Acute Flaccid Paralysis

We don't know what causes it, but something causes acute paralysis (inability to move arms, legs, etc) in kids. We don't see it too often, but when we do it is always pretty bad. This is Anna and she has AFP. She gives Dr. Bill a daily shoulder shrug as a greeting wave and does little movements with her fingers and toes, but that is about as far as she gets. Thankfully, she didn't get respiratory failure, which can happen, and now it is a long process of rehab for this little girl. She has 2 loving parents who are looking after her, but pray that everyday she would gain more strength and would get better. We just got a PNG PT student and are hoping that Ben working with her will be a big blessing.

Dehydration

We see a lot of dehydrated kids here, but this little baby was one of the worst. Her mom abandoned her at around 4 months and she was being looked after by her grandparents. Then her mom came back and was suppose to be looking after her, but apparently wasn't. So a few weeks later her grandparents found her in this current condition. Pray for this baby, and for this family as they work out whatever issues are preventing the mom from caring for this little baby.

Susan needs your prayers

Imagine one day you are working in the garden and you start feeling a heaviness in your legs. Throughout the day, you notice the heaviness has turned into a weakness of your legs from your knees down and you start having difficulty walking. You go to bed and when you wake up in the morning, it isn't just your lower legs, but now includes your upper legs and you need help to go the bathroom. The next day the weakness and heaviness isn't only confined to your legs, but now has worked it's way up to your arms. You spend most of your day in bed which concerns your family, so they bring you to the hospital Friday evening.

I was on call when Susan arrived. I listened to the history, and then did an exam. I found a 19 year old female who could barely move her legs or arms, had no reflexes, but could feel my hands when

I touched her. When I sat her up to listen to her lungs, she almost fell back except her brothers and sister held her up. I diagnosed her with Guillian Barre Syndrome and was worried she was only going to get worse.

Guillain Barre is an acute ascending paralysis that usually starts in the legs and works it's way up. After the legs, it goes to the arms, and then can get the muscles used for breathing. This is the most feared complication for us, and puts our patients at risk of dying because we don't have a machine, ventilator, that can breathe for them. Many pts, if they aren't already in the hospital when this paralysis occurs, won't make it to us in time to help. When we are faced with a patient who is paralyzed and can't breathe, our options include intubating the patien

t and bagging them until the paralysis recovers (2-4 wks later), or transferring them to a hospital with a ventilator.

So at 6pm on Friday night, I was talking to the family about transferring the pt to Mt. Hagen, where they have a ventilator and an ICU, so that when she stops breathing, she would be in a hospital that could care for her. The family agreed, so off she went to Hagen, only to return to us on Sunday, as their ventilator doesn't work. When she returned, she wasn't moving her

her arms or her legs, could barely talk, but was still breathing. Within 8 hours, she stopped being able to breathe on her own and Dr. Scott, who was on call, intubated her. He explained to the family, the need for them to continuously squeeze the bag which would breathe for her. If they stopped she would die. All night long, they faithfully squeezed the bag over and over about 20-30 times a minute breathing for Susan.

I had no idea that Susan had returned to us when I started my rounds on Monday am. It didn't take me long to find Susan and a faithful wasmeri sitting at

her bedside squeezing life into Susan's lungs. I knew the situation in front of us wasn't good. We can only keep breathing for someone for so long, because eventually the tube will come dislodged, someone will fall asleep and quit squeezing the back and she will die. As I talked to Bill about the case, he said to try and see if the pt can be transferred to Port Moresby General Hospital. So I start making phone calls, many phone calls. After 2 hours and having hurdled many obstacles, I find myself along with Grace (an anesthesia training officer), and 3 of Susan's brothers in the back of our ambulance on the way to the Mt. Hagen airport to get on a MAF (Mission Aviation Fellowship) airplane to go to Port Moresby General Hospital.

The trip wasn't easy, with numerous tube readjustments we made when her sats dropped, got low on oxygen and had to change bottles, and she almost fell off the backboard as we put her into the plane, but God was with us. We prayed numerous times along the way, but specifically with Susan as we started to make our way to the runway. Grace and I got to talk to her about Christ. She has gone to church, but isn't a Christian and so we got to share with her about Jesus's love for her. 2.5 hours later we landed in Port Moresby at the airport waiting for the ambulance to pick her up and take her to the hospital where doctors were waiting to put her on a ventilator and breathe for her.

On the 2.5 hr trip home, I couldn't help but pray for Susan and I ask that you would too. Pray for her to know the one who died for her. Pray for the doctors in Port Moresby to know how best to care for her. Pray that the ventilator would be able to sustain her until she is able to breathe on her own again (2-4 wks from now). Pray for her family as they look after her and care for her while she is there.

Pray for Paul

Paul was playing rugby when he got hit in the head. After that he lost sensation and movement of his legs and most of his arms. He could shrug his shoulders and that was about all. His friends wisely brought him to the hospital shortly after this. His xray revealed he had a C6-C7 dislocation of his cervical spine which was causing his paralysis. Before Jim left on Monday, he was able to track down some cervical traction tongs from Kundiawa hospital and have them brought to us so he could put Paul in them. The first attempt at reduction didn't fully straighten out his spine, but further weights and positioning did. So the xray on Tues showed normal alignment of his cervical spine, then it became a waiting game. I wasn't really sure how long it would take for him to regain his function, even asking Bill how long I should expect to wait before we see a change, and he said keep waiting. So since Monday, every day I see him I ask him to move his fingers and every day he says he can't. On Thurs, when I asked him this, he said he can't, but as I am looking at his fingers I see his index finger moving. Yeah. On Friday, he can move all his fingers, his toes, and bend his knees. The traction is working.

Paul has a long road ahead of him. He will be with us for a couple months in traction to stabilize his spine. Pray for him. He isn't a christian and I when I see him every day I pray with him and have shared the gospel with him. Pray that during his time here that he would draw closer to Jesus and that he would know the true healer. Pray also for his patience and ability to hang in there as his spine heals.

Too many goodbyes

This past few days we have had to say goodbye to lots of our family here. Sam Bennett and his friend, Jonathon, spent the summer back at Kudjip. Andy and Judy sure enjoyed having their boys for the summer and will greatly miss them, as will Sam's PNG family, and the rest of us.

The Radcliffes also headed out for their home assignment. Jim will be teaching at Mount Vernon Nazarene University this coming semester, so they will be nearby for Cilla who starts at MVNU.

Unfortunately, Cilla won't be

returning with the rest of her family when they come back to Kudjip. We will miss her and will be praying for her as she transitions to college in the US. They all are looking forward to seeing their twin granddaughters/nieces when they get home.

Problems in a Csection

Problem 1 - former nurse with a transverse lie (baby sleeping sideways in mom's belly) in labor

How to solve problem 1 - needs a Csection

Problem 2 - pt has a fibroid in her uterus (a benign muscular growth)

How to solve problem 2 - ultrasound to see position of baby and location of fibroid, thankful the baby's back is up and won't require a classical incision

Problem 3 - due to fibroid the Csection will be more difficult and it is 0630 and I am a Family Practice doctor who doesn't have any formal training in high-risk Csections or surgery

How to solve problem 3 - see Jim and briefly discuss with him, recommends get good help - wake up Becky to see if will help, find Jim in OT waiting for us

Problem 4 - while gowning up for the surgery, a handle of the OT faucet breaks off the wall leaving a hole in the wall and hot water pouring on the floor

How to solve problem 4 - have someone try and put the handle back in the wall, call Marsha to call maintenance, rescrub/gown

Problem 5 - the spinal didn't fully set up

How to solve problem 5 - use lidocaine as needed, start incision lower, only cut up if necessary, give other meds as preparing to take baby out

Problem 6 - the suction machine was broken in the process of trying to get it to work

How to solve problem 6 - jerry rig it to get through the case

Problem 7 - can't feel fibroid when get to uterus

How to solve problem 7 - reconfirm with Jim, who is standing by, where to make the incision

Problem 8 - the uterine incision went right through the fibroid, blood is filling up in her belly, I can't get into the uterus itself nor find any part of the baby

How to solve problem 8 - pray, ask Jim to quickly gown and help out, hold pressure

Problem 9 - the uterine incision went right through the fibroid, about 2 inches in and no baby yet

How to solve problem 9 - pray as Jim just keeps going and going and going until he finally gets inside the uterine cavity

Problem 10 - the baby is breech and the fibroid is making the extraction very difficult

How to solve problem 10 - pray and keep going, retractors, bandage scissors, more prayer

Problem 11 - baby somewhat depressed after delivery

How to solve problem 11 - Becky breaks scrub and helps out baby catcher

Problem 12 - there is a huge fibroid in her uterus, making the closure difficult

How to solve problem 12 - keep sewing, layer by layer, until the bleeding stops

Problem 13 - she and/or next baby may not survive another Csection

How to solve problem 13 - send Becky to talk to husband about a BTL, he gives consent, and do the tubal

Problem 14 - the uterus is still bleeding

How to solve problem 14 - pressure, more stitches, surgicel

Problems 1-14 - by God's grace were solved and we had a healthy mom and baby at the end

Problem 15 - the work day is just beginning

How to solve problem 15 - thanking God for what He has just done and asking for strength to keep going

Bible Study

Every Wednesday night, slowly but steadily, we are working our way through the book of John in our ladies bible study. We are in the middle of Ch.8 now, but still have a ways to go. It has been fun to get to know some of the ladies who I work with everyday. Recently, Maggie (in middle of pic on R), a PNG doctor who came to work with Jim for the past 3 months, has been joining us. It has been great to get to know her and to be encouraged by the work she is doing in the Gulf Province. She is the only doctor at her small hospital, and through the Rural Registrar program spent 3 months with Jim learning surgery. We are sad to see her go, but look forward to her return to us next year.

Riggin's Carnival

Scot, Jill, Aden, Wiley and Noah will be leaving their PNG home in September and head to a new, yet unknown, mission station. On Sunday, we had a carnival in the park to celebrate and remember them. The carnival was complete with games - bowling, croquet, bubble blowing contest, face painting, bean bag toss and more. The Dooley's made funnel cakes, which were a hit, despite the majority of folks here having never heard of them. We also had popcorn and cooked hot dogs over the fire. Following the carnival, we

gathered at the McCoys (due to rain) and

shared stories about the Riggins family. We are all going to miss them. Pray for them as they enjoy their last few weeks here. Pray especially for Aden, who understands what is about to happen and is struggling with having to say good-bye.

The river can be dangerous

This little guy was in the river playing when he slipped and fell. He didn't know exactly what he fell on, but he felt something going inside his rectum. This happened 24 hrs before he was carried into our ER by his family. He complained of abdominal pain and had vomited once today. He was a tough kid. His belly was soft, but diffusely tender. I was concerned that the stick may have perforated his rectum, so I got a xray. Just that morning, I had explained to Charlotte, the new medical student, the importance of looking for free air under the diaphragm on xray, but I had never seen it. But this time it was there. I talked to Jim and he agreed he needed surgery and took him to the OT. He started crying when we told him he needed surgery, but he let me pray for him and then off he went. They found 2 perforations in his colon in surgery, but thankfully he is doing well. I am thankful for the opportunity to serve and help him.

Best and Worst

One of the best things about going to climb Mt. Wilhelm is the view that you get as you drive on the 3 hr road from Kundiawa to Kegsugal. With mountains all around and the river below, it is very picturesque. The more you look, the more you notice how many gardens are up on the hillsides. You can follow the zigzag dirt paths that gardeners daily travel to work their gardens. Some of the gardens are right on the edge of a cliff, how the people don't fall, I am not sure. They sure are making every effort to use all the land they can.

One of the worst things about going to climb Mt. Wilhelm is the 3 hr drive from Kundiawa to Kegsugal. The dirt road has many ruts and

rocks along the way making for a very bumpy ride. Not only that, but it is only a one lane road with very few opportunities to get by another car, thankfu

lly there isn't a lot of traffic, but if there was you would be in trouble. The beauty of the hillsides and water, also require you to cross 14 bridges to get to the Kegsugal. This wouldn't be bad if the bridges were sturdy like in the US, but they aren't. One bridge in particular had almost no wooden boards across, just the rails of the bridge and 2 rows of boards for the vehicle to ride on. Thankfully, Bill was able to get the vehicles safely across while the rest of us wa

lked. We also had a wooden bridge with no sides if drove anywhere other than the middle you were risking a fall. If the bridges themselves weren't bad enough, there was also a bridge that was guarded by some locals who were demanding a bridge toll and had a tree in the middle of the bridge. Thankfully, the bridge itself was fine and we just had to pay the 10 Kina and crossed without difficulty.

Lost without the ultrasound

When you don't have a CT scan or an MRI, the ultrasound machine becomes your best friend, at least it has been our best friend. About 2 yrs ago we got a new ultrasound machine, which is really nice, and so we use it for everything. We use it to see babies inside mommies, to see if the fluid in the abdomen can be drained, to see if the enlarged heart on CXR is fluid in the sac around the heart or just a large heart, to see if the abdominal pain is caused by an abscess in the pelvis or if the pt has a ruptured ectopic pregnancy and blood in the belly. We use it at least 50 times a day, if not more. We have a whole room just for the ultrasound machine and the exams that we do, but we also take it with us to the wards and ER. It is probably out of it's room about a quarter of the day because we are using it everywhere else.

As we recently found out, we rely on it a lot. About 2 wks ago, I needed the US in the ER and when I got it to the ER, the battery was almost dead, so I needed to plug it in. Unfortunately, when I did that, it didn't work, the machine wasn't getting the power from the plug, something was wrong. I kept trying to play with it, and when I couldn't get it I asked others. None of us could get it to work, and so we were stuck without our good ultrasound machine. The machine we have to use is like a 1950

TV compared to a modern flatscreen HDTV that you might buy today, it wasn't even close. However, it was all we had, so we were happy for something.

I was trying to see if a lady was pregnant and had to really strain hard to find anything that looked like a baby on the US. I started ordering more pregnancy tests than I ever did before because I couldn't rely on what I was seeing. We all wanted our good machine back, but the McCoys were unable to get the parts before they left (we only gave them about 4 days notice). So we were stuck with our old machine that Jim kept in his surgery clinic, but hadn't used in a long time because our other machine was so much better. For about 10 days we have suffered without our US machine. Then today, Jim tells me that he was fiddling with the cord and got it to register, he taped it in the position it needs to be in and this afternoon we were able to use the machine, praise God. We should be getting our new cord on the 9th of August, which will help us so we don't have all the tape on the machine, but we will take what we got for now.

Wilhelm firsts

Climbing up to Wilhelm was a first for many people on the trip. Susan, Scot Riggins and I were the only ones who had made it to the top previously, but now a number of us say we have done it.

Jeff Myers has gone 2 previous times and for various reasons wasn't able to make it all the way up. This time, with the help of his family's support, the guides in his

group, and the strength of our Lord, he made it. The whole Myers family made it, which was very special for them.

Bill also has never been to Wilhelm despite being here for 14 yrs and having climbed lots of other mountains around here. He seemed to often be on furlough when trips occurred, but not this time. It was fun to be able to climb it together with Bill.

Cilla (see prev blog), Jordan, Jonathon, Nicholas, and Apa (one of our maintenance guys) also made it up for their first time. Nicholas is a UK med student with us who has climbed the highest mountains in 10 countries in which he has traveled. Unfortunately, his shoes weren't quite made for hiking and pretty much fell apart about 3/4s of the way up, but he kept going. He was hurting pretty good on the way down and Jonathon, a friend of Sam Bennett's and an MK who often goes barefoot, gave Nicholas his shoes to wear. Nicholas felt much better with some protection over his feet, and Jonathon won the respect of all of us with his act of service to Nicholas.

Kudjip summited Mt. Wilhelm

On Friday, 12 missionaries and 2 PNG nationals traveled from Kudjip to Kundiawa to Kegsugal to start the trek to the summit of Mt. Wilhelm. We had some rain on Friday as we got to Kegsugal, so our trip to base camp was delayed some and we got a little wet, but it could have been much worse. 2 yrs ago when I went, I thought the trip up to base camp was tougher than the trip to the top. I was carrying a pack up the whole way and it probably didn't help, so this year I decided to pay the 20K and have someone carry it up for me. This was definitely the way to go, and I enjoyed the walk up to base camp so much more this year. We managed to get to base camp around 5pm, enough time to fill up our water bottles and have Bill try and catch a fish, before it got dark. We enjoyed a dinner of maggie noodles and crackers and then went to bed.

We started our journey around 0430 on Saturday, thankfully the

rain had stopped. At one of our first breaks, Susan made up a rendition of This is the Day that we climb Wilhelm, We will rejoice when we get to the top. It was cute. We had 4 guides so were split up into 3 groups of 4. Bill, Jonathon, and Cilla made up our group with Michael, our guide. Cilla was feeling sick, even before we started, but she toughed it out and showed a lot of courage as we made our way all the way to the top. She is now the 4th Radcliffe child to make their way to the top, and is one of the main reasons why this trip occurred to begin with. She made up a list of things she wanted to do before she left for college and Mt.

Wilhelm was on there, she can now check it off.

We got to the top after the other groups, but they were all up there, so we got to enjoy the summit together. We attempted to get a group photo, but the camera was on zoom, and the guide didn't know how to unzoom, so he got some of us. After we enjoyed a brief bite to eat up top, we started our way down. At times, coming down was harder than

going up, but we made it. We got down to base camp in enough time to walk to the car. This required an extra 2.5 hours of hiking, but then we just had to drive today (sunday) and not do any other hiking,

which was nice. We enjoyed a nice night at the home of Willie, one of our guides, and his family, who allowed us to sleep in one of their houses and their cookhouse. I got 10 hrs of much needed sleep, so I appreciated it. Then we made the 4 hr drive back to Kudjip today and rested.

Habakkuk 3:19 "The Sovereign Lord is my strength; he makes my feet like the feet of a deer, he enables me to go to the heights."