Thursday, November 26, 2009
Many countries have Thanksgiving. In Canada it is the second Monday in October. In Papua New Guinea it is the last Sunday of June. But most of the missionaries here at Kudjip are Americans, who are used to celebrating the last Thursday of October. That would be today.
Some years we have a big station-wide dinner, with decorations, and an elaborate menu. The year the Hospitality Team had enough to do getting ready for Christmas, so they decided not to plan a big one. So it was up to each family to plan their own celebration. Jeff and Susan invited us along with Riley Klassen, a young man from Canada who is staying with us, to join them. Also invited were Harmon, Cindy and Quentin Schmelzenbach and Steph Doenges.
Today was a blessedly slow day in the Outpatient Department. We actually finished up by about 2:30, which allowed a leisurely afternoon, and preparation for the evening. I got to have a nice long workout, then get home to do Facebook, shower and get ready for dinner.
We had a great time around the table together. The "Turkey" may have had small drumbsticks, but there were a lot of them, and there was plenty to go around, along with stuffing, mashed potatoes, gravy, several vegetables, salads, fruit and dinner rolls. Dessert was a choice of pumpkin or pecan pie.
1. Riley Klassen, Jessica Myers, Ethan Myers, Quentin Schmelzenbach
2. Cindy Schmelzenbach, Harmon Schmelzenbach, Steph Doenges
3. Jeff Myers, Susan Myers, Judy Bennett, Andy Bennett
4. These guys are really serious about their dessert, aren't they?
Wednesday, November 25, 2009
An old reliable technique is the cute baby method. Everyone loves a cute baby, so it's a sure winner for a quick blog post. This is Noah. He likes me. He's also quite interested in my pulse oximeter (a cute little machine that tells me about oxygen in a patient's blood).
Saturday, November 21, 2009
Yesterday I got on the net to look for some educational material to use with the parents of my clubfoot patients. As some of you know, I have a special interest in treating children with this birth deformity. The method of treatment that I attempt to use, and which has become the "gold standard" of treatment for this was pioneered by Dr. Ignatio Ponseti. When I logged onto the web site of the Ponseti International Association, I saw the notice of his death about a month ago. There is a nice tribute there, as well as links to dozens of obituaries and tributes.
I have known of him for several years, and this past summer I was privileged to spend three days in the clinic that bears his name. I was worried that I wouldn't be able to meet "Papa Ponseti" (as he was known to the small group of his patients who were old enough to call him anything), as I had heard that he was no longer working. He had sustained a hip fracture a few months earlier, and at age 95, it was reasonable to assume that he would be staying close to home.
My first morning there, after about a half-hour of seeing patients with one of his younger colleagues, I came out into the hall, and there he was, a commanding presence, despite his slight build and the bit of stoop brought on by his 95 years, and a recent hip fracture. He was still coming to the clinic every day, although he no longer was directly treating patients. He watched the younger doctors, making occasional comments. Mostly he focused on the patients. The toddlers gravitated to him, standing at his knee, and exchanging stories and observations. They had no trouble understanding his weak voice and heavy Spanish accent.
I had a couple of brief conversations with him, and had my picture taken with him. Then on the second day, he left me a note, asking me to come by his office after his siesta in the afternoon. I hovered near his office, checking frequently to see if the "do not disturb sign" was still there. As soon as it was gone, I knocked. I spent the next hour and 15 minutes listening to his stories and answering his questions about myself, about PNG and about my work here. He gave me a treasure of gifts; teaching materials, practice models, and an autographed copy of his book.
Our conversation touched only briefly on spiritual things. He had felt deeply betrayed when the Catholic Church supported Franco in the Spanish Revolution. He served as a surgeon in the Loyalist Army, eventually evacuating 40 wounded soldiers by mule over the Pyrenees to France, where he continued to work for a time. His path led to Mexico, where he served as a country doctor for 2 years before seeking orthopedic training at the University of Iowa, where he stayed on as a member of the teaching faculty.
Through most of Dr. Ponseti's life, the medical world believed that the only treatment for clubfoot (also known as congenital talipes equinovarus, or just "talipes") was surgery. Dr. P noticed that most patients who had surgery for this problem ended up with stiff, painful, poorly-functioning feet. Through careful study of the biomechanics of the foot, he came to realize that gentle manipulation could correct the problem in nearly 100% of cases. Patients treated this way usually have pain-free, functional feet for the rest of their lives.
In 1948, when he was 34 years old, Dr. Ponseti had the insight that led to the development of his method of treatment. In 1963, when he was 49 years old, he published the definitive paper on the non-surgical treatment of talipes. He retired in 1984 at the age of 70, with very few people recognizing the value of his work. Only the orthopedic surgeons at the University of Iowa, and the ones that they had trained used his method. In 1986 he came out of retirement to work part-time, mostly treating clubfoot.
Then in the early 1990s when he was about 80, two key events changed his life. First, two younger colleagues published a long-term follow-up study of his patients, documenting conclusively the superiority of his method over surgery. Second, the internet happened, and parents seeking alternatives to surgery for their children started learning about The Ponseti Method, and started flocking to Iowa city, where their babies were lovingly and gently treated by this genius. Soon doctors started flocking after them to learn the method. Dr. P's younger colleagues have traveled the world, teaching it to thousands of doctors in dozens of countries.
From about 1994 until he sustained his hip fracture in January of 2009, Dr. Ponseti worked 3 mornings per week, treating children from all over the world in the clinic that is now called "The Ponseti Clubfood Clinic". He treated more patients in most weeks than he had treated per year early in his career.
My interest in the Ponseti Method grew out of necessity, seeing patients here in PNG who had talipes. I learned from books, and from the internet. A couple of years ago I contacted Dr. P by email to ask a couple of questions. I received a very quick and helpful response. Later he invited me to come to Iowa City, and spend time with him in the clinic. After his hip fracture, his work load was assumed by Dr. Jose Morcuende (also a Spaniard, incidentally), who graciously extended the same invitation to me.
I know that the details of Dr. Ponseti's life might not be interesting to everyone, but I just wanted to tell my friends about this great man who has had a great impact on my life and work. He epitomizes many of my cherished values; overcoming adversity, serving others. And, the fact that he did his greatest work in the last 10 years of his long life is a great encouragement to me.
The first picture is a stock photo from the University of Iowa obtained from the web, but it shows Dr. P very much as he was when I visited with him in his office, right down to the book case behind him, and the skeletal model in his hand.
The second is of me with Dr. P and Dr. Morcuende.
The third is one that I took of Dr. P and a little girl that he had treated some years earlier who was in for a recheck.
Tuesday, November 17, 2009
Elsie has a pretty painful burn, but she somehow manages to entertain little Sabath. I don't know how long Sabath will remember Elsie, but for now, her hospital stay is a lot nicer because of an unselfish girl.
Monday, November 16, 2009
I was on call yesterday. In the morning I did my first cesarean section in the new OR. My camera had dead batteries, or I'd have a couple of photos for you.
Let me tell you that the new facilities are great! Yeah, we have found a few glitches, and I'll probably share a few from time to time, but it's really, really nice. When I have occasion to go back into the old OPD, I just marvel at how run-down it was.
But I haven't been taking a lot of photos around the hospital the last couple days. But here's one of Bill McCoy seeing what was technically the first patient to be seen in the new ER. He is the son of a staff member who had gastroenteritis. He was admitted (making him the first new admission to the new wards) and recovered just fine.
Saturday, November 14, 2009
It's a bit of a long story, but to make it short, a family felt led of the Lord to turn part of their land into a prayer retreat, a place where people can go for some quiet time with the Lord.
We drove through the town of Minj (for those of you who know your way around these parts) and then up to Tsigmil, turned south (I think) and drove for another 20 minutes, parked and walked for about a half-hour.
We heard someone singing in the distance. I had not expected a formal welcome. I thought that we'd just walk to the place, look around, maybe rest for a little while, then walk back. But as we came around a curve in the path along a small river, we found a group of people singing a welcome song. There were about 20-- they had formed a double line for us to walk through. We were met by the "Papa Graun" (literally the father of the land--just means the senior member of the family that owns the land) who escorted us up a beautiful path.
They had transplanted flowering plants, including several varieties of orchid, and some soft fluffy moss to decorate the path. There were signs naming the several small streams that converged here after names of rivers from the Old Testament. They had added a collection of seashells from the coast, and a couple of rocks that they thought were fossils (which I don't think are).
The path leads to the site where one of their houses once stood until it was burned by enemies during tribal fighting several years ago. At that time they felt that God was directing then not to rebuild on that site, but turn it into a place of prayer. We sat around and sang songs, then Pastor Bill, one of the sons of the family shared a brief devotional, and we had a short time of prayer.
This was honestly the best time of worship I have had in weeks. I believe that worship is something between the individual and God, that no pastor or "worship leader" can make you worship, or keep you from it, for that matter. When music is not to your liking, or when the words spoken don't stir you emotionally, or the environment is not conducive to worship, it's up to you to worship God. When the music is your favorite, when the leader says things that really minister to you, when the surroundings make it easy to turn your thoughts to God, it's still up to you to worship. But for whatever reason, this morning in a little clearing near the top of a mountain in the jungle, it was easy for me to worship.
The folks had prepared a lunch for us. We ate together, walked back down to the car, then drove back to Kudjip. The day was little more than half-gone, and I had had an adventure, a time of worship, and a good lunch. What more could I ask for in a Saturday?
Thursday, November 12, 2009
Five years ago tonight, she was hurrying to get to the hospital. She was in labor with her second child, and had waited just a little too long to leave her house here on Kudjip Station. As she reached the top of the "Hydro Hill Road" she realized that the baby was about to come. She didn't want to give birth right under the security light, so she headed for the deepest shadows she could see--in our front yard.
The baby came just fine. What was the point in going to the hospital now? Well, I can think of several points, but she couldn't, so she headed back down the hill to home.
She and her husband had already decided to name the baby in honor of Judy if it was a girl, and it was. Ordinarily names aren't given until the baby is a month or more old, but we were about to leave for our first furlough, and they wanted to tell us before we left. So the day after the birth, her husband came to our house to tell us about the baby.
Today she's five, and very proud of the birthday cake that "big Judy" made for her, complete with candles!
Tuesday, November 10, 2009
One surprise is how acoustically "live" the OPD is. We'll probably have to figure out some ways to deaden the resonance a bit.
I'm on call, so I guess that makes me the first to be on call for the officially-open ER (Dr. Bill saw a staff member's baby there a few days ago). I've now been to the ER twice, and hoping that's it for the night! The second photo is of my first ER patient and some staff.
There are a few more photos here.
Monday, November 9, 2009
Saturday morning the mumu pit in our back yard was used to cook one of the pigs for a mumu that was done in celebration of the new hospital. Ishigel and Aku are friends (sons of Simon and Esther Tausi, of whom I've written several times). I love the photo. They are sitting by the fire that was used to heat the stones for cooking the food in the pit.
Saturday, before and after the mumu, Judy and I worked on a few more details in the new Outpatient Department. This included repairing and hanging x-ray view boxes, hanging BP cuffs and other wall-mounted items. Judy dusted all the high windows.
Finally, on Sunday afternoon I was showing a new visiting doctor around the hospital, and I found out that the first baby had been born. Her she is.
Tomorrow will be the first day in the new OPD and ER. I'll report tomorrow evening.
Thursday, November 5, 2009
The day yesterday began nothing like any other day. I woke up at 5:15, and couldn't get back to sleep. I got up, drank coffee, did Facebook and email, and still got ready and went to the hospital by 7:30. I wanted to have time to take plenty of photos, and still start rounds at the usual time.
I stopped at the materniny to see if the last baby had been born. There was a lady in late labor, and no others in labor, so I knew that she was a pretty safe bet for the last delivery. Her name was Marina Samson, and she shortly gave birth to a little girl.
On rounds on pediatrics (my ward) I tried to discharge all the patients I could. I had two kids on oxygen. I checked their oxygen saturation off supplemental oxygen. One did well for about 10 minutes, the other was able to stop using oxygen.
During rounds all unoccupied beds were moved to the new hospital. There were a number of new beds, divided between Maternity, Medicine and Surgery.
About 9:00 the first ward Maternity (B-Ward in the old hospital, D-Ward in the new) started moving. I got a photo of the first lady to move. Each patient got a wrist band with their bed number and name, to avoid any confusion on arrival. They were supposed to go into the same bed number in the new ward as in the old. Each one was accompanied by a nurse or a doctor, and their own family members who helped carry their personal belongings, and sometimes an IV flask. Most were wheeled in wheelchairs. The new maternity ward got a lion's share of new beds, so most of the old beds did not need to be moved.
After all the B-Ward patients had moved to the new D-Ward, the patients from the old C-Ward started moving into the new B-Ward (are you keeping track?) Most went by wheelchair. Since there were only a few new beds on the new ward, so for most of these patients the bed had to be brought along. Nursing students, off-duty staff members, the chaplains, doctors' family members, other missionaries all helped with bed duties.
In-between the patients, staff members were taking furniture and boxes of supplies. For heavier items, any rolling device was pressed into service as transport. Beds with exam tables, gurneys with cabinets on top, any wheeled conveyance at all was used.
As the last of the C-Ward patients went over we got the word to start moving the old A-Ward to the new A-Ward. That's right, peds is the only ward to keep its old letter-name. Peds didn't get any of the new beds, so the old ones had to follow each patient. I waited until my most critically-ill baby, and went with him. I had kept him on oxygen until the last minute. There was an oxygen concentrator waiting on the new ward. I went back and accompanied the last patient, who rode a gurney, as he was too big to carry, and to weak to sit up in a wheelchair.
There was a brief break for the 11:00 med pass, then D-Ward started moving to the new C-Ward. The tricky thing about this bunch, is that 3 of them are in traction, 2 for femur (thigh-bone) fractures, and one for a cervical spine (neck) fracture. They had to stay in their beds, with tension on the traction. Dr. Jim took part of the weight off the traction to reduce bouncing and jerking during the move. Then 4 men lifted the bed and carried it as carefully and smoothly as possible. These beds had to go a different route than the general population in order to use wide doors. Out of D-Ward, through the now-vacant C-Ward, out through Labor and Delivery, a sharp left, then follow the sidewalks around to the car-park by Administration, then across the gravel drive to the sidewalks, and on to the new ward, where the traction was adjusted and the patients settled. I was one of the 4 carriers for 3 of them (but with a reliever, and we rotated).
The move of patients was completed by 11:30. But a lot of work remained. There was (and still is) a lot of work to be done to get the new Outpatient Department ready for Monday's opening. I've been helping Judy (who is coordinating the OPD prep). The operating room staff have been working hard getting the new OR ready for use, getting the minor procedure room ready, and the surgical part of the OPD arranged. The emergency generator had to be moved and re-installed at the new hospital. There are countless tasks remaining, that have to be finished by Monday morning. We'll keep working.
For more photos, see the albums listed in yesterday's post, and also look here for Steph Doenges' pictures.
Wednesday, November 4, 2009
Here's one album. It may be tomorrow before I get the rest up.
And here's a second.
And a third.
The move started at about 9:00 this morning, and was completed by about 11:30.
For the first time, I maxed out a 4-gigabyte memory card, and had to swap in a back-up card for my camera. My video camera was in use by some of the MK high school students, who got the day off to film and photograph the move. I haven't seen any video yet. Shucks, I haven't even gotten my video camera back yet. Maybe I'll be able to post some video clips later. I will certainly post some photos. Not 4 gigabytes worth, but a lot!
Tuesday, November 3, 2009
The ER is open, but only to stabilize life-threatening emergencies.
Tomorrow we will round on our wards, thinking about each patient, and how they can best be moved to the new ward. For most, it won't be a difficult problem. Most can walk, or be wheeled in a wheelchair. A family member will walk along, carrying their personal belongings, or maybe an IV flask. A few will be more complex, needing to be carried carefully, or wheeled on a gurney. Some will need oxygen, which will be provided from a tank wheeled along side by a nursing student. We'll write appropriate orders for each one.
Then we will hang out waiting until we get the ward for our ward to start moving. They will go, one at a time, but one closely after another, each accompanied by a staff member, first the maternity ward, then medicine, peds (my ward) and finally surgery. Surgery will have some of the trickiest patients, those in traction. I don't know how that will be done, but we'll see.
There will be nurses both in the old ward and in the new one until all patients are moved. Oxygen tanks or concentrators will be available on the new ward to receive the patients who need it as they arrive. We don't have all new beds, so in many cases the bed will have to be moved at the same time as the patient.
This evening there was one more event marking this time of transition. You see, the sidewalks of the new hospital are great places to skate and ride bikes and scooters. The MKs have loved doing this. But when there are patients in the area they won't be allowed to do it any more. So this evening they had one last ride.
The first photo here is of Mr. Lapongo leaving the Outpatient Department. More of my photos from this afternoon are here.
The second is one Judy took of the Last Ride. There are more here.
Sunday, November 1, 2009
We went to each of seven areas. In each one, Steph would share a few thoughts and a portion of scripture, then people would walk individually around the area praying for the future of that area. We prayed for the people who would occupy the beds or receive the services of that area in the future. After a few minutes someone would lead in prayer, and we'd move on to the next area.
In OPD the scripture was Psalm 100. Steph drew an analogy between the "gates" and "courts" of the psalm and OPD as the portal of entry into the hospital. She suggested prayers of praise and thanksgiving for the hospital, those who had had a part in planning and building it, as well as for the people who would pass through, and the people who would work there. After the individual prayer time, Scott Dooley led in prayer.
In Maternity Steph read from Ephesians 2:19-23, emphasizing that just as Paul refered to Christ as the cornerstone, that He is the cornerstone of Nazarene Hospital. It says in verse 22 that we "are being built together to become a dwelling in which God lives", and that God is building the hospital out of people, more than of block and lumber. After the individual prayers, Sister Elizabeth, our Director of Nurses prayed for the ward and the women who would come there, and the new lives that would begin there.
In the Surgical ward, the scripture was Psalm 90:17 which speaks of God establishing the work of our hands, and suggested prayer that emphasized asking God's guidance and wisdom in the care of our patients. Jim Radcliffe prayed to close the time there.
In Medicine Steph read from Philippians 1:3-6, and talked about how so many had partnered to build this new facility, and that God would complete this work. She suggested prayer for our supporters and volunteers around the world. After the individual prayer, I led in prayer, emphasizing that people often come to the medical ward on the verge of death. I prayed that many of these would recover, but that none would die there without knowing the Lord.
In the Pediatric ward, Steph read from Luke 18:15-17, the story of people bringing children to Jesus. She suggested prayer for the ministry of our chaplains, and for the spiritual children who would begin their spiritual lives there. We all prayed throughout the ward, then Dr. Susan prayed for the children and the parents would occupy the ward.
We then went over to the OT--the operating theater, what we would call the operating room in the US. Steph read Eph 6:10-13, and asked that we pray for the spiritual battles that go on around us. Many of the results of Satan's attacks end up in the OT, with domestic or tribal violence and violent crime. Many of the perpetrators of this evil are bound in the darkness of sin. We walked through the pre-op/post-op area, the OR and the sterile instrument room and prayed. The time in this area was closed in prayer by Chaplain Moses.
The final area was the ER. The scripture was from Isaiah 58:6-12. This scripture cuts so deeply into my heart that I want to share the whole passage with you here.
Prior to this passage, the people had complained that they had gone through the act of fasting, but God hadn't done what they wanted Him to do. God replies:
Is not this the kind of fasting I have chosen:
to loose the chains of injustice
and untie the cords of the yoke,
to set the oppressed free
and break every yoke?
Is it not to share your food with the hungry
and to provide the poor wanderer with shelter--
when you see the naked, to clothe him,
and not to turn away from your own flesh and blood?
Then your light will break forth like the dawn
and your healing will quickly appear;
then your righteousness will go before you,
and the glory of the Lord will be your rear guard.
Then you will call, and the Lord will answer;
you will cry for help, and he will say: Here am I.
If you do away with the yoke of oppression,
with the pointing finger and malicious talk,
and if you spend yourselves in behalf of the hungry
and satisfy the needs of the oppressed,
then you light will rise in the darkness,
and your night will become like the noonday.
The Lord will guide you always;
he will satisfy your needs in a sun-scorched land
and will strengthen your frame.
You will be like a well-watered garden,
like a spring whose waters never fail.
Your people will rebuild the ancient ruins
and will raise up the age-old foundations;
you will be called Repairer of Broken Walls,
Restorer of Streets with Dwellings.
Steph urged us to pray that God would use us to "restore broken bodies, broken lives, broken spirits, broken families." After the individual prayer time, Dr. Bill McCoy shared a few thoughts about the people that God has used to build the new facility, many faithful servants of His, some indifferent, some even antagonistic to the things of God. He then closed in prayer.
There was a sweet atmosphere that hovered around us as we lingered, and visited with each other before separating and going home.
3. Chaplain Moses