A battle for their lives

In the Highlands of Papua New Guinea, kids between the ages of 2-6 yo are fighting a battle for their lives and they don’t even know it.  For many, the odds are against them. 

The culture in the Highlands of PNG is one of subsistence farming where many eat what grows out of their garden and only occasionally enjoy protein at mumu celebrations.  As a result, the majority of kids are malnourished and don’t have enough of the enzyme needed to breakdown protein.  Kaukau (sweet potateo), their dietary staple, also serves to inhibit what enzymes they do have.  As a result, when they do eat meat, which is often undercooked, the bacteria (clostridium perfringens) found in the meat  produces a toxin that wages war on the child’s small intestine. 

The kids don’t know any of this, they run and play, eating meat and celebrating with their family one day and in a day or 2 they start to complain of abdominal pain.  Pain is usually just after eating, but sometimes drinking will cause pain too.  The pain is severe enough that they are miserable, crying, and writhing on the beds in pain.  Their abdomens start to swell and they have both diarrhea and vomiting, usually bloody or black. 

Early antibiotics are the key to treatment, but too often the kids don’t come in until they have been sick for 3-5 days.  We give them IVFs, antibiotics, put a tube in their nose to empty out what is in their stomach, get labs and xrays and we pray.  We watch them daily to see how they are or aren’t responding and Jim makes the tough decision of when and if they need surgery.  Occasionally, they get better without surgery, but often they need surgery, which brings no guarantee that they will survive. 

In the past 6 weeks, this disease, which for years had disappeared when the government was supplying the vaccine, has seemed to come back with a vengeance.  There have been at least 10 kids that I have known of who have had pigbel.  Some had extensive small bowel resections in surgery and survived, one child died in the ER before we could do anything but start an IV and give one dose of antibiotics, children have died in surgery and just after surgery – their bodies so sick from the toxins that even when we try and take out the diseased portion of bowel, it isn’t enough, but some have made it even without surgery.  

Pigbel is a killing off too many of our little kids, yet to stop it we need to change the only culture they have known their whole lives.  Pray for wisdom for all of us to know where to go from here.  Pray for Jim to know when and if to do surgery on these kids.  Pray for those working on educating the public about this and steps they can take to decrease the chance their kid may get pigbel.  Pray that the government make look into supplying the vaccine once again. 

Time in Surgery

The past few weeks, I have had the opportunity to work in surgery with Jim and Scott Pringle, a volunteer, OB/Gyn who is here for his 2^nd 3 month stint.  I have always enjoyed surgery, especially after my time in Ghana, Africa as a student and resident, where I worked in a mission hospital and where the surgeons there let me do so much.  I am thankful  I get to do C/Sections here regularly, but I do enjoy being in there for other things also.  Usually, I am needed in clinic to help see all our outpts everyday, so it isn’t feasible for me to spend time in the OT much, but we currently have some extra help and so I am able to do some more surgery. 

It has been great to work with both Jim and Scott and to learn from them and to have them teach me how to do various surgeries.  There are times when Jim isn’t around and we have to send all of our surgical cases to Mt. Hagen, an hour by ambulance to have them seen.  I know I will never be able to do everything that Jim does, but maybe I could learn enough to become proficient at somethings, like ruptured ectopics which would help folks out, we shall see.  

Young Adult Fellowship

For the past 3 months we have had a young adult get together of one sort or the other, usually involving playing games and eating.  This month we had a Mexican Potluck and enjoyed some games we could play mostly in the dark since the power was out a lot.  We had a good time and enjoy having all the new volunteers join us when we get together, this time we had Jennifer, an Image resident, and Andy and Amanda Peters (med student and his wife).  

People waiting to be seen

Our hospital served over 45,000 people last year, they come from all over PNG to be seen and cared for, but most come from right around our area.    These are some recent pics of a few people waiting to be seen in our OPD area.  The 3 ladies were all excited when I shared some pineapples with them.  The little boy on the R was being looked after by his slightly older sibling as they were hanging out by Xray.  It is a privilege to be able to be here serving them and many others who come.

"Dokta, can I have some chocolate please?"

I got called by Jennifer, the resident I was on call with, that there was a 8 yo kid in the ER who was crying, talking nonsense and was hard to control.  When I got here, I found a grandpa trying to prevent his grandson from falling off the bed.  His mom and grandpa told me that he had fine until the day before, when he got a fever, started talking nonsense and just started crying.  No matter what they did, he just kept crying and moving all around.

Jennifer and I examined him and then talked to his mom about having to do a lumbar puncture to make sure he didn’t have meningitis.  It was a difficult LP, with Bande moving all over the place, but Jennifer got it.  After we got it, I gave Bande antibiotics and then sedated him to try and keep him under control so he didn’t pull out his IV.  

The next day, he was just sleeping and he didn't talk to me, mom said he continued to cry when the shots wore off overnight.  We kept him on IV fluids and the antibiotics for an infection in his brain and prayed God would make him better.  The next day, mom reported that he had sat up and ate a little bit, but everytime I saw him, he was still sleeping.  

The 3rd day of admission, Bande was sleeping, or it seemed so, and I was talking to mom about how he was doing, when I hear this little voice coming from the bed.  "Dokta?"  "Dokta?"  I realized it was Bande talking to me, so I bend down so I am right in front of his face and say "Yes Bande."  Then this little cute voice says, "Dokta, can I have some chocolate please?"  I look at his mom, with a puzzled look on my face, "Chocolate?" I say, "Is he asking me for chocolate?"  She says, yes, with an embarassed look on her face.  A minute later, I hear "Dokta, can I have a biscuit (cookie)?"

I thought he was still too sick and sedated to know what was going on, but here is this little boy asking me for chocolate cookies.  I have never given chocolate cookies to any other kid, I don't know why he thought I would have them and why he asked for them, but since he did, I sure did give them to him.  I went home and got a package of Oreo's that I had gotten in town and took it back down to him.  He was asleep when I got back there, but I told his mom to share with the other kids when he woke up.  She said she would.  The next day, he was all smiles when I saw him, he apparently liked his chocolate cookies.  

A few days later, he was well enough to be sitting up.  He ended up with an infection of his brain that has currently weakened the left side of his body, but we managed to play catch the day before he went home.  We don't know how much residual weakness he might have, but will you pray with us that it will all resolve quickly.  

Lots of volunteers

We have been blessed to have a number of volunteers visit us recently and help out.  The Elerdings came back for their 3rd time, helping Jim with surgery and their son Joey, helped out with maintenance while he was here.  The Pringles are back for their 2^nd time, being great hosts to us all in the Barnabas house and providing OB coverage.  We have had 2 medical students – Josh and Andy and their wives, a FP resident from Image – Jennifer, and an IM doc and his wife, the Crawfords, from California.  Volunteers are a blessing in many ways to us, helping provide coverage when we are short of folks, bringing a specialty with them which allows us to care for a wider range of folks, the bring stuff to us from the US, they give us an opportunity to teach, and become great friends in the years to come.  Thanks to all who have served with us and who will be serving with us soon, you are a blessing to each of us. 

Nelson and his "Merry Men"

Nelson only weighs about 1 lb and he is 1 month old.  His mom adopted him and he hasn’t gained weight with formula, so he came into the hospital so we could bulk him up some.   On admission, I had written for mom to get a supply of medicines that would hopefully help her be able to produce breastmilk so she could breastfeed Nelson instead of relying on the bottle.  When I saw him the next day, mom hadn’t gotten the medicines yet, she didn’t want to leave Nelson alone.  So after much prodding she went, but only because I picked up Nelson and said I would watch him while she was gone.  He is small, but cute. 

So Nelson and I made the rounds on the ward, visiting the other kids and talking to them.  Nelson didn’t do much talking, but he did look at the other kids and the older kids enjoyed having him come and visit.  The other moms thought it was funny that I was having Nelson meet his neighbors or the other Merry Men.  There was Gideon (with his homemade bow and arrow, slingshot and fish hook) who is Robin Hood, little John, Maid Mirriam “aka Serah” and many more. 

I have enjoyed my time on A ward, playing with the kids and interacting with them.  It is great to see the worry leave mom’s face when she knows her baby is going to be ok.  Thankfully, most kids heal up pretty quick and so go home after only a short stay with us.