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# 31 Cameroon
3-17-06
So what do you get when you pray for more patents in
the hospital and more operations. Well you get what
you pray for. Over January and Feb. we had had a
decrease in patients down to about 25. While this is
great for our family time and other interests it is
not good for paying salaries (still a month behind).
So last week we prayed for more patients and more
operations. God heard us and we now are averaging 48
inpatients and I have done 5 surgeries this past week.
We do not want more people sick, just that when they
are they come here. So yesterday I did three
surgeries. First was a woman who had broken her water
about 48 hours before being referred here by a local
dispensary. She had meconium coming out (a sign of
fetal distress). And when I listened to the baby’s
heart rate it was not normal. So we took her for an
urgent Cesarean section. Fortunately Audrey was able
to be there to revive the child. Both mom and baby
are doing well.
The second one was one planned for a couple days. He
has had stool coming out with his urine. I know all
you non-medical people also know this is not good. So
I took him to the operating room. He had a large mass
in his pelvis and it was unresectable. So I diverted
his colon to his abdomen. This allows him to have a
more quality life rather than having obstruction in
the near future. But this causes one new problem. We
have no ostomy supplies. We have a few OLD sacs but
they fall off before leaving the operating room. So I
modify a glove and tape it in place. Not real
effective either.
Finally Audrey and I make it home about 6PM. I then
get a call at 10:30PM for someone who was stabbed.
(our third like this). I feel fortunate there are not
many guns around here. So not many gunshot wounds.
So he has a stab wound in his left upper abdomen. No
other injuries found. So I take him to the OR. I
explore his abdomen and find two holes in his colon
near his spleen. Stool is everywhere inside. He is
also hypotensive (low blood pressure). So I decide to
make him a diverting ostomy and resect the contused
and injured area. He remains hypotensive in spite of
fluid and not much blood loss. So normally in the US
there are a number of medication drips that are
possible to deal with situations like this. Here we
have one medication that can help. Epinephrine! So I
give him some that helps for about 5 minutes.
Fortunately we have received our donated stuff in the
container. We have dynamaps 2 that were donated to
us. So I know have one in the OR. So I can get
regular BPs and Heart rates. And I can see the
result. No more asking the nurse constantly. I
cannot leave the decisions up to him because he does
not know enough. They just accept SBP 60 as
acceptable and chalk it up to him being tired or meds
received. Well with the hypotension we are getting
frequent BP’s and all of a sudden there is an
“electrical burning” smell and the Dynamap quits. So
we are back to manual. So I had started a “drip” of
epinephrine on this patient while I finished the
operation. We did manual BP’s to adjust the drip.
Also the power went out. But just as the nurse was
getting my flashlight it came back on. Wow,
electricity makes such a difference. Fortunately when
our last student missionary was here she gave me her
headlamp that works better, so I use that now. So
when the operation was done we sat there for about 2
hours until he woke up enough and his BP rose. He is
doing well today.
God answers prayers! We are busy and doing surgeries
again. We now pray for a slow Sabbath to rest. We
are slowly installing monitors and equipment donations
we received before leaving the US. It all arrived in
our container. We are very blessed. We also hear
that we have more donation money and a dermatome,
arriving with the next student missionary. Thank you
all so much for all of your prayers and help to the
people of Koza. We pray God’s blessing on you for
your help to His children here.
In His Service, the Shanks

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Shanksteps #30

Fever
When you think of fever, what usually enters your
mind? For me it means that someone’s whole body is
warm to the touch, often feels cold, is usually sick
(often here with malaria, typhoid or other sickness),
and often can be treated with Tylenol or Ibuprofen.
Recently, I found that fever does not mean the same
thing to all people. I realized this when I asked a
man from Nigeria (in English) how long he had had
fever. He answered 8 years; every day; all day long.
Then I asked if when his wife or family touches him if
he is hot to the touch. Oh no, never that. So, what
do they mean by fever? To this man it means hurting
all over. To others it means sickness or warmth in a
certain area (ie. He has fever in his mouth…). One
woman had fever of the feet – she believed she had
fever because her feet were sweating.

History and Physical
For those of you medical types, learning to take a
good History and Physical is one of the earliest and
most important things you learn in medical school.
You use these skills throughout the rest of your
career. However, when you move to a new culture, you
must adapt these skills to the new environment. I’d
like to give you an example of the type of H & P we
have to do here. Remember, everything is translated
at least once, sometimes up to three times.
I walk into the ER to learn that there is a 1 ∏ year
old male with fever, headache (I’m not sure how the
parents know this, but EVERY child comes with
headache), body pain, abdominal pain, and vomiting.
How long has he had these symptoms?
*1 day (even the kids about to die, that have
obviously been sick for a long time).
I see that he was seen a week ago for similar
symptoms, has he been sick for several weeks?
* Yes, it started 1 day before we went to the
dispensary. He isn’t better yet.
Has he taken any other medications than the ones given
at the dispensary?
* No, and since he wasn’t better after one day, we
stopped giving those meds
Have you been to a traditional healer?
*No.
Have you given him any traditional medicines or roots?
* No.
Have you had his uvula cut?
* Yes, 2 days ago.
For what reason?
* He was coughing.
Where did you have it done?
* I don’t know the man’s name, but he cuts our
neighbor’s hair.

On Physical Exam, I find a severely anemic child,
breathing horribly and very fast, very hot to the
touch, with a distended belly and a very large spleen.
When I look in his mouth I find what look like burns
around his lips, and back of his mouth. Similar burns
are around the anus. Across the chest are numerous
cut marks that look to be 2-3 days old.

Again I ask:
Where did he get all of those cuts on his chest.
* The traditional healer.
For what reason?
* His heart was beating fast. It releases the
sickness.
Did you give him any roots or traditional medication
in his mouth. Some roots are more potent at this time
of year and can burn.
* Yes, we gave him roots to help dissolve his uvula.
But we gave the same to his brother last year and he
didn’t have any problems.
Has anyone massaged his belly recently.
* Yes, the traditional healer did because he was
having pain, and his belly was getting bigger.

So, this is how I put together the story. He got sick
with malaria and became anemic from the malaria; had
his chest cut due to the fast heartbeat from anemia;
was coughing from malaria and therefore had his uvula
cut; was having respiratory difficulty after cutting
the uvula and was given roots to burn the rest away;
inhaled and swallowed some of the root and therefore
burned his esophagus and trachea causing further
respiratory and now swallowing problems, and probably
contributed to the vomiting; had a large spleen from
malaria untreated and therefore had it massaged by the
healer. (Normally you have to be very careful with a
large spleen for fear of rupture – and I have seen
kids die of ruptured spleens after having them
massaged by the traditional healer.)
So, now a simple malaria has turned into a nightmare
and probably death for the child. He needs treatment
for malaria; transfusion of blood for anemia;
antibiotics for the infection in his throat and mouth
from cutting the uvula and chemical burns; tetanus
shot and serum antitetanus after having the uvula cut
with the same razor as is used in the community to cut
hair; HIV testing in 6 months; Neosporin on his chest
wounds; oxygen; and LOTS AND LOTS OF PRAYER!!!

Although this story is a mixture of several patients,
it is all true and happens here on a regular basis.
Some of these kids die, many have long expensive
hospital stays. There is NO preventive medicine here
and very little education. Even when I try to educate
parents, usually they trust tradition much more than
the white doctor. It’s very sad, so much is
preventable.

Please continue to pray for our patience, and
patients! Some days are very frustrating, and many
are medically challenging. Pray for our patients to
understand what we are trying to do and teach. Pray
for continued miracles here. Thank you for your
prayers, encouragement and love.
In His Awesome Service,
The Shanks

Cameroon #28 2-18-06
Oh Im glad your back! We had just been on a couple
days of relaxation before Dr. Hamza leaves for good.
We had spent a few days in Rumsiki, an expensive,
beautiful tourist spot a couple hours by motorcycle
from here. Dr. Hamza came by to get me. The power
was out but someone had come in with a stab wound to
the right abdomen with intestines hanging out. He
needed to be operated on. So I grabbed my flashlight
and headed for the hospital. We still have no way to
start the generator and wait for our container for a
possible solution, so it would be done again by
flashlight. At least it’s better at night because my
eyes adjust to the darkness and then the flashlight in
the surgery seems bright. If it’s during the day it
seems very dim as some light enteres the windows of
the operating room but leaves the insides of the
patient to dark to operate. When I examined the
patient, I found a hole in his right side and large
intestine sticking out. He had fought with someone
over a girl and was drunk with millet wine. Drunks
are hard to operate on generally. They either take
very little anesthesia or a WHOLE LOT! He was as most
in the WHOLE LOT group. We gave him the Ketamine and
Valium and gave more and more then finally we were
able to start. Fortunately our electricity had not
been out so long that our water was gone, so I was
able to scrub properly. I operated with the help of
Dr. Hamza. We found a near transection of the large
intestine and seven other holes. The small intestine
also had a couple holes to fix. It took us 5 hours
with hand suturing each hole. Then we brought out a
proximal ostomy (an area where the intestinal contents
empty out on the abdomen). This is my first ostomy
here. I don’t know how it will be received overall.
They will not be able to afford ostomy bags for three
months while I wait to repair this with another
surgery. So he will have to devise some other method
of dealing with constant drainage on his abdomen. We
also have a very limited supply of these anyway. Not
something we can buy, only something that was donated
a long time ago. So about 4AM we finished. He is
stable so far. I am praying he doesn’t have any
problems with the repair that I did.
As I mentioned above the other doctor who has helped
us is leaving now. Today was his last day. We will
greatly miss him. He has great patient care and
interactions with the hospital workers. He is moved
by the government to another place for payback for his
education for 10 years. We will then be on our own.
24/7/365. Please pray for our stamina and also that
we are able to teach the workers as to be able to
leave them for a day or two with good results so we
can have a break at times. We know we are where God
wants us to be and also that He will give us the
stamina to work. Please continue to keep us in your
prayers. Also I again want to thank you who are
donating to the Hospital. We are in the process of
getting a dermatome that will help with skin grafting
the burn patients. Hopefully we will get this out to
us soon. Thank you all!
In His Service, Shanks