MissionDocs.org

May 14, 2006

Wow, it has been a long time since we have sent out any Shanksteps. In our last note, Greg mentioned that we were praying for patients to come to the hospital.
Although I don¡¦t believe that God created a meningitis epidemic, HE did use it to bring up our census. We started receiving kids with meningitis around the end of February, and about 2 weeks ago it finally let up. I think that during med school and residency I saw 2 patients with meningitis, and did 2 or 3 spinal taps. Now¡K I could treat meningitis in my sleep ¡V which is a good thing because we were getting called every night, often several times a night to admit these kids. The hospital census increased from 25 patients to 55-60 for about 2 months. We turned the pediatrics ward into a meningitis ward, and moved the rest of the kids into a different ward. I think in all we treated over 100 cases of meningitis here. But I know for every person with meningitis we saw here, there were 2 or 3 in the villages that probably didn¡¦t survive. We lost 4 patients to the disease, 3 after having been treated with a deadly ¡§over the counter¡¨medication made up of Tylenol and cocaine, or other traditional medications.

We have finally started taking days off as a family.
From the time that Dr Hamza left, we have worked 7 days a week, 24 hours a day, and gotten very little sleep during this time. About 4 weeks ago we took our first day off with Mindy (4th year med student from
LLU) and her husband, and travelled for the day to Waza ¡V wild animal park. We left early that Wednesday morning and got to Waza about 7am. We drove around the park until about 1pm then decided to stop and eat lunch. This time of year is the hottest and dryest, so all of the animals head to 1 or 2 watering holes. We were able to see several giraffe, 1 elephant, a huge lizard, a python (thanks to Scott¡¦s good eyes) and VERY fortunately, we saw a lion chasing after a gazelle. It was a beautiful sight. We were all hot and tired and so decided to head to Maroua to drop Mindy and Scott at a hotel in preparation for their trip home (8-10 hrs by bus, 12-20 hrs by train,
12-15 hrs by plane ¡V not an easy trip). Greg and I returned home to relieve our nurse from on call duty.

The following week we had unexpected guests. James Appel and Sarah came to stay with us for a week while the political unrest, and potential problems calmed down in Chad. After Chad¡¦s presidential elections on May 3rd they were able to return home. We thoroughly enjoyed spending that time with our friends and fellow missionaries. We swapped stories, played games, did rounds together. They even gave us 2 days off. Our first day off we spent on ¡§vacation¡¨ at a hotel in Maroua, where we spent the day swimming in the pool and reading in an air conditioned room. We ate pizza and drank soda. It was pure gluttony. The AC was an added bonus, as we had just gone 4 days without electricity and water at home, which also meant no fans¡KOn Sunday, our busiest day, James and Sarah offered to man the hosptial so we could work on unpacking boxes that had come in the container. It was a true blessing, and we were able to get a bunch done. We definitely brought too many personal things, but it¡¦s like Christmas every day we open another box. We had no electricity the whole week that James and Sarah were here (I guess preparing them for returning to Chadƒº) so we all slept outside under the stars. It was much cooler, but I expect the malaria epidemic to hit our house any day now.

We are now back to a normal schedule. The hospital was full before James got here, the census decreased to 9 patients while he was here (3 docs in the hospital and only 9 patients), and now the census has picked back up a bit, so we have been a little more busy. We are now in the home stretch looking forward to coming home. We have 36 days before we leave here and are very excited about seeing family and friends and our pets, and eating good food.

We thank all of you for your prayers, gifts, donations, ideas, thoughts, notes etc. God has really taken care of us.

We have one specific prayer request we would like to make known. We are desperately in need of a western trained nurse to come out here and train our nurses.
If our nurses can have actual training, our jobs will be much easier, and the patient care will improve considerably. Because this is such a male dominated culture, we are praying for a male nurse, or nurse practitioner, with some years of experience, lots of energy, leadership skills, ability to speak French (or learn quickly), and great heart for the Lord.
Although all of our employees are Adventist in name, most have a very weak spirituality or even understanding of a relationship with God. Please keep this request in your prayers. God has already done amazing things here and I believe that he has big plans for this hospital.

Thank you for your love and prayers,
In His Hands,
Audrey and Family

Dear Family and Friends,
Its been a while since we wrote because we have been
busy, as Im sure all of you have. We just finished
our Meningitis season with 60 patients in house and
now we are down to 15. Feast then Famin. Feast was
good we finally caught up with all of our back
salaries, but now with it as slow as it is we will be
going backwards again. The local population just does
not have enough to support the prices necessary to
support a self sufficient hospital. We are praying
for other sources or ways to augment our income to
continue the quality of care we want and should give.
So now that meningitis is done we now have the
vomiting and diarrhea season starting. Now it has
rained a few times and whenever there is standing
water it is much easier to get and use that water than
to look for it a number of kilometers away from your
house and carry it in a clay pot back to your house
every day. So it is no supprise that they get the
diarrhea and vomiting. It has been especially hot up
to 110 deg F and down to 95 deg during the night.
Feels like a sauna when the fan blows that hot of air
on you. For the last week we didnt have to worry
about the fan, We had NO electricity. We attempted to
start the generator for the hospital to replenish the
water tower and recool the refrigerator with the
vaccinations… in it but it was connected to the
battery incorrectly and blew up the starter. So after
spending a few days and a bit of money we were
fortunate to get it fixed and get it started. We ran
it for 4 hours (5 liters an hour $1/liter) Wow, thats
expensive. Also didnt have long enought to get the
fridge cool or the water tower full. So we gave up on
it. Did another surgery by Petzel headlamp, a
strangulated inguinal hernia. It was terribly hot and
I couldnt keep from dripping on the patient. Terrible
sterility that night and nothing I could do about it.
We just kept on wiping our brows hoping to stop the
dipping without avail. When all done it looked as if
we had showered with our cloths on we were so wet.
We were blessed recently with a visit from the Appells
form Bere, Chad. They came here for about a week to
let the unrest in Chad die down before going back to
their hospital. We were very happy to have them with
us for a few days and James Appell helped on that
surgery as well. What a wonderful few days it was
with them.
We are still counding the time till we get to come
back to the US. Still trying to find out about
tickets, but plan on being there end of June to mid
August. We hope to see as many of you as possilbe
though our travels will be primarily limited to the
East and our families.

Please keep us and this hospital in your prayers.
There is much to do both spiritually, physically, and
financially. Thank you for all your notes and help.
In His Service, Greg

# 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

Please remember we are UNABLE to check our email
regularly. It’s usually about every 2-4 weeks,
sometimes longer. Please be patient or plan in
advance!

www.missiondocs.org our website by a friend
Phone from USA 011-237-522-0278 www.viapin.com has
best rates 15c/min
Hopital Adventiste de Koza
BP 53
Koza, Extreme Nord
Cameroun

US contact:
Greg Shank
C/o Steve Shank
Box F
Summersville, WV 26651

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