Sunday, 12 December 2010

Sweet P vs. the Christmas decorations

Becky and I (and Pete and Brutus and Herbie) recently welcomed a new member to our family.  Meet our new kitten, "Princess Buttercup" or "Sweet P" for short.
Sweet P has quickly adjusted to her new surroundings.  She loves her mamas and the big house to run and jump and play in.  Wow, she is an energetic little ball of fuzz.  She wasn't too fond of her big brother Brutus at first, but the are on their way to becoming the best of friends.  Their favorite game is hide and seek.  Sweet P hides and Brutus seeks.  Her other brother Pete has been pouting ever since her arrival and refuses to come into the house, even for a can of tuna.

In Sweet P's opinion, the best things about her new house are the Christmas decorations:  the strings of lights, the nutcracker, sheep from the nativity, and of course... the Christmas tree.  I have found her half way to the top on more than one occasion.  Those shiny ornaments are just too tempting!  I hope that someday she will chase rats with the same enthusiasm.

Saturday, 11 December 2010

Stephoscope: December 2010 Newsletter

Dear friends of PNG,

Here is the December 2010 edition of my newsletter.  Wow, another year has finished!

Mom and Dad will be making their first trip to PNG in just one week.  I am excited to share this place with them!  What a wonderful Christmas present.

It is a joy for missionaries to serve around the world.  Such a joy!  The holidays can be difficult for those who are far away from their home.  Remember to pray for your missionary friends and their families during this season.

Hepi Krismas!
~ steph

"You did not choose me, but I chose you and appointed you to go and bear fruit--fruit that will last." ~ John 15:16

"I am the vine; you are the branches. If a man remains in me and I in him, he will bear much fruit; apart from me you can do nothing." ~ John 15:5

Growing up

Over the past couple of months, the nursery has had quite a run of low birth weight babies.  It has been full to overflowing at times, with two or three sharing each bed.  Five of the babies were actually VERY low birth weight, which means that they weighed less than 1500 grams when they were born.  I am completely amazed by how well these little ones have done, every one of them!  We have celebrated parties for babies of Rosa, Dorothy, and Priscilla.  

Baby of Maria is one of our miracle stories.  She weighed about 1400 grams at birth.  At a few days of life, she stopped breathing.  Apnea is a common problem in premature babies.  The nursing staff bagged the baby of Maria on and off for 24 hours.  I was shocked when I came in the next morning and found that she was still alive and doing well.  It has been a long and very slow process... feedings and antibiotics and oxygen and more antibiotics.  Two months later, Maria finally got to take her baby home!  She was discharged on Friday.

This past week we threw a 2000 gram party for baby of Grace, another little miracle.  Unfortunately her mother was not there to celebrate.  She died from a complication of the delivery.  The nursery staff have so diligently looked after the baby, and she has done quite well.  A sister of the mother recently arrived at the hospital and she will be adopting her niece.
"Like newborn babies, crave pure spiritual milk, so that by it you may grow up in your salvation, now that you have tasted that the Lord is good."
~ 1 Peter 2:2-3

Friday, 3 December 2010

Mad Hatter Tea Party

Dr. Becky Wallace came to PNG two years ago as a long term "volunteer" through the Samaritan Purse/World Medical Mission's post residency program.  Sadly for us her time with the post residency program has come to the end.  On Monday we will be gathering at the circle for yet another "see you in heaven if not before."  We are all hoping for before!  She will be heading home to spend time with her family and seek God's direction for her future.

Becky a.k.a. Becky 2 or B-2 has been an important part of the Kudjip family.  She has taught music to the MKs, treated thousands of patients, played numerous games of Settlers, learned to do c-sections, entertained, journeyed with us.  I have also enjoyed some special adventures with my 10 toea friend... from Bible college to the Down Under.  She has brought us so much joy.  We won't be the same without her.  

In honor of our friend and her service, we decided to throw a little "un-staying party" with all the flair of one of her own productions.  In the tradition of Alice in Wonderland, we threw a Mad Hatter Tea Party.  Everyone was ordered to attend by decree of Her Majesty the Queen of Hearts.  

Guests entered through the looking glass and sat for tea at cakes at the whimsically decorated tables.  Hats were provided for those who didn't bring their own.  

Special guests included Rambo, the Chesire Cat, Tweedle-Dumb, and Her Majesty.  OFF WITH YOUR HEAD!

It was such a sweet time of celebration and fellowship!  Beck, we are certainly going to miss you.

For more pictures of this and other Kudjip silliness, take a peek at what we do for fun in the bush :).

"Your love has given me great joy and encouragement, because you, [sister], have refreshed the hearts of the Lord's people."
~ Philemon 1:7

Monday, 29 November 2010

Christmas English Lotu

Start:     Dec 5, '10
Location:     Chapel, Kudjip
English church service for Kudjip and the surrounding missions.

Caroling on the hospital wards

Start:     Dec 24, '10
Location:     Kudjip Hospital

D-ward Party

Start:     Dec 31, '10
Location:     Dr. Steph's house, Kudjip
Tentative date!

Becky 2's Un-staying Party

Start:     Dec 3, '10
Location:     Barnabas House, Kudjip
We are really going to miss you, Beck!

Missionary Christmas Party

Start:     Dec 18, '10
Location:     Barnabas House, Kudjip

Christmas Eve Eve Party

Start:     Dec 23, '10
Location:     The Myers house, Kudjip.
A Myers family tradition!

Turkey Day

Since it is an American holiday, Thanksgiving is not celebrated by the general public in PNG.  Yet we missionaries hold fast to this custom from our homeland.  Families and friends gather together for the celebration feast--after everyone has finished work for the day.  It is often referred to as "turkey day" after the main dinner course.  At Kudjip, it is usually "big chicken day" or maybe even "ham day."  Turkeys are few and far between, expensive, and not always edible.

A few months ago I was shopping at Best Buy.  No, it is not an electronics store but one of the better places to buy groceries in Mt. Hagen.  While browsing through the meat section,  I was surprised to find a freezer full of small turkeys at a bargain price of 18 kina (about $7).  I was a bit skeptical.  First of all, could I be sure this was really a turkey and not a large chicken?  And if it was a turkey, it was probably imported from somewhere far away.  There was a possibility that it wouldn't be any good.  But hey, for 18K I was willing to give it a try.  I bought the turkey and put it in the freezer to be saved for a special occasion.

This year Beck and I were invited to the Dooleys' house for Thanksgiving dinner.  Five volunteers also joined the party:  the Kerrigans (surgeon and wife covering for Dr. Jim's furlough), Missy (FP resident), Renie (EBC nurse), and Dave (here to install our new phone system).  Dinner was set for 6:30 PM.  Beck and I would bring the turkey, gravy, and green bean casserole.

I don't think I have ever cooked a turkey all by myself before.  There have been several holidays where cousins gathered together and made a group effort, usually with lots of encouragement over the phone from our mothers.  And a few disasters such as potato peels spewing from the garbage disposal.  I was nervous about being responsible for such an important part of the meal.  Thanks to the now functioning internet and Google "how to cook a turkey," I found several recipes and some good advice.  The bird went in the oven mid-afternoon.  The house was soon filled with the aromas of the holiday.  Of course the turkey took a bit longer to cook than I calculated.  I think as a watched pot never boils, so a roasting turkey never gets to 165 degrees.  But it really wouldn't be Thanksgiving in our family if you had dinner on time.

At 6:45 the turkey was finally done and whisked away to the Dooleys' to be carved.  We gathered around the table, so beautifully decorated with fall plates and napkins, pilgrim place cards, and candy cups.  Dr. Kevin gave thanks to the Lord for his goodness and provision.  Let the feasting begin!  There was hardly enough room for turkey and all the fixin's... mashed potatoes, stuffing, gravy, pumpkin souffle, green bean casserole, crescent rolls, cranberry sauce, berry salad.  I am sure I am forgetting something.  Once we were finished, there was hardly room for dessert... derby, pumpkin, and peanut butter pies.  Just like a Thanksgiving back home.
Since Thanksgiving is a time of giving thanks, I have so much to be thankful for this and every year.  I want to especially thank the lord for my families.  Yep... families.

I am blessed to have family back home in the US, one that has supported me in my crazy life and adventures.  We have had so many wonderful times together from Ohio to Texas and soon to be PNG.  You continue to love me from the other side of the world with your care packages, Skype calls, and prayers.  I love you so much.

I am grateful for my PNG family.  The Dooleys and the other missionaries and I may not share the same DNA, but we are related by blood--the blood of Christ.  We laugh and cry and pray together.  We share holidays and special times together like families do!  This Thanksgiving was definitely one of those special times.

"Give thanks to the Lord, for he is good;
his love endures forever.
~ 1 Chronicles 16:34

Wednesday, 17 November 2010

“A new command I give you: Love one another. As I have loved you, so you must love one another. By this everyone will know that you are my disciples, if you love one another.” ~ John 13: 34-35

Hot chocolate with marshmallows

Early this year, my fellow missionary doctor Erin and I started a Bible study for the single ladies who live and work on station.  We were also joined by Rachel, the MK high school teacher and honorary single gal on Wednesday evenings.  I was excited about the possibilities for this ministry, a chance to grow closer to the Lord and build relationships with the Papua New Guineans.  I had no idea...

We began with the book of 1 Timothy and soon learned that most of the girls had never been involved in such a Bible study.  We decided to move out of church issues and back to the foundation of our faith, the life of Jesus.  For the the last 7 months or so, we have been making our way through the Gospel of John.  (We just finished chapter 13, almost.)  I have been stretched:  learning to study the Word, learning to lead others and teaching them study.  I have been challenged:  to love one another and wash feet and live like Jesus, and so much more.  Wow, this has way exceeded my expectations.  

We finish each study with a round of "hot drinks," a choice of tea or hot chocolate.  Hot chocolate is the preferred drink just about every time.  Thanks to one of my Texas LINKS churches for the supply!  It is definitely being put to good use.

Marshmallows are a favorite, too.  Grace is especially fond of them.  One night she asked me where they came from.  No, they don't grow on a bush!  Hee hee.  This week I introduced the gals to roasted marshmallows.  We cooked them over the gas burner.  And they were a hit!  Just wait until you try smores :).

It is always a special time of getting to know each other, learning about each others families and cultures.  I just love storying with the girls :).  I have been so blessed by their friendships.

"Dear friends, let us love one another, for love comes from God.  Everyone who loves has been born of God and knows God.  Whoever does not love does not know God, because God is love.  This is how God showed his love among us:  He sent his one and only Son into the world that we might live through him.  This is love:  not that we have loved God, but that he loved us and sent his Son as an atoning sacrifice for our sins.  Dear friends, since God so loved us, we also ought to love one another.  No one has ever seen God; but if we love one another, God lives in us and his love is made complete in us."
~ 1 John 4:7-12

Sunday, 14 November 2010

Short staffed

"The harvest is plentiful, but the workers are few.  Ask the Lord of the harvest, therefore, to send out workers into his harvest field."
~ Luke 10:2

The harvest is oh so plentiful.  Every day, people from around the Western Highlands and across the country come to Kudjip Hospital.  They receive care for typhoid and hypertension and pyomositis and cervical cancer.  Wounds are bandaged and bones set.  Babies are delivered and surgeries performed.  Most important of all, our patients have the opportunity to hear about Jesus and see his love in action.

We are in desperate need of workers for the harvest.  Due to recent staff transfers and resignations for a variety of reasons, we are seriously short staffed.  The most critical shortage is nurses.  And without nurses, you can't run a hospital.

On Monday morning, we closed our gate to "longwe" patients.  "Longwe" or "long way" refers to people from outside Jiwaka.  This was done so that we can continue to care for patients in our primary service area without overworking our remaining staff.  The closure makes sense.  It is something that had to be done.  But I am sorry to think about all the patients we will be turning away.

Kudjip Hospital needs your prayers.  Will you pray with us for harvest workers?  Please pray for our current nursing staff and students, that they will be strengthened and encouraged despite the overtime and extra shifts.  Pray for all of us, that we will not miss one opportunity to share Christ with our patients!

Matters of the heart

Sunday last week was quite a call.  After rounds, the day was unusually quiet.  Things began rolling around 5:30 PM when I received a call from the nurse in the ER.  A young woman was just brought in who had swelling of the abdomen and legs, and she was really sick.  Could I come see her?  I grabbed my stethoscope and my bilum of doctor tools, headed out the door to the hospital.

I picked up the skel buk (a portable medical record) and scanned the brief history.  There were no previous entries, which suggested that this was her first visit to a doctor.  The patient was too sick to speak so I gathered further information from her family members.  Apparently Salome had been ill for about 5 months... weakness, shortness of breath, fevers, swelling of her lower legs and then her abdomen.  I looked at her and shook my head.  She had been sick for 5 months, and today might just be too late.  Why it took so long for the family to bring her to the hospital was never really clear.

I pulled my pulseox from my bag and the saturation read 90%.  Her pulse was palpable, but weak and thready.  Heart sounds were distant, and I couldn't hear nay air moving in her left lung.  Her abdomen was swollen with ascites and her legs edematous.  Ultrasound confirmed a 5-6 cm pericardial effusion, or fluid around her heart.  There was barely enough room for her heart to fill and contract.  No wonder her pulse was weak and thready!  I could also see that the left side of her chest was completely filled with fluid from a plerual effusion.

Pericardial effusion is not an uncommon finding or diagnosis at Kudjip.  The most common cause, we suspect, is tuberculosis pericarditis.  (TB does all sorts of weird stuff.)  Infection from viruses or bacteria is another cause.  And cancer would also be at the top of our list.  Well, we can't do anything about cancer.  We treat what we can.  I admitted Salome to medical ward and started her on antibiotics and TB treatment.  I asked the nurse to call me with any change of her condition.

Before Salome went off to the ward, I took a few minutes to talk with her.  You are very sick, I said.  We will do our best to take care of you, but I am afraid your illness will win.  Sickness of the body is one thing; the condition of your soul is the most important.  Salome said that she had been a Christian but had fallen away from her faith.  We prayed together, and she gave her life back to Jesus.

Around 10:00 PM I received another call.  There was a chop chop in the ER.  I evaluated the patient, looked at the wound and decided that the almost amputated hand was a little too much for me to handle.  Our volunteer surgeon came up to help stop the bleeding.

While working on the chop, the ER had filled up with patients.  I looked through the skel buks that were lined up on the counter.  The patient in bed #3 had a heart rate of 220.  He was the first priority.  Unlike my first patient, he had been to Kudjip before.  Notes from the other doctors documented a liver mass that was suspicious for cancer.  He had been doing fairly well until this evening when his heart suddenly started to race.  I did a quick exam and confirmed the tachycardia.

Back home in the Sates, a patient like this would have been immediately hooked up to a cardiac monitor.  An EKG would be on the chart before the doctor even made it to the bed side.  Things don't work that way here.  We have one EKG machine.  It lives in the lab and EKGs are done by a lab tech, if the tech knows how.  Thankfully our on call lab person was already working on a CBC for the chop.  Since the phones are out, I sent the nurse with an urgent request for EKG.  

Meanwhile, I was concerned that my patient would become unstable.  The heart can only beat that fast for so long before giving out.  I searched through the crash cart and found an amp of adenosine.  The nurse quickly inserted an IV.  I placed my left hand on the patient's chest to monitor his heart rate and pushed the medication with my right hand.  I felt the heart rate slow and become irregular.  The lab tech arrived with the EKG machine.  The read out confirmed my now suspected diagnosis of a-fib with RVR.  I returned to the crash cart and searched through the vials.  I hoped that digoxin would control the patient's heart rate because it was my only option.  The patient was loaded with dig and taken to the ward.  I sped through the last of the waiting patients and headed home with the hope of getting a little more shut eye.

And hour or so later, I was awaked from a restless sleep by the ringing of my cell phone.  Salome, the patient with pericardial effusion, had no pulse or blood pressure.  I pulled on my scrubs, jumped into Herbie, and sped up the road to the hospital.  Salome was still conscious, but neither could I feel a pulse or get a blood pressure.  I did a quick sono and found that the fluid around her heart was no longer allowing it to fill with blood.  Cardiac tamponade!  This was a true emergency.  Pericardiocentesis is a dangerous procedure, but it was the only thing that would save her life.  I explained to the patient and her watch meri that I needed to stick a needle into her heart.  It could kill her.  But if I didn't try, she would surely die.

I had only ever seen one pericardiocentesis months before, so I called in Dr. Bill.  He has seen and done just about everything.  We set up for the procedure and had a word of prayer.  I got the first try.  I pointed the needle into Salome's chest and slowly advanced it toward the heart.  The syringe began to fill with blood tinged fluid.  A slight readjustment stopped the flow.  I rechecked her vitals... pulse was slightly stronger but still no blood pressure.  Dr. Bill tried a second and a third time.  We never got a continuous return, but the 300cc we took off was enough for the time being.  Salome's pulse was stronger, her heart rate had slowed form the 160s to 90s.  And she looked better.

As I headed out of medical ward, I walked by the bed of the patient with a-fib.  He was now complaining of severe shortness of breath.  I suspected that he may have through a PE, a blood clot to the lungs.  The nurse tried to start oxygen.  He was too distressed and pulled it away.  She prayed for him, that God would bring peace and comfort.

I stumbled back to my bed, this time for another hour or two of sleep.  It was waaaay too early when my alarm went off.  I got ready and headed to work, making a detour through medical ward to check on my patients.  Salome was sitting up, still alive and looking a little better.  We got her through the first night, but whatever was making her sick was too big and too bad.  She died the following day.  I am confident that she is in a better place.

I paused at the bed of my second patient.  He was no longer conscious and his breathing labored.  He was also not long for this world, and died just a few hours later.  I grieve that I did not take time out of my busy night to pray with him.  I am thankful that the nurse did.

"But in your hearts revere Christ as Lord.  Always be prepared to give an answer to everyone who asks you to give the reason for the hope you have.  But do this with gentleness and respect."
~ 1 Peter 3:15

Thursday, 11 November 2010

Meri meri quite contrary... how does your garden grow?

This scene caught my eye on the way home from lunch today.

Thanks be to the Lord for the wonderful showers and even a thunder storm that we have had over the last couple of weeks. The greatest blessing, especially for my PNG friends and neighbors, is that gardens are starting to grow again!  It will be a few weeks before the food can be harvested.  So please pray that the rains continue to come.

I just wanted to share a little PTL :).  Em tasol.

"Ask the Lord for rain in the springtime;
it is the Lord who sends the thunderstorms.
He gives showers of rain to all people,
and plants of the field to everyone.
~ Zechariah 10:1

Saturday, 6 November 2010

"Now that I, your Lord and Teacher, have washed your feet, you also should wash one another's feet. I have set you an example that you should do as I have done for you." ~ John 13:14-15

Washing feet

In our Wednesday evening ladies' Bible study, we have been working our way through the Gospel of John.  This past week we arrived at Chapter 13.  I was the designated leader, so I reflected on this passage for an entire week before our meeting.  I think I must have had a thing or two to learn.  Wow, it was quite a challenge!

The context of the passage is this... a few days before, Jesus entered Jerusalem on the colt of a donkey and to the cheers and praises of the crowds.  This is also what we know as the Triumphal Entry.  Jesus knows that his death is approaching.  "I tell you the truth," he says, "unless a kernel of wheat falls to the ground an dies, it remains only a single seed.  But if it dies, it produces many seeds."  With only a few hours remaining before his arrest, Jesus withdraws from his public ministry to spend time with his closest friends.

John doesn't tell us much about the preparation for this last supper.  Mostly he spends the next 5 chapters recording Jesus's final words to his disciples.  If you turn back a book, Luke 22 gives us a bit more info.  The disciples have made preparations and they are gathering for dinner in the upper room.  An argument breaks out... who among them was the greatest?

Jesus responds by showing them the full extent of his love.  He takes off his outer garments, wraps a towel around his waist, and bends down to wash their feet.  The Creator of the universe, the King of kings, the Messiah humbled himself to the role of slave for this rag tag band of fishermen and tax collectors and sinners.

Jesus makes his way around the circle, washing the dusty feet of each disciple.  Can you imagine the hush that fell over the room?  He stoops in front of Peter.  And it typical Peter fashion, he tries to take control of the situation.  "You shall never wash my feet," he says to Jesus.  Peter, you are my follower and your heart is clean because of the words I have spoken.  But the worries and distractions of this world are like dust on your feet.  Let me refresh and renew and sanctify you.  For unless I wash you, you have no part with me.

Jesus finishes washing the feet of the last disciple.  He says, "Now that I, your Lord and Teacher, have washed your feet, you should also wash one another's feet.  I have set you an example that you should do as I have done for you."

And what was that example?  Washing feet was the symbol of something bigger.  The Kingdom of God is not about power and might and greatness.  It is about service.  It is about humility.  It is about loving one another with a love that is greater than ourselves.  "A new command I give you:  Love one another.  As I have loved you, so you must love one another.  By this all men will know that you are my disciples, if you love one another."  (John 13:34-35)

"Your attitude should be the same of that of Christ Jesus:
Who being in very nature God,
did not consider equality with God something to be grasped,
but made himself nothing,
taking the very nature of a servant,
being made in human likeness.
And being found in appearance as a man,
he humbled himself
and became obedient to death--
even death on a cross!"
~ Philippians 2:5-8

Saturday, 30 October 2010

Stephoscope: November 2010 Newsletter

Dear friends of PNG,

Here is my November 2010 newsletter (one day early).

There are quite a few stories about babies in the nursery.  It has been a hopin' place this past month!  (Each blue/underlined word or phrase is a link to another story if you would like to read more.)

If you are interested in maternal health, read about my patient with "a new name" and maternal mortality in PNG.

I've included some links to fun stories, too... I recently learned a thing or two about speaking English from some of our volunteers.  And yesterday we enjoyed our annual Harvest Party!  Check out the costumes :).

Thanks for your prayers for the included requests, and for the WEF Plus offering that is coming up in November.

Happy Thanksgiving!
~ steph

Lost in translation

There are some American holidays that have obvious PNG counterparts.  Instead of President's Day, we observe the Queen's birthday.  PNG's "Memorial Day" is called Remembrance Day.  Independence Day is celebrated in September rather than July.  Churches celebrate a Thanksgiving, though it has nothing to do with pilgrims and turkeys.

But some of our customs don't really translate to Pidgin.  The idea of a harvest is one of those.  You see, we live in the land of perpetual spring.  Except for the recent havoc that a prolonged dry season had on gardens, food grows year round.  Some things like coffee and mangoes are seasonal, but most fruits and vegetables can be picked straight from the garden any time of the year.

Nevertheless, we missionaries hold fast to some such traditions... even if they are lost in translation!  Every year about this time, we get together for our annual Harvest Party.  The homemade costumes this year included a lumber-jack-o-lantern, clown, Mt. Wilhelm skiing accident, black cat, pirate, indian, 80's chick complete with leg warmers and security guard, and a bride who was running a bit late for her wedding to a man having an identity crisis.  

Bobbing for lemons is one Harvest Party tradition, because lemons are free and much easier to find than apples.  We also cooked hobo dinners on the coals of the fire and made smores.  Graham crackers and marshmallows and chocolate bars were imported from the US especially for the occasion.  Did you know that you can make sparklers from steel wool?  No, not an urban--or in this case bush--legend. 


One very special event this year was the carving of an orange pumpkin.  Pumpkins do grow here, but they are usually green and a bit small or the wrong shape.  Someone had given Meti some orange pumpkin seeds and they produced a crop of 3 pumpkins.  The Myers saved their pumpkin for about 5 months so that they could make a jack-o-lantern during the Harvest Party.  Emma Dooley said it was the first time she had seen one in real life.

It was such a sweet night, just being together with the missionary family :).  The best kind of fun you can have.

For more pictures of this interesting evening and last year's festivities, here is a look at what we do for fun in PNG!

Now he who supplies seed to the sower and bread for food will also supply and increase your store of seed and will enlarge the harvest of your righteousness.
~ 2 Corinthians 9:10

Wednesday, 27 October 2010

Maternal mortality

In 2008, 1,000 women died every day from complications of pregnancy and childbirth: 570 in sub-Saharan Africa, 300 in South Asia, and 5 in high-income countries (WHO 2010).  The most common causes of death are bleeding, infections, high blood pressure, and unsafe abortions.

Maternal mortality ratio is the number of maternal deaths per 100,000 live births.  According to the World Health Organization, a maternal death is "the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management."  The definition of a live birth is basically a baby that shows any signs of life, from heart beat to muscle contraction.  This number represents the risk associated with pregnancy and delivery.

Maternal mortality ratio is one of the indicators that is used to asses health in countries around the world.  Countries with more resources, better education, and adequate health care have lower ratios than poorer countries.  In fact, this statistic shows one of the widest gaps between the rich and the poor.  Here are a couple of countries for comparison (WHO 2005 data):
Afghanistan = 1,800/100,000
Brazil = 110
Guatemala = 290
Haiti = 670
Ireland = 1 (the best place to have a baby)
Papua New Guinea = 430 --> 733 (should be orange on the map)
Sierra Leon = 2,100 (the worst)
Sweden, Greece, Italy = 3
United States = 11

There is a major problem with using maternal mortality or any other sort of statistic as a health indicator.  Calculation of such a number requires accurate records of births and deaths.  In a place like PNG, you are unlikely to find such information.  So I don't know how in the world they come up with the ratio.  This definition also does not account for the birth of a dead baby, as obviously it is not a "live birth."

In 2000, world leaders gathered at the UN in NYC and adopted the United Nations Millennium Declaration.  This Declaration was a partnership to reduce extreme poverty by the year 2015.  The Millennium Development Goals were designed with specific targets for reducing poverty.  Several of these focus on improving health-related indicators.  Target 5.A aims to reduce maternal mortality ratio by 75%.

So 10 years in to the Millennium Declaration, how are we doing?  Well, the world is actually doing better:  maternal mortality ratio declined by 34% from 1990 to 2008.  Good progress is being made but still a long way to reach the 75% goal by 2015.  PNG, on the other hand, is not doing so well:  the maternal mortality ratio has almost doubled from 430 to 733.  (Though I do wonder about the accuracy of the information.)  One of the contributing factors is that only 50% of women in PNG are delivered by a skilled birth attendant.  That means that the other half are delivering at home or in the bush or at a health center that doesn't have a nurse.  The mother might have an untrained friend or family member assisting her.  If there is an emergency, it is very difficult to get to help... mountain paths, bad roads, unreliable or no vehicles, rascals, distant health centers, etc.  You can probably see why our maternal mortality ratio is so bad.

During my 4 years of medical school, 3 years of residency, and one year of fellowship in the United States, I don't remember even hearing about a maternal death.  I can think of 4 since I came to PNG in early 2009.  The first was a mother with liver and kidney failure.  The second was a woman with heart failure.  In both of these cases, the pregnancy and delivery worsened the underlying illnesses in an already critical patient.  The third patient came to our hospital after laboring for several days at home.  The fetus was already dead when she arrived.  Mother had an infection, she was very sick with sepsis.  Her condition was complicated by a difficult delivery and post partum hemorrhage.  The combination of sepsis and hemorrhage damaged her kidneys and caused renal failure.  She died several days later.  Dai was the fourth.

With about 1,200 deliveries a year, that would make the maternal mortality ratio of Kudjip Hospital about 333 per 100,000 live births.  Though this number is higher than I would like, I remember countless faces of women who were saved because of the care that they received at our hospital!

"A woman giving birth to a child has pain because her time has come; but when her baby is born she forgets the anguish because of her joy that a child is born into the world."
~ John 16:21

Monday, 25 October 2010

A new name

Names in the Bible are so full of meaning.  Someone's name might be a description of their character or prophesy about the future.  In Genesis Chapter 15, God changed Abram's name to Abraham.  "Exalted father" became "father of many."  Isaac's name means "he laughs" because his mother found it amusing that she would bear a child in her old age.  Esau was a hairy man, and so he was called.  Jacob was born grasping the heal of his brother.  Any guess on what his name means?  Naomi suffered much in her life and changed her name from "pleasant" to Mara, which means "bitter."  Skip ahead a few generations to the birth of Jesus.  His name means "the Lord saves."

I started caring for Dai about a month ago.  There were two sort of foreboding things about her case from the beginning.   The first was her list of medical problems, which was quite impressive and only got more so as time went along.  I will get to that in a minute.  The second was her name.  "Dai" means either "to faint" or "to die" in Pidgin.  I'm wondering if her name had another meaning in her local language?  I sure hope so.

Dai came from the Southern Highlands, one of our neighboring provinces.  The doctors at the hospital there referred her because she was pregnant and had a low blood count.  One of her family members works at the local tea plantation, so she ended up at Kudjip.  I saw her in clinic and started her problem list:  23 weeks pregnant with twins, anemia (Hgb 9), enormous spleen, asthma, and hepatitis B.  As tiny as she was, I was amazed that two babies and the big spleen could all fit inside her short little abdomen.  And she still had 17 weeks to go!

A couple of weeks later, Dai returned to clinic with nose bleeds and jaundice.  Dr. Bill saw her and ordered a complete blood count.  Sure enough, her anemia had worsened and platelets were so low that her blood was not clotting well.  She was admitted to the hospital where I took care of her on D-ward.  I ordered all the lab tests I could think of and came up with a working diagnosis of "hypersplenism."  Big spleens are common in some parts of PNG, usually from multiple infections with malaria.  A big spleen can become overactive, collecting platelets and breaking down blood cells.  I gave her a couple of units of blood and her blood count stabilized.  She was discharged after several days in the hospital.

Another week passed by and Dai returned to clinic with yet another problem to add to her list.  Now her blood pressure was high, she had a head ache and quite a bit of swelling in her legs.  Multiple blood pressure checks and a few more lab results confirmed the dreaded diagnosis of severe pre-eclampsia.  This is a sickness of pregnancy that is only cured by delivering the baby.  Dai's condition continued to worsen.  If we didn't deliver the babies and soon, she was going to die.  Even so the decision was not an easy one... at 27 weeks gestation, the twins were not likely to survive in PNG.

Dai was re-admitted and started on medicine to control her blood pressure and magnesium to prevent seizures of eclampsia.  I think it was during this second admission that I decided to call her "Hope."  Anyways, the induction was quite a process.  It took three days to get her into labor!  She finally delivered her babies early Friday morning.  As I feared, the babies were too small.  The first was a boy who died shortly after birth.  The second was a girl.  She weighed only 875 grams.  This one lived through the day but died Friday evening.

Dai herself was quite ill by the time she delivered, starting to show signs of pulmonary edema.  Dr. Susan was on call and stayed with her through the early hours of the morning.  Dai received a couple of units of blood to keep her from bleeding to death and a medication to clear the fluid from her lungs.  I saw her later in the afternoon and she was already starting to look better.  By rounds on Saturday morning, Dai was doing amazingly well.

On Monday morning, Dai looked like a new woman!  What an improvement from how sick she was, and a dramatic example of how delivery cures pre-eclampsia.  It seemed as though we had made it through the most critical period.  I decided to keep her one more day to tune up her asthma and re-check a blood count.

Tuesday morning I walked into D-ward and found the crash cart at the foot of Dai's bed.  Not a good sign.  Dr. Susan who was on call again.  She and a crowd of nurses were hovering over the patient.  Apparently Dai had gone outside and had fallen down.  By the time she was found, she was unconscious.  Somehow the nurses got her back to D-ward and they called Dr. Susan.  Dai was going in and out of consciousness, her blood pressure was low, pulse weak, and her abdomen was starting to swell.  Dr. Susan did an ultrasound and discovered free fluid in the abdomen that looked suspiciously like blood.  Dr. Bill, Dr. Rosie, and I all arrived and listened to the story.  We concluded that the fall had probably ruptured the Dai's enlarged spleen and she was hemorrhaging into her abdomen.  The surgeon was called.  Drs. Susan and Rosie went to give blood.  The nurses started a second IV.  The first unit of blood had just started to go in when Dai became unresponsive and stopped breathing.  Our team worked hard at CPR, but we were unable to save her.  Tears brimmed in my eyes and flowed freely down the cheeks of others.

Sorry for the heaviness of this story.  We don't lose many mothers at Kudjip Hospital, and it is always a tragedy when we do.  But I want to leave you with the happy ending to this story.  Dai was a Christian.  She believed in Jesus and tonight she is with Him in heaven!  I would imagine that she has already received her new name... "Life."

Zion's new name

"The nations will see your righteousness,
and all kings your glory;
you will be called by a new name
that the mouth of the Lord will bestow.
You will be a crown of splendor in the Lord's hand,
a royal diadem in the hand of your God.
No longer will they call you Deserted
or name your land Desolate.
But you will be called [My Delight is in Her],
and your land [Married];
for the Lord will take delight in you,
and your land will be married.
They will be called the Holy People,
the Redeemed of the Lord;
and you will be called Sought After,
the City No Longer Deserted."

~ excerpts from Isaiah 62


When a patient is admitted to the hospital, one of the family members will also stay with him or her on the ward.  We call this person the "watchman."  We have a small staff compared to the number of patients we serve, so the watchmen are very important in helping to care for patients.  Basically they do the work of an orderly or nursing assistant extraordinaire:  they cook for and feed the patients, wash them, turn them (sometimes), help them to the bathroom, transport to x-ray, take them outside for some fresh air, notify the nurse if there is a problem.

On pediatrics ward, the watchman is usually a mother or father who stays with their child.  Spouses or siblings or parents or cousin brothers or all of the above watch for patients on medical and surgical wards.  In the nursery, she is almost always the baby's mother.

When I walked into the nursery this morning, I was amused to find some rather unusual "watchmen" looking out for several of the babies...  Can you spot them?  A good laugh is a great way to start Monday morning :).

BTW, baby of Dorothy was the main character in my blog "Teeny tiny."  She was only about 1300 grams when she was born.  As you can see, we recently celebrated her 2000 gram milestone!

"I lift up my eyes to the hills--
where does my help come from?
My help comes from the Lord,
the Maker of heaven and earth.
He will not let your foot slip--
he who watches over you will not slumber;
indeed, he who watches over Israel
will neither slumber nor sleep.
The Lord watches over you--
the Lord is your shade at your right hand;
the sun will not harm you by day,
nor the moon by night.
The Lord will keep you from all harm--
he will watch over your life;
the Lord will watch over your coming and going
both now and forevermore."
~ Psalm 121

Tuesday, 19 October 2010

"I tell you the truth, unless a kernel of wheat falls to the ground and dies, it remains only a single seed. But if it dies, it produces many seeds. The man who loves his life will lose it, while the man who hates his life in this world will keep it for eternal life." ~ John 12:24-25

A Night at Kudjip Hospital

"A Night at Kudjip Hospital" is a video documentary recently posted by Engage Magazine.  It tells the story of one of Dr. Bill's call nights without electricity and in the dark.

Well, I'm sorry if I have ever complained about the sporadic electricity.  Now we are having problems with TOO MUCH power...  

The first power surge came about three weeks ago.  There was a loud boom during Monday morning chapel.  Loud boom = not good.  The surge burned out the station phone system, home computers and electronics, and various equipment around the hospital.  When and how the phone system will be fixed isn't clear yet.  Maybe the end of November?  For now if there is an emergency or other need at the hospital, the nurses have to send messages to the on call doc by security guard.  (I haven't decided if this makes call better or worse.)  Pray that our patients won't suffer from delays in notifying the doctor!  

The second surge came last Thursday during prayer meeting.  Suddenly the lights in the room became brighter and began to buzz.  Brighter buzzing lights = not good either.  The following morning we learned that the internet was no longer working.  Our best method of communication with the outside world was knocked out... yet another martyr to PNG Power.  Luckily we were able to get some parts and the service was restored early this week.

Power surges and power outages.  We are so in need of rebuilding our hydroelectric dam.  Proposals and plans are in progress but a new hydro is still months or years away.  Your prayers would be appreciate for this as well.

Writing on power issues has turned my thoughts to the Source of all power.  In light of our challenges here on earth, the power of God only seems more perfect and holy and awesome!  Papa, thank you for your life-giving power.

"His divine power has given us everything we need for life and godliness through our knowledge of him how called us by his own glory and goodness."
~ 2 Peter 1:3

Wednesday, 13 October 2010

On speaking English

We at Kudjip have the pleasure of working with volunteers from all sorts of places.  Frequently visitors come from the US, though we do have some from other countries on occasion.  During the past several months, we have had a number of volunteers come from other parts of the English speaking world.

Charlotte and Nick are newlyweds who came to PNG directly after their honeymoon.  They are from Cornwall in the south of England.  Charlotte is in her 4th year of medical school, so she spent her time with us at the hospital.  She has such a sweet spirit and really ministered to our patients.  She was a special blessing to one of our D-ward mothers who named her new baby "Charlotte."  Nick comes from a farming family and is also a bread baker.  He mostly worked with maintenance and did all sorts of handy things around the station.  Did I mention that he bakes bread?

Francine is another UK medical student who recently came for elective rotation.  She is from Jersey... the country, NOT the state.  I never knew there was any such place as Jersey.  Although I suppose if there is a "New Jersey" there must be an original.  What do you know... there really is!  Jersey is a small island off the coast of France.  Since it doesn't appear on every map, Francine makes a habit of adding Jersey graffiti, as she did on our bathroom shower curtain (at my insistence).

Once upon a time Jersey belonged to France, but after WW2 it came under the British Crown.  The politics of it all are still a bit confusing to me... under the Crown but not part of the United Kingdom, or something like that.  Francine will be aghast that she spent seven weeks at Kudjip and I am still not completely clear.  But even she would admit that it is complicated.  

Francine is attending medical school in Wales, which IS in the UK.  She spent about seven weeks with us.  I loved hanging out with her, as she is so full of life and passion for Jesus!  I enjoyed hearing about her home and her culture.  Now that I have a friend from this recently discovered country called Jersey, I will definitely have to visit some day.

Graham and Elaine are on their second "tour" to Kudjip.  They are from our neighboring Australia.  They came last year to get a feel for the place, and are now back for a couple of months.  Dr. Graham is a general surgeon and is covering for Dr. Jim while he is on home assignment.  Graham and Elaine are amazing, really... jumping right in to things and becoming part of our mission family.  It has been such a blessing to have them here!

It has been really fun to learn about culture and language from these visitors.  Despite our common language, I have found that there are quite a few differences.  Sometimes we have to translate because words or phrases have different meanings.  And there have been a few laughs along the way!  For example, when in the UK you should probably not refer to the rubber thing on a baby bottle as a "nipple."  Apparently that word is a bit crass in British English.  See below for the more appropriate term.

Here is a bit of an "English" dictionary for you...

United States Cornwall/Jersey Australia
hello, etc. g'day
dude bloke mate
awesome brilliant
dishes crockery
silverware cutlery
dinner tea
not sweet, salty? savory
French fries chips chips
French press cafetiere coffee plunger
baby stroller pram
baby bottle nipple teat
14 pounds (weight) one stone
2 weeks fortnight fortnight
premature prem
GERD GORD (o=oesophagus)

"After this I looked and there before me was a great multitude that no one could count, from every nation, tribe, people and language, standing before the throne and in front of the Lamb.  They were wearing white robes and were holding palm branches in their hands.  And they cried out in a loud voice, 'Salvation belongs to our God, who sits on the throne, and to the Lamb.'"
~ Revelation 7:9-10

Sunday, 10 October 2010

Itty bitty

And I thought that baby of Dorothy was teeny tiny.

Well, let me introduce you to our newest arrival to the nursery...  baby of Rosa was born at home on Tuesday or Wednesday last week.  She was brought into the ER on Friday because she was having some difficulty breathing.  I was shocked to learn that this little one had been living and surviving at home for three whole days!

Baby of Rosa's admission weight was 1200 grams (2.6 pounds).  As expected she has dropped a bit to about 1125 grams (2.5 pounds).  She is on IV fluids and antibiotics, and just started feeding yesterday.  So far so good for such an itty bitty thing!  But she has a looooong way to go.

There is only one warmer in the nursery, so babies of Dorothy and Rosa are sharing a bed.  Baby of Dorothy, who is now growing like a weed, looks like a giant compared to her new roommate!