Rachel’s Blog

Blog #3. February 12. Happy Birthday to me.

I have now been working at Kapuna for a little over a week.  Dr Mark Smith,
a physician from New Zealand joined us this week and started working
yesterday.  Dr Valerie will be leaving for two weeks, and Dr. Mark and I
will be running the hospital.  I have been busy learning the specific
approaches to disease used in PNG.  The country has a standard treatment
book based on the medications that they supply to the hospitals.    One of
my challenges has been just learning drugs that I am unfamiliar with.  Some
of the drugs are only very rarely used in the US because there are many
alternatives.  Some drugs are the same but have different names.

I also feel very challenged by the language.  PNG has many
languages.  While English is the official language, many people,
particularly the elderly, do not understand it.  Even among those who speak
it, communication is difficult.  I will ask a staff member to translate “Is
there blood in the urine?”  Then, they translate the answer back as “Yes,
he made urine.”  That’s nice, but did he have blood in the urine?  My other
favorite is when you ask a yes or no question, they translate it, you see
the patient nod his head yes, and the translator turns to you and says
no.  As Dr. Valerie says, you have to ask questions several time.  You also
have to use very simple English.  I have learned to ask, “Does he have
pain?” rather than “Does he hurt?”  I am still learning how to
communicate.  The important thing is just to have a sense of humor and be
patient.  It is hard to communicate in a language that is not your primary.

We had a lady with a hernia in her groin that presented during my first
week.  Dr. Valerie had asked me to do a hernia repair, since I have had
some experience with them.  While I definitely felt comfortable with the
surgery, I was unsure of doing it without the watchful eye of a chief
resident or attending.  I also have never been involved with one done only
under local, and I have never done a signifcant operation without
electrocautery.  We decided to wait for Dr. Mark, in case he had any extra
surgical expertise, so yesterday morning we did the repair.  I was
concerned because from my physical exam, I believed it to be a femoral
hernia.  These are not as common as other types of groin hernias.  What
happens is that part of the abdominal wall and, in her case, bowel, slides
through an area between the large femoral vein and the pubic symphysis
(pubic bone).  I have never seen one of these.  Dr. Mark had actually never
done a hernia operation.  Dr. Valerie has assisted with a few hernias, none
of them femoral.  So, we read about the operation in some surgical
textbooks and then performed it, two general practitioners and medical
student going into surgery.

So, in PNG, you operate barefoot in a cloth dress with a cloth surgical
gown.  It was very hot, as there is no air conditioning, and also because I
was standing under the light.  By the end of the surgery, I had a pool of
water under my feet.  We had to be sponged frequently to keep from dripping
into the field.  The woman turned out to have a very difficult hernia to
reduce, and the operation takes place very close to the large femoral
artery and vein, which can easily be injured.  At one point we were unsure
if we should continue but just at the right moment my finger finally slid
into the hernia defect, and we were able to dilate it enough to finally
reduce the hernia. It was still very difficult, and we even discussed
cutting the inguinal ligament to make more room.  Fortunately, we did not
have to do so.  We finished this surgery on the 11th.  My birthday happens
to be February 12.  The patient has done well since the surgery with only
minor pain.  As I told everyone, that was the only birthday present that I
wanted.  Thank you, God!  I really enjoy being in a place where the whole
surgical team will pause and pray together for direction when things get
difficult or uncertain.

The Calvert family made me a little “cake” out of melted marshmellow and
chocolate candies with a candle stuck in the top.  It was so warm outside
that the candle fell down while we were eating dinner (chocolate was
getting softer).  They gave me a little PNG mug and a local seashell.  They
are very thoughtful, nice people.  While I do miss my family, they have a
way of making you feel like you are a part of theirs.