Shanksteps #77 Have you ever had to think of surgery on your child?  I’m sure some of you have, but I had not until recently.  Well not actually my child, but someone who I was responsible for and felt as if my close family member or child.  We had been in Béré Hospital for about 2 weeks.  The hospital is fortunate to have 4 student missionaries and a couple other temporary volunteers.   Some of the student missionaries went off on motorcycles to a town near by to purchase some things and pick up the mail.  Whiletraveling, one motorcycle had a problem and the SM (student missionary) had to wait for it to be fixed, waiting in the hot sun a few hours.  During this time she started having an upset stomach.  On her ride back to Béré she was feeling worse.  We saw her that evening after we got back from the hospital and she was having a lot of cramps. “Are you feeling OK?”  My wife asked her.  “Not to well!”  She stood to go into the bathroom.  Audrey was prompted to follow her.  Just as she entered the door she collapsed.  Audrey caught her before she hit the floor.  She came to and sat up in a few seconds.  As she sat up she passed out again.  This time for a long period.  We figured she was dehydrated or hypoglycemic so we ran to the hospital and got an IV and started it.  She didn’t move.  We gave her some medications.  Slowly she becameconscious.  She complained of a headache and abdominal cramps.  All of us were huddling around trying to take care of her.  We put her in a bed.  After examining her, her pain was all across the lower abdomen. As you may know by now, there are not many diagnostic tests available here in the bush.  We did an ultrasound and found a couple ovarian cysts.  We decided to treat her for typhoid and other intestinal bacteria so prevalent in our surroundings. Later that night she was in more pain.  Her exam was the same.  It’s 3AM and I’m thinking what would I do if it were my daughter?  I guess if this continues I would want her out of Chad and to Europe or the US.  By morning she was feeling a little better and was hungry.  Since she was still was having bowl functions I let her eat.  I decided to call James Appel telling him that it would be nice if he and the plane with Gary could come our way in case we needed to evacuate her out to the capitalof Chad and Europe.  They immediately left and would be with us in about 6 hours.  During the day she felt better till about 2PM. She had gone without pain medicine for a while and then she started having more intense pain again.  This time it gradually got worse and worse.  James and Gary finally arrived.  We discussed the different options.  The capital of Chad, N’djamena was not in a good choice.  So it was either treatment in Béré or in Europe.  At this point we felt she needed surgery based on her abdominal exam.  The student missionary was able to talk to her parents in the US and it was decided to stay at Béré. We went to the operating room with a fully volunteer, Caucasian staff.  The surgery went well and we found appendicitis.  We were very relieved to finally know the real source of her problem.  And I was very relieved that the operation went well and that she came through it all with only a headache. We praised God that James and Gary were able to come and that she did well!  Lack of diagnostic tools really inhibits our ability to diagnose patients here in Cameroon as well as in Chad.  Fortunately God impresses us often in what we should be doing in spite of our diagnostic and other inadequacies.  We praise God for His leading and help in every situation.  In His Service, Shanks
Shanksteps #78- Greg
Shanksteps #78- Greg
We are now in the cooler season (85-90 deg during the day). There was a case of Polio (a disease that paralyses extremities) here in the north of Cameroon. So the last three days have been designated by the government for vaccination of all children 0-5 yrs. That means that vaccinators go from house to house vaccinating all the children. As doctors of the hospital we are included in the supervision of the vaccination in our area.
When they are vaccinated they are given the oral polio vaccine and then marked on their finger with a mark to show they were vaccinated. Then we can tell who has been vaccinated or not. Also the house is marked in a way to know how many of the children were vaccinated.
So I go to houses and check and make sure they were vaccinated. Some houses are done well; others have missed some children because they were out with their mothers in the fields or at school or elsewhere. So they get vaccinated the next day.
In walking around I get to see more of the community.  I greet many people sitting under trees shelling out peanuts, grinding up food on a hollow rock, or threshing millet. Other old men or women are watching small children at home. This consists of letting the children wander all over while the grandpa sleeps under a tree or shade of the hanger (a “roof” on posts that is there to store millet and other things out of reach of the goats and other animals).
I decided to go up the hill and check some houses that were out of the way. One group of huts was perched on a large rock. An old man lay sleeping on a “bed” of sticks with a rock as his pillow. A small boy was playing with a scrap of cloth a few inches in length. After waking the grandpa we found out that there were three children in the age range. They hadn’t been vaccinated.
Walking further we came upon two huts with one dirty old woman who walked with a stick as a cane. She lived there by herself. She had one relative in the valley but didn’t want to live in the valley. When asked where she got water, she said that she would go down to the valley and about a mile away pull up water from the well. Then she would carry it back to her house. I can see why many of these people don’t bathe very often. Life for her looked very hard, but she preferred it to the valley.
Moving on to the last house. It was also half way up the mountain and perched on a large rock.  After scrambling up the rock path we arrived at the group of huts. Two old men sat face to face with a chicken on one’s lap. A little boy of about 7 couldn’t decide to run and hide or stay and watch the strangers. His mother was near by nursing a little newborn. She had a torn shirt and skirt that didn’t cover much. But then again, women’s chests are not private here. They greeted us warmly with
the usual shaking of hands. They had been to the valley and were vaccinated. I saw the man pulling something off the chickens’ legs as it lay on his lap. I asked him if he was preparing it to eat. Then the other old man of the house decided it was time for us to go. The guy translating for me said he was a “fettisher” traditional witchdoctor that was getting ready to do a sacrifice. He is the one people come to see to cast spells on people, find out how a journey will go, or foretell the future.
My translator asked him what he saw for the coming year as far as disease was concerned. He said it would be a very difficult year and more disease than last year, with many deaths. Shaking his hand I agreed with him that the Bible says times would get worse and worse until Jesus comes. The “fettisher” asked me to pray to my God and he would pray to his gods about this. I said I would pray to my God and also hope that someday he would know my God that loves him and sacrificed for him. He smiled
and we parted ways. After scrambling down the rock we prayed for him and his family that they would come to know Jesus that died for them. It is a strange feeling to know that you were in the presence of someone that communicates with the devil in a direct way. Please remember us as we try to reach people like this that do not know God and haven’t had a chance to yet.
In His Service, Shanks
Shanksteps #78 Sarah
So here we are!  Back in Koza!  As my dad probably told you, we spent a month in Tchad.  The hospital there  was always busy; and Dad was always at the hospital; and Mom, being the devoted wife and doctor that she is, was always in the hospital with Dad.  So naturally, they were always worn out when the finished work.    I never went into the hospital.  I avoided it like the plague, so I don’t know their side of the story.  My side of the story was filled with lazy days and horse-back riding.  I wish I could tell you I went from house to house proclaiming the word of God and converting the whole town, but I can’t.  Neither did I cure the entire village of sickness.  My time there was spent with the animals and the plants.  You would be amazed about how much you can learn about God by just sitting and watching! When did time get so endangered that we must chase after it always?  We are always, always moving!  So now I have a message for all you workaholics out there.  This is it:  SIT DOWN!  DON’T MOVE!  That’s the message.      So often we just need the kick off our shoes, slip on our cute little bunny slippers, and sit down.  You need to watch the plants grow.  I could fill up this page with all I learned from just sitting and watching in Tchad, but I’m not going to.  The things I learned mean nothing in words!  You have to go out and experience God’s peace yourself.      And if you want to use that I-CAN’T-SPEND-TIME-WITH-GOD-BECAUSE-I-HAVE-TOO-MUCH-WORK excuse, you can just save your breath!  If God wants to spend time with you (which He does) then there will be a way to find peace and quiet.      It’s there that you will always find God.  He wants desperately to talk to you, but He won’t force you to talk.  You have to go to Him yourself.  I promise you that if you go to Him in the quiet you will never regret it.                                                                                                                                              SarahÂ
Shanksteps #76
 There are constantly new ways of doing things when one lives in a rural situation without many supplies.  We order medications and only half of our order arrives.  So we do without medications a long time.  We are forced to make due with what’s available at the time.  There are other medications available through pharmacies in town but the cost is prohibitive to the local population.  Our prices are already to high compared to the health clinics in the area.  Our prices have remained the same formany years but we are still just existing financially.  Even with our “high” prices we can barely pay our workers each month.  The government dictates the salaries of workers and unfortunately as of yet we have not received any financial help from the government to help purchase medications∑  In addition, in rural areas we use what is available out of necessity.  Here are a few examples: This hernia is to difficult to close with only sutures.  “Well we have mesh!” “Mesh?”  “Yes we sterilized it yesterday.”  To my mindset this sounds very strange.  I have repaired all hernias here with only suture since coming to Cameroon.  Now I’m in a hospital in Chad, and they have mesh?  After asking further questions I discovered that the “mesh” was a cut up mosquito net.  I thought, what! a mosquito net?  I guess there have been studies done with using mosquito nets as mesh in impoverishedareas.  So I tried it.  It lay very nicely in the repair.  After the surgery the man was healing well and went home in a couple days.   Another was in prostatectomies.  We have many old guys whose prostates are so large that they cannot urinate well and get urine infections.  And as we do not have sufficient supplies of medications for this disease, in general we treat them for a few weeks and then operate on them.  Well after the prostate is removed they usually bleed a lot and need continuous bladder irrigation.  Some people can afford the regular saline flushs and others cannot.  We have heard in the past some surgeons have usedplane water irrigations.  So we have done this at times out of necessity.  And it appears to work well.  Also the family can add water and if the nurse is busy and doesn’t do it, then at least there is still irrigation running. Another is our treatment of meningitis.  IN the US this is generally treated for a few weeks with intravenous antibiotics.  Here the people cannot afford it.  It takes a great deal to even convince them of a few days.  As soon as the person is awake again they want to take them home.  We generally do 5 days IV and then 2 weeks of oral antibiotics. I think the most important part of our patients health is Gods healing them.  In spite of our inadequacies and in spite if our lack of appropriate medications, people get well at the hospital.  We try to encourage our patients that it’s God that heals them at to look to Him.  Thanks for your prayers and please continue to pray for all those we care for.  We are all His children whether we know it or not.Â
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