Grace Chew’s Blog

26/2/2009: Day 15, Kapuna Hospital

A bunch of patients had gone across to Kikori
over the weekend for X-Rays to be taken, when
transport was sent for the VIPs for the
graduation ceremony, and they’d arrived the day
before. This morning they all turned up for ward
round, and after dispensing with the normal ward
round duties we quickly gathered a crowd while we
squinted at those fairly well-produced films
through natural light. I say well-produced, but
nothing beats the electronic system (I’m so
pampered :P) and while development of most films
were good, some were streaky and of poorer
quality, and the long boat ride over didn’t help
matters. Other patients and family members,
especially the children, looked on as if they
knew what we were trying to identify, but I guess
it was more of the novelty of seeing X-ray films.
It was probably also the natural inquisitiveness
of the people, who don’t know what privacy is and
will ask about anyone’s condition if they wish to
know. They live very communally here- they all
cook at the communal kitchens, sleep in the
mini-halls that are the wards, and hang out
mostly on the ward verandahs where it’s usually
cooler, quite like their villages I suppose,
where everyone knows and is expected to know
everyone else. In several ways it’s good, but
surely people need privacy some times? (Of
course, from the books I’ve been reading about
near-death experiences of heaven, we probably
won’t have any privacy up there, so they’re preparing well for the afterlife!)

There are some patients whom you’d like to give a
bit more privacy, and the best that can be done
is a side-room in the wards. We’ve seen several
people in quite a bad way this few weeks, from a
man with a mysterious illness who died quite
unexpectedly over the weekend, to two cases of
probable malignancy where there usually average
one cancer a year. Not only does one want to give
them some semblance of privacy and dignity, I
have the frustrating feeling of wanting to give a
concrete diagnosis but find my knowledge and facilities lacking to do so.

The unfortunate young man came in with pus-filled
neck lymph nodes, which probably meant that he
had TB of the glands, and he was duly put on
anti-TB drugs. However he developed
hyperpigmented painful patches of skin in his
axilla and perineal area which ulcerated and
caused him lots of pain. His illness also left
him weak, and on top of all that he developed
acute renal failure. He’d been here since we
arrived and I had a few tries trying to diagnose
him, but couldn’t make the picture any clearer.
He was apparently getting better despite
everything that had happened, when he developed a
cough. He was tried on penicillin Saturday
morning, but he suddenly died later in the
afternoon. The provisional diagnosis was pyoderma
gangrenosum, but whether or not it was that it
was a sudden and sad way to pass away.

An old man was brought in one afternoon and I was
present to do his clerking in. He’d had problems
with swallowing for a few months, but you could
see the problem was more than that – he looked
absolutely cachectic, and when he lay down his
abdomen was a yawning cave mouth. With his
progressive history of dysphagia, and in the
absence of fevers and night sweats (which would
have made it oesophageal TB) the only other
diagnosis would be oesophageal cancer. But there
was no real way to make sure – we had no X-ray
machine or any barium to do a barium swallow, and
definitely no endoscope to put down his throat.
And he had no other signs that could lead to a
definitive diagnosis. As a last-ditch effort he
tried to swallow anti-TB meds, but it only made
him feel bad and vomit more. In the end, he
decided to go back to his home to die, and Dr
Valerie tried to tell him and his family the
gospel good news in his own language which she
didn’t really know. I hope she did get through to
him, and that he’s feeling peace now even as his body rebels against him.

The other case of cancer was an old lady from the
village down the river, and she came in with a
humongous swollen abdomen – ascites, so big that
it was causing her pain and difficulty breathing
and eating and drinking. She had no
temperature/fevers or anything to show that it
was infective in nature, so the other possibility
was malignancy (no alcohol problems here), and
that was supported by the bloody nature of the
fluid Dr. Valerie took out from her distended
abdomen. No fancy catheters and what not, just an
IV canula and loads of tape. It lasted only a
short while, because she wanted to lie on the
floor and the family hung the fluid bag above her
– fluid could have gone back in that way. Anyway,
just as quickly as she came, she was gone, back to her home to die in peace.

So although we’ve been told that our time in
Kapuna will be very relaxing, it hasn’t really
been that – we’ve had our share of interesting,
confusing, or worrying (and sometimes all of the
above) patients. And most, if not all, have a
definite need for healthcare, some of which just
cannot be given here. There is good quality staff
here – the CHWs and nurses trained here and
elsewhere do a terrific job of keeping things
together, but all this for one doctor to handle
can be an awesome challenge. Add to that the fact
that a lot of the drugs and instruments are
out-of-date and/or of questionable quality, and
many of the simplest investigative methods aren’t
available (e.g. microscope) let alone more
high-tech ones (e.g. X-ray machine), and it means
that even the best people are limited in their
healthcare giving capabilities, as is the case here.

They do their best though, and a very amazing
best it is too. (Their postnatal mothers may have
better immediate follow-up care at their disposal
than mothers in UK, for instance!) And what they
lack, they leave other more capable Hands. The
willingness of the staff to share and lay hands
and pray may be better for health than any of the medicines, sometimes.