Danielle's Graduation

Today we gathered to congratulate Danielle on her graduation from high school. She has been homeschooled since kindergarten as her parents have been missionaries with the Nazarene Church, but she has done very well in school and has a full scholarship to SNU (Southern Nazarene University). She currently is planning on becoming a doctor and would like to be a surgeon. Since her and her family have moved to our station, she has enjoyed spending time in the operating room and getting to see a bunch of surgeries.

This afternoon we enjoyed a time of fellowship together on the McCoy's porch. We sang a song, had some scripture read, heard from her dad, and Kathy read something Danielle wrote about being home schooled, it was very nice. We also played a game about how well you know Danielle. Becky divided us up into teams based on where we were sitting, of course if there is a competition I want to win. Thankfully, it was multiple choice and we didn't lose points for being wrong, so we pulled it out, it was fun. We also enjoyed cake, ice cream, cookies and other treats that everyone brought. She had a slide show of pictures and even the little guys enjoyed watching it. It was a nice afternoon and we pray God continues to guide and direct Danielle in her future. She is heading home to the US with week with her parents as they start their home assignment and get ready to say goodbye to her as she starts school.

Track and Field Day

Today we had track and field day with the elementary students and the students from CLTC. The high schoolers helped me out as we enjoyed a day of races and relays. Initially, we had some time waiting for the CLTC kids to arrive, so the elem and HS kids did some sack races, played ultimate frisbee, worked on getting out of the human knot, and more. Once the CLTC kids arrived, we set up our stations for our individual events. We had a 30m run, a frisbee throw, a sack race, a broad jump, and a big ball throw. The kids seemed to enjoy it and having done it last year the kids seemed to understand what they were doing. Following this, we did some relays - a 2 person sack race relay, a wheelbarrow relay, and a clothes relay. I am not sure why, but the kids really seem to enjoy and laugh throughout the clothes relay as they are trying to put on the scrubs and run as fast as they can. Following this, we had a water balloon toss and egg toss. Then we went to the park for lunch. At the end of lunch, some of the students started in a water fight with Aunt Diane, the elementary teacher. Most of all the elementary students got involved trying to get Aunt Diane. I initially took pics, but then got involved also and wet in the process, but it was fun. We finished the day with bear, mosquito, fish and kickball. It seemed like the kids enjoyed it and had a good day.

Motor Vehicle Accident

This weekend was the first weekend I haven't been on call in one way or another for 3 wks. On Saturday, I was looking forward to playing tennis, gardening, making some pillow cases for my nephews, and just relaxing. I had already accomplished some of that when Cilla rode her bike to my house at like 1230 and said there was a car accident and her dad was asking for my help. I quickly changed into scrubs and headed down to the ER.

Car accidents here are never a good thing. Too often the vehicles are PMVs (public motor vehicles) who have 10-20 people in the back of an open bed truck of some sort, which ends up flipping over and throwing everyone out. This one was an open bed truck vs. semi - the semi won.

When I got to the ER it was full of patients, nursing students, wasman, security guards, nurses, other hospital workers, and Jim and Scott. Patients were on beds, the floor, trolleys in the OPD area and in exam rooms. One of the blessings of our hospital is that when something like this happens, everyone mobilizes to help out - students who aren't working, workers who aren't in the ER, etc, all come to pitch in. Jim was telling me how he was doing things and then I quickly started assessing patients that hadn't been seen yet.

One of my patients was the wife of the driver, she had a femur fracture, a dislocated wrist, and neck pain. We put a collar on her, got Xrays of her neck and extremities, and then set her up in traction, reduced her wrist and sent her to the ward. My second patient had a large scalp laceration, but otherwise had no major injuries.

My third patient, Dolly about 20, didn't appear to have any major injuries initially. She was uncooperative, but wasn't really saying anything hurt her. She had a head laceration, but that was all I initially found. While Jim was helping me with the tibial traction pin on my first lady, she really started to get uncooperative. I went back for a second assessment and now found her abdomen quite tender. I grabbed the ultrasound machine and found free fluid in her abdomen. We quickly got her an IV, blood, and got her ready for surgery. We watched her initially and when her hemoglobin didn't go up after blood, and her vitals got more unstable, Jim took her to surgery and repaired her splenic laceration.

Unfortunately, Dolly's parents didn't fare as well as she did in the accident. Her mom wasn't alive when she came to us. Her dad was confused and unstable when he presented to us. Jim put a chest tube in him and he seemed to be doing better, but later went into cardiac arrest, and passed away in the ER. Another lady who was pregnant, also passed away with massive head injuries shortly after she came in. Her husband was asking if there was anyway we could help the baby or her by doing a Csection to remove the baby. Unfortunately, she had a massive head injury so doing a Csection wouldn't have helped and the baby was too small to survive outside of mom.

A group of people got into a truck yesterday on their way somewhere and now 4 are no longer on this earth. Although my day yesterday didn't go exactly how I planned it, I am thankful that I have another day to live. Another volunteer saw me yesterday after the accident. As we were talking we heard people crying at the morgue over those who had passed away and she asked how I was doing. I have seen too many people die and have told too many family members that there isn't anything more medically I can do for them except pray to be devastated by the patients who passed away. However, it still doesn't make it easy to walk away from the ER knowing 4 patients didn't make it. I know the Lord is in control of all of our lives and knows the number of days that we each have. Ps 139:16 "And in your book were all written the days that were ordained for me, when as yet there was not one of them." I know it sure reminds me that you never know when the time to meet the Lord is coming so it is important to make the most of each day, to love lots, and obey what God has called you to.

Saturday Evening Fun

Last evening a bunch of the ladies got together for some snacks and games. Steph hosted us and Becky, Katie, Danielle, Jessica, Lydia and I enjoyed our evening together. Steph had prepared soft pretzel dough for us to roll our own pretzels and flavor. I haven't had a soft pretzel in a long time, so it was fun to make and eat them. After we rolled our pretzels, we enjoyed playing games and just hanging out and talking. We played some games - Spoons, the ever popular Pit, and Claymania. Pit got a little loud, and Steph's roommate Becky, who wasn't feeling so well, came out of her bedroom saying one, one, one, two, two, two. Apparently, we had awaken her from her rest. We asked her to join in, but instead she just enjoyed watching us and laughing. Katie pulled off an amazing Claymania creation when she sculpted an abyss and Becky correctly guessed it. All in all, a good night with good food, lots of laughs and fun.

Help Wanted - New Xray Machine Needed

We recently had Jim Moore, Bill Wright, and Ken Thomas from World Medical Mission here with us for 2 weeks. They surveyed our medical equipment and electrical things in order to fix what they could and to help us know what we need to do to improve. Well they found a lot of stuff that they were able to fix and a lot more that they couldn't. Our hospital is in major need of electrical repairs, but is also in major need of a new Xray machine.

Our current Xray machine, apparently, stopped being produced about 35 yrs ago. Our plan was to move it into the new hospital and continue to use it, that is until the WMM guys showed up. Not only does it weigh a ton and we don't know how we would move it to the new hospital, it also has "30,000 wires" that need to be connected exactly as they are in order for it to work again. They gave it a less than 5% chance of ever working again if we tried to move it. Given the odds, we have determined we need a new one.

The WMM guys are able to get us a smaller, lighter unit that will actually take good Xrays. I haven't seen a nonPNG Xray in so long that I actually think our Xrays are pretty good, but truthfully they need improved. So we are in the process of having a new Xray machine purchased for us and sent over to us. A new machine will cost $35,000, so we are trying to raise this money. We already have $10,000, so we are on our way. If you would like to contribute, you can send a check that will be tax deductible to "Global Treasurer" designate "Work of Nazarene Hospital, Kudjip, PNG" send to Church of the Nazarene 17001 Praire Star Parkway Lenexa, KS 66220. Thanks for your support.

Cucumbers and roundup

Bill has been gone a lot recently so I have been in charge of the garden. It is a lot of work for one person, but I enjoy it. I love cucumbers and watermelon and was really exciting about the new plants that we had started to grow. I watered them daily to make sure they would get the water they needed since we were having a dry season. I noticed that they were getting eaten by some bugs, so I thought I should spray some insecticide on them to prevent the bugs from destroying them before I could enjoy them. A few days after treating them, I noticed that they were starting to turn brown and weren't looking as healthy as before. I wasn't sure what was going on. I noticed it was the watermelon, cucumbers, and some beans. It seemed kind of weird to me, but I have seen some fungus before and wasn't sure if something got to them all. I kept watering hoping they would recover all the while wondering what happened. One day it hit me. Instead of putting on insecticide, which I have to mix in a water jug, I sprayed them with roundup for the weeds. It was the roundup that was killing the cucumbers, watermelon, cabbage, beans, and some chinese cabbage. I felt horrible for killing my plants that had looked so promising. Despite trying to water them and give them good compost to get nutrition, they died, all of them. So disappointing as I was looking forward to having some fresh cucumbers in the next few weeks.

I recently planted more cucumbers in a nursery box with the hope of replacing those I lost. I have also planted some beans for Bill and some cabbage as replacements. So far they are all doing good, and look promising. I have made a sign to remind me not to spray the roundup on the plants again. Hopefully, the new cucumbers with transplant well and will produce some good cucumbers in another month or so. After realizing what I did, it reminded me how fragile like is, all life. Some of us are entrusted with looking out for the lives of others - whether as parents, physicians, pilots, etc. This job/responsibility isn't to be taken lightly. Thankfully, we have a heavenly Father who is watching out for us, looking over us, giving us wisdom so we don't spray roundup on those we are looking out for. I pray God would continue to grant me wisdom as I care for patients that He has entrusted me with.

Mark

Seeing patients who you thought were going to die get better and go home is a great joy and something only God can do. Mark came to us about a month or more ago. I saw him initially in the clinic and was concerned he had HIV because he was having weight loss, had temporal wasting, fevers, and diarrhea. I admitted him for IVFs and further testing. Thankfully for him, his HIV came back negative, much to our surprise. I wasn't taking care of him in the hosptial, but he was treated for his diarrhea and started on TB treatment for suspected pulmonary TB. He seemed to be doing somewhat better, but then he absconded, left AMA. Thankfully, he returned a few days later to the clinic, so I again readmitted him.

He continued with fevers, had a pleural effusion, and some altered mental status. His diarrhea had stopped at this point, but that was about all I could get out of him as he was confused. Still not convinced he didn't have HIV, I rechecked it. Sure enough, negative again, great, but now where do I go. He was started back on the TB treatment, but he continued with fevers, and was really sick. I consulted Bill to look at his ultrasound as I was seeing something that didn't seem right. Instead of finding something abnormal on his ultrasound, he thought he had abdominal tenderness and was concerned that he had an infection in his abdomen. I continued him on the TB treatment, but also started him on antibiotics. Within a few days, he got better, much better. His fevers started to trend down, his abdominal pain decreased, his mentation improved, he started eating, his temporal wasting disappeared and he seemed to be back to normal.

Given our lab capabilities, we won't ever know for sure if it was an infection alone, an infection plus TB, or what was going on, but the important thing is he is better. He does have a lower abdominal mass on ultrasound that we are watching, not sure if it is a TB granuloma, or some other mass, but we continued him on treatment and sent him home. Some may not think this was a miracle, but to see how sick Mark was on admission and then to see him walk out the door smiling and happy, is a miracle. I am thankful for the priviledge for serving at Kudjip, of being used by God to see frequent miralces in people's lives both physically and spiritually. Pray that Mark would continue to recover.

Phone conversation

I was on call on Saturday, and it was pretty busy. Steph had invited me for pizza, but I ended up having to do a Csection and seeing other folks in the ER. It was almost 8 and I was almost done so I called to see if there was still food left. I told her, "I would be right down after I put back this kid's rectum." She started laughing, and then I realized what I said and how it sounded. Putting a kid's rectum back is not a normal thing, this is actually the first time I have done it. Soloman, the pt about 3 yo, had diarrhea for about a week and this afternoon after going the bathroom, his rectum came out too. Thankfully it went back in ok, and hopefully treating his diarrhea will prevent it from coming out again.

Kulno

Kulno came to us about 2 weeks ago from the Jimi (far away). She complained of weakness, abd pain, some vaginal bleeding, and fever. On exam she was found to have a large pelvic/abdominal mass and a hemoglobin of 4. She was admitted, transfused blood, and we got Jim involved to see if he wanted to take out this mass. Through further diagnostic tests Jim was concerned that she may have a metastatic choriocarcinoma. Jim consulted me to see if I could give her some chemo, as I have become the resident oncologist in Bill's absence. Her initial pregnancy test was negative, but the rest have come back strongly positive. She has pulmonary and liver mets as well as her large pelvic tumor. I discussed our options with her and her husband and started treatment.

Her husband, Mark, has been a great blessing to her, truly serving her as Christ has the church. He is always attentively caring for her, serving her, and helping her. Almost everyday he tells me that if we can't do anything further he wants to know so he can take her back to the Jimi. Getting back to the Jimi is hard enough, but to take a dead body back is even more difficult. Despite never treating choriocarcinoma before, everyday I have reassured him that I understand his concern, but feel that we still have a shot with this and will let him know when I feel otherwise.

Today, I had to tell him it was too late. I had given her a series of methotrexate injections to try and shrink the tumor to see if it would respond to the chemo and to see if we might get things smaller so Jim can do surgery. She seemed to tolerate the chemo ok despite having some hemoptysis (blood in her sputum) and anemia which required transfusion, and even said she thought the swelling in her abdomen seemed to have gone down. Today, however, things were different. I was rounding with Jessica, a student we have here now, and as we were seeing a different patient, I was distracted as I was watching Kulno laboriously breathing and sweating, and seeing her husband gently sponge her with cool clothes. She didn't look good. When I got to her, I found her with a high fever, an increased respiratory rate and heart rate, and worsening abdominal pain. I was concerned that the tumor might have hemorrhaged causing the worsening abdominal pain, but thankfully the ultrasound didn't support that. However, she is still quite sick.

I told Mark that he had wanted me to tell him when we can't do anything so he can take her home, and today I had to tell him that I was really concerned about her today and I thought she could die. However, it was too late to take her home, as she might even die on the way. I told him I didn't know if what I have to offer is going to make her all better, but I wanted to try. He agreed to stay here and do what we can for her.

I am thankful that I am not the one who decides when folks live and when they die. I am thankful that God is sovereign and in charge of all of that. I am thankful that Mark and Kulno know the Lord and that Mark trusts God with her life. I am thankful that for some reason Mark also trusts me to take care of her to the best of my ability. It is days like today where I realize how much I too trust, and need to trust, Him to guide me and give me wisdom as I care for patients, and how little ability I have without Him.

Pundi

Pundi came to us about a week ago. He had been being treated for anemia as an outpatient, but on admission we determined he had AML - acute myelogenous leukemia. Treatment for AML isn't easy, and the disease is deadly. I have taken care of kids and young adults that died from AML since I have been here, and I lost my grandma to this last April. I know the treatment isn't easy, but it is the only chance we have. When William Walker, pathologist in the US, confirmed the diagnosis, I discussed the reality of the disease with Pundi and his family, and told him that the treatment itself can kill him. He is probably in his 50s, but he is healthy and hasn't been sick prior to this, so they wanted to fight. He is a Christian and trusts the Lord and was willing to give it a try. Pray for him as we start this process of fighting the leukemia and trusting God with his life.

WMM Biomed guys

World Medical Mission is sponsoring me while I am here. WMM sends lots of short term medical missionaries to mission hospitals all over the world, but they also support these hospitals too. The Biomed guys at WMM work hard to get medical supplies to the hospitals and they also service equipment that hospitals need. For the next 2 weeks, 3 of these guys are here working at our hospital. Jim Moore, Bill Wright, and Ken Thomas will spend the next 10 days or so fixing our equipment and helping to get our electrical system in good working order. We are thankful for their service to us.

Ben and Katherine's Graduation

Ben and Katherine Radcliffe will graduate from their medical school at Wright State on the 22nd of May when they get back to the US. Their PNG family won't be able to be there, so we had a little celebration for them here. Ben and Katherine shared testimonies of what God has done and how God has worked in their lives, we sang, others shared memories, and we prayed for them before a time of refreshments and pictures. As Bill put it, it wasn't just a graduation service, it was also a sending service. They were being sent from their home PNG church to the next phase of the medical training, residency, in preparation for the calling God has placed on them - to be medical missionaries. The song, Here I am Lord, is a song I use to sing a lot in the Catholic Church growing up. I enjoyed singing the song when I was younger, but it has only recently really started to mean something to me. The song talks of one hearing God's calling and being willing to say, Here I am, I will go. As we sang that song, I couldn't help but think of my calling from the Lord. The calling He has given me to continue to serve Him as a missionary. I still am trying to figure out where that is, but I can't deny the call He has placed on my life. As I saw the Kudjip station family surround Ben and Katherine with love, prayers, and support, I couldn't help but be thankful for the time God has given me here. The time I have had to be a part of this family and the blessing it has been. I trust God for the future and for His leading in where to serve Him, but until then, I will make the most of my time here with this family.

2 - Forever

Bill and I have been playing tennis since Sept. We play at least 2 times a week, sometimes more. Prior to this weekend, I had only beaten him once. That victory came as a surprise to both of us. I beat him after only playing tennis for 3 months and wasn't very good at that point. Given the number of losses since then it was definitely a fluke. However, I have been getting better and playing more consistently and the goal of winning seemed to be getting closer. However, it still seemed far away. There were days when we were playing and I would be winning 5-2, and then he would come back and win, on other days, he would win 6-1. My mistakes were my limiting factor in winning. I knew once I cut down my mistakes, I had a great chance of winning.

On Wed am, we played before work. We started at 0600 and at 0720 we were at 6-5 deuce, my favor. We continued to play for 10 minutes, and still had the same score. At this point, we had to stop and get ready for work. Given the condition of the court, we often have to redo a point because of the bad bounces that the ball takes, which makes our games go long. We have gotten quite good at adjusting to the bad bounces, reacting and hitting a backhand when you were getting ready to hit a forehand, etc. There have been other times when we were tied and had to stop for various reasons, but we never finished those games, we just started again. This time, I wanted to finish, I was so close to winning. So Sat am we finished. I won the first game and thus won the set. I finally obtained my goal of beating him. However, we went on to play 2 more sets, which he won, which continues my forever number of losses. So after winning on Sat, my goal is to keep winning. Giving our competitive natures, I know it will be a battle each time we hit the court, which makes it fun.