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.”

When you turn on your faucet and water comes out, flip on a light switch and the lights come on or enjoy the luxury of flushing a toilet,  remember to pray for rain in PNG.

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.

As a surgeon I often get to care for patients who find themselves in desperate need. One time it may be from advanced cancer, another from severe infection, and yet another due to a car accident or an act of tribal or domestic violence. These individuals come to Kudjip looking for healing as well as something or someone to ease their suffering. One of the most challenging lessons that I am learning is that not every patient can be helped. Sometimes my best as a surgeon just isn’t good enough. Too often what we have to offer in this resource-limited place just doesn’t cut it. I knew that this would be the case long before I moved back to PNG to serve. I don’t think I was naive about the reality of being a surgeon in Papua New Guinea. In the past five months I have witnessed more death on my watch than in my five years of surgical training.  I’d like to think that each of these deaths has been from advanced disease or lack of resources.  But I know there have been instances when my inexperience as a young surgeon has led me to operate when perhaps I should have waited or maybe not even gone to surgery at all. Thankfully I have an experienced, invested, and supportive senior partner who on many occasions has gotten me out of a jam or kept me from getting into one in the first place. To have my father as a partner is an incredible resource and thrill for me. He has helped me to see which patients we can help and how best to do it. And at times, he’s shown when it is best to do nothing. I am coming to realize the truth of the surgical adage that states, “The best surgeons are the ones who know when not to operate.” Its becoming clear that this wisdom comes from experience…experience that sometimes teaches unpleasant lessons.

As a physician I feel that I’m called to go to battle with death and disease. But as a follower of Jesus I am compelled to believe that we were not brought into existence for death and disease. The Creator’s intent was never suffering, but rather life…and life to the fullest.  Two poems have been on my mind as I have been wrestling with these concepts of life and death in this setting where they are so very tangible. These poems have crossed my mind frequently at the end of the day or in the middle of the night after a particularly difficult case or when I’ve done all I can for a patient on the ward. I’ll share portions of each that have been especially present on my mind in these days. The first is Dylan Thomas’s, “Do not go gentle into that good night.”

And you, my father, there on the sad height.                                                                                     Curse, bless, me now with your fierce tears, I pray.                                                                                 Do not go gentle into that good night.                                                                                                 Rage, rage against the dying of the light.

The second that has become so meaningful to me is Annie Flint’s, “He giveth more grace.” The second stanza has become my testimony in recent days.

When we have exhausted our store of endurance,                                                                           When our strength has failed ere the day is half done,                                                                   When we reach the end of our hoarded resources                                                                               Our Father’s full giving is only begun.                                                                                                     His love has no limits                                                                                                                                   His grace has no measure,                                                                                                                             His power, no boundary know unto men;                                                                                               For out of His infinite riches in Jesus                                                                                                         He giveth, and giveth, and giveth again.

I want my patients to rage against the dying of the light. My promise to them is that I will do the same. The only way I make this commitment is through my firm belief in a God who cares infinitely more for my patients than I ever can.

“But He said to me, ‘My grace is sufficient for you, for My power is made perfect in weakness.’”  2 Corinthians 12:9a