Day in the life of this PNG doctor

I thought you might be interested in what a day is like here at Nazarene Hospital in Kudjip. Warning - this does contain some medical content and pictures, and it does not represent everyday, but here is what happened today.

I was on call last night, but thankfully slept until 0445. I got a call from Labor Ward of a mom who was 7cm dilated, but the baby's face was presenting, not the head like normal. I have never seen this, but I didn't think I wanted to try and deliver it vaginally. My call buddy (Megan) wasn't coming through with an answer, so I told them to get her ready for CS. I quickly got on the computer to look up more information about this. I found out at times it can be delivered vaginally depending what way the face is pointed. So I quickly showered and went down, checked and determined she needed to go to section. So around 0545 I started the section, which went pretty well and Elis now has a new baby girl. Praise God. I had time to come home, shower again, read my Bible, and eat some breakfast before starting my day rounding.

I met Dr. Bill and we did some Xray rounds on our C ward pts. We talked about some of the patients and plans for them, then we went to work. I have about 12-13 pts to see each am. I just go down the row of beds and see each patient. Today was a "top rounds" day, so I only needed to see those recently admited, those with new complaints, on O2 or with an IV. One of my patients - Manmul, is a lady of about 60 or so, who I just diagnosed last week with CML - chronic leukemia. Dr. Dave Oviatt had looked at the blood smear to confirm this diagnosis. I had started her on some chemo, but after 1 wk she came back not any better, in pain, and not eating. So I consulted Dr. Bill this am - the closest we have to an oncologist. We talked about starting her on a different chemo regimen since we hadn't seen a response in 1 week and she was feeling pretty bad. So he told me what to do and I prepared and gave her Doxorubicin. She will get this for the next 2 days, and then we will see what happens. Pray that her leukemia improves.

After I finished all the ward patients, I went to clinic. My first pt was a f/u for GERD - very common here. The next pt - Luther, came in with a scarf over his face. Often pts will put something over their face if there is something they want to hide or conseal. I looked through his scalebook (chart) and found that he had been diagnsosed with mouth cancer at another hospital and was sent to us to see if we could give him Methotrexate (a chemo med). So I asked to look at his face and found a 3x3cm growth on his R cheek, but the inside was ulcerated. So once again I consulted the oncologist on call - Dr. Bill, who came to give his expert opinion. As we talked, we agreed that the outside looked like a keratoacanthoma (a kind of SCC), but the inside suggested invasive squamous cell cancer. So after consulting our PNG management of malignant disease book we decided to give him Vincristine, Hydrocortisone, and Methotrexate. This was only part of what was suggested, but it was all we had available. I talked to Luther about trying to decrease the size of his tumor with the meds so that he might be able to see a surgeon who can try and remove the tumor. Luther agreed. So I drew up the meds and proceeded to give them to him. Pray for Luther that his tumor would reduce in size and he might be able to have surgery to remove it once it is smaller.

Just as I was finishing giving the meds to Luther, a group of people walked into the ER carrying a bamboo stretcher. On top was a young lady face down. They proceeded to put her on a bed and she was covered in blood. I quickly finished with Luther and attended to her. She had been stabbed by her husband's second wife. She had a wound on her back, R breast, abdomen. Her omentum was actually extruding from her abdominal wound. I quickly explored the back and the breast with my finger just as Dr. Jim walked in. He quickly did his consult and we prepared her for surgery. 2 donors to lab to give blood, IVs started, foley inserted, medicines given, fees to pay - especially the fight fee, sew up the back wound, and off she went. Pray for Sina as she recovers and for reconcilation between her and her husband and his other wife.

After this excitement in the ER, I went back to clinic to see some pts before lunch at 12. I saw a few f/u pts - for HTN, GERD, OA. It was close to time for lunch - and my afternoon off, but we still had time for another patient. So Wapi comes in. He is an elderly man who is here to get his indwelling foley replaced, but also had some vague complaints. As we were talking I found out that he had 8 wives. This is unfortunately quite common. I asked him why and he said that is a custom of his generation. He said he now has only 2 wives, and 2 kids between them. He got rid of the others because they didn't listen to him. Through all this we got to share the gospel. He thought that since he got rid of his 6 wives and was trying to do good things, he would go to heaven. My student (Swata) and I got to share about Jesus and his birth and what Christmas is about, and how He died for our sins at Easter. Pray that God would use this conversation to help him truly understand the gospel.

After Wapi, I returned to my house for lunch - tunafish, and then proceeded to have PE class with the MKs. They wanted to play a game so we played some 3-3, after I taught them some basic defensive concepts, and a pick and roll. They did pretty good and seemed to have fun. After playing, I made some calls to check on some meds we needed in pharmacy. Then I delivered some Christmas presents to the other missionaries and visited with them. Now I will have dinner, go to prayer meeting, read some, and then go to bed. Such is the life of this PNG doctor.