Friday, October 31, 2008

Brief Update

Just to let you know. The lady I called "Amban" in the story from a few days ago is recovering nicely on the surgical ward, at least in terms of her physical wounds. I'm quite concerned that she does not have any family members staying in the hospital with her. She said that her family has visited, but that no one is staying. Please pray that her family will support and care for her in this time of great need.


Tuesday, October 28, 2008

Photo Gallery

Here is a link to a gallery of photos taken by Matt Powell, of World Medical Mission, an organization that helps mission hospitals (like ours) find volunteer doctors. They are also the organization that supports Dr. Erin Meier and will support Dr. Rebecca Wallace (to arrive soon) in their post-residency fellowships. Matt was here last March (as I recall) and took lots of photos and video.

There's a video that he produced about Erin, but I can't find the link right now. I'll post it later.

Monday, October 27, 2008

Alone in Paradise

You are never more alone than when you have trouble or pain, and none of your loved ones are there to share and comfort you. At such a time, even a kind stranger is welcome relief.

I've been trying not to dwell on the negative, the violent, the tragic aspects of life in PNG. But that side of things exists, and I can't ignore it. This story has a bright side, too.

Amban was walking by herself along the road when she was attacked. I didn't get the whole story, but I heard something about the family of one of the other wives. I'm pretty sure that it was a man who wielded the bush knife. It was a very sharp knife. It's hard to cut all the way through an arm with a single stroke. We see lots of attempts to do just that, but only occasionally do we see a complete amputation.
The attackers left her there, bleeding, crying and in awful pain there alone by the road. In PNG culture there is no real obligation to help people from outside your own tribe, but it happens all the time. Someone saw the attack, waited until the attackers were gone, and then went to Amban's aid. They wrapped the bleeding stump tightly in whatever cloth they could find. They wrapped up the severed arm and brought it along, no doubt hoping that we could sew it back on. Unfortunately, reimplantation is well beyond our technical limitations.

The good Samaritans drove Amban to Nazarene Hospital, helped her into the ER, and then went back to find and inform her family. I gave her pain medicine and antibiotics. Dr. Salim Wahab, volunteer surgeon, took her to the operating room, cleaned up the damaged tissue and closed the skin. She's now recovering in surgical ward.

I don't post many blood and gore photos (I sure could if I wanted to!) but here is Amban as we first met her. I'll make it very small here. If you are brave and interested, you can click on this image and see a larger one.

Because you give and pray, we are here to help people like Amban. If Nazarene Hospital were not at Kudjip, what would have happened to her? Would the strangers have been willing to drive her all the way to the government hospital? Would a surgeon have been available to operate on her on a Saturday afternoon? Would the doctor have prayed with her? We don't know, and because you are faithful, people like Amban don't have to find out.

1 Sunset in Madang. We don't have many palm trees in the Highlands.
2 Kids from Kudjip station playing at the river. Don't worry, responsible adults are nearby.


Tuesday, October 21, 2008

The Girl in the Red Hat

She didn't think it was funny, either, that I was talking about her blue hat as a red one. PNG kids don't often correct their elders, and if I said that the hat was red, I could just think that it was red as far as she was concerned. She looked mildly worried when I swiped it and put it on, and even more mildly relieved when I gave it back. Actually, her expression changed very little the whole time she was in my exam room. That's Marla the student nurse, who is more interested in my camera (being operated by Roselyn, the other student nurse) than in my lame attempt to be funny.

Sunday, October 19, 2008


My honorarium for speaking at the Kukon Church of the Nazarene this morning.

This includes 1 large cabbage (which hasn't been shared by any snails--how do they do that?); 2 small pineapples (this is the sweetest variety); 5 very large green bell peppers (that's "capsicum" to all our British, Ozzie and PNG friends); 6 large, ripe (despite being green in color), sweet oranges; 6 "sugafrut", a sweet (rather than tart) variety of passion fruit; and one small bunch of asparagus.

And you didn't think missionaries are well-paid!

Facing The World



Yeah, I know. You weren't thinking about scrolling down until I mentioned it. It's just that I want to tell you about the pictures before you see them. The first one looks a little disturbing, but it's a happy story, it really is.

When the nurse called me (precisely 30 minutes after I got into bed, as is almost always the case) said that it was a footling breech, and that it was the young woman's first delivery. I groaned inwardly. At least I'm pretty sure that I didn't groan out loud. I was too groggy to be sure. You see, this combination of circumstances dictates that I must to do a cesarean section. I told the nurse to call the OR crew, and that I'd come right in.

A breech presentation (for those of you who don't already know, but are still interested) is when the baby's bottom is leading the way, rather than the head. In most breech deliveries, the buttocks come first, with the legs laid flat along the body. When the feet come out first, we call it a "footling breech." For a mom who has had previous babies, we will go ahead and deliver the baby vaginally, but for a first delivery, we always do a c-section. Usually our nurses are quite accurate in diagnosing breech presentations.

Bleary-eyed, I staggered into the delivery ward, found some sterile gloves and checked the patient. It certainly wasn't the baby's head I was feeling, and it sure wasn't feet or buttocks. There was a hard lump, then a hole, then a soft lump. Gradually, the truth dawned on me. I was feeling a chin, a mouth and then a nose. This was a face presentation!

My previous experience with face deliveries totals exactly 1. Oh, and read about it in a book once. The books say that most can deliver safely. It worked out OK the other time I had seen it.

This mom had already been pushing for a while, and was tired. I coached her to push harder. I can usually get better pushes out of the patients than the nurses can. She was having hard contractions, and was giving it a good effort. Still, things didn't seem to be progressing. I contemplated doing a c-section, but then whole head was now well down into the birth canal, and I didn't think I could get it out the other way! So I tried to be patient.

As time stretched out, push after seemingly futile push, I began to occasionally see slight progress. Then I'd get discouraged again. I thought about other options. I had already made a large episiotomy, but there are various other things that one can cut (you don't really want the details, do you?) to make things open up better. I had even scrubbed the skin and injected local anesthetic to do something called a symphysiotomy, when I noted a bit more progress.

As the little face became more visible, I could see the effects of the pressure. The face can't take the pressure, and the pounding of contractions and pushing the way the top of the head can. The soft tissues of the face become swollen and purple. Several times I asked the nurse to listen for the baby's heart beat, to assure myself that it was still alive. It was.

Finally, after what seemed like an eternity, or at least like a long time, the head slipped out, and the rest of the body followed easily. The baby made no effort to breath. There was no movement. It looked far worse than the picture that you are slowly scrolling down to. (I didn't have my trusty camera on my belt, so I didn't get the picture until the next morning.) I gave it a few breaths with a breathing bag, and it took, first a feeble breath, then a stronger one. There was a little tiny cry. The ugly white body turned a beautiful pink. The face was still purple, and not a shade that went nicely with the pink. But he was alive, and breathing on his own.

I then spent the next hour sewing up his mom. It was close to 4 a.m. when I crawled into bed, happy with the good outcome of my night's work.

The first photo was taken in the nursery the next morning. I had left him there on oxygen, but by morning he didn't need any extra help, beyond what babies commonly need.

Wednesday morning

By Friday morning he and his happy mom were ready to go home. I stopped in the ward just in time to get the additional photos.

Friday morning. Big improvement, huh?

Our star with his happy mom.

And of course, I couldn't resist including one with the happy doctor.

Monday, October 6, 2008

The Big Meeting

First things first. I'm always going to change names in my stories. People in PNG read blogs. There is a PNG Gossip Newsletter that finds and distributes links to interesting blogs about PNG. The last thing I want to do is to further compromise the privacy of people who are already hurting. I'll change other facts, too to help obscure their identity. The core facts of my stories will always be true, but many of the details will be flat out lies! There, I've confessed in advance.
So, with that in mind.... Maria and John. Yeah, Maria and John.

They've been married just a few months. Within a couple of months of their marriage Maria began to be ill. She felt weak, had frequent nausea, and lost weight. By about 5 months into the marriage John began to worry that Maria had AIDS. It's a testament to his faith in her that he assumed that in order for her to have it, he had to be HIV positive. So instead of suggesting that she be tested, he went and had himself tested, and was quite relieved to be negative. He let the matter drop.

A few months later, as she was getting worse, he went and repeated the test. Still negative. Finally, just a few weeks ago, he took her to a hospital in a province near ours. Among the many tests that they did there was an HIV test, which was positive. By then her symptoms included confusion. Her mother was with her there, and for reasons that I don't understand, took her, and they slipped out of the hospital and ran away back to Maria's home village. Perhaps the mother underestimated the depth of John's commitment to Maria, and was afraid that he would take some reprisal.

Within a few days, her family began to recognize how ill she was (although only her mother knew about the positive HIV test), and brought her here to Nazarene Hospital. John has relatives who work here, and was actually staying here with them, but it was a day or two until he found out that she'd been admitted. In her evaluation here, the HIV status was confirmed. John was tested yet again, and was again negative.
John's dilemma was that when Maria's male relatives finally found out the situation, they would assume (as he himself had) that he was the one who had infected her, and would attack and possibly even kill him. He wanted someone in a position of authority (you'll be surprised to learn that he was thinking of me!) to be the one to inform them that she has AIDS, and at the same time explain to them that he was HIV-negative. Because of the advanced state of her AIDS, it is in fact likely that she contracted HIV long before she met John.

So, as Maria herself was now too confused to give informed consent herself, I felt it was John's right to grant me permission to tell the family. I discussed it with some of my colleagues, and decided that that was indeed the best way to proceed. He would ring her family and ask them to come to the hospital Saturday morning because the doctor needed to talk to them about Maria.

Saturday morning I went to do ward rounds with a sense of dread. I knew that it could be a difficult and even tense meeting. I had mixed emotions when I got to the ward and discovered that Maria and her mother had again run away! But a couple of hours later I learned that the family had tracked them down near the provincial border. They were probably heading back to the first hospital. The meeting was now rescheduled for John's relative's back yard.

I was surprised at some of the people who were there. There were several other people from the station who were related in some way. John's relatives had invited Pastor Robert from the nearby Nazarene church. He opened the meeting in prayer, and then turned it over to me. It wasn't an easy task. It was hard to know what to say at all, but then I had to say it in my second language, and the more nervous I get, the worse my Pidgin gets.

I stated the facts as simply as I could. Then I stated that I was no longer speaking as the doctor, but as a friend. I talked about the fact that not one of us there was without the need for forgiveness. We've all done wrong, and God has either forgiven us, or is ready and willing to do so. I said that just as past actions (especially Maria's) have affected present circumstances, our actions now would affect our lives into the future for better or for worse. I turned to Maria's family and stated that they must have seen some good in John if they had allowed their daughter to marry him. There were nods of agreement. I turned to John's family and stated that they must have seen good in Maria to allow one of their young men to marry her. Again, the nods.
"Those things have not changed," I said, "they are still there. This hasn't changed them." Again there were nods all around. "These young people will need the support of both families if they are to get through this and strengthen their marriage. Anger or fighting won't help them. Only your love and support will help." I asked for the privilege of praying with them, and asked God to direct and guide them all.

I looked up to see a security guard from the hospital who had obviously been sent to summon me back there. I explained that I had to get back and excused myself. On my way I passed near Maria's dad, whose eyes met mine. I could only imagine the flood of emotions that were going through his heart. Sorrow for his daughter. A sense of betrayal. Anger. He offered me his hand, and shook mine warmly.

Several hours later I passed by the house where the meeting had been held, and saw Maria's family at the road loading into the truck that they had come in, while still visiting with John's family. I saw no blood, wound or bandages, so I was happy! They all greeted me cheerfully, but it just wasn't a good time to ask about details of the rest of the meeting. Later I talked to one of John's relatives, who told me that it had gone very well. There had been hours of speeches, of course, but in the end they all agreed to help and support this young couple. Later yet, I learned that a few days before, John had prayed to recommit his life to Jesus.
Please pray with me for John and Maria. God knows their real names! He knows the pain in their hearts. He knows the pain and frustration of their families. Please pray that Maria will be consistent with medical treatment, which will probably involve the use of anti-retroviral drugs. Pray that she will follow John's lead in committing her life to Jesus. And pray for me, Bill, Jim, Susan, Scott, Erin, and the soon-to-come Rebecca and Stephanie as we battle on against AIDS, violence, and the countless other consequences of sin and evil in the world. Pray the the Great Physician would give us strength, wisdom, good judgment and the stretching of limited resources.

Yours and His,

1 A sunset seen from near Konduk
2 A flower of some kind. Photo by Sam Bennett
3 A wedding, not John and Maria's. The couple are kneeling, surrounded by a large wreath of flowers that has a lot of the same symbolism as a wedding ring, but also symbolizes the prayers of their families which will continue to surround.

Ok, the last 2 photos look a little silly and out of place, but really they fit in nicely. They are three of my fellow doctors here that I request prayer for in the last paragraph.

4 The always-dignified Dr. Bill McCoy, holding treasure.

5 To introduce my soon-to-be-newest colleague, Dr. Rebecca Wallace, seen here dressed as Strawberry Shortcake during a Harvest party on her visit last year. She will be arriving soon. She will be coming as a post-residency fellow, like Dr. Erin Meier (shown here on the right in a costume that I don't recall), who is one year into her two-year fellowship.

Saturday, October 4, 2008

Faces of C-Ward

Inspired by Dr. Erin Meier's nice collection of photos of patients from her ward, I decided to do one of faces from my ward. Trouble is, her patients (being kids) are cuter than mine. But the folks in C-Ward have their own special appeal. I'll add in a couple of patients who aren't actually on my ward, but I want to tell you about them and show you any way. Three of these are victims from last Tuesday's MVA. The man with the facial injuries, and the little girl with the hand injury were the main focus of my attention that afternoon.

Wednesday, October 1, 2008

Going Home

Not us. We are home. Well, at one of our homes.

I'm talking about the folk from last week's MVA (motor vehicle accident). I am still amazed that none of them were more seriously hurt. The last of the ones that we admitted to medical ward (they would usually all go to surgical, but there were just too many) went home this morning, with plans for a 1-week follow-up. I haven't checked on the little girl with the bad forearm injury, but I'll look in on her in the next day or two and report how she and her mom are doing.

I really recommend Erin Meier's blog. She does a way better job than any of the rest of us at keeping up. Sometimes you will learn more about Judy and me there than here! Check out the "Faces of the Pediatric Ward" that she posted a few days ago. (Sometimes it's just fun to make links.)

By the way, we sure enjoy it when you leave comments. On some of the recent posts I've added an extra-big COMMENTS link, but they all at least have the little "0 COMMENTS" link in tiny font at the bottom. Click on any of those to comment, and please sign your message.