Christine’s Blog

Home Again

After two very long days of travel and a few very fun hours in Narita, Japan, Ryan and I are finally home and what an adjustment it has been already!  First of all, we went from a sunny, tropical country right into the middle of a snow storm.  I don’t know how many inches are currently on the ground, but the snow is still falling.  Also, it’s amazing for me to realize now just how loud the United States is.  We went out to dinner last night and were struck by the noise that made talking impossible.  On the happy side, I can wear jeans again. : )  And of course it’s good to see friends.  However, what I want to write about today is what I miss about PNG.

I already mentioned the weather, but I do love the sun, so I miss the intense sun and the brilliantly blue sky.  I also miss the rain and the thunderstorms.  The rain in PNG is the most beautifully relaxing sound to fall asleep to at night.

I miss walking to work in the morning.  What a perfect commute!

I miss seeing the mountains on that walk to and from work.  And I miss the view of the mountains from behind the pharmacy building.  I always paused for a moment before I went in to check on the availability of whichever medication I was interested in using that day.

I miss seeing patients in the clinic, getting labs and x-rays, and having a follow-up appointment all in the same day.

I miss going to the market to get all sorts of fresh fruits and vegetables, but I don’t miss soaking them in bleach afterwards. : )

I miss the wild flowers, which were everywhere!

I miss all the doctors and other missionaries I worked with, and I miss the rest of the staff at the hospital, like Betty and Joe.

I miss speaking pidgin, or at least attempting to.

I miss all the geckos that kept us company around, and occasionally in, our apartment.

I miss how everyone said hi to us as we walked around.

And I miss the wonderfully quiet evenings….

Thank you again to everyone who supported us in this adventure through money, prayers, and encouraging words.  We couldn’t have done it without you.  God has certainly touched us through our experience in this beautiful corner of the world and we hope to touch you through what we have learned.

With much love,

Christine

What’s wrong with this patient?

Here’s another X-Ray challenge.  Any takers?

My Patients

A talented doctor and wonderful servant of the Lord has taught me that we must remember the individual patients who touch us in a setting like this. Now this will be a sad blog, I’ll warn you now, but there are a few patients I feel I need to write about. And there’s a happy ending, I promise. : )First of all, I have to start with Junior. He is a boy in his late teens who I wrote about in an earlier blog. He arrived in the ER with a horrible fever and had been sick for some time. In the end the diagnosis was endocarditis partly supported by the fact he had a stroke soon after admission. Well, Junior continued on antibiotics in the ward for several more weeks, and whether or not I was rounding on the medicine ward I have tried to visit him when I could. With lots of antibiotics running through his veins and his family by his side, he slowly got stronger. First he would sit up in bed with his mom holding him, then by himself. Soon I saw him out around the hospital in a wheelchair getting some sunshine. He still can’t move his right side, but he has an amazing smile. : ) I don’t know if he will ever recover function of his right side, but the boy who went home a few days ago certainly looks better than the feverish, unresponsive Junior I first met some weeks ago.

Death is as much a part of life here as anything else some days. But it’s been new to me. In the States I never saw children as sick as Melinda and Jack Joes. Melinda arrived in the ER on a Friday afternoon. This child of about 3 or 4 was sick, weak, and cold to the touch. We went to work immediately starting IV fluids, giving her antibiotics, and even putting a warm lamp over her to try to warm her small body. I don’t know what she was like before she got sick but I imagine she was full of energy. The child in front of me, however, was nearly lifeless. We started all the appropriate medicines and lab work and admitted her to the hospital. She died that night.

The next day, Saturday, I was on call and in the ER again. There I met Jack Joes and it was almost like déjà vu. This small child, again around 3 or 4, was limp and cold to the touch. And again we went to work with IV fluids, antibiotics, and admission to the pediatric ward. But that night at around 7:00 pm I received a phone call that there was an arrest in the pediatric ward. The whole way to the hospital I feared it would be little Jack and prayed that it wouldn’t be. However, when I reached the ward I found CPR in progress on little Jack’s now lifeless body.

Two days. Two admissions. Two deaths.

Last night I met Baby of Clement. In PNG parents often do not name their children immediately due to the high infant mortality rate. To give a child a name is to become attached. Little “baby of” was only four days old. He had been born at home in the village with no complications, but the day before he had started having a fever. Tonight in the ER he had already had one or two apneic episodes, short periods where he stopped breathing. When I first saw him he was breathing but struggling for air. We kept him on oxygen and immediately started IV fluids and antibiotics. He was breathing when I left him around 2:00 am, but when I arrived on the pediatrics ward at 3:30 they had already been breathing for tiny “baby of” using a bag-valve mask for at least half an hour. We kept breathing for him for another hour, but he never again took a breath on his own. Four days old and he was gone from this world.

One last story – I met another “baby of.” This one is baby of Maria. He started getting sick the day after he was born. He started having seizures and many apneic spells. When I first met him, he wasn’t breathing. But, within a minute or two of ventilating this baby by hand, he started pulling in wind once more. Over the next few days, that scenario replayed many times. Baby of stopped breathing, he was ventilated with the bag valve mask, and he came right back. Same as the other children, this little one has been on many medications. He has also had the watchful eye of his mother and grandmother on him constantly watching his breathing and calling out to the staff the moment there was a problem. In fact, I don’t think a moment went by those first few days when somebody wasn’t looking at this baby.

And now, for the time being this baby seems to have beat the odds and is getting better despite how very sick he was. He is still in the hospital on multiple IV antibiotics, but he has been free of apnea and seizures for about 5 days now and we are praying for a full and complete recovery! So amidst so many sad stories of lives snatched away by disease when they were just beginning, there is hope in happy stories like Maria’s baby. Thinking about the babies and small children we couldn’t save can be depressing and frustrating. It almost makes our actions seem futile without little ones like “baby of Maria.” I will always remember him and the fact that we must do our best for these little ones even if we can’t save them all.

Sunday, February 7, 2010

Which side of the river are you from?

Kudjip Nazarene Hospital has a specific area that it primarily serves, the Jiwaka province, with some very specific boundaries. Other parts of the country are covered by other hospitals. This is important for multiple reasons. Patient fees are based on whether someone is from Jiwaka or “longwe”. When the hospital is full, we close to “longwe” admissions altogether and refer those patients to other hospitals. This was the case a couple weeks ago in the medical ward when we had 5 people on the floor. And lastly, we only have one surgeon here, and as amazing as Dr. Jim is he can’t take every surgical patient in all of PNG, so we don’t accept longwe surgical patients unless it’s an emergency.

I’m explaining all this because a week or so ago I had a patient who had been injured 2 weeks previously and by ultrasound had a ruptured spleen. Because it happened two weeks ago it wasn’t an emergency at the moment, but it was unclear whether this man would need surgery or not. He certainly needed to be monitored to see if he was continuing to bleed. Since it was possible he would need surgery it was very important for us to determine whether he was longwe or not in case we need to refer him to another hospital.

He was from a village called Tuning, which is right on the edge of our hospital’s territory. In fact, the specific boundary is a river that goes right through Tuning. So the question gets more specific - Which side of the river are you from, Jiwaka side or Hagen side? The problem with this particular boundary is that the people of Tuning don’t make that distinction. They consider all of Tuning to be Jiwaka.

This past Thursday Ryan and I had a chance to go to Tuning. Part of the community based health program here is the Village Birth Attendant program and Tuning just graduated 8 new VBA’s. It was a very exciting time for the community with a ceremony and mumu. It was great for us to be a part of but really needs a blog all it’s own.

For me, it was great to go to Tuning that day and realize how far my patient had come and what this river was everyone kept talking about. Tuning was about 45 minutes to an hour away by car down a very bumpy, rocky road. Now imagine taking that road right after a large branch hit you in the back and you’re in extreme pain, and that’s assuming anyone is around with a vehicle who could take you. Suddenly it makes more sense why I saw this man two weeks after the accident. He was still in pain, but probably nothing like the day it had happened. And then to be asked what side of the river you’re from, knowing if you answer wrong you may be sent on another long car ride…

In the end, my patient answered Jiwaka side and stayed at our hospital. He never needed surgery, but Jim monitored him on the surgical ward to make sure he was alright. The hospital has to have boundaries, that’s an absolute necessity. But it’s interesting to see what those boundaries mean for those living on the edge. For those living in Tuning perhaps a simpler boundary can be found, but for now the question is still - What side of the river do you live on?

Saturday, February 6, 2010

A Day In the Life

This past Wednesday Ryan came with me to the hospital for the day to see more of what my life is like.  I think he enjoyed his time and more importantly, it means we have pictures.  : ) So welcome to B ward, the medical unit where my day started with rounds at 8:00.

Here is a picture of my half of the ward where I worked with Dr. Erin to see somewhere around 15 patients.  If Ryan had turned around 180 degrees and taken another picture it looks basically the same on the other end of the ward.  In the middle is the nurses’ station.

So one by one we made our way around the room talking to each patient, asking how they were doing, ordering labs and making adjustments to their medications as necessary.   It is not uncommon to pull the ultrasound machine up to the ward to scan someone along the way as well.

After we finish rounds, all the doctors head towards OPD, the outpatient department to start seeing patients.  Patients line up outside the building where they are first screened by nurses who take their history and vitals.  Simple problems the nurses will treat and send the patients home, but if they decide it is too complicated the patient continues on to the line to see the doctor.

I’ve spent some time in OPD seeing patients, but I generally check the ER first and take care of any patients that need to be seen there.  That’s where I am in this picture.  My patient is laying on a hard metal bed covered by a sheet of plastic.  The book down by his feet is his scale book.  Every patient has a book that they take to any medical facility they go to.  That is where we leave notes on the patient’s visit, prescriptions, and follow-up appointments.  Theoretically you can see a patient’s whole medical history by looking through this book.  Theoretically…

We stop seeing patients around noon and head off for lunch.  Ryan and I actually ventured off the station this day for lunch (instead of our typical PB&J).  We skipped on the betel nuts and cigarettes and went for flour balls and Coke.

Now flour balls are something like doughnuts holes, but not really.  They’re deep fried dough but much denser than doughnut holes and not coated in sugar.  They’re actually really filling.  And anyone who knows me knows I really can’t stand Coke, but it actually tastes different here!  I like the stuff!  All I can come up with is that it doesn’t have high fructose corn syrup in it.

Anyway, after lunch it’s back to more of the same.  We keep seeing patients in OPD and the ER usually until about 4:30 or 5. For the next pictures in order - First is me talking to the son of a patient whose prognosis was not very good.  Next is me doing a paracentesis on a man with extremely bad ascites.  I had taken 3 L off his belly the previous Saturday. This Wednesday he was still short of breath so I took off 3 more liters.  After that is me doing a lumbar puncture on a boy with a febrile illness of some sort.  Then me ultrasounding another patient’s belly in an attempt to figure out what his problem was. (Where’s a CT scanner when you need one…)  And of course, there is always plenty of paperwork to be done.  Although it is substantially less here compared to in the States. But that is how the afternoon continued until all the patients had been seen.

However, this particular day I was also on call.  So while I went home for dinner I was soon called back to the ER.  For those who read what Ryan put in the last blog entry, this is when I met the boy with the fish hook in his toe. And here’s a picture of that as well. : )

Thursday, February 4, 2010

So, What do They Really Need?

I’ve been teaching everything that I thought was long forgotten from my mind to a couple of nationals regarding electrical work, plumbing, appliance repair, and most importantly solar heating tech. The preferred method of training in PNG is apprenticeship, meaning that no matter how I explain the technology, they want to see me do it and then have me watch them before they even want to touch a job themselves. There are a few schools and training centers around; however, it seems like the majority of professionals/technicians learned their skill by working with someone else for a span of time before branching out on their own, or before the unfortunate passing of their aforementioned mentor.

My computer skills seem antiquated in the states. At times I wonder if my degree is actually in Punchcard Technology; however, here they will take whatever they can get, and old items are not thrown away simply on an account of age. You never know when you might need that MS-dos 3.5′” floppy disk again–yes I did have to use such a disk in the course of my repairs here. The Tech Center, where I spend much of my time, looks more like a technology antiques display; however, if you love to “MacGuyver” things, then the mission field has plenty of opportunities. I have married the old and new of the world of computers to make somethings work and the fun part is that what would be scoffed at back home, becomes someone’s first computer that saves them hours of overtime and walking here.

There is more more need here–with the nationals and the mission–than any one person has time to address. The point of interest that I continue to find is that you do not have to be an expert in any certain field to help. The smallest bit of knowledge is something that can be taught to and savored by another. What is considered a very common skill for most of us, can become a profession and a means of support for an individual over here. Granted, they first of all need Jesus. The vises of their culture, both from their ancestors and from the arrival of the white man do great harm to their struggle for cultural and social development; in-fact some claim that it is a fight that they are loosing; however, freedom from the spirits that continually plague them and the one hope that conquers all fear is needed here to give them the strength to stand for good and for progress in a culture trapped between two worlds. The training of nationals as missionaries and pastors who blanket this island calling for the people to repent of going after two gods, or more, and live a life seeking and depending upon the power and truth of the creator of this could-be paradise, will change these people more than anything else. Sharing God’s love in tangible ways is opening the door, but brave men and women in the same spirit as Boniface and Patrick who will walk through it will truly change the fabric of all 700 cultures here.

Finally; Kudos to my beautiful wife who is learning how to be a “Country Doc” from the talented Dr. Bennet and the brilliant Dr. McCoy (I still have yet to ask if I can call him “Bones”). She used an old Montana trick from Andy to separate a fish hook and an adolescent boy’s toe the other night that was truly impressive to watch. I would have gone for the trick using a long string and a quick jerking action, but her finesse left the crying boy with little more than a couple of holes the size of an 18 gauge needle. She is scared when she gets thrown into these environments, but she performs admirably. I am seeing a truly wonderful doctor in the making.

Thank all for your continuing prayers and support. We need them as we begin our final week here and our long trek home.

Grace and Peace,
-ry

What’s the Diagnosis?

Anyone know what this patient’s diagnosis is?  Post the answer if you know.

My PNG Birthday

Sunday, January 24, 2010

I thought it would be hard to celebrate my birthday in a strange place away from my friends and almost all of my family.  I was wrong. : )  I had the most wonderful birthday thanks largely to my husband but also thanks to old friends back home and new friends in PNG.  After lunch Andy, one of the doctors I have been working with here, came in to the ER with a delivery of flowers from Ryan along with a card.  Beautiful flowers that you can see in the picture here!

Then after work I noticed that there were a lot of birthday posts on my way on Facebook.  Thank you to everyone who left me a message.  Although I eventually caught on to Ryan’s “birthday event” (thanks Tracy), I felt very loved hearing from all of you back home.  I miss you all!

While I was checking email and facebook, Ryan was dragging his feet in the kitchen supposedly cooking me dinner.  Then all of a sudden Elana, one of our friends here, came to the door with a large tray of food.  Elana and the Bennetts made us the most amazing catered dinner.  There was the best salad we’ve had since leaving home (it’s amazing how I miss romaine) and a curry chicken dish with rice.  Such an amazing birthday dinner!  That’s it in the picture.

Then we went to the weekly prayer meeting which is every Thursday evening.  After we finished praying, everyone sang happy birthday to me.  And when I say “sang happy birthday” I mean they sang every birthday song ever invented.  It’s impressive.  And someone had made a birthday cake as well.  So I was able to celebrate my birthday with my new PNG family too who also made me feel incredibly loved even though they’ve only known me for a couple weeks.

In all, I had an amazing PNG birthday!

One Young Man

This is a story helplessness. I saw a young man in the ER two days ago. He had had a fever and headache for three weeks. Based on some clinical findings that don’t matter to this story we admitted looking at meningitis (infection in his spinal fluid) or endocarditis (infection in his heart) as possible diagnoses. Meningitis we ruled out by looking at his spinal fluid in the lab which left us with endocarditis or something else. If we were in the US we would do an echocardiogram and blood cultures to decide if he had endocarditis, here we can’t do either. Our diagnostic capabilities when it come to lab and radiology are very limited. So we put him on antibiotics and waited to see what happened next.

Tonight I am on call and my second call was about this young man. He was more restless than usual. After examining him, the doctor with me realized he wasn’t moving his right side. He had had a stroke. Probably an embolism from his heart, probably endocarditis. We still don’t know for sure, probably never will. More antibiotics. We’ll see what happens next.

But now, the difference between helplessness and hopelessness. We also prayed for this young man while we were there. Only God knows if he will recover and only God can make him better. So here in PNG we try not to think about what we can’t do, at times that could be overwhelming. We do what we can do and know that God is in control. There is both hope and peace in that.

Our Sunday Adventure

We went to a different church today, about a 45 minute walk away. Yes it was a long walk, but an interesting one.  Through the muddy paths we walked through many tea fields.  Have we mentioned the tea here is good?  It’s great and the fields it comes from are right next to us.  In fact, this area is a major producer of tea and coffee, some coffee that is even sold to Starbucks.  Impressive, right?

And we saw a few pigs hanging out too.  A very precious commodity around here.  They are often used in bride prices and killed during large festivals.  These were just wandering around eating whatever they could find.

 And then we got to the church itself.  Kusla Nazarene Church.  In the first picture I’m sitting on the ground outside the church talking to one of the young girls who attends the church with her family.  In the next picture you can see the church building itself.  Inside the church was very simple.  There was a pulpit and a whole arrangement of flowers and fruits and vegetables decorating the front of the church.  The rest of the room was empty with hay spread on the ground for us to sit on.  The service was simple.  We sang, had an offering, a short sermon, and prayed.  But it was beautiful to be there was people so different from us worshiping Jesus.  The service was done in a combination of Pidgin and Tok Place.  Tok place refers to a specific village’s language.  Each village speaks a different language, but then many learn pidgin as well as a second language in order to communicate with people from other villages and to do business with them.  Because each village still has it’s own language, there are over 800 languages spoken in PNG today, and most Papua new guineans are fluent in multiple languages.

  After church we headed out for the second part of our adventure - the rock slides.  We went to down a muddy jungle path to an area of waterfalls and many smooth rocks that served as slides.  Climbing over slippery rocks, we all made it to the top of the slides and down we went, sometimes intentionally, sometimes unintentionally.  Unfortunately we didn’t grab any pictures of the slides we spent the most time at (mostly because we were in the water the whole time) but the next picture shows and area close to where we were sliding and you get the general concept.

By the time we made it home we were very tired and very muddy.  It was a good day. : )