Shanksteps #141
by Greg Shank
December 13, 2009

It’s been a hectic last few weeks.  Multiple surgeries each day and the hospital ranging from 50-77 patients (full).  Pediatrics has sometimes had 28 patients in 25 beds.   Also the government had another session of a vaccination campaign.  This time it was for polio, Vit A, and mebendazole (worm medicine).  This is why I have not written in a while.

So Mbaitomou (a nurse) comes to my door and says, Je une cado pour vous! (I have a gift for you) shaking his head.  He describes an old man who was on a motorcycle in Garoua and had an accident.  This resulted in an open tibial fracture in about three places.  He was treated initially at a health center there.  They cleaned out the wounds, then the patient was taken to a traditional bone setter.  He was placed in wood splints and then brought back home to Nguetchewe, a village to our North.  There he was treated by the traditional healer there for two months, with weekly replacing of the wood splints, and “setting” of the fracture.  So they brought him in a pickup because it was smelling bad.  I asked Mbaitomou if he had removed the dressing, “No, but the smell is overpowering, the other patients in the ER got up and went outside when they brought him in.”

It was night so I walked in with my headlamp.  Walking in I saw the eyes of two bush babies jumping through the trees and those of a ring-tailed wild cat.  Also a barn owl catching insects near a florescent light.  Arriving at maternity the smell is powerful.  I see an OLD, thin man laying on a foam mattress with blood and pus dried in pools around his left leg.  Wood splint were visible with cloth wrapped around the splints at two inch intervals up to his knee.  The foot lay cocked at an odd angle off to the side.  As I look closer there are maggots of different sizes moving about the lower edge of this “dressing.”   The man appeared very sick and malnourished.  As I remove the dressing and wood pieces I see exposed tibia from near the knee down to almost the ankle.  Skin attached to the dressing comes off the leg easily.  Two fractures are easily seen on the exposed bone.  Maggots pour from a necrotic area near the knee, the visiting doc leaves the room.

An elastic tourniquet is applied and the leg prepped.  With the help of the visiting doc we amputate the leg above the knee.  The removed part is given to the family for them to bury the following morning.  He is then taken to his room to wake up from the anesthesia.  About two days later he finally wakes up and takes porridge.

The following day was also full of surgeries.  We perform an inguinal hernia repair; explore a woman for an extra-uterine pregnancy, evacuating an huge hematoma; and do an emergency cesarean delivery for failure of progression of labor in a woman with previous  cesarean.

“Lord, give us strength to serve you day by day.”