Rachel’s Blog

Blog #6. Wednesday February 24th. Happenings in PNG

I have learned a new peculiarity to PNG.  While all countries have their
particular methods of suicide or self harm, I have learned that a
particular form of self injury is rather common to a particular community
in PNG.  We had a man come into outpatient with self-inflicted
burns.  Apparently, they pour kerosine on themselves and then light
themselves on fire.  That really amazes me.  What a gruesome thing to do to
yourself.  In this case, it was about a fight over a girl.  Fortunately, he
burned only about 7-10% of his body area and it is only a partial thickness
burn.  He will recover, but the healing will be quite painful.

We also received the sad news that Morea, our eleven-year-old with the
fluid in his abdomen, died on his way to Port Moresby.  He only made it to
Kerema.  There was also apparently some kind of drama, where the father
left for awhile and there were accusations that there might have been some
wrong done by the mother.  We really don’t know the details, but we were
all very sad to hear the news and are praying for healing for his
family.  We still don’t know exactly what had caused his illness.

It is very challenging to practice in a place where you lack many
diagnostic tools.  In some ways, it challenges you to be a better physician
and learn to rely on your physical exam, yet in others it is very
frustrating.  Often, it becomes an educated guess and trial and error.  For
example, you get a patient with pulmonary symptoms and
fevers.  Immediately, they will get fansidar and chloroquine for malaria
based on the fever.  If you have abnormal lung sounds, you will try a trial
of antibiotics.  You don’t know for sure that it is bacterial
pneumonia.  There is a high prevalence of TB, and it may be hard to
distinguish.  There are some cases of COPD, with wheezing and diminished
air entry.  Regardless, you start antibiotics and see if they improve.  The
fever may go away, but was that from antibiotics or from malaria
treatment?  Lung findings persist. Even after adequate therapy, it may take
time for pleural effusions to resolve.  TB does not always cause fevers, so
then you wonder if this is a resolving pneumonia or pulmonary TB. You have
no chest x-rays to aide in diagnosis. If they don’t improve clinically, you
start a TB trial.  If they get better, you ask them to commit to staying on
the ward for two months and taking the full outpatient treatment after
that- a big commitment.  Often at the end of the trial, it is not clear
whether or not it has helped, and the decision to commit them to full TB
treatment or to stop is very difficult.  Worst of all, when they die, you
wonder if you missed something or if there was something else that could
have been done, especially when they are young like Morea.

This has impressed me with how difficult it truly is to combat TB in a
developing country where the prevalence is so high.  I will discuss this in
further detail in my next blog.