Tuesday, December 20, 2016

The walls came down

Part of my ability to survive in PNG has been to put up walls to protect myself from taking each patient's illness, hurt, struggle, grief, etc. and carrying it myself.  Despite trying, I have realized that there is only so much that I can do as a doctor, only so many patients that my limited medical resources can help, and only so much that my heart can carry.  So in order to survive, I have learned to put up some walls, I have learned to not ask too many questions when the situation doesn't look good, I have learned not to spend too much time at a bedside when there is little hope.  Right or wrong, it is how I survive, but there are patients who break down that wall without much effort.

Kenduman is one of those patients.  He followed his dad into my exam room, a large scarf wrapped around his neck and shoulder.  I quickly scanned his book, seeing something about a growth on his shoulder, and asked him and his dad, what was wrong.  His dad unwrapped his neck and shoulder revealing a large tumor of his arm.  Instantly the wall came down, there is something about kids with cancer that gets to me every time.  Every time we have a kid with cancer, it goes bad, really really bad, and despite that, my heart opens up to these kids and their families.  I want to be able to help them, I want to be able to cure them - but our resources are so limited, that despite giving them all the meds we have, we don't succeed.  
Despite knowing there was little hope of helping this kid, despite knowing that it was probably too late, my heart was opened and I did what I could to try and help.  I made sure there wasn't any evidence of metastasis to his lungs or his liver, then I talked to our surgeons, to see if there might be a way to remove this tumor.  Unfortunately, as I suspected, the tumor was too big and surgery was no longer an option.  

These cases are the worst because they came too late.  As much as part of me wants to find out more, find out why they didn't come sooner, why they waited so long, I realize that none of that matters.  What I do know is that this dad is from the deep bush, the border between two provinces and not close to much of anything.  He did what he could for his son and what he thought was best, going to the closest health center they had, and when their treatment wasn't enough, they finally found their way to us.  

As we shared what was happening, the dad seemed to understand better than I expected that he was going to lose his son.  The son didn't understand Pidgin too much, and so it was hard to talk to him, but the dad definitely knew the true meaning of Christmas, knew of the love God had for each of us.  There was little more I could do, but pray for them and trust God to comfort them in ways that only He can, and to slowly rebuild the walls around my heart again, until next time.  

Friday, December 16, 2016

A good save

There are very few diseases/illnesses that I see each day that are really rewarding, as a doctor, to treat.  There are very few conditions where the medicine I give a patient makes a significant difference that they or I see.  Treating someone's asthma exacerbation is definitely one where I have seen patients on the brink of death and have seen them come back after treatment, and it is quite rewarding as a doctor, to know you played a part in helping that patient come back from the brink of death.  Outside of asthma, almost all of the other patients I see have a chronic condition requiring medicines to control their illness or an acute condition requiring medicines to help them feel better, but few medicines change the condition significantly.

Cyanide poisoning is definitely, one of the other conditions where administering a medicine can make a life saving difference.  In the past 9 years, I have seen numerous kids and adults present to the Emergency Room in varying stages of Cyanide poisoning after eating undercooked bush beans or tapioca.  A few times I have, helplessly, stood by their bedsides and have had patients die because we didn't have the medicine we needed to treat them, but thankfully more times than not, I have stood by their bedsides administering the medicine and seen them go from near death to life in just a few minutes.  Even when I haven't been the doctor at the bedside, I still find it rewarding that we are able to seemingly alter the course of one's life by administering the cyanide poisoning antidote, and kids/adults go from near death to life.

Last night, Bill was called to the ER for a kid that was unconscious and near death.  The family had little to offer history wise, when they last saw him, he was healthy and fine, and then they found him unconscious hours later outside and rushed him to the ER.  As Bill started to ask questions, he quickly focused on the things that can cause someone to go from being healthy to almost dying within hours.  In our setting, cyanide poisoning has to be right up at the top of that list.  The poison beans grow everywhere (including my garden) and tapioca is a staple in many's diets, but if they aren't cooked well cyanide poisoning results.  The family didn't know if he ate beans, but knew he was often out in the bush eating the foods he found, there were no other leading diagnosis, so Bill started treating him and very quickly the unconscious kid started to respond.  As he kept giving more of the medicines the kid continued to respond, to the point that he was able to talk and when asked he told his family about picking the beans in the bush and cooking and eating them.

The next day, the kid is sitting in bed without any complaints wanting to know when he can go home.   We reminded him that he should never eat the bush beans again and was sent home.  I don't know if he or his parents will ever understand how close he came to not being with us today, but their understanding or gratitude doesn't change the joy that I felt in seeing this boy alive and well.  This is one medical save that doesn't get old.

Monday, December 12, 2016

A smile despite the challenges

This kid is about 9 yo, but his life hasn't been easy.  Despite our poking and prodding, checking blood, ultrasounds, xrays, sticking needles in his abdomen to remove fluids we can't figure out why he has a huge spleen, and thus can't do much about it.  The spleen is so big that takes up most of his abdomen, causing him significant discomfort, difficulty in walking, prevents him from leading a normal 9 yo boy's life of climbing trees, running and playing with his friends, etc.  Despite altering his life, he doesn't have other sequalae from having a huge spleen, and having a spleen is a good thing in PNG, so we haven't taken it out. 

2 days ago he came with his mom and his dad to the clinic because his eye was swollen.  He was having trouble seeing, was having a fever, and his eye hurt.  I really wanted him to stay in the hospital, but he didn't want any part of that, so he got a shot for 2 days, and then came back to see me today.  Today he is all smiles, despite still being really sick.  The swelling is down in his eye, but he still can't see well out of it.  His abdomen is still really swollen causing him to not be able to walk long distances or play with other kids, yet despite that he smiles.  

When I saw him smile, I was challenged to smile myself despite the challenges around, to appreciate the little things in life and not focus on whatever the struggle is that is currently happening.  His smile reminded me that life doesn't always go our way, sometimes we get sick, sometimes a loved one gets sick, sometimes even when we have an illness we get another illness, but we can still be happy, still smile, still brighten someones day despite that.  I hope we can all be more like him and share our smile with others.  

Wednesday, December 7, 2016

One thing that never gets old

After you have lived and worked somewhere for 9 years, many of the things that used to be new, shocking, challenging, interesting, depressing, hard to handle, etc. have now become normal.  Bad chops, crazy histories, domestic violence, deaths, cancers, really really late presenting patients, lack of medicines or supplies, shortage of staff/doctors, etc - these are just everyday occurrences that I have grown accustomed to and think little of. 

One thing that I hope never gets old is getting to share Christ with a patient or encouraging a patient in their walk with Christ.  This is the reason why I am a missionary, to have the chance to introduce someone to Christ, or encouraging someone and helping someone grow in their relationship with Christ.  In the hospital, it is a privilege to have the opportunity to pray with patients and share Jesus's love with them.   

This week on medical ward, I met a woman who had been chopped by her husband to the back of her legs.  She was in the hospital because she was having pain when walking and her wounds were infected.  As I was talking to her, I needed to examine her legs, so I asked her family to help remove the dressings.  A man stood up and gently started removing the dressings.  I asked who he was, and he said he was her husband, and I said so you are the one who chopped her.  He said "yes," without hesitating, he seemed to not be ashamed of it nor did he show remorse that I could tell, unfortunately this isn't shocking to me anymore.  I talked to them for a bit, trying to find out more about the situation, and when I asked them if they had a relationship with Christ, they didn't.  I shared the Christmas story with them, and prayed for them and their marriage.  Later I found one of our Chaplains and asked him to talk more to this couple about their marriage and relationship due to the chop, but also about God's love for them. 

Later this week, I saw a patient in clinic who had tried to kill himself, by drinking weed killer, a few days prior because he was angry with his family.  Thankfully, he didn't succeed and will have a full recovery from his suicide attempt.  As we talked, it became clear that he although he was ready to die a few days ago, he didn't want to die now and was just angry with his family.  We talked about alternative ways to deal with the anger, including praying to God, as he has a relationship with Christ.  I was able to encourage and challenge him in that relationship and pray for him to grow closer to God and find strength in God during the difficult times.  

These might not be the medical breakthroughs that doctors dream of, or even the spiritual breakthroughs that missionaries dream of, but we never know what sort of fruit will sprout from the seeds that are planted.  I know many seeds were planted in my life before my relationship with Christ grew and I am happy to keep planting seeds, as the opportunities arise.  I am also thankful that I am not alone in this process, that everyone at the Hospital from the cleaners to the nurses to the chaplains and doctors are all working each day to plant seeds along the patient's way, showing and share the Love of Christ.  This year as a result of the ministry at Kudjip 100s have come to know Christ, new churches have been planted and lives have changed as folks have grown in their relationship with Christ.  Christmas is a great time to remember the best gift of all that God gave us and a great time to share that gift with others.

Thank you for your continued prayers and support of our ministry here at Kudjip. 

Monday, November 28, 2016

Rural Health Services

For the 2nd straight year the Bana Rural Health Clinic has had the opportunity to have a Kudjip Nazarene Hospital doctor join them in their work.  Last year it was Dr. Susan Myers and a team that installed solar power, did pastor training and church statistics training.  This year, Dr. Bill and Marsha McCoy joined the staff at Bana for a week. 

Bana is a small village in the Sepik, far away from Kudjip and far away from the nearest hospital.   The clinic, with a staff of 3, serves a population of about 15,000, with the nearest hospital over 4 hours away on a very bumpy road.  Buckley and Charity and their son Philip, have been serving at Bana since they graduated from the College of Nursing, 3 years ago.  Rose, is a Community Health Worker, who also serves along side of them.  The three of them serve that community in many ways: seeing the patients who come, giving immunizations, going out on patrols, delivering babies, doing health education and more.  Day in and day out, they are the front lines, they are the ones investing and giving their lives to the people in Bana. 

For one week in October, Dr. Bill and Marsha McCoy got to join Buckley, Charity and Rose in their work.  The McCoys weren't alone, Gabriel and Emelyn Mahisu (Rural Health Services Director), and Bapo (Community Based Health Care Work), DS Yambe and many other supporters of the church came out for this event and for the services held throughout the week.  Bill saw patients each day, treating those that needed a doctor's care, teaching Buckley and Charity about different diagnosis and management, and reassuring the patients about the treatment they were receiving at the clinic by Buckley, Charity and Rose. 

The visit was an encouragement to many, the patients, the Bana staff, the village of Bana, to the church, to Rural Health Services, to the McCoys and more.  Encouraging our staff is one of the reasons why we started sending doctors out to serve with our staff in our rural clinics.  Other reasons are to provide teaching and training to the clinical staff that will last beyond the doctor's time there, to give patients a chance to see a doctor that they might never otherwise have the opportunity to see, to connect Kudjip and Rural Health Services more, and to give the doctors a chance to see more of PNG and what lies beyond our station gates.  

This was the 4th successful trip, of doctors going out to rural clinics.  The first was Dr. Susan in Bana in 2015, then Dr. Imelda went to Dusin in 2016, then Dr. Andy to Ulamagi clinic in 2016 and now Dr. Bill to Bana.  As we reflect on these trips and get feedback from the doctors, the staff and our Rural Health Services, we continue to look for more opportunities and ways to train our staff and encourage those who work beyond Kudjip Nazarene Hospital's gates. 

Kudjip Nazarene Hospital serves over 60,000 outpatients a year, but there are many more patients that are seeing, hearing and being shown the love of Christ beyond the gates of Kudjip.  Rural Health Services is the avenue in which that happens.  RHS has 6 clinics in remote areas of PNG that are staffed by dedicated Nursing Officers and Community Health Workers who often are the only medical personnel in their small communities.  These clinics handle the routine and emergent medical care that comes up from delivering babies to treating hypertension, coughs, colds, doing suturing and more.  These workers have moved away from their homes and families and are being missionaries in the remote parts of PNG and lives are being impacted for eternity as a result. 

In 2016, RHS, like all Christian Health Services, had their budgets cut by 40% from the government.  This cut has been devastating to RHS.  They don't have the patient volume to use patient fees to account for their deficit, so as a result services are what get cut.  For some clinics that means a staff is being cut, for others the number of medicines being sent in is being cut, for others, the clinic itself is facing closure.  We would like to not have to close any of the clinic doors, to pay our staff correctly, to be able to have adequate supplies of medicines at the clinic and to be able to medevac patients out to larger hospitals when needed, but without funds it is hard to do all that.  We don't know what the budget will look like for 2017, but we know these clinics won't survive if they don't get more funds for next year.  Would you consider helping?  Would you consider praying about how you might be able to partner with us in serving those who need care in the rural parts of PNG? 

If you are interested in helping these clinics continue to run, you can go here to give support.  If you want to find out more about RHS, don't hesitate to contact Gabriel Mahisu, the RHS director at gmahisu@yahoo.com.