but I understand.
I went home as church was ending. Ate some breakfast
and relaxed for about a half hour before being called
back to someone who was bleeding a lot. I went in the
room to find a mom who was pregnant to 6 months with
pools of blood all over the floor and bed. She was
going to die in front of me I was sure! I convinced
the family to be tested for blood and they went off to
call the lab tech. They were able to give one unit
only. She needed more. I went to work on getting
out the already dead child that as I found out was
breach. Since she was almost fully dilated I thought
I would have no problems. I found both feet and
pulled him out. But the head got stuck. Oh it was
terrible. She was bleeding like crazy and I have the
head stuck. After working a long time I finally got
the child out and was able to get the placenta out and
stop the hemorrhage! They had found another person to
donate and we were very happy that her life was saved.
Another one came in just after that for obstruction
of labor. I found out her pelvis was too small for
the child she was trying to deliver. I performed a
symphisiotomy and pulled out a screaming child. This
is a huge relief. Especially after a couple
stillborns.
To finish off the day and kill the night we had been
watching another woman in the ER who I thought might
have pre-eclampsia. This is a disease that the only
help is to deliver the child. She had come in with a
BP of 130/80. This seems normal except everyone here
is much lower. Her pressure came down then went up to
150/90 by evening. She had a hemoglobin of around 5
gm/dl. Normal is about 12-15. So she really needed
blood before we operated on her. So finally another
family member arrived from about 2-hour bike ride away
and she was able to give blood. The woman who had
pre-eclampsia also started to have foot swelling,
headache, epigastric pain, and visual changes. All
signs that convulsions are near. I decided to give my
blood to her also so that we could proceed with the
surgery that she needed, a caesarian delivery. I
gave, and off we went to the operating room. During
the surgery all her bleeding was like running red
water. The child was still born and had been dead for
a while. Just at the end of the surgery her oxygen
saturation dropped. She had crackles over both sides.
She had gone into pulmonary edema. I bagged her with
oxygen, then intubated her. Initially her oxygen came
up to 94% then over the next two hours of bagging it
gradually dropped. Cardiac arrest followed. It was
now 1:30 AM. I was very tired. I saw one more
patient in the urgence (ER) before heading to bed.
We have been praying for our hospital to have more
patients so that we can continue to pay our workers
salaries. God is answering our prayers by bringing
the sick of the surrounding area in. We also thank
you for your prayers. As you saw in my last letter
there are many frustrations. I believe God is helping
us grow. I wonder for what? Please continue to keep
us in your prayers, In His Service, Shanks

“When life gets tough, when you’re overwhelmed with
doubt, or when you wonder if living for Christ is
worth the effort, remember that you are not home yet.
At death you won’t leave home”- you’ll be going home.
p. 51 The Purpose Driven Life by Rick Warren

9-16-06
Dear Family and Friends,
This is a different letter than the past. Today is
Sabbath (Saturday). For those of you who are unaware,
it is the day of rest and communion with God for our
church. A time spent with God and family, with a goal
of drawing closer to God. Today has been very
difficult for me and I, for some reason, feel the need
to share the difficulty.
I am a surgeon; I love surgery and the art of
medicine within the surgical realm. As you have seen
from my past letters I do much more than just surgery.
I feel that surgery is enough for me and it is my
interest. But being here I am the director of the
hospital, surgeon, family practitioner, gynecologist,
respiratory therapist, physical therapist, chief
nurse, and chief of lab, of grounds…and on a larger
scale, a representative of our global church to our
hospital in Northern Cameroon. So being the Director
is not something I’m trained in or have a real
interest in doing. I was well aware that it would be
part of my job here before I came. However having not
been trained in it did not know all that is entailed
in it. (though when God chose our location, I would
not have changed anything). I have a good
administrator who takes care of many problems but
there are still ones that come I need to deal with.
It seems like since I’ve been back that there has been
no lack of problems for me to deal with. This last
week dealing with personnel problems is very tiring
and difficult, and not something I am very good at or
experienced in.
Today as it is Sabbath, and the day I attend church,
I went to church. However the problems of the week
follow me wherever I go. They intrude my thoughts as
I worship God, as I pray, as I work at home or at the
hospital, as I do surgery. Today was like no other in
that regard. At church ,at home, as I read my
uplifting book, these thoughts enter. And questions
start. What decision should be made? What’s best for
the hospital? What will be the workers reactions?
When will I not feel all alone? When will the strife
end? When I awake in the middle of the night, they
start again. When I’m called into the hospital the
same! What would God do in this case? Is there
anything in the Bible that addresses a similar issue?
Then so many are unclear still and I struggle what
should be done.
I am very fortunate to have a woman of God as a wife.
Today she suggested we pray together and ask for Gods
wisdom. No lightning bolt of wisdom hit us but peace
is there. We need to continue turning things over to
Him. This is His hospital, regardless of whether or
not the workers are working for Him or their wallets
or their status.
I guess what I really want and need is an incredible
love for the people. It’s hard to love people who are
difficult. It’s easy to love those who love and
respect us. Very hard to love and minister to those
who do not.
So today and every day that you remember, please pray
for us! Pray that we have understanding, wisdom to
deal with all the situations we are not used to and to
show Gods love even though we do not feel it. Also
that God’s love be put in our hearts that we can do
His will, follow His plan, minister as He would
minister, practice medicine and surgery as He would
practice it, direct the hospital as He would direct
it. Have patience when needed, have tact and firmness
when needed. But most of all as in 1 Corinthians 13
have love! Please pray for us to have LOVE! Please
add us to your prayer chains and your family worships.
We appreciate all that are already praying for and
supporting us. God bless each one of you. God’s
servant, Greg