This certainly has been an odd trip to the USA for our family this time around. Normally we would have spent most of this time back traveling, speaking and meeting with friends and family. However, this pandemic significantly altered those plans. Ben has had a few opportunities to record some speaking for online broadcast. We wanted to share one of those recordings with all of you. We hope this will give you a glimpse in to our lives, our call and the work we are doing at the hospital in Kudjip, PNG. We are sad that we haven’t had the chance to see you in person but will look forward to the day when we can!
Here is our prayer card in digital format since we haven’t been able to give you a “real” one. If you’d like one to place on your fridge or stick in your Bible we’d be happy to mail you one. Just drop us an email at firstname.lastname@example.org with your mailing address and we’ll send one your way!
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!
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.
Shift change at the nurses station with the nurses and nursing students preparing for the day.
Mr. Pia, one of the senior staff.
Bruce, senior nursing student and Sr. Edna humored me as we raced through rounds.
Our semi-private rooms.
Sr. Alice, the wound care Boss.
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.
“Auntie” Margreth, supervisor of the Theatre staff, has given her life to make surgery a Kudjip a success.
Mr. David, senior anesthesia nursing officer
Sr. Miriam, scrub nurse.
The crew, getting organized for the rest of the day.
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.
Bill and Erin stop the bleeding and stabilize the patient in the ER.
Surgery clinic waiting room.
Sr. Roselyn taking care of tropical ulcer in the clinic.
Sr. Veronica, makes sure I don’t forget to check and see if Pathology results are back online. Thanks to IPS we have reliable path that doesn’t take a year to come back.
Central supply staff. They work hard helping us make the most of what we have. We reuse and repurpose a lot. Disposable things do eventually become disposable unfortunately 🙂
Sr. Melvin, surgery ward supervisor and Mr. Lash, anesthesia nursing officer, make sure the inpatients who need procedures are ready in the minor procedure room.
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.
A view of the ER from the turn for home.
The old hospital sign just steps from the house I grew up in.
Nice views on the walk home.
The rains returned it’s green again.
Bananas, just about ready to cut.
Aunt Lydia, Simeon and Matthias. If this sight doesn’t make a dad’s day I don’t know what would.
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.”
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.