After quite a long hiatus from providing patient care (and no, I’m not counting all the doctoring I do at home), for the last few months I’ve returned on just a short-term basis to help in our cervical cancer screening clinic here at Kudjip while two of our other physicians are away. The White House, as we call it, serves not just our female

population, but also a growing group of patients with HIV/AIDS. I will say that after being absent from the doctor-patient relationship for a couple of years I was a little nervous about what the return to medicine might look like for me. I suppose that practicing medicine, in some ways, is a bit like riding a bicycle. There are aspects of being a physician that (for me, at least) require little to no practice. The building of a relationship and creating a space where a patient can be vulnerable are things the Lord has helped me to do with ease, much of the time. However, a doctor also needs to know things! Ha! And I feel so out-of-practice when it comes to creating differential diagnoses and choosing appropriate medication regimens. But, fortunately, I know that those things will all come back with time once I’ve returned to the hospital on a more regular basis (even though at this point I don’t know exactly when that will be).

But in the meantime, I am absolutely loving the chance to care for these precious women in our cervical cancer screening clinic. During the week, my dear friend and gifted nurse, Pauline, sees women from all over our area who have been referred to the White House for the initial screening for cervical cancer. We don’t use Pap smears here at Kudjip because they

require a sample to be taken, stored, transported, viewed by a pathologist and then results reported back to us. We’ve found that this method of screening presents a lot of challenges, including follow up for these ladies who often don’t have cell phones or who may have made a full day’s journey to get to us in the first place. So, believe it or not, we have an equally effective method to screen for cervical cancer and it utilizes something found in most kitchens—vinegar! A dilute vinegar solution causes abnormal cells on the cervix to turn white and also allows us to directly visualize (with a colposcope) other changes that are indicative of all stages of early cancer cells.

Each week Pauline sees ladies from all over our area who have been referred to the

White House for one reason or another. She does an initial evaluation on these women and then refers the more concerning cases for me to see on Wednesday mornings. Often I’ll find pre-cancerous lesions that can easily be treated with cryotherapy (liquid nitrogen that freezes abnormal cells). This is an incredibly simple and cost-effective procedure that can be done at the time of initial evaluation and it absolutely save lives. Occasionally we find pre-cancerous lesions that are more progressed and in these cases we can schedule the patient for a LEEP (Loop Electrosurgical Excision Procedure) to be done at the hospital procedure room. And, as is sometimes the case, we discover more advanced disease. If the cancer seems localized to the cervix still, we are fortunate to have surgeons (I happen to know a good one) who can do a hysterectomy to save the woman’s life. And the

saddest cases are those that we see too late. Unfortunately, it is one of the stark realities of practicing medicine in a remote, underdeveloped place like Papua New Guinea. Some of the more advanced cancers that we see might be helped with radiation, but there’s currently not a hospital in this country that provides this service. I’m grateful that, even though we cannot always provide a life-saving measure, we CAN provide the hope of Jesus. Its really easy to feel overwhelmed by the sadness for the ones we cannot physically save and forget that there is One who provides healing of another variety that is far greater than the limited measures we can provide. And when I have the opportunity to share this very truth to the broken woman sitting before me, I realize that all of a physician’s book knowledge becomes a little less important, both for that moment and for eternity.

One of my favorite things about being a surgeon in PNG is that my children get to experience what I do in an up-close and personal way. In some ways I think it makes it much easier for them to understand the “why” when I have to leave the dinner table early or head to the ER in the middle of a bedtime story. It’s always a highlight for me when the family joins me on rounds. I think the only people who enjoy their company more than I do are my patients and the surgery ward nursing staff.

Naomi is the least shy of our four and is always there to ask questions, shake or hold a hand and greet the patients in “Tok Pisin.” The patient in this picture is a young girl who had a terrible infection of her right foot that required multiple debridements. Her heel bone ended up exposed and she’s now on wound VAC therapy to help prepare the wound for a skin graft sometime soon.

Matthias was quite fascinated by the wound VAC machine. He and Simeon always want to know how things work. They kill us with questions.

This young guy was speared in the left chest. The weapon narrowly missed the heart and injured one of the veins in his left lung. He lost a lot of blood but his family got him to the ER in time for us to help him. We thank the Lord for a team here at the hospital who can respond quickly when the need arises.

Naomi, ever the inquisitor, wanted to know why he’d been stabbed. This led to a conversation with a 2-year-old and a 6-year-old about what it means to be so drunk you can’t remember what happened. Life is just filled with teachable moments.

Ever the helper, Naomi insisted that she help Daddy with the chart. I found it most helpful for her to hold the medicine reconciliation sheet so I could check the patient’s meds while I wrote orders and notes.

This man had an unfortunate encounter with his brother’s bush knife (machete). It seems that his brother was less than pleased that the patient’s pig had gotten into his garden and damaged his crops. As an old missionary surgeon I know commonly said, “With families like these, who needs enemies.”

This is Chris. He’s been my patient now multiple times. He suffers from a terrible infection in the bone of his upper arm that has required multiple operations to try and get it cleaned and healed. This picture is from the second half of rounds. The other three kids have been otherwise distracted, but not Naomi. I’m pretty sure she thinks she’s already the Chief.

Right now we are in between trainees at Kudjip. This means that on the weekends if I want company on rounds I have to bring my own junior colleagues. That’s a pretty special privilege if you ask me!

Our days at home in the last months have been full of fun celebrations, visitors, and new friends. The kids are growing at lightning speed and I only wish I could share (or remember) all of the hilarious things they’ve done and said that have kept us in stitches. But this photo blog should get you caught up on some of the other highlights on the PNG home-front!