Worship on the Wards

Sunday a number of us spent time on the wards singing, praying and sharing a Bible story with the patients.  Jeff shared with the patients a story of David and Goliath, encouraging them to trust and believe in our Lord just as young David did when he went up against Goliath.  We prayed with patients hearing their struggles and stories of their faith or lack of faith in Jesus.  Some came to know Christ, others were encouraged and strengthened in their faith, and all smiled and shared a laugh or two as we talked and sang with them.  It was a great time of worship for us all.  

NCON students

We have a nursing school here that enrolls 25 students a year and 3 years later 25 new nurses leave the classrooms to serve the Lord all over PNG as nurses.  Some stay here and work with us, others go back home, or go to remote areas where God has called them.  Everyone at the hospital gets the opportunity to train them in one way or another.  Bosip, is one of our CHWs who works with our surgery team, but he is also one of our main orthopedic guys.  He does a lot of our casting and splinting, so one day I found him giving instructions to all the nursing students in our ortho room.  In PNG, the nurses are often the only health workers at small health centers and aidposts throughout PNG, so putting on a cast is something they may very well be doing when they leave.

Finally off

Peter is a little 7 yo who has bone cancer.  We first met Peter about 10 months ago when his family brought him in because his leg had started to swell.  His xray showed an abnormality in his bone and a biopsy proved it was cancer.  Our options for bone cancer are limited.  Amputation is what we recommend because our ability to get a cure or remission with chemo is right around 0%.  We always offer amputation to the patient and family, but almost always they stall and when they do finally come around to agree to it, it is too late because the cancer has spread. 

 

Dying from cancer is not fun for anyone, but to watch a little child suffer as his leg grows to 3 or 4 times it’s normal size, while the rest of his body turns into a skeleton is painful.  I have seen it more times than I want to already in my young career, so I strongly encourage patients and families to allow us to do an amputation. 

What child wants to have his leg amputated?  None of them.  What parent wants to allow their child’s leg to be amputated?  None of them.  I can’t blame them.  In a society and culture where walking is a necessity, where there aren’t prosthetic legs readily available, where folks who can’t get around likely won’t get married, won’t be able to provide for their families, won’t be able to outrun the enemy in a tribal fight, having an amputation is like a death sentence.  Trying to convince them they are going to die from this thing we call cancer isn’t easy. 

The families always want to try every other option like chemotherapy, radiation, herbal medicine and bush medicine before agreeing to surgery.  Thankfully for Peter, the chemo knocked his cancer down enough that when his knee started swelling again, the family had enough time to finally agree to allow us to do surgery before it was too late.  As far as we know there is no sign of spread, but only time will tell. 

Peter was a trooper, I saw a few tears in the days leading up to surgery, but he went into surgery fine and came out doing well and smiling as I saw him before he went home.  Pray that we did get it all and that the chemo we give him will work to knock down any residual cancer.  Pray that he will adjust to his one leg and that he will find strength in the one who died for Him.  Pray for his parents who made a tough decision, that they may be able to enjoy Peter in their house for a long time yet.  

Surgical Excitement

Thankfully, our surgery day wasn’t jammed full of cases.  As David went to start to give some anesthesia to our first case, he turned on the machine and we all heard a hissing sound – something was leaking.  David, Jim, the scrub nurses, the nursing students and myself all walked toward the anesthesia machine trying to determine where the hissing sound was coming from.  You could see us bending down listening to all the hoses that came and went from the machine – but they were all quiet, but still the hissing came.  We turned off the oxygen and the hissing stopped, so we identified what was leaking, but where was still the problem.  Finally, someone got on the floor and heard the hissing getting louder and identified the leak, but now we had to get to it, which required taking off the back of the anesthesia machine.  I went to Jim’s house for some tools while someone else called maintenance. 

 We got the back of the machine off and found the part that was leaking.  We reconnected it and tried it – still a hissing sound.  Now what?  Thankfully, we had another machine in our minor procedure room, so David set out to disconnect everything from the machine so it could be worked on, and then reconnect everything to the machine from the MPR.  It was a good 1-1.5 hrs of delay, but the 2^nd machine worked just fine and we were able to start our cases.  Jordan, one of our maintenance guys, was able to fix the problem and we now have 2 functioning machines once again. 

As a doctor on the mission field, knowing medicine isn’t all that is required or helpful.  Knowing something about power, how to run a generator, and how to take apart anesthesia machines are also quite helpful. I guess, in general, knowing how to fix things is quite helpful, unfortunately, this is not a gift I have.  Thankfully, there is a team of us here.  

A battle for their lives

In the Highlands of Papua New Guinea, kids between the ages of 2-6 yo are fighting a battle for their lives and they don’t even know it.  For many, the odds are against them. 

The culture in the Highlands of PNG is one of subsistence farming where many eat what grows out of their garden and only occasionally enjoy protein at mumu celebrations.  As a result, the majority of kids are malnourished and don’t have enough of the enzyme needed to breakdown protein.  Kaukau (sweet potateo), their dietary staple, also serves to inhibit what enzymes they do have.  As a result, when they do eat meat, which is often undercooked, the bacteria (clostridium perfringens) found in the meat  produces a toxin that wages war on the child’s small intestine. 

The kids don’t know any of this, they run and play, eating meat and celebrating with their family one day and in a day or 2 they start to complain of abdominal pain.  Pain is usually just after eating, but sometimes drinking will cause pain too.  The pain is severe enough that they are miserable, crying, and writhing on the beds in pain.  Their abdomens start to swell and they have both diarrhea and vomiting, usually bloody or black. 

Early antibiotics are the key to treatment, but too often the kids don’t come in until they have been sick for 3-5 days.  We give them IVFs, antibiotics, put a tube in their nose to empty out what is in their stomach, get labs and xrays and we pray.  We watch them daily to see how they are or aren’t responding and Jim makes the tough decision of when and if they need surgery.  Occasionally, they get better without surgery, but often they need surgery, which brings no guarantee that they will survive. 

In the past 6 weeks, this disease, which for years had disappeared when the government was supplying the vaccine, has seemed to come back with a vengeance.  There have been at least 10 kids that I have known of who have had pigbel.  Some had extensive small bowel resections in surgery and survived, one child died in the ER before we could do anything but start an IV and give one dose of antibiotics, children have died in surgery and just after surgery – their bodies so sick from the toxins that even when we try and take out the diseased portion of bowel, it isn’t enough, but some have made it even without surgery.  

Pigbel is a killing off too many of our little kids, yet to stop it we need to change the only culture they have known their whole lives.  Pray for wisdom for all of us to know where to go from here.  Pray for Jim to know when and if to do surgery on these kids.  Pray for those working on educating the public about this and steps they can take to decrease the chance their kid may get pigbel.  Pray that the government make look into supplying the vaccine once again. 

Time in Surgery

The past few weeks, I have had the opportunity to work in surgery with Jim and Scott Pringle, a volunteer, OB/Gyn who is here for his 2^nd 3 month stint.  I have always enjoyed surgery, especially after my time in Ghana, Africa as a student and resident, where I worked in a mission hospital and where the surgeons there let me do so much.  I am thankful  I get to do C/Sections here regularly, but I do enjoy being in there for other things also.  Usually, I am needed in clinic to help see all our outpts everyday, so it isn’t feasible for me to spend time in the OT much, but we currently have some extra help and so I am able to do some more surgery. 

It has been great to work with both Jim and Scott and to learn from them and to have them teach me how to do various surgeries.  There are times when Jim isn’t around and we have to send all of our surgical cases to Mt. Hagen, an hour by ambulance to have them seen.  I know I will never be able to do everything that Jim does, but maybe I could learn enough to become proficient at somethings, like ruptured ectopics which would help folks out, we shall see.  

Young Adult Fellowship

For the past 3 months we have had a young adult get together of one sort or the other, usually involving playing games and eating.  This month we had a Mexican Potluck and enjoyed some games we could play mostly in the dark since the power was out a lot.  We had a good time and enjoy having all the new volunteers join us when we get together, this time we had Jennifer, an Image resident, and Andy and Amanda Peters (med student and his wife).  

People waiting to be seen

Our hospital served over 45,000 people last year, they come from all over PNG to be seen and cared for, but most come from right around our area.    These are some recent pics of a few people waiting to be seen in our OPD area.  The 3 ladies were all excited when I shared some pineapples with them.  The little boy on the R was being looked after by his slightly older sibling as they were hanging out by Xray.  It is a privilege to be able to be here serving them and many others who come.

"Dokta, can I have some chocolate please?"

I got called by Jennifer, the resident I was on call with, that there was a 8 yo kid in the ER who was crying, talking nonsense and was hard to control.  When I got here, I found a grandpa trying to prevent his grandson from falling off the bed.  His mom and grandpa told me that he had fine until the day before, when he got a fever, started talking nonsense and just started crying.  No matter what they did, he just kept crying and moving all around.

Jennifer and I examined him and then talked to his mom about having to do a lumbar puncture to make sure he didn’t have meningitis.  It was a difficult LP, with Bande moving all over the place, but Jennifer got it.  After we got it, I gave Bande antibiotics and then sedated him to try and keep him under control so he didn’t pull out his IV.  

The next day, he was just sleeping and he didn't talk to me, mom said he continued to cry when the shots wore off overnight.  We kept him on IV fluids and the antibiotics for an infection in his brain and prayed God would make him better.  The next day, mom reported that he had sat up and ate a little bit, but everytime I saw him, he was still sleeping.  

The 3rd day of admission, Bande was sleeping, or it seemed so, and I was talking to mom about how he was doing, when I hear this little voice coming from the bed.  "Dokta?"  "Dokta?"  I realized it was Bande talking to me, so I bend down so I am right in front of his face and say "Yes Bande."  Then this little cute voice says, "Dokta, can I have some chocolate please?"  I look at his mom, with a puzzled look on my face, "Chocolate?" I say, "Is he asking me for chocolate?"  She says, yes, with an embarassed look on her face.  A minute later, I hear "Dokta, can I have a biscuit (cookie)?"

I thought he was still too sick and sedated to know what was going on, but here is this little boy asking me for chocolate cookies.  I have never given chocolate cookies to any other kid, I don't know why he thought I would have them and why he asked for them, but since he did, I sure did give them to him.  I went home and got a package of Oreo's that I had gotten in town and took it back down to him.  He was asleep when I got back there, but I told his mom to share with the other kids when he woke up.  She said she would.  The next day, he was all smiles when I saw him, he apparently liked his chocolate cookies.  

A few days later, he was well enough to be sitting up.  He ended up with an infection of his brain that has currently weakened the left side of his body, but we managed to play catch the day before he went home.  We don't know how much residual weakness he might have, but will you pray with us that it will all resolve quickly.