Bagarap

"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