#130 Shanksteps (Shanks steps of Faith)

#130 Shanksteps (Shanks steps of Faith)

Today was Sabbath.  I was able to “sleep in” till 6:30 when they called.  Actually I woke up at 6.  My body used to one time won’t let me really sleep in.  I go in to see Nafissa.  The woman who I talked about in #128.  I had seen her during the night when she went unconscious after getting up to use the bathroom.  I found out she was hypoglycemic with a glucose of 16 (normal >70)  Now I find her conscious but breathing very rapidly and seemed to be doing worse.  Her bleeding had stopped a few days ago, her nasal bleeding also.  There was no more diarrhea.  She was still anemic and had received 1.5 liters of blood since she came to the hospital, I believe a record for someone here.  All three family members that were here, were willing to give.  Her lungs sounded like she had pulmonary edema, her body puffy, as it has been for the past few days.  The nurse had put her on oxygen until the power went out again.  It flickered back on, so we restarted it.  She was breathing bett
er with it.  The nurse gave her medications and I went off to see other patients.
There was a question about a child with a hematocrit of 10% who they were not finding blood for and was unconscious, a woman who had a seizure at home and was now combative, and a 2 year old that had just arrived with anemia and a fever of 105.5  These were the beginning.   I saw them and headed home for a bite to eat and planned on going to church.
After preparing, I left to go to church, only to be stopped by the guard, Allah-Hokki, telling me that they needed me at the hospital again.
I placed my Bible on the ER table and started examining a woman with severe epigastric pain.  I saw a few on the wards that the nurse had questions about and did a lumbar puncture for meningitis on a 2 year old.  I walked back to church just as everyone was leaving.
The afternoon I admitted a couple more.  About 4PM I decided to go for a motorcycle ride.  Audrey had a migraine so she stayed at home.
I ride out of the village.  All is green as it is the rainy season.  Millet stalks 9 feet high sway in the breeze.  Bugs hit me in the face.  Large cumulus clouds hang in the sky.  I ride past three little boys, each pushing a bicycle tire with a stick.  Little kids are sitting in the dirt pouring it on their legs.  Mangy dogs, with flees and ribs showing, give me a sideways glance as they make sure they are out of the way.  Men sit in groups under trees playing cards or speaking the latest gossip.  I pass some women carrying wood on their heads, headed for home.  Near the government protected forest, I see little thatch roofed shelters along the road with boys, a man, or woman sitting outside them.  I stop beside one to ask why they sit there where no one is and where there is no village.  The boys tell me that they are protecting their crops, across the road, from the baboons.  They say the baboons especially like corn.  I go on up through a shallow river bed and on to the
mountain with red dirt.  I figure I have been gone long enough and need to get back to see if the hospital needs me.  I am refreshed once again.  I ride back past all the same things.  Many people are in the same places.  Life is slow and purposeful.
I stop my motorcycle outside the “urgence’ (ER) and immediately I hear wailing.  It is coming from maternity.  Nafissa!  I cringe and walk to inside.  Jonas confirms it was her.  Also another 10 year old boy we had been treating for an arm infection, who has been getting better for the past week; went out side to use the latrine and he died as he walked.  Crying could be heard from the adult ward as the woman with seizures and meningitis died.  I go back to see the man who was breathing hard and we had put on oxygen.  The power had just been cut off again for the third time today and he was breathing his last.  No time to get my little generator out for the oxygen machine.  Four deaths within an hour.  We have sensed a spirit of death here before, and have had much prayer asking God to remove it.  We ask God to guard the physical and spiritual entrances to the hospital with His guardian angels.  Please pray with us that the devils power at the hospital be overthrown by Gods
power, and that whatever is allowing the devil freedom to work here be made null.  Pray that my life and in the workers lives are put in harmony with Gods will that His power can be manifest through us and that we reflect His love to these people.  We appreciate your prayers and letters.  In His Service, Greg

Shanksteps #129

Shanksteps #129

She was there when I arrived at the hospital. She was about 18, lying on her side on her bed. Gaunt eyes looked up at me. I approached and asked how she was doing. She said OK, but almost inaudible. I saw a small piece of gauze hanging from her left nostril. It looked like dried, maroon colored blood. Her abdomen protruded with a gravid uterus. She was 7months pregnant. She had come into the hospital with a hematocrit of 10%. Her husband had already given her 250ml of blood and her mother also 250ml. Her repeat hematocrit was 16%. Her husband again gave 500ml of blood. She had developed epistaxis again overnight and had had her nose repacked by the nurse. I checked her conjunctiva and she was very pale. She noted that whenever she sat up she got very dizzy. Her BP was 110/60 and her pulse 136. She needed more blood. As I examined her she was having abdominal pain. I checked her abdomen and found a very firm uterus. The nurse had not tried to get a fetal he
art rate, so we searched for it, but found none. She was having contractions. I asked them to try to find more blood as I continued rounds. After only a couple patients her mother came to get us. She thought she was delivering. The nurse ran to get gloves while I finished with a patient. As I go back to her room I find a still born lying on a small white sheet. Jacques is massaging her uterus, she is bleeding vaginally now, as one would expect. Running to the lab I encounter her one other family member who was being checked out. She did not match. Kanas didn’t want to take my blood as I gave a little yesterday. I sit in the chair. My left arm is swabbed with alcohol. A LARGE 12G needle is inserted into my bulging anticubital fossa. “Red life” flows from me into the bag on the floor. Soon it is bulging with 500ml of blood. I run back to maternity. It seems the bleeding has slowed.
I continue my rounds. After seeing about 6 outpatients, Jacques comes into my office, “Doc, she is still bleeding!” I hurry the patient in front of me out of the room and run to the delivery room with my headlamp in hand. Pools of clotted blood surround her buttocks. I perform curettage and remove some pieces of retained placenta. The bleeding subsides. Her BP is 90/40 and her pulse 145. There is no one else able or willing to give blood. Fluid slowly brings down her pulse.
I am called to see her again. She is having copious, watery, diarrhea. She is very thirsty. We pour in more fluids. Her husband looks concerned. He is happy that her bleeding has stopped but is still worried if she will do all right. I am concerned too. God made us incredibly resistant, but at some point it becomes “to much!” There is no power for two days now. The water has just run out of the tank. We make sure each nurse has batteries in their flashlight and we head home for bed. We have just heard that tomorrow our order of medications is arriving from the south; we must go to Maroua to pick them up. I am thankful to have friends at Meskine Hospital where they will arrive. I call them and they agree to keep them a few days for us. I can operate as planned on the old woman with a partial bowel obstruction and do the circumcision on the 18 year old I saw today in clinic.
God, give me peace and rest for tonight.

In His Service, Greg

Shanksteps #128

The sweat beads on my nearly naked body as I lay under my mosquito net. Mosquitoes buzzing around my mosquito net. The power is out in this section of Ndjamena, the capital of Chad. I switch on the ceiling fan just in case it comes on overnight. I drift off to sleep thinking of what has transpired over our vacation to the US.
We left Cameroon discouraged and needing vacation. We decided to talk about Koza whenever there was opportunity. That lead to about six different presentations while we were back. A friend of mine in Chad mentioned that there was a conference about placing intramedullary nails in Washington state. He had been given money to attend and offered to fly me out too. It was a great orthopedic conference where we heard about placing the SIGN nail. I wrote about this in our last email. We received a donation of equipment to start this technique in Koza. This was a HUGE answer to prayer, and a huge improvement to the care we will be able to give the people of Koza with long bone fractures. Then my previous residency in Sayre, PA (Robert Packer Hospital) decided to give us other medical equipment and suture to bring back after doing a presentation there. Also MAP international, who partners with Ethicon, donated suture to take back as well. These were all answers to pray
er.
We arrived at the airport in WV with EIGHT check in bags. Well that was a hit in the wallet as extra bags have gotten much more expensive. After discussion on how to enter extra bags, we were entered with all 8 bags. We had a 6 hour layover in Dullas Intl Airport. We affirmed that all bags had arrived there with the agent. At departure we were called up to the counter. The agent said “Im sorry, but it appears that Economy class is full!” There was a tense pause. Then he said “so we have placed you and Audrey in business class. WOW, God gave us another sign of His continued leading in our lives. We traveled to Paris in the plush, wide seats that recline to nearly flat to sleep, and slept the whole way. In Paris we were also moved to business class, God is amazing.
We arrive in Cameroon with the usual knots in our stomachs. Though God has shown us recently that He is leading we still doubt Him. We are just like the Israelites in Bible times. “God why have you sent us out of the land of plenty to the desert?” We are anxious of what problems await us in the terminal. Audrey renewed her passport this year and her visa was in the old one. In the terminal was different that we expected. We entered the Ndjamena airport, passed immigration without difficulty. Then on to claim our baggage. We found the taxi person that we use ready and with part of our bags already piled together. We waited and eventually got all 8 bags. Our last two flights into Ndjamena we had lost bags so this was amazing that all arrived safely. As we left the baggage area we had to stop by the customs officials. This is usually the most difficult place to pass as we have many bags and they want their pockets lined. He looked at our donation documents and let
us pass with very little harassment. Outside he came to find us, and harassed us for about 10 minutes trying to get money from us. We finally left after much discussion.
We arrived at the Catholic mission compound where we were to sleep, without electricity. With profuse sweating we drifted off to sleep.
I am now awakened at 4:30AM to the Muslim call to prayer. It is Ramadan and it seems especially strong over the loudspeakers this morning. I am unable to sleep any longer. I realize the power is back on, I turn the fan on. the fan doesn’t work. I cannot sleep any longer and choose to write you.
God has again showed His power. It is amazing to me that the God who created the universe has an interest in our lives. He spoke and our solar system was made. He spoke and galaxies were thrown into space. We know of millions of galaxies thanks to the Hubble telescope. So in spite of our insignificant planet in space, God chose to create humans here and loves and cares for each on of us. I praise Him that the God of our universe cares for me and my flight and my luggage! Praise HIM! In His Service, Greg

Shanksteps #127
We have been back in the US for more than a month. Though discouraged in Cameroon, God has given us the strength to push on. Since arriving back in the US at the end of June, we have traveled to many states and visited many people. We began in WV with my parents, then on to CT to visit Audreys father. A few days were spent in our old residencies in PA and NY doing medical presentations. Then back to CT. We then continued up to Maine to have a little time, just the three of us, backpacking. We backpacked about 18 miles and camped by a beautiful lake. After returning to CT we flew out to Phoenix for ASI. ASI is a meeting about how to share Christ in your marketplace. It was a real spiritual renewal and we were able to see my parents and sisters and some Aunts and Uncles. We spoke about the Koza hospital at the Phoenix Central SDA Church. Then attended the conference over the next few days. We would love to see some of you at the conference next year in Orlando, the first weekend in August 4-8, 2010. We expect to be there, though we may change our vacation schedule in the coming year.

It seems that each year the God gives us circumstances that confirm once again that He is working in our lives. While home I got an email from my friend, Dr. James Appel in Bere, Chad. He was on vacation earlier this year and ran into an orthopedic surgeon. As James described the situation he worked in the surgeon told him he should attend the SIGN conference on intramedullary nails (a metal rod into the broken bone to stabilize it). That they had a technique that did not require intraoperative x-rays. He felt that it was so important that he chose to sponsor James to go from Chad to the Conference in Richland, WA. When the money arrived it was well more than enough for him to attend. He asked the man if he could bring a friend, me, and he said yes. So after conferring about the conference I decided that this was a great opportunity.

So this weekend I find my self flying to Seattle to meet James. We thought it was near by, but after consulting a map, upon arrival, we discover it is quite a drive. We rented a car and drove to Richland. SIGN was started 10 years ago by a Dr. Zirkle and American orthopedist who has a passion for developing countries and their fracture treatment. He and a team of others, developed the “nail” that I described above. By the end of 2008 SIGN had 144 programs in 49 countries and there implant had been placed in more than 36,000 patients. So there I sat with orthopedic surgeons from all over the world. Vietnam, Iraq, Pakistan, Bangladesh, Philippines, USA, Kenya, Cameroon, Nigeria, Tanzania, Egypt, Guatemala and more. As you may know, most fractures I treat are placed in casts or put in traction for a few months in the hospital, however most are treated traditionally with the traditional bone setters and wood splints. This technique allows for early mobility, within a few days, and better fracture healing.

God works in incredible ways. He touched the heart of the founders of this program and they have chosen to give me all the materials to start doing this in Koza. I am amazed and VERY THANKFUL.. This will make a huge difference in the lives of even more people in Koza and the surrounding area. They run off of donations given to them to support what they are doing. They asked that we try to help them cover the cost of the materials that they gave me to use in Koza. Their cost of materials was $9200. Look up the website www.sign-post.org If you would like to help cover the cost of this incredible gift, so they can continue providing this to others, please contact me, my dad or make a donation directly to SIGN noting that the monies are for the SIGN equipment given to Koza Adventist Hospital.

God has given Audrey and I encouragement once again, to continue on in His work in Cameroon. Please continue to pray for courage and strength. In His Service, Greg

Greg Shank MD
Director Hopital Adventiste de Koza
BP 53
Koza, Extreme Nord
Cameroon

US address:
Box F
Summersville, WV 26651
current cell number 304-651-6922

phone number from US to Cameroon 011-237-7522-0278
www.missiondocs.org