Ruptured Membranes

Hello from the Tropical Paradise of Papua New Guinea,

My pen has been quiet for the past few weeks and realize I only have a little more than one week before we leave the station. I am sad and relieved all at the same time, it is hard to describe.

Tyronza and I are doing well and remain healthy. We have had no further earthquake activity and the rains have been steady and are keeping my cisterns full.

Our power has been much better as of late. The maintenance guys have recently changed the filter on the big diesel generator and it has been working well. The PNG power company has also seemed to have much fewer outages. I have discovered the local power comes from a large hydro-generator about 40 miles away. This fall a team of engineers will arrive from South America to build a dam on the river here at the station. The Australian government is funding the 3 million dollar project, which should solve the power problems for our area for many years to come. The construction of the dam and hydro-generator will take a little more than a year to complete.

The medical practice is much to same and I have some good things to report and some bad. First the good, I may have told you about my premature rupture of membranes (PROM) patients. I have been managing three PROM mothers. One ruptured at 29 weeks and two ruptured at 24 weeks. The 29 weeker carried without infection to 35 weeks and was delivered last week by caesarian. The baby really had a smashed head, but that rounded up quickly and she looked very good within 24 hours. Both mother and baby are now home and doing fine. One of the 24 weekers delivered at 31 weeks. The baby weighed a little over 900 grams and died after 48 hours. The other 24 weeker is still pregnant and is now 33 weeks along. There has been no sign of infection and the baby seems to be growing. The baby is in the transverse position and my plan is to deliver her in another week. Please pray for this mother. I will keep you posted.

Now for the bad news. Last week I saw two very sad antenatal patients in the clinic. One was 24 weeks pregnant and newly diagnosed with leukemia. The mother went into labor this weekend and the baby died, but the mother has now been started on chemo for the leukemia. The other mother is also 24 weeks and has advanced cervical cancer. Both kidneys seem dilated and I am not sure the patient can survive long enough to get the baby to adequate lung maturity for delivery.

Gynecologic surgery has been interesting with several ectopics and PID abscesses. One of the abscesses was so bad, we had to remove several feet of small bowel. She was so ill I thought she might die, but she passed flatus on day 4 and looks like a rose.

Hope you are all well and doing fine. We pray for all the folks back home every day and I know many of you pray for us. We do appreciate that.

God Bless,

Scot & Tyronza

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Caesarean Sections

It has been several weeks since I last used this pen. I thought some of you might wish to know what has been going on across the Pacific. Tyronza and I are fine and enjoying our stay in Papua New Guinea. You have probably heard that we have had several earthquakes, which is true, but not much damage.

Last Saturday during the very early morning, I was in the OR for an emergency caesarean section and things started to move around. It was about 12:30 am here and a 5.4 magnitude quake hit the area. It lasted about 20 seconds and moved the OR lights and rattled some equipment on the counters, but did no damage. There was a short after shock and then all was quiet. When I asked Tyronza if she had felt it, she said, no, that she had been asleep. Then on Tuesday mid-morning we had another quake. This one was 6.7 and lasted about 30 seconds. I was standing outside the hospital and noticed a ferocious growling sound and then the ground shook. Tyronza was at home and said things rattled and shook enough that she hurried outside. I don't think there was any major damage on the station, but one of the neighbor's banana trees fell down.

We have been on several interesting outings since I last communicated with you; a church service at a home for HIV/Aids orphans, a service at a bush church, rafting on the river and a visit to a tea plantation. Tyronza and I met an Indian couple at the monthly English "lotu" service. The first Sunday of each month there is a worship service conducted in English at the hospital and people come from the surrounding area to attend.

The Indian couple, Priap and Elizabeth invited several of us to come for tea and a tour of the plantation. He manages the tea plantation and factory. We were allowed to visit the harvest and also were given a guided tour of the manufacturing process. It was quite an operation. All together they had over 2,000 acres of tea plants and harvested tea 281 days each year. This is the largest tea farm in Papua New Guinea and they ship tea in shipping containers all over the world. Our guide told us that their largest customer was Russia. The tea plants produce a new crop of tea every 25 days, so harvest and pruning goes on constantly. This plant produces black tea only. This type of tea is the most common tea product. There is only one type of tea plant (which is really a tree). The different types of tea you may drink:  green, white, red are all just different types of processing. After the tour we went to their home and had refreshments and some interesting Indian cuisine.

Medical work goes on as usual. I have had several interesting on call days. Friday, a week ago, I had two routine hysterectomies for bleeding problems. The third case was a C/S because the baby had hydrocephalus. On pre-op ultrasound, the baby's head measured AP-21 cm and BPD-12 cm. It was a bit of a struggle to get the head out. The baby was very abnormal and only survived for a few minutes.

My fourth case was also a C/S for twins; two boys - both breech. I let the medical student, Andy Peters, do that one and he did an excellent job. We thought she would name them Scot and Andy, but no such luck!

I had one patient come into clinic late Friday afternoon that had not felt fetal movement that day. On ultrasound I could see fetal heart activity, but no fetal movement and there was reduced amniotic fluid. I called for a stat C/S, but was not able to get started for a little over an hour which is typical for PNG. The baby was very acidotic, with thick meconium. I hand bagged the baby for 30 minutes, but got minimal respiratory effort. We had to give up, as we have no ventilator. I feel the baby would have been badly damaged anyway.

Later on that same call day, I had a mother come in with active labor. She was complete and breech. The baby looked large and I called for another C/S. This time it only took 45 minutes to get ready and she did not deliver during the wait. I was on call with a Papa New Guinea resident physician, Dr. Imelda, and let her do the honors. The baby and placenta were delivered without problems and then she reached in with ring forceps to pull some membranes out. She pulled down a second set of toes! Both babies were healthy, again another set of boys. Neither of which were named Scot! Oh well, maybe next time.

Bye for now,

Scot & Tyronza

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When the Power Goes Out

Hello again, coming to you from paradise, well, almost paradise!

On some days it is difficult to remind myself that I am living and working in a third (or fourth) world environment. The doctors working here are very conscientious, well trained and qualified. The clinic, though dirty, moves patients through in a productive and orderly fashion. The x-ray department provides good quality films and the portable ultrasound machines are nearly as good as what I am used to working with back home. The surgical suite is clean, well stocked and air conditioned. Anesthesia service functions much the same as in the states. All is well, until the doors fly off. Here is the tale of my last night on call:

The daylight hours had gone well with 3 major gynecology surgeries and a late afternoon Cesarean. I was able to stop work at 5:30 and come home to relax and have one of Tyronza's fine suppers. I was tired and went to bed at 9:30pm only to be awakened by the telephone at 11pm. The emergency room was calling with a patient that had an acute abdomen and they were requesting my presence, so I hurried in to the hospital.

The patient was indeed in great distress with a rapid pulse and low blood pressure. A quick urine pregnancy test was positive and her hemoglobin was 7.6 gm. A few steps over to the clinic allowed me to retrieve my portable ultrasound machine and two minutes later her problem was obvious. An abdomen full of blood confirmed my fear of an ectopic pregnancy. We started two IV's and requested two units of blood for "stat" cross match. It seemed just like the big city; but that was when reality struck and the third-world medicine thing came home to roost.

The power around here is notoriously unreliable. It seems to go off and on multiple times each day and we are use to the big generator kicking on when this happens. This time when the power went off, the big generator didn't come on. A quick check showed that Dixon, one of the station's trouble shooters, was on generator call. He only carried a cell phone, which was also out and so I had to send the hospital guard out to find him. Meanwhile the patient in shock is needing blood; but, without power the cross match is stalled! Dixon was finally located and was able to start the little generator. The big generator could not be resuscitated! I thought my problems were solved. I had power in the ER and in surgery, but soon discovered there was still no power in the lab. The lab guy, Andy, was sitting over there in total darkness and was still no help. He reported that he could do a group and Rh on the patient, if he had a flashlight. I retrieved my headlamp from the clinic and gave it to him with my blessing. In a few minutes , he discovered that the patient had 0 negative blood. He handed me two units of blood and I headed back to the ER. On inspection, I discovered there was no Rh factor on either unit. Both the ER staff and Andy said this was alright, because all people in Papua New Guinea are Rh negative. Andy said, "We never check the Rh factor on any blood we use." I had seen several locals that looked like there was a "honky" in the wood pile, but said nothing. We finally gave the patient the two units without difficulty and surgery, two hours late, took care of the problem. By 2 am I was back in bed, only to be awakened at 3:30.

This time it was a nurse in delivery who had just delivered a term baby with meconium aspiration. The power had again gone off at a strategic moment and she was not able to suction the baby very well. I tried to suction the child out and do percussions and drainage as best I could, but he was retracting a lot and I felt sure he would die. In the third world there are no respirators; even if we had reliable power to run them. The baby would have to "take a chance".

The next morning, the nurse seemed pleased and the baby did seem to be breathing easier. I peeled back the diaper for a closer look and was met with a big stream of urine followed by a full arrest. He would not resuscitate!

Life is cheap here in the bush and with unreliable power it doesn't show any sign of getting better. It is fortunate there is always reliable power with God. He is always there to make our light shine; we need only to believe and ask.

I hope your day goes better than mine. I think about you guys a lot.

God Bless,

Scot & Tyronza

Typical day for Scot

Hello from beautiful Papua New Guinea. It has been a beautiful week here. We have had no rain for the past six days, so we are beginning to be concerned about the cistern, but other than that we are both healthy and doing fine.

I thought I would take some time, like Tyronza, and let you know what my typical day and week is like.

I rise at 5:45am each day. All is calm except for the whistling of the locusts and the crowing of the local kakarukas (roosters). The locusts look like our cicadas, but make a buzzing whistle-like noise that sounds like an alarm clock going off. This serenade usually lasts about 30 minutes. During this time, I am up walking with several other mission doctors and Brutus. The course is two miles.

Brutus is a beautiful black Labrador. He is not very well trained and it is hard to say who is taking whom for a walk. He is always eager to go and seems to be slowing improving in the obedience department.

After the walk, a shower and breakfast are in order. The shower water is left in the tank from the previous days sun - heat and so is only warm, but feels good after a long walk. Breakfast consists of oatmeal, bananas, pineapple, toast from Tyronza's bread and tea. The bananas here are like nothing I have ever experienced in the states. My favorites are called apple bananas. They are short, firm and very sweet. They taste a bit alike an apple and go down very well. There are over 200 varieties of bananas here, some very large and some small. Most are yellow but a few are red. Some are for eating and some are for cooking (strang banana). As I write this note, I have had my eye on a particularly large bunch of eating bananas. I hope to have the whole bunch hanging from my porch very soon.

At 8am, after breakfast, I walk 2-3 blocks to the hospital to start by medical day. I usually have 7-8 Gynecology patients to round on, then 20-30 obstetric patients to see. After rounds I either go to surgery or to the clinic.

The clinic consists of gynecology patients that have mostly been screened by the family doctors and I see them to consult and review for possible surgery. There are also problem obstetric patients to see. I usually do a physical exam and ultrasound on each one. I see about 15 clinic patients each day.

Scheduled surgeries are primarily done on Tuesdays and Thursdays and unscheduled surgeries fit in on a daily basis as needed. Each week I do 6-8 major cases plus 4-6 unscheduled c-sections and ectopics. I also assist the general surgeon, Dr. Jim Radcliff, on his major cases, usually 6-8 per week.

We break for lunch at noon each day and are usually back in the clinic by 1pm. The work day ends at 5 or before, except for call. I am being on call every other night and every other weekend for obstetrics and gynecology.

My days are fairly busy, but I do find time to enjoy this beautiful place. God's creations are so astounding!

I hope all of you are well and staying busy. God bless you and keep you safe. I hope to write again soon. (Mi raitem yu bihain sun.)

Scot

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Typical Day for Tyronza

A typical PNG day for Tyronza: T gets up around 5:30am and checks emails and facebook. She is happy to receive messages from family and friends. She then wakes Scot and they go out for a morning exercise walk and run at 6:00. There are several other volunteers, missionaries and a few locals who exercise at this time of the morning. At 6:00 it is still dark, but begins to lighten very quickly. By 7am, we are typically back at our place and heading to the showers or getting the breakfast ready. By 8am, Scot is heading to the hospital for either clinic or surgery. Tyronza is cleaning up breakfast dishes and preparing for her day. She tries to leave the house by 9-9:30. She often begins bread making or clothes washing before leaving. She also needs to have the lunch preparation started and the dinner menu planned (making sure she has all the ingredients).

By 9:30, T is helping either at the hospital, storeroom or field office. Depending upon where she is needed, she might be cleaning a room at the hospital, sorting or unpacking items in the storeroom or helping with filing and bookkeeping in the office. (The field office is the Nazarene Melanesian Regional Office and covers several countries.)

By 11:30-12 noon, T is back at the house completing preparation for lunch and serving Scot and usually two others.  We are living in the Barnabas House; a house that can sleep up to 24. There are two wings, with a bathroom on each wing and a large kitchen and living area between. Fortunately, there are typically only two couples in it during the months we are in PNG and on occasion a single medical student or resident volunteering  for a month. After we leave in May, there will be two large groups arriving to work for two weeks each.) After eating lunch, Scot returns to the hospital for either clinic patients or surgery. Tyronza cleans up after lunch, brings clothes in from the clothes line or puts the loaves of bread in the oven.

There is usually an hour or two of down time and then it is time to start dinner preparation. (Time for picture taking, reviewing recipes, catching up on daily Bible devotions, a little bit of reading, or a Tok Pisin - pidgin lesson.) For dinner there is usually 4-8 to be served. The most common main meals are chicken or ground beef. There is a large variety of vegetables available. Experimenting is fun and usually turns out. This week we have had tacos, banana pancakes and chicken potpie for dinner. For desert there has been pineapple (fresh) upside down cake, homemade chocolate banana ice cream, bread pudding and tonight homemade mango (fresh) ice cream. Lunches are usually soup (pumpkin and carrot, cream of broccoli, zucchini and tomato) and sandwiches (tuna salad, grilled cheese and tomato, PB&J). The "More with Less" cookbook that Laura Meece gave T last year is getting a good use. (Thank you, Laura.) Dinner is usually served between 6-6:30.

Scot is great helping with evening dishes, cutting up fresh pineapple or opening and shaving the coconut. He is typically back from the hospital by 5. He is at the hospital Monday-Friday and is on call for OB/Gyn every other night and every other weekend.

A typical evening has friends coming over for dinner or for games later. There are many board games: Settlers, Monopoly, etc. and dice games: Zilch, also Pictionary and Pit, etc. Visiting with the other volunteers and the missionaries is a lot of fun and we appreciate their company. There is much talk and laughter. Fellowship with others is such a blessing. Scot enjoys having a new audience for his tales!

We are typically preparing for bed by 9-9:30pm. We enjoy our time in PNG and find it very rewarding. This simple lifestyle is good for the heart, mind and soul. It feels like stepping back in time 50 years.

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Rain in PNG

It has been a beautiful first two weeks here in Papua New Guinea, except for the rain. Rain is a popular product of the Western Highlands Province and our hospital is no exception. It has rained 12 of our first 14 days here. The locals report the annual rainfall was a staggering 150+ inches this past year. The wet season extends from November to June with the typical dry season being July through September.

Too much rain can cause flooding and the dreaded mud slides. A few weeks ago there was a mud slide that took out a small village with loss of life and in one case a P.M.V. (public motor vehicle) was covered as it traveled along with 21 resulting deaths and only one survivor.

Those of you in southeast Missouri are well acquainted with flooding. Around here, this is a major problem with the local farms and gardens. Farmers in the US try to take advantage of the available moisture, while people in PNG dig special drainage channels throughout their gardens to carry the water away.

To me, adequate rain means a good supply of water in my cistern, so there will be a plentiful water supply for drinking, bathing, washing dishes, laundry and flushing the toilet!

The typical day here on the station starts with mist trapped by the mountains filling the valleys. This greatly limits early morning visibility. The mist is usually gone by 8 am and intense high-altitude sun with a few passing clouds predominates until mid afternoon.  The sun at high altitude is dangerous and sunburn can get you in 30-45 minutes without protection.  Temperatures are usually quite mild to the upper 70's and low 80's. By 2-3 pm the clouds start to stack up and by 5 pm the rain starts. Rainfall can last through the night, but usually stops by dawn. Precipitation is mostly light, but can be intense - especially at night.

Too little rain can also be a problem at the station. This means dry cisterns and rationing our water for drinking, showers and toilet flushing.

God's secret to the existence of plants and animals on our planet involves a balance of soil, sun and rain. Without each of these there can be no life. Let us pray for a year without flood or drought and of course for my cistern to remain full.

See you later (lukim yu bihain),

Scot & Tyronza

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