Plastic Surgery and Netter

While I was in the labor ward finishing a repair of a vaginal laceration, I got called from the ER about a patient they wanted me to see. So, I finished what I was doing and headed for the ER. I found a lady who had been in a car accident who suffered some bad lacerations to her face. A nursing student had initially tried to sew up her lac, but he wisely called and asked for help.

She had a laceration that involved the base of her nose and part of her upper lip. The base of her nose was off of her face and the area between the 2 nostrils was separated. I put my finger into this lac at the base of her nose and I was amazed at how far it went. Thankfully I didn't hit brain or go through her palate so I decided to start sewing. The nursing student stayed to help me hold things open and to blot her eye as water would go in. During the procedure she often had to sit up and spit out a bunch of blood that she had accumulated in her throat, but we kept going. Early on as I was trying to figure out how to put this together she says, "Doctor, please don't leave a scar." I had to try not to laugh. She had no understanding of what her nose/face looked like when she came in, and now she wants me to try and not leave a scar. Plastic surgery wasn't part of my residency training, but I was doing the best I could, but I knew a scar was inevitable. I told her I was going to do by best, but I thought she would have a scar.

It was late by the time I got done, so she stayed overnight on the ward. I had attempted to draw a picture in her scalebook to try and show where the lacs were for anyone who might be interested later. As I was drawing it, I was thinking, I am not an artist, I shouldn't be doing this, but I drew it anyway. The next morning Jim comes and finds me on the ward asking about her. He shows me my drawing and informed me that Frank Netter has nothing to worry about. (Netter is the illustrator of a number of anatomy textbooks). I went to see her on the ward and was surprised at how well she looked. I don't think any plastic surgery programs are going to come knocking on my door, but I was thankful to be able to help her look a lot better than when she came in.

Kathy's Birthday

Kathy's birthday was Saturday, so Marsha had the Radcliffes, Riggins and I over for dinner to celebrate. There were a lot of us (14) around the table as we enjoyed a great meal of grilled meat, vegetables, and a great truffle cake which Jill made. We had a good time of fellowship and enjoyed the entertainment of the Riggin's boys and Bill.

Wiley was quite an eater, especially of his mom's potatoes. At times, Wiley would smile and put a whole bunch of potatoes in his mouth, showing off. We all enjoyed watching him as he ate. Bill, during the middle of the conversation, yells "Oh my nose." We all turned our heads to see why he said this and see a plastic fork stuck to his nose. Aden, who was sitting next to him, didn't know what to say or do, and seemed somewhat afraid. Initially, Marsha looked concerned for her husband, then we all realized he was just kidding and started laughing. Soon after that Aden starts saying "Oh my nose." After dinner, he got some of his toys and would put them in his nose and say "Oh my nose," just like his Uncle Bill. Apparently, Bill's brother does this at various family gatherings, so Bill thought he would do it for all of us. In doing so, he may have started a new tradition in the Riggin's household. Aden came over to play today, and was putting things in his nose saying "Oh my nose."

After dinner, we sang the birthday song and were enjoying Jill's cake. We all commented on how good it was and we asked Jill how she made it. She told us she just made it up. Shortly there after, Aden says, "Hey, Uncle Bill." Bill says, "Yes, Aden." Aden says, "I made the cake." Everyone started laughing, as this something Bill would say. Bill often tells people that he made whatever food was served, when he didn't. We all kid and joke about Bill making things when we get together and apparently Aden has caught on.

Following dinner, Kathy and Aden opened up her presents. Aden was hoping that there might be some toys in her gifts and was somewhat disappointed when she got books, towels, and lotion. We then enjoyed watching some basketball, talking, and the boys enjoyed looking at pictures on Aunt Marsha's computer of elephants and tigers and more.

New Students

This week 2 new medical students joined us, Ben and Katherine Radcliffe. They aren't really new to the station, as they are family. Ben is the oldest child of Jim and Kathy, and Katherine is Ben's wife. I gave them their tour of the hospital when they first got here, and it wasn't really a tour. It was really time for Ben to hug everyone he hasn't seen in a number of years and for him to introduce Katherine to them.

I also got to spend some time with them their first day in the clinic showing them how things work around here. Ben was able to follow along in the conversations I was having with the patients and then was translating back to Katherine. I was quite impressed with his ability to recall Pidgin after being gone for almost 8 full years. Katherine has continued to work with me on medical ward, while Ben is working with his dad on the surgery side of things for now. Ben is going to follow in his father's footsteps and do a general surgery residency and train at Riverside, where his dad trained. Katherine will be doing a family practice residency at Grant in Columbus, OH. They received the Ernie Steury Scholarship in medical school, which is given by the Christian Medical and Dental Association to students interested in long term missions. They will be here for 7 wks and hopefully their experiences here prove to be the beginning of what they will be doing the rest of their lives.

Julie and her son

2 weeks ago I was Csection backup. This means that I don't get to round or do any patient care stuff, unless there is a Csection, then I get to work. Well, that Saturday, I got to work a lot (3 Csections and one 4th degree repair). I had admitted Julie, late Friday afternoon, with placenta previa at term. She wasn't from our area, but I was concerned that if we didn't admit her and do her Csection, that she might not get the care she needs elsewhere, so I admitted her. It took a while for family to come in order for us to do the section, so we did it Saturday afternoon.

I have only done 1 placenta previa, which was with my sister, almost a year ago, so I asked Jim if he wouldn't mind being in there in case I needed him.  When we got to the uterus, it didn't look like anything I had seen before, but I figured well this must be what previa's look like. It was all vascular, and darker color. Jim walks in at this time and says WOW, what do we have here. It was good timing to say the least. We ended up cutting above this placenta in the upper segment and getting the baby out. When it came time to remove the placenta, it was quite adherent to the rest of the uterus, and it made up the lower segment of the uterus. She didn't just have placenta previa, she also had placenta percreta.

Thankfully, Jim was able to sew the pieces back together into a uterus again. We wanted to do a tubal ligation on her, but her husband was in Port Moresby, and the family couldn't consent to it. So we just finished the Csection. In the days she was here in the hospital, I had numerous discussions with her about her needing a repeat CSection, and should even consider a BTL now, as she is at risk of having the same thing happen next time. She seemed to understand. This week, I got to see her and her son in followup. It was neat to see them and know that they are both doing well. She will stay up in the are for a few more weeks before heading back to POM with her husband.

Hospital fines

Outside the hospital between the outpatient waiting area and administration are 2 signs. One says We treat, Jesus Heals. The other is a sign which lists 16 things which are not permitted on station and the fine for each infraction of this. When one first gets here the sign is a good test of your pidgin knowledge. If you can read it and understand it, you are doing well with your pidgin, if not you need to keep working on your language training. Some of the rules include - urinating/ defecating on the grass is a 5K fine, fighting in the hospital area is 10K, 20K fine if you are drunk, 5K fine to throw trash on the ground, 2K fine for smoking, you aren't allowed to have too many wasman with the patients - but no fine is listed, 10K fine for weapons - axe, spear, knife, or gun, 5K fine if you drive a wheelchair on the grass and more.

I am not sure when the sign was placed, but I know it has been for a number of years. I have always had a lot of questions about this sign - who enforces these rules? who came up with these rules and fines? This past Sunday was the first time I was aware of anyone enforcing these rules, the other missionaries have told me that at times they do get enforced, but I guess I just hadn't seen it.

On Sunday, I was called to the ER by a nurse to see a patient. As I was walking through the OPD area I saw 2 security men quickly walking through the outpatient area toward the ER, and 1 security man opened the ER door to come inside. We usually have 1 security for the ER/OPD area, so I wasn't sure what was going on to attract all these folks at one time, but I figured it must be something big. I didn't hear any loud sounds, didn't see any fighting as I was approaching, so I wasn't sure why they were all there. When I got inside and found 5 people - 2 patients and 3 wasman, all of who were patiently waiting, no big security threat to me. I started looking at the chart of my patient when I heard the security men talking to one of the wasman.

They were questioning him as to why someone had urinated on the grass. They tried to explain that the patient was sick and didn't make it to the toilet, it was an accident. The security men understood this, but said that we have laws (rules) here on station which say you aren't allowed to do this and need to pay a 5K fine now. They didn't have 5 more kina to pay at this time, so then they said that they were going to talk to the nurse about not giving them medicine until they pay the fine. I was kind of shocked by this, having never seen or heard anyone enforce these rules before. They explained to these folks that we have a big sign on station with the rules of the station that are enforced. This was news to me.

I didn't feel it was my place to get in the middle of this and explain to these new security men that I've never seen these rules enforced and that this patient just didn't make it to the toilet, she was sick. So I didn't say anything. I didn't end up seeing the patient as they were treated by the nurse, but I do believe they got some medicines before leaving, even without paying the 5K fine. Since January we have had a new security firm, Asila, which does our security. They have done a good job and we are thankful for them. They not only do a good job of security, they also have helped out in the ER with various things that need done, which I have appreciated on more than one occasion.

Kimil Coffee Plantation

Saturday am a bunch of us went to Kimil to their coffee plantation. Meghan Harlan, a volunteer here, knows someone from her hometown who buys coffee from this place, so she wanted to see it. The Radcliffe family was gracious enough to take the singles out there Saturday am. We had a good time. We were originally thinking we were just going for a picture as we didn't arrange for a tour, but that changed when we got there. The manager of the plantation is an Indian guy who both Jim and I have taken care of in the hospital. He has invited us to come and see his plantation numerous times, but for various reasons we hadn't gotten out there. So when we saw him and started talking with him, he graciously gave us a tour of the place.

Coffee is pretty big in the Highlands of PNG. Almost everyone has one or lots of coffee trees which they harvest each year. They collect the coffee beans and then sell them to the plantations. They often use the money to pay for school fees for their kids, or other expenses. At times in the hospital a patient will say they don't have money to be admitted now, but next week after they sell their coffee they will come back. This plantation is, apparently, one of the biggest producers of coffee in the Highlands. We got to see all the machines they use to break the shells, clean, ferment, sort, and dry the beans. The guys working at the factory were very excited about showing us what they do and what the machines do. I don't drink coffee, so I don't appreciate how good the PNG coffee is, but from what everyone else says, it is pretty good. So the next time you are at Starbucks and get PNG coffee, it is likely that the beans are probably grown somewhere close to me here in the Highlands of PNG.

Sunday hike

I went on a hike with Bill and a volunteer this past Sunday. We left after church and headed to Suicide Rocks, then up to the Catholic Mission, and the ridges above us (ridge in pic is part of where we were). It was a great day for a hike, thankfully the rain held off until we got back. At the Catholic Mission, we picked up a bunch of kids who joined us on our hike.

A bunch of them started walking with me and 2 of them just grabbed my hands to hold them. Other kids tried to join in on the hand holding, but the 2 who had my hands wouldn't let them in. The kids talked a lot, I told them they had to talk in Pidgin so I could understand them, not in tok ples which I don't know. I talked to them and found out the 2 holding my hands were brothers. One was named Joe, the other I didn't fully understand. They have 5 kids in their family, they are the last 2. One was in 2nd grade and the other 4th. I asked them what they learned at church, but they couldn't really tell me, but I used the opportunity to share the gospel with them. They would have walked with us forever, if we let them. You rarely go on a hike without someone coming with you - just like the fishing trip, we had a bunch of kids following us. I kept telling them we didn't need guides, we would be fine by ourselves, but they insisted. Finally, I asked them if they would stay there and we 3 would go ahead on our own. For some reason, they obeyed, at least for a while.

While they were gone, it became a lot quieter, and we heard some birds. Bill was able to identify the call of a Superb Bird of Paradise, and after a while we spotted him. PNG is unique in that it has a lot of species of Birds of Paradise in the country, I think I have seen 2 now in the wild since I have been here. The kids caught up to us at this point, but I think they might have seen us bird watching and didn't continue with us.

We continued hiking on a trail up the ridges, but at one point we got off the beaten trail. We knew where we were and where we needed to go, so we just headed that way. We went through some brush and had to do some sliding down the sides of the hills, but we all survived. We picked up the trail, only to lose it again, but we kept going. We came to a house and Bill stopped to ask where the trail was to take us to a place to cross the river. The house we stumbled upon belonged to an employee of the hospital, so he graciously had his son take us down to the river and helped us across. Then we were home free. PNG is so beautiful, it has been fun to enjoy God's creation while I have been here.

Mystery Dinner

Becky loves to dress up and get everyone participating in having fun, so what better way to do that than to have a mystery dinner. She organized the mystery dinner so almost everyone would be here with the Myers being back from furlough and the Bennetts not yet leaving for furlough. About a week before the dinner she gave us our characters, potluck food assignments, and costume recommendations so we could be ready. The setting for the mystery was in the 50s, so everyone was suppose to dress accordingly. I have nothing from the 50s or any other era in my wardrobe, so Becky took charge of finding me something to wear.

We all gathered at the MK high school for our evening of fun. I am sure the Papua New Guineans had a few good laughs as they saw us walking in our outfits to the dinner. We ate first and then started to go through the mystery. Becky did a great job of assigning characters to all of us. There were more of us than the 8 people of the mystery, so there were between 2-5 of the same character and we all participated together. I was thankful to have a part that didn't require a lot of speaking or acting, which I enjoyed. Others did a great job acting out their parts and we all shared a number of laughs together. We had a lot of fun.

Becky's Birthday

Becky turned 31 on Thursday, so we celebrated. She got to wear the ever popular Dooley's birthday hat in the hospital as numberous folks sung Happy Birthday to her. After work, the singles came to my house and we had a spaghetti dinner before heading to the Radcliffes for prayer meeting. Almost everyone was out for prayer meeting where we had a big celebration - cake, happy birthday signs, the 5 song birthday melody, gifts and more. I think Becky enjoyed her day even though she was far away from her family back home. It has been great having Becky here, she is a blessing to us all.

Cute kid not liking the flash on peds ward

Myers Return

Jeff, Susan, Jessica and Ethan have been away on home assignment for 7 months, but on Sunday they returned to Kudjip. They enjoyed their time away, but were glad to get back. While gone they toured Kruger National Park in South Africa, visited Hawaii and many other places in the US. Jessica enjoyed playing 8th grade basketball and Ethan enjoyed - well he doesn't really know. I enjoyed having them back in PE this week. We now have 11 kids in PE - 12 counting me.

When folks come back from Home Assignment or are leaving for Home Assignment the rest of us here on station host them in our homes for dinner. It is quite challenging, or seems so, to have me cook for a family of 4, so I don't usually sign up for these things. Tonight Steph, Becky, and I collectively got together to make a Mexican meal. It was quite nice. We had to eat at Steph's because she has the biggest table. We enjoyed seeing pictures and hearing about their trip home. It is good to have them back.

Konduk Church

This Sunday I went with the volunteers and Steph up to Konduk for church. Konduk is about a 30 minute walk from station up a really big hill. The hill is quite slippery after it rains which makes the trek interesting. The view from above is amazing though, so it is sure worth it. Pastor David is the pastor, but a lay preacher, Robert shared with us about being touched by Jesus. Robert was very animated and passionate as he spoke, which was exciting to see. He encouraged everyone that it isn't enough to just go to church because someone has invited you, you need to go and be touched by Jesus, be changed by Jesus, want to go because of Jesus. He talked about Bartimeus in Luke who cried out to Jesus, and was healed because of his faith.

At the end of the service, one of the guys from the church brought us some passion fruit from the trees which grow nearby. We got out our cameras to take some pictures of the people and everyone gathered around to be in the picture. We had one of the guys take a picture of everyone, and it was funny to watch him and those around him trying to figure out the camera. They enjoyed it.

Luke turns 2

My nephew Luke is 2 today - March 6th. He is quite a talker now, and always seems to be saying something when I talk to him and his mom on the computer. One of his new words is "Oh no!" said in such a way where he sounds really disappointed about whatever it is that isn't going quite right. He is cute. He can say Ant E too, which is good for me. He has enjoyed playing with his blowup space shuttle that he got a few weeks back from me. The cat decided to put some holes in it, but his mom is planning on patching it. Luke also like trains, trucks, and Mickey. He went with his parents and grandparents to see Mickey on Ice 2 wks ago and really like Mickey. He also liked the astronaut who came out (it wasn't an astronaut, he just thought it looked like one). Soon Luke will be a big brother, but for now he is enjoying being the only child. I look forward to visiting with him and his family in a few months when I go home to meet my new nephew.

Kos

Kos came to us in January, he is from a very remote place in the bush (Kombo) about 3 days walk away. He had a sore of his L leg and so him and his dad decided to walk out of the bush to see us. The first day they walked from 7 til 3pm without a trail to get to a relative's house. The second day they walked all day long into the evening to get to another house of someone they knew. They crossed 2 large rivers, the Ramu and Jimi, with the dad putting him on his shoulders to get across the rivers which were up to the dad's chest. The 3rd day they finally got to a road and then took a 20K PMV to get to Banz. The following day they came and saw me.

When I saw him, he walked in with a big smile on his face, but had a green cloth on his leg. When I removed this bandage I found part of his tibia exposed through his skin. I knew he had osteomyelitis and that he needed surgery, but he was from longwe. Due to the overabundance of surgical cases in our Jiwaka area, we typically don't do longwe elective surgery cases. If we did surgery on everyone that needed surgery who came to us in PNG, our whole hospital would be a surgical ward and Jim would be in the OR all the time. I discussed the case with Jim and explained that they came from really far away, and he looked at the leg and agreed to do the surgery.

It has now been 3 months, and Kos and his dad are getting ready to go home. Jim performed a sequestectomy on him and now his leg is healing up well. They are looking forward to going home and seeing the rest of his family, he has 3 siblings at home. Meghan Harlan, one of our volunteers has been spending some time with him these past few days. She has really enjoyed getting to know them and will miss them when they are gone. I saw Kos and his dad, Paul, outside yesterday and was talking with them. Paul informed me that the white meri was going to take Kos home with her. I tried to clarify this, did he think Meghan was going to take him home here on Kudjip station, or home like America. He assured me it was America. I told him, I think Meghan misspoke and that she is unable to take him back to America with her. He assured me that is what she said. At lunch, I talked to Meghan to make sure she knew what he understood so she could straighten it out. Through a translator she was able to straighten it out. Although I think Meghan would love to get to see Kos everyday, taking him to America isn't really an option.

Games, Bible Trivia, and more

This past Saturday, I joined Becky, Stephanie, and Michelle at the volunteers for some fun and games. We have some volunteers who are here serving with us. A family physician and his wife a physical therapist. They were here last year for 3 months, and this year came back.  The FP has been spending his time mostly on the medicine ward, but recently is tackling OB.  Patty works daily with our postop patients, and others on the ward doing physical therapy and teaching some of our nurses and CHWs more about it, so they are able to do some when she leaves. On Saturday, Becky and I got to going tubing with Jim and the volunteers also came along, it was fun.

So game night started out with bible trivia played on a trivia pursuit board. Becky loves bible trivia and has played for years with her grandma, so she always does quite well. It was a close game, but Becky, Michelle, and the FP pulled out the win. After bible trivia we played real trivia pursuit - this was not a good idea. The teams were quite even in bible trivia, but some of us were really bad at trivia pursuit (I being one of those), and so the game was quite lopsided. Michelle, a medical student who is also here for 3 months, stole the show. She was amazing answering almost all the questions for her team. It was fun to watch her and try and stump her, but we didn't do it too often. As a result her team crushed my team, but it was still fun. If we play again, I want to be on Michelle's team.