Ruth Chen’s Blog

The wonders of God and Medicine (25/02/2009 1630 GMT +10)

I just returned from the labour ward after having
done my first delivery. This woman who was in
labour had been having regular contractions since
last night 9pm, only to deliver at 9.20pm
tonight. Her contractions reported from last
night were probably Braxton-Hicks, but still, she
was dilated at 2cm at 2am. For a multip, this one
was taking a long time to pop. Apparently her
membranes were ruptured earlier in the day today,
but when we did a PV again, it seemed that the
SROM was probably incomplete. Anyway, Valerie
gave me the opportunity to deliver, and although
I’ve been putting off performing deliveries for
the longest time, the time had finally arrived
for me to do one (under supervision of course). I
shan’t go into why I havent done any deliveries –
partly my own fault, but the education system
doesn’t help either. Anyway, being grossly
incompetent, I was relieved that Susie, the main
nurse who does deliveries, was there to guide me
along. As with all babies, this one came really
quick after the SROM, and with hands-on things
seem to happen much faster than it would seem
with observing. So a baby boy was brought into
this world. This woman had a history of retained
placenta with manual ERCP, so we had to be
cautious with removal of placenta. Unfortunately,
the cord actually broke, and Valerie went in to
pull on the cord. I wonder how she did it really,
everything becomes so slippery. Slowly but surely
though, she got the placenta out.

When I first read feedbacks from previous
students who did their elective at Kapuna, they
spoke about how Kapuna is a place where one could
observe how God and medicine came together.
Tonight, I witnessed that for myself. This woman
was really having a difficult labour, and Susie
led the group and decided that we took a moment
to pray to God, with the patient and her
relatives. I don’t know if they understood our
prayer, but in any case, I definitely felt God’s
hand at work in that delivery - even when the
cord broke and we couldn’t quite find the other end of it for a while.

It is customary for the labour team to say a
prayer and sing a worship song after each
delivery and given my time here, I have observed
how open surgeries have been done with grossly
limited supplies, but never short of God’s grace
and providence. Patients have been able to walk
away with healing lesions and regained hand
functions. Their scars heal beautifully (they have their PNG skin to thank).

Other hospital stuff , there’s a patient in the
ward who’s been having repeated knee effusions
and we’ve aspirated it 3 times already. Mr Knee’s
(that’s our nickname for hime) right knee’s been
flaring up with tenderness and stiffness, and now
his left knee seems to be following the
progression of the right. His left ankle’s also
starting to hurt. We treated him as TB knee, but
symptoms aren’t improving on TB meds, so that’s
been stopped now, and we’re treating as septic
arthritis now. Have to see how that goes. There’s
another woman, Mr Knee’s neighbour, Ms Ascites,
who’s having severe oedema all the way to her
sacrum, and without jaundice, one wonders if
she’s got a malignancy going on somewhere.
Valerie says its too tense to be TB abdo, so
we’ll be doing an ascitic tap tmr. Trouble is,
there’s no microscope here so the tap wouldn’t be
that useful apart from seeing the colour and appearance of it. Ahwell.

**

The graduation ceremony took place on Saturday
and that morning, Valerie and I were doing our
normal morning ward rounds. It was a lovely
morning, the breeze was cool, almost chilly and
the clouds were beginning to look really angry.
It was going to rain, which wasn’t great news
because the grad was going to be taking place in
the open grass field. Anyway, the rain came, and
what it left was a perfect nice afternoon for the
ceremony. Ah, bliss. The ceremony was a very
heartfelt one, nothing like the ones I know of
where lists of names are called out. When each
student walked out to collect his or her
certificate, family and friends would carry their
gifts and walked up to the stage with her. A
particular grandma of 2 students was so ecstatic
and she started dancing in front of her
grandchildren as they walked towards the stage!
The gifts that they brought to give away, either
to the graduate or the tutors, were things like
brooms, grass skirts, straw mats, and even
chicken! Simple gifts they were, yet so
meaningful and genuine were their intentions.

**

Shortly after the graduation, we were told that
one of our patients had died. This patient had
been admitted since the beginning of the year,
and we hadn’t been able to diagnose him properly.
It’s a great pity because I think in a developed
country, this would probably not have happened..
at least more tests could be done. Ohwell, that’s
the one thing I really struggle with over here –
having to make do with limited resources, and
learning to practise proper old school medicine
using clinical judgement (this of course is
really difficult due to the way we now learn
medicine in med school – so much emphasis on
investigations and results! Even the most basic
patient in hospital in UK would have a FBC at
least.. But not here unfortunately). Back to my
dead patient – he had these lumps all over his
body, and they almost felt like hardened skin. He
was having proteinuria, and developed extensor
paralysis of both his wrists. Apart from that, he
had peripheral neuropathy with bilateral foot
drop, ulcerating lesions all over his scrotum,
amongst many other signs. I should actually get
his notes and properly document it so that I can
search for an answer when I get home. He reacted
to almost every drug we gave him, and the morning
before he died, he was complaining of SOB, which
we decided to treat as pneumonia. I think its
something autoimmune, Valerie’s take is pyoderma
gangrenosum, and Grace thinks its lymphoma. Hrms.
Anyway, the whole Saturday afternoon was spent
dealing with logistical issues of getting his
body back to him village, and suffice to say,
everything around here is the doctor’s problem –
from curing the sick, to replacing medical
stocks, fixing the broken light bulb, and
arranging transport for a dead man. Oh, and
hungry patients look for Valerie too. Jack-of-all-trades, you can say.

That night, a gravida 4 woman came in and her
abdomen didn’t feel quite right. It looked as if
it was a transverse lie, but I could hear fetal
heart rate at the left lower quadrant (which
meant baby should be in vertex position). However
others thought it was in the right upper
quadrant. The worry was that baby was breeched,
which turned out to be a false alarm. So no, I
didn’t get to see a breech delivery in the end.
Which is a good thing for mum.. But it would have been cool to see one!

**

Church on Sunday seemed to go on forever. In the
same time we had one service here, second service
would be over and done with back home. I guess
its because sharing is really encouraged over
here. Rita, the girl I met on the plane to
Baimuru, had just returned to Kapuna after
spending 3 months in Australia. She had new
experiences to share, and it was really good
hearing her share as she inspired the people at
Kapuna to rise up and pray for the Gulf Province.
I can really see and feel the hope she has for
her province – so passionate, such a deep sense
of burning desire. It’ll be an awesome revival
for the land of PNG for the people to rise up and
stand in the gap. I am really looking forward to see how things in PNG change..

The kids came together during the service, and we
finally put together an item of Ode to Joy
together (they were on the recorder, while I
accompanied them on the piano. Grace played the
recorder with them too!) It’s all Valerie’s hard
work though, and I think we should have given her
the credit! The kids were all so pleased with
themselves, and I’m so proud of them J

**

I’ve established some sort of routine around
here. Day starts at around 5am, where the chicken
intermittently awakes me. I finally get out of
bed about half 6 and get to hospital sometime
between 645 and 7 where ward rounds start. After
ward round, its time for breakfast and we go
round to Valerie’s for some homemade bread. If
Grandma’s around, we’d get toasted bread. Or
else, we’ll make do with normal bread. After
that, I go round to the computer to see if I’ve
got any new mail before heading to devotions
(that is, it devotions is still on. Timing
depends on what time ward rounds end). We’ll sit
around until 11, where we go back to the hospital
for either outpatients/postnatal/antenatal
clinics. The walk to hospital at 11 is the worst
– the sun’s shining in its full glory and the
short 2-minute walk is enough to make me feel
uncomfortable for a good hour or so. At 1, we
leave clinic to teach the kids piano – Grace
takes the young ones, and I take the older kids.
Depending on how fast the kids learn for the day,
we’ll spend the time after class ends to 4pm just
sitting around, catching whatever wind that blows
our way. Oh, we try to find something to eat too,
for lunch. Or start the fire if we’ve got too
much time to kill/get too hungry/want to eat
something hot. 4 to 6 would be a walkabout around
the hospital to see if any patients require
attention. If there’s no problems, we would
either be sorting out meds in the drug store or
clearing stuff in the OT or checking the labour
ward out or walking around kapuna looking for
food (we sound like animals don’t we – the food
bit). Then its time for dinner after the
electricity comes on, and checking mail again,
and time for bed – I love going to my bed and
hiding under my mosquito net. I feel safe and
clean under my mosquito net hehe. Aveline says I
should just get used to not being clean (which is
a big deal for me. I’m quite the clean freak)
well, I’m getting there.. slowly. If we’re in a
very keen mood, we may be tripping down to the
ward to see if any mum-to-be is gonna pop anytime soon.

This week, we taught the CHWs some anatomy and I
had to teach them terms. Terms, of all things!
Terms like medial, lateral, proximal, distal..
And I’ve forgotten how it’s like to teach until I
taught on Monday. Its.. tiring. Once again,
respect to all my teachers who once taught me.
Another challenge I faced this time round was
teaching these students when their command of
English isn’t that great. It’s not quite a piece
of cake getting them to understand what proximal
and distal mean. Anyway, I’ve done my best. I
hope they understood at least 60% of what I said.
Oh, and apparently we’ve been given another
learning outcome each to teach because we were
such efficient workers that we completed our
learning outcomes early! Cardiovascular and
Lymphatic system. Hm, its going to be challenging!

I’m quite happy that my older kids are finally
able to read notes and understand that notes
ascend step by step. They are no longer confused
about the treble and bass clef. So that’s
satisfaction I’m getting out of teaching. Yay for me.

Ok, the electricity just came on. I’m going to
make full use of it and stop here now. Till next time!