I have just gone to sleep. I am awakened by a knock on the window. I stumble out of bed, and stick on something presentable. I find the guard of the hospital standing there with a carnet. A 18 year old boy from here in Koza was in a fight and stabbed in the back. I tell him I’ll be in. I fumble around and find my keys and my headlamp. It is cool outside. The moon is nearly full and I can walk into the hospital without a light. A dog runs past me in his search for food. I hear the cry of the bush babies in the near by treas. It does, in fact, sound somewhat like the cry of a baby. I shine my light in the trees and see two large eyes staring back, then they are gone. I see his 8 inch form jumping easily 8-10 feet. Wish I could jump like that little guy.
On the metal gurney in the dressing room lays a teenager with a pool of blood around his back. I see a small hole in his left flank about 1.5 cm wide. I take a forcep and probe it’s depth. It sinks in easily up to about 8 cm. This confirms what I was hoping to refute, he needed an operation. I call Jacques and Ganava. Only one is around and the other is in Mokolo. I have to use the night nurse again in the place of him. We take the kid to the OR. Prep him and give Ketamine. He falls to sleep. I open the abdomen. It looks normal. I search around and see a small hematoma near the splenic flexure of the colon. I free up the colon in this area and find a small hole in the back wall. I repair this and we close him up. I go home about 3AM.
Over the next few days he feels fine and his intestines start working. He begins eating without problem. The father of the guy who stabbed him has a business in Maroua but is unwilling to pay. He was on many days of IV antibiotics and now has a huge bill. He has not paid anything. Today when I make rounds he had run away. He is feeling good, eating, and now is at home in our village. That’s the risk of caring for people before they pay for their treatment. And it seems that it happens most often with the young men of the village who have been in fights. That’s another huge sum of money lost. We will again try to get the chief of the village to intervene, but sometimes that does not help recuperate lost money. Greg
Shanksteps #145B
We have come to visit Faissam. He calls to his wife and she brings up a tree stump for me to sit on. He offers a flat rock to Avava. At the head of his plastic mat is a semi-flat rock that he lays his head on. His shirt has a couple buttons at the top. It gapes open at the bottom revealing his stomach mass. He notices and pulls the edges together, to hide the reality. We do the usual greeting, which consists of asking how he is doing, how is his health, how is his family and relatives. Like in the US everything is “fine” even though in reality you know it isn’t. Isn’t it kind of bizarre that we show concern for one another in such a superficial way, but rarely ever go beyond that to reality, or a deeper level of friendship. It’s often just to keep up appearances and not let others know how things are really going. It’s sad that we don’t support each other as real friends more often and share how things are really going. True concern for others is definitely a true Christian attribute.
A couple of teenage boys come sauntering up to see why a white guy is at Faissam’s house. They greet us all and then sit down under a near by tree. We sit in the hot sunshine with a slight breeze. I pray internally to know how to start with him. He says it’s a good time for him too. So I started before creation. “Before there was a world God existed. He, Jesus, angels and a perfect environment. God and Jesus decided to make the universe that we know. He made the sun, moon and our planet. (I try to keep this as simple as possible, so that everyone present can understand) After the world was created God made plants, animals, and humans. He made a special garden to put the first humans in. This was a perfect place. There was no sickness, no pain, no death. All types of plants, trees, fruits and vegetables grew there. Humans could walk and talk with God during that time. About that time the most important angel started thinking thoughts against God. He thought it unfair that God and Jesus had created a world without his help. He became jealous and wanted to be like God. He convinced 1/3 of the angels of his opinion. They could not be like God so he had to remove them from the perfect place. That is when he started to be called by the name devil. It was then that he came to earth and lied to the first humans and they believed him. This is how pain and suffering entered the first perfect garden. Because before that everything was perfect. Because humans had believed the devil and his lie, and disobeyed God, they had live outside the perfect garden. The and because they did not obey God they had the consequences of difficulty in life, birth and growing food. That’s why there are thorns, death, drought and people are not nice to each other. They steal, cheat, and kill each other.” A couple more little boys and girls ran up to see what was happening. An old woman with a cane walked up and sat down too. We talked of how Christ was born to a virgin in a way that assured that His birth was not normal like ours. “He did have a mother and father but He was born before they “knew” each other. He learned about God like you and I. He studied nature and talked to God. He saw the miraculous things, like how a little seed becomes a huge tree. He noticed how male and female animals can create life, babies. He saw how birds fly and probably thought it amazing how our eyes can see different colors, see clearly close and at a distance, and see dark things and light things. He grew up with his parents and learned his fathers work, carpentry. He wasn’t like normal children. He was respectful, kind and loving to everyone, even those who made fun of him. His parents knew he was the savior because an angel had told them so. So as he grew they were not surprised, and they noticed the differences.”
It was getting dark so I told him I guessed that we must go. I asked him if we should come back again to talk. He said that would be great and we could stay into the night if we wanted to. I don’t know how to tell some with his beliefs about God but he seems to be very open and interested in knowing. Please pray that I will be inspired with the right words that will help him to understand and want a relationship with God. Greg
Shanksteps #145A
How do I share God with an idolater?
I believe that as a Christian I have two things I am to do in life. First is to have a relationship with God. The second is to share what we learned with others who want to know Him.
I was in my office seeing a patient, Faissam. Audrey had seen him already and thought he had a liver tumor. He has had epigastric pain for about 3 years and it’s been worsening. As she examined his abdomen there is a prominent mass in his upper abdomen on the right side.
Faissam lay down on the exam table, exposing his abdomen. A mass can easily be seen in his guant form. A scafoid abdomen is draped over a mass in his upper abdomen. His ribs are visible, he has swelling of his feet. His neck muscles stand out more than normal as do his facial bones. As I palpate the mass it feels irregular and is larger than the size of a softball. I do an ultrasound and find that the tumor replaces his entire right lobe of the liver. His left liver appears normal. Afterwards I tell him that there is nothing that can be done here. If he is someone with money, a biopsy could be done and then based on that chemotherapy agents might be helpful. He said he did not have any money.
I know that his time is limited, so I asked him what his beliefs were, traditional, muslim, Christian? He said he believed the traditional beliefs. As you have read before this consists of idolatry, sorcery, sacrifices and appeasing evil spirits. I can only imagine the uncertainty and fear this belief system would have on him. I shared with him what I believe.
“I believe different than you! You know that this is a Christian institution and I am a Christian. I believe that there is a God. I believe that God created the world and humans too. I believe that God loves us and wants the best for us. He doesn’t want the pain and suffering that you are feeling now. It makes Him sad to see your pain and that you have this disease. One day He will come back and take those that believe in Him to paradise. A place where there is no more disease, no more pain, no more suffering. I believe that He wants all of us to be there with Him (I point to all us in the room). He has created a special place for you and your family in paradise. If you are interested I will try to arrange another Christian to come to your house and talk with you some more.” He says he is interested. I asked the person translating- Avava if there is any Christian church in his village. He said there is one. But he felt that he may not accept to learn from someone in his own village. So he offered to visit him. I know that Avava does not have a motorcycle to go out to his village. So I told Faissam that sometime we would both come out there to visit him.
A week later we went out to his house. We had gotten the area from him when in my office. So we headed out on the moto. As we left my house we went past the primary school and past the men gathered under a large tree playing cards. Winding through the village towards the west. Children are yelling Nassara and waving. Some yell Bic, Bic. They want a pen. We cross the dry river bed and pass women at a well pulling up buckets of water. (typhoid central) We go past hundreds of thatch roofed huts. Then a little open area with sparsely placed huts. Next is a larger concession with a mud wall around it. This is the Lawan. I park my moto in front of his house. We greet him and tell him we are going to see Faissam. He points the direction to go. A young boy leads us to his house, it’s a short walk.
As I walk up I see him laying on a plastic mat out in front of his hut. Chickens and chicks run around and scatter as we walk up. Faissam and his wife are shelling peanuts with their 5 year old daughter. I find out she is not theirs but their children have died so they have been raising her for the past five years. He is laying in the shade of his hanger. A place that has a few dried millet stalks and corn husks piled on them. They are for storing food away from the animals reach, but for him it appears to be more of a shade from the sun.
Shanksteps # 144
The florescent lights light up a thin woman about 17 year old. I call her a woman because this is her second child. The first one died at birth. She is black skinned and very trim from working in the gardens. She lies on the delivery table exposed to the people present in the room. They happen to be her mother, and an uncle. The husband has already left the hospital. He came just to drop her off. She started to have contractions at home. Then when the labor stayed on for quite a few hours, she went to the nearest health clinic. There she broke her “water”. { Not pertinent to her- many women think that when you vomit during labor that you are vomiting the amniotic fluid} As she broke her water the umbilical cord prolapsed out. This is very dangerous for the child. If the child is not held in until delivered by a C-section then the pressure on the cord cuts off the blood supply to the baby and it dies. This was, of course, not adhered to and after staying there a few hours was referred to the hospital.
I brought the ultrasound but the battery was dead. I again felt the abdomen. It was an odd shape with kind of an oblique tilt to the uterus. As I did a vaginal exam I felt two feet and a hand, and a dark thrombosed (clotted/spasmed) cord. The child was transverse. I called Jacques and Yaouke helped also. The three of us went to the OR.
She writhed around in pain. The spinal needle bent as she squirmed. I couldn’t find the spinal canal. I gave up and gave here Ketamine knowing already that the baby was dead. She was finally calm. As I opened her abdomen, everything looked normal. I opened the uterus low. It seemed very tight. Ketamine! I also cant seem to find the head of the baby. I extend the incision up along the midline of the uterus. The head and the buttocks are nearly together, with legs and arm and chest heading for the outlet. I pull out the baby boy; his skin is macerated. The uterus seems very thick. I pull it out to take a better look. It is a bifid uterus. It is kind of shaped like a heart (this shape ©!). We close it up. At the end of the operation we clean the operating room to be prepared if anything else comes tonight. As I step outside the air is cool. It is dry and dusty. All outside lights have a halo of dust. I can smell it in the air at times, but I’m pretty used to it now. Jacques is riding home on his moto and he offers me a ride. I feel cold in the 75deg air as we go. At home I hear the peep- peep of the sleeping chicks in their cage. They are in a woven cage at night so that the ring tailed wild cats don’t eat them. I try to sleep but Im unsuccessful. So I write to you. Maybe sleep will come now. Good Night.
Greg