Happy Birthday

Today my sister and I turn 30, Happy Birthday Megan. I realized this evening that this is the only time I am older than her, at least for a few hours as the 30th comes to PNG sooner than in the US. I had a nice day, especially since it was my half day off. This afternoon I mowed the lawn and worked in the garden before playing tennis with Bill. This evening I had dinner with the McCoys and Becky and got to enjoy Marsha's very delicious chicken enchiladas. Part of the condition of Becky's invite was she could only eat 1 enchilada so I would have more leftovers, she ate 2, but we let her stay anyway. After dinner, we resumed our Mah Jong playing which we had started last Nov when Becky was here. Becky and I were a bit rusty, but we enjoyed lots of laughs as we played. The McCoys sang the traditional Kudjip 5 song birthday melody, minus one song because they forgot where it went, as we had cake - it was very nice day. Hope your birthday is good too Megan. Miss ya and Love ya.

Christmas laughs

On Christmas, all the missionaries gathered together to share Christmas dinner this year. Following dinner, we started into the entertainment part of the program. For some reason they asked Becky if she would head up the entertainment. Becky has been here for 5 wks now, apparently they wanted some fresh ideas. So Becky, Kim and Lawrence (volunteers, also here for 5 wks) and myself were in charge of entertainment. We put our heads together and came up with telephone charades and a Christmas themed Family Feud.

Telephone charades is much like the game telephone - one person says something to the next person and they repeat what they heard to the next person and by the end it doesn't sound anything like what was started. It is the same, but as charades. So for example, my group was suppose to act out the wisemen coming and bringing gifts to Jesus. I started and took a gift and walked up and knelt down and laid the gift down and continued to bow in reverence like you see the wisemen doing. Emma followed me. She walked up with the gift and then turned around and walked back. So everyone after her did the same thing. As you might be able to imagine, it is a lot funnier to be in the audience for this, than to be doing it. We enjoyed lots of laughs as people tried to remember what they saw, and then passed on wrong things to the next person. Lawrence did a great job of building a snowman, which was successfully passed on to each member of his team.

Family Feud was also full of laughs, mainly at those who were surveyed - Becky, Kim, Lawrence, and I. Since our answers didn't always match up with what everyone else was answering, everyone was giving us a hard time. One of the questions was what do PNG missionaries send home to family as presents - one of the first answers from the team was coffee. Since none of the 4 of us drink coffee, and 3 of us have only been in the country for 5 wks, coffee wasn't on our list. This didn't go over so well with those playing, but it started the laughing and jokes that continued throughout the game as to having to think like one of the judges who is younger and doesn't know or think of things like everyone else did.

It wasn't just the surveyors who were laughed at. One team decided on Rudolph the Red-nosed Reindeer for a popular Christmas song as a steal, but when Judy got up to say what they wanted, she said Jingle Bells. Her teammates were yelling at her wondering what she was thinking and telling the judges not to accept her answer, while the other team was telling us to accept her answer. The judges were laughing too hard to really deliberate, so we let them have it, since we knew they wanted Rudolph. We also had to watch so no cheating occurred, yes at times even missionaries cheat when playing games. Despite being told numerous times folks would continue to try and give answers to their teammates. One team even tried to say they get to cheat 3 times, just like 3 wrong answers. It was quite funny.

Christmas wouldn't be complete without the visit from Santa. Olivia was fun to watch, as she was somewhat scared of Santa despite being told it was Uncle Bill. After he left she told me he wasn't the real Santa. I said, "Well, who was he?" "Uncle Bill," she said with a smile. The Dooley girls enjoyed their gifts from their missionary aunts and uncles.

Judy shared with us the gifts that we have received from Christ - hope, peace, rest, love, and much more. Praying you embrace the gift of Christ this Christmas season.

Caroling on the Wards

This year, as always, well as long as I know of anyway, the missionaries got together to do some caroling on the wards and then to give Christmas presents to the patients. It was a special time for the missionary family to be together, but also for me to have the opportunity to share Christmas in a small way with the patients. For some of the patients this will be their last Christmas, which is hard to think of, but a great reminder of why I am here serving these people.

I couldn't help but think of Jesmeal throughout most of the caroling. He had been an active energetic kid who now just lays there sleeping most of the time and occasionally smiles and laughs. Too often I thought that this would be his last Christmas, but how I pray that he will walk and run again.

On C ward, I saw Bill say hi to Anton. Anton, not much younger than I, has AML - leukemia, and didn't fare too well with a round of chemo. He has been in the hospital for over a month now, and will likely be here until he dies. His family faithfully takes him outside each day where he can feel the breeze and lay under the sun. The leukemia has made him blind, so he can no longer see, but he will see one day soon when he is in heaven.

Christmas is usually a time of joy and good memories, but for some it involves heartache and sadness, due to the sin in our world. The birth of Christ was a joyous time for those who were waiting for Him, for his parents, and for us today. Shortly after Christmas there was heartache and sadness as Herod killed all males under the age of 2, hoping Jesus would be one of them. Jesus wasn't, and so today we have a Risen Savior who we can worship and follow. This Savior also says He is with us always (Matt 28:20), and strengthens us for the battles we face.

Christmas Miracles and more

It is a privilege to care for patients each day at the hospital. As a doctor, my job is try and determine what they have and to care for them the best I can with what is available. At times, this is difficult due to limited resources, an unknown diagnosis, or pts coming in very late with their illness. It is these difficult patients, in particular, which clearly show me God's healing touch. The healing is His and His alone, sure we treat, but He heals. He heals us all from disease, sickness, and sin through the blood of Jesus. As we remember the gift that God gave us this Christmas season, I wanted to share with you some of the gifts God has recently given the patients and I.

Paul, 30, came in with multisystem organ failure and despite 4 antibiotics was very, very sick. At one point, we got a CXR that shouldn't be compatible with life here at Kudjip (due to not having a ventilator or other ways of supporting his pulmonary function.) By God's grace, he is alive and walking today. He knows the Savior and is able to praise Him this Christmas season for the life he lives and the life of Christ.

Tongamb, 7, came to us with abd pain and was found to have a very large liver abscess. He had become septic and we weren't sure he was going to survive another day without surgery. During surgery, his oxygen saturation was in the 60s the majority of the case (20-30 min). I was concerned that he was going to be brain damaged secondary to the hypoxia. Thankfully, God protected him from brain injury and used the surgery to start his healing process. I saw him today in f/u 1 week out of the hospital and he looked great - smiling, laughing, walking, and all without pain. God also used this time to bring his family closer to himself, as the chaplains got to spend time with his parents sharing with them about our Savior.

Jesmeal, 5, such a cute kid with a cute laugh. He came about 2 months ago unable to turn his neck from one side to the other, he just moved his whole upper body. His neck xray revealed some changes in his cervical spine and we were concerned about TB. He and his family moved into our TB ward so he could get his 2 months of injections of one of the TB meds. During this time, he improved, he was turning his head from side to side in 1-2 weeks. I would go to see him and he would be running around the TB ward, laughing, sweeping the floor, always very active. He would always smile and answer my questions. He even taught me a tok ples word for no - mon (not sure the spelling). Last week I went to see him to send him home, but instead of my cute energetic Jesmeal, he was laying on his bed, sleeping. I tried to wake him, but when he opened his eyes I saw they were going from side to side (nystagmus - not good). He smiled and laughed, like he always did, then went back to sleep. His family reported that he wasn't able to sit anymore, was vomiting, and wasn't moving his R side. I rewoke him up and couldn't get him to move his R arm or leg, his L side he would move, but when he tried his R he would say "nogat" (so cute). Concerned about some sort of worsening CNS disease, he went back to A ward (peds) so I can watch him closer. Unfortunately, it looks like he has some sort of CNS tumor which has caused his symptoms, and there isn't anything here to cure him. I am praying that God would continue to strengthen him and his parents, and if He chooses would do a miracle in his life and allow Jesmeal to walk home this Christmas season.

Zacii, 9 months, always smiling despite being significantly burned on his face, ear, L arm. He had been with us more than a month while he was getting skin grafts. He never cried, always just smiled and was content. He is from the Jimi (far away), so he stayed with some relatives for a week and when he came back, his head was all crusted and infected. Although his mom didn't want to stay again, she knew it was the best, so we got to see his smiling face for another week. I discharged him to home (the Jimi) this week so he could be home for Christmas. Home for Christmas - it isn't always the place of "home", but the people, the love, and the hope of a "home" that we have in heaven because of the birth of Christ.

Ambike,10, lived at the hospital for a number of months back in July, August, September, and October. She was always smiling unless you were changing bandages, making her move her leg, or putting needles in her. She had sepsis, osteomyelitis, and tuberculosis. She went home one weekend only to fall and break her femoral neck due to the osteo. She then lived on D ward in traction for a long time. Today she came back to outpatient in followup. She was all smiles and using her crutches well. Previously she had a total disarticulation of her femoral head and femur, but now God has grown them back. It is amazing to think of how God created our bodies so that we are able to recover, regrow, and regain strength that was lost. He supplies us with the strength we need, not just physically, but mentally, emotionally, and spiritually too.

William, 8, never smiling in a picture, but it brings a smile to my face just to see him alive and well. He has pus in his pericardial sac that was drained and he improved and went home. 2 wks later he came with some worsening symptoms, but after draining the pus and blood again, he is better. He continues to have some pus around his heart, but improves daily, and at times even smiles. He recently has bled from the site where we aspirated the pus. He has bled so much that his clothes and sheets were soaked with blood. Just yesterday I was there when he started bleeding again and I saw the blood pour over everything in it's path, covering it. This is exactly what Christ's blood does for you and me, it covers our sins so they are not seen by God. We are counted as righteous, not because of us, but because of Him.

Praying that this Christmas, you take the time to worship our Savior, and take the time to thank God for the work that He did which started in the manger and ended on the cross and with an empty tomb. Merry Christmas.

Lawrence's Concert

This evening, we here at Kudjip Station, were privileged to attend a piano concert by Lawrence Lee. The concert was Lawrence and Kim's way of saying thanks to all of us here and we were truly blessed by it. Lawrence blessed us with classical pieces, hymns, worship songs, and ended with a few Christmas carols. We all joined in singing the songs which had words, and it was a great time of praise to our Savior. Allison got to sit right next to the piano and it was fun to watch her face as Lawrence's hands went up and down the keyboard, she was in awe. I am wondering if Lawrence will make this an annual event, but am not sure if his new job in North Dakota will understand his need to come here each year. Next up in our Christmas celebration here - gift giving on the wards.

Saturday's Adventure

Getting off station isn't something I get to do too often, as I am not allowed to go by myself. So I thought that going for a hike would be a good idea. I talked to Lawrence and Kim Lee (FP resident and his wife) to see if they wanted to go and then talked to Bill, our tour guide. Due to events of the week, Bill wasn't able to be gone for a long time, so we did a modified hike and a trip to Suicide Rocks, works for me. I wish we had a pool here to go swimming more regularly, but we don't, so a trip to Suicide Rocks is always fun. Bill and I successfully completed the first Synchronized Jumping at Suicide Rocks. We weren't quite up to Olympic quality, our splash was a bit large, but it was fun. Kim decided she wanted to jump in, but Lawrence passed.

Lawrence asked me at one point as we were walking by some houses, people actually live in these houses? Yes, yes they do. Compared to what we are use to, the houses that they live in are quite simple. They are made of bush material - grass, wood, bamboo and other things that are woven together in ways so that it all stays. The whole house is usually about the size of a room in an American house - or smaller, with a cook house close by. As we were walking we saw people doing their daily activities - kids fishing, women working in the garden, women washing clothes and kaukau in the water, kids washing and playing in the water.

Once we got back from our short journey, I set out to work in the garden, which I have really come to enjoy. A few weeks ago, I managed to lose a piece for the weedeater, so we have lots of weeds growing all around. I took the lawnmower to the garden and got everything I could, but it isn't the same as the weedeater. We have some very large watermelon growing, which we are hoping to enjoy on Christmas. We also have lots of cherry tomatoes, pumpkins, and recently some green peppers. I have sure enjoyed being able to go outside and pick and eat vegetables without having to go to the store for them.

After gardening, I joined Becky, Lawrence, and Kim for dinner, discussion of our Christmas Party entertainment, and a game of Cities and Knights (Settlers). We had a good time and enjoyed the company of one another. Becky was on call and got called away, but she still managed to win, as we kept playing for her.

Melioidosis

Systemic Melioidosis, What? you ask, that is what I said too. Honestly, I thought Bill was making this up when he said that is what this patient I admitted has. At times, Bill does say fictitious things, and despite knowing him for over a year now and thinking I had figured out when he was making something up and when he was serious, I was wrong.

Over the weekend, I admitted this very sick guy who was transferred from another hospital with a very bad soft tissue infection of his neck. His neck was swollen and very indurated. I did an ultrasound and couldn't find a pocket of fluid to drain, but thought he was going to need it later on so I talked to Kevin and admitted him to the surgical ward on 4 antibiotics (Kudjip special). He was septic, sat 76% on RA, and his CXR had patchy infiltrates B/L. The next day I see him and find he is significantly jaundiced, I didn't remember seeing that the day before, but I could have missed it. AST 280, bili 10 - yep, jaundice. Monday, Kevin sees him and asks me to please transfer him as he is too sick to be on his surgical ward. He was definitely declaring himself as a medical patient and so I agreed.

I had mentioned this pt to Bill over the weekend and asked him to take a look at him to give me his thoughts on what could be going on. We talked about it on Monday, and didn't come up with anything, but knew it wasn't good. Tuesday am a bunch of us are in the Xray room, Lawrence and I had just talked about this guy and looked at the CXR and Bill comes in and says he has Systemic Melioidosis, what?

We won't know if he really has Melioidosis as we can't do blood cultures or anything here, but it is still interesting to read about and learn about. I likely would never had heard of this if this patient hadn't come it. So, what is Melioidosis you are asking. It is a gm neg bacterial infection that can cause pneumonia, septicemia, and localized infections. The organism is found in soil and water, and is not transmitted from other infected persons (this is a good thing). The septicemia variant, is what our guy has, if he has it, and it can be fatal. Based on his CXR it looks like he should have died already (for the nonmedical folks the white stuff in his lungs shouldn't be there), but he continues to fight.

He told us on Monday that he will be alright no matter what - he trusts in God. Today he told me his hope is in Christ - how encouraging for me to hear. His illness could easily take his life, but he knows he will see his Savior who was born this Christmas season if he does die. In the mean time, we keep treating him, praying for him, and are encouraged and blessed each day we get to talk with him and see his faith in action.

What do I learn from all this - we have a lot of bad diseases here in PNG, I have a lot to learn in medicine, God is good and uses people you don't expect to encourage you, and Bill is amazing. How does he know this stuff? I am thankful to have the opportunity to learn from him and hope to continue to glean knowledge from him while I am here.

PE - Basketball

We recently finished our time learning the game of basketball. We learned how to dribble, shoot, pass, what offense and defense are, and we tried to play some too. The kids really improved tremendously in our few weeks together playing basketball. Unfortunately, the net being 10 feet high was a big too high for most of them to make a bucket, but they did well.

I had forgotten how difficult it is to grasp concepts like offense with getting open, passing the ball, and not bunching up. We did our best and they started to understand more and more as we played.

We started soccer today, but now have a 3 week break for Christmas. When we start up again we will have some of the older kids back from furlough, so that will make things interesting and challenging for sure.

Ameloblastoma

Ameloblastoma - ever heard of it? Prior to coming here I sure hadn't. I had heard Jim mention it a few times this past year, but had never seen one, so I didn't know anything about it, until now.

A pt presented c/o of pain of her R mandible. She had a 3 year history of swelling of her R mandible after having an unknown dental surgery some years prior. On exam, it is clear that you can see swelling of the R side of her face. Inside her mouth, her R gum was swollen and hard - definitely not normal. I got an xray to look for anything and found this large cyst like mass.

Ameloblastomas are tumors typically found in young adults of the mandible or maxilla (face). They are often benign, but disfiguring. The form from the cells that would normally produce tooth enamel. Treatment is wide surgical excision by specialists. I am not sure who are specialists here are, but I sent her to the ENT doctor to get a confirmatory diagnosis and to see if they are able to do surgery on it.

The Christmas Season is here

Christmas has definitely come to Kudjip station. Last weekend, I was wondering what Marsha was doing as I kept hearing lots of noises next door, saw she had removed everything from her shelves in her dining room, and had lots of boxes everywhere. I then saw the wreath on her front door and realized it was the weekend after Thanksgiving, time to start thinking and decorating for Christmas.

I decided to wait a weekend before I started decorating, but went to work yesterday and today. My sister had sent me some stuff she got on sale after Christmas last year, so now I have a lot of lights which enabled me to decorate outside and inside. It was fun. I have already received some boxes from my dad and sister with Christmas presents, so my tree is watching over many presents. I continued my sister and I's tradition of listening to the Peter, Paul, and Mary Christmas concert that was on PBS many years ago as I decorated the tree, and watched one of the best Christmas shows ever - Emmet Otter's Jugband Christmas by Jim Henson.

Yesterday I spent some time with Diane, Leslie, and Miss Par as we decorated some christmas cookies for today's English Lotu. Today was our monthly English church service in the chapel. The kids at the MK school always do a drama for Christmas, and today's was pretty cute. All the kids knew their lines and sang their songs as they shared with us the story of Jesus. Olivia, only 3, got to be a wiseman (or woman) and it was quite cute to watch her throughout the play. I look forward to one of the other traditions that we do here on Christmas Eve as we give gifts and sing carols to the patients in the hospital.

This season isn't about the gifts we give or receive, but about the gift we have received from God. God sent us Jesus, whose birth we remember this Christmas. Jesus is the best gift any of us can receive because He died for our sins and when we believe and place our faith in Him we are assured of Eternal life, there is no present that is better than that. Enjoy Him this Christmas.

Pus - it is everywhere

In my time here, the other docs have always told me that abscesses were more common and to err on the side of giving antibiotics due to the incidence of infections. This has sure proved true in my time here. I have seen a lot of soft tissue abscesses and at least a few times a week I drain an abscess on someone. There have been lots of kids with pyomyositis (pus in the muscle) that I have drained down to the bone, which often then forms osteomyelitis. I have seen a few kids with retroperitoneal abscesses and lung abscesses also. Recently, these abscesses seem to be more common and more severe, where the kids are septic as a result and look like they could die.

About 3 wks ago, I admitted William, who had a lot of pus in his pericardium (sac around his heart). Just last week we did surgery on him to drain the pericardium, and praise God, he is now doing much better and should be going home tomorrow.

While rounding on Saturday, I had a kid, Tangamb, with worsening RUQ pain, fever, high HR, and looked very sick. The family told me to do whatever I could, he was their only child. I did an ultrasound of his liver, and knew it looked abnormal, but I didn't localize a definite abscess. Later, Bill and I repeated the US and we found pus and lots of it. That night, Kevin, our volunteer surgeon and I went in to drain the abscess. I got to do an ultrasound guided aspiration first, which was a good opportunity to do something I may need to use in the future. We got out a lot of pus in the surgery and he is getting better. He is still very sick, but looks better than when he came in. I thought that pus in the liver and the pericardium was pretty neat, but then I found more.

Tues on rounds, another 7 yo girl was admitted with RUQ pain. She wasn't as sick as Tangamb, but on ultrasound she sure has an abscess. She is doing okay on antibiotics for now, so we are just waiting on her. That is 2 in 1 wk, amazing.

Wednesday things got even more interesting. Tofa, a girl I had seen in the clinic 2 times in the last week and wanted to admit, but the family refused returned to the ER. She was having continued abd pain with LUQ tenderness and swelling. On ultrasound, she has a huge splenic abscess, which I had never seen before. She went to surgery that day and Kevin got out a lot of pus.

So this is a lot of pus that we have here. Not sure where it is coming from, or why they are getting it, but we keep finding it and will keep looking for more.