Saturday, 30 June 2012

Friday, 29 June 2012

Hewa: the addendum

Well, that pretty much sums it up for Hewa.  OK, not really.  I could write a book about our adventure.  But 5 chapters is enough... until the next time!

Will there be a next time?  We sure hope so.  Matthew and Becky would like to return to both Fiyowana and Yififiki to continue training in community based health care.  Right now that would mean a two day hike from the airstrip to Yififiki, or they could wait for a couple of years until the new one is completed.  If God wills, He will make a way.

I want to share a couple of other links with you.  Dr. Allan has also posted some blogs about the trip.  I know you will enjoy reading from his perspective.  Be sure to read the one about Tiger the missionary cat and our foot washing, since I didn't have time to write about those stories.

BTW, for those of your who are interested... the Hewa tribe was the filming site for the last episode of Survivorman.  I haven't see it but I am told that Survivorman didn't actually "survive", that he abandoned his adventure a few days early.  Too bad he didn't have the Kopfs and the people of Yififiki to take care of him.  He certainly would have more than survived.

So I'll close this addendum with a photo the last day in Hewa.  What a great group!

P.S.  Can you find Waldo?  I think he is in there somewhere.

Wednesday, 27 June 2012

Hewa (part 5): beautiful feet

"How, then, can they call on the one they have not believed in?  And how can they believe in the one of whom they have not heard?  And how can they hear without someone preaching to them?  And how can they preach unless they are sent?  As it is written, 'How beautiful are the feet of those who bring good news!'"
~ Romans 10:14-15

Beautiful feet come in all shapes and colors and sizes: bush man; pedicured; wearing boots that have traveled the world, sandals that were given by a new friend, or forever barefoot; American; calloused and dirt covered; missionary; on crutches or bandaged up; Papua New Guinean.

The Kopfs are missionaries with New Tribes Mission.  They first moved to Fiyowana (where we were stranded overnight) in 2000.  After learning the language and culture of the Hewa, their team began to share Bible stores and eventually the gospel with the people of that village.  The missionaries were all evacuated in 2006 due to escalating tribal violence.  After a couple of years in the bush States, the Kopfs returned to PNG and relocated to Yififiki.  Several believers from Fiyowana and another village named Kudufundu also moved to this new place.  Jonathan has continued to work on translating the Bible into the Hewa language.  Both he and Susan are discipling local believers and teaching them how to read and write.  Susan, who is also a nurse, runs a small medical clinic and is training several men to be health workers.  Their love for the Hewa people is contagious!  And their feet are oh, so beautiful.

Many in Yififiki have accepted the good news about Jesus Christ.  Not only have they accepted, but they are passionate about sharing the truth with others who have not heard.  During the week of VBA training, the local believers opened their homes to house and feed visitors from other villages.  Every night they shared with their guests from the scriptures that Jonathan had translated.  On Sunday, they led a wonderful time of praise and worship and study.  Just beautiful.

Allan and Teresa Sawyer are... well... A-mazing.  Allan is an OB/Gyn doctor.  They own a private practice in Phoenix, Arizona.  Every other year for the last I don't know how many years, they shut down the practice for a month and bring the entire family to PNG.  The Sawyers are always an incredible blessing to those of us at Kudjip-- their service, hospitality, generosity, encouragement, love, and so much more.  And that blessing has been extended to the Hewa people!  BTW, the Sawyers have also helped to send thousands of gifts to children around the world through Operation Christmas Child.  How beautiful is that?

Arthur, Matthew, Mike, Fainbat, Joel, Susie, Emius, David, Jonathan, Becky, the other David, MAF, Michael...

These and more, there were so many beautiful feet in Hewa.
What a joy it was to walk among them.

Sunday, 24 June 2012

Bikpela liklik

I am taking a short break from writing about Hewa (there are a couple more blogs to post) to share one sweet story with you...

The nursery is probably my favorite place in the whole hospital.  As you probably know, I love taking care of mamas and their babies.  The premies stay for two and sometimes three months.  I become rather attached to them and their mothers during that time.  Once the babies are big enough and healthy and growing, they can go home.  Unfortunately I rarely ever see them again.  I often wonder how my little ones do once they leave the hospital.

This past Saturday I was on call and stopped by A-ward.  There was a familiar face in the corner bed.  Hellen was one of my nursery mothers from last year.  Her baby Samantha was just 1400 grams when she was born in September.  Samantha lived in the nursery for the first three months of her life.  She is now 9 months old, and so grown up from the last time I saw her.  She was admitted for pneumonia, but had recovered and was well enough to discharge.

What a joy to see Samantha, who is now "bikpela liklik."  That is a Pidgin phrase that means "a little big."  Such a beautiful baby!

"But grow in the grace and knowledge of our Lord and Savior Jesus Christ.  To him be glory both now and forever!  Amen."
~ 1 Peter 3:18

Friday, 22 June 2012

Hewa (part 4): the doctor and the "dentist"

As I mentioned in my previous blog, the Hewa tribe is a very medically underserved community.  A missionary nurse is the only trained healthcare provider in Yififiki.  The nearest aid post is a 2 day walk, and the nearest hospital a few more than that.  Since our team consisted of three doctors, a nurse, and a community health worker, we couldn't very well visit the Hewa and without holding some sort of medical clinic.

Every afternoon when we finished up with the VBA training, Susan and I would go around the corner to the two-room medical clinic that was on the back side of the school.  Well, one room was the clinic and the other served as a pharmacy/store room.  Susan already knew many of the patients who came to see me, so she was able to provide a little history for their illness.  I would ask some additional questions in Pidgin and she translated to and from the Hewa language.  My doctor bag contained a stethoscope, blood pressure cuff, pulseoximeter, an otoscope and ophthalmoscope.  But my most important tools were my ears, hands, and heart!!!  

I saw quite a few kiddos with fevers (probably malaria), colds, and very bad ear infections.  Untreated otitis is a common cause of deafness among children in the bush.  There was a girl with asthma, a woman with pneumonia, and an old papa with COPD.  Tobacco and smoke from cook fires contribute to the high number of respiratory illnesses.  Musculoskeletal and abdominal pain were also common complaints.  And two pregnant women came just for a check-up with the OB doctor!

The most impressive patient that I took care of was a man who had a bad infection in his face.  It had probably started as a simple tooth infection.  But without access to a dentist or a doctor or medicines, it turned into an abscess that infected the bone and ate a hole into the side of his cheek.  We started him on two of the strongest antibiotics that we had available.  He was already improving by the time we left a couple of days later!

There were only a few medicines in the pharmacy:  amoxicillin, bactrim, CMP, antibiotic eye ointment, tylenol, iron, albendazole, and antimalarials.  Yep, that is just about it.  Some of meds were supplied by an NGO and a few more were purchased by the Kopfs.  We added prednisone, cipro, misoprostol, and ibuprofen to the selection.  There was a chalk board on the wall where Susan keeps track of her patients and what exactly they are taking.  The Hewa people are not accustomed to medicine and often fail to take as directed.  This is a big problem, especially when there is an infection that needs antibiotics.  Susan has them come to clinic every day to pick up their supply for that day.  That way she can make sure that they complete their treatment.

The biggest medical need in Hewa is actually dental--cavities, broken or rotting teeth, infections.  When plans were being made for the trip, Jonathan asked if we might be able to bring along a dentist.  Well how about an OB/Gyn who knows how to pull teeth?  Allan had learned this very important skill from an oral surgeon in Phoenix.  He and his lovely assistant Teresa set up a dental clinic in the bottom of the Kopfs' house.  Check out that dental chair!  They pulled more than 30 teeth, and even had some repeat customers.  This little guy Jius was one of them.  What an amazing ministry!

"Is there no balm in Gilead?
Is there no physician there?
Why then is there no healing
for the wound of my people?"
~ Jeremiah 8:22

Wednesday, 20 June 2012

Hewa (part 3): emergency intervention

The major driving force behind this big bush adventure was the health of the Hewa people--specifically related to maternal and neonatal mortality.  Lots of women die in childbirth and even more babies die in the first few months of life.  I'm not sure exactly how many women, but we heard too many tragic stories during our time in Yififiki.  The Kopfs estimated that about 85% of babies don't make it past 3 months of age.

There are two main reasons for these horrible statistics.  First of all, there is almost no health care in this far off place.  Susan is a nurse.  She runs a small clinic, supplied with medicines that she mostly purchases herself.  Back in Fiyowana there is a government aid post.  But that is a 2 day walk from Yififiki and they don't do deliveries there anyways.  The nearest hospital is a 3 day hike through enemy territory, so you are just as likely to be killed on your way to the hospital as to die from your illness.  There is a safer route to another hospital, but you have to walk 7 days to get to that one.  Can you imagine making that trek if you were sick or pregnant?

The cultural practices of the Hewa people also contribute to the high mortality.  
Click here to read about how babies are born in this tribe.  It is unbelievable.

Community Based Health Care was invited to come in and do a training for village birth attendants (VBA).  The CBHC program usually begins with community organization, leadership training, and then basic preventive and health education--everything from washing hands to clean water supply to using pit toilets.  The VBA part comes much later in the process.  It is a program for specifically for the few women who are selected by their community to help deliver babies.  But the desperate situation called for an emergency intervention.  We only had 5 days to teach everything we possibly could.  We just skipped the preliminary stuff all together.  And we decided to involve as many people as possible, even the men who up until then had no idea how babies were born.

As the head of CBHC, Becky was our fearless leader.  Matthew started and reviewed the class each day.  He had worked as a nurse at a rural health center in the Sepik, so he had many stories to illustrate what we were teaching.  Joel Funfun is a community health worker at Singape health center in Middle Ramu, a bush place very similar to Hewa.  He was the only one who had actually taught the VBA course before.  He did such a great job helping us through the curriculum.  Allan talked about the complications of pregnancy.  The men were especially amazed that he had delivered more than 9,000 babies without getting sick.  I had so much fun helping our students practice what they had learned!

We condensed the VBA course into five one-day parts:  reproduction, normal pregnancy, normal delivery, complications, and newborn care.  We did our best to encourage things that the Hewa were already doing well, and emphasize some different practices that would hopefully save lives.  Some of the new things that we taught included drying and stimulating the baby, tying and cutting the cord with a clean razor, active delivery of the placenta, and breast feeding/uterine massage to help control bleeding.  All of this, of course, was taught in Pidgin and translated to the local language.

There were probably about 50 people from 5 villages who came to the VBA training.  That doesn't include children, dogs, and our most faithful attender--a baby cassowary.  They were amazingly receptive.  Over and over again we heard comments like "Oh, we never knew this before.  Now we know! Thank you for teaching us."  The most surprising thing to me was how many men participated.  They really, really want to help their wives and children.  It was absolutely incredible.

We threw a lot of information at our students in those few days.  I don't know how much they will remember.  I'm not sure how it will change what they do.  I pray that the Holy Spirit will bring something to someone's mind that will save a mother's life. I pray that the Hewa will have the strength and courage to reject the cultural practices that are killing their babies.  And most importantly I pray that they will hear the good news, believe, and receive eternal life through Christ our Lord.

"Praise be to the God and Father of our Lord Jesus Christ!  In his great mercy he has given us new birth into a living hope through the resurrection of Jesus Christ from the dead."
~ 1 Peter 1:3

Monday, 18 June 2012

Hewa (part 2): big bush hospitality

I was a bit stiff when I woke up on Friday, June 8, but the promise of a sunny day made it easy to roll out of bed.  We started to pack things up in faith that the helicopter would be able to fly in.  And we were not disappointed.  It wasn't long before we heard the beating of the rotor blades against the morning air.  A few minutes later, the helicopter landed on the nearby basketball court.  Jonathan Kopf jumped out and ran up to the house to make sure we had survived the night.  What a warm smile!

The guys in charge decided that the women should be on the first shuttle out, just in case the weather turned bad again and prevented further evacuation.  Teresa, Becky, Susie, and I, along with Joel and Matthew climbed into the chopper.  Seat belts fastened, door secured.  A few minutes later we were taking off and up over the mountains.  The 10 minute ride was absolutely breathtaking as skimmed over trees and through the fog that was lifting out of the valleys.  Let's just say that helicopter is THE way to see PNG!


It wasn't long until we once again began to see signs of life on the earth below.  There were a few areas where the rainforest had been cleared and bush houses had been built.  Another stripe of green earth marked the early stages of a new airstrip.  As we touched down and de-boarded, Susan and McKenna Kopf and dozens of Hewa villagers were there to welcome us to Yififiki.  We were greeted with handshakes and even a few hugs.

Susan led us up the muddy jungle path from the airstrip to their family home.  The two-story dwelling was simple, yet quite nice.  In some ways it reminded me of Swiss Family Robinson, with a few modern perks.  The second floor had two bedrooms, a bathroom, and a kitchen/living area.  This is where the Sawyers and we gals slept.  A solar power system provided enough electricity for lights and warm water.  There was a radio for communication with the outside world.  Apparently email worked through the radio as well.  There was a freezer (but no fridge) to keep food cold and a stove (with a non-functioning oven).  The men stayed on the lower level which had a room with bunk beds, a shower, and workshop and storage areas.

We settled in while we waited for the rest of the shuttles to arrive.  The warm shower was quite a treat after a night on the hard floor.  Susan heated up waffles for breakfast.  Her fellow New Tribes missionaries form around PNG had sent in food to help feed our group for the week... sweet and sour chicken, BBQ pork, spaghetti, home made granola and cookies and pita bread.  We were so well fed.  In fact, I don't eat that well at home.  The Kopf's certainly have have the gift of hospitality!  The whole experience was rather different than the more primitive conditions that I was expecting.  On my first CBHC trip to Vanuatu, we stayed in a bush house, used a pit toilet, "showered" from a bucket, and ate local cuisine.

One of the great things of this trip--and there were many--was getting to know this wonderful family.  Jonathan and Susan have such sweet spirits, and a deep love for the Hewa people.  That was so evident as we listened to the stories of their 10+ years in the bush.  (And I mean big bush.  This was the most remote of any place that Becky has traveled to, and she has been to a lot of remote places with CBHC.)  I'll share more about the Kopfs and their ministry in a later blog.

Did I mention that the have an absolutely adorable almost four year old daughter?  McKenna was especially excited to reunite with her cousin Susie.

Stay tuned for soon to be coming part 3--village birth attendant training!

"Above all, love each other deeply... Offer hospitality to one another... Each one should use whatever gift he has received to serve others, faithfully administering God's grace in its various forms."
~ 1 Peter 4:8-10

Friday, 15 June 2012

The Big Bush--Hewa 2012

Here are some shots of our trip to Hewa. The pictures just don't do it justice!!! Except the ones taken by Dr. Allan. I have included a couple of his, too.

(Caution for the faint of heart: this photo album contains some images of indigenous nudity and butchered pigs.)

Hewa (part 1): breaking and entering

It was still dark and a steady drizzle was falling early on Thursday morning.  Members of the Hewa team and all of their cargo piled into two land cruisers for the drive into the airport.  There were 11 of us traveling that day.  You have already met Allan and Teresa Sawyer, my roommate Becky, Matthew Galman, and me (of course).  We were also joined by Susie, 16 year old niece of missionaries Jonathan and Susan Kopf.  She would be spending the summer with them in Hewa.  Arthur and David are two photographers/videographers with Samaritan's Purse (SP).  They were tagging along to document the trip and will someday be producing a video.  (I have seen the previews, and I think it is going to be a blockbuster.)  Jonathan is another videographer who was going to do some work for the Kopfs.  We stopped by the Bible College to pick up Joel Funfun, a community health worker and village birth attendant trainer from the Middle Ramu, another bush place in PNG.  Joel was the only one in our group who had actually taught the VBA class, and it was totally a God thing that he was able to join us last minute.

Our 11th passenger was a very special one--Tiger, missionary cat to the Hewa.  She deserves a blog all of her own, so I will save that for another time.

We arrived at Mission Aviation Fellowship (MAF) just before 7A, unloaded and weighed in with all of our stuff.  The weather delayed our departure, but it wasn't long before we were piling into the twin otter plane.  The pilots had to rearrange us a bit to make sure the aircraft was properly balanced--one passenger move forward three seats, and another move across the aisle.  We were briefed on safety and emergency procedures, including where to find supplies that would help us survive in case of a crash.  [Gulp.]  A few minutes later we taxied onto the runway and lifted off.  The plane climbed into the sky.  The pilots put on oxygen masks when we reached our cruising altitude.  That was a bit disconcerting.  But I figured if anyone needed to well oxygenated, it was the pilots and not we passengers.

Our flight path took us west to Enga Province.  The mountains are so incredibly beautiful.  I only wish that a camera could show you how much so.  I guess you will just have to visit someday and see for yourself.  As we neared our destination, the plane began to circle into a valley and the Hewa airstrip became visible--a bright green stripe of grass cutting through the dense rain forest.  There were a few houses scattered along the strip, and people began running when they heard our approach.  The pilots did an amazing job bringing us down oh so smoothly, despite the poor condition of the runway.  The plane slowed to a stop.  We unloaded ourselves and all of the cargo onto the airstrip.

A helicopter was going to be along shortly, and would transport us across two more mountains and another deep valley.  The 10 minute ride would take at least two days if we had to hike the same distance.  The MAF crew had a schedule to keep, so they could not wait for long.  Allan assured them that we would be OK and they took off for their next run.

It turns out that this particular village, called Fiyawana, was the Kopfs first Hewa residence.  They lived there from about 2000 until 2006.  We later learned that they had to leave Fiyawana because of escalating violence and tribal warfare.  Soooo glad that I didn't know that before we were stranded there.  Yep... stranded.  The rain continued throughout the afternoon and the clouds never cleared.  The helicopter was unable to fly in that day.  We moved all of our things to the Kopfs old house and camped out in the cellar-like basement for a few hours since the main part of the house was locked.

When it became apparent that we would be spending the night, we decided that the basement just wouldn't do for a place to sleep.  Matthew and Yoke, one of the locals who had taken upon himself to watch after the house, pulled off the door frame and broke in to the house.  We hauled everything upstairs and were pleasantly surprised to find that the place was still in relatively decent condition.  Thankfully Allan had packed a water filter, so we were able to refill our bottles.  We pooled together our various travel snacks for a rather dinner--Pringles and beef jerky and mandarin oranges and cranberries and nuts.  Someone found a 6 year old can of Coke in the cupboard that was still fizzy.  There were two couches with cushions that became our mattresses for the night.  The SP guys had brought a tarp that we spread out on the floor and a couple of blankets that we shared among us.  The toilet even flushed!  Not bad for being stranded in a hostile village in the bush.  What an adventure.

Don't worry, Mom and Dad.  We were completely safe.  After all, we were in the Lord's hand!  We believe that even our delay was part of His plan for the trip.  Matthew connected well with the people in Fiyawana.  We were able to build on that over the following week, as quite a few of them (including Yoke and his wife) traveled with us to the training.  Matthew has such a burden for these people.  He hopes to return there someday to train them in community based health care.

More adventures coming soon...

"Save us and help us with your right hand,
that those you love [the Hewa] may be delivered."
~ Psalm 60:5

Weight in gold

In PNG, there is a national formulary of medicines and other equipment/supplies that the government supplies to hospital and health centers and aid posts throughout the country.  Well, in theory.  The government supplier is frequently out of this or that.  Or more likely--a lot of things.  Sometimes we do without.  Sometimes we find other sources either in PNG or from around the world and buy what we need.  We also receive a container of medicines and supplies from Nazarene Hospital Foundation about twice a year.  In fact, one arrived last week (right)--the very same day that we ran out of every government supplied pain medication.  The acetaminophen and ibuprofen that were on the container were just in time!  Thank the Lord for His provision through this awesome ministry.

Antibiotics are probably the most critical of the medications that we occasionally run out of.  These medicines kill bacteria and stop life-threatening infections including pneumonia, meningitis, and sepsis.  Sometimes we have to use a 2nd or 3rd or 10th line antibiotic because there just isn't a better choice.  Bush medicine can certainly be an interesting sort of a challenge!

One commonly used high-powered antibiotic is called chloramphenicol (CMP).  This antibiotic is cheap, usually available in places like PNG, and it fights most kinds of infections.  CMP is the treatment of choice for pigbel, a sickness that has killed maybe a dozen kiddos at our hospital in the last year.  Dr. Jim currently has five children who are admitted with this diagnosis.  One of them died today.  But we are running out of CMP.  Thankfully I was able to locate a few vials at one of the pharmacies in town--enough to last us through the weekend.  A few more are on their way from another pharmacy and will arrive next week.  These vials are worth their weight in gold as they have the potential to save our precious patients.  I pray that they will.  And hopefully we can continue to purchase CMP until the government supplier is re-stocked.

[Just in case my medical readers are curious about what meds we are running out of, here is a partial list:  ferrous sulfate (out for months), calcium; acetaminophen, ibuprofen, indocin, morphine; aminophilline (cousin of theophylline, used to treat COPD/asthma); metoclopramide IV (our only IV antiemetic); CMP IV, flucloxicillin PO and IV, metronidazole IV, augmentin, and bactrim.

The good news is that we have lots of IV fluids--this week!!!

Suppose you are wondering which antibiotics we DO have?  The government provides ceftriaxone IV, penicillin IV, gentamycin IV, amoxicillin, doxycycline, azithromycin, erythromycin, tinidazole.  Our donated or purchased stock includes cefuroxime IV, cefdinir, cephalexin, clarithromycin, and clindamycin.  We sometimes have cipro as well.  That's what we have to work with!]

"Then Peter said, 'Silver or gold I do not have, but what I have I give you.  In the name of Jesus Christ of Nazareth, walk.'"
~ Acts 3:6

Tuesday, 5 June 2012

Heading out to Hewa

This is just a quick reminder to ask you to pray for the Hewa tribe (follow this link for the story) and our trip this week.

In just a few hours, we will on our way to the Hewa village.  Our trip begins at the break of dawn.  Ten travelers will be loaded into a couple of land cruisers for the drive to the Hagen airport.  We are flying with MAF to the Hewa airstrip in Enga Province.  The last leg of the journey will be by helicopter--about a 10 minute flight to our final destination.  My first ride in a helicopter!

Here is a picture of the Kudjip delgation:  Allan and Teresa Sawyer are on the left.  Allan is a volunteer OB/Gyn doctor and the organizer of the trip.  I'm in the middle.  My roomie Becky is the one in the yellow shirt.  She is the head of the Community Based Health Care program.  Matthew, on the right, is a nurse and CBHC trainer.  What a super team.

This is the most recent prayer request from Jonathan Kopf, the New Tribes missionary that we will be partnering with.
"One request is that this time will be the first time that this little group of believers will host an event like this, and they have a desire to shine Jesus to everyone who comes... Pray that the Holy Spirit gives boldness to the believers so they can speak out for righteousness and peace... Pray the people that will gather will be struck by the presence of the Lord in this place and will have a hunger to turn to the Lord of forgiveness and a relationship with him.  Your team's presence is not only going to provide much needed medical help, but it will also provide a platform on which these few believers can have an impact in the lives of the other Hewa people who come."

Thank you for your prayers!!!


I had several AWESOME follow-up visits in clinic this past week.  These patients were such and encouragement to me that I wanted to share their stories with you!

The first f/u may be familiar to those of you who read my blog or heard me speak while I was on home assignment.  Do you remember Joseph?  He was the guy who almost died before we drained off more than a liter of fluid from his pericardium.  Our working diagnosis at the time of his admission was tuberculosis.  Joseph was started on TB meds and did VERY well.  In fact, he just finished his treatment this week...  it was such a blessing to see him looking so good!!!

Some of you may also remember the story of Brenda.  She is the little girl with congenital hypothyroidism.  Here is an update from Dr. Erin:
"Brenda, who is so cute, lovable and brings joy to my life, came back to see me today.  It has been almost a year since she has started on her treatment for congenital hypothyroidism.  Is she totally better?  No, she isn't talking much, only really saying Mama and calling her sister a name.  However, she is walking better, doing a few chores around the house, understanding more and more, and taking care of herself more on her own now.  She is growing and hasn't lost her smile or her love.  Always a joy to see her and to get a hug from her which erases all the day's frustrations away.  Today her and her mom and sister gave me this bilum to say thanks.  I wanted to say thanks to them for allowing me to share in the joy of knowing and being loved by Brenda, what a gift is has been."

And the last patient may be new to you, but she is well known to me.  I began taking care of Rebecca more than a year ago.  She was diagnosed with an early stage of cervical cancer.  At the time of surgery, the surgeon found that she had some enlarged lymph nodes which were suspicious for metastatic cancer.  She was referred to me, and I referred her for radiation therapy.  One year later, she is cancer free.  What a joy to visit and pray with one of my survivors!  To God be the glory.

"May the God who gives endurance and encouragement give you a spirit of unity among yourselves as you follow Christ Jesus, so that with one heart and mouth you may glorify the God and Father of our Lord Jesus Christ."
~ Romans 15:5-6