Shanksteps #152 Malaria

#152 Shanksteps- Malaria
Day 1: Today is Friday. Greg was called away to a meeting Monday- Wednesday so I was left to “hold down the fort”. It truly wasn’t too bad; there were no surgeries; I was able to sleep for 8 hours during the 3 days. I took Thursday off to “recuperate”, so why do I feel sooooo tired. MALARIA. And I thought my stomach hurt because I was drinking too much coffee. Again: MALARIA. That dizzy spell I had on Monday in the middle of clinic that I thought was due to not drinking enough water. MALARIA. The nightmares and difficulty sleeping – could it be due to stress or…MALARIA. I mentioned something to Eliza today and she said that I ought to get tested. Afterall, the test is free and the lab was on my way from the Peds ward to the Clinic. So, after telling the lab tech to take my blood, but not expect to find anything, was I surprised to find MALARIA? Plasmodium Falciparium! So, that’s why I’ve been feeling to crummy lately.

Since I feel like I’m going to die every time I take Quinine, Greg thought it would be educational (funny) if I kept a malaria journal for the next 7 days and explained to all of you what I was experiencing. So, welcome to my world of malaria and quinine.

Shanksteps #149

Wandala was grunting and holding his abdomen. He is an elder in a nearby church. He has had abdominal pain for two days. He has an IV dripping into his right arm. He lies on his side to relieve the pressure from all the bloating. I palpate his distended abdomen, which has no signs of peritonitis. He says that he had diarrhea yesterday and that he has eaten bouille (porridge) today. I get a typhoid test that is positive and hope that with treatment possible intestinal inflammation will resolve. I also place a nasogastric tube.
The next day is our “day off”. Which essentially means that we don’t make rounds and they call us less often. This day it means that we have a few calls that we take care of in their carnet (little medical record) then Jacques calls about 10AM and says I need to see a child. He has had also had a distended abdomen for two days. This one has a small hard mass at the umbilicus. A strangulated umbilical hernia. I ask them to get him ready. I see a few other patients the nurses ask me to see. Then to the OR.
I open up under the hernia. As I get into the abdomen cloudy fluid comes out. As I inspect the bowl from the small opening I see a black area. After pulling this out, I see that it is a necrotic piece of bowl, Richter’s hernia. I resect the dead area and go about making the anastomosis. As there are no staplers here, I do a hand-sewn anastomosis that takes some time. I write my note and leave the OR, I examine Wandala again, he says he feels better and has passed a little gas. I do a few ultrasounds before returning home. Audrey is sewing OR masks and hats and table drapes.
Today Audrey is helping out with the nationwide polio vaccination. She is climbing mountains looking for vaccination teams. She is to evaluate whether or not they are maintaining the vaccines in a cooler properly, filling out the paperwork for the vaccinated kids, and marking the houses of the families vaccinated correctly. I go in the hospital at 7AM, before morning worship, to evaluate Wandala. He is still very distended. Says he had a stool last night. He does not really appear to be improving.
The blade slides through the skin, then fascia. Intestines burst from their entrapment. They are very dilated. There is a twisted area of sigmoid volvulus that has blocked off the bowl. Fortunately for him, none is necrotic. I decide to close and await another day to prep him properly and resect the redundant bowl.
As I step outside to head to my office to see outpatients, it’s cooler today, 102F. I dread what it will be at the end of March. HOT! Greg

Shanksteps #148

Shanksteps #148

As you already know, life here is far from boring. Three days ago I got a message from the health district that there was a meeting two days later lasting three days. This meeting was in Maroua, three hours away. Well I had not scheduled any surgeries for two of those days so I decided to go all but the one day. This meeting involves all the hospitals and health districts for the far North of Cameroon. I planned on going the first day and due to circumstances waited till the second day to go.
This morning I get up at 5:30 to the alarm. I get out of bed, it’s still dark. Get my things together, put on my helmet and head out the door. I’ve decided to take the motorcycle because it costs to much to take the car to Maroua ($50) and I have nothing else to bring back, so it would have been an empty trip. I just replaced the rear brake pads on the motorcycle yesterday. They seems to be working well. The sun is just coming up as I crest the top of the hill leaving Koza. It’s a beautiful morning. All along the road there are women and girls with clay pots on their shoulders, heading for the wells, to fill the pots with water. Unlike other heavy objects which are carried on their heads, these pots are carried on the back of the shoulder when full. Dogs scurry past as I round a corner. Three boys, one with only a shirt on, one naked, and the other with pants and shirt, all run out to the road, waving and yelling “nassara!” I wave and smile to myself thinking of
how little boys all over the world are the same. They would rather be naked and dirty then any other way.
After 45 minutes I make it to Mokolo. This is where the pavement begins. I’m making good time. I pass many high school students in their blue uniforms walking along the road toward school. I try to honk and then remember I do not have a functional battery so the horn doesn’t work. In a few spots where children are crossing the road in front of me I rev my engine to make my presence known. I get about 15 miles out of Maroua and my engine looses power. I rev again but it keeps loosing and then the engine locks up. I am near a little village. I push the motorcycle to the little market area. Moto mechanics eye me with glee. White guy + big moto = big money! I leave my moto and walk away. I try to call the guy who repairs my moto in Maroua without success. I walk over to some old guys sitting in front of a little shop. After questioning they indicate a man who could watch my moto. He is an older man front of another shop. My motorcycle is larger (600cc) and more
expensive than others here so I prefer not to leave it with people for fear it will get stolen. I have no choice. He pushes it inside his little storage building along side the sacs of millet and corn. I then ask him how to get to Maroua. He says he will take me. He places a little cushion on the back rack of his small 90cc moto and off we head toward Maroua. We get there at 8:30 when my meeting is to start.
Near the bridge, under some trees, is a area that motorcycles are repaired. This is obvious by black sand under the trees. Black from all the oil changes emptied out on the ground. My mechanic is not their yet. The guy who’s driving me lets some guy who knows the mechanics house use his moto, so this other guy and I head off for the mechanics house. We arrive and he is just leaving. I explain the situation. He says he will take care of it. I give him the key and go to my meeting.
At 11;30 on our first break I go to the same trees and see my moto there. They took a moto and with an outstretched foot, pushed it all the way back to Maroua, one rider on each. He says I ran out of oil and the engine seized up. Oh how stupid! It never used to burn oil, so I stopped checking it. He says he’ll take it apart tomorrow, put a battery in it, fix the muffler too and bring it back to me in Koza. I’m sure it will be costly, but the service is great. I head back to my meeting.
They have cut the meeting to two days, so this was the last day. I ask for a ride with someone else returning to Koza. While driving from Maroua to Mokolo we hit a pothole and a battery light comes on. The truck continues running so we continue. Arriving in Mokolo we drop off one person. The truck will not start. Under the hood we see that the alternator is loose and the fan belt is so loose that it is not turning anything. The owner of the vehicle goes to find a mechanic at his home, to repair it and get a push start. I grab a passing moto. He takes me to the market where I look for a moto to take me home. I tell them the price I am willing to pay. He takes me to a group of motos and dicker about the price. They give him 500F and I leave with that person. He is from Koza and gave the guy the 500 ($1) for finding him a client.
We roll through the night with a headlight pointed at the stars. He does not have a battery. This is apparent by the fact that when the RPM of the moto drops down the headlight dims to nothing. So its with constant revving the engine that we can see and slowly make it back the rocky road to Koza. 12 miles in 1.5 hours. We arrive safely at my house and I pay him 2000F ($4) for the trip.
I’m thankful for Gods protection of this day. Greg

Follow Up 145 B

Just to let all of you know that Faissam passed away this past weekend. Im so glad that it is God who reads hearts and not man. And God, who loves us so much, is our judge. I plan on seeing Faissam in heaven some day. Hope to see each of you also. Greg