MissionDocs.org

Shanksteps #10
16-9-05

C’est le main gauche. Oh no, not again. This was the
third delivery with “hand presentation” in as many
weeks. What is it with Cameroonian women that the
hand comes out before the head? She started to have
contractions this morning in a nearby village and went
to the local medical personnel. When they checked to
see how dilated she was, they felt a foot and pulled.
Unfortunately it was not a foot, but a hand. So they
sent her down the horribly bumpy dirt road to Koza for
us to take care of. Greg and I ran down to the OR for
yet another C-section. This hand was a bit different
than the others though as the skin had already started
sloughing. We feared what the rest of the baby would
look like. The operation went well but the baby was
dead, and had been for quite awhile as evidenced by
the amount of decomposition. Mom has done well.

She’s eight months pregnant, delirious, with jaundice.
Why? Three days ago she had been fine, they tell me.
I search my brain, Williams Obstetrics text, Current
Medical Management text, and Manson’s text of Tropical
Medicine. We perform the labs we have, only to find
out that mom’s blood is Rh- and her husband is Rh+(so
baby could be Rh+ also). Could this be some form of
blood incompatability reaction? One of the nurses has
seen Rh problems before and said they looked similar.
I go to check on mom again and her heart rate is now
170. Her breathing is irregular and she is thrashing
about. I wonder if mom’s reaction against baby has
been so severe that the baby has died and mom is
becoming septic; I wonder about hepatitis and
encephalopathy; I wonder if this could be a weird
presentation of eclampsia and HELLP syndrome (we had
one earlier in the week). I never found a fetal
heartbeat, but that’s not as surprising using just a
stethascope. All I know is that if the fetus is
causing the problems, we need to get it out. Another
c-section. Baby was dead and mottled. Mom’s vital
signs started to level out once the baby was removed.
I still wasn’t totally convinced that that was the
whole story. Late in the evening Greg was told that
this patient wasn’t doing well. She had Kussmal
breathing (end of life breathing) and altered mental
status. Several hours later she was dead. Why??? At
our morning worship and patient sign-out the next
morning we get an answer. One of the patient’s
neighbors came to the hospital to tell the rest of the
story. The patient had not been feeling well for
about a week. 3-4 days prior to coming to the
hospital she had gone to a traditional healer who had
given her a potion to drink. She did and immediately
fell to the ground and started acting strange. The
family kept her at home like this for 3 days, then
finally brought her to the hospital as a “last ditch
effort”. Unfortunately I do not have a traditional
medicine textbook to refer to. Tribal potions was not
on the differential diagnosis for jaundice in my
medical text. (It will on my personal differential
next time though.)

So many patients wait until the last minute before
coming into the hospital. They go to the market to buy
(prescription) meds; they go to traditional healers
for potions, cuttings, burnings and spells. By the
time they come to us they are in very serious
condition. If we are able to help, very often the
family doesn’t want to pay for the medications and
care and will take the patient home before they are
ready, especially the women and children. Some days I
just want to come home and cry for all the death we
see, and the seeming indifference to it. I feel that
the difference we make is so miniscule that it doesn’t
really matter. But then I remember that we are not
here for us. We are here in Cameroon because God
called us to be here. He has plans for us that we
know nothing about. I have been out of my “comfort”
zone since landing on Cameroonian soil. I have felt
inadequate medically, culturally, spiritually,
emotionally, physically, in language, understanding.
But God is not done with me yet. He continually
reminds me that “My grace is sufficient for you, for
my power is made perfect in weakness.” (2 Cor 12:9)
He has a lot of weakness to work with…
Please continue to pray for our hospital and it’s
spirituality. Please pray for our strength to keep
working for HIM through the life and the death. We
feel your prayers as we are given boosts of energy and
have the privilege to see miracles throughout the day.
In his service,
Audrey, Greg, and Sarah

Cameroon Shank steps #8
At times we are up, at others we are down.  It seems
our emotions are like the rivers here.  At times dry
and other times of the year flowing.  A lot of the
feelings depend on whether we feel like we have helped
someone that day or whether someone has died.  As
mentioned before it seems is very much a part of life
here and accepted very differently.  But for us with a
western mindset it’s sometimes harder than it seems
for some of the family members.  I had another child
die in front of me yesterday.  Many children are
brought in by parents very late in the malaria process
when the child is already worn down by repeated
malaria and also malnutrition.  In children like this
even a few days may be too much.  Their hemoglobin may
be very low and they bring them in when there is
difficulty breathing from the anemia and they seem to
die often before or while the blood transfusion starts
running into them.  This is one of our most common
difficulties to deal with.
The other is the constant strain of insufficient
money.  Again this month the workers were paid only
1/3 of their salaries because the hospital doesn’t
have enough to pay them.  We ran out of Quinine today.
This is one of the essential, most used, medications
for treating malaria.  Nearly every patient in the
hospital and clinic receive this.  Today the
“pharmacist” came to us saying they were out.  And of
course the nearest place to get it is 3 hours away in
Maroua.  So the hospital ends up sending patients to
surrounding dispensaries to fill the necessary
medications.  Not a good move to have to take.  But
since we just paid the 1/3 salary we don’t have enough
to buy today.  We may be able to buy a few essential
medications tomorrow after seeing some patients and
discharging others.  It is also hard for us to hear a
worker say “It’s hard to treat the patients well when
you’re hungry”.  Or “My family hasn’t eaten in 3 days
because the salary is late.”  The needs here are very
real and at this time of insufficient funds, are
amongst our staff too.  Often it is more common
amongst those without jobs or income who are waiting
for their crops to produce.  But now since the
hospital is behind a few months the crunch is real and
also amongst those with a job.  Our administrator has
just had a baby boy in the hospital in the capital of
Cameroon.  He hasn’t been able to travel there now for
a week because of lack of funds to go.  Unfortunately
some parents and husbands also make medical decisions
based on cost.  We had a child who’s father took them
home today with cerebral malaria because he was
worried about the bill getting to high for him to pay
so he paid and left.  Another mother came in with a
child with a broken tibia and fibula (leg) and when
the nurse mentioned the child should be hospitalized
and casted she left with the child.  So along with the
joys of working for Him in this place amongst these
very friendly and hospitable people there are real
challenges.  Please pray for us and for this hospital
that we may grow to be the people and institution that
God wants us to be and that we will some day have the
ability to provide more care and aid to those here who
really need it.
We are still not able to use our ham email yet.  We
are waiting for the permit to use it.  Also pray for
this that we may get it soon so that we can stay in
more constant contact with you all.  Unfortunately it
is hung up in the telecommunications department here.
When it is rough I am reminded of the Bible text:
Isaiah 40:28-29, 31 “Do you not know?  Have you not
heard?  The Everlasting God, the Lord, the Creator of
the ends of the earth does not become weary or tired.
His understanding is inscrutable.  He gives strength
to the weary, and to him who lacks might He increases
power.  V 31. Those who wait for the Lord will gain
new strength:  They will mount up with wings like
eagles, they will run and not get tired, they will
walk and not become weary.”  God is giving us the
strength to do what He has called us to do.  We praise
Him for this.  We serve an awesome God who is
interested in each issue in our lives and has
experiences the same difficulties that we have.  I am
very thankful for a God who understands our
difficulties and is interested in each aspect of our
lives.

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