Happy birthday friend

Dear Cam,

Today is your b-day.  It has been your birthday in PNG for about 18 hours now, but your birthday in Indiana for just two hours.  And you are probably sleeping now because it is the middle of the night.  Funny to think about wishing you a happy day from the other side of the world.  If you were here, I would sing you the infinite verse (well, really 5 verse or so I think) Kudjip birthday song!  If I were there, I would give you a call to say hello.  I am planning to send you a card in the mail, but you won't receive it for another month or so.  Sorry in advance for being so belated.  I need to plan ahead for these things.

You have been in my thoughts lately.  I remember the last trip I made through Indiana.  I so enjoyed my visit with you and Bryan and the kids.  You pulled out one of your favorite books, "Basic Country Skills: A Practical Guide to Self-Reliance," and gave it to me as a gift.  Quite a big book, but I was bound and determined to carry it in my suitcase to PNG.

And it has already been proven to be useful.  You see, I have a lovely blackberry patch out back that is producing loads of blackberries.  I have never had a blackberry patch before.  I had no idea how to nurture one (PNG does do a pretty good job without me) or preserve blackberries for times when there are none (though I may discover that growing season is year round and there is no reason to store up).  I pulled out "Basic Country Skills" and what do you know... it has a chapter all about blackberries!  There are many others that will prove useful as well:  home improvement, composting, gardening, preserving fruits and veggies.  Who knows, but someday I might even use the information on how to pluck a chicken.  I think I'll skip the section on how to butcher a pig.  I'll leave that the to Papua New Guineans, as they already have plenty of experience there.  Too bad there isn't a chapter on what to do with three trees worth of lemons!

So today I celebrate you from the other side of the world.  I celebrate your special day.  I celebrate our friendship.

hugs from PNG,

~ steph

 ____________________________________________________________________

Camela (Hill) Schmitz is a long time friend.  One of those friends that you always pick up just where you left of.  She grew up on a dairy farm in Eastern Ohio.  We both attended MVNU and were students together in the Biology department.  While my career path took me toward doctoring people, Cam followed her life-long dream of becoming a veterinarian.  We roomed together during our first two years of medical/vet school... we studied together, laughed together, watched scary movies together, and raised Dog the cat together.  Looking back, our years in Columbus were some of the best of the best years of my life.  Cam married her vet-school sweetheart.  She and her husband Bryan now live in Economy, Indiana where they have a small farm and own their own practice.  And of course, they have two very adorable kiddos, Avery and Isaac.  Love ya, Cam!

College of Nursing Graduation

Start:

Feb 28, '09

Weeding pineapples under the shade of a banana tree

That sounds like a good title for my first book!  JK :).

Every full time doc at Kudjip Hospital has one free afternoon per week.  So nice, because it helps to make up for the nights we are up on call.  My afternoon off is Thursday for now.  I began the morning seeing patients on Medical or "C-ward," where I am assigned to this week.  After finishing rounds, I headed home for some R&R.  Well, an afternoon off anyways.

I chose to spend my day working in the monstrous garden that Becky and I inherited with our house.  Having a garden is very practical here in PNG.  The missionaries only go to town and market once a month, so a garden makes it possible to have fresh fruits and veggies throughout the rest of the month.  It is so productive thanks to warm sunshine and a daily shower.  And I have also discovered that pulling weeds can be quite therapeutic.

I changed into my get dirty clothes and mud shoes, slathered up with sun screen, and added a layer of bug repellent.  My first two hours were occupied by weeding a row of pineapple... bushes?  I guess that is what I would call them.  We have about 5 rows of these things.  Before coming to PNG I thought that pineapples grow on trees.  Nope, they grow from the ground.  The first crop produces only one fruit, but in subsequent years each bush will produce several at a time.  I learned today that the leaves of pineapple bushes are quite sharp.  Note to self #1:  wear a long sleeve shirt next time.

Next stop of my gardening rampage was the blackberry patch.  From what I understand, these are not native to PNG.  One of the former missionaries planted a few seeds, and the plants have grown up beautifully.  We have berries in all stages of development, from flowers to green buds to red to black ripe fruit.   I picked about a quart of berries today, and that was after I picked every patch clean yesterday!  They seem to ripen before your eyes.  I am going to start freezing them with plans to make a pie one of these days.  Yummm.

I finished up my afternoon by collecting lemons from our three lemon trees out front.  We have more lemons than I know what to do with!  Lemonade, lemon bars, lemon chicken, lemon this, and lemon that.  Let me know if you have any good recipes.  Note to self #2:  squeeze lemons BEFORE getting sliced up while working in the garden.  Ouch.

"The Lord will guide you always...

you will be like a well-watered garden,

like a spring whose waters never fail."

~ Isaiah 58:11

Physician's prayer

Dr. Dana shared this prayer with me during my sending service at Lower Lights Church of the Nazarene.  And this is my prayer as I continue on this incredible journey...

Lord, You are the Great Physician.  I come before you today.  Every good and perfect gift comes from You.  I pray that you will give skill to my hand, clear vision to my mind, and kindness and sympathy to my heart.  Give me a singleness of purpose, strength to lift the burden of our suffering fellow man, and a true realization of the privilege that is mine. Take from me heart all guile and wordliness that with the simple faith of a child she may rely totally on You.  Amen.

The basics

When leaving the marvels of modern medicine to work at a hospital in a developing country, there are certain things you know that you will be giving up.  I only dream about ordering many of the fancy tests that are easily available back in the States.  Pathology results come back in 3-6 months, or not at all.  The nearest CT scanner is in the capital city, a place that patients can only reach by plane IF they can afford it.  Forget about MRI. 

Despite the lack of high tech gadgets, Kudjip Hospital does pretty well.  We have an x-ray machine and a nice portable ultrasound.  EKG is available.  I can order some basic blood tests such as CBC, chemistries and liver panel, ESR, HIV and Hep B, VDRL, urinalysis, etc.  And for what we don't have, I know will become a better doctor.  I am learning depend on my brain, my ears, and my hands to give me the information I may defer to a machine back in the US.

This week, however, has been interesting as we have dealt with challenges of the most basic nature:  electricity, water, and communication.  It started with the electricity.  Something somewhere that I don’t completely understand needs to be replaced, so power at the hospital has been sporadic.  Power begats both water pumps and phone.  So if electricity is out, so is the water and communication.

Let’s walk through a typical day under such circumstances.  I begin with B-ward rounds.  There is generally a laboring patient or two that needs to be evaluated.  Oh great... no water to wash my hands.  Thank goodness for hand sanitizer.  Step into the nursery where we currently have two tiny babies (about 2.5 pounds each) who need to be kept warm.  Hmmm... the current is not working in the nursery so the warmers don’t warm.  The babies are being kept warm by hot water bottles that are placed in their bed.  Where are the nurses getting the water and how are they heating it?  Move onto B-ward where there is very little light shining in through the windows.  My head lamp illuminates any post c-section incisions that need to be checked.  On to the out patient department.  Fortunately enough light spills into the exam rooms that I can see my patients.  Again, the head lamp proves to be an extremely valuable tool.  (Thanks, Narn!)  Without water to wash my hands, my little bottle of hand sanitizer is being put to good use.  I order an x-ray, but find out that even if they had electricity to run the machine there is no water to develop the film.  I walk to the lab to look at something under the microscope and find that the microscopes are also without power.  We can use the ultrasound machine if we move it to the ER, which for some reason still has electricity.  And finally I end the day back on B-ward, doing a D&C under the light of my head lamp.  Hey, how come the electricity is off but the water is working now?  Who knows.  I’m just thankful I can wash my hands with soap and water.  On call, phones become the issue.  Urgent messages are sent via nurses, students, or security guards.  Hopefully they knock loudly enough that I hear them and wake up.  Hopefully the something urgent doesn't require electricity or water or phone.

So it has been an interesting week.  The lack of these basic things has challenged me far more than the things I expected to do without.  But in missions you frequently encounter such challenges.  What do you do?  Know it is coming.  And pray for God’s grace to face whatever comes your way.

All in a day's work

Wow, what a day.

B-ward is the place where all expecting and recently delivered moms and their babies stay in the hospital.  It is a large room with 19 beds placed around the perimeter, and about 1/2 of them are currently full.  The delivery room and nursery are located at the back of the ward.

This particular morning began at 8:00 with rounds on B-ward.  Upon arrival, I made my way through the double doors and into the delivery room.  Sister Sylvia, the head nurse, pointed to a patient behind the far curtain.  “I think you should see her first,” she said with a touch of urgency in her voice.  I pulled the curtain and found two nursing students cleaning up a patient who sitting in a pool of blood.  She had been about three months pregnant, and was now bleeding heavily due to a miscarriage.  I quickly examined her and decided that she needed an emergency D&C.  Thankfully the bleeding slowed after the procedure.  The patient was moved to the ward in stable condition.

And that was just the beginning...

I made my way around the ward, seeing post c-section and other more complicated patients.  (The nurses deliver, care for, and discharge all of the normal deliveries.)  Bed 19 was the last bed.  Sister Sylvia began by telling me that this patient was complicated.  Uh oh.  This patient was nearing the due date for her sixth pregnancy.  She had been admitted the day before with difficulty breathing, stomach pain, and low blood pressure.  The patient thought that her water may have broken.  I pulled the ultrasound to her bedside to check the fluid level and take a look at the baby.  My heart sank as I realized that this baby did not have a heart beat.

The story continues...

After rounds, all the docs head to Outpatient Department (OPD) and begin seeing the multitude of patients that line up there every day.  People in PNG don't generally know how old they are, and this young woman was no different.  But she looked young, definitely no older than 30s and possibly late 20s.  She had many complaints:  lower abdominal pain, bleeding, right flank pain.  By my exam it was obvious that this patient had cervical cancer.  Oh, shucks.  I took her to ultrasound and confirmed that the cancer had already spread to her bladder and was blocking her right kidney.  Her father pleaded for us to do surgery, but the cancer was too advanced for any treatment.  Palliative care is all that we have to offer.  Scott and I prayed with the family.  Jesus says for all who are carrying heavy burdens to come to him, and he will give rest.  I will continue to pray for this young woman, that God will give her peace and comfort.

Happy ending...

I finished the day with my first solo c-section since arriving here in PNG.  This patient had two previous c-sections and was now near her due date for the third pregnancy, so she was scheduled to come in today for a repeat c-section.  I would do the surgery since I am the B-ward doc of the month.  The patient was taken to the operating room and prepared for the surgery.  My word that is a big belly, I thought as I entered the OR.  The c-section began and as I worked my way through the layers of tissue, I encountered quite a bit of scar tissue.  That always makes things interesting.  I eventually found the uterus, cut into the muscle, and placed my hand through the opening.  Wow, this kid has a large head.  O.K. not just a large head, he came out looking like a sumo wrestler... weighing in at 11 pounds 7 ounces!  I believe that is the biggest baby I have ever delivered.  And apparently this may be the biggest baby ever born at Kudjip Hospital!  I finished sewing mom up without any further problems.  Mom and baby are doing well.  Yeah for happy endings :).

Every morning and many times throughout the day I pray for wisdom beyond my understanding, that the Lord will help me to know how to care for and love my patients here.  He is THE Great Physician.  Thank you Jesus for helping me today.

Orientation and such

Hard to believe that I have been here almost three weeks now!  Official "orientation" is wrapping up.  This past week I began my days by rounding on the OB ward, and then on to the outpatient clinic for the rest of the morning.  I felt quite rusty with my medicine at first and it seemed like I was referring to my reference books for every patient I saw.  Thankfully that is getting better!  We see a variety of things from low back pain to malaria to pregnancy to...  The outpatient docs also cover the ER.  I have drained pus out of a multitude of body parts just this week.  Oops... sorry to you non-medical folks out there.  I also scrubbed on two c-sections this weekend!  It is good to be back in the OR.

Afternoons were filled with Pidgin study.  Margi was my language tutor.  We spent hours conversing (or Margi talking and making a feeble attempt to talk back), reading, singing, etc. all in Pidgin!  I feel that my comprehension has really improved, although I have not completely achieved getting the words out in the correct order.  The patients and hospital staff are all very helpful!  I think they appreciate my attempts to speak their language.  So official instruction is now complete, but I will continue studying on my own.

I am unpacked and settled, getting into the routine of this place.  My roomie Becky has only been home briefly, but I so enjoyed my time with her.  I am so happy that we are sharing a home.  Still working on my cooking skills, which after years of working like a crazy women had pretty much shriveled up and blown away.  I did venture to make tortillas, salsa, and sour cream this week.  Yes, I made sour cream.

Looking back over these weeks... so far so good!  I really do feel like I am home :).  Thanks for your notes and prayers.

New hospital dedication

Drs. Andy, Bill, and Jim played the PNG national anthem on their trumpets.

The new Kudjip Hospital was dedicated on January 30, 2009. Here are a few pics from around the new building and the dedication celebration. Thanks to Mike and Diane Chapman for the use of some of their pictures!

New and improved Kudjip Haussik

Friday, January 30 was a long anticipated day:  dedication of the new and improved Kudjip Nazarene Hospital.  The festivities began with a parade of special guests, including church leaders, representatives from Australia, hospital administration, and missionaries.  We marched to the beat of kanduk drums and through the Tari gate.  Hospital staff and community members lined the pathway, singing and and showering us with flower petals.  A large tent had been erected for the occasion.  The program continued with some special songs, including a wonderful trumpet trip by Drs. Jim, Bill, and Andy.  Mr. John Feaks, Deputy High Commissioner for Australia, gave his greetings.  And he was followed by several others who had been invited to share a brief remark (LOL... so much for brief, the speeches continued for almost three hours).  Dr. Jesse Middendorf, General Superintendent for Church of the Nazarene, was the keynote and final speaker.  From there we proceeded to the new hospital.  Dr. Middendorf offered a prayer of dedication and cut the red ribbon!  Wow, what a day.

The current Kudjip Hospital has been in use for about 42 years now.  The structure itself is old and beginning to crumble.  The hospital has capacity for 100 inpatients, though this number is often exceeded.  Overflowing patients may sleep on the floor because there is no where else to put them.  Thanks to financial support from AusAID and PNG Incentive Fund, construction on the new hospital began last year.  The building is now about 85+% complete.  It will almost double our capacity for inpatients, and will also expand the outpatient area and ER.  We hope to move in sometime in the next couple of months!