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!
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| 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.
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| 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.
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| 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.
