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Shank steps #9 9-13-05
One of the hospital workers sons comes in three days
ago with severe facial pain on the left side. He had
been in a fight and hadn’t won. He could barely open
his mouth for me to examine him. He had severe pain
over his left cheekbone and left jawbone. I was
unable to get further exam on him. At our daily
worship that morning his father emphatically said that
he would not pay for the injury as it should be the
assailant who is to pay. Unfortunately, as director
of the hospital, this left me having to talk to him
because he shouldn’t be saying such things to all the
hospital workers and it is his responsibility. The
issue between him and the assailant is not hospital
business, but his. So after examining the patient
and not getting very far I decided to wait a couple
days till the swelling went down, then reexamine him.
After a couple days it wasn’t much better so I decided
to examine him under anesthesia (Ketamine). But
yesterday the power had been out for a day and a half
and without light would not be able to evaluate him
well. So I put it off till today hoping that the
electricity would be back. Fortunately it did come
back on this morning and I was able to look at it
today. He DID have a broken jaw and a couple of his
teeth moved separately to demonstrate the location.
We had gotten one facial x-ray but this was unhelpful.
Then as Murphy’s Law would have it we were out of
x-ray films, so no more films till there is more money
(that should only take a few more months…sarcasm…) so
when I was able to demonstrate the fracture I decided
to wire his mouth shut so that it would heal
appropriately. I did this wiring periodic bottom
teeth to the periodic top teeth in such a way to pull
the fractured site together. Of course as he was
waking up from the anesthesia he was flailing all
around and hallucinating and trying to open his mouth
stretching the wires. So I had to sedate him to keep
him from tearing apart what we had just done.
We had a rude realization this week. The power had
been off about 24 hours then our water ran out. I was
surprised because I had been told by someone that when
the power was out that the water lasts about a week
when the water tower is full. Well 24 hours after the
power was out no water. Also the reagents in the lab
and vaccines were about ready to go bad also because
of warming up. So we were running low on water and
many other problems. So we needed to start the
generator. This poses a few problems. 1: we don’t
have diesel – we need to buy it (available locally)
2: the oil has not been changed in more than a year
and it was seizing up last time we ran it- thus we
need to change the oil before starting 3: It will need
to run about 5 hours minimum to cool the refrigerators
to keep the lab and vaccines from going bad and to
pump water to the tower. 4: the ever-present shortage
of funds. Well, praise God, as I was trying to figure
out what to do the power came back on, and all is
avoided temporarily.
I believe we are starting to be blessed. The
hospital made a priority of paying tithe this month.
It has not done so for some months. It seems that
when things are tight with individuals or institutions
that they cut out tithe paying because they feel they
can’t afford it. I believe it keeps God from blessing
them like He would like if we only gave Him back his
10% like he requests. So we paid it yesterday and
today was very busy, and I believe God is able to
bless us. I encourage any of you who have found it
difficult to pay tithe to God to do so now. He only
requests 10%, but it is our duty to give it to Him,
then He can bless us when we are faithful to Him.
Liz, nurse practitioner student, is leaving tomorrow.
The people here have been very thankful for her help
and we pray God uses her in a mighty way in the
future.
Please keep the hospital in your prayers and us as we
continue to serve Him in Cameroon. We think of you
all often and cannot wait till we have email access
here by ham radio whenever the permit comes through so
we can stay in better tough personally. Until then it
will be every few weeks. Thank you for remembering us
in prayer. In His Service, Shanks

Cameroon Shanksteps of faith #7
She was 8 months pregnant and seizing. We were
called to come and evaluate. She had eclampsia. This
is a fatal condition if not treated aggressively and
the baby delivered. We had to rush her to the
operating room. It was the middle of the night. So
the guard set off on bicycle to round up the operating
room staff while we established intravenous fluid and
treated her seizures. About an hour later we were
able to start the cesarean section. We got a healthy
baby, which cried vigorously. Next as we were getting
ready to sew up the uterus we realized she had a tear
through one of her uterine arteries that was bleeding
badly. At this time the power went out. Fortunately
I had remembered my camping headlamp that day. So the
nurse put it on me and we went on repairing the uterus
in the semidarkness. God blessed this woman and she
and her baby are doing well.
Have you felt like you have a large task that needs
to be done but you are afraid of what may happen if
you do it? I felt that way this week. The Chief of
Koza came to see me in the clinic last week with his
4-year-old son who had a hernia he wanted repaired and
a circumcision. Well a hernia is fine with me, the
chiefs son isn’t. I feel it would be much better to
operate on these high profile people far in the future
when the kinks have been worked out and things are
running “smoothly”! Well we did not have the
appropriate suture for this surgery, well for most
surgeries. So I told the Chief that I would like to
postpone it a week to allow us to get the equipment
that we needed. So he agreed to come into the
hospital this week. We were able to find the
appropriate suture in Maroua. Unlike the states I
brought the child in the night before to obtain some
labs and make sure he stayed without anything to eat.
I decided to do it with Audrey and fortunately she was
back from Maroua that day. We started in the morning
after staff worship. The IV line was difficult to
obtain and the child was poked many times. Then off
to the operating room. Using Ketamine for anesthesia
Audrey and I explored the groin and found a very
adherent, septated hydrocele. What happened next? You
probably guessed it, the power went out. We were
trying to find the base to tie it off. We continued
on by flashlight. Fortunately about a half hour later
they were able to find a car to jumpstart the
generator so we had power once again. This is the
usual problem with the power going out. We end up not
having labs, and operating by flashlight and oil lamp
because we either don’t have diesel for the generator
or a vehicle to jump-start it. Well the child has
done well other than not being able to urinate the
first day. God has blessed us with the chief’s son
doing well.
There have been times of gladness, when we were able
to help someone in a critical condition, and others
when we do all we are able to do and they die in front
of us. Sometimes for things preventable. We pray for
the appropriate equipment for the hospital and for
knowledge to use what we have to the maximum, and to
know when excess effort is fruitless. We find our
peace in knowing that we are here on His mission and
not ours. As “The Purpose Driven Life” book says:
“It’s all about Him.” It’s NOT about us but His
purpose for us being here. Please continue to pray
that we stay willing to go in whatever path God wants
us to take, to be open to His leading at every step.
Thank you for your prayers and support.
In His Service, the Shanks

Dear Family and Friends,
Come quick she just delivered and now is pale and not
looking well. So started our first Sabbath here.
Audrey went in to check the woman. She checked her
and she looked like she was alert but not doing well.
She checked the baby who was doing OK. Then back to
mother, who now had stopped breathing. Since we have
ambu bags and no masks, Audrey did mouth to mouth
though a gauze but without avail. She had
exsanguinated. She was suppose to have gotten blood
two days before from her husband or family members or
they were to call on me to give some, as I am able to
give to most people. They didn’t do any of the above
and we left the next day for Maroua to get some
hospital supplies and food for our house. We got back
in the evening and I went to the hospital to check
things over. There were a couple issues I attended to
and there was “nothing else” that needed to be
addressed. So I went home. Then we woke up to this.
She was 18 and this was her third child, she hadn’t
bled much because she didn’t have much to loose.
Audrey was very shaken as can be expected. Later on
that day…
We have an urgent problem: a woman is 8 months
pregnant and convulsing. We went in and she had been
seizing for “3 hours”. She was in eclampsia. We
arranged for an urgent C-section. Using Ketamine as
the anesthetic, only what is available here, we did
the operation and the baby came out limp. Audrey
again did a valiant effort and did CPR on the infant
for 30 minutes and finally revived the 2.5 kg infant,
again with gauze as a barrier. Oh how I wish we had
the appropriate equipment. It is hard to leave the
land of “plenty” for the land of famine (equipment
wise). We pray our container of medical equipment
arrives as fast as possible. (4mo instead of 2 years
like some) And still later that day…
“This boy was out watching the cows when a bull caught
him with his horn. He has a laceration of the scrotum
and a testis hanging out.” He also had a cut on his
abdomen. So I took him to the OR for repair.
Now today, a week into our stay here in Koza we have
another. A woman is brought here from 40 km away who
has been in labor when they noticed a hand as the
presenting part. They brought her here. She ended up
being a transverse lie. The infant was not moving and
limp and blue. Audrey did CPR for 35 min. without
success. Is it Ketamine? was it the child? what could
we have done different? We are plagued by questions
that we search our minds and books for answers. Some
are answered some aren’t. We hope we are making the
difference that God wants us to make. We are only a
week into it and are taxed. The mental anguish is
more than the physical. Our schedules aren’t bad but
we are very tired by the afternoon. I pray we never
become calloused to the pain and suffering around us.
The people here seem to accept death, where as we have
been taught to fight it at all costs. We pray for
constant direction from HIM(God). Please pray for us!
Serving Him, the Shanks

Shanks
Hopital Adventiste de Koza
BP 53
Koza, Extreme Nord
Cameroon

Cameroon Shank steps # 6 8-23-05
Hello Family and Friends,
We are two weeks into things here. We have just met
the other doctor that has been covering the hospital
for the last three months. Dr. Hamza has recently
finished medical school in Yaounde and is in the
process of being placed by the government. We are now
taking call. Audrey and him are switching call each
week, and I’m always on for surgical things. So far
(two days) it’s been nice. He is from near here and
reacts very well with staff and patients.
Yesterday we sat down with the administrator and
discussed all the finances of the hospital. It is in
real bad shape financially and has been unable to pay
its workers salaries for the last 3 months. They have
received about 1/3 of what they are supposed to get.
The hospital also owes past electric bills from
1998-2000. Owes the Union for many past things. Owes
tithe to the church. And a number of other creditors.
So it is essentially living from “hand to mouth”. We
pay for medications most used and IV fluids and
laboratory bare minimum. The real issue has been the
past year without constant physicians. When this
occurred the patients go to other facilities. And now
that it’s the rainy season people are out working and
the roads are so bad that people that normally come
from Nigeria can’t make it across the rivers. So this
makes it difficult to get the needed supplies to treat
the patients like we could. We very much appreciate
all the donations that were given to us. We brought
some smaller items with us like gloves, pulse oxymeter
by Nonin, rigid proctoscope, stethoscopes….and other
small items. We anxiously await our container, which
has apparently left the US and should arrive in Douala
by the end of September. How long it will take to
clear customs and make its way up Cameroon a thousand
kilometers only God would know. We pray for rapid
transit. Please pray for the financial situation of
the hospital and also for continued spiritual growth
of the employees in this difficult time that we all
will grow closer to God and serve His children here as
best we are capable of.
At the hospital there have been more interesting
surgeries. We had a patient come in with birth of a
baby at home then retained placenta. We attempted
about an hour to remove it unsuccessfully. The
patient had a low blood pressure and fast heart rate
indicating significant blood loss. So we took her to
the operating room and took out the uterus. Her
family refused to give her blood. So I donated it to
her preoperatively. With that and the other fluid she
stabilized then we took her when things were ready in
the operating room. With much prayer we were
successful in getting the uterus out and the patient
out of the operating room alive. The next day they
would still not give her any of their blood but we
were able to give some that had been donated for
someone else who had expired before receiving it. She
seems to be doing well about 4 days postoperatively
now. I am very thankful to have Audrey help me in
these surgeries as it is very helpful to have someone
who speaks English and adheres to sterile technique.
For this and many other reasons we look forward to the
student missionaries coming here to help. Our first
one is to arrive at the end of this week. She will
stay a month then another will come for a month. I
think this is invaluable to the student as I went on a
number of student mission trips myself in the past. I
would encourage anyone considering it to pursue it, as
it will undoubtedly change your life in a positive
way. We are happy to accept student missionaries as
is Dr. Appel in Bere, Chad. If you are not
considering being a student missionary I would
encourage you to help financially support one in your
church or through AHI or directly with someone
interested in serving overseas.
Power is one thing we are very thankful for. We have
it most of the time. It went out for about 8 hours
today which put a stop to some lab work and made
rounding difficult but most got done without much
difficulty. Fortunately there were no surgical
emergencies today. As mentioned before the power
company has threatened to cut off our power but as of
yet that has not occurred. We continue to pray for
this also.
So at 2 weeks into Koza we have good days and
difficult days. But regardless of how our feelings
are at the time we are all happy to be doing what God
has called us to do. We praise Him for leading in our
lives so directly in the past that we are confident He
will continue in the future. Please continue to lift
us up in your prayers. We would love to have visitors
if anyone of you are interested.
In His Service, The Shanks