#84 Shanksteps
Breathing hard I arrived to Maternity. A woman lay on the delivery table with her eyes closed. Blood was all over her wrap skirt and up her back. Her abdomen looked pregnant beneath the flower print with blood all over it. Her palms and feet were white for her black skin. The maternity nurse was placing an IV. He said her blood pressure was 60 and he couldn’t find a pulse but that her heart sounded fast. Her family said she was 10 months pregnant. I did an ultrasound and found the baby’s
head was down and that her placenta was blocking the exit. (placenta previa)
We told her husband we needed to do an emergent surgery and that she also needed blood right away. The lab technician came and drew her blood and did the blood type.   The husband stood in the corner looking squeamish.   After much persuasion and harassment he finally had his blood checked. Should I give blood or hope they find someone willing? A neighbor gave blood and after getting the oxygen machine, giving her ketamine and placing a urine catheter, we started.
The tissues were pale. The small vessels we cut oozed a liquid that appeared like blood and water mixed together. I was careful to have as little blood loss as possible. The little boy came out flaccid and blue. His heart was going slowly and he did not breath. I broke sterility (meaning I left the operation temporarily and help with resuscitation of the boy. He started taking intermittent breaths. One of the nurses continued bagging him as I reentered the surgery. Mom did not loose too much
blood.
After finishing the surgery I again continued bagging the child. The baby was still blue and now was not taking breaths like before. We put the saturation machine on the baby now that mom was done and it was 5% (normal is >95%) With me bagging it climbed temporarily then plummeted. We worked on him about 1.5 hours in all. He died as we bagged.
The father and family live very far away and asked if they could bury the child behind the maternity ward since they could not make it home. Out back he dug a hole and buried his son.
Many children are lost in childbirth. And many complications occur from childbirth. I saw another woman today who had been pregnant 7 times. The first two each died at about one year of age from disease. The third was delivered prematurely at 4 months gestation, the fourth is living, the 5th and 6th were twins and died 3 days after birth. And the seventh died at 6 months of age from disease. She now has been 5 years without another pregnancy and wondering what she can do. She has obtained
a sexually transmitted disease, like from an unfaithful husband. So I’m praying that after I treat her STD that she may get pregnant again. I say we see about one or two a week that have infertility from infections. With polygamy and promiscuity, even outside polygamous families, there are many with STD’s.
It was a long day. Had 12 hours straight in the hospital today. Am thankful to be home. Just wish it could be with my family. Please keep my mother-in-law in your prayers as she is facing end of life very soon. Also for my wife who is taking care of her. Thank you all for your love, prayers, and various forms of support. In His Service, Greg
Shanksteps #83
Shanksteps #83The baby was convulsing. Â Her head was arched back towards her toes. Â Toes were curled backwards. Â The arms were beating a rhythm that could be confused with the drums outside. Â Sweat beads formed on her tiny forehead. Â And breaths came with long pauses. Â Urine flowed all over her mother as she cradled her on her lap. Â The nurse was trying to get an IV in the child’s flat rolling veins. Â The child’s hair was very short and was straight with a reddish color (malnourished). Â Finally the rhythmic beatingof the arms subsided. Â As I tried to bend the neck forward it lifted the whole torso into the air. Â A lumbar puncture to get spinal fluid was in order. Â I prepped the back with betadine, dawned my sterile gloves and swatted at a fly landing in my sterile area. Â It was persistent but so was I and finally he left me alone. Â With Gods help I was able to get right in and withdrew a very cloudy spinal fluid. (Normally this fluid is clear like water) Â I explained to the family the child’s need for IV antibioticsfor a few days then oral antibiotics for a couple weeks. Â They were concerned about the price but knew that meningitis (infection around the brain) often kills children. Â So we started treatment.A couple hours later I return to the ward and find the child laying flatter but with rhythmic beating of her hands. Â I give an anticonvulsant and wait about 10 minutes. Â Her brain is still irritated so it takes a second and third dosing. Â It stops then returns in the morning before rounds. Â After that the IV comes out and the nurses are unable to find another vein that is accessible and they give the medications intramuscular.Today she is starting to swallow milk dripped into her mouth. Â And the day nurse was able to get an IV in so the medications are IV again.We are hoping that this year is not as bad for the population. Â The first year we were here we vaccinated about 300 people. Â The second year about 400. Â There are 50 doses in each vial of vaccine. Â So the people interested in being vaccinated get a list together, and when there are around 50 people a nurse goes out and vaccinates them. Â They are charged 350 francs, about 75cents. Â But even with that many don’t want to do it. Â Others don’t do it because the local thinking is that meningitis is dueto something magic. Â So what they really need to do is when they get meningitis is to get the witch doctor to do some sacrifices (chicken, sheep, goat or combination) and some other things to heal the person. Â Also as we discussed before in emails, there is a “devils heaven” where people could go and sell the life of another to buy the life of their loved one with meningitis. Â So between these ideas, cost of medications, and slowness of recovery (in general) it combines to make a difficult thingto convince parents to treat their children. Â So many die at home without coming to the hospital or they go to a local dispensary that treats them poorly with an equally poor result. Â We already have enough vaccine for 500 people this year, and hope that we will be able to use even more.In His Service, Greg
#82 Shanksteps – the mountains
Since the last several Shanksteps we have sent out have been of a serious nature, I thought I’d write about some fun experiences we’ve had lately.Every time a case of polio is found in our region, the whole of Koza is revaccinated against this dreaded disease. Because the vaccine is given orally, local people can be trained to give it, and they go house to house in EVERY part of Koza to vaccinate ALL children under the age of five. During the three day vaccination campaign, supervisors also travel around to make sure that every child in every neighborhood receives their vaccine and that it is being distributed correctly. Each house is markedwith the number of children living there under age five, and the number actually vaccinated at the time of visit. It is a huge undertaking, but very effective. I was one of the supervisors, and I requested to supervise a region in the mountains (as I love the mountains).I was directed to an area of Koza that I have never seen before. To get there, it is best to take a motorcycle to the base of the mountains (so you have an easier way to get home at the end of the day). After that it is all on foot. The trail up the mountain is somewhat strenuous. I needed to use both feet and hands in several parts (probably because I’m a weak American…). Anyhow, once partway up the mountain, the view is absolutely incredible. At the top of the mountain range, the land dipsdown a bit and there is a fairly large village nestled among the rocky outcroppings. In all, I had 5 cartiers (or neighborhoods) to survey. We (me and a translator, Dougdje) decided to go to the farthest area first. What a walk. We wound our way up the side of another mountain and ended up pulling ourselves up over the outer wall of a house (hut). We had found the center of this cartier. The people up there were incredibly nice. No one really stared. No one followed us gawking. No one askedfor money or gifts. They were just hospitable, simple people. They explained to me the different activities they were involved in. One group was shaving the bark off of dried branches that would later be ground into a fine powder to be made into sauce. I was able to see a man spinning cotton yarn from the cotton he had grown and just recently harvested. I saw the tiny loom only 2 inches wide that the local people weave on. I watched as the women and girls of the village sewed these pieces offabric together to make clothing. One of the women brought out the finished product, a beautiful gandara (local long robe). This is given by the groom-to-be to his future father-in-law as part of the dowry. This is a very special piece of clothing that is only worn for the highest of holidays, and as a burial shroud.  After seeing all of these interesting things, I did a little bit of surveillance in this village for the vaccination program. We then continued on to another cartier where we sawthe “forgerons” (translated blacksmith, but in this society are the ones to make the axes, pottery, bury the dead, and deliver the babies…). They were in the process of making the large clay pots that hold water, which sit at the entrance to every house. The forgerons are considered a “lower” class, and no self-respecting Mafa is allowed to voluntarily mingle with these families. It is completely forbidden for marriage between a forgeron and non-forgeron. It was very interesting watching themmake these huge pots by hand (no potter’s wheel). We then continued on to visit the Lawan of this village. The Lawan is the highest-ranking political official for the region. He is a local man, chosen by the government. I chose to visit him just because I was “in the neighborhood” although his hut was way up the side of yet another mountain. I found a very nice man, surrounded by his five wives and some of their kids. He had grown up in that very house and counted 140 people in his “immediate”family. We visited for a while and upon leaving, he gave me the gift of a rooster. I told him that I would return to visit him with my family. After that we left the mountain for “civilization”. I had a wonderful day. Didn’t get much work done, but found a reason for being here in Cameroun.Last Wednesday, we decided to go up the mountain as a family. (Wednesday is our day off.) I wanted to show my family all of the things I had seen on the mountain. So Greg, Sarah, Katie (peace corps worker), Vambi (Camerounian friend and translator), and I went up the mountain for the “real” African experience. We were able to see a whole family in the process of making the clothing I had seen the previous time. This time I was able to see how the loom worked. They weave with 40 strings at atime, and they use their hands and feet to maneuver the loom and shuttle. In this particular family, two young boys spun the yarn, the father wove the fabric, and the wife and the daughter sewed the strips of fabric together to make the gandara. It was fascinating to watch. Then we went on the visit the Lawan. He was so surprised to see me return. He told our translator that he thought I was joking when I said that I would bring my family back to meet him. We talked with him for a while andthen, out of the door of his house he brought me a ram as a gift. I wanted to refuse it as this is a HUGE gift, but it would have been culturally inappropriate to do so. He said that because we didn’t come during mealtime, he felt that he had to give us some kind of food. So, we made a deal that the next time I visited, it would be only for a visit, not for food. I then decided to invite him to our house for lunch the following week. It was quite interesting walking down the mountain with aram that didn’t want to leave home. In the end we paid a young boy to carry the animal down off the mountain for us.Today the Lawan, his son, Dougdje, and Vambi came to our house for lunch. This was the first time that the Lawan has ever been inside a white man’s house, let alone eaten with one. I think he felt honored, but also somewhat uncomfortable here. We just have SO much, and they so little. For lunch we had planned to give him the “all American” meal of spaghetti, bread, and salad. We were advised, however, to have some kind of meat at the meal, as a vegetarian meal would not “honor” our guests.So, this morning, our cook whipped up a great meat dish in addition to spaghetti. It was very interesting watching the Lawan and his son eat here. They are completely unused to utensils and therefore ate with their hands (we had told them they could). I also think they had never had spaghetti before (kind of a weird food if it’s the first time you’ve ever seen it). We had a very nice visit, but it really opened my eyes again to how totally different our cultures are. I have become used to thepeople in the “city” of Koza, who have at least been influenced by Western culture. But the mountain people are still largely untouched by prior colonialism. What a breath of fresh air. I often think that with the good that western culture brought to Africa, came a whole lot of bad. I hope you’ve enjoyed this trip to the mountains with me. I will surely return when I can. —AudreyOh, by the way, during our dinner, we were discussing Camerounian delicacies. There is something called potasse that is made by slow cooking your cow feces for many hours. Then you filter water through what is left. Apparently it gives off a wonderful taste used for soups and sauces, not to mention that it is used to calm the stomach and intestines. (Now who was the first to think of doing that…?) The other side dish that was discussed is apparently only eaten at the big festivals when killinga goat or lamb. The goat is killed by cutting the jugular vein in the neck. The blood is collected and allowed to clot. Then it is mixed with the stool filled intestines (although now in the “city” the intestines are cleaned out). And voila, a tasty side dish, suitable for kids and adults alike. Take heart, most Christians no longer partake in this meal, although the ones we talked to said that it’s delicious…  
#81 Shanksteps – leaving Cameroun
#81 Shanksteps – leaving CamerounWe just wanted to give all of you an update on what our plans are for the near future. Â As many of you may remember, my (Audrey’s) mom was diagnosed with lung cancer just before we moved here in 2005. Â At that time she underwent surgery, chemotherapy and radiation therapy. Â She suffered through the treatments, but did well afterwards. Â While we were home on vacation in June, we found out that she has metastases and has had to suffer through another round of chemo. This time she is not toleratingit well, and the first medication didn’t work. Â With much prayer we have decided that it would be best for Sarah and I to return to the US to help out my mom and dad (and give medical and moral support) while she is going through this. Â All three of us will be leaving Cameroun the 30th of December. Â Greg will return to Koza around the 13th of Jan and Sarah and I will remain in the US as long as necessary. Â Please pray for my family both here in Koza and in Connecticut, as this will be a difficulttime for everyone. —Audrey
