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	<title>Ruth Chen's Blog</title>
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	<pubDate>Tue, 24 Mar 2009 14:37:28 +0000</pubDate>
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		<title>22/03/2009 2300 GMT +10 The past week at Kikori</title>
		<link>http://inmedblogs.us/ruthchen/2009/03/24/22032009-2300-gmt-10-the-past-week-at-kikori/</link>
		<comments>http://inmedblogs.us/ruthchen/2009/03/24/22032009-2300-gmt-10-the-past-week-at-kikori/#comments</comments>
		<pubDate>Tue, 24 Mar 2009 14:37:28 +0000</pubDate>
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		<description><![CDATA[The past week has gone by pretty slowly, mainly because there haven’t been many patients in the hospital, and we don’t have much to do after daily ward rounds.
We took about half an hour to get to church on Sunday, by foot! As we made our way to church, I found that there were quite [...]]]></description>
			<content:encoded><![CDATA[<p>The past week has gone by pretty slowly, mainly because there haven’t been many patients in the hospital, and we don’t have much to do after daily ward rounds.</p>
<p>We took about half an hour to get to church on Sunday, by foot! As we made our way to church, I found that there were quite a number of churches around in Kikori, the nearest being just a minute away from the hospital, a Baptist church. Not many of the hospital staff attends that church though. Thankfully the weather was cool, and as we arrived at church, it started to drizzle, so it wasn’t unbearably hot. Church was quite interesting. Some of the local praise and worship songs that they sing at Kapuna were sung, so I could follow a bit. Sister Sarah, the head matron of the hospital, spoke about equipping oneself with God’s word to do God’s work and quoted quite several meaningful verses during her teaching. It was a good sermon, serving as a reminder for myself!</p>
<p>The rest of the Sunday was spent in the company of Dr Manar, one of the 2 doctors here at Kikori. She comes from England, Newcastle. So in the past week, during ward rounds, things have been somewhat familiar – the English accent, BNF, the way ward rounds are being conducted (standing ones, compared to the sitting ones at Kapuna), the drug charts etc. Its almost feels like we’re slowly integrating back into the familiar UK way we’re so used to! After lunch and sitting around to chat, it was time for bilum making – this time with Sister Alofa, who happens to be the bilum expert at Kikori. We were taught a couple of new stitches here and there, but the trick is remembering how to start and end stitches. Anyway, we hope to get more lessons from Sister Alofa when she makes her way to UK later this year!</p>
<p>**</p>
<p>It’s been unusually quiet at the hospital, not many patients on the wards and not many mothers in labour either. However, for a quiet week, we’ve seen a handful of interesting cases.<br />
There’s a patient on the surgical ward with interesting neurological signs – clonus ++, with brisk reflexes and increased tone (spasticity), with loss of sensation T10-L3/4. He’s on the surgical ward because he developed a pressure sore secondary to immobility/loss of sensation. Poor guy, we don’t really have the means to find out what actually is the problem. We need an MRI machine! Ohwell.<br />
And there was a 32-year old female patient who had really severe chest signs (decreased air entry, creps, bronchial breathing etc). We had treated from pneumonia, but she wasn’t getting better. Then we treated for TB. Due to her pale conjunctiva, indicative of anaemia, one of the staff kindly donated some blood, and the patient had a blood transfusion too. Her condition picked up after the transfusion for a couple of days, but she soon developed jaundice, which was attributed to the TB meds. So, TB meds were stopped, oxygen was continually given, but before anything else was done, she died, at the young age of only 32 years. Sad.<br />
On the O&amp;G ward, there was a 39-year old mother who came in with a 5 day history of losing water. Her tummy looked small for a term pregnancy, and at one point of time, I actually wondered if she was really pregnant (you never know, could be an ovarian mass/fibroid?). Dr Ovoi wanted to make sure and the pregnancy test was positive. After getting more history from her (history taking here is challenging, the story changes all the time), we finally established that she most probably have a spontaneous rupture of membranes, 5 days ago. It explains the small tummy (no more amniotic fluid surrounding baby. Fetal heart sounds were still going strong though, strong baby!).To add on, the woman wasn’t sure of her last menstrual period, so we couldn’t establish if the baby was gonna be a premie (no ultrasounds here, unfortunately). And, I think we all agreed after much prodding (very rigid womb due to lack of amniotic fluid), that the lie was transverse. So, with multiple obstetric challenges in one case, and no option of caesarean, the next best option was to put the mother on the next plane out to Port Moresby. She was out the next morning, and latest I heard was that both mother and baby are doing fine.</p>
<p>On Tuesdays, the doctors do an operating list and the Tuesday that had passed was a very urological day, what with a circumcision and vasectomy on the list! Grace assisted Dr Ovoi for the circumcision, while I assumed the role of theatre nurse, getting equipment/gauze/scissors etc. The patient was under ketamine, so he was confused and I had to hold his hands down several times as the doctors worked their way around. Under ketamine, he told me to get lost, told Dr Ovoi that he was going to beat us up, insisted that having 3 girls in the theatre with him was a big no-no etc! Haha, comical moments were plenty as he sprouted nonsense throughout the surgery.. the effects of ketamine!<br />
It was my turn to assist for the vasectomy case, and just as we were quite pleased with ourselves for finding the vas so quickly on one side, the other took a good 30 minutes or so. Dr Ovoi and I kept feeling, and re-feeling for it, but kept losing it. Anyhow, we managed. Grace and Dr Manar provided us with entertainment while we prodded along – Grace with her jumpy self (it was very very cold in the OT, we’re so not used to the cold already), Dr Manar commenting on how we’re faring much better than the first vas that they attempted! Haha, these 2 doctors are fun to work with. I’d wished we had more time with them. Anyway, I have seen the vasectomy patient more than once since, and he looks happy, so that’s good. The doctors are quite keen for him to encourage the other males around here to go for a vasectomy (read below). Now, who would have thought that the first time I observe/assist in a vasectomy would be in PNG?</p>
<p>I got the opportunity to do a couple of deliveries here as well. On Monday, a primiparous woman was in labour. It was quite funny actually because the CHW was just preparing to use the amnihook to break her waters, and I was just asking for permission to be supervised for the rupture of membranes. I then proceeded to do a PV on her. And just as I felt the bulging membranes, the membranes ruptured, there and then! I’m pretty sure it was spontaneous rupture though – my fingernails are nice and short! Anyway, she progressed pretty quickly from there, going from about 6cm to second stage in just 3-4 hours. I was called back after dinner to do the delivery, and it turned out that she wasn’t that great of a pusher (she was pushing for a good hour or so). We were hoping that she would deliver before the power went off. Thankfully, power went off later than expected, at about quarter to 11 (power usually goes off at 10). So yes, she delivered before power went off, but she had an episiotomy. The power went off soon after and I was left to sew the episiotomy up in the dark! Ok, not really in the dark. Luke, one of the experienced nurses (who happens to be really comical), used a metal tray thingy to reflect the light that was running on the generator power so I had a ray of light shining through as I did my sutures. Very interesting indeed.</p>
<p>On our ward rounds, it’s interesting to observe how the doctors try their best to convince mothers about family completion (after they’ve given birth to 4 or 5 or 6 children!). In Dr Manar’s words, ‘too many pikeninis!’, which means ‘too many children’, she tries in vain to advise mothers to go for ligation of tubes. Mothers here don’t get it though. They frequently reply with ‘custom’, meaning that they will use custom ways to stop themselves from getting pregnant. I’m just as clueless as you are as you read this, because what exactly is the custom way? Then, trying to convince the father to go for a vasectomy would be the next option. But the guys are worried that they can’t go climbing mountains after the op! Sigh. Well, I’ll definitely remember Dr Manar’s phrase - ‘too many pikeninis’!</p>
<p>**</p>
<p>The weekend that has just gone was a relaxing one. I decided to go running with Dr Manar on Friday evening, only to realise my appalling level of fitness. I guess that’s a wake up call for me to get my act together when I get back home. It was a rocky run, with up- and down-slopes, but nonetheless, a good workout. Kinda a good make up for Saturday, which turned out to be a lazy day in. It rained the whole day, and I was glad for the cool weather as I caught up on the sleep that I had lost the night before. My first day not sweating in PNG! The rest of the Saturday was spent watching random movies on the laptop and more bilum making!</p>
<p>Today was spent at church followed by a lovely brunch at the Chinese family’s place. We also spent some time talking about Chinese traditions/family culture/recipes (yum). It was cool getting insight from a Chinese who lived her growing days in China – true first hand information! We’ve been so spoilt by this family because each time we visit, they shower us with different food stuffs. This time, it was dumplings and buns! And as usual, they insisted that we’d stay for dinner. We had dinner plans with the doctors and Sister Alofa, so we kindly turned them down.</p>
<p>As I write now, I’m feeling so full! We cooked too much again! After that dinner of crabs, steamed egg, stirfried beef and veggies, tuna sandwiches, banana cake and pineapples, I think we really had a good meal. And it’s already 1130, but the power’s still on, which I gather it’s because of a op that’s going on. Sigh! Things are picking up at the hospital, only when we’re leaving!</p>
<p>Anyway, we’re going to fly out of Kikori tmr. We were meant to fly out on Tuesday, but just to play safe, we decided to go early. They are capable of canceling flights at the last minute, and because we’ve got a connecting flight to catch to Brisbane on Wednesday, its better that we gave ourselves one extra day. So yes, if all goes well, this shall be my last post from Kikori. I can’t quite believe my time in PNG is coming to an end. Has it really been 6 weeks? It’s really just gone by too quickly. Ohwell, all good things must come to an end. I guess, for now, I’ll just have to make do with the memories and the photos I have with me. Till next time when I’m in Port Moresby!</p>
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		<title>14/03/2009 0915 GMT +10) Post Patrol and Orientating myself to Kikori</title>
		<link>http://inmedblogs.us/ruthchen/2009/03/17/14032009-0915-gmt-10-post-patrol-and-orientating-myself-to-kikori/</link>
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		<pubDate>Tue, 17 Mar 2009 14:40:52 +0000</pubDate>
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		<description><![CDATA[Hello world! I’m still very much alive and am
finally at Kikori now, after meandering through
the many rivers and creeks of Gulf Province!
Its been an interesting week so far. What meant
to be a 5-day patrol was cut short to 3 days, and
we arrived at Kikori earlier than expected.
It was sad to leave Kapuna on Monday – [...]]]></description>
			<content:encoded><![CDATA[<p>Hello world! I’m still very much alive and am<br />
finally at Kikori now, after meandering through<br />
the many rivers and creeks of Gulf Province!</p>
<p>Its been an interesting week so far. What meant<br />
to be a 5-day patrol was cut short to 3 days, and<br />
we arrived at Kikori earlier than expected.</p>
<p>It was sad to leave Kapuna on Monday – Grace and<br />
I were walking around Kapuna, saying our goodbyes<br />
to the patients as well as friends we’ve made<br />
during our time there, taking some photos along<br />
the way. We were blessed to have received so much<br />
from the people at Kapuna during our stay there –<br />
Valerie and Grandma, for feeding us so well, with<br />
both food and stories; Uncle John, for being a<br />
fatherly figure to us, sending food and<br />
necessities our way; Debbie and Robbie, for<br />
giving us pointers before we even stepped foot<br />
into Kapuna; the kids, for the amount of laughter<br />
they bring; the girls, for the amount of stories<br />
and music they have to share; Paul, for being<br />
instrumental in my connection to the outside<br />
world (he does the radio-thing that allows us to<br />
receive and send out emails); the Kapuna staff,<br />
for teaching us practical stuff like how to<br />
deliver a baby (!); the English speaking<br />
patients, who are lifesavers in terms of helping<br />
a struggling med student like myself to translate!</p>
<p>Anyway, we were meant to leave at about 8ish. But<br />
as with all things, we finally only left at half<br />
9. The tide came up quite high, and we began our<br />
journey of becoming PNG-ified as we waddled<br />
barefooted through the water to get to our dingy!<br />
Our first stop was Baitoti, where we stopped to<br />
get some drinks and random food stuff at the<br />
store. There, we met a Chinese guy (first Chinese<br />
guy I’ve seen since I left for PNG), and very<br />
quickly we started chatting (in Mandarin)! Yes,<br />
my Mandarin is a bit rusty, but good on me, I<br />
still managed pretty well. Apparently his whole<br />
family is here, and his parents run a store at<br />
Kikori (see later). He gave us 2 cans of coke<br />
(haven’t had that in ages), and we were trying to<br />
save it for later in the trip, but some kid from<br />
the village nicked it! Ohwell, nevermind.</p>
<p>**</p>
<p>So after that, we began our patrol proper. Our<br />
first stop was Bavi. We got started really<br />
quickly, with some patrol members doing screening<br />
(where they weigh the children, and check what<br />
immunizations they need), and others doing things<br />
like drawing up the immunizations, giving<br />
immunizations, and seeing patients. It became<br />
rather chaotic with the villagers all flowing in<br />
(like an army), kids crying and brawling their<br />
eyes out, parents telling kids to shut up,<br />
onlookers laughing and trying to pin the child<br />
down etc. You can picture it. I got started on<br />
drawing up immunizations at Bavi, but later that<br />
got quite monotonous so we rotated around, and at<br />
the other villages (Buri, Ubu’o, Goilavi), I gave<br />
the imms (and made lots of kids cry), saw<br />
patients and screened them too. One thing about<br />
giving imms though, you’ve got to be really<br />
strong, and not care too much about hurting the<br />
kid. Some of them are really strong, and if you<br />
don’t pin them down proper, you run the risk of a<br />
needle stick injury/having to give them another<br />
jab bcos the needle comes out. The worst one to<br />
give is BCG – to draw it up is already quite<br />
difficult due to the tiny amount that is required<br />
(0.05ml/0.1ml). To give it intradermal is<br />
tortuous. The kid struggles so much and you<br />
actually need to get the bulge in the skin before<br />
you can withdraw the needle. Anyway, I hate giving BCGs.</p>
<p>Apparently these villages have not been visited<br />
in quite awhile, and because villagers tend to<br />
deliver in the village, very few parents actually<br />
bring their children to the health centre for<br />
imms. So we had a lot of kids who had been<br />
overdued for their imms coming in, much more than<br />
anticipated. Some were quite old (like 3-4 years<br />
old, the worst age for immunizations really), and<br />
what meant to be a small-ish village had about 80<br />
kids coming in for imms (small village = about 30<br />
kids). We intended to go to 6 villages, but<br />
because we ran out of vaccines, we had to cut<br />
short the patrol. A pity though, for the other 2 villages to have missed out.</p>
<p>Grace saw a severely malnourished child during<br />
patrol as well, and it was really heartbreaking<br />
to see the kid. One wonders – how can any parent<br />
allow her kid to go on like that without seeking<br />
any form of help at all? The pains of poverty and<br />
ignorance I suppose? We didn’t have the resources<br />
for that child and the best advice we could give<br />
was for his mother to send him to the hospital<br />
asap. We also saw a emaciated man who had an<br />
array of symptoms with episodes of fainting +<br />
jerking movements (?tics) + chronic backache +<br />
cough + weight lost + lethargy, but no fever or<br />
night sweats (on the contrary, feeling cold all<br />
the time). We wondered if he was Parkinson due to<br />
the ?tremor he had, or some sort of neurological<br />
thing going on (had abit of passing pointing +<br />
intention tremor). We’re not sure if the team<br />
managed to pick these 2 cases up on the way back,<br />
but in any case, we shall find out soon. Other<br />
cases I saw were conditions like malaria, ?TB, GI<br />
reflux, musculoskeletal pains etc. The rest of<br />
the patrol experience from the other villages is<br />
kinda hazy to me, perhaps due to the combination<br />
of the intensity of the work we were doing +<br />
stresses of moving around everyday.</p>
<p>After each visit to the village, if it were too<br />
late, we would stay in that village. The local<br />
villagers would look for a house for us to stay<br />
for the night, and the first night was spent at<br />
Bavi, the second at Ubu’o (the chief’s house). To<br />
actually live out in these villages was quite an<br />
experience, I must say. For one, there was no<br />
electricity at Bavi. So when it got dark, it<br />
really got dark. The villagers use kerosene lamps<br />
and even then, everything was quite dim. My handy<br />
headlight definitely came in very useful those 2<br />
nights. To live out there was to soak oneself in<br />
the PNG culture/lifestyle. After a few failed<br />
attempts to walk with our sandals, I soon gave up<br />
and walked around barefoot (To lose my sandals<br />
while I waddle through the mud would be worse<br />
than getting my feet all dirty!). I tried my best<br />
to control my water intake too so that I didn’t<br />
have to visit the loo (of long-drop variety) too<br />
often as well. Fortunately, we didn’t need to get<br />
up in the middle of the night to find our way to<br />
the loo (located by the river!). I never really<br />
realised the advantage of a full moon until this<br />
time on patrol, where a full moon actually helped<br />
a lot in terms of getting around in the dark!</p>
<p>Each morning, we would have to then pack up our<br />
sleeping stuff, and move onto the next village.<br />
It was fantastic that many people would actually<br />
come forward to help us move stuff to the dingy!<br />
The villagers would then give us parting gifts<br />
like coconuts (yummy), pineapples and guavas (big<br />
yums). On the whole, going on patrol felt really<br />
satisfying. I actually felt like I was able to<br />
help the villagers, especially those who could<br />
not get to help, those in proper need. To wrap<br />
things up, by the time we finished at Goilavi,<br />
most of our supplies ran out, and so we decided to head to Kikori.</p>
<p>According to Olina, the villages we visited were<br />
infested with these annoying flies. But during<br />
patrol, as she said, it was a miracle that the<br />
mudflies were nowhere near us. Praise God – He<br />
really watched over us! Thanks to Uncle John’s<br />
rather soothing insecting repellent lotion too!<br />
Another miracle was journey mercy that was<br />
granted to us. So many times, we saw rain pouring<br />
in a distance. But we didn’t get any rain when we<br />
were traveling in between the villages at all. Our God is really great!</p>
<p>**</p>
<p>So now at Kikori, we’re trying to pass time.<br />
We’ve got no kids to teach music to, we’ve got no<br />
fruits to pick. And, we woke up early too (thanks<br />
to the chickens). So, after having breakfast,<br />
watching a movie, and blogging this post, its only 10.30am! Ohwell.</p>
<p>Kikori has a different feel to Kapuna. I miss<br />
Kapuna already – the community, the activities we<br />
do, the walkabouts we had, the pawpaws and<br />
coconuts (mmm). The compound here feels bigger<br />
and less personal, with more staff housing around<br />
and we’re living in a house that’s next to one of<br />
the doctors. It didn’t take long for us to fit<br />
right back in with the modern tools of living<br />
i.e. gas stove and fridge, + fan though! More electricity time as well.</p>
<p>Kikori is much bigger, with more people as well.<br />
In Kapuna, the staff at the hospital forms the<br />
community. But here, you’ve got people from the<br />
hospital, the local people, and workers from the<br />
big logging companies around this area. It’s more<br />
crowded, and they’ve got more stores here too. We<br />
went down for a walk yesterday, and bought stuff<br />
like tinned curry chicken, ice popsicles, and<br />
chicken! We also met the family of the guy whom<br />
we met at Baitoti. They are a family of five from<br />
the province of Guangdong, of Toechew descent,<br />
and they have been running the Jackson store down<br />
in the ‘town centre’ for about 5-6 years now. I<br />
think they’ve kinda ‘adopted’ us (in Dr Manar’s<br />
words), giving us stuff (my favourite pork mince<br />
with bean paste, plus some pork and beef!). They<br />
even invited us over for dinner! So yeah, we went<br />
over last night (don’t worry Mum and Dad, we<br />
found out from the doctors here that it was safe<br />
to do so), and the mum cooked up a storm, with<br />
traditional Teochew cuisine – taukwa mixed with<br />
pork + pork ribs and red dates + sharks’ fin<br />
even! Who would have thought that we would get<br />
proper Teochew food in Kikori?! Oh, and I’ve put<br />
my mandarin and abit of Teochew into good use.<br />
Afterall, I was speaking Mandarin for a whole<br />
night (yes, hard to imagine). I wonder where our<br />
ancestors come from – maybe somewhere around<br />
their area? (No Kor, not the ‘London version’ of ancestors).</p>
<p>So anyway, that’s Kikori for now. Very<br />
interesting experiences and people I’ve met so<br />
far. We shall see what the rest of my time here<br />
brings! Just 10 more days left here!</p>
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		<title>(07/03/2009 2130 GMT +10) My last post from Kapuna</title>
		<link>http://inmedblogs.us/ruthchen/2009/03/16/07032009-2130-gmt-10-my-last-post-from-kapuna/</link>
		<comments>http://inmedblogs.us/ruthchen/2009/03/16/07032009-2130-gmt-10-my-last-post-from-kapuna/#comments</comments>
		<pubDate>Mon, 16 Mar 2009 14:49:34 +0000</pubDate>
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		<description><![CDATA[I drafted this before my previous post, but
didn’t have time to upload it to send it off, so here it is!
So, I’m at the end of my stay at Kapuna. It’s
been an experience here, practicing medicine in
the bush, learning to survive in the bush. I’m
not sure what Kikori is going to be like, but I
hear [...]]]></description>
			<content:encoded><![CDATA[<p>I drafted this before my previous post, but<br />
didn’t have time to upload it to send it off, so here it is!</p>
<p>So, I’m at the end of my stay at Kapuna. It’s<br />
been an experience here, practicing medicine in<br />
the bush, learning to survive in the bush. I’m<br />
not sure what Kikori is going to be like, but I<br />
hear it’s more modern, with concrete buildings<br />
and floorings. Anyway, I will miss the way of<br />
life here – my morning alarm clock (thanks to the<br />
chicken), starting the fire for a hot meal,<br />
sleeping under my mosquito net watching the<br />
fireflies create some sort of spectacle under the<br />
roof, listening to the flapping of flying foxes, and lizards chuckling.</p>
<p>This is probably gonna be my last post from<br />
Kapuna. This past week has somewhat gone by in a<br />
haze to me. I can’t really recall what has been<br />
happening, apart from some handicraft work and a<br />
few very sick patients in the hospital. I have<br />
been doing the children ward round with Valerie<br />
this week, and what started out as a quiet week<br />
quickly morphed into a harrowing ward round this<br />
morning. A couple of children have become unwell,<br />
with ?TB Meningitis and typhoid on the list.<br />
Children are really adorable, and its fun getting<br />
the PNG kids here to laugh (PNG people laugh a<br />
lot, at almost everything. Read previous posts).<br />
Grace and I have almost assumed the role of being<br />
the hospital clowns for the kids here, and<br />
everyday as we make our way to and fro the<br />
hospital, its such a joy to see kids (especially<br />
those who have been very unwell previously)<br />
playing in the fields. Some will be carrying<br />
grass that had been cut, or playing with love<br />
grass, or just kicking a ball around.</p>
<p>To deal with very sick children is another matter<br />
altogether. I mean, just take today for example –<br />
to get an IV into a patient, a 12-year old girl<br />
was pricked just about 5 times, by various<br />
people. 5 times! For a 12-year old girl! At my<br />
age, I wouldn’t like that very much. Imagine a<br />
12-year old girl! A fitting 7 month old child<br />
with starry eyes and a desperate mother with sore<br />
breasts from expressing breast milk crying<br />
because of her child’s ill health are painfully<br />
heartbreaking as well. Imagine performing an LP<br />
(lumbar puncture) for such a baby! Seeing<br />
children so ill is emotionally challenging – I<br />
wonder how paediatricians handle such cases.</p>
<p>Today Valerie had to pick the new med student and<br />
the Pettersons, from Baimuru, so she left the<br />
hospital in our hands. Apart from those sick<br />
children, the adult ward was quiet (enough)<br />
(fortunately). I hope we did a satisfactory job.<br />
It was tiring, nonetheless satisfying. I guess<br />
with all things, when you have to bear<br />
responsibility, its slightly different. You start<br />
making active moves, and form decisions based on<br />
common sense and whatever knowledge one<br />
has.  Well, so much for being in-charge for the day!</p>
<p>I’m starting to feel sad about the end of our<br />
stay at Kapuna, kinda abit reluctant to leave!<br />
Some of the girls have started to tear at the<br />
mention of us leaving, and the 2 girls who have<br />
been helping us with the bilum bags are doing the<br />
bilum bag quite religiously. We’re also trying to<br />
do as many friendship bands as possible, teach<br />
the kids as much music as possible, and tie up<br />
loose ends like signing of paperwork for uni and<br />
getting the necessities to bring along with us on<br />
patrol. Well, as with everything, all good things must come to an end.</p>
<p>I don’t really know what to expect from patrol.<br />
Many have said that you will never know how its<br />
like until you’re on one. Nothing can prepare you<br />
for it. Although it leaves us with just a week at<br />
Kikori (where a lot of hospital action takes<br />
place apparently), it will be an experience, to<br />
go out into the community to see how PNG people<br />
actually live, to follow up on patients, to make<br />
more kids cry cos we’re giving them their<br />
immunizations! We’ll probably arrive at Kikori on<br />
Friday.</p>
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		<title>Time to say bye! (9/09/2009 0800 GMT +10)</title>
		<link>http://inmedblogs.us/ruthchen/2009/03/09/time-to-say-bye-9092009-0800-gmt-10/</link>
		<comments>http://inmedblogs.us/ruthchen/2009/03/09/time-to-say-bye-9092009-0800-gmt-10/#comments</comments>
		<pubDate>Mon, 09 Mar 2009 14:32:29 +0000</pubDate>
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		<description><![CDATA[And so, my time in Kapuna has come to an end. We take the boat out
today and start our patrol in various villages before reaching our
final destination, Kikori Hospital on Friday/Saturday. A whole new
experience again, and I am looking forward to it!
I haven&#8217;t had the time to sit down, collate my thoughts and write
them out [...]]]></description>
			<content:encoded><![CDATA[<p>And so, my time in Kapuna has come to an end. We take the boat out<br />
today and start our patrol in various villages before reaching our<br />
final destination, Kikori Hospital on Friday/Saturday. A whole new<br />
experience again, and I am looking forward to it!</p>
<p>I haven&#8217;t had the time to sit down, collate my thoughts and write<br />
them out yet - been busy with packing and saying my goodbyes around<br />
here. Perhaps I&#8217;ll do it during the boat ride - I hope its not too long!</p>
<p>Anyway, its been good here at Kapuna. I shall miss it muchly. Will<br />
write again when I have the chance. Sorry this is short, but it will<br />
be longer next time, I promise!</p>
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		<title>Of handicraft and food (02/03/2009 2130 GMT +10)</title>
		<link>http://inmedblogs.us/ruthchen/2009/03/03/of-handicraft-and-food-02032009-2130-gmt-10/</link>
		<comments>http://inmedblogs.us/ruthchen/2009/03/03/of-handicraft-and-food-02032009-2130-gmt-10/#comments</comments>
		<pubDate>Tue, 03 Mar 2009 17:24:18 +0000</pubDate>
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		<description><![CDATA[It’s pouring, finally. The feeling of having the
rain can almost be likened to having my first
bowl of bak chor mee after I touch down from
London. It’s been a really hot day here in Kapuna
today, and I was just wondering when it was going
to rain (it hasn’t rained in a couple of days).
So, since my last [...]]]></description>
			<content:encoded><![CDATA[<p>It’s pouring, finally. The feeling of having the<br />
rain can almost be likened to having my first<br />
bowl of bak chor mee after I touch down from<br />
London. It’s been a really hot day here in Kapuna<br />
today, and I was just wondering when it was going<br />
to rain (it hasn’t rained in a couple of days).</p>
<p>So, since my last entry, I’ve been quite slack<br />
with hospital stuff – nothing much has been<br />
happening (I’m quite sure now that I’ve said<br />
this, things will pick up tomorrow, as with all<br />
things!). Patients are all getting better, which<br />
is always good news. The weekend was a quiet one,<br />
with no mothers wanting to pop. Since my last<br />
entry though, I managed to do a couple more of<br />
deliveries – multiparous mothers(had previous<br />
pregnancies), hence quicker labours. I still<br />
haven’t quite gotten the hang of it. After all,<br />
babies all come out in their own unique way! I’m<br />
guessing that it’ll probably take me 10 or 20<br />
deliveries to get the hang of it? Ohwell. The<br />
patients all come in waves – one minute all the<br />
moms decide to pop, and all the kids in the same<br />
village come down with pneumonia or bronchitis,<br />
and the adults all come in with some sort of<br />
nasty illness (read: malignancy. See previous<br />
post). And then, they all get better at the same time.</p>
<p>Anyway, I’m not complaining. It’s nice to have<br />
some time to do other things. Things like buying<br />
wool from the local store to make friendship<br />
bands for the girls as parting gifts (yes, I am<br />
reminded of primary school days where we would do<br />
countless of friendship bands after exams!). Or<br />
learning how to make a bilum bag using the wool.<br />
Bilum is the Pidgin word (Pidgin is one of the<br />
main spoken languages in PNG, after English) for<br />
string. So bilum bag = string bag. It’s a<br />
traditional PNG custom for daughters to learn how<br />
to make bilum from their mums, and the girls here<br />
(by girls I mean the CHWs/nurses who work at<br />
Kapuna Hospital) have all learnt it well.<br />
Basically you take two strings of wool, roll it<br />
together, and using the metal bit of an old<br />
umbrella as your needle, you thread the wool in,<br />
and start your bilum (quite a lot of complicated<br />
stitches). I’m learning from the girls at the<br />
moment. Every evening at half 5, we meet them<br />
under the Old Dorm, and they have been teaching<br />
us, bit by bit. It’s not as easy as it looks, so<br />
we’re progressing quite slowly. The girls are<br />
determined for us to finish a bilum bag before we<br />
leave Kapuna, so they show us the stitching, and<br />
after we do a bit, they take the bag to continue<br />
the stitching! Yes, not the ideal way to learn.<br />
But at least we’ll get a bag each! Heh. One of<br />
the girls teaching us will be heading to Kikori<br />
with us, so hopefully when we start on our new<br />
bilum bag, she can correct the mistakes we make!<br />
(Mum, you should probably youtube it! If by the<br />
time I get home I can still remember how to do<br />
it, I will definitely need to show you how to do<br />
it! The wool here is about S$1.40/ 0.70 for<br />
25grams. Not sure if that’s cheap/expensive, but<br />
the girls say that wool here is much cheaper than<br />
at Kikori, so I might just get more so that I<br />
have something to occupy myself with.)</p>
<p>**</p>
<p>How time flies, its March already! Another 3<br />
weeks here – its going to be hard to leave<br />
Kapuna! At church on Sunday, we had communion<br />
with sago bread and lime juice. And compared to<br />
back home and in London, it’s interesting to see<br />
how different ingredients can be used to signify<br />
the very same thing, of Jesus Christ dying on the<br />
cross for us to save us from our sinful ways.</p>
<p>The girls here really love singing so much – if<br />
they really buy my laptop from me, I’ll leave all<br />
my Christian songs in the laptop for them! I<br />
think they’ll bring Kapuna down with all that singing and dancing!</p>
<p>**</p>
<p>The rest of the Sunday was spent hovering over<br />
the fire stove again. We got the fire going<br />
again, and we’ve established a system around here<br />
– Grace does the fire, and I cook. This time, we<br />
cooked the chicken that Dr Ovoi kindly sent over<br />
from Kikori with 5-spice seasoning, maggi<br />
seasoning + oyster sauce, and using the chicken<br />
skin and a bit of ginger, I fried the rice. We<br />
were smarter this time, and decided to cook the<br />
rice using the microwave. When the power came on,<br />
we put in the rice to cook straightaway. And for<br />
the first time in PNG, our rice turned out just<br />
right. (The last time we cooked pineapple rice,<br />
the rice became really gunky – we tried to cook<br />
rice over the stove, you see. And given the fact<br />
that we normally use the rice cooker to cook<br />
rice, we obviously failed miserably with cooking<br />
rice using the stove, whatmore a fire stove.) At<br />
one point, I had to use my headlight to see what<br />
I was cooking because it got quite dark before<br />
the power came on! So anyway, we’ve got warm<br />
water to shower with today (which is good<br />
considering how it’s pouring!) and that’s the<br />
nice thing about starting the fire.</p>
<p>[Warning: I’m a foodie junkie, so more Food Talk below]<br />
I think I can perish the thought of losing any<br />
weight here in PNG. I’ve gotten accustomed to the<br />
food here – bread with peanut butter for<br />
breakfast, followed by weird lunching habits like<br />
eating papaya, pineapple, guava or<br />
coconut/sago/crackers/more bread, and then sweet<br />
potato/pumpkin/tapioca/pitt pitt + beans and<br />
greens + crabs/fish for dinner! I love the sweet<br />
potatoes here.. they are actually quite sweet,<br />
and make very yummy sweet potato porridge! Crabs<br />
here are good too, and I don’t think I’ve ever<br />
eaten so many crabs in a month before. The<br />
coconuts are great too – the locals keep telling<br />
me which ones are the good ones, but each time I<br />
go back and break it, the meat is too hard. Then<br />
I realized that their idea of a good coconut is<br />
for scraping to make coconut cream. Not mine<br />
though – I want young ones because I love the<br />
soft succulent coconut meat! So I’ve learnt my<br />
lesson to ask them, which one is young, instead<br />
of which one is imau miki (= very good). Today, I<br />
intended to return to the market to buy a coconut<br />
after ward rounds at 9. When I came back at 1,<br />
they were all gone! And they were all young<br />
coconuts! Tsk. So that’s my coconut story.</p>
<p>Other than coconuts, papayas, guavas (the guavas<br />
have decided that they don’t wanna bear any<br />
fruits, so we’re running low on them), bananas<br />
and pineapples, we finally had our soursop<br />
(yummy!). They take awfully long to ripen, and at<br />
the moment there are 2 soursops sitting in the<br />
kitchen, and everyday I look at them and press<br />
them. But too bad, not ripe yet. Sigh. Oh, and<br />
eating papaya with lime is very yummy. Looks like<br />
I’m over the gastroenteritis that I had with the papaya milk already!</p>
<p>**</p>
<p>I think it has been decided that we’ll be able to<br />
go for patrol after all. Patrol is when<br />
healthcare workers go out to a village, and carry<br />
out clinics for child immunization, antenatal<br />
clinics, TB checks, etc. Patrol will be leaving<br />
Kapuna next Monday. And this one that’s going to<br />
happen (we hope it does! In typical PNG fashion,<br />
things can always change!) will be over 3-4 days.<br />
Since the patrol is going towards Kikori, we’ll<br />
get dropped off at Kikori after the patrol. So<br />
I’m guessing by Friday next week, we should be in<br />
Kikori. And we’ll spend 2 weekends there, before<br />
heading back to Port Moresby on the 24th.</p>
<p>So yup. Hopefully the next time I blog, I can<br />
tell you my first bilum bag is done. I shall go<br />
back to doing the friendship bands now.</p>
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		<title>Funny PNG Patients! (26/02/2009 2200 GMT +10)</title>
		<link>http://inmedblogs.us/ruthchen/2009/03/03/funny-png-patients-26022009-2200-gmt-10/</link>
		<comments>http://inmedblogs.us/ruthchen/2009/03/03/funny-png-patients-26022009-2200-gmt-10/#comments</comments>
		<pubDate>Tue, 03 Mar 2009 17:23:28 +0000</pubDate>
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		<description><![CDATA[The past few days have been eventful. Hospital
wise. The adult ward has got interesting patients
at the moment, with 2 patients with ?malignancy.
One can’t be 100% sure because we don’t have the
investigations to prove it but we are almost
certain that the lady with haemorrhagic ascites
has got some sort of abdominopelvic malignancy,
and the man with lost of [...]]]></description>
			<content:encoded><![CDATA[<p>The past few days have been eventful. Hospital<br />
wise. The adult ward has got interesting patients<br />
at the moment, with 2 patients with ?malignancy.<br />
One can’t be 100% sure because we don’t have the<br />
investigations to prove it but we are almost<br />
certain that the lady with haemorrhagic ascites<br />
has got some sort of abdominopelvic malignancy,<br />
and the man with lost of weight, clubbing,<br />
inability to first swallow food followed by<br />
liquid probably has oesophageal cancer. Cancers<br />
aren’t common here, but in a span of a week, I<br />
see 2 admissions of terminal stage Ca.</p>
<p>Its really sad that nothing much can be done for<br />
them here. Perhaps they presented too late? But<br />
even if they came in earlier, what more could we<br />
have offered them? Probably advice for them to<br />
seek further treatment at Port Moresby. Afterall,<br />
we are treating patients in the bush. The Xray<br />
machine should be arriving from New Zealand soon,<br />
and that’s about the best offer we’ve had so far.<br />
As I saw the ascitic tap draining bloody fluid,<br />
and the patient vomiting the little water that he<br />
had drunk, I felt a sense of helplessness for<br />
these patients – chemotherapy, radiotherapy,<br />
surgery.. so totally unheard of. Its really sad<br />
that nothing more can be done for these patients.</p>
<p>Yesterday, during children’s ward round, I saw a<br />
kid with dextrocardia (heart on the right side of<br />
the body). With cyanotic heart disease, it is a<br />
miracle that at the age of 3, this girl is still<br />
alive (mind you, she hasn’t had any surgery yet).<br />
She was admitted once again for pneumonia. Option<br />
of surgery was discussed with parents, but as<br />
what Valerie says.. it’s a tough decision for the<br />
parents to make. Finances is one thing.. the risk<br />
they have to take - that surgery may not make the<br />
child any better, if not worse.</p>
<p>Talking about xrays earlier, thanks to the<br />
graduation, there was a canoe going over to<br />
Kikori to drop the guests back there. Making full<br />
use of the opportunity, patients who needed xrays<br />
got onto that canoe, went to Kikori, and got<br />
their chest films done there. Just yesterday they<br />
all arrived back to Kapuna, and I found it<br />
amusing how everyone (including patients)<br />
gathered around the veranda this morning looking<br />
at the xrays with us. They must be so curious to<br />
actually stand there for a good hour or so<br />
looking at all these films! I actually took a<br />
photo of it – will try to see if I can post photos up!</p>
<p>I’m really enjoying hospital work now. Finally<br />
getting into the swing of things. Plus, funny<br />
things happen all the time. Funny as in haha<br />
funny! Things like teaching a patient how to use<br />
a peak flow – Valerie shows the patient how to<br />
use it. The patient attempts it, albeit wrongly.<br />
Then the CHW does it, and the patient tries<br />
again, unsuccessfully. Then another patient<br />
explains it, and the patient tries again. By this<br />
time, everyone is laughing away, both healthcare<br />
workers and all the other patients!<br />
With my morning sniffles, Valerie chides me for<br />
being the worst patient ever, for not using my<br />
nasal spray. I’m sent away to take my med, and my patients all laugh at me!<br />
I was taken aback to hear a patient’s dad use the<br />
F word today (I haven’t heard it since I came<br />
here), and apparently in Pidgin, its primary<br />
meaning is screwed up. Not so for the English<br />
language, Valerie explains and everyone laughs!<br />
These PNGs, they laugh at everything! Such a happy bunch of people hehe.</p>
<p>I’m enjoying teaching the kids music more and<br />
more each day too. I guess its all part of<br />
building relationships. 2 weeks here, and with my<br />
routine set up, I’ve settled in. We don’t know<br />
when we’re going over to Kikori as yet, but I<br />
don’t think either of us minds staying at Kapuna<br />
longer! Better still if we can go on patrol<br />
(Patrol is when we go out to the village to treat<br />
patients out there, each trip lasting about 4-5<br />
days). I definitely look forward to more story<br />
telling with Grandma and Valerie and the girls in<br />
my reminding time here. I think the time has come<br />
for me to realise and accept the fact that I will<br />
definitely miss Kapuna when the day comes for me to finally leave.</p>
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		<title>The wonders of God and Medicine (25/02/2009 1630 GMT +10)</title>
		<link>http://inmedblogs.us/ruthchen/2009/02/26/the-wonders-of-god-and-medicine-25022009-1630-gmt-10/</link>
		<comments>http://inmedblogs.us/ruthchen/2009/02/26/the-wonders-of-god-and-medicine-25022009-1630-gmt-10/#comments</comments>
		<pubDate>Thu, 26 Feb 2009 15:01:41 +0000</pubDate>
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		<description><![CDATA[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 [...]]]></description>
			<content:encoded><![CDATA[<p>I just returned from the labour ward after having<br />
done my first delivery. This woman who was in<br />
labour had been having regular contractions since<br />
last night 9pm, only to deliver at 9.20pm<br />
tonight. Her contractions reported from last<br />
night were probably Braxton-Hicks, but still, she<br />
was dilated at 2cm at 2am. For a multip, this one<br />
was taking a long time to pop. Apparently her<br />
membranes were ruptured earlier in the day today,<br />
but when we did a PV again, it seemed that the<br />
SROM was probably incomplete. Anyway, Valerie<br />
gave me the opportunity to deliver, and although<br />
I’ve been putting off performing deliveries for<br />
the longest time, the time had finally arrived<br />
for me to do one (under supervision of course). I<br />
shan’t go into why I havent done any deliveries –<br />
partly my own fault, but the education system<br />
doesn’t help either. Anyway, being grossly<br />
incompetent, I was relieved that Susie, the main<br />
nurse who does deliveries, was there to guide me<br />
along. As with all babies, this one came really<br />
quick after the SROM, and with hands-on things<br />
seem to happen much faster than it would seem<br />
with observing. So a baby boy was brought into<br />
this world. This woman had a history of retained<br />
placenta with manual ERCP, so we had to be<br />
cautious with removal of placenta. Unfortunately,<br />
the cord actually broke, and Valerie went in to<br />
pull on the cord. I wonder how she did it really,<br />
everything becomes so slippery. Slowly but surely<br />
though, she got the placenta out.</p>
<p>When I first read feedbacks from previous<br />
students who did their elective at Kapuna, they<br />
spoke about how Kapuna is a place where one could<br />
observe how God and medicine came together.<br />
Tonight, I witnessed that for myself. This woman<br />
was really having a difficult labour, and Susie<br />
led the group and decided that we took a moment<br />
to pray to God, with the patient and her<br />
relatives. I don’t know if they understood our<br />
prayer, but in any case, I definitely felt God’s<br />
hand at work in that delivery - even when the<br />
cord broke and we couldn’t quite find the other end of it for a while.</p>
<p>It is customary for the labour team to say a<br />
prayer and sing a worship song after each<br />
delivery and given my time here, I have observed<br />
how open surgeries have been done with grossly<br />
limited supplies, but never short of God’s grace<br />
and providence. Patients have been able to walk<br />
away with healing lesions and regained hand<br />
functions. Their scars heal beautifully (they have their PNG skin to thank).</p>
<p>Other hospital stuff , there’s a patient in the<br />
ward who’s been having repeated knee effusions<br />
and we’ve aspirated it 3 times already. Mr Knee’s<br />
(that’s our nickname for hime) right knee’s been<br />
flaring up with tenderness and stiffness, and now<br />
his left knee seems to be following the<br />
progression of the right. His left ankle’s also<br />
starting to hurt. We treated him as TB knee, but<br />
symptoms aren’t improving on TB meds, so that’s<br />
been stopped now, and we’re treating as septic<br />
arthritis now. Have to see how that goes. There’s<br />
another woman, Mr Knee’s neighbour, Ms Ascites,<br />
who’s having severe oedema all the way to her<br />
sacrum, and without jaundice, one wonders if<br />
she’s got a malignancy going on somewhere.<br />
Valerie says its too tense to be TB abdo, so<br />
we’ll be doing an ascitic tap tmr. Trouble is,<br />
there’s no microscope here so the tap wouldn’t be<br />
that useful apart from seeing the colour and appearance of it. Ahwell.</p>
<p>**</p>
<p>The graduation ceremony took place on Saturday<br />
and that morning, Valerie and I were doing our<br />
normal morning ward rounds. It was a lovely<br />
morning, the breeze was cool, almost chilly and<br />
the clouds were beginning to look really angry.<br />
It was going to rain, which wasn’t great news<br />
because the grad was going to be taking place in<br />
the open grass field. Anyway, the rain came, and<br />
what it left was a perfect nice afternoon for the<br />
ceremony. Ah, bliss. The ceremony was a very<br />
heartfelt one, nothing like the ones I know of<br />
where lists of names are called out. When each<br />
student walked out to collect his or her<br />
certificate, family and friends would carry their<br />
gifts and walked up to the stage with her. A<br />
particular grandma of 2 students was so ecstatic<br />
and she started dancing in front of her<br />
grandchildren as they walked towards the stage!<br />
The gifts that they brought to give away, either<br />
to the graduate or the tutors, were things like<br />
brooms, grass skirts, straw mats, and even<br />
chicken! Simple gifts they were, yet so<br />
meaningful and genuine were their intentions.</p>
<p>**</p>
<p>Shortly after the graduation, we were told that<br />
one of our patients had died. This patient had<br />
been admitted since the beginning of the year,<br />
and we hadn’t been able to diagnose him properly.<br />
It’s a great pity because I think in a developed<br />
country, this would probably not have happened..<br />
at least more tests could be done. Ohwell, that’s<br />
the one thing I really struggle with over here –<br />
having to make do with limited resources, and<br />
learning to practise proper old school medicine<br />
using clinical judgement (this of course is<br />
really difficult due to the way we now learn<br />
medicine in med school – so much emphasis on<br />
investigations and results! Even the most basic<br />
patient in hospital in UK would have a FBC at<br />
least.. But not here unfortunately). Back to my<br />
dead patient – he had these lumps all over his<br />
body, and they almost felt like hardened skin. He<br />
was having proteinuria, and developed extensor<br />
paralysis of both his wrists. Apart from that, he<br />
had peripheral neuropathy with bilateral foot<br />
drop, ulcerating lesions all over his scrotum,<br />
amongst many other signs. I should actually get<br />
his notes and properly document it so that I can<br />
search for an answer when I get home. He reacted<br />
to almost every drug we gave him, and the morning<br />
before he died, he was complaining of SOB, which<br />
we decided to treat as pneumonia. I think its<br />
something autoimmune, Valerie’s take is pyoderma<br />
gangrenosum, and Grace thinks its lymphoma. Hrms.<br />
Anyway, the whole Saturday afternoon was spent<br />
dealing with logistical issues of getting his<br />
body back to him village, and suffice to say,<br />
everything around here is the doctor’s problem –<br />
from curing the sick, to replacing medical<br />
stocks, fixing the broken light bulb, and<br />
arranging transport for a dead man. Oh, and<br />
hungry patients look for Valerie too. Jack-of-all-trades, you can say.</p>
<p>That night, a gravida 4 woman came in and her<br />
abdomen didn’t feel quite right. It looked as if<br />
it was a transverse lie, but I could hear fetal<br />
heart rate at the left lower quadrant (which<br />
meant baby should be in vertex position). However<br />
others thought it was in the right upper<br />
quadrant. The worry was that baby was breeched,<br />
which turned out to be a false alarm. So no, I<br />
didn’t get to see a breech delivery in the end.<br />
Which is a good thing for mum.. But it would have been cool to see one!</p>
<p>**</p>
<p>Church on Sunday seemed to go on forever. In the<br />
same time we had one service here, second service<br />
would be over and done with back home. I guess<br />
its because sharing is really encouraged over<br />
here. Rita, the girl I met on the plane to<br />
Baimuru, had just returned to Kapuna after<br />
spending 3 months in Australia. She had new<br />
experiences to share, and it was really good<br />
hearing her share as she inspired the people at<br />
Kapuna to rise up and pray for the Gulf Province.<br />
I can really see and feel the hope she has for<br />
her province – so passionate, such a deep sense<br />
of burning desire. It’ll be an awesome revival<br />
for the land of PNG for the people to rise up and<br />
stand in the gap. I am really looking forward to see how things in PNG change..</p>
<p>The kids came together during the service, and we<br />
finally put together an item of Ode to Joy<br />
together (they were on the recorder, while I<br />
accompanied them on the piano. Grace played the<br />
recorder with them too!) It’s all Valerie’s hard<br />
work though, and I think we should have given her<br />
the credit! The kids were all so pleased with<br />
themselves, and I’m so proud of them J</p>
<p>**</p>
<p>I’ve established some sort of routine around<br />
here. Day starts at around 5am, where the chicken<br />
intermittently awakes me. I finally get out of<br />
bed about half 6 and get to hospital sometime<br />
between 645 and 7 where ward rounds start. After<br />
ward round, its time for breakfast and we go<br />
round to Valerie’s for some homemade bread. If<br />
Grandma’s around, we’d get toasted bread. Or<br />
else, we’ll make do with normal bread. After<br />
that, I go round to the computer to see if I’ve<br />
got any new mail before heading to devotions<br />
(that is, it devotions is still on. Timing<br />
depends on what time ward rounds end). We’ll sit<br />
around until 11, where we go back to the hospital<br />
for either outpatients/postnatal/antenatal<br />
clinics. The walk to hospital at 11 is the worst<br />
– the sun’s shining in its full glory and the<br />
short 2-minute walk is enough to make me feel<br />
uncomfortable for a good hour or so. At 1, we<br />
leave clinic to teach the kids piano – Grace<br />
takes the young ones, and I take the older kids.<br />
Depending on how fast the kids learn for the day,<br />
we’ll spend the time after class ends to 4pm just<br />
sitting around, catching whatever wind that blows<br />
our way. Oh, we try to find something to eat too,<br />
for lunch. Or start the fire if we’ve got too<br />
much time to kill/get too hungry/want to eat<br />
something hot. 4 to 6 would be a walkabout around<br />
the hospital to see if any patients require<br />
attention. If there’s no problems, we would<br />
either be sorting out meds in the drug store or<br />
clearing stuff in the OT or checking the labour<br />
ward out or walking around kapuna looking for<br />
food (we sound like animals don’t we – the food<br />
bit). Then its time for dinner after the<br />
electricity comes on, and checking mail again,<br />
and time for bed – I love going to my bed and<br />
hiding under my mosquito net. I feel safe and<br />
clean under my mosquito net hehe. Aveline says I<br />
should just get used to not being clean (which is<br />
a big deal for me. I’m quite the clean freak)<br />
well, I’m getting there.. slowly. If we’re in a<br />
very keen mood, we may be tripping down to the<br />
ward to see if any mum-to-be is gonna pop anytime soon.</p>
<p>This week, we taught the CHWs some anatomy and I<br />
had to teach them terms. Terms, of all things!<br />
Terms like medial, lateral, proximal, distal..<br />
And I’ve forgotten how it’s like to teach until I<br />
taught on Monday. Its.. tiring. Once again,<br />
respect to all my teachers who once taught me.<br />
Another challenge I faced this time round was<br />
teaching these students when their command of<br />
English isn’t that great. It’s not quite a piece<br />
of cake getting them to understand what proximal<br />
and distal mean. Anyway, I’ve done my best. I<br />
hope they understood at least 60% of what I said.<br />
Oh, and apparently we’ve been given another<br />
learning outcome each to teach because we were<br />
such efficient workers that we completed our<br />
learning outcomes early! Cardiovascular and<br />
Lymphatic system. Hm, its going to be challenging!</p>
<p>I’m quite happy that my older kids are finally<br />
able to read notes and understand that notes<br />
ascend step by step. They are no longer confused<br />
about the treble and bass clef. So that’s<br />
satisfaction I’m getting out of teaching. Yay for me.</p>
<p>Ok, the electricity just came on. I’m going to<br />
make full use of it and stop here now. Till next time!</p>
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		<title>The rain came!  (20/2/2009 1130 GMT +10)</title>
		<link>http://inmedblogs.us/ruthchen/2009/02/23/the-rain-came-2022009-1130-gmt-10/</link>
		<comments>http://inmedblogs.us/ruthchen/2009/02/23/the-rain-came-2022009-1130-gmt-10/#comments</comments>
		<pubDate>Mon, 23 Feb 2009 15:15:19 +0000</pubDate>
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		<description><![CDATA[I had a slow start to the week as I nursed my
problematic nose and sore throat. Thankfully, I
got better after some self medication and
intranasal steroid spray from Valerie. Hospital
wise, things have been going fine and I have
started seeing my own patients during the ward
rounds. Some interesting cases this week – a
woman with a 5 year [...]]]></description>
			<content:encoded><![CDATA[<p>I had a slow start to the week as I nursed my<br />
problematic nose and sore throat. Thankfully, I<br />
got better after some self medication and<br />
intranasal steroid spray from Valerie. Hospital<br />
wise, things have been going fine and I have<br />
started seeing my own patients during the ward<br />
rounds. Some interesting cases this week – a<br />
woman with a 5 year history of growing mass in<br />
her pelvic cavity spiking temperature, a GORD<br />
patient with ?haemoptysis/epistaxis,<br />
oligoarthritis in a 21 year-old female with no<br />
genitourinary symptoms and an ulcerating<br />
offensive smelling lesion in the vulva, spreading<br />
inferiorly to her medial thigh. Many of these<br />
patients presented quite late, which is very<br />
unfortunate and saddening because more often than<br />
not, nothing curative can be done at that stage.<br />
If only they sought treatment earlier – and this<br />
seems to be the main problem here. Villagers tend<br />
to put things off, until it interferes with<br />
activities of daily living when it is often too<br />
late. Apart from ward rounds, we have been<br />
attending the outpatient clinics, where we deal<br />
with minor injuries, mostly cuts and wounds. I’ve<br />
also got the chance once again to feel pregnant<br />
tummies and go through the whole antenatal checks.</p>
<p>We started teaching the school kids intensive<br />
keyboard lessons this week as well, everyday at<br />
1pm. I think we’re overloading them with the<br />
lessons, but because we’re only here for 2 more<br />
weeks, we thought we would just make the most out<br />
of it. Now, I think I might have been abit too<br />
optimistic about the scope I had in mind to<br />
cover. I actually had to go back to lesson 1 to<br />
revise/teach again. Perhaps I’m talking too<br />
quickly. Or maybe the kids do not understand me<br />
very well. Hrms. It’s slightly discouraging, but we’ll see.</p>
<p>The graduation for the CHWs is this weekend, so<br />
all around Kapuna, people are preparing for the<br />
big event. Workers have been collecting tree<br />
trunks and bamboo poles, and coconut leaves to<br />
build shelter, and the first year students have<br />
been putting Hillsongs ‘At The Cross’ on repeat<br />
as they practise for their dance item. That kind<br />
of got me started on listening to all my favourite Hillsongs songs on my iPod.</p>
<p>It was so good to hear Mummy’s voice when it was<br />
by coincidence that I was sitting at the computer<br />
sending out my emails when the phone rang. And to<br />
all those who have been sending emails my way,<br />
thank you so very much. It’s always comforting to<br />
hear from you. I wonder how people did it in the<br />
old days, without telephones and internet!<br />
Imagine having to do snail mailing all over again!</p>
<p>It rained really heavily beginning of this week.<br />
I think I would actually call it a rainstorm. The<br />
whole house actually shook at one point, but it<br />
was perfect weather to sleep in. Perhaps because<br />
of so much rain, I&#8217;m noticing more insects and<br />
flies around. Yesterday was probably my most<br />
miserable day in PNG so far. I was victim to<br />
mudflies/sandflies so they bit both my legs and<br />
arms like there was no tomorrow. For those out<br />
there who has ever been bitten before, I now<br />
truly understand what it feels like. They’re<br />
painfully itchy, and the itch lasts for at least<br />
one whole day. They’re small bites, but way more<br />
potent than mosquito bites. I probably have<br />
gotten at least 10 bites in each limb. Pity I<br />
don’t have any mopiko with me. Preventing bites<br />
is one matter, relieving the bites is another<br />
matter altogether.. My advice? Bring mopiko<br />
(anti-itch cream) and chermos (?spelling) towel<br />
(for afternoon wipedowns). We were told to try<br />
aloe vera, so I picked some out of the bush, and<br />
applied them on. So far, so good. It’s providing<br />
some relief (colgate somehow didn’t work this<br />
time), or maybe it’s the zyrtec that I took<br />
that’s working. Either way, if anyone out there<br />
has got any homemade remedy for mudfly/sandfly<br />
bites, I would love to hear from you <img src='http://inmedblogs.us/ruthchen/wp-includes/images/smilies/icon_smile.gif' alt=':)' class='wp-smiley' /> Email me<br />
at &lt;mailto:kapunarh@online.net.pg&gt;kapunarh@online.net.pg Heh. Thanks.</p>
<p>The weekend is near once again, and its going to<br />
be all joy and merry this weekend as the CHWs<br />
graduate! We’re going to be teaching the first<br />
year students some basic anatomy next week –<br />
hopefully I won’t bore them with all the new<br />
terms! I definitely know how it feels like to be<br />
on the other end, having fallen asleep in most of<br />
my anatomy classes anyway (oops)!</p>
<p>Not much fruit picking lately – probably cos<br />
we’ve picked almost all that can be picked. We’ll<br />
just have to wait. Not much fire starting as well<br />
cos its takes up too much effort and time. We<br />
just eat over at Valerie’s and bath with cold<br />
water, which is fine for the hot days here.</p>
<p>Alrighty, that’s all for now. Till next time.</p>
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		<title>15.2.2009,  Finally stepping on Kapuna soil</title>
		<link>http://inmedblogs.us/ruthchen/2009/02/16/1522009-finally-stepping-on-kapuna-soil/</link>
		<comments>http://inmedblogs.us/ruthchen/2009/02/16/1522009-finally-stepping-on-kapuna-soil/#comments</comments>
		<pubDate>Mon, 16 Feb 2009 15:25:35 +0000</pubDate>
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		<description><![CDATA[
Today, being Sunday, is a day of rest for
everyone, and I munch on my starfruit and
pineapple as I type this. Its been a week since I
left the comforts of my own home for PNG, and one
week on, I’m sitting in the balcony of Colin and
Barbara Calvert’s house, trying to recollect my
thoughts on the past week, [...]]]></description>
			<content:encoded><![CDATA[<p>
Today, being Sunday, is a day of rest for<br />
everyone, and I munch on my starfruit and<br />
pineapple as I type this. Its been a week since I<br />
left the comforts of my own home for PNG, and one<br />
week on, I’m sitting in the balcony of Colin and<br />
Barbara Calvert’s house, trying to recollect my<br />
thoughts on the past week, to put them down into words.</p>
<p>The journey into Kapuna wasn’t too bad. We made<br />
it for the airport at Port Moresby pretty early<br />
(Bob so kindly sent us all the way to the gates),<br />
and customs stopped us when our bags were being<br />
scanned. Apparently, some metal item was showing<br />
up on their scanner, and after unpacking 2-3<br />
times, I suddenly remembered that I kept all my<br />
lovely aussie coins together in a Ziploc bag and<br />
shoved them into a pocket. That was quite a funny<br />
incident that got both Grace and the officers<br />
laughing (at me) and the night before, I was just<br />
telling Grace that the coins won’t be seeing the<br />
world till we get back to Brisbane. I even<br />
proudly told her that they will hold out in that<br />
nice orderly fashion I OCDedly arranged them in.</p>
<p>The plane we sat from Port Moresby to Baimuru is<br />
probably the smallest plane I’ve ever sat in. It<br />
was quite difficult to get any sleep on the<br />
plane, so I kept looking out of the window to<br />
take in the spectacular views of PNG – endless<br />
streams of rivers and deltas, trees after trees.<br />
Along the way, some passengers were dropped off<br />
at Kerema, and there, we got round to getting to<br />
know the other passengers on board. Got to know<br />
Rita, who works at Kapuna Hospital, and John, who<br />
was Kapuna-bound as well to do some engineering volunteering at Kapuna.</p>
<p>We finally got to Baimuru where we were greeted<br />
by Dr Archer, one of the two doctors at Kapuna,<br />
and Everlyn, a CHW (community health worker). Our<br />
bags, before we knew it, were carried for us by<br />
the local villagers and Everline! I was so spoilt by their hospitality.</p>
<p>On route to Kapuna Hospital, we stopped by the<br />
Baimuru store and got whatever necessities we<br />
could get our hands on. It’s abit like shopping<br />
the Argos way, where you tell the shopkeeper what<br />
you need, and he gets it for you. None of the<br />
typical pick and choose sort of grocery shopping.<br />
We were pleasantly surprised to find oyster sauce<br />
too – Singapore’s Kee’s brand even! We were then<br />
given a tour of the local medical ‘health centre’<br />
there and I saw the work of Dr Valerie where she<br />
took on the roles of doctor, stocktaker,<br />
storekeeper, and friend. I guess that’s how it is<br />
in rural regions, where the doctor is just about<br />
the port of call for everything and anything.</p>
<p>After an hour on the dingy, we finally arrived<br />
Kapuna. Kapuna, which means place, is not<br />
actually a village. Before I came, I tried<br />
looking it up on Google maps, and what I got was<br />
a jungle. And literally, it’s in the midst of the<br />
jungle. Its not part of another settlement, it<br />
functions wholly as a hospital. I guess you can<br />
call it a hospital village. The buildings here<br />
are all made it wood, and they house the staff,<br />
patients, and patient’s family members. Here, the<br />
whole family travel from neighbouring villages<br />
for the sick to seek treatment, and when the<br />
patient needs to stay in hospital, the family<br />
stays in these houses, where they can cook and<br />
provide for themselves. It’s a very different<br />
concept from modern hospitals, where meals are provided by the hospital.</p>
<p>We were showed our home for the next three weeks,<br />
and as soon as we got our stuff into the house,<br />
we went around walking as Dr Valerie showed us<br />
the locations of different fruit trees where<br />
we’re free to pick our own fruits – coconuts<br />
(favourite); pawpaws (which is papayas);<br />
bananas(none for me, no thanks to my allergy);<br />
guavas(ok); mini jambu; starfruit(second<br />
favourite); lime etc, the hospital, and her own<br />
home. She also gave us a breakdown of life in Kapuna along the way.</p>
<p>I guess I’ll give myself credit for doing rather<br />
well so far – we’ve made ourselves somewhat<br />
comfortable with the living conditions here; only<br />
thing I can’t really handle yet is ultimately the<br />
heat and humidity. I actually don’t internet<br />
withdrawal symptoms (I’m pretty sure that’s the<br />
heat taking over my whole mind – how to make<br />
myself feel cooler!), and I am happy to put<br />
myself to bed by 11pm (cos that’s when lights go<br />
off, literally.) I look forward to simple<br />
pleasures of life, like thinking of what fruit to<br />
pick next, getting emails from family and<br />
friends, and experiencing any amount of breeze I<br />
can get. So, its my 5th day here. What have I learnt?</p>
<p>Well, I’ve learned that to cook anything, we have<br />
to start a fire (Yenling jie, I wished I took<br />
proper lessons from you over Christmas at Wales),<br />
and its not all that fun given the climate that<br />
I’m currently experiencing! Electricity runs from<br />
7pm to 11pm (hence my bedtime of 11pm), so<br />
boiling water from the electric kettle is unheard<br />
of! I’ve definitely learnt to treasure whatever<br />
electricity we’ve got. The heat and humidity are<br />
also issues I battle with (on a daily basis), and<br />
I’m so thankful I brought my prickly heat powder<br />
– it does wonders! The early morning is cool, but<br />
come 11am to about 4pm, the heat is unbearable,<br />
and I can’t wait for it to rain. It’s also during<br />
this time of the day when Grace and I are free,<br />
and all I would do, is to sit out at the balcony<br />
as I’m doing now, to catch as much breeze as<br />
possible. It gets too hot to do anything though,<br />
and I hope I’ll get used to the heat soon cos I<br />
would probably need to do some reading, and<br />
that’s about the only free time I can get each<br />
day! 6pm is my favourite time of the day because<br />
the weather is just right, I don’t mind getting<br />
really smelly cos its time to bathe anyway, and<br />
its time for picking fruits and gathering eggs<br />
(at the expense of getting a loud chuckle from<br />
the mother hen) and walking around Kapuna! I’m<br />
also trying to face my phobias of lizards, slowly<br />
but surely! There’s so many here, its literally a<br />
way of life to be friends with them.</p>
<p>Hospital wise, we have been shadowing Valerie<br />
around on her daily ward rounds. The day starts<br />
early at 7am (yes! I can actually wake up at<br />
6.30am nowadays, thanks to the chuckles of 20-30<br />
chickens – I suspect they all think they’re part<br />
of a choir or something), with Mondays,<br />
Wednesdays and Fridays being kiddies’ ward round,<br />
and Tuesdays, Thursday and Saturdays being<br />
adults’ ward round. Wednesdays are also TB clinic<br />
days, and everyday, Dr Lin (Dr Valerie’s<br />
84-year-old mother) takes the mummies-to-be/new<br />
mums clinic. We have seen quite a number of<br />
interesting cases so far – a couple of<br />
deliveries, a procedure to join the extensor<br />
digitorium longus tendon of a woman who<br />
accidentally cut herself with a knife back<br />
together, TB affecting different kinds of organs<br />
(breast, knee, lungs), a lady presenting with<br />
pelvic pain + a huge lump in the hypogastric<br />
region, and a male patient with symptoms that<br />
can’t quite fit a diagnosis. Come tomorrow,<br />
hopefully we’ll be able to run our own clinics<br />
and see our own patients. Hope language won’t<br />
pose too much of a problem (many patients come<br />
from different villagers, where they speak their own local language)!</p>
<p>Dinners are times when we get together with Drs<br />
Lin and Valerie, and the 2 Johns and the<br />
Pattersons. Stories of snakes and crocodiles<br />
experiences of working in the mission field and<br />
sharing of NZ, Aussie and Malaysian/Singaporean<br />
cultures have been exchanged over the meals, and<br />
we’ve been blessed with good food. Mum and Pap,<br />
don’t worry – I won’t starve. Just having had 4<br />
dinners here, we’ve already eaten 2 meals of<br />
crabs, pork, local vegetables, sago (different<br />
kind from back home. The ones here come in<br />
blocks), pasta, Chinese stirfry, fried rice with<br />
smoked prawns (similar to dried shrimps,<br />
hairbee), and lots of pawpaws (papayas).</p>
<p>I’ve met some pretty amazing people out here too.<br />
Dr Valerie and Dr Lin are probably two of the<br />
very few women I know who have boundless amount<br />
of energy. They are on their feet the whole day,<br />
from 6 in the morning, to 11 at night. Dr Lin,<br />
affectionally known as Grandma to all, is a very<br />
fit woman for her age, and she’s always out,<br />
either doing her gardening, or seeing her<br />
patients. Dr Valerie is on her feet 24/7 as well.<br />
After seeing patients, she would teach the local<br />
kids the recorder or piano (she got me to teach<br />
them as well, and I’m probably gonna be teaching<br />
them quite a lot these 2-3 weeks here!), or<br />
she’ll chop the banana trees, or sort things out<br />
in the medicine store, or jump into the river for<br />
a swim. Really, the two Calverts put me to shame!</p>
<p>We attended our first church service today, and<br />
as we sang different Christian songs in different<br />
languages, I reflected and felt amazed at how I<br />
could be miles away from home, from Singapore,<br />
and yet be in a house of God, in a building made<br />
of wood. The differences in surroundings between<br />
PNG and Singapore/London are so apparent, yet all<br />
God’s people can come together on a Sunday<br />
morning, to worship the same true living God.<br />
It’s just amazing. God really loves all His<br />
people, and I was reminded of this song, which is<br />
a personal favourite during my Sunday school days:</p>
<p>Jesus loves the little children<br />
All the children of this world<br />
Red and yellow, black and white; they are precious in His sight<br />
Jesus loves the little children of the world.</p>
<p>And so, that’s how it’s been in PNG so far. It’s<br />
been a week of many firsts. Tomorrow, we shall be<br />
starting on hospital work proper. I shall bring you more next time!</p>
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		<title>My Journey So Far</title>
		<link>http://inmedblogs.us/ruthchen/2009/02/03/hello-world/</link>
		<comments>http://inmedblogs.us/ruthchen/2009/02/03/hello-world/#comments</comments>
		<pubDate>Tue, 03 Feb 2009 21:13:51 +0000</pubDate>
		<dc:creator>ruthchen</dc:creator>
		
		<category><![CDATA[Uncategorized]]></category>

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		<description><![CDATA[And so, I&#8217;m finally here in Port Moresby, the capital of Papua New Guinea.
The flight from Singapore to Brisbane was uneventful, and fortunately, I was able to catch quite alot of sleep on the plane. At Brisbane international, I managed to clear customs (thankfully - I had to gobble my Bengawan Solo munchie just before [...]]]></description>
			<content:encoded><![CDATA[<p>And so, I&#8217;m finally here in Port Moresby, the capital of Papua New Guinea.</p>
<p>The flight from Singapore to Brisbane was uneventful, and fortunately, I was able to catch quite alot of sleep on the plane. At Brisbane international, I managed to clear customs (thankfully - I had to gobble my Bengawan Solo munchie just before landing) and by about 9, I was out. It took me awhile to find the tourist information centre. Given that it was a Sunday night, I was very relieved that the info counter was actually operating. I got transport to my accommodation, and ventured out to look for food at Chinatown after settling in. Grace met up with me at the apartment just before midnight, and it was nice to see a familiar face again. A familiar face in foreign land is very comforting.</p>
<p>I couldnt really sleep that night, perhaps due to the fact that I had a flight to catch early next morning. The manager at our accom got us a taxi, and we arrived the airport early, which was a good thing cos we had to do the whole packing-unpacking business to make sure we weren&#8217;t overlimit with our baggage.</p>
<p>As we flew into PNG, I saw the vast amount of jungle and the blue sea, all so beautifully untouched, isolated and kept away from the world. It was truly a sight to behold. The flight was rather empty as well, it was nice to stretch out my feet and to catch a good 40 winks.</p>
<p>We arrived into Jackson Airport and as we exited the airport, we were greeted by Mr Browne, who in his hands had a poster bearing both our names. He is originally from London, and has been in PNG since the 1970s. I&#8217;ve been truly blessed by his kindness as he waited so patiently while we sorted out our flights for our onward journeys, took us for a drive around Port Moresby, and shared stories of himself and his family with the both of us. Coincidentally, his wife used to work with OM, and they are friends with Uncle Kenny, my sunday school teacher&#8217;s husband and a family friend of ours!</p>
<p>Bob brought us to our accommodation at Mapang, and it has been good so far. We have been staying in mainly, only venturing out briefly earlier this morning to get some food from Boroko Food Worlds. Things here are quite costly(!), mainly cos most things are imported I guess. Apart from that, I&#8217;ve been kept entertained by the piano, a couple of episodes of Gossip Girl, and conversations with different people here at Mapang. Last night, we had dinner with the other guests, and met this lady, Debbie Petterson. She&#8217;s from NZ, and is working here as a translator. She was so kind as to offer us stories and tips of Kapuna, and even showed us a couple of pictures! We&#8217;ll be seeing her again this Thursday when we finally get there (by air, then by boat).</p>
<p>Tomorrow, we&#8217;ll be getting the plane to Baimuru, and I really hope the flight goes according to schedule. After that, it will be an hour or so of river meandering before finally reaching Kapuna. They say PNG is the land of unexpected. Well, we see. In such a short span of time, I&#8217;ve seen the hand of God work in so many ways. So amazing, so blessed!</p>
<p>Alritey, for now, I think I shall retreat to my room and enjoy the air-con while I still have it here at Mapang.</p>
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