The Foot Club

This is why I always reinforce Jeremiah's casts with fiberglass!

Yeah, it's a pun.  As people who follow this blog know, I have a special interest in treating kids with clubfoot, (technically called "congenital talipes equinovarus").  These kids are treated by the "Ponseti Method", which involves stretching the ligaments in their feet, and applying casts.  The procedure is done weekly for several weeks, and then is usually followed by a simple operation to lengthen their Achilles tendons.

Seeing the kids over and over weekly allows me to develop more of a relationship with them than with most patients.  Most don't come to love me as much as I love them, however!

Some members of Dr. Andy's Foot Club

Lately I've had several older kids (treatment started after the age of 24 months is called "neglected clubfoot" and is usually more difficult than when you start younger.  One is Jeremiah.  He is five years old, and is not at all afraid of me nor of the power cast cutter that I have to use to remove his casts each week.

This past week, because of a heavy work load, I asked him to skip a week, and come back after 2 weeks.  This gave him extra time to destroy his casts.  He usually crawls around in the dirt and rocks, but this time has obviously been in some serious mud.  For kids who are big enough to crawl, I always reinforce the plaster casts with fiberglass.  Just imagine what these casts would be like if they were only plaster!

Feet are pointed down, turned under, twisted at the center

People here rarely have the opportunity to develop friendships outside their own or neighboring clans.  The families that gather every week outside the orthopedic room for my clubfoot clinic, have a lot in common in their children.  They get to know each other, they sometimes helps with holding kids, giving advice, etc.

The talipes work is one of the most rewarding parts of my life here.  You've seen this in some of the older posts, like this one.  Seeing a child who could only look forward to a life of disability and exclusion from a normal life be able to return to normal in just a few weeks provides a special feeling.  And for most of these kids, the contrast is really that great.  With untreated clubfoot, they are marginalized, unable to participate in many normal activities.  After treatment they usually can live and function normally.

AB

Preaching At a Bush Church

I was invited speak this morning at a new preaching point.  It is an offshoot of the Kurumul church, which is the second-oldest Nazarene church in PNG.  I didn't realize that it would be about a half-hour walk from the road, but it wasn't a difficult walk.

Here is a "preacher's-eye" view of the church.  I preached from Luke 15, the story of the Prodigal Son, one of the clearest passages we have on grace and the Father's love for us.  Nine people came forward to pray, all Christians, several of them believers for many years.

AB

Round Numbers

Number 190035.  I think.

Yeah, I'm the kind of guy who loves to see big, round numbers.  Like on the odometer of a car.  I think it's fun to notice when the mileage rolls around to 100000, or 123456, or 111111, or 020202.  I have even been known to pull over to the side of the road to stare at a number for a minute, or to take a picture of it.

So naturally I took notice when I started seeing the patient numbers at the hospital approach 190,000.  When we write a discharge summary for a patient who is well enough to go home from the hospital, we note the number so that the hospital record can be found easily later if needed.  I started wondering when the numbering system had been adopted.  Was it with the first patient who was admitted, or did they start this system at a later time.  I asked around, but no one seemed to know.

Then I had an inspiration.  I correspond with Hal Frye, who was either the first, or at least one of the very early administrators here.  I emailed him and asked about it.  He wrote back to say that he believed that the system started from the very beginning.

When I saw that the new numbers had gone past 190,000 I got to thinking that it would be fun to take a picture and to tell you all about him or her.  After a few days, I "sprung" (sometimes I spring slowly) into action, and went to the log book and looked up patient number 190000.  It was a lady named Elis who had been admitted to the maternity ward several days earlier.  I went to the ward in hopes that she was still there, but she had had her baby, and was long gone.

The next morning I was discharging a baby from the pediatric ward, and noticed that his number was only about 190035 (sorry, I didn't write it down, so I'm not sure).  I figured that he was the closest I'd come to documenting the big even number, so I took his picture.

What's the point?  It's that the hard work, prayers, giving and dedication of Nazarene people everywhere (and a lot of others as well) has resulted in ministry to 190,000 men, women, boys and girls in the wards of Nazarene Hospital.  If you think about the families of patients, I'm sure that you could multiply this number by 5 or 6.  Then think that we see about 10 outpatients for each inpatient, and the number is into the millions.

Some of those people had minor problems, some had devastating diseases or injuries.  Some recovered, some died.  Some were Christians, some weren't.  Some heard the gospel and accepted it for their soul's salvation.  Some turned cold hearts away from the message.  But every one was touched in some way.  Every one was loved.  Every one was prayed for.  Every one was more than a number.

AB

You Can't Have Too Much of Baby Andy

This is a first for me, embedding a video in the blog.  However, it is a far too important video not to publicize far and wide!



There you go!  Amazing, huh?

My Morning

So, ya wanna know what I did between ward rounds and lunch today?  Today was my "half-day", which is one day per week when each doctor has some time away from the hospital to do non patient care work, or catch up from times on call.  Whether is is really half of the day, or more or less depends on how many doctors are here, and how busy things are.  Sometimes there are enough doctors that we can leave the hospital right after ward rounds.  Sometimes we work in outpatient until lunch time.  If we are particularly short-handed, we don't take the half-day at all.  But this week we tried out a new system; after ward rounds, we see eight patients in outpatient, and then go.

Patient number 5.  With his mother.

So, I thought you might like to know about the eight patients I saw.  They represented a good selection of the patients we see.

1.  A young adult woman with a bladder infection.  She had taken medicine for a week, but didn't get better.  I was pretty sure that it was really a bladder infection, so I prescribed a different antibiotic.

2.  A young woman with a couple of lumps on her arm.  I told her that these were lipomas, and were harmless, that they didn't need to be removed.  She was quite uncertain, and asked several time if they should be removed.  Finally she asked if they were cancer.  I assured her that they weren't, and she finally seemed relieved.

3.  A man in his early thirties who had recently completed treatment for abdominal TB.  He was feeling well, his exam was normal.  Those meds really work!  And, yes, TB can infect areas other than the lungs.

4.  An elderly lady with a chronic cough.  She has been treated for both pneumonia and chronic obstructive pulmonary disease, but has recently started coughing up blood.  I got her most recent chest x-ray from the x-ray room to review.  I then sent her to the TB nurse to start TB treatment.

5.  Baby boy with several days of diarrhea.  Not sick enough to need to be admitted to the hospital (he was laughing and smiling, for goodness' sake--a sure way for a baby to disqualify himself from admission to our hospital!) I prescribed some meds, and asked his mom to bring him back on Friday, sooner if he should get worse.  See photo above.

6.  A young woman with chronic pelvic pain.  She had been treated several times for pelvic inflammatory disease, without any improvement.  When I examined her, I noted that her uterus was enlarged.  In fact, it was about the size of a uterus with a 12-week pregnancy.  Yeah, yeah, I should have asked her about menstrual periods earlier, but I asked then, and she said that she hadn't had any for at least 2 months.  An ultrasound revealed a healthy 14-week pregnancy (2 weeks error ain't too bad in this situation).  I gave her vitamins, iron tablets and paracetamol to take for her pain.

7.  Young man with a severe cough, fever and a sore in a location that suggested a venereal disease.  I sent him to the lab for a test called a VDRL, and to the x-ray room for a chest film.  Because I thought he was number 8, and I didn't want to wait around, I asked Dr. Imelda to review his results and write for meds when he got back.

So now I realize that I only saw 7.  Wait!  There was an old man who wandered into outpatient who thought that when the doctor told him to come back in 2 weeks that meant he could skip paying fees and waiting his turn in the long discouraging line.  I had sent him to go pay and wait.  I wasn't going to count him, but without him, I only saw 7, so now I think I should count him.  He has benign prostatic hypertrophy, by the way, with complete urinary outlet obstruction.  He was being treated with a catheter and medicines.

There.  That's 8.  Good variety, but not fully representative of what we see.  There was no trauma in the group, no fractures, no arthritis, no abscesses, no malaria, and no AIDS, which are all pretty common in our work.

AB

Saturday in Kudjip

What do we do on a Saturday on a tropical island?

Some of us sleep.

Some of us long to eat small children.

Some of us work on refinishing the tennis/basketball court.

And some of us watch.

Some of us make dog and cat food.

 

Some of us keep working and working.

And some work in different ways.

Newly engaged couples take romantic walks - not holding hands of course.

And we knit!

JB

Catching Up

Yes, we're back in Kudjip after a wonderful 3-month home assignment and 4 weeks of vacation in the US.  We had wonderful times with our kids extended family, friends and hundreds of Nazarene supporters.  Here are a few photos to catch up on the trip back and the first few days here.

In the morning of our departure day we stopped by to see my dad at Karcher Estates, where he has lived for the last 15 years or so, first in Independent Living with Mom, then in Assisted Living, and now in "Health Care".  Dad had a stroke in December, and is now unable to walk.  It was hard to see him so dependent, but wonderful to see how his spirit, his love for Jesus, and his indomitable humor are still fully intact.  We hope to see him again here on earth, but if that is not in God's timing we will plan on a big reunion in heaven.

My sister Cammi and bro-in-law Denny Ellis took us to the airport, along with Sam and Amy.  Here Cammi is showing the info sheet on their new sponsoree in the Nazarene Child Sponsorship Program.  He is Josiah John, the son of one of the pastors near Kudjip.  His family have been our friends from our earliest days in PNG.  He has a little brother who is my namesake.

Our return route took us through Fiji.  Because the Pacific Air did not check our bags through to PNG, we had to claim them in Fiji, wait in the very long lines for Fiji Customs and for Immigration, and then take them a distance to the arrival lounge to the Air Niugini counter and check them again. It took a long time, but went OK, and Air Niugini did not charge us for excess baggage, as Pacific Air had done (we're not feeling like recommending Pacific Air right now).

When we finally made it through to the departure lounge, we only had about an hour to wait for our flight.  In typical Fiji fashion, they had this group of musicians performing for the waiting passengers.

The big surprise was who we encountered among our fellow passengers: Harmon and Quinton Schmelzenbach.  Harmon is our Field Strategy Coordinator (fancy language for "boss").  They were booked on the same Air Niugini flight from Fiji, but only as far as the Solomon Islands (Fiji and the Solomons are both part of the territory that Harmon is responsible for).  They were actually in the flights immediately behind us on the plane, so we managed to have a good visit as we traveled.  (That's Quinton in the middle of the photo, using the free internet.)

We arrived back in Kudjip, 36 1/2 hours after leaving Boise.  It just took 6 flights (Boise-Phoenix-Nadi-Honiara-Moresby-Hagen).  The ride from Hagen to Kudjip was provided by Tim and Karla Deuel, new missionaries who arrived in Kudjip just a couple of weeks before we left.  At the house were the usual welcome signs.  It took a while to locate the keys to our house, but eventually we got in for quick showers before proceeding to supper with Randy, Joani, Emma, Alexia and Ethan Goosen.  They are new missionaries who arrived just days after we left for home assignment.  We met Joani's parents in the US, but this was our first meeting with them.

 

Emma and Alexia                                              Ethan              

Simon, Esther and Ishigel Tausi came by the next day.  Here they are looking at our album of photos of Baby Andy.

Our "old friend" Bobby is doing well!  He's now living with the Tausis.  He got some lollies from the bag of candy that Sam sent for his PNG brothers, sisters and friends.  Bobby's new favorite words are "choc", "o" and "late".  "Late is pronounced like "late at night".

***

We're now settled back into our Kudjip routine.  Each departure from the US is different than the others.  This time we were affected by the fact that we were leaving a new little grandson behind, as well as our kids, Dad and the rest of the family.  The veteran missionaries told us early-on that the departures don't get any easier as time goes on, and they were right.  But we love PNG, we love Kudjip, we love our family here, both missionary and PNG, and we love being in God's will.  We know that, for now at least, this is where He wants us, and we are happy serving him here to the best of our abilities.

AB