Being a general surgeon in Papua New Guinea means that some days I do orthopedic surgery, others urologic or gynecologic, and on others, trauma, plastic or burn surgery. Variety truly is the spice of a surgeon’s life here. One of the more rewarding “surgeons” that I get to be is a pediatric surgeon.
Each week I have the privilege of getting to take care of children who are sick, hurting, and in need of surgical care. This past month seems to have been filled with more sick kids than usual. I wanted to share the stories of two of those children with you. Getting to take care of these small patients has been an incredible privilege.
Simpson is two-and-a-half-year-old boy who is almost the exact age of our second son, Matthias. Simpson came to the hospital short of breath and very sick. His chest x-ray showed an enlarged heart, several times bigger than normal. Based on the history of tuberculosis in his family, he was started on a course of treatment. However, after a couple of days of this his condition worsened. Dr. Erin, one of our family doctors, realized that something other than tuberculosis must be the cause. In the middle of the night he was having difficulty breathing and his blood pressure began dropping. After scanning his heart with the ultrasound, Dr. Erin drained a significant amount of pus from his pericardium (the lining that surrounds the heart). This temporarily relieved the pressure on his heart and allowed his vital signs to improve. The next morning I took him to surgery and did a procedure called a pericardial window to drain and washout the infection surrounding his heart. When we arrived in the OR we found that Simpson had no intravenous access because of the severe swelling from his infection. In the night, Erin had put in a special IV line directly into the marrow of one of his leg bones. Unfortunately, this was no longer working and we struggled to find alternate access. Simpson’s infection was so severe that it had caused a condition called Disseminated Intravascular Coagulopathy (DIC), which was making the veins all over his body fill up with clots. I tried unsuccessfully to put a large IV in one of the veins in his neck, legs or upper arms.
Dr. Paul Hitchen, a visiting orthopedic surgeon from Australia, was finally able to place another IV in Simpson’s bone and this allowed us to complete the procedure.
Simpson is still in the hospital and has had several setbacks along the way, but we praise God that he will soon be going home. He’s alive today because of the Lord and thanks to the great team of doctors, nurses and volunteers we have here at Kudjip.
Remna is a ten-year-old girl who has been Simpson’s bed neighbor on the surgery ward for the past couple of weeks. Remna was initially admitted to the pediatric ward with fevers and several painful and swollen joints from septic arthritis. Unfortunately, like many of our patients, she had come to the hospital very late and her disease was extensive. Despite being started on multiple antibiotics, her infection spread and she began to have difficulty breathing and, just like Simpson, her blood pressure started to drop.
On chest x-ray, her heart, like Simpson’s, was enlarged. The ultrasound showed that her heart was struggling to beat because of all the pressure from the fluid. As we were getting ready to start the procedure to drain the fluid around her heart, her heart suddenly stopped beating and we had to begin CPR in order to save her life. I quickly placed a large needle under the edge of her breast bone and withdrew some of the fluid around her heart to relieve the pressure. Fortunately, it was thin, watery fluid and not pus. During CPR I was able to place a drain into the space around the heart that allowed the fluid to come out. The drain removed almost a liter of fluid from around her heart. During the next twenty minutes (which felt more like twenty hours) we continued CPR.
In total, Remna was defibrillated four times, but eventually she resumed a normal heart beat and regained a blood pressure. Clearly the hand of the Lord was upon Remna in those moments. The type of drain that we used to remove the fluid from her heart is not something that could be purchased here in Papua New Guinea. However, on the most recent shipment of supplies from Nazarene Hospital Foundation, we received a number of donated pericardial drain kits. This is not coincidence, but rather divine provision!
When the procedure was complete, we eventually drained the infection from her joints and then prayed that she would wake up. When we checked on her later that evening she was awake, talking, and telling her mother that she was hungry! Through her recovery she has shown no signs of any brain injury or damage. Remna still needs a lot of prayer and ongoing care. She now has a deep infection in several of her major bones (called osteomyelitis) that will require months of care, and possibly more operations in the future.
These two children represent the reward and privilege that I feel it is to care for some of the sick children who arrive at Kudjip Nazarene Hospital. They are a testament to how the Lord provides what we need exactly when we need it. Sometimes he sends the right person to do a procedure or sometimes its a medicine or specialized piece of equipment. These kids also represent the many other stories of children that I haven’t shared. Perhaps some of those stories aren’t as hopeful and unfortunately, in some cases, the families of those children continue to feel the loss of their little ones that we couldn’t save. But in the midst of it all, we know that God provides the hope, grace and comfort that each of our patients needs.
“Whatever you did for one of the least of these brothers and sisters of mine, you did for me.” – Jesus
I’ve been meaning to get this post up for over a month now but haven’t been able to get around to it. What follows is a collection of photos from one Monday at the hospital. This was a busy day that included forty-nine patients in the clinic, three minor procedures and two major surgeries. Thanks to our amazing staff and my doctor colleagues I still made it home in time to play with my boys.
After morning report I head for the pediatric and medical wards to see consults and then to the surgery ward to round. As I’m starting rounds we find out there is a cesarean section that needs to be done before I start seeing clinic patients.
The operating theatre staff (yes, the British colonial influence lives on) had the patient ready and mother and baby were soon headed back to labour and delivery safe and sound. I couldn’t do what I do without such committed, caring and compassionate co-workers.
With the case done we all head for the surgery clinic to get started, a little late but all the patients are still there waiting. Walking through the ER on the way I find Dr. Bill and Dr. Erin stopping the bleeding from a patients arm who had been assaulted with a machete. Looks like I have another case for a little later.
The rest of the morning and early afternoon are spent bouncing between the clinic and the minor procedure room. Later in the afternoon we head to the Operating Theatre to finish patching up the man from the ER. During the case the skies open up with a downpour, it’s finally raining in PNG again!!. The afternoon rains also serve another purpose, they cool of the OR.
I take one last look at the ER door through the trees as I make the turn for home, hoping I don’t get called tonight. On the walk home I enjoy the views and the smell of a rainy PNG highlands afternoon. I’m almost home when I hear, “Daddy!” and see Simeon sprinting up the road towards me. It’s now a very good day. I’m grateful that we are here.
Papua New Guinea is a land covered in mountains and rainforests. Typically the monsoon rains roll out across the Pacific from southeast Asia and keep PNG soaked. Our year here is marked by two seasons “rainy” and “dry.” Dry season usually meaning it only rains 2-3 times per week instead of twice a day. This year is quite different. The monsoon season that usually will run through June ended early with very little rain in June-September. This included a five week stretch without a drop. This abnormal weather is being caused by one of the most significant El Niño weather patterns in recent history. While other parts of the world are flooding PNG is on pace to have one of the driest years in its’ history. Similar droughts having occurred in 1964 and 1997. In a place where almost everyone relies on their gardens for most of their staple food this is starting to become a real hardship with many families going hungry. The staple food here is kaukau, very similar to yam or sweat potato, which is harvested four times per year. One growing cycle has been completely lost and another is in jeopardy. Imagine how this affects a place that has no familiarity with drought and where most homes are still without electricity. This country’s ability to cope with drought and famine is not present. We need rain and need it badly. I can not recall every experiencing first hand how important water is. We’ve begun seeing increasing numbers of infectious diseases related to the worsening water supply. As small streams are drying up and people are utilizing the bigger rivers nearby much more heavily the contamination in these water sources is mounting. The Kane, our river, is now so low that even with the new reservoir the hospital’s hydro is not able to produce enough electricity to keep the station and hospital powered. We have resorted to running on generators for long stints when the water level is too low. The hospital’s backup generator is in the process of being replaced as the current one is well beyond its’ lifespan. Usually the generator kicks on in a few seconds when the power goes down but today the auto switch was not working. The lights were out for several minutes in the operating theatre. Today, I was thankful for battery powered headlamps and a battery backup for the anesthesia machine. I was also reminded of one of my favorite quotes from a seasoned missionary surgeon, “Anyone can operate with the lights on.”
In my short career as a physician I have offered to pray with countless patients. I remember feeling a bit apprehensive about this in my early years of medical training. Would he be offended? Might she say ‘no’? What if a nurse (or worse yet, my preceptor) walked in while I was praying with a patient? But very quickly, those moments of solitude and connection with patients and their families became my own refuge. I would look forward to opportunities to provide this gift of prayer to those who desired comfort and peace in some of the most lonesome days of their lives. And since that very first day that I, a timid medical student, sat at the bedside of a terminal patient and prayed a quiet prayer, not one patient or family member has ever declined my offer. I believe there’s a message there! Particularly in the medical world, prayer opens doors and creates a space that is safe, accepting, whole and impartial. Prayer allows for the most unique opportunity to commune with the One who makes all things new, whether in body or spirit. Now that I’ve transitioned into this life of medical service in a mission hospital you’d be correct to assume that the opportunities to pray with patients are countless and precious. My challenge at the start was to learn how to pray in a new language and meaningfully express what I could easily articulate in my own language. I still find myself paying close attention during prayers in church or when I’m working with one of our hospital chaplains as they comfort a patient. There are certainly times when my Tok Pisin words are not enough, but thankfully, God hears prayers in all languages, including those of the heart. In the last two weeks it seems that I’ve encountered some of my more sweet moments of connection with patients and I hope that these glimpses into my clinic exam room will serve as a reminder to pray for our work in the hospital as we minister to both the physical and spiritual needs of our patients.
Maria came to my clinic room with her son one morning. As she entered the room, I hoped that she might share that she was here for an antenatal visit. Unfortunately, this was not the case. She was not pregnant. For several months now she had slowly been accumulating fluid in her abdominal cavity and she also complained of right-sided pain. She had been seen in several other medical facilities and at the last hospital where she was evaluated, she was told she likely had abdominal tuberculosis. As I heard her story and examined her full-term-sized abdomen, the diagnosis of abdominal tuberculosis rose to the top of my differential diagnosis. However, as I got her comfortable on the ultrasound table and moved the probe over her right-upper quadrant, the abnormal appearance of her liver suggested that her diagnosis was unlikely Tb and more likely chronic liver disease. I had hoped it was tuberculosis, because we have treatments for this very prevalent disease. Chronic liver disease in this middle-aged woman will come with many doctor visits and likely hospitalizations as well. She’ll be on diuretic medications for the rest of her life and eventually this disease will likely claim her life. I prayed with Maria that morning after sharing this news with her. I prayed a prayer that I pray with most every patient. “Papa God, stap klostu Maria. (Father, be near Maria.)” In my own heartache and desperation, I’ve found that closeness and communion with my God is the only thing that brings peace beyond measure.
Nenspe is a sweet old papa who was led into my exam room by his two adult children. He used his bamboo walking stick to lower himself onto the chair. Nenspe’s daughter shared his story. For two months he’s been having increasing difficulty swallowing. At first it was hard to swallow rice and kaukau, but now water won’t seem to stay down either. He vomits after most meals and says food seems to get stuck in his chest. He has been losing weight and can hardly climb small hills, let alone the mountains that he could easily manage before. The rest of his story, my exam, and his chest x-ray confirmed what seemed most likely from the start. Nenspe most certainly has esophageal cancer. His children were realistic about his diagnosis and his daughter even said that Nenspe himself felt certain he had cancer. I referred him to a nearby hospital for a barium swallow study to help confirm the diagnosis and I prescribed some mild pain medication. The family is Lutheran and Nenspe has given his life to the Lord. His son, who was present, is a pastor and felt so privileged that I would offer to pray with them. They all prayed aloud with me and I believe the Lord heard our prayers and will answer our request for peace that passes understanding. I asked if I could take a photo of Nenspe to share with my family and friends who will also be praying for him. I’m grateful for the lack of privacy laws in PNG that in any developed nation would prevent me from sharing these stories and photos. This family was thrilled to know that others would pray as well. After I took their picture, Nenspe’s son insisted that I get in the photo as well so that he could take one with his phone and share it with their village. Nenspe knows that this cancer will claim his life one day, but he testified that God claimed him first, so he’ll rest easy in that promise. What a beautiful story of the surrendered life!
Matlyn was especially quiet as she made her way into my room with her grown daughter and brother. As I asked about her symptoms and what brought her to Kudjip that day, her daughter asked if she could tell the story for her mom. About seven months ago, Matlyn felt a small lump in her tongue. She ignored it at first because it was small and not all that bothersome. But over the last few months her tongue has become more sore, firm and now she can hardly talk or swallow. As I listened, I wondered to myself what I would find when I donned my gloves and asked her to open her mouth. The few times that Matlyn spoke were mumbled and she had difficulty controlling her saliva. My exam revealed what I feared…advanced tongue cancer. The entire right side of her tongue was a solid mass which had grown into the soft tissues below, tightly tethering it. She could not move her tongue more than a centimeter at the very tip. Unfortunately, Matlyn was not from our province and any biopsy or treatment (which was unlikely) would have to be done at the next provincial hospital. Her prognosis is dismal, but once again, I was allowed to enter into a beautiful time of prayer with this family. As I began to pray, the daughter asked if she could share one more thing. Matlyn is a mother of eight children, but only five are now living. Matlyn’s oldest daughter proceeded to share that Matlyn’s 17-month-old daughter passed away last week after complications from tuberculosis. I could hardly contain my sadness as I allowed this piece of news to sink in. In those moments, I prayed for God’s infinite grace to settle over this family and for His spirit to comfort the deepest reaches of their souls. And what a blessing to know that those words are not empty, nor do they fall on deaf ears. In this place, where death and tragedy are daily occurrences, I often remind patients (and myself) that God does not promise to bring complete and miraculous physical healing (although He is able), but he DOES promise to abide with us and weather the storm with our hand tightly grasped in His. The storm may rage around us and threaten to swallow us, but our God remains a firm foundation, the hearer of our prayers.