Wednesday, 29 September 2010

How to conserve water

My good friend Amber recently initiated a Facebook discussion about water consumption and conservation.  Water conservation is something that we are thinking about every day, especially now during dry season.  Because we have to.  The Highlands of PNG is experiencing one of the driest dry seasons in more than a decade.  We had a bit of a respite, with a couple of weeks of on and off showers.  But the dry season has returned with a vengeance.  The sun has been hot and there has been almost no rain for the last two weeks.

Since we mostly depend on rain for our water supply, we are really having to watch our water usage.  Beck, who thinks I am a bit crazy about the whole thing, has referred to me as "the water nutsy."  OK, I will admit to being at least a little crazy.  But hey... desperate times call for desperate measures.

So here are some of the ways that we are conserving water.

  • #1 and most importantly... PRAY FOR RAIN!!!
  • Check the tank on a daily basis to see how much water is left.  (We are currently down to 1/4 tank or less.)

  • Use dirty dish water for watering potted plants.

  • Consider reducing morning walk/exercise to every other day.  If you don't get sweaty, maybe you can get by one extra day without a shower.  (My bro would be so proud.  He knows how I like my daily shower.)
  • Take what we un-affectionately call a "military shower."  This means that you turn on the water long enough to get wet, turn off to lather up, and turn on again to rinse.  No leisurely 20 minute showers these days!
  • Collect cold shower water (the part where you are waiting for it to get warm) in a bucket and use for flushing the toilet.
  • If it is yellow let it mellow, brown flush it down.

  • Wear clothes more than once, unless they are covered with blood or pus or other such things from working at the hospital.
  • Only do laundry when it rains, you run out of "the essentials" (a.k.a. scrubs), or are otherwise desperate for clean clothes.
  • Borrow a hose from the neighbors so that you can pump water from the well faucet into the washing machine.  Return the hose when you find out it doesn't fit.  Physically haul 5-6 buckets of water from the well faucet, through the back door, and to the washing machine to fill it up.  Try not to spill any precious drops.  Call the neighbors and ask them to catch Brutus the Wonder Dog who has escaped out the back door while you are hauling water.  Wait for the rinse cycle and sprint to the laundry room to refill the machine with well water.  Thankfully rinse only requires 4 buckets.  You figure if you started out the laundry conserving resources, you might as well finish it that way and hang the clothes out to dry.
  • While hanging out the clothes, scan the horizon for rain clouds for about the millionth time today.  You feel like Elijah.  Think about your PNG friends who depend on rain to water their gardens.  And pray some more.

  • Hope that someone else has a hose that fits your faucet in case the rain tank runs dry and you need to fill it from the well.  (Not sure what to do if no one has a hose that fits.  I guess we will cross that bridge when we come to it!)
  • Spending half the day in conservation efforts has caused you to work up quite a thirst!  Sit down and enjoy a nice glass of ice water.  A small glass.
  • Take a nap because you are tired from hauling water.
  • Despite the comedy of it all, you feel thankful that you don't have to bathe or wash clothes in the river (yet) and only have to carry water as far as the back door.

When a Samaritan woman came to draw water, Jesus said to her, "Will you give me a drink?"
The Samaritan woman said to him, "You are a Jew and I am a Samaritan woman.  How can you ask me for a drink?"  (For Jews do not associate with Samaritans.)
Jesus answered her, "If you knew the gift of God and who it is that asks you for a drink, you would have asked him and he would have given you living water."
"Sir," the woman said, "you have nothing to draw with and the well is deep.  Where can you get this living water?"
Jesus answered, "Everyone who drinks this water will be thirsty again, but whoever drinks the water I give him will never thirst.  Indeed, the water I give him will become in him a spring of water welling up to eternal life."
~ John 4:7-14

Thursday, 23 September 2010

World Evangelism Fund and WEF Plus

The World Evangelism Fund or WEF is the fund that supports the mission of the Church of the Nazarene:  "to make Christlike disciples in the nations."  Churches from all over the world contribute to WEF through Faith Promise (a program of planned giving) and Easter and Thanksgiving offerings.  WEF helps to support many ministries of the Church of the Nazarene, such as...
  • outreach in almost 150 world areas
  • primary and secondary schools serving almost 69,000 children
  • more than 40 Bible colleges and seminaries and 3 vocational and training colleges for 10,000 students
  • 60 medical clinics and 2 hospitals
  • literature translation and production in 95 languages
  • administrative costs for Work & Witness, World Evangelism Broadcast, Nazarene Compassionate Ministries, Jesus Film Harvest Partners, and many other ministries
  • salary, living and travel expenses, and benefits such as medical care to hundreds of missionaries serving around the world... including me!
This November, Nazarenes are being challenged to give the largest offering for the WEF in the history of the church:  WEF Plus.  In these times of global financial crisis, the WEF Plus is needed to sustain our mission at the current level.

What is WEF Plus?
Prevailing Prayer--this will not happen by human strength; "Not by might nor by power, but by my Spirit, says the Lord Almighty," (Zechariah 4:6).
Love Offering--this gift is above any obligation or commitment' it must come from a heart of love and desire to fulfill the mission of God.
Unanimous Participation--we need every Nazarene in every church around the world to take part in this endeavor.
Strategic Sacrifice--every adult giving an extra $10 and every child giving 40 coins.

Will you pray for this special offering?  And will you consider a gift to help continue the mission of the church around the world?   If you would like to contribute to WEF Plus, click here.  

Thank you to all of you who are supporting me and the work in Papua New Guinea.  As Paul says in Philippians 1, I pray with joy because of your partnership in the Gospel!

Sunday, 19 September 2010

Steph visits Sarah and David

Start:     Feb 24, '11
End:     Feb 28, '11
Location:     Singapore
I'm spending a few post-Thailand-conference days in Singapore before heading back to PNG. Looking forward to meeting the infamous purple couch! Maski... I am happy just to spend some quality time with my friends :).

CMDA Conference

Start:     Feb 10, '11
End:     Feb 24, '11
Location:     Chiang Mai, Thailand!!!
A group of us docs (+ families) will be headed to Thailand for the bi-annual CMDA conference.

"I am the resurrection and the life. He who believes in me will live, even though he dies; and whoever lives and believes in me will never die. Do you believe this?" ~ John 11:25

Saturday, 18 September 2010

Independence Day get-away

It has been a pretty rough couple of weeks, with too many "heavies" and difficult cases.  When the September schedule came out and I wasn't working the three day holiday weekend, it was time to plan a mental health get-away.  I recruited Becky 2 and volunteer med student Francine to join me in the excursion.

Of course when you are a trio of single girls living in PNG, "get-away" means:  a) you leave the country, b) you travel with an entire escort, or c) you go to a guest house at another mission station.  Becky and I took advantage of "a" last year when we visited Cairns, Australia.  That wasn't an option for this short trip.  The other missionary families, a.k.a. escorts, either had other plans or the docs were on call.  So that left a visit to some of our missionary neighbors.

On Friday morning, Becky and Francine and I loaded the mocha cruiser with our back packs and laundry basket of food and supplies.  We left Kudjip station and drove just 20 minutes down the road to Melanesia Nazarene Bible College.  Yep, our big excursion was 20 minutes down the road to the Bible College.  LOL.  We were welcomed by Rosie Kerr, our fellow missionary and half-time doc at the hospital.  Rosie's husband Dave is a teacher at the Bible College.  Grace and Anna Kerr are two of my precious nieces.  

Our home sweet home for the evening was one of the few two story buildings on the compound.  It seemed as though we were living in a very nice tree house, with beautiful views of the campus and surrounding mountains.  On Friday afternoon, we all enjoyed a well needed rest.  That evening we invited the Kerrs for pizza and played a few games of our favorite Settlers of Catan.  Settlers is a mission field tradition, all over the world.  Rosie fixed a wonderful waffle breakfast on Saturday morning.  It was a breakfast fit for a queen, or several queens and a couple of princesses.  I contributed a honeydew mellon, a splurge for about $6 at the grocery store in town.  Special treat for a special occasion!  

Grace and Anna organized the morning entertainment, a puppet show starring some very bouncy monkeys.  The monkeys were almost as bouncy as their puppeteers... almost.

After breakfast, we picked up Geneva and headed into Hagen for a bit of shopping.  We had lunch at the Poroman Hotel.  I had never been there before, so it was fun to try a new place.

So that concludes our Independence Day get-away.  It was a much needed time away.  Short, but definitely sweet.  Thanks to the Kerrs for being such wonderful hosts!

"The Lord is my shepherd, I shall not be in want.
He makes me lie down in green pastures,
he leads me beside quiet waters,
he restores my soul.
He guides me in paths of righteousness
for his name's sake.
Even though I walk
through the valley of the shadow of death,
I will fear no evil,
for you are with me;
your rod and your staff,
they comfort me.
You prepare a table before me
in the presence of my enemies.
You anoint my head with oil;
my cup overflows.
Surely goodness and love will follow me
all the days of my life,
and I will dwell in the house of the Lord
~ Psalm 23

Wednesday, 15 September 2010

Trauma: Life in the ER

Thursday was Independence Day, and PNG was celebrating the 35th anniversary.  And of course many celebrations would be taking place across the country.  The hospital was open for business, with plans to observe the holiday as a three day weekend.  I was sure it was going to be a quiet day in the outpatient department.  After all, wouldn't our patients rather take part in the festivities than wait in line to see a doctor?  Or so I wished...

I was finishing up with a procedure in the emergency room about noon.  There were only a few patients left in the OPD line.  I figured we would be done with work shortly after returning from lunch.

Suddenly a man burst through the front door of the ER carrying a 10 year old girl.  He said that there had been an accident, a PMV (public motor vehicle) had crashed.  Apparently the vehicle had lost a tire and rolled down the side of a mountain.  Several people had died and many more were injured.  This little girl was the first to arrive.

Jossina's face was covered with blood and badly lacerated, her eyes almost swollen shut.  The nurses quickly took her vital signs and started an IV.  I looked her over from head to toe.  She was conscious and responded to questions and commands.  There didn't appear to be any injuries other than the deep cuts on her face.  I washed the dried blood from her skin and the dirt from her wounds.  I began to suture the lacerations, and prayed as she cried.
A few minutes later, a truck pulled up in front of the ER entrance.  The back was filled with more than 20 victims of the accident.  Some were carried into the ER and other limped.  Soon the beds were occupied with the most critical patients.  A nursing student or officer was assigned to each patient with the task of triaging and taking vital signs.  More trolleys were brought to accommodate the injured, and those with minor bumps and bruises waited on the floor.  The doctors made their way through the room, assessing patients and ordering stat labs and x-rays.  Someone called for an ambu bag and crash cart.  Mournful wails filled the room as one woman was pronounced dead.  Several were admitted.  One man was taken to surgery for a pelvic hematoma.  Lacerations were sutured and fractures splinted.  Another woman later died on the ward.  

This was definitely one of those days when I didn't want to be a doctor.

PMVs or "public motor vehicles" are the major for of public transportation in PNG.  A PMV is most commonly a passenger van, but can also be a Land Cruiser or open backed truck or just about any sort of a vehicle that can carry a lot of people.  Traveling by PMV is dangerous for multiple reasons... over crowding, lack of seat belts, high speed on a bad road, poor vehicle maintenance, rascals, etc.  (You can understand why we docs dread PMV accidents.)  But the average person in PNG has to depend on this system to get around from place to place.  It is the only transportation available for those who cannot afford a car.  The situation is similar in many countries around the world.

According to the WHO
  • More than 1 million people die as a result of traffic accidents every year.  This makes road crashes the #11 cause of death world wide.  Wow!  And most of these deaths occur in low or middle-income countries.  
  • 20 to 50 million are injured or disabled every year.  
  • Traffic accidents cost the world billions and billions of dollars every year.  I can think of many other things to spend those billions of dollars on.
  • Correct use of seat belts reduces the risk of death in a crash by 61%.  Seat belts are used much less frequently in low or middle-income countries.  
Don't worry Mom and Dad... I never leave the station without a seat belt!

(A few pictures may be added later.)

"I will turn all my mountains into roads, and my highways will be raised up."
~ Isaiah 49:11

Home assignment 2012... now scheduling!

Updated 11/5/11

Dear friends,

I will be coming to the U.S. for my first "home assignment" form January through April of 2012.  This is the time when I get to travel around and visit with friends, prayer partners, and churches who are supporting the work at Kudjip Hospital.

Time has flown quickly by and I will be leaving for the US is just about 6 weeks.  My calendar is mostly complete, but I can always find time to visit with friends.  Let me know if you want to get together:

I am really excited to share with you (in person) about all that God is doing in Papua New Guinea!

See you SOON!!!
~ steph

P.S.  I've attached my calendar of already confirmed speaking engagements--current as of November 5, 2011.

Saturday, 11 September 2010

Rock sliding

After such an intense week (see previous blog entries, and those aren't even all of the stories), it was time to have some serious fun...

On Saturday, the Dooley family led an excursion to one of their favorite spots.  The rock slide is about a 45 minute hike from Kudjip.  And when I say "rock slide," I don't mean an avalanche of pebbles or stones.  This is actually a giant slide that has been carved out of the mountain by a waterfall and it's associated stream/river.  The smooth route of the running water is also lined with a moss that makes it especially slick.  So if you don't mind getting a little slimy or a few holes in your britches, it makes for an awesome ride!

"I waited patiently for the Lord; he turned to me and heard my cry.
He lifted me out of the slimy pit, out of the mud and mire;
he set my feet on a rock and gave me a firm place to stand.
He put a new song in my mouth, a hymn of praise to our God.
Many will see and fear and put their trust in the Lord."
~ Psalm 40:1-3


Pigbel is a nasty sort of disease.  The illness is caused by ingestion of food that is contaminated with a bacteria called Clostridium perfringens.  The bacteria produce a toxin that causes enteritis necroticans, or necrosis of the small bowel.  

The literal translation of the Pidgin name is "stomach of a pig."  I imagine it is called that because kids get sick after eating a protein meal, often after a mumu with pig meat.  Children with chronic protein malnutrition are most susceptible.  People who live in the highlands of PNG eat mostly fruits and vegetables, with occasional protein from peanuts, eggs, or chicken.  So kids here are definitely at risk of protein malnutrition.  Sweet potatoes also increase the risk of pigbel because they contain a trypsin inhibitor.  This inhibitor blocks an enzyme and prevents the body from breaking down the toxin.

Symptoms of pigbel include abdominal pain, distention, bloody diarrhea, and emesis with black flecks.  Eventually the small bowel necrosis leads to perforation and death of the patient.  Antibiotics are first line therapy, but patients frequently need surgery to remove the dead bowel.  

Children with pigbel get really sick.  And diagnosis is a challenge because pigbel can masquerade as typhoid, gastroenteritis, or dysentery.  If you aren't on the lookout, you can easily miss a case.  I know, I have.

Last Friday I was on call with Francine, one of our visiting medical students.  Francine came to tell me about one of our kids on A-ward.  Israel was admitted the day before with diarrhea and there was concern he might have pigbel.  He was on multiple antibiotics, but had been getting worse throughout the day.  Around noon he became confused.  His abdomen started to swell and a couple of hours later he began vomiting.  The emesis contained black flecks.  This was definitely looking like pigbel and our patient was getting worse.  It was time to do surgery.

We called in Dr. Graham, the volunteer surgeon who is covering for Dr. Jim.  A hour later we said a word of prayer and started cutting.  At first the bowel looked completely normal.  We wondered if we had made the right diagnosis and decision.  As we followed the bowel toward the jejunum, we found what we were looking for.  Thankfully this is one case we didn't miss.  The inflammed and necrotic area was removed, the good bowel reapproximated, and the abdomen closed.  Israel did well during the surgery and is now recovering on the ward.

Wow... what a way to end this crazy week.

During the 1960's and 1970's, pigbel was the leading cause of death in children over age 1 who lived in the highlands of PNG.  A vaccine was introduced and the disease almost disappeared for several decades.  In 2005, PNG stopped paying and the manufacturer stopped making the vaccine.  And surprise, surprise... pigbel is back.  Not quite with the vengeance of 50 years ago (yet), but it is back.

Wednesday, 8 September 2010

"I am the good shepherd; I know my sheep and my sheep know me... and I lay down my life for the sheep." ~ John 10:14 / "He tends his flock like a shepherd: He gathers the lambs in his arms and carries them close to his heart..." ~ Isaiah 40:11

A man born blind

In our Wednesday evening ladies Bible study, we have been working our way through the Gospel of John.  The last couple of weeks we studied chapter 9.  The chapter tells the story of a man who was blind from birth.  The disciples questioned Jesus, "Who sinned, this man or his parents, that he was born blind?"  Jesus responds by saying that he wasn't blind because of anyone's sin, "but this happened so that the work of God might be displayed in his life."  As the story goes, Jesus spits in the dirt and puts the mud on the blind man's eyes.  The man goes to wash in the Pool of Siloam and is healed.  He came home seeing!  Because of this miracle, the man came to believe in Jesus as the promised Messiah.  And thus the work of God was displayed in his life.

I have a friend who is a man born blind.  I previously introduced you to Robert and Kauantz.  I met them when Robert was a student at the Bible college.  Robert was mostly blind from birth.  He did have some vision, enough to walk without assistance, recognized faces, and read very large print.

Over the weekend, Robert began to notice some changes in his sight.  There was a new pain in his left eye, the one he could actually kinda sorta see out of.  His vision became more cloudy than normal.  He came to see me in clinic on Tuesday, and on the way he lost what little vision he had left.  Robert was no longer able to walk without someone to guide him.

Last year Robert was able to travel to see an ophthalmologist, an eye specialist, at the Christian Blind Mission in Goroka.  I recently learned that there is no longer such a specialist in Goroka.  Thankfully the ophthalmologist in Mount Hagen, who has been out of the country for several months, returned to PNG and began seeing patients just this week.  I wrote a referral letter and sent Robert to see the Hagen eye doctor.  He made the trip this morning, but unfortunately was unable to locate the clinic and arrived after the doctor was finished for the day.  Robert is scheduled to return, but not until next week.

Today my heart is heavy.  I am worried about Robert and his eye sight.  Vision changes like this need prompt attention.  Maybe there is nothing to be done.  But if there was, waiting another week is not a good thing.  Robert may permanently lose what little vision he did have.

The man in John chapter 9 was born blind so that the work of God might be displayed in his life.  I am praying for a miracle for Robert... praying that God will work a miracle and restore his vision, praying that God will be glorified through his life.  Will you pray with me?

"Therefore we do not lose heart.  Though outwardly we are wasting away, yet inwardly we are being renewed day by day.  For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all.  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 4:16-18

You can read more about Robert and Kauantz by following these blog links:

Tuesday, 7 September 2010

Polygamy in PNG

Polygamy is a fact of PNG life.  While not acceptable in the Christian community, it is widely practiced in our area of the country.  The number of wives a man has is directly proportional to power and money.  If you are a "big man" or a wealthy, you are expected to have more than one wife.  More wives equals more women work the gardens and watch the pigs and bear children.

We often see the negative consequences of polygamy.  STIs or HIV shared between husband and wife and wife.  Wife number 1 chops wife number 2 because she is angry that her husband married someone else.  Or wife number 2 stabs husband.  You get the idea.

Dr. Erin had an interesting family situation in clinic the other day.  Here is her story...

"A young mom walks into my exam room carrying a small child in a baby bilum.  She is closely followed by a 30ish female and a 4 year old girl.  As we say hi, the medical student asks me if the woman holding the child, who doesn't look more than 15, is really the mom.  So we ask.  She tells us yes and doesn't seem shy about it so we take the opportunity to ask some more questions.  We learned quite a bit.  The mom really is only 15 and her baby is 6 months old.  She has been married a little over a year to a guy much older than her who has many wives.  Currently she is one of only 4 wives, but he had others who left him when he got new wives.  The 30ish female was not a wife, but the daughter of the 15 year old's husband.  With her was her 3 year old daughter.  So we had in front of us a mom and her small son.  The son being the half brother to the 30 year old lady, and an uncle to the 3 year old girl.  It was kind of crazy."  
I guess that would also make the 15 year old the step-mother to the 30 year old, and a step-grandmother to the 3 year old.  Do you follow that?

Erin continues, "This family isn't the only family like this in PNG.  Polygamy allows men to marry as many women as he wants or can afford, and the wives become younger and younger as he gets older.  Pray for women here, who often have no choice in who they are forced to marry.  Pray for their protection physically from the abuse that is too common in marriages.  Pray for parents to not sell their daughters to a man who is willing to pay a lot of money, but that they will allow their daughters to choose a man they love to marry.  Pray for Christians to take the lead in this and not give in to cultural pressures."

My first responses to reading this story were a combination of anger, disgust, and sorrow.  Wow, this is messed up.  But Erin has the better idea.  We need to pray... pray for transformation of lives, families, and culture in PNG.

"But since there is so much immorality, each man should have is own wife, and each woman her own husband."
~ 1 Corinthians 7:2


Working in a low-resource setting definitely teaches doctors to be better physicians.  Labs are basic.  There are no fancy tests.  X-ray may or may not be helpful.  There are no ultrasonogrophers or radiologists or super specialists.  A doctor must rely on observation, physical exam, and the power of his or her brain.

I have noticed some definite improvements in my observation and physical exam skills over the last year and a half.  For example, before doing a spinal tap you must first check the patients eyes.  The absence of papilledema, or swelling of the optic nerve, makes significantly increased intracranial pressure unlikely.  This is important because doing an LP in the presence of increased ICP could kill the patient.  Once upon a time, I had difficulty doing fundoscopic exam.  Now I can easily find the optic nerve!  Liver edges and spleen tips are palpable.  Heart murmurs and lung sounds are more clear.  I still have a lot to learn (that is the power of the brain part of the equation), but I am on my way!

There are certain illnesses that you can diagnoses even from across the room, if you just pay attention.  Patients with COPD are easy to pick out of the line.  They are usually older, quite thin, breathing rapidly with the use of accessory muscles.  Someone with swelling of the abdomen and legs probably has chronic liver disease.  Paining body parts are usually tied with some sort of cloth.  Patients with head ache turn a scarf around their head like a turban.  Knees and other extremities are wrapped in a bandage.

Abraham is 15 years old.  He comes from the Jimi Valley, a remote part of PNG with very little health care.  He has been sick for about 8 months.  He and his father recently traveled to Madang, but left the hospital without understanding what was wrong.  Abraham's father had heard about a Christian hospital at Kudjip, so they traveled many more hours by PMV to come see us.

When Abraham walked into my clinic room, I had a sinking feeling about his diagnosis.  His eyes were slightly jaundice and he had a very large epigastric swelling.  I hoped that there was another reason for the swelling of his stomach.  Maybe tuberculosis or heart failure?  Yep, pretty sad when you are hoping for TB or heart failure.  But these diseases could be cured or at least treated with medications.  Abraham laid on the exam table and I palpated a hard, irregular mass growing in place of his liver.  Ultrasound confirmed my feared diagnosis... hepatoma, or liver cancer.

There are very few cancers that we can treat here, and liver cancer is not one of them.  There isn't a medicine, chemotherapy drug, or surgery that will help Abraham.  He probably won't live for very long.  No, we can't help his illness.  But there is something that the Christian hospital at Kudjip, such a long way from Jimi or Madang, can offer... the good news of the Gospel and hope for eternal life.  Abraham's family goes to church, but he was not a Christian.  We were able to pray together at the end of the visit.  Now I have a new brother in the family of God!  And Abraham will soon have a new pain-free, cancer-free body.

In Mark chapter 8, Jesus is talking to the disciples about the cost of following him.  He says, "What good is it for a man to gain the whole world, yet forfeit his soul?"  Or what good is it if we spend our time and resources and lives to bring health to patients if we don't take the opportunity to share about Jesus?  That is why we do what we do.

We see an unfortunate number of patients with liver cancer.  With a national prevalence rate of 20%, hepatitis B is the likely culprit.  The virus causes some bad problems such as chronic hepatitis, cirrhosis, and liver cancer.  Abraham is the youngest patient I have seen with hepatoma.  Dr. Erin once diagnosed an 8 year old with the same disease.  Thankfully the hepatitis B vaccine is available and is being given to children.  Hopefully with time this vaccine will help to decrease the incidence of hepatitis B and its complications.

Saturday, 4 September 2010

Home assignment 2012

Start:     Jan 1, '12
End:     Apr 30, '12
Location:     USA :)
I will be home in the US from January through April 2012. So far I am planning to spend time in Ohio (of course), surrounding states, Texas, and only the Lord knows where else. I am currently working on my speaking schedule and tour itinerary. For more info, follow this link:

Friday, 3 September 2010

Thursday, 2 September 2010

Pet therapy

Benny is one of my special patients.  He is 21 years old, only looks about 12.  Benny is sick with a condition called nephrotic syndrome.  His child-like face is a side effect of steroids that were used to treat his disease.  The illness has damaged his kidneys to the point that they no longer work; his creatinine is unmeasurable by our lab (something greater than 10).  He has been admitted to the hospital several times for complications such as anemia and heart failure.  And his admissions have become more frequent over the last couple of months. Really, it is amazing that he is still alive.

Dialysis would be the first line treatment for Benny's disease, IF he lived in Australia or America or another such country.  Dialysis is a mechanical kidney, a machine that cleans the blood of patients with renal failure.  Patients on dialysis must be hooked up to a machine 3 times a week, every week for the rest of their lives.  I'm not sure if dialysis is available anywhere in PNG, but certainly not in the highlands.  A kidney transplant would cure his problem, but of course that is no more possible than dialysis.  There isn't much we can do for him, so Benny will continue to get sicker and sicker until he goes home to heaven.

On Monday I opened the door from my clinic room and saw Benny waiting in the hallway.  He was so weak he could barely walk.  I quickly helped him into my room and took the history.  He was having increasing symptoms of heart failure, feeling more chest pain and shortness of breath.  I listened to his heart and heard a pericardial rub, a sign of pericarditis or inflammation around the heart... most likely a complication of his renal failure.  

Benny was looking pretty bad and I wondered if this would be his last hospital admission.  For the past few days Dr. Becky has been taking care of him on medical ward.  Thankfully he has perked up a bit with some adjustments in his medications!

A few months ago, Benny asked me if there was some sort of medicine that you could give a dog to help it learn to do tricks.  He wanted a dog, and the miracle medicine to go with it.  I laughed and told him that it just takes a lot of hard work.  That gave me an idea... pet therapy :).  So this afternoon four of my nieces (the Dooley and Kerr girls) and I took Brutus for a walk to visit Benny.  Brutus loved meeting this new friend and gave him lots of slobbery kisses.  And the visit was definitely therapeutic for our patient.  He couldn't stop smiling!

You know what they say about laughter and medicine.  Did you also know that it comes from the Bible?  After all, the writer of Proverbs was a very, very wise man.
"A cheerful heart is good medicine."
~ Proverbs 17:22