Unusual delivery

Still on call for the weekend. Josh and I had a lady come in at 27wks pregnant with vaginal bleeding. One of the concerns is placenta previa, but the ultrasound showed the placenta to be up in the fundus. She was stable, so we initially just monitored her and the baby. A few hours later a call came that she was bleeding a lot more, and the baby's heartrate had dropped. I was at the Radcliffe's and so I discussed the situation with Jim prior to heading over. We found a stable mom with good blood pressure and pulse, and the FHTs were actually 120s. So our plan was conservative management. Jim called over, as he often does to check on things, so he recommended a pelvic exam to just see what we were dealing with down below. So I do this and find what I think is the placenta coming out, with mom wanting to push. So then I started to think I was wrong on the US, and she did have a previa and now it is coming out and I am praying she won't bleed to death before we could section her. I left the room quickly to rediscuss with Jim and the nurse calls out that the baby came out. As I walked behind the curtain I found the baby had come out head first, still wrapped in it's membranes with the placenta all as one. Mom had stopped bleeding at this point. We ruptured the membranes, and started working on our premature baby. He started breathing on his own, we transferred him to the nursery and got him warm and gave oxygen and prayed over him and then with mom that all would be well. Mom, Janet, was very thankful and was praising God as we prayed with her. He is very small, so we will just trust the Lord with his life.

1st breech delivery

I was on call this weekend with Josh Adams, a 4th year medical student. He calls me at midnight saying there was a lady who had delivered a twin at a health care center and now is here because the 2nd twin didn't come. He said, "I am not really sure what to do," so I said "I will meet you there." So we go and see her, and find a mom fully dilated with a buldging bag of fluid and feel an extremity just inside it. I knew we had 2 options - either Csection or try and rupture her and stick my hand in and grab the legs and deliver the baby breech. Josh and I were talking about our options. All I could think of was a time in residency when a resident delivered a breech baby and then told us the qualifications for delivering a breech baby, which included having experience in doing this. I knew I had no experience in vaginal breech deliveries, but I had delivered breech babies in CSections. I had also never delivered a twin, nor a 2nd twin that I had to pull out breech. Thankfully, I had talked about this exact situation with Bill previously, so I felt like I knew what I was suppose to do even though I hadn't seen it or done it before. So I ruptured her, found 2 feet, and pulled the legs out and then delivered the baby breech. The baby was blue when he came out, and only about 1500gms. He wasn't breathing, so we had to resuscitate it, and thankfully he started crying and breathing on his own.

Josh was asking me about surfactant and what we do for this very small baby. I told him we needed to consult an experienced OB for the breech and now need a neonatology consult for this baby. Unfortunately, we don't have either of those here, we are them. That is one of the great things about mission work - you get to do it all. Pray for these twins - babies of Esther.

McCoys heading home on furlough

One neat thing about believers is that the love of Christ binds people together in a way that allows for folks to become family when you are far away from family. This has been true in my life when I was in residency with the Leiberts, and now in PNG with the McCoys, who live next door. Bill and Marsha have been a great source of encouragement, the answerers of many of my questions, the teachers of cooking and medicine, a bike riding friend, and more. Today they left to return to the States for their 4 month furlough. They will spend 3 months of this time traveling around the US to different Nazarene churches sharing stories of what God has done in and through their lives. They will also be spending time with their family while back home, you can pray for them while they are away.


Before folks leave on furlough, the other missionaries invite them over for dinner so they don't have to worry about cooking while they are packing and getting things ready to leave. So I had them over for dinner last night. I was somewhat nervous about this dinner. At a recent dinner with the McCoys and some others, Bill mentioned how living with Marsha has made him somewhat picky. He really appreciates and enjoys Marsha's good cooking, and looks forward to it. This is not what one who doesn't cook wants to hear prior to cooking for them. I figured if I made a recipe of Marsha's and asked lots of questions to make sure I got it right, it shouldn't be too bad. So we had sweet and sour chicken, rice and zucchini cake. It seemed to turn out alright, they ate it.


As a result of the McCoys leaving, I have inherited added responsibilities. I get to water their plants and feed Buster. They didn't ask if I was any good with plants, just if I would water them. I will attempt to not kill them while they are gone, but I can't promise anything. I haven't been real successful with plants before, but we shall see. I also get to feed Buster. Buster is their cat, which a previous missionary had left with them. He sleeps a lot and is a picky eater. Thankfully, unlike the silent plants, he will whine and purr if I don't feed him, so I don't think I will forget him. I also get to tend to Bill's garden - but more on that later.


With the McCoys leaving today, I have been doing a lot of praying. Goodbyes are never easy, but I am thankful that the Lord never leaves us, when all else around us changes, He is a constant. Matt 28:20 "And surely I am with you always, to the very end of the age." Romans 8:38-39 "For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the Love of God that is in Christ Jesus our Lord."

Recent Postpartum Complications

Lydia came to us about 1 week after delivering her baby at home. She came in unable to walk, with severe weakness of her legs. and only able to move her arms a little. Lydia was suffering from Guillain Barre Syndrome. This is an ascending paralysis that often starts in the legs and works it way up the body. If severe enough it can involve the muscles used for breathing, and require temporary intubation. Thankfully Lydia's respirations never were compromised. She stayed with us for about 2 months.

When Patty came to us in mid February and wondered if there were any patients that she could work with as a Physical Therapist, I told her about Lydia. After some work, Patty was able to help Lydia regain some of the strength she had lost. She was able to walk with a walker and transfer by herself. She was having difficulty with fine motor skills, but at the time of discharge had improved immensely in this area. She also was walking without a walker. What a blessing for Lydia to be able to recover almost completely from this illness which could have taken her life, and to be able to care for her new baby.

Cathy came in while I was on call with Ben, a medical student. The report was she had delivered at home, but was complaining of SOB, and had some neck and facial swelling right after delivery.

We found her somewhat uncooperative with many family members all around her. Given the frequency of domestic violence here, we started asking questions if she had been beaten or something, but the family denied it. Initially on exam, it seemed like the pt was overreacting. She was saturating 98% on room air, had equal breath sounds, but seemed to be in pain. The nurses were talking about her facial swelling, so I put my hand on her face and neck felt some crackling. At this point we got a stat portable CXR to confirm our presumed diagnosis of subcutaneous emphysema. The CXR did show air above both lungs and into her neck.


So she ruptured something inside her respiratory system to allow air to leak out into her soft tissue (face, neck, shoulder area). No pneumothorax (collapsed lung) was initially seen. I reassured the family that she would be alright, but it would take sometime. I presume she developed this while delivering her baby. The father (I presume) was suggesting some sort of evil spirit caused this to happen, I assured him no evil spirit was involved. This didn't stop the family from asking a village guy to come in that night and check her out himself. He too concluded that air was leaking into her body somehow. We have been following her CXR to make sure no pneumo developed, and today she had a pneumopericardium (air around her heart), which was interesting to see. Thankfully she is doing well, sitting up in bed, no longer complaining of severe pain or SOB. She will probably go home soon, however her baby was a bit premature, so she will stay with us a little longer in order to get her weight up before going home.

He is Risen

He is Risen. What a glorious day to celebrate the Resurrection of our Saviour, Jesus Christ. On Good Friday, Jesus willingly gave His life and died on the cross, taking the punishment for our sins upon Him. He was buried, but 3 days later - Easter Sunday, He Arose, death was defeated. Now, for those who believe, we have the hope of eternal life. This Easter was special because I have been thinking and praying a lot for my grandma. My grandma is dying of leukemia and is spending Easter in the hospital. This past year, she came to understand what Easter is all about in a new way, as the Lord saved her. So even though I probably won't see my grandma in person on this earth again, I know I will see her in heaven, and can rejoice in that. Bill recently shared with me a sermon "But Sunday is a Coming." Good Friday was very dark with the pain and the agony that Jesus faced, however on Sunday there was hope and joy when He arose. How comforting this has been to know and realize that through the dark times of my grandma's illness, there is a day coming when we will rejoice.

The morning started with a sunrise service at the Radcliffe porch. I wasn't sure how we would all fit, but we managed pretty well and had almost the whole missionary family of Kudjip in attendance. We sang a few songs, shared a few testimonies, and enjoyed some breakfast.

Following this, I then went with the Myers Family, Kristen (school teacher), Cassie (school teacher), Becky (missionary), Pam (xray tech), and Josh and Sara (med student and wife) to Kumi church where Jeff preached. We had a fun drive out to church as we enjoyed the beautiful scenery and the many bumps along the road. We then had to walk across a very sturdy bridge in order to walk up the hill to our church. Kumi church is a preaching point of Tuning Church (about 15 minute car ride away). We all squeezed into a small building that was nicely decorated with lots of flowers and vegetables that the church people had brought. Susan played a special song on her flute, and Jeff preached. He preached on Peter how he denied Christ, yet was restored, and knowing the hope that God too forgives us. The church then gave us the vegetables that were decorating the church and we headed home.


Following church we headed back to the Myers where we enjoyed our Easter meal. We had ham, pumpkin, rice (instead of potatoes for someone who doesn't eat potatoes), green beans, salad, jello, crescent rolls, and cabbage. For dessert we had oreo dessert. So it was quite a meal, and I got to enjoy a nap once I got home.

Praying for Water

Each house has 1 or 2 water tanks that hold between 2000 - 3000 gallons of water in each. We rely on the rain to fill these tanks for our daily needs of drinking water, water for the shower and toilet, water to wash dishes, and anything else that comes up. We are suppose to be in the wet season - but someone forgot to tell God this. We have had quite a dry spurt for the past 2-3 weeks. We get an occasional rain, but not enough. As a result, the 2 water tanks that I share with the McCoys are about empty (total of 5000 gallons). Today I was noticing that the water pressure was quite low, so I called next door. Through further investigation, the McCoys discovered our tanks are about dry. Thankfully, Bill was able to divert some well water into them, but this won't last long. So we are now praying for rain, and ask that you would do the same as we try and store up some water for our use.

Becky to come to PNG

Becky Wallace, my former roommate, who is currently a 3rd year Family Practice Resident at the Valley Baptist Family Practice Residency Program, will be joining the Kudjip team in the Fall of 08 to start her 2 year Post Residency Program. Becky was accepted by World Medical Mission to be a part of their Post Residency Program, just like I was. (link on side) She had been praying about where to go, had looked into some options, but hadn't felt like any fit her. She volunteered here in November, and really enjoyed it, and Praise God the Lord opened the door for her to come back. You can pray for her as she (1) starts her preparations - obtaining a visa, getting necessary items to live and work here, learns Pidgin, (2) as she says goodbye to her very close family in Oregon, and (3) as she finishes her residency that she would finish strong and learn all she can while there.

A prayer and A praise

Susan was admitted in January with congenital heart disease, preg at 24 wks, and elev bp. Her BP when she came in was >200/100. I have cared for her for these past 8 wks, working on getting her BP down, and doing what we could to help the baby. We got the BP down, but the baby quit growing and had IUGR. So yesterday, Dr. Jim and I did a CSection on her in the hopes that the baby might do better on the outside. She had a girl who weighs just 1200 grams. Please be praying for her in the days, weeks, months ahead that the Lord might continue to sustain her and to help her grow.

We had a huge praise this week in the maternity ward. Nato came to us about 2 weeks ago (or more) and delivered a baby, but sustained a deep laceration in the process. Her laceration was repaired, but she lost a lot of blood in the process and went into shock and acute renal failure as a result. Andy was caring for her at that time and despite doing everything he knew, her creatinine (Cr, a blood test for kidneys) kept going up and up - to 15. We don't really have the capability to do dialysis here, although it has been tried in the past, so we didn't have much to offer her medically. We could only wait and hope and pray that the Lord would see her through. When I took over B ward her Cr was still 15, but it has been going down to 12, 9, 6, and yesterday 4.4. Praise God - what a recovery. This has nothing to do with our medical care and everything to do with the Lord's work in her life. Yesterday, I tried to explain how close she was to dying and how thankful I was to see her and her baby and to know that God has done this work. I am not sure if she caught it all, but it was great to pray with her and thank the Lord for His hand upon her.

HAPPY 1ST BIRTHDAY LUKELUKE

1 year ago Luke Allen Nash was born to my twin sister and her husband, Megan and Joe Nash. I enjoyed spending the 1st 6 months of his life with him and his parents. I changed him, held him, fed him, dressed him up, played with him, read to him, bought him things, and did everything else aunts do. As I was learning the Pidgin language, I noticed a lot of words were repeated - kaikai (food), kaukau (sweet potatoe), liklik (little), sipsip (sheep) and much more. As a result I started to call Luke, LukeLuke. I sure miss seeing him in person as he grows. He is walking now, and starting to do some sign language for milk and more. He is also saying a few words, I am still waiting for E or Aunt E or some variation to come out. I enjoy getting to see him through the webcam on the computer when I talk with my sister. She usually talks to me, but puts the camera on him so I can watch him play his drum (taking after his father), or throw the balls, or chase the animals. It is such a joy to see him. I continue to pray that God will watch over him and his parents, and save him at an early age. Numbers 6:24-26 "The Lord bless you and keep you; the Lord make his face shine upon you and be gracious to you; The Lord turn his face toward you and give you peace." I love you LukeLuke, wish I was there.

Return to B ward

Recently, Bill mentioned that maybe I should go back to B (maternity) ward to help me gain more confidence in that area. My first reaction was no. I felt that I was okay because I had gained experience on call, and was actually feeling pretty comfortable with things on B ward. Being able to do CSections on my own has certainly helped. If I make a decision that a pt needs to go to CS, I no longer have to worry about what my colleague will think when they come in to help me, I just do it. So right or wrong I stick to what I have decided and do it, which has been good. But if I was going to go back to B ward, I would prefer to do it when Bill was here to field my questions. So after Bill talked to Andy this am and he agreed to swap wards with me, I found myself back on B ward.

Today was a reminder why doing more of B ward is a good thing. Over the weekend, we had a pt (Annah) who came in with a retained placenta. A volunteer attempted to manually remove it, but couldn't get a plane, so he started a D&C. After a while he stopped, but knew there was more to get, that she likely had a placenta accreta. So we stabilized mom with IVFs and blood, and reassessed today. She was still bleeding some today, but her BP was more stable and her Hgb was 9. So when she had more blood ready, Bill and I proceeded with a D&C this afternoon. I got out a lot of tissue, but still felt like there was more. After a while, we stopped and got her some more blood and went back to OPD. After OPD, I went to check on her and found her bleeding again with lots of clots in her vagina and uterus. So after giving her some more meds to help her uterus contract, I retalked with Bill. Although I hadn't really asked him to help initially, but he thought I had, I was sure glad he was there. He agreed there was too much bleeding. We had talked earlier that this pt may need a hysterectomy due to the placenta accreta, so he went to retalk to Jim about her. By this point her bleeding had slowed a bit, but her Hgb was 6 - a little lower than we would have liked. So she is currently getting more blood and we are stabilizing her for a possible hysterectomy or repeat D&C in the morning.

This was a good reminder for me of how precious life is and how quickly it can be taken away. Psalm 103:15-17 "As for man, his days are like grass, he flourishes like a flower of the field; the wind blows over it and it is gone, and its place remembers it no more. But from everlasting to everlasting the Lord's love is with those who fear him, and his righteousness with their children's children." Pregnancy is one of the happiest times as God brings new life into the world. However, caring for these pts isn't always that simple. I often have thought that OB was one of the scariest things because you have 2 lives that you are responsible for. Usually 2 healthy lives that no one expects something bad to happen to, but at times bad things do happen that aren't always expected. Keep praying for the patients (especially Annah above), and for God to give me wisdom as I care for these moms and babies.

ChopChops

I am on call this weekend as a backup for a volunteer from Minnesota who is here for 2 months. He just called me about a Chopchop. The 1st wife had gotten upset at her for some reason and chopped her in the head with a machete, and then managed to completely chop off her L hand at the wrist. The ER staff and the FP were able to get a good dressing on her arm, and sewed up the scalp laceration. We stabilized her with IVFs and now will be transporting her to Mt. Hagen for definitive care, since this afternoon we don't have a surgeon. Each month we have English Lotu (church), well today it is being held at the Bible College which is about 20 minutes away, so the FP and I are holding down the fort while everyone else is at the Bible College. Unfortunately, this isn't the first time I have seen a chopchop.

Bush knives - machetes, are all too common here. You can see a small little child using a knife like it is a normal child's toy. Unforunately, using the bush knife to cut someone else is also normal. Almost everyday we see someone at the hospital who has been suffered a chopchop. Sometimes these are even self inflicted, and other times are done by others. After fighting with their husbands, women will often chop off their fingers. The lady on the R did just this. She is a Christian, but she was upset at her husband and chopped her fingers, not once, but 3 times. I am not sure how this helps, in my mind it only serves to require further amputation at the hospital and much pain, however many women do it. Thankfully when they come in we have the opportunity to share Jesus with them and pray with them.

Often the chopchops are a result of someone else. Someone may steal something, or injure someone in some way, so the family or lain of the injured person will go back to seek retaliation. One guy (on L) came in with an injury that went into his shoulder, buttocks, and calf. Dr. Jim worked hard to help him and praise God he went home. I pray that we might be able to help them understand God's love for them and the love they should have for each other. Christians are just as likely to be involved in these fights as nonchristians. The Bible tells us not to get revenge. 1 Thessalonians 5:15 - "Make sure nobody pays back wrong for wrong, but always try and be kind to each other and to everyone else." Romans 12:19 "Do not take revenge, my friends, but leave room for God's wrath, for it is written: ' It is mine to avenge; I will repay,' says the Lord." Pray that the PNGers would leave behind the traditions of the past and live in peace and learn to love each other.