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#22 Cameroon
Well it’s 7 days till Christmas. It was 90 degrees
today and dry. Now those of you in the south-west may
be used to that. We are not! It doesn’t at all seem
like Christmas here. We are however very thankful for
a friend of mine who was able to fix our MP3 player
and we now have all our music back on it. So we have
started playing Christmas music in our house. That
helps a lot. Especially if we turn on the fans and
close all the windows in the morning so it stays cool
and we cannot see the dry outsides. We are definitely
“dreaming of a white Christmas!” We have cut
“snowflakes” and hung them around the house. We saw
a little plastic Christmas tree in Maroua about 2 ft.
tall. Sarah really wanted it but I couldn’t bring
myself to purchase it (it was to pitiful). I would
rather cut a desiduous tree from the yard than buy
THAT! We were also blessed to have a group from Loma
Linda here a few days ago just for a night as they
traveled through. It was nice to spend time with
them. They were on there way to a health fair at
Batouri Adventist Hospital (our sister hospital in a
rural area of the south). Anyway it was nice to see a
little familiarity. I think it’s most difficult to be
far away at times of the year like this and loved ones
birthdays. It seems like the holidays have always
been a time for extended family. Now it’s the nuclear
family. I must say Im very thankful for all my family
members here and in the US. They give me much support
especially when it is needed. When being a Director
was NOT what I had in mind, Audrey is very supportive.
I am also blessed by a good Administrator of the
hospital. He is very good and I think we are each
able to make eachothers job a little easier. The most
difficult issues are dealing with things that occurred
before I arrived and knowing what is best to do with
it. I would be happy to continue receiving your
prayers for my own wisdom administratively and
medically. The challenges are never ending.
I was very encouraged recently when I learned of two
girls who gave significantly to our hospital, Nichole
and Christy. They had a birthday recently and had
heard of the financial difficulties we are having at
the hospital. They decided at their birthday party
they would ask everyone who came NOT to bring them
presents but to bring them money that they would have
used on the presents. They took this money, $100, and
sent it as a donation to our work here in Koza. What
a blessing that was and what commitment to advancing
God’s work. Nichole and Christy, I am very thankful
for your generosity and I know that God is very happy
too. I am praying that you will always keep Him
first in your lives and that we will be able to meet
someday soon, and in heaven!
Also to let each one that is praying for us we very
much appreciate it and know God is leading. We expect
to be back stateside for a few weeks in early summer
2006. If you know of any physicians who would be
interested in covering a hospital for any time frame
up to a couple months while we are gone please let me
know. I pray that each one of you are growing closer
to God and following His plan for your life.
In His Service, Shanks

Shanksteps #23

In the States when someone gets sick what do they do?
If it is mild or something they have had before they
may go to the pharmacy to look for some type of
over-the-counter medication, possibly discussing it
first with the trained pharmacist. If it is more
serious, they go to their local family doctor or
urgent care center or the hospital. Here in Cameroun
the usual sequence is: 1) Wait at home until you make
sure you are very sick. 2) Go to the traditional
healer for a potion or a powder of herbs, roots, and
sometimes, crushed animal parts; or cutting of the
skin to release the bad spirits. 3) If that doesn’t
work, try the local outdoor market for the boy with
the pharmacy on the front of his bicycle. 4) Still
sick, take a trip to the dispensary to see a
marginally trained nurse and receive a real treatment
(although not always correct in dosage or duration).
5) If all else fails, go to the hospital and complain
about how you have already spent all of your money on
medical treatment. Granted, the hospital doctor’s
fees are a bit more than the “pharmacy on a bicycle”,
but by the time they get to us, they have already
spent a lot of money, and precious time that the
person (often a child or woman) could be healing.
As we have seen recently, these steps may overlap,
more than we first realized. Very often after
surgery, a cord with a sack, or often a nut of some
sort will appear on the patient. One woman who came
in with an open fracture of the forearm now wears a
type of dried fruit around her arm for healing. A
sack of seeds appeared around a little girl’s wrist
after having abdominal surgery for typhoid
perforation. Greg teases these patients about taking
off their cast if the dried fruit works as well; or
that they should have had their sack of seeds ready to
ward off surgery. Usually the patient and family
laugh, knowing that it doesn’t really work, but afraid
not to try it. The sack of seeds is relatively
harmless from a medical point of view (a bit more
harmful from a spiritual one however…). I often will
see kids in the hospital who have a powder pasted to
their skin as a type of healing. This is potentially
a bit more harmful from a medical standpoint because I
don’t know what types of active ingredients are in
this treatment. I have seen this powder placed
around the neck, under the armpits and recently in the
ears and nose. Yesterday I saw a child who has been
in the hospital for about 5 days. She initially had
an IV for quinine, but was able to eat so it was
removed. The next day she started vomiting and the
family couldn’t afford another IV, so we have tried
several methods of getting her medication into her.
She was finally able to keep it down. She initially
came in with coughing, vomiting, and occasional
diarrhea (often these are all symptoms of malaria).
We tested her stool to make sure she didn’t have
dysentery or other GI ailment. After asking a bit
more, we found that three days before coming to the
hospital she had her uvula cut out, because this is
what they do for cough. Yesterday as I was going
through her bag of meds I came across a baggie of
unlabeled pills. I asked the mom what these were and
she said that since the child was having diarrhea and
we weren’t treating it, she went to the local pharmacy
(box on the front of a bike) and bought medication
for diarrhea and gave her one pill. Sometimes I just
throw up my hands and wonder what it is that I do here
anyway. We try to practice the best medicine we can
under the circumstances, and still the “pharmacy on a
bike” is trusted more than the hospital. I need to
realize that trust takes time, and we’ve only been
here in Koza for four months. I also have to remember
that Satan is at work here. He doesn’t want people to
trust or come to the hospital to receive God’s
healing. It seems that the more God blesses the
hospital, the more Satan attacks it. Please pray for
God’s blessing on our hospital. Also pray that we
(the workers here) show Christ to our patients and
that they realize that true healing is from God, not
man. Many of our workers need spiritual healing as
well for us to be all unified in Christ. We thank you
for your continued prayers. -Audrey

Cameroon # 20

He was very stoic. It was obvious he was badly hurt.
He was an 18 y/o male with multiple stab wounds that
was brought in to our hospital by car from a village
30 minutes away. On his left upper arm there was a
large laceration with shin and muscle missing. This
wend down to bone. His right shoulder was bandaged
tightly and as I loosened it to see the injury he
began to drip blood from this injury. This side also
was a glancing wound with loss of skin and muscle down
to bone. His right middle finger was also dripping
with bone exposed. His abdomen was wrapped tightly
and as I asked about this spot I was told his
“intestines had come out” of a hole in his abdomen.
As I unwrapped this I noted small and large intestine
lying down to the table at his side. At least the
decision to operate on him was a rapid one.
Fortunately for him he did not have a real high heart
rate or low blood pressure. So we started intravenous
fluids on him and took him to the OR. About ∏ hour
later the operating staff were there with me and we
started in the abdomen. I went in through a midline
(up and down) incision from the sternum to pubis. I
noted a cut in the liver about 4cm deep and 7 inches
in length. This was bleeding slowly. I examined all
the small and large intestine and fortunately for the
patient and myself no injuries were seen. He had had
his liver sliced and that appeared to be all. I then
noticed with each of his breaths that air was entering
his diaphragm (the muscle from breathing separating
chest from abdomen). I also saw that a rib had been
cut in half and the cut slid along the underside of
the next rib up along the chest wall. I reached my
hand into his chest from the abdomen and swiped out
the clots and felt the collapsed lung. So at this
time I’m even more amazed that his is alive. We
operate here with limited resources, and have no
general anesthetics. I did his entire operation under
Ketamine while he breathed. In the US he would be
intubated with a double lumen endotrachial tube and
his lung inflated. This is not an option here. And
in addition I have no chest tube to help inflate his
lung. So I adapted a urinary catheter for this
purpose. I also don’t have suction I can use to help
inflate the lung with the chest tube either. So I
connected the urine catheter in his chest to a urine
bag, added water to it and flipped it upside down to
make a water seal. I’m sure everyone medical is
laughing now. This is NOT the normal treatment but it
is what I had to work with and I was trying to help
save his life. I then proceeded to close the
diaphragmatic laceration. This was successful after
much struggle and liver retraction to visualize the
laceration. Now the liver was bleeding more because
of manipulation. Fortunately I found some surgical
(helps stop bleeding) and after that the oozing
stopped. So I closed his abdomen. Fortunately for
the patient Dr. Appel and his wife arrived to visit
for a day on their way to some meetings. They helped
me “close” the shoulder and finger injuries and
repaired a finger tendon while I closed the abdomen.
So 4 hours after starting we were finished.
It is now a week later. He has healed his abdominal
wounds and granulating his shoulders. Audrey took out
his “chest tube” while I’ve been gone about a week at
other meetings. God is definitely blessing our
efforts with this patient. We give glory to Him for
what He has done. Later we found out the person who
had done this to him was a younger brother who he had
called a donkey thief. I guess that is a serious
accusation; the brother apparently was also brought in
by the army for more minor wound care. Praise God for
this patient’s life today. We explain this to him
daily. I pray he realizes the reality of this. Thank
you for your prayers for our work here, it IS making a
huge difference in this spiritual battlefield. In His
Grip, The Shanks

Cameroon #21

Oh what a trip!!! I was asked by the Central African
Union to assist in a meeting in Yaounde that occurs
every 5 years. I felt this was not wise as we have
not caught up on the hospital workers salaries yet,
and the hospital was the one to foot the expense for
my travel and stay… but many people thought it was
very important, so I went. It’s a long trip at
minimum. I got on the taxi motorcycle form Koza to
Mokolo, along with Dr. Appel and his wife from Bere,
Chad. They were on their way to the same meetings.
So it was nice to travel together. At Mokolo we got a
local minibus transport to Maroua. We only waited
about 2 hours, which is about average. The bus must
be full before it leaves. So we arrived in Maroua at
about 7PM. One of my new friends met us there and
took us to find a room to stay in. After checking the
Baptist Mission for rented rooms we were able to find
two at the Catholic mission. Early in the morning
(5:30) we went to the bus station to catch the first
bus to N’gounderi. After an 8-hour ride we arrived at
the train station there. We had a couple of hours to
spare so we went into “town” and ate at a
“restaurant.” We didn’t know the area so ate where
the taxi motorcycle took us. The “restaurant”
definitely wouldn’t have passed standards in the US
and would be immediately closed. Tables had been
cleaned onto the floor and there were food particles
all over the places in piles. In the back, rats were
seen near the bathroom. Flies were everywhere. But
we had a good salad (risky here) and were able to
watch a soccer match on TV in there. So at 5:30PM
(train was to leave at 6PM) we went to the train and
boarded. We were fortunate to get the sleeper cars
and 4 small beds in a room. To be able to sleep the
night and arrive the following day around noon in
Yaounde (the capital). After getting comfortable in
our beds on the train we just sat there. 1 ∏ hours
later they said we must deboard. Apparently the cargo
train had derailed part way up the route and 10 or so
cars were turned over. We asked if we could stay on
the train and of course we could not. Fortunately by
this time we had met up with the conference president
and he had some church member contacts there who put
us up for the night. So we spent a lovely evening
with them. The next morning someone went to the train
station to see if it would run that night (only daily
departures). Unfortunately it wouldn’t be. So they
arranged for us to take local minibus transport. Well
comparing this to sleeping the night on the train it
didn’t sound like too much fun. But no other options
and we had to make it to Yaounde for the meetings. So
we were to leave at 11AM and arrive, after an all
night trip, at around 6AM in Yaounde. So we set off.
With in 1kmof the train station we were on a bumpy
dirt road packed 5 wide in the minibus. The chicken
sitting on someone’s lap was squawking and the dust
was stifling. About every 2 km’s we met an army or
police stop to ask for our documents. These are after
just a chance to rip off people and increase their
salaries if not all is in order or you want them to
leave you alone and let you continue on. Cameroon is
noted as one of the top 5 corrupt countries.
Fortunately after about 5 stops there were less for
the rest of the trip. Though there was about 15 in
all. After a couple hours we were covered with dust
and sneezing. A couple hours later we stopped at a
small bus station and changed minibuses. Then a few
hours later the same thing. We passed many scenic
spots. I noticed quite a change in hut styles as we
came down the country. At midnight we stopped at
another town to change buses. They moved all the
luggage to the top of the next bus then we waited… and
waited. After about an hour of waiting people were
getting inpatient. Some started to complain to the
office and were getting upset at the wait (especially
when the bus was already full). So they called the
driver of the bus. He arrived on a taxi motorcycle
and some in the group yelled at him also. So he got
upset and said he would not drive till the morning and
left. So they were even more upset and assembled all
the passengers to speak to the people at the ticket
counter. They did this and threatened to call the
police for leaving them there like animals and
threatened to burn things. Well the ticket office
closed and they came up with the chief of that bus
station, who after hearing all the same threats got
another driver to come. So they transferred all the
luggage to this new minibus and we were off like a
rocket of sardines (packed 5 wide, hitting our heads
on the roof frequently) We were off at 2:30 AM.
With my knees buried in the back of the seat in front
of me and squished on either side. We finally
arrived, after about 5 more stops by police/army, at
about 9:30AM. FATIGUE! So I feel I got the full
African travel experience. I also enjoyed seeing
other minibuses with goats tied to the roof rack with
the luggage traveling down the road. I am thankful
that at least we did not have flat tires, and made it
there safely. Thank you Lord, Greg Shank

ShankSteps #17
Hello. Louie (The civet living in the roof of the
Shanks house) here to narrate: ‘Behind the Scenes of
ShankSteps’! But first, some messages from our
supporters!
(Boring commercials)
Were back with some exciting news! The electricity
has been on for two days now without going out! A
Shank member has noted they were getting used to
sleeping on the floor because it was cooler. Lets go
over and interview Greg Shank, shall we?
Hello Greg.
“Hello?”
May I ask you a few questions?
“What does Louie want to know?”
Yes, well. How do you feel about getting up often
in the night to go to the hospital often? 1:00 and
the like.
“It bothers me less than in the U.S. because at
least the people are really sick when I see them.”
I see. Thank you Greg. Remember folks, these are
the reel responses! None of that ‘make the people say
what you want them to say’ stuff!

Well, wile I’ve been feasting on lizards, the
Shank family has been eating the rations of a siege.
Pore Shanks. Rice and beans, rice and beans, rice and
beans, all the time! Rice and beans! At least they
have a lemon tree out back! Some of which Sarah will
be selling!
Lets move on to the hospital.
Ah. It’s doing better! But, tisk! What’s this?
Almost out of saline bags you say! Such a shame!
But wait! Good news! Sarah has watched a total
of 4 operations! Her response? ‘You’d ‘a thought it
would be more bloody.’
According to Sarah, you can find out where the
different body parts are by remembering these helpful
hints:
1. The intestines are the things that look like worms
located in the area you grab when you say, “Ow! My
stomach!”
2. Your stomach is located above the area you say
“Ouch” when you get a stomachache on the left side.
3. You’re heart is the thing that go’s BOOMB BA BOOM,
BA BOOM in you’re chest.
4. You’re throat is the thing that hurts when you’ve
got a cold.
5. You’re bladder is the thing that feels like it’ll
burst in the morning when you just wake up.
6. And the lungs are the things that go up ‘n down
when you breathe.

That’s just great. Very nice! Now, to the rest
of Koza!
It looks sandy and dusty. Highly populated, and
dirty. But it’s got potential! With two doctors, a
peace core worker, and a little blond girl, my
estimate of time until it becomes some thing great,
is, oh, abooouuut, 234 years. Nah! Just kiddin!
But it definitely needs help! Which is where you
come in! One prayer a day from each of you is a BIG
help!
Well. Hasta le vista! Au revoir! See ya! And
tune in next time for, ‘Behind the Scenes of Shank
Steps!
(Credits role)

#19 Cameroon

I walked into the room and the chest tube is half out
of the chest. She was a thin old woman with a cough.
She had come into the hospital with difficulty
breathing and coughing constantly. She had been
coughing for three months. We checked a test for
terbculosis and she had it. She also had fluid
outside her lung and it needed to be removed. We do
not have the normal tubes for this so I put in another
type of tube, and it drained into a urine sac. She
drained off about 800ml of fluid. This is a huge
amount, especially for a very small, thin woman. So
she went about one week and had a lot of pain at the
site of entry to her chest. After a week she demanded
it out. I did not think this was a good idea as I
knew that with the tuberculosis treatment, which I
suspected was the cause of this effusion, she would
reaccumulate the same fluid. But she was very set and
I warned her that she would need it again. So we took
it out and in the next week be needed another tube.
She refused, but accepted a needle decompression of
the site. So I put a small IV catheter into her chest
and withdrew a similar quantity of fluid. I told her
that the next time she needed it she would get a tube
again. So about a week and a half later she ended up
with the same symptoms. Then she got another small
tube. She has stayed with this for a few weeks.
Every so often when I make rounds on that ward I have
to untangle the macramé she has made of the tubing.
About 4 days ago she was having a lot of difficulty
and so I went to see her. She had swelling of her two
arms and also right side of face and her right chest.
So I figured out that her tube was plugged. So I used
a syringue to suck out the clots in it. We got about
500ml more of fluid. She immeadiately started
breathing better.
So today I walk into her room about noon. And I hear
a sucking sound, suck—swish, suck—swish. I see her
breathing relatively calmly and the “chest tube” in
half with a small portion sticking out of her chest
and the rest laying next to her. The tube making the
sound with each breath. So I immeadiatly think I’m
looking at an open pneumothorax with the tube in place
and the characteristic sound. Now the question is
WHAT HAPPENED? Since she was not in visible distress
I asked her. Through the translation I learned that
that morning she was coming back from using the
latrine and her daughter stepped on the tubing as they
walked and she had intense pain in her chest as it
pulled on the stitch holding in the chest tube. The
tube broke in half and she had difficulty breathing.
So then she went to her room and asked her daughter to
get the nurse. The daughter refused and left the
hospital. I think she must have been scared of what
she had done. So the patient sat there for a few
hours till I came by.
I connected the residual tubing to the tube again but
there was still a huge leak. So I occluded the area
with pressure and was able to use a syringe and a
stopcock to withdraw much of the air out from around
her lung (hopefully reinflating her lung). The next
dilemma was when to get the chest x-ray. I had been
trying to convince her to allow me to get one. She
did not have the money for it and so refused.
Normally I would want one now, when the next chest
tube was in and after it was in to make sure that
there were no tumors in the lung. But I am having a
hard time convincing her of one. So I think I will
wait till she has a hard time breathing again, put in
the chest tube, then after a day get the x-ray if she
will let me. I had hoped that with TB treatment that
this effusion would stop but it has not. I may need
to perform a chemical pleurodesis ( a way to
chemically stick the lung to the chest wall so the
fluid cannot collect), but with what?
It seems each day has something new to amaze,
challenge and intrigue us. We have had a number of
children with huge abdominal ascites that we are not
able to figure out the cause of. We have received
generous donations recently which my dad was able to
bring to us. We have used some of this money for
buying reagents to outfit our laboratory with more
tests to attempt to diagnose these children and also
aid in many other diagnostics. We have already used a
large sum of money to buy medications for our
pharmacy. We now have most of the medications we need
that are available locally. We are looking into
making an order from a company in Holland to be able
to get other medications we need that are not
available here. We will also use some of the
donations for Bibles, so that more people here will
have them. There are very few, as none are available
here and they are costly for the local population. We
thank you all SO much for your prayers and support of
the people here and our working amongst them. We
thank you for you emails. We download them at Mokolo
when we are able to get there and then read them when
we are back in Koza and respond at our next trip.
This minimizes our time at the “internet café” (very
loosely said as there are often animals bleeting
outside and various smells wafting through the musty
air inside.) We thank you all so much and feel your
love in Cameroon. In His Service, the Shanks