Wednesday, 17 February 2010

Survivor: Vanuatu

Start:     Mar 20, '10
End:     Mar 29, '10
Location:     Aniwa, Vanuatu
Steph, Susan, Jessica, and Cilla are joining Becky 1 for a CBHC ministry trip to the island of Aniwa, Vanuatu.

Friday, 12 February 2010

Meti's 1st birthday

Meti is one of my favorite people in PNG, and maybe the whole world.  She is a national woman who cleans and gardens for several of the missionary families here on station.  But she doesn't just do domestic chores, she considers her work a ministry to the missionaries.  And what an amazing ministry.  

I love Saturdays with Meti, as it is the day she straightens up our house.  I especially enjoy her stories, her singing and prayers.  When Meti prays, the presence of the Spirit is so real.

Meti is 41 this year.  Like many of our PNGian friends, she doesn't know the exact day she was born.  PNGians don't traditionally mark a birthday as an important day.  She happens to have an idea of her age because she knows the years that she went to school.  

Well, last summer Meti had the opportunity to go to America and represent PNG at the Nazarene Missions International meeting.  To go to America, you need a passport.  And to get a passport, you need a birthday.  So she choose February 17 as her special day, sharing it with her good friend Judy Bennett.

Because Meti choose her birthday after the actual date last year, she had never really celebrated before.  Becky and I decided put together a little surprise for her last Saturday.  Beck adorned her with the Kudjip birthday hat and I pinned on the birthday girl ribbon.  We iced some cupcakes and topped them with Valentine sprinkles, put a candle in each one.  Meti received a poor excuse for a serenade since we forgot half the words to the five birthday songs.  We schooled her on the fine art of blowing out all the candles with one breath so that her wish would come true.  There were a few presents to open.  And of course lots of smiles and a few tears of joy to top it all off.  It wonderful afternoon of celebrating our special friend.

Thursday, 11 February 2010

9950 gram party

Last month I wrote about the busyness of maternity ward in my blog entitled "Babies babies everywhere."  At that time, the nursery was just about overflowing with premature and low birth weight babies.  Well those little ones have been growing like weeds!  Last week we threw a big 9950 gram party.  No, we were not celebrating the largest baby to be born in the history of the world.  Four babies had reached the 2000 gram milestone... twins of Miriam, baby of Hellen, and baby of Regina.  Baby of Miriam Simon weighed in at 1950 grams, so we had a follow up party a few days later.

"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

Saturday, 6 February 2010

Saturday on call

0700:  Alarm goes off to wake me up for the day.  I push the snooze button one too many times.  Hard to motivate myself to get out of bed on a Saturday call day.

0815:  On my way to the hospital, a 5 minute walking commute from my house.

0830:  See babies in the nursery, which also serves as the NICU.  The little ones are growing :).  Baby of Maria has only seized once in the last 24 hours!  Thank you, Lord.

0845:  Make rounds on the mamas and babies on maternity ward... post c-section, retained placenta, post partum hemorrhage, endometritis, neonatal sepsis.  

0910:  One still-pregnant patient has prolonged rupture of membranes.  'Bout time this mama had her baby!  Start antibiotics and labor augmentation.

0950:  Somewhere in the middle of rounding on medical ward.  The patients I have seen have diagnosis including tuberculosis, congestive heart failure, cervical cancer, COPD, pneumonia, multiple myeloma, and gastroenteritis.  Just to name a few.

1135:  The ER is full to overflowing which is pretty typical for a Saturday.  I drain an abscess and admit the child for IV antibiotics.  See a patient who has had a stroke, probably secondary to a heart arrhythmia.  Who knows when the EKG will be done.  Admit her, too.

1220:  Take a 30 minute mandatory mental health break, a.k.a. lunch.

1300:  Back in the ER.  One of our staff has a fever.  Diagnose a kid with scabies and tropical splenomegaly syndrome.  Send him on his way with months of malaria treatment.  Admit a young woman with seizures.  I wonder why a patient with months of deafness decides to come to the ER on Saturday.  Write a referral letter for ENT specialist to see her for a perforated ear drum.  
Thankfully none of these patients needed oxygen, because the hospital has been out of O2 for a few days.

1530:  Stop by L&D.  Mama from this morning has delivered without too much trouble.  Another pregnant patient has just arrived.  She has a fever and probably chorioamnionitis.  Start antibiotics and induce labor.

1545:  Hey, not bad for a Saturday.  I am now at home and taking a nap on the couch.  My favorite Saturday afternoon past time.

1630:  Called back to ER to see a 4 year old kid who fell out of a tree and hit his face on something, I'm not sure what.  Looks like he will be OK.

1710:  Still not too bad for a Saturday.  At home again thinking of what I might want to have for dinner.

1755:  Waited to long for dinner.  Oops, that was a mistake.  Grab a couple of dinner rolls on my way out the door and back to the ER.  A young man twisted his left leg and fell while playing rugby.  The massive swelling of his knee and ankle suggest a fracture.  Order x-ray.  Evaluate another patient with an axe injury to his right foot.  A little deep, but missed most of the important stuff like tendons and arteries.  Wash and suture the wound.  Discharge home.

1920:  A group of men come into the ER dragging one of their buddies.  Some sort of fight down at the road bung.  The man has a chop chop to the forehead.  Nurses screen the patient and start an IV while I look him over from head to toe.  Other than being drunk, the laceration appears to be his only injury.  Clean and evaluate the wound.  There is an indentation in the skull bone from whatever weapon cut his head, but it does not appear to be a through and through fracture.  Tie off a couple of bleeders, close the laceration over a drain, and place a pressure bandage.  Patient is too intoxicated to even need anesthesia.  Admit to surgery ward for observation.

1945:  Still waiting for x-rays.  Rugby player requests not to be admitted.  The chop chop victim is from the Kuma tribe and was attacked by a member of the Sagang tribe.  The rugby player is Sagang and apparently fears retribution.  This rivalry runs deep in the Wahgi Valley.  Think West Side Story PNG style.  X-rays arrive and I find that the patient has both a patella and distal fibula fracture.  No more rugby for you for a while.  He does not have transportation and cannot walk on this injured leg.  Agrees to admission after a little convincing.  Knee immobilizer and ankle splint placed.  Will do a plaster splint or cast when the swelling goes down a bit.  Admit to surgery ward.

2030:  Seeing the light at the end of the tunnel!  Must have been a mirage.  Suddenly there is commotion outside the ER door.  A truck has pulled up with three more chop chop victims, these from the Sagang side.  So much for going home.  Begin triaging the patients.  One was hit with a stone and has a deep laceration to the forehead.  He is semi-conscious and the most critical.  A teenage boy has been chopped across the forearm, all tendons severed.  A third man has been beaten and has a knife wound to his leg that has cut through his Achilles tendon.  Dr. Jim and some off duty nurses show up to help out.  We have such a great team!  They patch together the two patients with arm and leg lacerations.  I begin working on the guy with the forehead wound and discover that he also has a depressed skull fracture.  
Dr. Jim takes a look and helps with the repair.  Patient begins seizing.  Nurses give IV diazepam and the convulsion stops.  Finish wound care for all the patients and admit them to the other side of surgery ward.  Dr. Jim prays for peace.

2210:  Finally home.  Change out of my bloody scrubs.  Warm up some leftovers and sit on the couch to decompress.  Start to take a sip of my chai...

2225:  Call from maternity ward.  The patient with the fever has just delivered and has a deep laceration.  I am needed for the repair.  Lord, please give me strength.  I change into a clean pair of scrubs and head back to the hospital.  There is still blood on my mud shoes from the mayhem in the ER.  Make a mental note to wash that off later.

2350:  Laceration repair complete and clean up has commenced.  I am notified of another patient who has just arrived.  She delivered a stillborn baby in the village at 3PM today.  Placenta is still in.  She has lost a lot of blood and is pale and shocky.  Start second IV.  Order blood to be transfused ASAP.  Decide not to mess with the placenta until I am sure we have blood ready.  Go home.

0230:  Get a call from surgery ward.  The patient with the skull fracture woke up and is requesting to have his foley catheter removed.

0405:  Notified by maternity ward.  1st unit of blood has gone in and 2nd is ready.  I head back to the hospital.  We can't figure out how to get the stirrups on the bed.  Attempt to move the patient to another bed and she faints.  Nurse brings wheel chair for transfer.  We are finally ready.  I pray with the patient and give her IV sedation.  Procedure went well.  Thankfully I do not have to do a D&C.

0445:  Home again, home again.  Looking forward to a few hours of sleep, though interrupted by one or two phone calls from the wards.  

0700:  Alarm goes off.  I push the snooze about 5 too many times.  I hope those last few phone calls weren't too important.  I don't remember much when I wake up.

0810:  Back to nursery and maternity for post call rounds.  Baby of Maria is crying and responsive this morning.  Praise God!  This little one who was so critically ill is going to make it.  Mama with the deep laceration is feeling dizzy.  Check hemoglobin, she may need a transfusion.  Patient with retained placenta has received her second unit of blood and is looking much better.

0915:  Rounds finished.  Check out to Dr. Bill.  Hope your call is better than mine!  Now I get to go home and stay home.  
What a night.  Thanks, Lord, for your help.

0930:  zzzz...

"The Lord is my strength and my shield;
my heart trusts in him, and I am helped.
My heart leaps for joy
and I will give thanks to him in song.
~ Psalm 28:7

Monday, 1 February 2010

My least favorite

It must be pretty bad if a disease makes it to a doc's least favorite list.  And I have a couple:  measles, SSPE, heart disease in kids, incurable cancer.  But this one is the least of all my least favorites.

I first developed an interest in cervical cancer when I came to PNG as a medical student.  Dr. Bill asked me to help with writing a grant to fund cervical cancer screening.  I did some background research for the project and was surprised to learn that this disease is one of the leading causes of cancer death in women in the developing world.  It is an illness that is so easily preventable and/or treatable after detection with a simple pap smear, yet it is killing hundreds of thousands of women every year.  And as I dug into the hospital records, the info confirmed that there were many women in PNG who were also dying from cervical cancer.

Here are some of the stats (from Comprehensive Cervical Cancer Control, WHO 2006):
~ 95% of women in developing countries have never been screened for cervical cancer.
~ In 2005 there were more than 500,000 new cases of cervical cancer, more than 90% were in the developing world.
~ It is estimated that more than 1,000,000 women worldwide have cervical cancer.  Most have not been diagnosed or do not have access to treatment.
~ In 2005, almost 260,000 women died of cervical cancer, almost 95% were in developing countries.

Well, that grant that Dr. Bill and I worked on way back when was actually funded.  Nazarene Health Ministries used the grant money to begin a cervical cancer screening program.  A building called the "White House" was constructed to house the clinic as well as offices for STI and HIV treatment.  
Pauline is a CHW or community health worker, the PNG equivalent of a medical assistant.  She has been trained to do pap smears and follow up.  The slides are sent to Meripath, a non-profit organization in Australia that provides necessary supplies and reads pap smear slides.  The only cost to our patients is a few kina (less than $2) for shipping expense.  Special thanks to Meripath for this wonderful ministry!

A few months ago, Dr. Susan asked me to help with the cervical cancer screening program.  Dr. Susan, who is a pediatrician by training, had been supervising the program for several years.  ("Flexible" is the middle name of every missionary.)  Last year she added "Director of Medical Services" to her job description.  Despite her love for the program and patients, she decided to share some of the responsibilities.  

So Dr. Becky 2 and I are now the dynamic duo of Kudip Hospital, working together to fight cervical cancer!  Our weapons are a bit unusual:  speculums, cytobrushes, biopsy forceps, and liquid nitrogen.  On Tuesdays and Thursdays, Pauline refers patients who have abnormal pap smears to see us in clinic.  Tuesday is my day and Thursday is Becky's day to do a procedure called "colposcopy."  This gives us a closer look at the potential abnormality.  If we see something abnormal, we take a biopsy which goes to Meripath for diagnosis.  Patients with evidence of cervical pre-cancer or early cancer are treated with cyrotherapy, LEEP, or a hysterectomy.  It is so satisfying to be able to prevent a future cancer with such simple procedures!

Sometimes we see women who already have cancer, and at a stage that is too far advanced for treatment at Kudjip.  Actually since I have started working with the program, I have seen more women with advanced cancer than the pre-cancers that we can take care of.  It used to be that there was no hope for these women.  They were destined to die, slowly bleeding to death.  They also suffer from a bad smelling discharge, urinary incontinence, and severe pain.  As you probably can tell, I have seen one too many of these cases and one too many women die.  

However, today there is a hope of treatment.  In May of last year, the PNG Cancer Treatment Centre was re-opened in Lae after a 10 year hiatus.  A very big thanks to Dr. Niblett and all the folks at Angau Hospital for your service to the women of PNG!  Patients who qualify and are able to travel can receive free radiation therapy that is potentially curative.  Sometimes the logistics are a bit challenging to work out.  Patients must pay their own transportation costs, which amounts to about $35 per person (usually one patient and one or two watchmen will travel).  This cost may be prohibitive to some.  They must also be away from home for up to 8 weeks, as the standard course of treatment is at least 5 weeks.  And it is preferred that the patient has family or "wantoks" in Lae in case there is no room to stay at the hospital.  But every challenge is worth it for one patient who is cured from her disease.

I want to share about three patients I have cared for over the past year.

I first met Wendy last fall.  I can't remember her exact story.  Maybe she was a follow up of an abnormal pap smear, or maybe someone found something abnormal on a pelvic exam.  She was referred to me and I diagnosed her with cervical cancer.  She was the first patient I was able to refer to Lae for radiation therapy.  Just after the new year, she returned for a check-up.  Dr. Becky saw her and brought her to my room for a visit.  I could barely contain my tears for the joy of seeing how well she looked.  Thanks to the Lord for working this healing miracle!

Kuni is a pastor's wife from a nearby town.  I saw her in clinic last October and also diagnosed her with cervical cancer.  I was particularly burdened for her as she is a mother of 4, with the youngest being only 2 years old.  She disappeared for a few months, and I later learned she had gone to see a traditional healer of some sort.  She came back to see me a few weeks ago, asking me to check and see if the sickness was still there.  Unfortunately it was, and it had grown larger and was now blocking one of her kidneys.  After considering the news, she and her husband decided to find a way to go to Lae.  She is there now, being evaluated at the Cancer Centre.  Please pray for Kuni and her healing, for the wisdom of the doctors and the nurses who care for Kuni and many more like here.

Christina is the last patient I want to write about.  I took care of her in December when she was admitted to D-ward (maternity).  She was nine months pregnant with her 4th child.  She also had cervical cancer.  The cancer would have prevented her from delivering normally, so Dr. Jim did a c-section.  My plan was to see her a few weeks after discharge and refer her for treatment, but unfortunately she has been lost to follow-up.  It is because of patients like Christina that cervical cancer is my least favorite disease.  My prayer is that someday she will make it back to the hospital so that we can help her get the care that she needs.

These are only a few of the many many stories, and three in particular that have touched my heart.  Will you pray for Dr. Becky and me as we continue work with the cervical cancer screening program?  For the Meripath team in Australia?  For the doctors and nurses at the Cancer Centre?  And for our patients and their families?  Thank you for prayer partnering with us in this ministry.