Friday, October 6, 2017

See one, Do one, Teach one

See one, Do one, Teach one is a common practice in teaching of medicine.  Often there are quite a few seeings and doings before the teaching happens, but the general point is we have to pass on our knowledge of medicine to those who are learning to become a doctor.  At Nazarene Hospital, we have been doing that for years and now are looking to do it even more by being more involved in training of PNGian doctors and medical students.

Since 2008, PNG has been training doctors in a Rural and Remote Registry Program.  We have been involved in this in various degrees through having our own Registrar (Imelda) to helping train other Registrars for 3 months at a time in Surgery.  Since 2008, we have been involved in training 12 Registrars and we hope to train more in the years ahead.  Imelda is finishing her 6 years of training with us at the end of December, and although we don't yet know what the future holds for her, we are thankful the for the time we have had with her and her with us, learning from each other, and watching her grow as a PNG doctor. We know that whether she stays with us or goes elsewhere in PNG, she is ready to serve as a Minister of Christ in medicine to the people she cares for.

As Mel is finishing, we are wanting to continue training and are looking for another Registrar to join us.  Vuia is interested in the program and is with us for a few months seeing if we/he are a good fit together.  During this trial period, he is not only learning from the missionaries, but from our PNG doctors too.  Here he is doing a C-Section with Rebecca, who is here for 3 months doing her surgery rotation.  This is her 2nd 3 month rotation with us and she is able to do C-Sections without help and so had the opportunity to walk Vuia through doing one.

We are supposed to have our first batch of PNG medical students rotating with us the end of October and look forward to the chance to impact medical students as well as doctors.

Saturday, September 30, 2017

From death comes life

To some death represents the end.  The end of a life, the end of a relationship, the end of the person on this ground, and while that is true, to a believer in Christ, death is also the beginning.  It is the beginning of a new life in heaven with the Lord and the saints who have gone before.

One week ago, the earth and it's inhabitants, cried as they said goodbye to Sr. Regina Kintak, while heaven rejoiced and cried "Well Done", as they said hello.  Sr. Regina worked at NHM for over 30 years as a nurse, midwife, supervisor and as the Deputy Director of Nursing.  Her husband, White, is the principal of Nazarene College of Nursing and is still a big part of Nazarene Health Ministries.  Together, outside of their kids, they have influenced the lives of many students, nurses and people in the community through their lives of service to the Lord.

As people shared at her funeral, the theme that was repeated over and over again, was how she had a mission heart and was always working in a way to serve the Lord.  Today her body was buried in the ground and the pastor had a service for those of us who are still living.  He urged us to make a decision today, who we are serving, if it is the Lord like Regina, or ourselves, as we never know when our time with come.  This message resonated with many in the crowd and 7 people came forth to pray to receive Christ.  One man sharing a testimony of how he had said he was a believer, but how he never lived like one, and now he knows he needs to change with God's help.

I know the 7 people who went forward today, who received new life in Christ, are only the tip of the iceberg, of the many who have been been introduced to God's love through Regina and White and their service to Him on this ground.  Her life serves as an example to many, of how to live well as a follower of Christ.

Thursday, September 21, 2017

Reaching for Hope

As she walked, heads turned, noses discreetly covered, and people moved to the opposite side of the road, seats around her on the PMV remained open, no one wanted to be near her, even her family.  The small lump that she found in her breast, had grown and grown and grown and now was a large fungating mass producing a smelly discharge that no one could ignore.  The smell went before her, stayed with her, and remained for minutes after she left. The smell, the mass was so bad that she was desperate for help.

The doctors near her home were unable to help her, but the smell, stares, looks continued.  She became desperate for help, desperate for the smell to go away, desperate to not have people walk away from her, and desperate for healing.  She collected her savings, withstood the stares and traveled many hours equipped with a can of fragrance spray to try and hide the smell and came to Kudjip Nazarene Hospital for help.

As she waited to be seen, people moved away from her, reenforcing the desire she had to be healed.  When I called for the next patient, she painfully made her way into my exam room, hunched over so her meri blouse wouldn’t rub against the open sores on her chest.  When I asked what was wrong, she asked, no, pleaded for help.  She asked for us to be able to remove the mass on her chest, but as I examined her I found that the mass was too big and too advanced for surgery.  I knew that even if we could remove the mass, to help reduce the smell, the odor, the discharge, that we could never close the wound.

As I looked at her, I thought of the hemorrhaging woman in Mark, and thought the women in front of me could be the woman in the story of Mark 5:25-28, “A woman who had had a hemorrhage for twelve years, and had endured much at the hands of many physicians, and had spent all that hse had and was not helped at all, but rather had grown worse – after hearing about Jesus, she came up in the crowd behind Him and touched His cloak. For she thought, “If I just touch His garment, I will get well.”

The women in Mark, thought that if she could just touch Jesus’s garment, she would get well.  The women in my room thought that if she could just reach out, if she could save her money and make her way to Kudjip, she would get well, and yet I was telling her otherwise.  Tears started rolling down her cheeks as she looked at me, telling me how she thought we were going to help her, and now we are doing nothing.  I don’t often think of examining a patient and giving my medical expertise as nothing, but I do realize that by not doing surgery, and removing the mass and the smell, we were very far from reaching her expectations. 

As she was crying in front of me, I tried to comfort her and help her see that getting well might look different than what she had thought.  I prayed for her and had our chaplain to come and talk with her more.  When I saw her waiting for a dressing to be placed, I can’t say I saw a peace, or an understanding, I still saw the tears, and the disappointment on her face.  I wish there was more that I could do, but often times I do all I can and have to trust that God will take care of the rest.  Pray for her to find that peace, to find the understanding before it is too late.  

Saturday, September 16, 2017

10 years at Kudjip

When I boarded a plane in Texas, 10 years ago to travel to Papua New Guinea and work at Kudjip, I thought I would be gone for 2 years.  Shortly after arriving in PNG, I knew God was calling me into full-time missions, and so after my 2 years with the Post Residency Program ended, I stayed for a 3rd year as a volunteer in order to determine if Papua New Guinea was the place God had me to serve long term.  Within 6 months of that 3rd year, I knew PNG was where God had called and continued to call me, and so I joined the Angus Church of the Nazarene in New Mexico on Easter Sunday in 2010 and my journey as a Nazarene Missionary has continued ever since.

Sept 16th, 2007 was the day I arrived in Papua New Guinea.  It is hard to believe it has been so long, and yet in other ways, I remember arriving like it was yesterday.  Remembering staying overnight in Port Moresby unexpectedly, remembering my first market experience right outside the airport in Mt. Hagen, the big welcoming party, my first of many meals with my new neighbors (McCoys), my hospital tour, and so much more.  I remember my first week rounding on our Surgical Ward while Dr. Jim was away, and the patients and staff all laughing at my attempts to speak Tok Pisin.  I remember my language tutor Samsali and her kids who helped me to learn Pidgin in my first weeks here.  I remember working with Bill on our Medical Ward and bombarding him with questions.  I remember trying to talk and pray with patients in Pidgin, as I was first learning it.  I remember my first few weeks/months in OPD and trying to rotate which doctor I would ask a question too, so it didn't appear to one doctor that I was as clueless as I felt in caring for the tropical diseases I was seeing in PNG.  I remember doing some of my first C-Sections with the help of other missionaries and transitioning from needing help to doing them on my own.  My first introduction to Settlers, to Rock Slides, to Bush Churches, gardens and so much more.  Despite being far from home, the welcoming nature of the PNGians and the missionaries, allowed me to quickly settle in and soon PNG became home.

Thankfully, some of my early memories are still happening today, not a lot changes here - patients still laugh at me and my Pidgin, Bill still answers all my questions, I still eat meals with the McCoys or other missionaries, I get to share Jesus and pray with patients, I get to care for patients with a variety of diseases, at times feeling like a seasoned missionary and at other times I feel like an outsider, trying to understand the PNG culture, why orders don't happen, why violence and abuse keeps happening and much more.  10 years from now, I fear I may still be wondering about some of the cultural things I don't currently understand.

10 years is a long time to be anywhere and for most of us, we ask ourselves - if it has been worth it.    I don't know for sure how many patients I have seen, but this is the best estimation of those I have seen in the past 10 years.  
- over 100,000 Outpatients cared for
- over 30,000 Inpatients cared for
- over 500 Nights on call (although it seems like a lot more)
- over 250 C-sections
- Tens of Thousands of patients learning more about Jesus and being prayed for and with.  

As a missionary, numbers of patients is one thing, but lives touched and changed by God's love is another, and one not easily counted, but I trust God knows.  Yet, even if the numbers were only a quarter or half of what I estimated, it would still be worth it.  I know Kudjip is where God called me to 11 years ago, and is the place He is still calling me to serve today.   I really can't imagine anywhere else I would rather be serving today, and hope that I can continue to serve as He has called for as long as He calls.

I also know I couldn't be here without the prayers and support of many people/churches back home, who make this possible.  THANK YOU to all of you who Pray and Support me and make it possible for me to be here and continue to be here.  If anyone would like to learn more about that - you can go to this website or email me with questions.

Monday, September 11, 2017

Happy Ending

Kids in PNG seem to get Meningitis easily.  I am not sure if this is due to a lack of vaccinations or just the overall amount of bacterial load that seems to be in PNG, but it is pretty common to have at least 1 if not 2 or more kids being treated for meningitis at any one time on the Pediatric ward.  The signs are symptoms of Meningitis are taught early on in medical school, because you don't want to miss meningitis.  Meningitis, if untreated, or treated too late, or even sometimes when treated correctly and on time - can be deadly, or can result in permanent brain damage, so you don't want to miss it.  As a doctor, you learn to pick up the clues that a kid might have meningitis - the history of a fever with irritability, the inconsolable cry, the bulging fontanelle, and a stiff neck are all signs and symptoms of meningitis.

The diagnosis, outside of clinical suspicion, requires a lumbar puncture.  Putting a small needle into the spine, to collect some of the cerebrospinal fluid that runs in our spinal cord.  Clear fluid is a good sign, you will need the lab to confirm if they do or don't have meningitis, but if they do have it, you probably got it early and they should be okay.   Cloudy fluid is bad - it means they  have meningitis, even without a lab telling you such, they need antibiotics and admitted, and their overall prognosis you hope will be good.  Pus in the fluid is the worst - this means they definitely have meningitis and not just a little infection of the meninges, but a big infection - one that has replaced the cerebrospinal fluid with pus instead.  This usually means a very bad prognosis, mostly because you found out late in the game and the pus has already started affecting the brain - the organ that helps us walk, talk, coordinates our thinking and much much more.

Thankfully for this little guy, Azariah, the pus coming out of the needle, was no match for the IV antibiotics that he received.  Seemingly, the pus caused no lasting effect on his brain, as evidenced by his huge smile that greeted me each day.  I am thankful that not everything goes as my experience would otherwise predict.  Pray for the other kids on the ward with meningitis who aren't all faring as well as he did.

Wednesday, September 6, 2017


Life in the village is usually quite peaceful in the Highlands of PNG.  The women get up and go out to the gardens to dig some kaukau and harvest some vegetables to feed their families.  They head to the market with their produce to get some money to get cooking oil, matches, diapers for their kids at the little store in the village.  Men dig barrets (ditches) in the gardens, look for work, repair/build houses.  Children run around with little clothing on, playing with their toy cars made out of bamboo, or playing a jack like game with rocks, or soccer with a makeshift ball.  Laughter and talking are easily heard. 
Most villages enjoy the peace when it comes, but everyone knows how quickly that can change.  One fight can change everything for everyone in the village.   One night a man got drunk and got into a fight, killing another man. The lain (family) of the first guy killed, wasn’t happy that this drunk guy killed their family member, so they sought retaliation.  The family of the drunk guy, had to fight back, to protect their family as well.  So now there are 2 large family groups fighting against each other, in a retaliatory eye for an eye like fight, which for over a year now continues.    
Fighting in PNG isn’t like the war movies that you see on TV.  It happens more in the bush (tree, wooded areas), in areas where you can hide, and try and not be seen by your enemy.  It can happen at night, when others are sleeping, keeping those involved in the fighting always on edge, with little sleep.  It can happen when you don’t expect it, like in the daytime as you go to the market to buy food for your family, but someone from the enemy lain, sees you and comes after you.  When you live close together, surviving in the midst of a fight is difficult. 

Out of necessity, some lains, abandon their homes, and flee to safety, as fights break out.  In an effort of preserving their family, they run away from their homes, from their gardens and food sources, from the life they have known.  They become refugees on the run.  While the fighting might endanger the life of the men of the family, fleeing can endanger the life of everyone. 

As they flee, they have to find ways to make new houses, leaving them exposed to the elements until they do.  Not having the time to make their typical “permanent” bush houses, they make quick ones, that don’t take as much time and can easily be abandoned if they need to run again.  Gardens are a bigger issue though.  Typically, PNGians live off of their gardens.  The gardens are their source of kaukau, beans, pineapple, etc.  It feeds the family, with some left over to sell at the market to get other essential items to live off of.  Without a home, without land, you have no garden.  So you scrounge for food, which can be a death sentence to the children and elderly among you. 

Just a few weeks ago, a mom brought her small child (little C.) to our hospital.  They had been living out in the bush, living far from a garden, making feeding the almost 2 year old, very difficult.  The girl began losing weight and eventually started developing swelling of her body from a lack of protein in her diet.  Finally, mom was able to bring her to the hospital, where we have slowly been refeeding her.  Her weight is going up, but she has a long way to go.  She doesn't really want to eat, so the tube going from her nose to her stomach, helps the life giving calories get inside  her starving body.  We treated her with antibiotics to fight off the infections that were threatening her life when she first came in, and now are working to maintain her weight, and keep her hemoglobin up as well.  I am thankful for the progress, but know there is a long way to go.

When I asked her mom where they would go when they left the hospital, the answer was back to the bush with her family.  Back to a place without a house, back to a place without food, without a garden, back to the place that almost killed her daughter.  I can't change their situation, but sure pray that it does change, so that this little girl's life won't continue to hang in the balance.   Would you pray with me for little C.

Tuesday, August 29, 2017

A Good Day

When people get home from work or school, someone often asks them, "How was your day."  The typical response is, "Good."  But what defines a "good" day vs a "bad" day?  Likely, one person's good day could be interpreted as bad by another person, it is very subjective.   For me, as a doctor when someone asks my how my day was, a "good" day could mean lots of things.  It could be that no one died that day, that I slept while on call, that I got to help someone, that I got to pray with someone, that I got to do a procedure, that I wasn't at the hospital all day when on call, or any combination of these.  I like that "good" days don't all look the same, especially as a missionary in Papua New Guinea, very few days look the same, but many of them are "good."  Today was one of them.

Today was the 1st day back after a 3 day weekend, typically a really busy clinic day.  We have seen up to 200 patients on days like this, which can be quite taxing with the sheer number of patients and the physical needs they present with.  Thankfully, there are 6 of us in clinic these days, so we share the load of patients better, giving us more time with the patients we see.

Just before lunch, I thought to myself, this has been a really good day.  For me today "good" was defined by really helping people who were sick.  There was a women who had missed her period for 3 months, she had become pregnant, but the baby didn't form inside the uterus, instead formed outside.  She had fainted at home and was rushed in, she had a ruptured ectopic pregnancy and a belly full of blood, had she waiting just a few hours more, it might have been too late.  There were two patients who had cancer of their mouths, while I couldn't help them with medicine to cure them, I was able to share with them about Jesus and pray with them.  There was a little girl who feel 3 days ago and had a swollen arm due to a fracture and we were able to help by straightening it out, and decreasing the pain she felt.  There was a 30ish yo man who had swelling of his mouth and couldn't swallow, he got admitted for IV antibiotics and may need surgery, but had he waited a bit longer he likely would have ended up intubated and having emergency surgery because he couldn't breathe.  There were kids with pneumonia, moms who were concerned about their child's diarrhea, daughter's concerned about their mom's cough, a women who fell and broke her ankle, who was so happy to get a nice walking boot to go home in and many more.

So today was a good day.  We definitely saved some people's life with our medical and surgical skills, we helped calm fears in some of our patients, we gave people hope with their diagnosis, we introduced people to Jesus and prayed with them.  Definitely a good day.