Friday, 27 February 2009
Thursday, 26 February 2009
Wednesday, 25 February 2009
Sunday, 22 February 2009
Monday, 16 February 2009
When leaving the marvels of modern medicine to work at a hospital in a developing country, there are certain things you know that you will be giving up. I only dream about ordering many of the fancy tests that are easily available back in the States. Pathology results come back in 3-6 months, or not at all. The nearest CT scanner is in the capital city, a place that patients can only reach by plane IF they can afford it. Forget about MRI.
Despite the lack of high tech gadgets, Kudjip Hospital does pretty well. We have an x-ray machine and a nice portable ultrasound. EKG is available. I can order some basic blood tests such as CBC, chemistries and liver panel, ESR, HIV and Hep B, VDRL, urinalysis, etc. And for what we don't have, I know will become a better doctor. I am learning depend on my brain, my ears, and my hands to give me the information I may defer to a machine back in the US.
This week, however, has been interesting as we have dealt with challenges of the most basic nature: electricity, water, and communication. It started with the electricity. Something somewhere that I don’t completely understand needs to be replaced, so power at the hospital has been sporadic. Power begats both water pumps and phone. So if electricity is out, so is the water and communication.
Let’s walk through a typical day under such circumstances. I begin with B-ward rounds. There is generally a laboring patient or two that needs to be evaluated. Oh great... no water to wash my hands. Thank goodness for hand sanitizer. Step into the nursery where we currently have two tiny babies (about 2.5 pounds each) who need to be kept warm. Hmmm... the current is not working in the nursery so the warmers don’t warm. The babies are being kept warm by hot water bottles that are placed in their bed. Where are the nurses getting the water and how are they heating it? Move onto B-ward where there is very little light shining in through the windows. My head lamp illuminates any post c-section incisions that need to be checked. On to the out patient department. Fortunately enough light spills into the exam rooms that I can see my patients. Again, the head lamp proves to be an extremely valuable tool. (Thanks, Narn!) Without water to wash my hands, my little bottle of hand sanitizer is being put to good use. I order an x-ray, but find out that even if they had electricity to run the machine there is no water to develop the film. I walk to the lab to look at something under the microscope and find that the microscopes are also without power. We can use the ultrasound machine if we move it to the ER, which for some reason still has electricity. And finally I end the day back on B-ward, doing a D&C under the light of my head lamp. Hey, how come the electricity is off but the water is working now? Who knows. I’m just thankful I can wash my hands with soap and water. On call, phones become the issue. Urgent messages are sent via nurses, students, or security guards. Hopefully they knock loudly enough that I hear them and wake up. Hopefully the something urgent doesn't require electricity or water or phone.
So it has been an interesting week. The lack of these basic things has challenged me far more than the things I expected to do without. But in missions you frequently encounter such challenges. What do you do? Know it is coming. And pray for God’s grace to face whatever comes your way.
Friday, 13 February 2009
Wow, what a day.
B-ward is the place where all expecting and recently delivered moms and their babies stay in the hospital. It is a large room with 19 beds placed around the perimeter, and about 1/2 of them are currently full. The delivery room and nursery are located at the back of the ward.
This particular morning began at 8:00 with rounds on B-ward. Upon arrival, I made my way through the double doors and into the delivery room. Sister Sylvia, the head nurse, pointed to a patient behind the far curtain. “I think you should see her first,” she said with a touch of urgency in her voice. I pulled the curtain and found two nursing students cleaning up a patient who sitting in a pool of blood. She had been about three months pregnant, and was now bleeding heavily due to a miscarriage. I quickly examined her and decided that she needed an emergency D&C. Thankfully the bleeding slowed after the procedure. The patient was moved to the ward in stable condition.
And that was just the beginning...
I made my way around the ward, seeing post c-section and other more complicated patients. (The nurses deliver, care for, and discharge all of the normal deliveries.) Bed 19 was the last bed. Sister Sylvia began by telling me that this patient was complicated. Uh oh. This patient was nearing the due date for her sixth pregnancy. She had been admitted the day before with difficulty breathing, stomach pain, and low blood pressure. The patient thought that her water may have broken. I pulled the ultrasound to her bedside to check the fluid level and take a look at the baby. My heart sank as I realized that this baby did not have a heart beat.
The story continues...
After rounds, all the docs head to Outpatient Department (OPD) and begin seeing the multitude of patients that line up there every day. People in PNG don't generally know how old they are, and this young woman was no different. But she looked young, definitely no older than 30s and possibly late 20s. She had many complaints: lower abdominal pain, bleeding, right flank pain. By my exam it was obvious that this patient had cervical cancer. Oh, shucks. I took her to ultrasound and confirmed that the cancer had already spread to her bladder and was blocking her right kidney. Her father pleaded for us to do surgery, but the cancer was too advanced for any treatment. Palliative care is all that we have to offer. Scott and I prayed with the family. Jesus says for all who are carrying heavy burdens to come to him, and he will give rest. I will continue to pray for this young woman, that God will give her peace and comfort.
I finished the day with my first solo c-section since arriving here in PNG. This patient had two previous c-sections and was now near her due date for the third pregnancy, so she was scheduled to come in today for a repeat c-section. I would do the surgery since I am the B-ward doc of the month. The patient was taken to the operating room and prepared for the surgery. My word that is a big belly, I thought as I entered the OR. The c-section began and as I worked my way through the layers of tissue, I encountered quite a bit of scar tissue. That always makes things interesting. I eventually found the uterus, cut into the muscle, and placed my hand through the opening. Wow, this kid has a large head. O.K. not just a large head, he came out looking like a sumo wrestler... weighing in at 11 pounds 7 ounces! I believe that is the biggest baby I have ever delivered. And apparently this may be the biggest baby ever born at Kudjip Hospital! I finished sewing mom up without any further problems. Mom and baby are doing well. Yeah for happy endings :).
Every morning and many times throughout the day I pray for wisdom beyond my understanding, that the Lord will help me to know how to care for and love my patients here. He is THE Great Physician. Thank you Jesus for helping me today.
Friday, 6 February 2009
Sunday, 1 February 2009
Drs. Andy, Bill, and Jim played the PNG national anthem on their trumpets.
The new Kudjip Hospital was dedicated on January 30, 2009. Here are a few pics from around the new building and the dedication celebration. Thanks to Mike and Diane Chapman for the use of some of their pictures!