My First 3 Days at Kudjip

I arrived at the Kudjip Nazarene Hospital in PNG late Monday evening after a day of travelling, and this is where I will be spending the rest of 2019. It has always been my dream to do medical missions in some form or another, and this all worked out so perfectly by God’s grace that I was given time off from work to be able to partner with World Medical Mission for two months.

I knew life here would be very different, so let me share with you a bit more about my past three days. (Apologies in advance for the medical jargon ahead)

It always takes me a while to warm up to my accommodation whenever I do missions, but this view and the cool air definitely helped me fall in love with the place!

My morning view outside my house

Day 1 (half day since I spent the morning doing a month’s worth of groceries from town) was a bit more of an orientation for me. I got a tour around the hospital grounds - we have five wards (paediatrics, medicine, surgery, obstetrics/gynae and TB), an outpatient department, an emergency department as well as a pathology lab and pharmacy. Here, doctors are expected to do a bit of everything - they work flexibly between different wards in the morning and then see outpatients in the afternoon.

This day, I shadowed Dr Nathan who has worked here for a number of years. Our first patient was a woman who had fallen and sustained a dislocated shoulder, which we reduced under ketamine sedation. An interesting note as I observed the open boxes of ketamine lying on the trolley - there’s no need to keep addictive meds in lock boxes to be signed out by two nurses, namely because we face very different problems here than back at home. I digress. Anyways, apart from that, we also saw a man with oral cancer barely able to open his mouth, a young boy who likely had a brain tumour based on a good story and the finding of evident papilloedema but unfortunately there are no CT or MRI scanners here (and the issue is even if we get the diagnosis, we don’t have neurosurgical capabilities), several pregnant mums, a woman with recurrent skin infections thought due to the locally-prevalent MRSA (a resistant bacteria), a man with post herpetic neuralgia complicated by amnesia from his pain medications and a few more patients who have escaped my memory as well. 

We have recently limited our outpatient attendees to 100 people per day due to being short staffed, but even amongst 4-5 doctors that is still a huge amount!

For the rest of this week, I would be doing morning ward rounds with Dr Susan in the paediatrics ward, followed by helping out in either ED or the outpatients department. 

Day 2 - We had only just started our morning ward rounds when Dr Susan got called to ED about a woman who was very short of breath. We went to ED and found this incredibly cachectic woman with a very distended abdomen - she suffers from liver cancer and recurrent pleural effusions (fluid build up in the space that contains the lung). She has a poor prognosis and only had the fluid removed 4 days ago, but it’s already re-accumulated. For comfort measures, we decided to remove the fluid again. 

My first time performing a thoracocentesis with guidance from Dr Susan

We head back to the ward after that, and saw a few more patients.

This happy little bubba got to go home cause he’s all better

Then I went to ED and saw a woman for wound review post C-section for eclampsia, a man with malaria, a woman who was kicked in her chest by her abusive husband, an accident victim who suffered a terrible clavicle fracture, a severely underweight baby who was born preterm at home and mum is not producing enough milk (picture below), another man needing a thoracocentesis for recurrent symptomatic pleural effusions, and an elderly woman in septic shock from pneumonia. Being so new here, it was extremely daunting to see this woman alone while the other doctor was on a break. I was told she wasn’t doing too badly, and then I got a manual blood pressure reading of 65/30, hypothermic 33C, hypoxic saturating 80% on 4L of oxygen, listened to a horribly crackly right lung and saw blood results - haemoglobin 6.1 and white cells 24.6. Unfortunately once again I am reminded that this is a rural hospital in a third world country - there’s only so much we can do. I give her fluids, antibiotics, oxygen and organise for a blood transfusion. Here, our blood bank will usually only release blood once a relative of the patient agrees to donate blood in exchange; namely because we have such a shortage of blood. Eventually we decided she was not for a trial of inotropes (intensive medications to raise blood pressure) partly because it is very difficult to execute here for multiple reasons, and due to her advanced age. We admitted her to the ward, and I’m not sure what has happened since. 

Day 3 today. Soon after I arrived to the paediatrics ward, I noticed a flurry of nurses heading for a very sick young child who was admitted overnight. He was unconscious but vomiting dark “coffee-ground” material through his nose and mouth despite a drainage tube put in place. I read the notes - this child has been unwell for two days, had fevers and seizures yesterday and is now unconscious. He was treated for meningitis (extremely common here) and all we could do next was wait and see. I could see the absolute devastation in mum’s face as she sat quietly praying by his bedside, while he lay almost completely covered by a blue UNICEF blanket to ward off the flies around him. I later learnt that he went into cardiac arrest in the afternoon and passed away.

In my three almost four years being a doctor, this is my first time experiencing the death of a paediatric patient under my care. Sadly though, I am certain he would not be the last in my time here. The harrowing sound of his mother’s wails from the morgue as she grieved the loss of her child will remain in my thoughts for a long time.

And yet.. the day continued, for there were still numerous patients that needed to be seen.

Happier parts of today - I ended the day with a lovely patient Mama Rachael who was soft spoken but had the biggest smile in thanking me for looking after her today, so much so that she insisted to bring me fruits next time. Also I had such a wonderful interpreter today named Jenny. She was very pleased that I was trying to pick up Tok Pisin and we had great conversations around faith and God as well, I was even blessed with a home grown cucumber from her garden after lunch today!

I would upload photos of them both but my blogspot and Digicel 3G are not keen to work together much longer. Also I just wanted to note that all these photos were taken with patient/parent consent.

All in all it’s really been a whirlwind of emotions and experiences, and I’m only at day 3! There’s truly so much to learn and so many people to love on while I have the opportunity to. I am so grateful that God had brought me here for this season, for such a time as this and I pray that He will continue use my hands and feet to do whatever good I am able to do. 

Dr Mark Smith

I remember wondering if I should text him when I found out our study group got cancelled, and eventually decided it would be better to say too much nice things than to regret never saying anything at all.

I didn’t realise those words would be the last thing I ever said to him.

Thank you sir, for how much you’ve sown into us. You will be so, so dearly missed.

The Waiting Place

"Be kind, for everyone you meet is fighting a difficult battle."

...

On a busy night shift a while ago, I picked up the next longest waiting patient to be seen. Before I left our staff base to speak to him though, I was warned by a colleague.

"Be careful, that patient looked really angry earlier."

I walked into the cubicle and was coldly greeted by a middle-aged man. The conversation escalated quickly as he was extremely unhappy about having to wait over two hours in the ED prior to being seen by a doctor, despite being given intravenous pain relief fairly early on. He had come in with abdominal pain and an intestinal stoma which had stopped functioning on a background of multiple complex abdominal surgeries for cancer in the past.

Whilst standing (generally a good sign that they aren't critically unwell), he looked me in the eye and said to me seriously, "If anything happens to me, it will be your fault. Maybe not you specifically Candice, but this hospital. It will be negligence, because I am a sick man, and I am not just someone with a broken leg or a mental health issue."

More than halfway into this demanding night shift where I had been working as hard as I possibly could, (let me be real here and say that) I was not very impressed in that moment. I did not appreciate the threats upon introduction, nor the sarcastic sighs and demands that followed.

Part of me wanted to retaliate. The truth is, he did not see the young woman I looked after while he was waiting. She was practically blue, struggling to breathe despite having the highest possible concentration of oxygen being delivered via a face mask. He did not see the crying woman who was miscarrying her unborn child and was bleeding large blood clots. Nor did he see the elderly woman dropping her blood pressure and becoming more and more unwell despite the machines we had her connected to to help her breathe.

Still, professionally and spiritually, I knew better than to fight fire with fire. I chose the wiser - I held my tongue and continued trying to defuse the situation.

"I'm very sorry for your inconvenience, but I can assure you that we are all trying our best to care for everyone in this department while being short staffed. Now, how can I help you? Tell me more about this pain."

He lay back down onto the hospital bed and started telling me about what had happened. His caring wife stood by his side and gently added information as he went along.

As he spoke, his anger dissipated slowly, revealing a very raw and vulnerable.. fear.

He was diagnosed with metastatic bowel cancer months ago and had been told that he had under six months to live. He explained that he was so scared of his bowels perforating after the intense surgery he had, and that he wanted to see a doctor quickly because he was afraid of this being the end of the road for him.

"I did the surgery because I wanted more time with her," he said tearfully while holding on to his wife's hand. She too wept softly while listening to him speak.

The initial tension in that room was long gone by now.
All that was left was, peace.. God's peace, I dare say.

Long story short, after taking a proper history and looking at his XRay, I figured out that he was actually constipated. His stoma was not working because it was blocked by hard faeces. All that needed to be done was to essentially "unclog the pipes". The three of us got to work manually clearing it bit by bit, even laughing together in that little cubicle that it still smelled like papaya instead of being malodorous. He began to feel much better once all that faecal material was removed, and his pain improved significantly too. I checked him over once more and satisfactorily told them that they could go home.

Their faces upon getting discharged were completely different that the initial glares I was introduced to. Their eyes were soft, the frowns replaced with an unmistakable peace, and they kept thanking me for taking care of him that night.

They offered me kind, large smiles of gratefulness as they waved goodbye to me and slowly walked out the ED together.

...

Be kind, for everyone you meet is fighting a difficult battle.

These words came to mind as I reflected on that encounter later in the morning. I remembered also a Bible verse that was prophesied over me in the past - "when treated with slander, you respond with kindness." That was from 1 Corinthians 4:13.

How grateful I felt really, that we got to have an ending like that after all that had happened. They truly were beautiful people, and it would've been a shame if I had missed out on seeing that because of my preconceived ideas, or if I chose to remain blinded by my own anger.

I write this story not to boast in any way.
I write this because it was a powerful reminder to myself to not judge people too quickly.

People will have reasons for their actions, and from the outside looking in without getting to know their battles, our judgments can too often be incredibly unfair and incredibly wrong. After all, we're all running our own challenging races in this life.

Perhaps all we need to do to see the beauty and magic all around us, is to take our eyes off our own pity parties, show a little kindness, and try, really try, to ease the sufferings of our fellow men, even if only in a brief encounter. 

Finding Peace

”Work can’t be your only thing. You’ll go mad within the week! I must admit, this really took its toll on me at one point too.
Do you feel like you have an outlet outside from work?”

The overwhelming kindness from my older colleague was completely unexpected; little did I know that my venture into his office to talk about a patient would end up in a short deep-and-meaningful talk.

There are days when it gets too much - unfair comments being made by other inpatient teams, manipulative aggressive patients, those I could not save, those I want to save but will not save themselves, the unending pace, the care that goes unnoticed and the emotional toll it takes on us all. There are days when I leave work and all I feel is defeat.

Ray’s been encouraging me to get more exercise to clear my mind.
Two thousand steps up a mountain later and some good quality time with Papa, I must say, I feel so much better, and ready to try again.

I think of the middle aged man whom I crossed paths with three times today, and on the third time as I was on my second lap up 1000 steps, he gave me a big grin with bright eyes and said, “Good job!”

I’m slowly learning to find my feet again in the midst of it all, to understand what it meant to be a disciple on the same boat as Jesus when the storm rages on. I’m thankful that His peace is attainable at any time, and that not for a moment was I forsaken. I’m thankful for the kindness of strangers, or rather friends I have just yet to make.

Because when I sit and still my heart, I know, that I have been blessed beyond measure and have much to be grateful for.

...

“I look to the mountains, from where my help comes from, my help comes from the Lord.”
- Psalm 121:1-2

“Courage is not that it didn’t make you cry.
Courage is going back again after it did, because you know that what you do is important.”

The Left-Behind Ones

A few nights ago, I was at work when I heard the emergency buzzer for Resuscitation Cubicle 5. I hurried along with several other medical staff to find an elderly woman lying unresponsive on the bed.

She was in cardiac arrest.

Everyone quickly found a job to do - start compressions, give medications, get more intravenous access, ventilate the patient, suction the vomit. In the midst of all that was happening, I heard my boss' voice say, "Has anyone contacted the family yet?"

The next thing I know, a phone was tossed at me whereby her unsuspecting daughter was on the other line. The ward clerk had contacted her for us and escalated the job of speaking to her to the doctor in closest proximity.

"Hi, this is Candice, one of the doctors in the hospital. Your mother has gone into cardiac arrest and we are attempting CPR at the moment. You need to come in now."

In that moment, she responded with this incredible, loud, heart-wrenching wail over the phone.

It's days later yet I can still hear that sound in my head ever so clearly.

"I'm coming in right now," she cried, just before she hung up.

Unfortunately, it was a matter of minutes later that a time of death was finally called.

...

If there's one word that I can use to describe the Emergency Department as I reflect on this memory, it's anguish.

I think also of the teary wife of the man who had successfully poisoned himself in his suicide attempt.
I remember the grieving husband travailing by the darkened bedside of his deceased wife.
I reflect on the son who had held back his tears in front of his mother and sister, and wept alone in the quiet corridor.
I look back at the woman who sobbed as she told me stories of her late husband who had passed away years prior.
I remember the daughter whose heart broke as she realised her father's time was finally coming to an end.

Week in week out, I'm there in the midst of that anguish, and I see the left-behind ones.
I may not remember all their names, but I remember their faces, and I remember their sorrow.

And deep in my heart as I walk away, I suppress a heavy recurring burden, this immense fear; that one day it would be my turn to be left behind and so carelessly abandoned in that place of utter anguish.