Shanksteps – Habiba #105

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Shanksteps – Habiba #105

Like many of the women here, Habiba delivered her baby at home.   Fortunately she didn’t have any problems during the delivery, and the baby was born healthy.   For about a week before having her baby, she had been having bloody diarrhea at home.  She finally decided to come to the hospital a couple of days after delivery to get checked out.  She was found to have dysentery and started on treatment.  After several days of being in the hospital she was still having diarrhea, but now was also found
to be anemic.  Her family donated a sac of blood for her.  We arrived from the US one or two days after she was transfused.  She continued to have bloody diarrhea, abdominal pain, and was still very short on blood. Now though, she was also vomiting and not able to keep food or her medications down.  Greg realized that she was also bleeding vaginally and performed a curettage.  She was transfused a second time and seemed to do better.  Several days passed and she wanted to go home, so Greg discharged
her.
Three days later, she returned to the hospital with the same symptoms; bloody diarrhea, abdominal pain, vomiting, and anemia.  She was transfused a third time and started on a different set of antibiotics. She perked up for a day, but was then very pale again.  After the fourth transfusion, I started to think that there was more to this sickness than just the obvious physical ailments.  I found out that her mother wanted to take her home so that that whole side of the family could perform sacrifices
to their idols and call on their sorcerer.  Her husband (a wonderful Christian man) wanted her to remain at the hospital and asked if we would pray for him to stay strong for her.  He said that if he told the family that he didn’t want them to take her home, that they would tell everyone that he had abandoned her, and that he didn’t want what was best for her.  So we prayed for his strength, for her healing, and for the right decision to be made.  She was allowed to stay, but I realized that there
was very serious spiritual warfare going on.  I heard that same day that the belief within the family was that she had been “spiritually taken captive and was being held in chains in the devil’s heaven.”
If you don’t remember what the “devil’s heaven” is from previous stories, I’ll give you a brief review.  The Mafa people believe that god (small g) is the one that brings both good and bad on people.  You have to keep this god happy or something bad will happen to you or your family.  (Even most Christians and Muslims believe this way about the Mafa god; even if they say that they believe in the God of the universe.)  The Mafa people also believe that there is a second heaven (also called the devil’s
heaven) where only the sorcerers can go.  They believe that it is a real place, set up like a market, where sorcerers can buy and sell anything, even intelligence, sickness, death, and longevity.  If someone goes uninvited, or doesn’t do the correct sacrifice; or if a sorcerer is “employed” to capture someone, that person will remain in chains in the “devil’s heaven” until a sufficient sacrifice is made.    When anyone is a spiritual captive in the devil’s heaven, it is manifested as sickness, even
to the point of death, in “our world”. This is what was believed to be going on with her.
As is our norm, Eliza and I had been praying for and with Habiba and her husband every day since she arrived on our ward.  I realized that this was going to take more spiritual “fire-power” than just a simple prayer. So, I asked all of the workers who had the desire, to come and pray for her in a group.  We surrounded her, laid hands on her and prayed. We prayed for healing; for faith; for comfort; for her husband; and for the bondage of Satan to be broken.  We commanded the bad spirits to leave
her body, and for her to be restored to complete health.  As is normal for Americans, I wanted to see an instantaneous change in her – which didn’t come.
However, when I went to see Habiba the following day, she was a different woman.  She was eating, had no more bleeding, there were no signs of the anemia that had plagued her for days, and most amazing was the smile that was on her face.  She continued to stay at the hospital for the next week, mostly to be ministered to.  She was afraid that when she left the hospital that her problems would just reemerge.  She and her husband finally set a discharge date.  Her one request was that we all come as
a group to have one last prayer with her and her husband.  So, about 15 of us went and prayed for Habiba, her continued healing, and most importantly her continued faith.
I have since heard that she did not go home to the village of her parents, but to the house of one of our church elders for continued spiritual mentoring.  Our chaplain visits her once a week as well to see how she is doing.
We thank God for His healing power.  We thank the willingness of our workers to lay out their hearts in prayer for this tormented woman.  We thank you readers for continued prayers for our little hospital, which we hope will be a light in the darkness here.
In His Grasp,  Audrey (for the Cameroun Shanks)

Shanksteps #104

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Shanksteps #104
I went to bed at 10PM after playing some games with the student missionaries.  We splurged with brownies from a box and Kool-Aid.  Knowing today was going to be a “day off” I planned on sleeping in.  I awoke at 6AM as usual, wide awake and couldn’t get myself to sleep in.  It was finally a cloudy day and cooler than it has been.  I made a cup of chocolate with local chocolate powder then went outside to read for my personal worship.  Mosquitoes and wood bees keep me company while I read.  Up high
in the trees dragon flies fly around looking for insects.  I have a peaceful worship then decide to eat breakfast.  That consists of bouille (local porridge made of rice, flour, sugar, and a dash of lemon) and toast (made of white flour and millet flour).  I then go out to take apart my motorcycle carburetor because it has been choking and coughing for the last few days and new gas didn’t seem to do the trick.  I take it all apart and see all kinds of sediment in the bottom.  After cleaning this,
Im replacing it when the nurse from the hospital comes by.  He wants me to see a patient in maternity that has been in labor since yesterday evening, and has stopped progressing.  I finished putting the motorcycle together, and rode it into the hospital.
I find a woman on the bed who is thin and short.  After examining her, I find the pelvis is small and the child has not really descended much at all.  I decided she needed a cesarean (operation) to deliver the baby.  The husband agrees wanting the best for the baby.  I nearly gape in surprise!  This is the first time I have heard a father say that here.  I assure him I think it’s necessary and we will do our best and ask God to be in control.
I slide the knife blade into the handle and after prayer slice open the abdomen.  She bleeds and I control this with electrocautery.  Through the fascia, muscles and peritoneum.  A transverse incision in the uterus.  The baby is hard to get out.  The head is there but it’s not coming.  I ask for forceps and pull it through the incision with them.  He is floppy and blue.  I ruff him up, drying vigorously, the nurse prepares the oxygen concentrator to give oxygen to him.  He finally starts breathing
then yells for all he’s worth.  He’s ALIVE!  I breathe a sigh of relief and thank God for a live baby.  I sew up the uterus, fascia and skin.  I want to escape home but the other nurses have a couple patients for me to see.
One elderly man came in with red urine.  The nurse put a Foley (urine catheter) in him and didn’t get much so took it out.  I feel his abdomen and his bladder is up to his umbilicus.  His is full to overflowing!  Red blood is coming out his penis.  I think the nurse blew up the balloon below the prostate and ruptured the urethra.  With difficulty I put in another Foley and get about 400 ml dark red blood/ “urine”.  He needs a cystoscopy but we don’t have it.  I give him Vit K, to ensure he has part
of the things necessary to clot.  The nurse had already given him Diclofinac which affects the platelets and inhibits clotting.
The other one was a 6 month old chunky boy with meningitis.  He had been convulsing all night.  I had given him the maximum of Phenobarbital without success.  This morning he had finally stopped and even had some breast milk.  His IV had come out for the 4th time.  Yes you DO need to replace it.  He still needs IV antibiotics and treatment for concomitant malaria.
I am finally headed home.  Our helper has made eggplant peanut butter sauce(affectionately know as “acid”.).  I choke it down and take the motorcycle for  a longer ride to ensure it’s working well.  When I get back we head for a hike up the Mawa Mountain.  It goes well but we reach the 2500 ft summit after bushwhacking a path straight up the side to the top.  It is near dark and we’ve been walking for nearly 2 hours.  We start scrambling back down and choose a nearly vertical route.  We stumble,
skid and fall to the bottom and arrive at the village after dark.  I’m exhausted.  We head home.  I check on those same two patients.  They are doing a little better.  I head home for more “acid”.  It is raining and I arrive soaked, thankful to finally be cold once again.  Im falling asleep as I write this and will hit the sack.  Good,  busy day
In His Service, Greg

A message by one student missionaries

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Here is a message sent out by one of our student missionaries I have the permission to forward on.  It will give you a new perspective on Koza.  We will periodically send some of their messages on.  Enjoy:

Hello!A busy week has gone by. Two Sabbaths ago Mary-cecille, a women from the south preached. The south is known as being more liberal and she has a good husband which allowed her to speak so freely. She preached on how men should not beat their wives and how God had made woman to be man’s helper not his slave! Dr. Shank was translating for us and the next week when the men had the podium again a rebuttal was given. The sermon opened with the verse about it being “better to live in the desert than
live
with a quarrelsome wife”. It is so strange to hear them preaching on issues like beating your wife. This last week was about not using the traditional healers. The sermon topics here deal with issues that are so foreign to me. The people here in Koza are saturated in tradition. The local medicine man is still visited. A sorcerer lives up in the hills and still makes sacrifices, while fishing around in the goat’s guts so as to foretell some event. That’s a bit scary. Most of the people here in
Koza are farmers. If they do happen to get an education there are no job openings for them and when they come back home many go back to the fields. So why go to school? This past week I’ve been working in the emergency room with Kalda, one of the few nurses that speak English, he has been so good about teaching me. I’ve given several depo shot’s (birth control) and wish that I could give out much more. But being fertile here and having many children is almost a sign of wealth. As well as since many
men take more than one wife the woman who has the most children is presumed to be the preferred wife. Well I don’t want to overload you with too much info and I know that life back home tends to be busy so I’ll try to make this a shorter than my last email…But I just have to tell you one more story…Ok, one last story. I just have to share! So last week a woman came in to give birth and Lauren and I got to get in on it. After walking into the room the nurse Ganava handed Lauren the sterile gloves
and said “Do you want to catch the baby?” “umm ok” say’s Lauren a little timidly as she explains she’s never done this before. With a couple quick instructions about grabbing the head and neck “c’est comment ca” which means “It’s like this” if your talking French. Ganava say’s this all while illustrating with his hands how to catch a baby. Lesson’s over the baby’s almost crowing. I’m standing there holding the clamps and scissors all ready to cut the cord when all of a sudden this huge gush of water

projects from this woman’s vagina, spraying all over me as it hits the wall behind me! I hadn’t understood when Ganava has said the BOW’s hadn’t broken… I really need to learn French! So, after Lauren grabs the baby and I cut the cord, we suction out his nose and mouth and wipe him off before weighing him. As they’re weighing the baby I start doing fundal massages to help the placenta come out. Remembering that the birth of the placenta can be a bloody mess I stand at the woman’s side as I continue
to massage her fundus…again not knowing French… Ganava tells the woman to push and with a huge surge of energy, from a woman who has just given birth, the placenta comes flying out in a surge of blood that fly over the woman’s leg and all over my arm in a warm bloody mess!! Did I mention the last time I was helping during a delivery I got barfed on… yeah, just my luck always at the wrong place at the wrong time. I’m never helping again during labor unless I have a full body suit!!! Well I guess that’s
all for now! Just remember birth is bloody. I’ll let you know some more disturbing stories next time. Till then S.

Shanksteps #102

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Shanksteps
The pediatric ward was full and I was just seeing my last patient.  One of the grounds workers comes running up saying that there was an emergency in the ER. Greg was in surgery.  I grabbed my medical bag and followed him into the Emergency Room.  Before me was a young man, about 20 years old, breathing terribly, flailing from side to side.  The room was full of his friends “trying to help”.  I could not get a straight story from anyone so I decided to try to examine him.  His breathing was labored
but with good breath sounds; Heart rate fast but regular; Extremities cool; Pupils, non-reactive;  Blood sugar – 21!  There was the cause of his agitation.  His blood sugar should be at least 65.  I always keep a ziplock of sugar in my bag.  I place sugar under his tongue with a drop or two of water hoping that he will absorb it quickly.  The ER nurse works on getting an IV in his arm to give him dextrose directly into his veins.  Finally he starts to calm down and I know his sugar level is back
in fairly normal range. I check him again – 82.  He’s now able to answer questions. Between him and his younger brother I find out that he’s been sick for about two months, worse for about two weeks, and in a coma since this morning.  He has complained of headache, body aches, and especially abdominal pain.  He has taken several unknown medications from the market, and I’m sure some traditional medications over the course of the past two months.  In addition he’s a big bili-bili drinker (the local
millet wine).  I examine him again to assure myself that he’s stable, place him on oxygen to make him more comfortable, and then go to write his orders.  I ask the lab to check for malaria, typhoid, dysentery, and liver disease.  By the time I leave the ER, he’s laying comfortably on his side making faces at the baby in the next bed.
I go to make rounds on the adult ward, but realize the one of the patients probably needs surgery so I go to find Greg.  I find him in the ER with the young man who had come in earlier.  He’s breathing terribly and somewhat delirious. Greg thinks he may have a pneumothorax because his breath sounds are diminished on one side.  He inserts a needle, but no air escapes.  He’s still receiving sugar in his IV so I worry less about hypoglycemia.  He sits up and seems to breathe better, so Greg goes to
check on the woman who needs surgery.  Several minutes later the patient sways and lays back on the ER bed.  Now he sounds like he’s breathing through water.  I listen again and his lungs are full of fluid.  I give him Lasix to remove some of the fluid and turn him on his side.  Greg returns to the ER and examines him.  In the mean time look for a mask and ambu-bag in case he crashes and needs CPR.  I find the bag but no mask.  I look all over the ER, tearing through drawers and cabinets.  Before
we left on vacation, there were at least 3 adult resuscitation masks there.  Greg cuts a hole in a rubber glove to do somewhat protected mouth-to-mouth.  I run to the stock room but to no avail.  Fortunately someone had run all the way to the OR and grabbed a mask and bag and brought it back to the ER.  By the time I made it back, Greg was bagging him. He had just vomited a full stomach of some type of alcohol mixed with blood.  I listened for breath sounds and found no heartbeat.  I started chest
compression while Greg bagged.  Every couple of minutes I listened to his chest again, and each time I heard more fluid/less breath sounds.  After about 15 minutes we decided to stop CPR.  He was dead.
About 20 minutes later we get the results of his labs.  Not much malaria, no typhoid, but his liver enzymes we so high they were above the range of our machines. The diagnosis: acute liver failure;  probably due to hepatitis and possibly exacerbated by traditional medications.  I go home that night to read about hepatic failure, complications and management.  What I find out about the initial management is frustrating.  My Medicine textbook says that he could have had kidney failure and I should
assess his volume status with invasive monitoring (NA -none available).  He may have cerebral edema (swelling of the brain) that needs to be monitored if possible (not) and given mannitol to decrease the swelling (NA).  He may have a GI bleed (which he did) that should be treated with antacids (none IV) and fresh frozen plasma (NA). He may have low oxygen due to fluid in his lungs (he did) that would require intubation with special ventilator settings (NA).  He might have low blood pressure that
could be treated with special medications (pressors) (NA). He may have an underlying infection causing sepsis and blood cultures should be done (NA). He may be acidotic and should be given Bicarbonate.  We have Bicarb, but no way to test if he is acidotic.  He may have low blood sugar. This we did find and treat.  He may have low potassium or low sodium.  Thanks to World Wide Labs, we would have been able to test these, but didn’t.  In the end, I read that even if he had been in the best of situations,
his chance of survival was only 10-40%; and the only treatment if it looks like he won’t recover from this attack is liver transplant.
We do the best with what we have available.  And thanks to help from family and many friends we’ve been able to improve the quality of care here considerably.  It’s still frustrating when we know that something could have been done for him had he been fortunate enough to have been born in a different country.  It still amazes me though how many people here do survive, not because of what we do, but sometimes in spite of what we do.  That is the powerful hand of God at work.  He heals our patients
and protects US every day from harm and deadly disease.  For those of you in the US and Western countries, never forget how blessed you are to have access to good health care.  Please continue to pray that God helps us through in spite of our deficiencies.
In His Grip,  Audrey (for the Cameroon Shanks)