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I want to thank all of you for praying for us.  The passports were retrieved the day before we left and sent to Maroua.  As we traveled through Maroua we retrieved them and continued on to Chad to leave.    Thank you so much for your prayers.  Greg

Shanksteps #107
I’m being shaken awake by my wife. “Wake up, get up”.  It was 11PM.  I had just fallen into a deep sleep.  i hadn’t heard the knock on the window.  She had, and had gone into the hospital, finding a 10 month old who’s breathing could be heard outside the building.  “Come in to the hospital, I think we need to do a tracheostomy”.  Well that got my attention.  I don’t have equipment for tracheostomies except a few sizes in adults.  This was a 10 months old.  She had apparently taken some rice grains
and tried to eat them but inhaled them instead, five days before.  Since that moment she had breathed terribly and now was much worse. I crawl into cloths acceptable for the hospital and walk into the ER with Audrey. A small girl is breathing about 50 times a minute.  At every breath her small chest is retracting and all extra musculature is helping her to breath making a LOUD wheezing sound at each shallow breath.  she will not last long like this, I agreed.  It IS necessary.  We had been up since
three the previous morning and were still groggy.  We quickly took him off oxygen and headed to the OR calling for the nurse to come do the Ketamine anesthesia.  She dropped her oxygen rapidly during the transfer to the next building.  The oxygen was replaced and the respirations again dropped from 70 to 50 (a slight improvement, but still very bad).  I selected an endotrachial tube to modify and place as a tracheostomy.  The girls neck was opened above the sternum.  We slowly dissected down, attempting
to make this as bloodless as possible, so as not to drowned the trachea when we opened it.  We made a “U” shaped incision in the trachea.  Immediately, extensive coughing produced a significant volume of pus from the lungs.  After suturing the tracheostomy open I performed a bronchoscopy.  I aspirated pus from both lung bronchi.  then I scoped upwards. It was difficult to see but something moved.  Afterwards I examined the larynx.  There lay a dislodged piece of rice.  Everything was very inflammed
and edematous.  I placed the modified tracheostomy tube into the trachea and sutured it in place.  She was breathing normally at 16 breaths a minute.

After finishing my notes and placing the patient in her room with oxygen I headed towards home.  I fell asleep dreaming of having a respiratory therapist.  One and a half hours later I was awakened by “the knock”. She was breathing difficultly.  I ran in, finding that the tube was nearly plugged with dried secretions.  I suctioned them and she started breathing better.  I told the nurse that if she was breathing badly or desaturating to call me.  OR if it completely plugged and the patient was dying
to cut the sutures and remove the tube.  I was called an hour later.  It was plugged and he had cut the suture and pulled it out.  I arrived to her breathing calmly without a tube.

Today was Sabbath and I have spent much of the day worrying about her and making sure this stays open.  i pray that the swelling in her throat will go down rapidly so she can breath normally from above again.  I’ve tried to sleep but it would not come.  Wasted but unable to sleep, I continue to think of her.  Lord help her live!  In His Service, Greg

Hello all,
I am just sending a short note to request your prayers.  We are traveling to Boston for a surgical conference in 4 days and our Passports have been stuck in Chad for the last nearly 4 weeks.  Please pray that we get them soon so we can travel as planned.  Thanks, Greg Shank

Hernia’s are nothing new.  I do them a little different here than in the US but the result is the same… No more bulging scrotum, No more incarcerated or strangulated bowel, less pain after healing.
I open the skin with the scalpel, control bleeding with electrocautery.  Divide the external oblique fascia.  Then search for the hernia sac.  Today it was very large on the left and smaller on the right.  I dissect it out from the rest of the testicular cord structures.  I open it, then twisting it at the base tie it off.  I place a piece of local mesh into the hole and place a patch of the same as a reinforcement.  I tack it in place.  As I start the left side I hear a commotion.  I ask Ganava to go out and check what’s going on.  He leaves, leaving Lauren to watch the patient and keep him asleep for me.  I am scrubbed for the first time with Allison.  She wants to learn but has no experience, it’s slow at the start.  Ganava comes back and says there is a woman there with a child that is breech (buttocks presenting first) and she’s pushing.  I ask them to call Audrey to evaluate the patient.  She needs a C-section.  I try to hurry.  Audrey pokes her head into the operating room and asks me if I want her to close this patient or start the spinal on the woman that needs a C-section.  Ganava rushs off to start an IV.  I am able to finish quickly and decide to use one of my seldom used staplers, to close skin quickly.  Ganava takes care of dressings and wheels the patient off to their room.
In the other room two feet are protruding from the vagina.  She is prepped and sitting on the feet so I can do a spinal.  I jokingly ask if the babies feet are OK with mother sitting on them.  I ease the needle into her back, clear spinal fluid flows out.  The spinal medication given I quickly lay her back and position the table.  Audrey and I scrub quickly.  Kalda preps and drapes the patient.  I sweep across her abdomen with the blade and her skin lays open.   The fascia is opened.  The bladder held down and the uterus opened.  Meconium (baby’s poop from distress) gushes out, blood is flowing.  I struggle to get the babies feet up to the incision.  Finally one releases after the other.   I pull him down.  The head is stuck.  I twist and the head pops out.  Thick, brown meconium sliming his face.  I suction frantically before he takes his first breath.  He takes a half breath.  He’s blue and floppy.  I suction, rub, tap and encourage him to breath.  Praying that he hasn’t already blocked his airway with meconium.  Finally he takes a big breath, then another.  I rub some more.  He starts to cry.  I am relieved!  I hand baby off to Kalda and continue working on the mother.  The uterus is closed and finally stops bleeding.  Sequential layers are closed as usual.  Audrey and I are happy to have a live baby, and so is the mother, who starts having shaking chills.  Her temperature at the start of surgery was 104”F.  Our medication is finally working and it’s coming down.  We start treatment for malaria and will check the malaria smear in the morning.  We head home to rehydrate after a full day.  Praise God for Life, Greg