Sunday, 29 August 2010

Stephoscope: August 2010 Newsletter

Dear friends of PNG,

Welcome to the latest edition of my newsletter!  This month's stories include those that have built my faith and my muscles.

And thank you for your prayers... God is answering!

hugs from PNG,
~ steph

P.S.  If you would like to be added to my newsletter email list, send your address to me at

Saturday, 28 August 2010

Retreat to Rondon Ridge

Rondon Ridge is a beautiful lodge located in the mountains above Mount Hagen.  It is one of the places where we like to go for special occasions... Mother's day, a birthday or anniversary, or to take our volunteers for a thank you outing.

To get to Rondon we travel about 45 minutes to Hagen town, turn down an unmarked road, cross a wooden bridge, and then another 45 minutes up a dirt road.  The road has some rather precarious looking drop-offs.  I imagine that the next good rain will wash it away (again).  As we wind our way up, there are glimpses of the mountains above and valley below.  Friendly locals smile and wave as we pass through their village.  Children offer flower boquets for just a few toea.  They are so precious it is hard to resist!

The hotel is rather nice, quite luxurious for PNG.  We missionaries don't usually stay there as the cost is out of our price range.  (I did have the privilege of staying one night when I first came to PNG, thanks to Becky who was attending a conference.)  The main hall is an interesting bit of architecture, a combination of modern and traditional materials.  There is a lovely flower garden and fish pond just outside the main hall.  The panoramic view of the Wahgi valley is breathtaking.  Mt. Hagen sits so far below it almost looks beautiful.  A 15 minute walk takes you through the rainforest to an orchid garden.  The garden is still in progress, but even more lovely every time I visit.  The orchids like to play hide an seek; each time I have seen new flowers that I haven't see before.  It is a fun place to explore.

Last Saturday, some of our volunteers and a couple of missionaries tag-alongs piled into the blue turbo cruiser and retreated to Rondon Ridge for the day.  We had quite an international group:  Tom and Lois from Springfield (Ohio), Francine from Jersey (the country, not the state), Nick and Charlotte from England, and Graham and Elaine from Australia.  The variety of English accents was fascinating!  We briefly stopped in Hagen for ATM and market goods, then bounced our way up the mountain to Rondon Ridge.  It was sprinkling a bit when we arrived, but that did not deter us from enjoying the valley views and orchid garden.  Lunch was a choice of chicken, beef, or fish with "chips" a.k.a. french fries.  Barramundi is one of my favorite kinds of fish.  Ice cream with strawberries concluded the delicious meal.  It was a lovely afternoon.  So nice to escape Kudjip for a few hours!

On the way home we did run into a bit of an unexpected detour.  We attempted to take the back way or scenic route home.  Unfortunately we came upon a bridge that was impassable and had to turn around.  Too bad we didn't BYOP (bring your own planks) for this outing.  Oh, well!

Saturday, 21 August 2010

Texas birthday

OK, sis... here is my promised b-day blog!

PNG is a collective culture.  The family is much more important that the individual.  Important events are centered much more on community than a particular person.  The first birthday of a child is cause for big celebration, probably because he or she has actually survived the most dangerous year of life.  But beyond the first year, birthdays are not traditionally celebrated.  The passing of years is marked by the passing of Christmas.  So if you want to know how old someone is, you would ask "How many Christmases do you have?"  Even then they may or may not know.

As I reached the mile stone birthday of, well... "30-something"... this year, I rather like the idea of not keeping track of age!  (If you really want to know, ask my sister and she will be happy to tell you.)  But nevertheless, celebrating birthdays is part of my home culture.  So my "community" and I celebrated in style.

Erin and Becky made plans for the evening, and decided they could not throw a party for Steph without some sort of theme.  (I have a reputation for themed parties.)  
Since all three of us trained in the Lone Star State, celebrating Texas style was only natural.  The Myers family were the most excellent hosts for the evening, and their house was completely rearranged with all sorts of Western decor... cowboys, stars, boots, BBQ, and even a portrait the former president George W. Bush.  Graham and Elaine, native Australians who jumped on the evening's band wagon, presented me with a yellow "rose" that was actually a yellow daisy picked outside the fence of my yard.  We feasted on chili and corn bread, salad with Jeff's homemade spicy dressing.  
And what would a such a party be without a flag birthday cake?  Becky led us in a match of Texas trivia and we sang "Deep in the Heart of Texas."  The evening concluded with a viewing of Louis L'Amour's "The Shodow Riders."  
It was a Texas-sized fun evening!  Thanks, ya'll, for making my day a special one.

Here is a bit of Texas trivia...
  • The first word spoken from the moon on July 20, 1969 was "Houston."
  • More land is farmed in Texas than any other state.
  • Texas is the only state to have the flags of 6 different nations fly over it:  Spain, France, Mexico, Republic of Texas, Confederate States, and the United States.
  • The Texas capital building stands seven feet higher than the nation's capital in Washington, D.C.
  • The armadillo is the official state mammal.
  • Texas comes from the Hsianai Indian word "tejas" meaning "friends" or "allies."

"Praise him, sun and moon, praise him, all you shining stars."
~ Psalm 148:3

Monday, 16 August 2010

Code blue

Miriam is a Nazarene meri pastor, or pastor's wife.  She was pregnant and just about due with her 5th child when she came to the hospital last week.  She was feeling some on and off contractions, the early signs of labor.  The nurses checked their patient and were concerned that her baby was not head down.  Dr. Scott did an ultrasound and diagnosed Miriam and her baby with a condition called "polyhydramnios," or too much amniotic fluid.  There was so much water in Miriam's uterus that the baby was doing hand stands and back flips!  

Sometimes polyhydramnios is due to a problem with the fetus, either a congenital or genetic defect.  Or it just happens and we never find a reason.  The condition has the potential to cause a several complications during labor, all of which are emergencies.  Because the fetus is so mobile, it is possible that he or she will turn sideways or bottom down during labor.  The baby may or may not be able to deliver vaginally depending on the actual presentation.  Another problem that can result from polyhydramnios is cord prolapse.  (Read about one of our other patients with cord prolapse in my blog "Giver of life.")  When the water breaks, a huge tsunami can sweep the umbilical cord into the birth canal along with the wave of fluid.  Pressure on the cord can cut off blood supply and the baby can die unless quickly delivered by c-section.  A third complication is called placenta abruption.  Rapid loss of the large volume of water causes the uterus to contract and the placenta can pull away from the wall of the uterus.  Again, the baby looses blood supply and will die unless an emergency c-section is done.  Finally, mothers with polyhydramnios have the potential of bleeding too much after a delivery.  Post partum hemorrhage occurs because the over stretched uterus fails to contract.

Because of these potential complications and our inability to do an emergency c-section if needed, Dr. Jim and I decided that the best course of action was to do a c-section before there was an emergency.  Or so we thought...

On Thursday morning, Miriam was taken to the operation theater.  She was given spinal anesthesia which is a medicine to make a patient numb from the waist down.  Dr. Jim and I scrubbed, gowned, and gloved.  We began to prep and drape the patient when we noticed that she was looking a little funny.  Suddenly she became unresponsive and stopped breathing.  Her pulse weakened and became undetectable.  Dr. Jim forgot about the prep and began doing CPR.  Our team of anesthetists intubated and secured the airway.  OT nurses started another IV to give more fluids.  Another nurse gave medicines to increase blood pressure and reverse the effects of the spinal anesthesia.  

Finally we detected a weak pulse.  Miriam's blood pressure began to rise.  She started to breathe on her own and then regained consciousness.  I did a quick ultrasound to confirm that the baby was still alive.  Praise God, there was a heart beat!

We re-gowned and gloved, prepped and draped for a second time.  An incision was made and a healthy baby girl was delivered a few minutes later.  The cry was music to my ears!  We sewed up the uterus and the bleeding stopped easily.  The surgery concluded without any further complications.  The baby was moved to the nursery and Miriam was taken to recovery.

Four days later, both mother and baby are doing great!  Miriam has done just about as well as any other post-op mother.  Look at her smile!  You would never know she almost died.  The baby is beautiful, and shows no signs of a congenital or genetic anomaly that would have caused the polyhydramnios.  They will likely be going home tomorrow.

Dr. Tom is an ENT doctor and one of our volunteers for the month.  I'm going to borrow the verse that he shared for this story, and for the many stories of Kudjip Hospital.  God has brought all each of us here--doctors and nurses, long termers and short timers, American and Australian and PNGian--to do good works and bring glory to His name!  Soli Deo Gloria.

"For We are God's workmanship, created in Christ Jesus to do good works, which God prepared in  advance for us to do."
~ Ephesians 2:10

Friday, 13 August 2010

Blessings of showers


Kudjip and the surrounding area has been experiencing a bit of a dry spell.  Well, more than a bit.  Gardens have started to shrivel and water tanks to run dry.  We were getting desperate.  (For more on the water situation, follow this link to my blog on "Rain, rain...".)

Many prayers from around the world were raised heavenward, asking for rain.

Thanks be to Papa God for the blessings of showers!  We have had several good rains over the past few days.  Our water tank is now full to overflowing :).

There Shall Be Showers of Blessing
words by Daniel W. Whittle (1883)
music by James McGranahan (1883)

"There shall be showers of blessing" -- 
This is the promise of love.
There shall be seasons refreshing,
Sent from the Savior above.

Showers of blessing,
Showers of blessing we need.
Mercy drops round us are falling,
But for the showers we plead.

"There shall be showers of blessing" -- 
Precious reviving again --
Over the hills and the valleys,
Sound of abundance of rain.

"There shall be showers of blessing."
Send them upon us, O Lord.
Grant to us now a refreshing;
Come, and now honor Thy Word.

"There shall be showers of blessing."
O that today they might fall,
Now as to God we're confessing,
Now as on Jesus we call!

Wednesday, 11 August 2010

Saturday, 7 August 2010


"Bagarap" is a Pidgin word that means "broken," "damaged," "not working."  Care for our patients is frequently complicated by equipment that is bagarap... oxygen concentrators, x-ray view boxes, lab machines.  Sometimes the equipment is damaged by power surges.  Sometimes it is already old and used, and then we use it some more and it just wears out.  Sometimes it is as simple as a blown fuse or light bulb, one that can't be replaced here in PNG.

We have experienced some extra challenges related to malfunctioning equipment over the last two weeks.  The first thing to go was the "good" ultrasound machine, leaving us with an older model that is much poorer quality.  The problem seems to be the power cord (we hope), and luckily we have discovered a temporary solution until another cord arrives!  On Tuesday, the colposcope that we use for cervical cancer screening developed a short in the lighting system.  The back-up scope didn't work at all.  Dr. Susan found some sort of microscope that should work until another one arrives in a few months.

Dr. Erin recently write about the ultrasound in her blog "Lost without the ultrasound."

"When you don't have a CT scan or MRI, the ultrasound machine becomes your best friend, at least it has been our best friend.  About 2 years ago we got a new ultrasound machine, which is really nice, and so we use it for everything.  We use it to see babies inside mommies, to see if the fluid in the abdomen can be drained, to see if the enlarged heart on CXR is fluid in the sac around the heart or just a large heart, to see if the abdominal pain is caused by an abscess in the pelvis or if the patient has a ruptured ectopic pregnancy and blood in the belly.  We use it at least 50 times a day, if not more.  We have a whole room just for the ultrasound machine and the exams that we do, but we also take it with us to the wards and ER.  It is probably out of its room about a quarter of the day because we are using it everywhere else.

"As we recently found out, we rely on it a lot.  About 2 weeks ago, I needed the ultrasound in the ER and when I got it to the ER, the battery was almost dead, so I needed to plug it in.  Unfortunately, when I did that, it didn't work, the machine wasn't getting the power from the plug, something was wrong.  I kept trying to play with it, and when I couldn't get it I asked others.  None of us could get it to work, and so we were stuck without our good ultrasound machine.  The machine we have to use is like a 1950 TV compared to a modern flatscreen HDTV that you might buy today, it wasn't even close.  However, it was all we had, so we were happy for something.

"I was trying to see if a lady was pregnant and had to really strain hard to find anything that looked like a baby on ultrasound.  I started ordering more pregnancy tests than I ever did before because I couldn't rely on what I was seeing.  We all wanted our good machine back, but the McCoys were unable to get the parts before they left (we only gave them about 4 days notice).  So we were stuck with our old machine that Jim kept in his surgery clinic, but hadn't used in a long time because our other machine was so much better.  For about 10 days we have suffered without our ultrasound machine.  Then today, Jim tells me that he was fiddling with the cord and got it to register, he taped it in the position it needs to be in and this afternoon we were able to use the machine, praise God.  We should be getting our new cord on the 9th of August, which will help us so we don't have all the tape on the machine, but we will take what we got for now."

Such are the challenges of practicing medicine in the bush!

"So we fix our eyes not on what is seen, but on what is unseen.  For what is seen is temporary, but what is unseen is eternal."
~ 2 Corinthians 4:18

Teach a man to fish

Or in this case, teach a doctor to do surgery...

One of the goals of a missionary, as we say, is to "work yourself out of a job."  Basically it is the "teach a man to fish" kind of a philosophy.  We aren't here just to do things for the PNGian people, but to train them to participate in and more importantly lead the work.  That way the ministry will continue on when we missionaries are long gone.

There are many ways this is happening at and around Kudjip.  Nazarene College of Nursing is located here on station.  We have daily opportunities to teach the nursing students as they do their clinicals.  Medical students and residents (from PNG and around the world) come to Kudjip for rural rotations.  Just down the road there is Melanesia Nazarene Bible College and the teachers college, where men and women are learning to be pastors and teachers.

As docs and missionaries, one of our great privileges is to help train up young PNG doctors.  There is a really awesome program called the rural registrar program.  It would be similar to a residency or fellowship back in the States.  A registrar has completed medical school, served for two years as a general doctor, and is now doing more specialized training.  This particular program is about five or six years long.  Each year the registrars work in their sponsoring hospital for nine months of the year, and do three months of rotations at other training sites.  The program was founded with the hope of preparing national doctors to serve in some of the more remote and underserved areas of the country.  And there are many remote and underserved areas, many hospital that do not have even one doctor!  

The first time I met Maggie, she had come to Kudjip to attend a surgery conference for the rural registrar program.  She is a first year registrar serving at Kanabea, a small Catholic hospital in the mountains of the Gulf Province.  Maggie's home place is the booming metropolis of Port Moresby, the capital of PNG.  To get to Kanabea, Maggie has to travel more than five hours by road to a gulf coast town called Kerema.  There are flights from Kerema to Kanabea several times a week.  A plane is the only way you can get to Kanabea because there are no roads.  Although flying isn't that reliable either, because the planes are often unable to land due to weather conditions.  Obviously, Kanabea is a pretty remote kind of a place.  A hydroelectric dam is being built, but there is no continuous source of electricity.  Maggie is the only doctor at her hospital for nine months of the year.  The other three months, while she is away doing her training, there is no doctor.  It is not an easy place to live or work or practice medicine, but Maggie feels a call to serve the people of Kanabea much like I have a call to PNG.  As you can imagine, I was immediately impressed by her!

Over the past three months, we have had the joy of serving along side of Maggie.  She came to Kudjip for a surgical rotation and has mostly been working with Dr. Jim.  I have especially enjoyed getting to know Maggie as a friend... through Bible study and surgical consults and eating pizza on Friday nights.  She is one amazing gal.

We said "see you later" to our new friend last Saturday as she headed back to Kanabea.  Maggie... our prayers are with you as you go.  Hope to see you again next year!

"Let the word of Christ dwell in you richly as you teach and admonish one another with all wisdom, and as you sing psalms, hymns and spiritual songs with gratitude in your hearts to God.  And whatever you do, whether in word or deed, do it all in the name of the Lord Jesus, giving thanks to God the Father through him."
~ Colossians 3:16-17

Monday, 2 August 2010

Breath of life

As a doc at a hospital in an underdeveloped country, I see and deal with some pretty tough situations.  I have already shared with you about some of them.  One of the more difficult for me is the death of a child.  I had never seen a kiddo die before coming to PNG.  I am sorry to say that it is not infrequent here... a baby or young child who comes in too late or too sick for us to help.  We don't have the right labs, medicines, equipment, vents, enough nurses, or just whatever we need to save this little life.  It just plain stinks.

I was seeing a patient in clinic this morning when a nursing student knocked on my exam room door.  Two babies were doing poorly and I was urgently needed in the nursery.  I rushed over to D ward and I found the nurses working on two very sick babies.  One was born overnight and was turning blue, just about as blue as any baby I have seen.  The more critical one wasn't breathing at all.

Baby of Lucy was born early this morning.  The delivery was uncomplicated and baby was strong at birth, receiving apgars of 10 and 10.  Lucy was a first time mother and didn't notice anything unusual other than crying.  Sister Sylvia, charge nurse on D ward, just happened to come by and found that the baby wasn't breathing at all.  He was rushed into the nursery and the nurses began breathing for him or "bagging" with a bag and mask.  This is the point where I walked in.  I assessed the baby and found the heart rate to be strong, no murmur, and breath sounds good with assistance.  But every time we stopped bagging the baby just wouldn't breathe.  Mr. David, our nurse anesthetist, came to intubate... I hoped that if we just helped him for a little while then maybe he would start up on his own again.  An IV was placed, glucose and antibiotics and aminophylline were given.  The baby moved around and even pulled out the tube, but he just wouldn't breathe.  With the tube out, the nurse began bagging again.  

Things didn't look good.  If this little one didn't start breathing on his own and soon, he would probably die.  We don't have a ventilator nor the staff to manually bag one sick baby for more than an hour or two.  I was frustrated, even mad that we would have to let this beautiful baby die.  The nurses and I prayed with mother, asking Jesus to give breath to her son.  I told the nurses to continue bagging while I went to lunch.  If the baby wasn't breathing by the time I returned, we would stop.

I popped by the Myers house on the way home to lunch.  Dr. Susan is a pediatrician, and I always appreciate her input.  She affirmed that I was already doing everything there was to do.  Jeff said a word of prayer.

After lunch, I walked back onto D ward with heavy steps.  I dreaded telling the mom that her baby was going to die, watching her hold him as his heart stopped beating and life left the little body.  I was surprised to see Sister Sylvia coming toward me with a huge smile.  Oh, me of little faith!  The baby had finally started breathing on his own and was doing well.  I checked on him after clinic and he looked great, ready to eat.  Oh, and by the way... blue baby was doing much better, too.  Sister Sylvia and I prayed together, a prayer of thanksgiving to God for giving breath of life to baby of Lucy.  

I wonder what special plan He has in store for this little one?

"The Spirit of God has made me;
the breath of the Almighty gives me life."
Job 33:4

Sunday, 1 August 2010

Mt. Wilhelm

Me and my new friends :).

Kudjipites tackled the highest peak in PNG, July 2010.