Elisabeth Hesse’s Blog

2-4-09: Performing American medicine in PNG

Today seemed to be an all-around American medical-system type of
day.  First, rounds went very quickly–what usually takes us four to
five hours to complete took two, and after some discharges, we’re now
down to one patient in the general ward, a malnourished
three-month-old who weighs less than two kilograms.  One of the
nurses, who is now about eight months pregnant, has been on bed-rest
in the OB ward for pre-eclampsia since the day before I arrived and
is now gone as well–she went to Port Moresby so she could have
cesarian back-up for when her labor is induced next week.

When rounds were over, we had three hours to sit around and relax
before reporting to the clinic in the afternoon.  Fortunately, we had
electricity for those three hours, which meant the fan was running in
the house and it wasn’t too hot.  Unfortunately, the power went off
just as soon as I arrived in clinic, so we cooked in the oven of a
clinic house for the afternoon.

I decided to see patients on my own in clinic, in part because
sitting around listening to someone speak to patients in a language I
can barely understand isn’t much fun, and in part because there were
a lot of patients to see.  Alofa, the CHW who was providing the
nursing staff for the clinic today, was picking and choosing patients
for me based on their abilities to speak English, which I
appreciated.  The first one was an elementary school inspector, so
she had very good English.  Unfortunately, she also had a long list
of complaints, making her more like an American patient than a PNG
patient.  She had a hysterectomy in September, so now she has
menopause symptoms, including hot flashes and headaches.  She also
has chest pain, and a sore throat, and abdominal pain, and pelvic
pain, and chronic hypertension.  She kept listing off these problems,
and finally I had to tell her that I can only address one problem at
a time.  I took her blood pressure, and that was normal, so that was
easy–I told her to keep taking her regular blood pressure
medicines.  Well, then she said that sometimes she feels funny and
light-headed when she takes them, which is also easy–I told her to
take them at night instead.  So we kept going through one problem at
a time until we both felt like everything was addressed and dealt
with.  In all, she left with instructions on how to take her blood
pressure medicine and birth control pills (the PNG version of
estrogen-replacement therapy), medicines for heart burn (the chest
pain and abdominal pain and sore throat), and stool softeners with
diet instructions (the abdominal pain and pelvic pain), as well as
instructions to return in four weeks for recheck.  I’ll be gone then,
so she’ll be someone else’s problem.

The other patients I saw were much more of your typical PNG-type
patient–one recheck for a wrist injury, and one medical clearance
form to apply for the police department.

Then it was back to the house to sit on the veranda trying to catch
the briefest of breezes (there wasn’t much) while I continued to burn
through my reading material.  Just when I thought I’d run out (I am
down to the last fifty pages of the last book I brought), Manar
brought over some fairly recent periodicals–a Time magazine covering
the inauguration and a Guardian (publication from Australia or New
Zealand or some other not-America place) from within the month.  I’m
looking forward to going through those and seeing what has been going
on since I’ve been cut off from the news.  Of course, I’ll be home in
a week, and then it won’t be long before I’m complaining about being
constantly inundated with news about things I don’t care about.  I
guess you can never win.