Tuesday, 21 July 2009

Nursery duty

I started back on B-ward/maternity a couple of weeks ago.  One of the duties of the B-ward doc of the month is to care for the babies in the nursery.  The nursery is a warm and cozy room where the mamas help to look after their babies under the supervision of the nurses.
  There isn't much in the way of fancy equipment such as respirators and incubators as you would find in an NICU.  There are a few warming beds (some of which may not work), some IV poles, and a hot pot on the sink to heat water for formula.  That is the extent of our fancy equipment!

Some of the babies in the nursery were born full term but have some sort of complication such as a breathing problem or infection.  They may be admitted for just a few hours or days, others need to stay for a bit longer.  We recently had a baby who developed respiratory distress shortly after birth.  A chest x-ray showed that he had a diaphragmatic hernia.  The congenital condition was due to a defect in the diaphragm, or the large flat breathing muscle that separates the chest from the abdomen.  The spleen and quite a bit of the small intestine were pushed up into the left side of the chest.  The left lung could not expand properly and caused the baby to be short of breath and blue.  This was one of those difficult situations where the baby would probably die if surgery was or was not done, either way.  Unfortunately he died several hours after the operation.

But there are many happy stories as well.  Some of the little ones do amazingly well.  Baby of Rosemary was born a couple of months ago and weighed only 1100 grams at birth, or about 2 1/2 pounds.  Her mother has meticulously cared for her, feeding every three hours through a tube and now with cup and dropper.  And bit by bit she has been growing.  This week we celebrated her life with what I hope will become a nursery tradition:  a 2000 gram party!  Thanks to my great aunt Naomi for the wonderful cookie recipe :).

Baby of Lucy is another one we have been watching over.  He was also quite small at birth.  No thanks to a rough start and some bumps along the way, he has been growing only very slowly.  I would so appreciate your prayers for this little one!  Weighing in at 1450 grams, he still has a long way to go.

(You may wonder why I keep referring to "Baby of so-and-so."  Parents do not usually name their children until they are a few months old.  I theorize that this is because of the high neonatal and infant mortality rate.)

Sunday, 19 July 2009

Road to Tumbang

A couple of months ago, Robert, my Bible college student friend, asked me to speak at the Tumbang church where he has been pastoring. I kind of mumbled something about thank you for the invitation and maybe someday I would speak there when I was feeling more comfortable with my Pidgin. Kauantz, Robert's wife, brought me a schedule of services for the church a few weeks later. I scanned through the page and found that I was listed as the speaker for July 19th. Gulp. Here goes nothing.

So this week I was working on my talk and feeling a bit nervous. Number one because of the language issue. And number two, I didn't go to school to become a preacher and have never felt that was my gift. I am just a doctor! But the Lord lifted me up with a passage from Jeremiah 1. It was rather perfect, actually. Jeremiah, one of the great prophets of the Old Testament, was having some of the same doubts that I was. Here is what he writes:

The word of the Lord came to me saying,
"Before I formed you in the womb I knew you,
before you were born I set you apart;
I appointed you as a prophet to the nations."
"Ah, Sovereign Lord," I said, "I do not know how to speak, I am only a child."
But the Lord said to me, "Do not say, 'I am only a child.' You must go to everyone I send you and to say whatever I command you. Do not be afraid of them, for I am with you and will rescue you," declares the Lord.
Then the Lord reached out his hand and touched my mouth and said to me, "Now, I have put my words in your mouth."
~ Jeremiah 1:4-9

As the day approached, there were a few other concerns that began to surface. Even the more experienced missionaries were not exactly sure where Tumbang was. It was a relatively new church and none of our missionaries had visited there before. Apparently it was out the road to Mondomil, one of the stations run by the Swiss EBC mission. The road was rumored to be in such bad condition that the Swiss missionaries no longer drove it. It was potentially passable in dry season, but we have had an unseasonable amount of rain in the last couple of weeks. The trip was cancelled, and then un-cancelled. We would proceed on the prayers of our fellow missionaries.

The mocha cruiser was loaded up at about 8:30 this AM. The Myers family had originally volunteered to accompany me on this day (little did they know...). Three of our volunteers also came along. We topped off the vehicle with Robert and Kauantz, and Rocky who is 1st year student at the Bible college. The open spaces were filled with hiking boots and shovels in case we needed to hike for a while or dig ourselves out of something. It was smooth riding the short way to Minj, where we squeezed another passenger into the already full vehicle. Willie brought his ax along and made a comment about the road being bad. Well, let's just say the road from Minj on to Tumbang is something you would have to experience to believe. Actually more of an amusement park ride, though not very amusing as you are going along. We bounced and slipped and bounced some more. There were a few rather precarious looking drop-offs along the way. (No worries, Mom and Dad... we were COMPLETELY safe the whole time. Jeff is a most excellent driver.) We all exited the vehicle and walked over one rickety bridge. Thanks to Willie and his ax, the missing boards were filled in with small tree limbs and Jeff was able to drive the cruiser across without falling into the raging river below. We continued bouncing along past the mission at Mondomil. The road actually improved from there, probably because most vehicles cannot make it that far! A few more miles and we arrived at Tumbang. 

Or almost... the cruiser was parked on the side of the road and we hiked about 15 more minutes across a broken down bridge and up a short road. We approached the church and were welcomed by the people with a song, many hand shakes and hugs. Flowers were draped around each of our necks. We were directed into a small building that was made of bush materials: woven mats for walls and a grass roof. The floor was so soft with freshly laid leaves. The church was beautifully decorated with flowers and fruits and vegetables. There was even a small pool at the front with two very large gold fish swimming in it. Plastic chairs had been brought in for the special guests as the regular attenders normally sit on the floor.

Pastor Robert opened the service with a prayer. We were officially welcomed by Willie the ax man and then heard a brief history of the church, which had only opened in 2006. Robert and Kauantz played their guitars and lead the congregation in worship. Jeff Myers sang the wonderful Pidgin version of "How Great Thou Art" and we all chimed in at the end to help with the English chorus. Ten children were dedicated to the Lord and the last was named "Stephanie" in honor of the first missionary to visit and speak at the church (that's me). I shared my testimony with the congregation, about my call and journey to PNG. At the close of the service, we all gathered outside for more hugs and handshakes and a few pictures. Baby Stephanie screamed and cried when I went up to her (I suspect she has never seen a white woman before), which brought on a good laugh from everyone. Our traveling party gathered back in the building for a lunch that had been prepared by some of the women of the church. Ethan particularly enjoyed the chicken foot. Then we loaded back up, bounced and slid all the way home. Only had to dig ourselves out once!

Wow, what an incredible day to worship with our brothers and sisters and to experience the worldwide family of God. It was a bit overwhelming at times. The trip itself was exhausting and I imagine I will be a bit sore from attempting to steady myself in the back of the bouncing cruiser. And I feel so humbled by how the PNGians honored us today, and so very blessed by them. They are such wonderful people.
Thank you, Lord, for the privilege of serving you here.

Tuesday, 14 July 2009

Selina's story

Let me share a story with you, one that touched my heart.
Selina is a young woman, maybe 30 years old.  About nine years ago she was pregnant with her first baby.  When her labor pains started, she stayed in the village with plans to deliver at home.  (Many of the women in PNG deliver at home.  Perhaps some choose to do so because it is their custom.  Others have no choice because traveling to the nearest health center or hospital takes hours or days.)  Selina labored for three or four days but the baby never came.  Finally she was able to get to a health center and was transferred in to a hospital.  A c-section was done, but it was too late for the baby who had already died.  A few days after the surgery Selina began leaking urine.  She has been incontinent of urine for nine years and she has never been able to have another baby.  She has been to several clinics and has spent too much money, but no one has been able to help her.  

Selina was feeling very discouraged so she went to church and prayed for the Lord to help her.  Then she came to Kudjip Hospital.  She was seen in clinic today by Dr. Becky Wallace, one of our docs who is sponsored by the World Medical Mission post-residency program.  Dr. Becky listened to her story and followed up with an exam.  During the pelvic exam, urine spilling down into the vagina from a hole that connected the bladder with the vagina.  (The picture below is Dr. Becky with Selina.  Becky is tall compared to me, but Selina is under 5 feet in height.)

What Selina has is called a vesicovaginal fistula, or more specifically an obstetric fistula because the cause was related to pregnancy and delivery.  When a mother is in labor and the baby is too big to fit through the birth canal, we call this obstructed labor.  It is easily managed by doing a c-section but as in Selina's case this is not always possible in a timely manner.  Unless the obstruction is relived, pressure from the baby's head causes tissue of the mother's birth canal to lose it's blood supply.  The dead tissue falls away and leaves a hole between the bladder and the vagina.  Urine continuously leaks out through that hole and causes incontinence.  Many women with fistulas suffer not only from the condition, but also from shame and isolation.

The problem is rarely seen in developing countries because women have easy access to hospitals and c-sections if needed.  Vesicovaginal fistulas are not uncommon in places like Ethiopia and Afghanistan.  And I have now seen my third case here in PNG.  It is estimated that there may be 2 million women around the world suffering from obstetric fistulas.  There are many roots to this problem:  poverty, limited education, poor nutrition, early pregnancy, inadequate health care, lack of basic infrastructure and roads.

But it is not all gloom and doom.  There is hope for many of these women.  In Ethiopia, there is an entire hospital dedicated to obstetric fistulas and more than 25,000 women have been treated.  This hospital is also training doctors from other developing countries to perform the corrective procedure.  Dr. Jim, our surgeon here at Kudjip, has done some of these repairs in the past.  Selina has been referred to surgery clinic, and I do hope that she comes back for the consultation.

Selina's story reminds me of a similar one in the Bible.  There was a woman who had been bleeding for twelve years.  According to Old Testament law, a woman who was bleeding was also considered to be unclean.  Those who were unclean lived in isolation because those they touched would also become unclean.  They were not permitted to take part in community life or worship in the Temple.  The Gospel of Luke (written by a doctor :) says that "no one was able to heal her."  Perhaps she had spent her life savings seeing doctor after doctor in hope of a cure.  Then she heard about Jesus, this rabbi who performed miracles and healed the sick.  Could he be the Messiah, the Promised One?  But she was unclean and she dared not approach him publicly.  Luke writes that "she came up behind him and touched the edge of his cloak, and immediately her bleeding stopped."  She believed in Jesus, and because of her faith she was healed.

For more information on obstetric fistulas, follow the links below:
eMedicine "Vesicovaginal Fistulas" for the healthcare providers out there.
Fistula Foundation gives some great info for the general public.
Addids Ababa Fistula Hospital in Ethiopia was one of the first to treat OB fistulas.
"Hospital by the River" is the story of the Hamlins and their work in Ethopia.
"A Walk to Beautiful" is a documentary about several women living with this condition and their journeys.  To watch online, click here.

Sunday, 12 July 2009

Culinary experiments

Especially good!

When you live at one of the far corners of the world, some comfort foods from home are not available... unless you make them from scratch. Here are a few of my experiments.

Saturday, 11 July 2009

Culinary experiments: homemade marshmallows

Once upon a time (oh, we were probably late high school or early college), my friends Amber and Sarah and I decided to make homemade marshmallows.  A couple of former missionaries had told us about making marshmallows when they lived in Africa.  We were so completely fascinated by the idea that we decided to give it a try.  I remember that the experiment took place in the kitchen at the Rhoton house.  Ingredients were mostly sugar, sugar, and more sugar, and some plain gelatin.  We didn't have plain gelatin but we did have some sort of flavored gelatin that was pink in color.  Maybe strawberry or cherry?  We decided that was good enough.  I don't remember much about the process, but I do remember the end result was rather nasty.  Note to self:  when making a recipe that calls for plain gelatin, do NOT use flavored.

Apparently that disaster did not deter me from ever trying to make homemade marshmallows again.  When you are desperate, you are willing to give (almost anything) a second chance.  We cannot buy marshmallows here in PNG, so a supply of Rice Crispies or a craving for smores = desperation.

So today, quire a few years after the first attempt, I decided to repeat the experiment.  The recipe came from "JoyofBaking.com" which also has many other delicious goodies from cakes to breads to candies.  The site has an entire section dedicated just to lemons.  I might have to check that out for my three lemon trees.  Anyways, I found a most excellent recipe for homemade marshmallows.  Do we have all the ingredients or are the ingredients something that can be substituted?  Those are the first two questions that I ask about every new recipe.  Water and sugar and salt are readily available in PNG... check.  Vanilla, corn syrup, and gelatin are not but we happen to have a small stock of each of those items... check.  I borrowed a candy thermometer from Kathy Radcliffe... check.  OK good to go.  After heating the sugary ingredients to the appropriate temperature, the hot syrup was combined with the gelatin and whipped on high speed in the Kitchen Aid mixer.  The Kitchen Aid, BTW, was a birthday present from my parents before I left the States.  It is one awesome machine.  Amazingly after a few minutes, the syrup started to look like marshmallow goo.  The white stuff was spread into a pan, dusted with powdered sugar, and allowed to sit for about 12 hours.  The next to the last step was the messiest
 part.  The marshmallow slab was removed from the pan and cut into squares with a pizza cutter.  Each side of the marshmallow had to be dusted with a mixture of corn starch and powdered sugar to keep the squares from sticking to one another.  There was white dust all over the kitchen when I finished!  Final step was the taste test... what ooey gooey goodness!  Much better than the store bought version in my opinion.  I'm not sure I want to waste them on Rice Crispy treats.  Well, maybe one small batch.  The marshmallows are especially excellent in a mug of hot chocolate.

My overall assessment of this experiment is that it was a success.  It was a bit messy, though, so perhaps I will save future marshmallow making for special occasions.  My cousin Elizabeth also recommended cutting into shapes with a cookie cutter and dipping in chocolate.  Mom... how about a homemade chocolate covered marshmallow Santa?

Sunday, 5 July 2009

Sing sing

The 4th

Of all the American holidays, the 4th of July is actually one I have celebrated overseas on more than one occasion.  Over one of my college summers, I traveled with a Youth in Mission team to a hospital in rural India.  The boys on the team found some fireworks and set them off outside of the girls' bungalow, then subsequently blamed the explosion on some militant group.  Ha ha, not funny.  We also shared some of our culture with the nationals by hosting a party for the hospital staff.  One year I was in Poland, touring Eastern Europe with a class of MPH students.  I remember our Polish bus driver hanging an American flag in the front of the bus and enjoying a treat of red raspberries and blue blueberries.  (I don't think I am making this up, but that is a possibility.)

My first American Independence weekend in Kudjip was celebrated with a variety of activities.  
On Friday night, the planned bonfire was converted to a cookout on the Radcliffe's back (or actually front) porch thanks to bit of rain.  But that did not dampen our patriotism.  We roasted marshmallows over the hot coals of the grill, marshmallows that were probably sent in a care package because you can't find them here in PNG (I am planning to try and make them from scratch, but that will be a culinary experiment for another day).  Becky Wallace led us in singing every patriotic song ever written.  It was a good time :).

Most of the missionaries joined in a good ole American game of softball on Saturday morning, though I was not able to attend due to a previously scheduled visit with some PNG friends.

Sunday the 5th was also the first Sunday of the month.  The first Sunday is the regularly scheduled day for "English lotu," or "English church," and every other month the service is preceded by a potluck lunch.  Missionaries from stations around the area gather together for a time of food, fellowship, and fun.  The Myers "haus win" (or gazebo-type structure) was decorated with red, white, and blue balloons.  Scott Dooley shared some scriptures and thoughts on true freedom, freedom in Christ.  We sang national anthems for the U.S, Australia, and PNG.  (Other countries such as New Zealand and Switzerland have also been represented in previous years.)  And the afternoon concluded with some fun and games including three-legged and sack races.  It was a wonderful day to celebrate our holiday, the other nationalities with whom we work and fellowship, and the freedom that we have in Jesus!

"It is for freedom that Christ has set us free."
~ Galations 5:1