MissionDocs.org

Cameroon #13 09-28-2005
“Where’s the mother of this 7 day old infant?” I said
as I entered the room.  This is a continuation of the
story of last time.  “She said she went to the river
to wash.”  Three hours later she was still nowhere to
be found.  Only the child was on the bed without
anything but the hospital sheet around him, now laying
in his own vomit.  The nurse cleaned him up at my
request and it was decided at that point that the
child had been abandoned.  His intestines still
haven’t started working yet so we cannot start working
on formula yet.  So we started new things with the
child since we cannot start an IV.  We placed a
subcutaneous catheter and are infusing it.  This
gradually will replace the fluid lost/ dehydration.
This raised a few eyebrows but is working.
(A few days later)  The child started to move his
bowels and everything appeared to be starting to work.
We purchased a bottle and used some of the donated
formula for the child.  I was starting to get hopeful
that the child would actually make it.  The following
day we entered to see him and he was distended and
breathing terribly.  His incision had opened more with
the distention.  He looked terrible.  So the ethical
question was: do we start an IV again and give him
antibiotics for the very small chance that this would
help, or make him comfortable for the inevitable?
After much discussion we made him comfortable.  Audrey
held him for more than an hour.  And he was comforted
some.  We had to continue with work and the child died
a few hours later.

Ohh, the smell was awful.  Before me sat a 50 year old
man with a tumor on the side of his face the size of a
basketball but not as pretty.  He had had a small
lesion under his chin ever since he was 15 but in the
last two years it had grown to this.  Unfortunately
people were covering their faces when he was near or
leaving the room.  He had wrapped a shirt around it to
cover the sight and to catch the drainage of pus.  I
was amazed in many ways.  How could he live like this
these past two years?  I felt sadness, suspecting how
he must be scorned.  Intrigue on what should I do with
him.  Dream of a pathologist once again!   Fortunately
my own nose doesn’t work real well and I was glad for
that at this time. (Later you may see pictures on the
website in about a month when I can get them back to
the US.  www.missiondocs.org) We continue to go well
beyond anything we have been trained for.  At times we
wish for the more straightforward US pathology and
excellent diagnostic techniques, at others we are
happy to be learning still more, entirely different,
medicine.  In the mean time I think that Burkett’s
Lymphoma is most likely or a salivary cancer.  Either
is difficult to do anything with here.  He however
doesn’t want to go back to the village.  He says if he
goes back that the people will all be talking about
how even the doctors have no hope for him.  He has
chosen to stay here and wait for me to try to find a
solution.  I will continue to try to find a
pathologist to be able to send a biopsy to.  I will
also try to send a picture to my ENT colleagues in the
US to see if they have any ideas.  I guess the good
thing about seeing all we see here is that it teaches
us to depend more on God.  Only He can lead us in the
things we have never seen before.  We are constantly
praying for His guiding and wisdom.  God is blessing
this hospital.  We started with about 15 inpatients
when we came and currently have more than 50.  Today,
Sunday, is our busiest day.  We admitted about 10
people and saw another 6 in clinic today.  God is
blessing!!  Please continue to pray for wisdom and
patience for us as we continue to work for HIM.  We
miss you all.  Also whenever any of you want to come
to Cameroon and visit you are welcome.  We do have
some extra room in the house for visitors and would
love to have more visitors.  God bless you also as you
serve Him in the US!
In His Grasp, Shanks

Cameroon Shanks steps of faith #12
9-25-05

He’s three days old and ate well the first day then
has had vomiting and his abdomen is very distended.
His mother says he has not had a bowel movement yet.
So I examined the child and found an imperforate anus
(an anus without a hole to have a bowel movement). So
for this child this was an emergency. I asked if the
patient had urinated that day. Mom said she thought
he had never urinated. This raised suspicion for me.
Especially since this malformation occurs frequently
with other problems. I have only read about this, but
unfortunately have never seen or operated on someone
like this. And the nearest pediatric surgeon is
possibly in the capital 800 miles away or further. So
I began to tell the family about the problem and that
it required surgery. Their first question is how much
it would cost. The nurse said probably 100000CFA.
Well this was a bit exaggerated an I didn’t know if it
would be only a small covering of skin over the anus
or anal atresia (inadequate development of the anus or
rectum) So I couldn’t tell how much surgery was
involved. I could tell by their faces they were
considering not doing anything. So I convinced them
to let me see if I could at least do the “small”
surgery and if more was needed I would talk to them
before proceeding. So this child was taken to the
operating room. We have no preoperative studies
available to see how far down the rectum and anus are
open (x-ray or other studies). So without studies I
figured I should be able to put a needle into where
the anus should be and if only a skin was covering it
I should be able to aspirate meconium (baby stool). I
attempted and could not. So I figured it must be anal
or rectal atresia (malformation up higher). So the
child needed a colostomy (bringing out the colon to
open on the skin of the abdomen). So I discussed
things over with the parents telling them this was
necessary for the life of the infant. Well they said
I should do whatever I think is best. So I continued
on with the surgery. Upon opening the tense belly the
intestines spill out onto the table as they are very
distended and trying to escape the confining space. I
choose a site to bring the intestine through the
abdominal wall and then attempt to close the incision.
This is very, very hard, as the intestines don’t want
to be confined to the small abdominal cavity.
Eventually with much effort we get them back in and
suture the ostomy in place. When opened it pours out
stool. The large intestine was about 10X normal size.
It took a lot of Ketamine to put the child to sleep
enough to do the operation. So during the middle of
the operation the child stopped breathing. I notice
the bowel getting purple instead of pink and ask the
nurse if the child is breathing. He says “yes” just
fine. I look for signs of respirations and there are
none. They start doing CPR on the infant, which is
ineffective. So I break sterility and bag the infant
myself. He pinks back up and starts breathing slowly.
I bagged him about 15 minutes then continue with the
operation as the nurse bags him. I believe this is
the medication we have given him are the cause. Dr.
Hamza who is operating with me thinks it’s the
distended abdomen. Again with difficulty I try to
close the abdomen, the bowel turns purple and I bag
again. Finally I am able to finish the case while the
nurse bags the child. I continue bagging the child
hoping he will live for another hour. Finally he
starts breathing on his own. I stay with him on the
operating room table a few more hours. Only the
on-call nurse has been with me since the end of the
operation. I know the child may not live. I remember
what the mom said about the urine so I attempt a
urinary catheter, it doesn’t pass. So there IS a
problem with the urinary system. I place a needle
into the bladder through his belly. I get 30ml of
urine (large amount for 6 pounds infant). He is
finally breathing well enough I feel ok with leaving
him with the “nurse”.
The next day the child is doing OK and the ostomy is
putting out a lot of stool but the child is crying
constantly. I place a catheter through his abdomen
into the bladder. He tolerated it well.
Now here we are 3 days later. Nothing has been paid
by the family but the husband has gone to sell his
grain supply to get money to pay for the
hospitalization and all we have done. It will likely
not cover the price of it all. The child’s intestines
still haven’t woken up and he is vomiting. I place a
nasogastric tube into his stomach and get many cc’s of
bile. He is dehydrated and his IV fell out overnight.
The nurse is now asking me, if they haven’t paid
anything should we continue with the catheter and
continue to do all this things when he is likely not
to live. If he does live with the urinary catheter he
will have repeated infections and more surgeries… and
more that the family like this will not be able to
support either here at our hospital or even frequent
treatment at dispensaries. I would not make the
decision on what to do. These decisions on whether or
not to continue are easier when I know there is no
chance of survival. But in a child who CAN live I
can’t make the decision on whether to stop treatment
or not. That is the families place not mine. For me
“First do NO harm” (In the physicians oath). So we
placed the IV tonight to rehydrate the child and await
the fathers return. We have seen so much death that
the chance of a life saved even if very sub optimal is
great. I don’t mean to say that we haven’t had
successes with Gods help, but there is enough death to
be very discouraging. Mostly because they come in at
such a late date, and are in bad shape when they
arrive. But also some young (example 14yo girl) who
come in and look just kind of sick but then have a
release of malaria trophozoits in the blood stream and
then decline rapidly. These are also hard.
Fortunately that is rarer, its harder to deal with
mentally because they don’t look like they are ready
to die like the others when they come in. But such is
the life of physicians working in this part of the
world. (Se la vie)
I think what is necessary as in everyone’s life is to
trust in God more. We are not here for our purposes,
or the patients, or hospital workers. We are only
here, because this is where God wants us! I do
believe it is to help the patients and hospital
workers and teach those who do not KNOW GOD about Him.
This is the most important. With some patients it is
easier than others. Also with some hospital workers
it is easier to show God’s love than others. But
that just reconfirms our need to become closer to God
and rely on Him more to be able to deal with these
people as God would and not as we feel like treating
them.
God please help us treat our patients like your
children. Help us to work with the employees who
betray us as you did with those who betrayed You.
Give us your strength as you promised in Isaiah 40:31.
Give us wisdom as You promised in James 1:5 when we
do not know how to treat your children best and what
medications to give them. As in
Psalms 62:2 be my rock and salvation, my stronghold,
and I will not greatly be shaken. Thank you for all
your promises in the Bible to comfort us in the times
of distress and disappointment and ignorance. And
thank You most of all for sending your Son as a
sacrifice for my sins that I can one day be with you.
Thank you Lord. The Shanks

Shanks steps in
Cameroon #11
Hi! Sarah here. The reason I’m writing because
we’ve gotten a few letters asking about me. Thus, I’m
writing.
Lot’s of things have been happening. The
highlight of my kid brain is the fact we found 2
hedgehogs. We kept them in a little box and fed them
bugs. Pierre (Our guard.) caught big inch long ∏ inch
wide bugs for them. Now, I’m not a girl that gets
grossed out by bugs, but when you see a can full of
big wiggling hopping bugs, you can get a little
grossed out.
I ended up letting the hedgehogs go.
Unlike my mom and dad, I have no great medical
stories. I don’t like the hospital for multiple
reasons. One, I think blood is cool! But 1 part of my
brain disagrees. I faint. I can’t explain it! I like
seeing blood, really! But I just get faint.
The other reason is because babies’ cries make me
nauseas. (I never really liked babies.) Trust me,
there are lots of babies in the hospital.
And the other reason I don’t like the hospital
is because seeing people so sick also makes me
nauseas.
Mostly, I do the staying home and praying part.
My day is made up mainly of home school, (Where
I teach myself until Mom gets home.) reading, and
drawing. So unless you want to hear that 109,786
divided by 10 = 10,978 r6, I’ll skip that part of my
life here.
I’ve made a few friends here even thou I can
only speak some French. I have learned that they like
Duck- Duck- Goose a lot. The 3 year olds to the 19
year olds play it with us.
Mainly the boys play with us. I think the girls
are shy, or they are just doing too much work. The
little children do very interesting jobs. Like the 3
year olds taking care or a big herd of cows, all with
horns at least 5 inches long. It’s kinda funny seeing
a boy 2 feet high hitting a cow with a stick and the
cows’ 5 feet high!
Many other funny things you see here are goat’s
tide to the tops of mini buses as they speed past. Big
satellite dish tied to a motorcycle ( Moto’s as they
say here.) with the man sitting in it as he drives by.
Bulls walking past our house. And ducks, goats, sheep,
donkeys, and an occasional horse in the road. We know
a man with 50 children! True story. There is only one
way describe Africa. Crazy.
One of the biggest problems I have here is not
enough books. I go through books fast. I read 315 page
books in 1 day! I’m so desperate for books that I’m
ready to read that one book I found here from the last
missionaries, The Basic Fundamentals of Golf.
The other draw back is not enough cheese or
chocolate. Sigh… Chocolate…
I like chocolate. Who doesn’t?
Africa is a different world. The mountains,
animals, plants, houses, weather, electricity, sand,
customs, cloths, weather, music, illnesses,
treatments, languages, food, bugs, people, all are so
different. Life here is more interesting than you can
imagine unless you’ve been here. We have been here for
about a month and are not yet settled down. We miss
every thing we left behind. Please pray we do well
here and start feeling comfortable.

Sincerely,