Bush church

One of my favorite weekend activities is going to "bush church."  A bush church is generally a one room building where a village congregation gathers for Sunday service.  The decorations are colorful flowers neatly arranged across the front of the church.  Benches or pews are a rare find.  Worshipers either stand or sit on the floor:  women and children on one side, men on the other.  Hymns and choruses are sung in Pidgin or "tok ples" (the local language), a capella or perhaps accompanied by a guitar or tambourine.  The offering is given not only in kina and toea (dollars and cents), but also in fresh produce from gardens.  And last but not least, the pastor preaches a sermon in Pidgin and/or tok ples.

This day I joined up with Niles and Patty and Niles Jr. (two volunteer docs and a PT from Minnesota) and Dr. Erin (here in PNG for 2 years with Samaritan's Purse post residency program:  http://www.samaritanspurse.org/index.php/Serving_Overseas/Post_Residency) for a hike up the mountain to Konduk church.  It is an intense but amazingly beautiful walk, about an hour straight up.  The view from the top is well worth the climb.  You practically get an aerial look at Kudjip Station.  The service was wonderful; I think I understood quite a bit of the sermon.  Hurray for Pidgin!  And the people of Konduk are so welcoming; always excited to have visiting missionaries.  One of the neatest things about such experiences is evidence that the family of God crosses barriers of language and culture.  The Papua New Guineans are our brothers and sisters!

"You are all sons of God through faith in Christ Jesus... For there is neither Jew nor Greek, slave nor free, male nor female, [black nor white, Papua New Guinean or American, or anything else for that matter], for you are all one in Christ Jesus."

~ Galations 3:26, 28

Tough decisions

I promise that not all of my stories will be heavy ones.  But I want to share about one more patient...

Joyce was brought into the ER my first weekend on call.  She was a student at one of the nearby Bible colleges, having recently moved to PNG from the Solomon Islands.  She was about 30 weeks pregnant (7 months) and was referred to our hospital because of very high blood pressure.  I evaluated her and gave the diagnosis of pre-eclampsia, or "toxemia" of pregnancy for the non-medical folks out there.  I admitted Joyce to B-ward for observation.  Lab tests and continued blood pressure readings confirmed that this disease was in the severe stage.  I did an ultrasound and there was very little water around the baby; this supported the diagnosis.  The only treatment for severe pre-eclampsia is delivery.

Back home in the States this would have been a no-brainer.  Let's the kid delivered and he or she will live in the NICU for a couple of months.  In fact, babies as small as 1 pound and early as 24 weeks can survive.  Not so here in PNG.  The smallest of babies cannot survive here without the incubators, ventilators, and fancy equipment of modern day NICUs.  Our nursery is a small and very toasty room where the premature babies share a couple of warming beds.  Oxygen is given by a tiny tube in the nose.  Mothers help to provide the care, feeding their babies expressed breast milk through another tube that goes into the stomach.  

So I here I was facing a difficult decision, though I knew the answer.  Do nothing and both mom and baby would become very sick and possibly die.  Inducing labor would save mom's life, but Joyce's baby was right on the edge of survival in our nursery.  I ordered medication that would start the contractions.  The next morning, Joyce delivered a baby boy who weighed only 1.4 kilograms, or about 2.6 pounds.  Baby Josh did surprisingly well for the first few days, breathing easily and tolerating feeds.  Then he took a turn for the worst:  pulse rate began to rise, breathing became labored, body temperature elevated.  Antibiotics were able to hold down the infection for a few days, but his tiny body was unable to continue the fight.  After just ten short days of life, Josh lost the battle.

Sometimes it is hard to understand God's plan in something like this.  The Father was watching as little Josh was being formed.  He knew that he would be born early and that he would only have ten days with his earthly family before going to heaven.  His love is so great, and I will trust in that love when things don't make sense.

"For you created my inmost being;

you knit me together in my mother's womb.

I praise you because I am fearfully and wonderfully made;

your works are wonderful,

I know that full well.

My frame was not hidden from you

when I was made in the secret place.

When I was woven together in the depths of the earth,

your eyes saw my unformed body.

All the days ordained for me

were written in your book

before one of them of them came to be.

How precious to me are your thoughts, O God!"

~ Psalm 139:13-17a

Sik cancer

Cancer in PNG is unlike almost anything I've seen in the States.  O.K., maybe you could compare to JPS (the county hospital in Fort Worth where I did residency) because we served an indigent population.  Maybe.  Patients here don't go to the doctor until they are really sick.  And by the time they are really sick with cancer, the disease is quite advanced and often untreatable.  Not that we have much in the way of chemotherapy agents.  The cancers we can treat are lymphoma, some leukemias (i.e. CML), early cervical or other gynecologic cancers (with a hysterectomy), and Wilm's tumor in children.  Palliative care is generally all we have to offer, which means we do what we can with medications so that the patients are comfortable until they die.

Hepatitis B is very prevalent in PNG (as high as 20% by some estimates) and is a known cause of liver cancer.  I have diagnosed three cases of liver cancer over the past one month, and will likely see many more.  Mouth cancers are not uncommon due to smoking or chewing beetle nut.  Lung cancer is another one.  If patients don't smoke they are probably exposed to smoke from cooking fires.

Paul sleeps in bed 21 on C-ward.  He has been diagnosed with CML, a type of leukemia.  He has been in the hospital for more than a month now because of a large ulcer on his foot.  I am showering him with all sorts of antibiotics, but the leukemia prevents his body from healing the wound.  For all the medical folks out there, his WBC count is currently > 100K.  The first chemotherapy medicine (busulfan) has failed, so I started him on the second line treatment today (hydroxyurea).  There is another treatment that has recently become available, but you can only find it t in Port Moresby.  Traveling to Moresby is an expense that Paul's family cannot afford.  Paul is praying and waiting for God to heal him.  Will you pray with me for Paul?

I wrote about Ai in one of my previous entry.  She is the young woman with advanced cervical cancer.  My best guess is that she is about 30 years old, because her children are seven and nine years old.  She came back to see me in clinic today.  The Tylenol and ibuprofen I had prescribed had significantly reduced her pain and she was feeling great.  Ai told me that she had shared about her diagnosis with her church, and that the pastor had prayed for healing.  She was certain that God had answered and the cancer was gone.  I examined her and found that the tumor had grown from her previous visit.  She continues to have faith that God will heal her.  He will answer her prayers.  She will have a new body someday.  Will it be in this life, or in heaven? Will you pray for Ai, too?

"Have faith in God," Jesus answered.  "I tell you the truth, if anyone says to this mountain, 'Go throw yourself into the sea,' and does not doubt in his heart but believes that what he says will happen, it will be done for him.  Therefore I tell you, whatever you ask for in prayer, believe that you have received it, and it will be yours."

~ Mark 11:22-24

Lord, increase my faith.