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Shanksteps of Faith #90 Mar 26, 2008

She lay on the table, drawing in short, shallow breaths. Blood pooled on the floor all around. Her cloths were soaked. The nurse couldn’t find a blood pressure or pulse. She was oblivious to her surroundings. Her husband, mother, and some neighbors stood by shaking their heads and “clucking” the way they do when something is to bad. She had been having her first child at home. Her water had broken about 12 hours before she made it to the hospital. She had bleed a lot at home then went unconscious as blood covered the floor of the house. She was brought to the hospital about 3 hours later. No fetal heart rate was found, the child had died and mom was following. I came into the delivery room where this was happening and ushered all the gawkers outside. She had received a little fluid and her blood pressure was 55 and her pulse only 80. She was dying in front of us. The nurse started a second IV and we gave more fluid while waiting for the lab technician to draw and find blood from the family for this woman. Her blood pressure slowly climbed and the pulse climbed also, up to 140. The bleeding had stopped. Fortunately not because she was gone. Probablybecause of the low blood pressure. As liter after liter poured into her she started to stabilize and became conscious. After much discussion the husband and mother both gave 500ml of whole blood for her. There seemed to be sufficient space for the baby to exit normally, so using forceps I delivered the stillborn. Liters of blood and the placenta and about a liter of blood clots gushed out after the baby. The mom had a condition called abrupto placenta. Over the next 24 hours the mother stabilizedand was week two days later but requesting to go home. I know that God is watching over this hospital. While I was gone at my mother-in-laws funeral there was only one surgical referral out to another hospital. Another, likely appendicitis, refused to go elsewhere and the nurses treated them with antibiotics and the child went home two weeks later. Since Ive been back these past few weeks, I have had 1-3 surgeries every day except Sabbaths (Saturday). There are still times when we don’t understand why some things are allowed to happen. Like thechild who died because of lack of oxygen as the nurse took them off unmonitored. Unfortunately the same nurse did it again a week later with the same result. So we have had to change oxygen “policy” and termination. Though there are things we may not know until heaven, I choose to trust in God. He has made Himself very evident in many ways to me in living here and in the nature around me. I hope you also have had that same experience. If not why not ask Him for it. He enjoys helping us. I hope that you feel His power and love in your life today.
In His Service, Greg

I’m suctioning out his mouth as he vomits all over everything. He has it caught in his throat. His blood oxygen plummets. “Where is the oral airway, why isn’t it here!?” He starts breathing again. But his oxygen reads in the single digits. I suck out his mouth, then bag, bag and suck. His oxygen slowly starts to pick up. We have been in the OR 3 hours and have still not gotten his Achilles tendon repaired. He has been moving all over and I cannot get a good enough view of the back of his
leg to hit the moving target. The nurse giving anesthesia is giving repeated doses of Ketamine and some valium. That’s when he started vomiting. Meat and corn mush are coming up. I feel nauseated as he vomits on my arm and I feel some hit my face. The smell is impossible to avoid. I feel like joining him in the vomiting frenzy. He stops breathing and his saturation drops to single digits. Finally I’m able to clear his airway and it comes up to 88 (still below normal). He starts moving all
over again. Then vomits, drops to low digits… we repeat the cycle many times. He vomits probably 15 times. Nearly dies 3 times. At the end he is not fighting any longer. I hope he is not brain dead. He is stable enough that the nurse takes over bagging him. I decide I might as well repair his tendon while he is still and we have to keep bagging him. I repair his tendon and skin in about 10 minutes, now much easier with a still target. He starts breathing enough to keep up his own saturation
with a mask. We clean off a lot of vomit off of him and transfer him to his room with the oxygen concentrator. His family chose a private room so there is an electrical outlet in the room. I come back home at 3AM. Not at all tired. I shower off trying to rid myself of that odor. Finally with writing this I’m tired enough to go to bed, 4AM. Guess Ill get two hours tonight. Tomorrow I’ll wish I had a partner to take call.
This is a Koza business man and 8 armed thieves came into his house and beat up everyone, stole approximately $8000 and then before leaving cut his Achilles tendon. I guess so he couldn’t chase them. I don’t think I would chase 8 guys with guns anyway. I’m surprised that there is even that kind of money here in Koza. As everywhere there is the very rich and very poor.
Now two days later. He is doing well. He is not brain damaged. I put a splint on his arm where he has some ligamentus injuries. He removed this and the traditional bone setter put wood splints on it and wrapped it in a elastic bandage. More trust in them it seems, at least for bones anyway.
The population has apprehended 3 of the thieves and dealt with them in different ways. One was brought to the hospital for treatment and was released a few hours later. They were from a few hours away and had local accomplices. This is apparently the first large robbery in Koza. Before its been for cows, sheep and goats. Large city violence in a rural town. We thank God for His protection once again. Greg

Shanksteps #88
It is sometimes the simple things that kill. The child came in last night. He was about 6 months of age. The nurse admitted the child and on exam found it to have crackles in the lungs and a low oxygen. He treated the child for malaria and pneumonia with nearly correct dosages. This morning was Sabbath morning. So as I got home at around 11PM I was trying to sleep in. I heard Allah …. Allah…. Chanting outside my house. A blind Muslim boy and his friend were outside my door begging. Theydid not speak any French or English. Just chanted with their metal bowl outstretched. I know they are taught to beg and I dislike that. But I also learned recently that they are dropped off by their parents to the Imam (Muslim teacher) to survive only by begging. So this morning unlike before I gave them some peanuts. I understand that the cash they get they are to take back to the Imam. So I was awake. Then they called me to see someone at the hospital. So I went in and evaluated the abdominalmass and found, palpable stool. Just a thin person with the mass being stool in the intestines that was palpable. On leaving the ward I stopped by the ER. The nurse told me about the child that had come in the night before. I listened and heard a very few crackles on one lobe. The oxygen was good with oxygen running so I asked the nurse to talk off he oxygen and monitor the blood oxygen (SAT) and restart the oxygen if the child dropped below the normal level. I thought everyone was aware howto do this simple act. Not the case. So he took off the oxygen, without monitoring the blood level. This afternoon after church I checked in again. The child was dead. Five minutes after being taken off he died. The nurse was going to recheck the oxygen at 10 minutes instead of monitoring it continuously. I physically cannot monitor everything and at times leave things to different people because I feel they are up to the task. To be sadly disappointed at times like this one. I am verysad because I think this death could have been avoided if I had taken 10 minutes of my time just to make sure the oxygen was all right. I gained 10 minutes and lost a child’s life today. Lord, forgive me! Give me more wisdom on how to treat your children here in Cameroon better than I do.
Greg

Shanksteps #87 follow up to 86 in Cameroon

This is a follow up to the adventure and craziness that I found myself in by surprise. I would think that Air Brussels would tell their passengers about the dangers in their arrival area, but that is not the case. So I was at the catholic mission and basically under “house arrest” because of all the turbulence in the streets. Wednesday I saw 200-400 men and boys go marching by denouncing the president of the country and gasoline prices. A military vehicle was following them with about 20 army personnel. Each day up till then I had heard of burning of cars that ventured out and also of motorcycles. The city was silent other than the protesters. I also watched on the national television about things theprotesters were doing and things they were destroying. It showed burning of items in the streets, police combating unruly protesters, and the general chaos of the day. Thursday was calmer and the flight north said they would likely be going. But in the morning they cancelled it saying they would go the following day. A few private cars started moving around. Taxies and buses were not to be seen. I stayed put again. Friday things were finally moving. The airline again cancelled their flight and said they would go on Sunday. I was real interested in reaching the hospital, which had been without physician for so long. So I traveled to Yaounde the capital. All traffic was moving. I boarded a bus with about 40 others and we left the city. On the road we left I saw evidence of black spots all over the road from burned things to stop cars. I saw about 8 cars that had been burned. 4 tanker trucks that werealso burned. And nearly every Total gas station I went passed was entirely ruined and everything stolen, papers strewn all over, pumps with holes all over and pulled off their bases. Hoses cut, and storefronts demolished. I passed one in good condition. I asked how that survived, the passenger next to me said, “he probably paid off the mob to leave it alone!” It was very sad all the destruction that occurred. I had an uneventful ride to Yaounde. I found out that a mission plane was travelingto the north, and I was able to purchase a ticket on that plane for Saturday. It left as planned and I arrived in Maroua to go get my truck. I was able to make it to Koza uneventfully that night, and thank God for His protection. Praise God, after leaving the USA 8 days ago, I’m finally at home. Thank you for all of your prayers.
In His Service, Greg