MissionDocs.org

Shanksteps 115

I have just completed my work day. Rounded on all the patients in the hospital, approximately 40. Have seen 18 outpatients. And did a bladder prolapse surgery. Now I have only one left. It’s a child who apparently got their foot stuck in the spokes of the bicycle. They have done dressings on him at a another mission clinic for the past week and now the foot smells rotten ( like rotten eggs) and has a large amount of dead skin up to the mid-calf. After prepping the leg with betadine I start
cutting off the dead tissue to expose the living tissue beneath. It goes well. I release the tight tourniquet that placed before surgery and everything starts bleeding (living tissue). It’s a good sign! I finish up my note and prepare to go home.
The maternity nurse askes me to see a patient that is not progressing in labor. She tried to deliver at home with the “forgerone” ( the blacksmiths who also bury people and make clay pots. How they ever got chosen to deliver babies is beyond my understanding). After trying for a while they were not successful in anything other than making her external genitalia look very abused and extremely edematous (swollen). A traditional birth attendant was then called who evaluated her and tried his hand
at it for a little while and then sent her to the hospital. As I evaluated her abdomen I feel what seems to be a “band” around the middle of her uterus. I worry about a uterine rupture. On examining her further I find meconium (baby poop in the amniotic fluid). The baby was distressed. The nurse had found a heart rate. But either way this baby was not coming out without surgical delivery. I called for the other OR staff and we headed in to prepare her. I make a low transverse incision. Take
the different layers, and as I open the abdomen blood gushes out. I find the baby free-floating in the abdomen with the placenta detached and the uterus contracted, baby dead! I’m to late! She was to late! But that doesn’t make me feel any better as I attempt to repair the damage to the uterus. She wants to conceive again because she only has three children. I also find her bladder is also torn. I repair her bladder and pray that the uterus and bladder, that are so fragile after being torn,
stay together for her to heal without creation of a VV fistula (a connection between the bladder and the vagina). I head for home at 10PM. Hoping that I am not called tonight so that I am rested for another day. I remember on the way home that I was supposed to have done vaccination supervision too. I guess it won’t be done. I hope they did a good job and that the women included got their tetanus vaccination. I sleep through the night and thank God for the rest in the morning. Today I have
the gentleman with the mandibular (jaw) fracture to repair. I will wire his mouth shut for 6 weeks. I pray he heals well. “God give me wisdom and strength for today!”

Shanksteps 113
So how does a country run out of one of its most important medicines? There is a national shortage of Quinine, probably the most important medicine in countries with malaria. We have tried to order it for the last two months and have not been able to get it in the usual government places to purchase medications. They do not have it. We have been forced to get it on the “Black market” to continue supplying our patients with needed medications. These prices are usually 2-3 times higher than normal.
And now the “Black market” is run out too.
This came about apparently because there were many who were taking the medicines from the government stock area and then selling them in the capital on the street. Recently the Director of the Department of Health issued an order to round up all these medications and burn them in the marketplace. This was done and now there is none in the government stock neither in the market.
We have seen severe anemia these past few months. Have transfused more than 150 persons, and are now extremely low on Quinine intravenous. There is also a national shortage of the oral form also.
So what do we do when we run out? We are praying now that that will not happen and when it does we will keep on praying. Maybe God will have His hospital one where people find only miraculous healing and medications become unnecessary. I would love to have faith like that. Unfortunately that was not something that is taught at Loma Linda School of Medicine. So as we get extremely low on our most critical medicines, please keep us in your prayers; that we find the medicine necessary; and that
when we cannot, that God gives us the faith to trust more in Him and ask for the unbelievable. In His Service, Shanks

Shanksteps 112
Another Miracle!!! I saw her when I got back from a trip to Maroua to buy saline. I got back and the nurse asked me to see a patient that had come in during the day. She had been “sick” for four months. She had been to numerous health centers and other hospitals, and had been given antibiotics and nothing was getting better. I couldn’t talk to her because no one spoke her language. She was about 50 and was with two other old women and one young man. He tried to communicate to me in English
or French. “De troat worry her all de time!” “Do you mean it hurts her?” I ask. “No it worry her big.” I assume he does, in fact, mean pain, based on what I hear from other Nigerians. “She take soup and no go down.” I switch to French hoping it will be better. His answers are either not what I was asking or the proverbial “Yes!” When all answers are YES I know they have no idea of what I’m talking about. The nurse with me cannot talk to them either. They say a few words in English, and
he appears to understand their English better than mine. The information I get after much back and forth is that she drank soup and something stuck in her throat 4 months ago and now she cannot even swallow water, due to this, she has lost a lot of weight.
The next morning I find out the real story with another visitor who really does speak enough English; She ate some sauce with meat in it and a bone got stuck in her throat… or so she thinks. Four months with a bone is quite unlikely but it seems anything is possible here, so I do a laryngoscopy and attempt an upper endoscopy. I find an inflammatory mass or tissue just behind the larynx in the esophagus and I attempt to dilate this unsuccessfully. I probe it for any hint of a hard structure
(bone) in it without results. After working an hour and attempting to pass the Gastroscope I give up and decide either she has inflammation around a retained bone I cannot find or esophageal cancer. I also think of a slight possibility of TB but after reading some text books I find no indication of this in the esophagus.
I tell the family that I did not find a bone and that she likely has esophageal cancer and that if they have “money” maybe she could see an ENT specialist in Garoua or Yaoundé. They apparently do have money and agree to go, but not for another week, they are busy with other things in Kousseri. She is very dehydrated so I decide to put in a gastrostomy tube. I thought I had one somewhere but can’t find it. So I put a large Foley (urine) catheter surgically into the stomach through the abdominal
wall and I tie a plastic piece on top to keep the balloon up against the abdominal wall. She is severely dehydrated and the normal glistening intestines are not really damp and stick to each other because of lack of fluid. I decide to start her on local porridge and TB meds.
The next morning I remember I have NOT prayed for her at her bedside like I try to do, especially with the patients I feel I have nothing to offer them. So I pray with and for her, asking God to heal her in a way that He is glorified, and that it’s obvious what He has done.
The following morning they ask if she can have some water and I say sure, knowing that I have not rectified anything in her neck and that it will be the same as before. They inform me that she is swallowing water in small quantities and the next day, she is taking lots of water. The following day she is drinking porridge and taking meds orally, then, today she was taking normal food, sauce, boule, and meat! I have nothing to say but to praise our Creator for His healing of this woman right before
our eyes. We serve an awesome God, who loves us more than our families and friends. He is worthy of our praise! Thank you God! Greg

He was about 2 years old and breathing hard, but appeared to be the size of a 9 month old baby.  His palms and the soles of his feet were white as was his conjunctiva. His hair was reddish brown and rather straight.  His skin hung in folds around his bones. After much badgering the father finally went to give blood.  At first he refused saying that he was to weak.  He was “sick”, didn’t feel well.  The child’s mother was obviously pregnant near term again.  Having already dealt with some difficult
patients that morning I wasn’t about to have another man not give blood for his child.  I informed him that he was truly “weaker” than all the women in the room. They could loose blood every month and work hard in the fields, have malaria and deliver babies.  But he couldn’t even loose 200cc’s of blood once in his life. Well this time it paid off, he chose to give. (I still haven’t decided wether  that’s the best way to deal with these ignorant fathers, but it is sometimes more effective than begging
and pleading, ?Christian tactic- I doubt it).  So he went off to give blood.  I put him on oxygen while he waits for blood.  The one next to him is also breathing badly, unconscious and has a bulging fontanelle. The nurse gives the antibiotics I order and I prepare to do a lumbar puncture.  When I come back with the things I see that he has already stopped breathing.  I bag him for a while, his heart is still going.  He starts to breath on his own.  He is keeping up his oxygen on his own at the moment.
Another one unconscious comes in to the ER and I look that child over before doing the lumbar puncture on the first.  By the time I come back his pupils are not moving any longer and he has just stopped breathing again.  I decide to not do more for him but take the lumbar puncture anyway to see what bacteria can be found (at the reference lab in Garoua), so that if an outbreak of meningitis happens, I might be better prepared.  I am very discouraged by the sick kids that have come in the last few
days.   Six have died in the hospital in the last 3 days.  Two with meningitis, one child with severe burns, neonatal infection, a teenager with a throat infection after his uvula being cut, and a 19 year old with hepatitis.

It is very discouraging to have so many deaths in the hospital.  we are praying that someday we will have enough faith that we could have a hospital of prayer and miraculous healing.  Pray that we have faith and that we have wisdom for each patient that we see that we know what’s best to do in our circumstances. Greg