#108 Shanksteps – Fight for life
I do not usually yell at parents; especially in French. In this case however, I made sure that every word I was saying was translated into the tribal language, Mafa. I think that the nurse translating for me was a bit embarrassed by my actions, and not entirely in agreement with what I was saying. Guedana had come in two days before with malaria and jaundice. The day prior to my yelling spree, he had been eating and talking, now he was comatose, with eyes the color of a school bus, and peeing
coca-cola colored urine. A very bad sign! As soon as he started in with the hiccups, I knew it would be a battle. The belief here is that if a sick person starts to hiccup, that they will surely die. So, when I entered Guedana’s room and saw that he had the hiccups, I knew I was in for a long day. The parents were set on taking Guedana home to die, and/or to make sacrifices or try traditional medicines. In fact, it was the traditional root powder that got him to this point in the first place.
Here the Mafa believe that if your eyes are yellow, and you can vomit enough (bile) yellow stuff, that you will be healed. Unfortunately, more often than not, the patients I have seen, that have taken this traditional root, have come in with severe jaundice and liver failure. Did they have severe liver failure first and the root did nothing, or did the drug make a bad problem, worse. I have no way to know for sure, but after seeing so many people really sick after taking this “medicine”, I sure
believe that it hasn’t helped. In Guedana’s case, his parents had given him the root two days in a row. When he didn’t get better, they decided to bring him to the hospital.
So, there I was, arguing with the parents’ “rights” to take 3-year-old Guedana home. I said that I was the advocate for the child. If I wasn’t going to be, who would? I told his parents that God loved this child and so did I, and that I would NOT let them take him home knowing that he still had a chance to live. They insisted that they needed to leave. I told them that they could leave, but that the child had to remain at the hospital. I assured them that I would take care of him and carry
him around on my back. After much discussion, they decided to stay (with the child). First hurdle overcome. I wrote the (expensive) prescription for care (and told them I would pay for it), then went off to start the rest of my rounds. Ten minutes later the nurse came to me saying that when she changed Guedana’s IV catheter, that his blood was very pale, and watery. So, back I went to see him. We checked his hematocrit and sure enough he was anemic and not clotting at all. Next hurdle… who
would give blood. We have no blood bank here, so usually we search for a blood match with the family. Dad was the same blood type but afraid to give. He, like many here, believe that each person only has a certain amount of blood, and if we take some from him, it means that he has less and will be weaker for the rest of his life. We finally convinced him to go to the lab; he went but refused to have his blood taken. Finally after what seemed like an eternity of heated discussion and pressure,
he agreed to give 200 ml of his own blood to save the life of his child. In the mean time I gave Guedana Vitamin K to help with clotting. I left to continue rounds. Ten minutes later, the nurse came again to tell me that he was pooping blood. I found myself back in his room looking at a mixture of blood and mucous that had just appeared. With his liver failure as bad as it was, he wasn’t clotting very well. The nurse had just placed a nasogastric tube that was now filled with blood. I started
to wonder if the parents had been right in their assumption that he would surely die. I gave him Cimetidine IV to decrease the acid in his stomach at about the same time as he started to receive the blood transfusion. I had been praying for him this whole time, but now I found Greg and Ambassador (one of the maintenance men) and the nurse, Eliza, and we had a small group prayer for him, and his parents. I again tried to finish rounds. After about 30 minutes, Eliza again found me to tell me that
his breathing pattern had changed. In fact he was hardly breathing, just an occasional breath every so often. With everything he had gone through that day, I was pretty sure that this should have been the end. I carried him to the emergency room where we have an oxygen concentrator. I had held off giving him oxygen because our ER had been crazy busy for the past week, and they really needed the bed there for the patients coming in. Anyhow, I put him on oxygen and his breathing started to normalize.
So, there we were, with three different IV bags hanging; an NG tube coming out of his nose; a nasal cannula in his nose for oxygen administration; and an oxygen saturation monitor probe clipped to his toe. His little corner of our ER was starting to look like an ICU. I prayed for him again and left him in the care of the ER nurse. I checked on him periodically throughout the day, fully expecting the nurse to say that he had died, but fully hoping that God would show how powerful and loving HE is,
and keep him alive.
He stayed like that all the next day. On the third morning, I went to morning report, bypassing the ER because I didn’t want to know yet that he had died. The report was that he had complained all night that there was something in his nose, and begged his brother to take it out. I ran to the ER and let out a scream of glee to see him conscious. He was still very sick, but now didn’t look like he was on death’s door. Finally, the parents weren’t quite so angry at me for vetoing their departure.
Today, two days later, he was sitting up in bed eating a doughnut. His eyes are still yellow, but getting a little less each day. I have been thanking God all day that he has taken this child into HIS care. This seemingly long week has given us a chance to tell his parents (as well as show them) about God’s love. Please pray for Guedana and his parents that they will follow God, and not their old traditional ways.
In His Grip, Audrey (for the Cameroun Shanks)
Shanksteps 107
I am constantly amazed by the interest the rest of the world has in our elections. I was awakened by a text message at 5AM with a worker telling me that Obama had won the elections. Over the past few weeks we have heard comment that “we” are prejudiced because we haven’t had an african american president. Now that we have one the word around Koza is that he is thier “brother” because he’s Kenyan. i then heard it was his mother. But some figure it will make their chances of goning to the US
easier if not helping Cameroon more than the US does at this point. As you probably know, we live in an area with about 100,000 people in the surrounding area and mountains. Word travels around as if it were only 100. Word of mouth gets any interesting idea or news out to all very quickly. Whereas things like when vaccinations or other health related things dont seem to make it out at all.
We are in the season of bad malaria and much anemia. We do blood transfusions almost daily. And have had a number of children die from malaria and its effects. There are about 65 patients in the hospital. Pediatrics is entirely full and Adults has much overflow from Peds. We have seen our first case of meningitis this year. we have had two die recently from Snake bites. Another is in house and has had extensive debredement of her leg and is still quite sick. Please keep her in your prayers.
I am starting a Fund for those patients with Snake bites. Currently we purchase antivenum for 14000-15000CFA ($28-$30) and we sell it for 14000CFA. Most people need many vials(5+) and we try to minimize the number to one to three, to not increase the cost for the patients. Many patients refuse any further after 2 vials as the cost is so hight for them. I am starting a fund for those of you who would like to help specifically for the snake bite patients. I would like to give them the antivenum
for a huge reduction so that I feel free to give them as much as I need without thinking about the cost. So if you would like to participate in this specific area please mark your donation as “Snake Bite Fund” we use all donations in the way designated. If there is no designation we have been using the funds mostly for purchasing medications in bulk in Yaounde, to reduce our costs of purchasing meds.
Another long term goal of mine is to reduce the cost of treatment to all patients who come to the hospital. We are trying to get the agreement with the government so that we benefit from the funds normally given to a district hospital. This is turning out to being a long process, mostly due to the stalling of the local health district doctor. If you can think of any other LONG TERM solution I would be happy to know about it. I want a solution that will last even after I leave or after the donations
dry up. I would appreciate any input you may have in this regard.
In the mean time we have prices similar to other hospitals in our region but more than the local dispensaries (health clinics). Most hospitals care for people only as they have money to start treatment, we treat and ask for money at the same time. some are unable to pay anything for a while and they stay “prisoner” of the hospital till they pay or run away when no one is watching. wE have about 40 unpaid bills that we are still trying to collect from. Both systems, ours and the other hospitals,
have difficulties.
Keep us in your prayers as we continue to try to show Christs love in this spiritual battleground. In His Service, Greg
Shanksteps 106b Update
I just wanted to give you a short update on the 10 month old girl I did a tracheostomy on before leaving for the conference in the US. When we left we took her to another mission hospital in Maroua. They took care of her for the days that we were gone and when we came back we picked her up and brought her back to Koza with us. I did a bronchoscopy on her yesterday and her airway is slowly opening up. she still cannot breath through it well enough to be without the tracheostomy. Please continue
to hold her up in prayer that her airway will heal in a way that the tracheostomy can be removed and she can grow normally. In HIS Service, Greg
Shanksteps #108
Shanksteps – Fasting
I had just finished a book by Paston Jentezen Franklin on fasting that morning. In it he discussed how the Bible encourages us to fast to become closer to God. I had decided earlier that week to start a fast, and was now on my seventh day without food, only taking water and juice. It really did make me more “tuned in” to the things of God. Greg and I woke up early that Wednesday morning because he had to leave to go to Maroua to attend a two day meeting for all the directors of the hospitals in the North of Cameroon. After he left, I read, and had my worship and prayer time. During that time I had a “feeling” that a woman would come in that day in need of a C-section. Now, I want you to realize that that has been one of my biggest fears since arriving in Cameroon; for a pregnant woman to come in distress in need of surgery, and Greg be gone. I had scrubbed on many c-sections in residency for this very purpose, but had never before needed to do one on my own – as I always “consulted the surgeon” when cases came in needing surgery. So, that morning, I told God that if He did indeed send someone my way, I would just trust in Him.
The day started like any other, with lots of kids to see. Fortunately, many of the kids had gotten better and I was able to discharge a bunch of them. I saw several people in clinic after finishing rounds on the rest of the hospital. All in all, everything had gone really smoothly. Right up to the point where the guard for the hospital came and said that he needed the key to the operating room. I asked him why he would need the key to the OR, but not the doctor, and he replied, “Oh, they need you there as well!” So, I went, not having any idea where the keys to the OR were. What I found in the delivery room was a woman who had just delivered a live baby girl, but the hand of the second twin was protruding from the vagina along with the umbilical cord of the first twin – the second twin was TRANSVERSE! I called Greg and told him to pray. There was no way of delivering this child vaginally, so we quickly wheeled her to the OR (through the nurses call room – as I still couldn’t find the key). Just as we got her on the table, Ganava came to assist me (he also had the key to the suture closet). Kalda gave her Ketamine anesthesia as there wasn’t even enough time to get sufficient fluid in her to do a spinal. As we were getting her prepped, I noticed that she already had a vertical C-section scar. “Oh great!” I thought, she’s going to be all scarred down, and I’ve never opened vertically. I called Greg a second time and he said to go in through the old scar and walked me through what to do, and again said he would pray. We prepped the woman, I said a prayer that God would get us through this ordeal, and started. I won’t give you all the details, just that EVERYTHING was scarred together. It was difficult to identify any normal layers. The uterus, which is usually paper thin, was already contracting after delivery of the first twin, and was almost 2cm thick. Even after doing many c-sections in residency, I NEVER was allowed to open the uterus (legal reasons), so this was my first time. I wrestled with my hand inside a contracting uterus, trying desperately to get the baby out. Finally I could feel it coming, a boy! A boy that was not breathing and floppy. I sucked out the mouth and nose, and stimulated the child until I thought I might rub his skin raw. Finally, the sound every OB enjoys hearing, a cry! I passed him off to Kalda to clean him up and weigh him. Now I had to deal with a very thick bleeding uterus. I put ring forceps all around the edge and did my best to close up the uterus, suturing through as much thickness as I could, realizing after closing the gaping hole in the uterus, that I would need to do a second later to include the true full thickness. Finally all the bleeding stopped. I then tried to approximate the fascia, but it was almost impossible to identify the layers with all the scarring. After checking and re-checking, I was finally satisfied with the closure. Finally, Ganava said he would close the skin for me, and I could write the orders and the procedure note.
When I finally got home, I was more tired than I can remember being in a long time. I was also very hungry. I spent a long time in prayer and thanksgiving to God, then ended my fast, on my 8th wedding anniversary, alone, but more at peace than I could remember being in a long time. I thank God that He once again “gently” showed me who was in control. Thank you all for your continued prayers for us and the people of Koza. -Audrey