Kudjip with Tyronza

It is really hard to believe that Scot and I have only two weeks left on the particular trip to Kudjip, Papua New Guinea! I really enjoy our time here. I've shared some in the past and have posted pictures, but I thought I would give you a bit more detail in this blog.

While Scot's days or fairly set for him and not that different from his medical time at home (seeing patients, delivering babies, performing surgeries). My responsibilities vary from day to day. On one morning, I might help Joani Goossens or Marsha McCoy with filing at the Melanesian Field Office which is located here at the Kudjip station. Many of my mornings are spent with or directed by Judy Bennett in the storeroom or searching in the old storage areas for items of use or cleaning and sorting an unending volume of medical “stuff” that is here and that has accumulated over the years.

The last two weeks, another short term volunteer, Linda Elerding, wife of general surgeon Steve Elerding, and I have enjoyed each others company as we have sorted and boxed needles, syringes, cotton, etc.

It's a dirty and dusty job, but there is satisfaction in completing a task and helping take some of the load from Judy's shoulders.

The two weeks prior to that, I helped in the elementary MK (missionary kid) school.

I was with the 4-6th grade students. The school uses a home school program by Abekka, a Christian based education curriculum. Each student has a DVD player and a set of DVD's. The student watches their class and follows the instructions given by the videoed teacher. It's very straight forward, although amusing, when each student verbally sings or recites their work – all at the same time, but different! I basically monitored, graded papers and was there to assist. (If this program had existed when Keara and Gavin were young and asking to be home schooled, I might have seriously considered it.) Now that, new couple, Ted and Rachel Henderson, have arrived, I have been relieved of school duties, other than occasionally assisting Cathy Hartwig with art.

Dr. Ted is a new physician here and his wife, Rachel, is actually a teacher from home. They are living next door to us.

There is also the opportunity of baby sitting with various of the young MK's.

All “Auntie's” are willing and happy to provide services on a needed basis.

Typically my afternoons are free for the abundant cooking and baking that I do. I know my family and friends at home are amazed by this; but if I don't cook, we don't eat. Part of the social time on station is inviting other volunteers and the missionaries and their families over for meals. Scot and I enjoy this and the invitations go both ways. We are truly blessed by our friendships with the dedicated families of Kudjip Nazarene Hospital.

Evenings are typically spent either having dinner with someone at their house or inviting them to ours. We enjoy playing card and dice games and visiting. Scot and I also enjoy reading books on our electronic readers and watching a few DVD's we brought.

We are currently beginning to look forward to returning home and our plans for this fall. We are also scheduling our return to Kudjip for next February through May. 

God's Blessings,

Tyronza

"BATS"

Hello Friends and Family,

Tyronza and Scot are back in Papua New Guinea and safe. The trip over was uneventful, just long, (St. Louis-Salt Lake-Los Angeles-Brisbane-Port Moresby-Mt. Hagen-Kudjip). Total air time was a little over 24 hours. We left on August 25^th and arrived in Kudjip on the 27^th. We are both healthy and doing well.

PNG is much the same as before, but in Kudjip things have really changed. The hydro-generator is up and running and we have no more power spikes or outages of electricity. I would say that, so far, electricity seems as dependable as in the USA.

Surgery and Labor/Delivery are running smoothly. We have no general surgeon, at the current time, so there is no competition for surgical time, but I have to do some cases that the general surgeon would ordinarily do. So far, I have had 8 major cases in the first one and a half weeks.

Today, I would like to talk to you about fruit bats. PNG is a tropical country and there are many banana, pineapple, mango, papaya, sweet fruit, guava and passion fruit growing. Because of all this fruit, there are many fruit bats. On the coast, fruit bats often sleep in large groups in certain trees.

It is customary, in PNG, to store bananas out on the porch hanging from a rope. This cuts down on fruit flies in the house. Usually, you try to cover the bananas with a cloth to protect them from sun, insects, and bats. We have stored our bananas this way all the other times we have been here and never had problems with bats – until now. Our usual cover is an old tee shirt with the neck and sleeves sowed closed. This bag can be opened and bananas added or removed as needed. Imagine my surprise when I went to get bananas for breakfast and found most of them half eaten. I was not sure what the culprit was. When I asked the locals, they said bats wouldn't come on the porch and most felt it was likely the work of a rat. (That didn't make Tyronza too happy!) That next night I decided to wait up and catch the thief. Once it was dark, I heard wings and knew it was really bats!

Some quick camera work caught these two photos. These guys were large – at least two feet from wing tip to wing tip.
When we showed the pictures to Lena, our haus meri, she called then flying foxes and wanted to know whey I was taking pictures instead of clubbing them for her supper!

The next day, I tried tying the bottom of the bag shut, but that night the bats just sucked the bananas through the cloth! I am now storing my bananas in a cardboard box on the porch. This seems to be working.

So long from this strange and interesting place,

The Stork

Morleen's Pregnancy

A big “Hello!” to all of you back in the U.S.A.

Tyronza and I will be leaving Papua New Guinea and heading your way on Thursday, May 1^st. We have enjoyed our time here, but we look forward to seeing all our friends and experiencing the “comforts of home.”  Tyronza has some big travel plans for us this summer, but as for me, rest and relaxation sounds much better.

I have one final story to tell of a woman by the name of Morleen. I met her the first morning I worked at the Kudjip clinic. On that visit she was 28 weeks pregnant, but looked like she was term with triplets. She was experiencing a lot of pressure and a quick vaginal check showed her to be dilated 1 cm and 75% effaced. The head was also quite low.

Her abdomen was massively distended and on ultrasound revealed a normal 28 week intrauterine pregnancy pushed to the right lower pelvis by a huge multicystic ovarian tumor. You might liken this to a tube of toothpaste slowly squeezing the baby out!

The decision was to operate on the tumor and risk premature delivery or keep her pregnant as long as possible and then operate on the tumor. I reasoned that the tumor was most likely benign and operating at this time would probably trigger labor. She agreed and consented to admission.

We placed her on bed rest, gave her steroids and medicine to keep the contractions quiet and hoped for the best. She really was a model patient. The baby went ahead and grew normally and the mother tolerated the situation, though growing ever bigger. To my surprise she was still pregnant at 37 weeks, though she could hardly move around and needed to sit up to breathe and keep her pulse-ox up.

I decided delivery was in everyone’s best interest. A vaginal check showed her to be 3 centimeters dilated and 100% effaced. A dose of vaginal cytotec set things in motion and she promptly delivered a 6.5 pound baby girl. Morleen lost a total of 11 pounds at delivery, but you could not notice any change in her abdominal size. She did say she could breathe easier.

She was given a week off to enjoy the baby and then asked to return for surgery to remove the tumor.

In surgery, she was found to have an 18.5kg left ovarian mucinous tumor. For those of you from the US, that is more than 40 pounds! I was able to salvage the right ovary, which thankfully looked normal.

Her recovery went fairly smooth and I am expecting to see her back before we return home. At discharge her abdomen still looked pretty big with post-op gas, but I expect her to be much skinnier soon. She should be able to have her next child without all the fanfare.

See you soon,

Dr. P

p.s. Just saw Morleen in the clinic. Both mother and baby are doing well. Her abdomen still sags a lot. She tells me she is going to start leg lifts and sit ups once her 6 week recovery is over.

Power Outages

A few weeks ago I posted a “facebook” status that indicated power was out again and that I was using the computer by candlelight, but waiting to wash dishes until power came on. One of my sisters commented the following day with, “can’t you wash dishes by candlelight?”

I thought I would share with friends and family concerning power outages. At Kudjip station, our water is rain collected in a cistern at the side of the house. Because of where the cistern in located, when the power goes off so does the inside water (the pump is electric). Fortunately, we are staying in a house that has an outdoor gravity faucet, and are able to collect water in bowls and pots to bring inside.

When the power is off, the water flow is slow, but better than nothing! Once the water is brought indoors, if it is for washing dishes or drinking, it must be heated or filtered.

We have a gas stove so I am still able to cook when the power it out. (Thank you, Lord!) Heating the water takes some time; I only have one large pot. It’s not too bad for washing the dishes, but it takes a lot of pots to have an inch of water for the bathtub!

I frequently use a crockpot for cooking, if you’ve been away from the house all day, you sometimes come back to an uncooked meal. You then have to transfer the food to a pot for the stove or oven and complete the cooking process. So far, we’ve not gotten sick from anything!

We try to keep your computer and e-readers fully charged at all times

and your dishes rinsed and washed as quickly as possible! You never know when the power outage imp will strike! You also keep flashlights and headlamps handy at night.

There is currently a hydro project that is almost complete. The dedication in April 30^th and it should be up and running by July. At that time, power outages should become a thing of the past.

Living in the highlands of Papua New Guinea is lovely, but not without some challenges. Scot and I are thankful for the opportunity of having these varied and interesting experiences and being able to serve the Lord here.

Tyronza

Ectopic Pregnacies

Hello Friends and Family, reporting from equatorial Papua New Guinea:

It has been a fairly quiet time here. I have been sick with the viral crud, but I am now on the mend. I hope none of you have been sick, and if you have, I hope you are feeling better.

Surgery and clinic have been running fairly smooth as of late. I had two ectopic pregnancy surgeries soon after we arrived, but nothing else until a few days ago. I have now had three ectopic cases in the past five days. The one today was exciting; the woman had 3.5 liters of blood in her abdomen. She looks good, so that may be enough. Her hemoglobin is now 8 grams.

She reported feeling bad for the past six days and came in today after fainting. So far, I have given her 4 units of blood.

There was another exciting case two weeks ago. The patient had the usual fulminate case of PID with secondary bowel obstruction to complicate. She tolerated surgery, but arrested in recovery. Following resuscitation, her pulse ox was stuck in the 40-50% range – even on 100% O2. She was on dopamine and received large doses of diuretic. We felt she had shock-lung and without a ventilator I did not give her much hope. When I arrived the following morning, she was still with us, had revived from her coma and was looking around. Her pulse ox was now in the mid to upper 80s. She recovered rapidly and went home 7-8 days later. They say miracles happen every day, and I must say that is the only explanation for her recovery. God was surely watching over her.

OB has also been fairly quiet. I did have a problem with a nurse giving a mistaken dose of vaginal cytotec to a premature labor patient. Thankfully, she only gave 25 micrograms and the premature labor medication quieted her down without incident. We also discovered her to be a newly diagnosed case of HIV. I have been seeing two new cases each week with retro-viral problems. It is very sad to contemplate the prospects for unwitting victims.

Hope you are doing well and enjoying spring. My second batch of sauerkraut is nearly done. The first batch was very tasty.

Bye All,

Dr. P & Tyronza

Female Nemesis of the Thirld World

Hello Friends and Family from the paradise of Western Highlands, Papua New Guinea, the land of perpetual spring!

Sorry it has been such a long and cold winter for you. I am glad to be missing out on all of that. I hope spring arrives soon for you too.

All is wellF here. Tyronza has been busy working in the storeroom (sorting stuff) and other odd jobs. She has also been busy with bread making and other “from scratch” cooking. Our current culinary project is making sauerkraut. I tasted it yesterday and it is coming along nicely. We plan to invite friends over this week for homemade sausage and sauerkraut.

I have been busy with the clinics, labor and delivery and surgery. I am trying to bring some of the other new family doctors up to speed on their surgical skills, and teaching what I can to the nurses and medical students. We are supposed to have a new PNG resident doctor in the next few weeks. That should be interesting and different.

I would like to spend a little time discussing the problem of cervical cancer in PNG with you. I had reported on this subject three years ago in this blog, but it merits another go. Cervical cancer is a major problem in all the third world areas around the globe. This is a particularly nasty problem in PNG. There is rampant human papilloma virus, multiple wives, multiple partners, lack of basic health care, non-existing pap smear screening, slow diagnosis, and poor treatment facilities. The patients scarcely stand a chance!

Cervical cancer is the number one cancer among women in PNG. It has the highest cancer mortality among women in PNG. It is slow to be diagnosed and treated. As a result, it is often quite advanced when first discovered.

There are precious few pap screening projects here, mostly due to medical manpower shortages, limited funds, and poor follow up. A pap smear must be sent off to Australia for interpretation. Eight or more weeks are required to get results back, and when you do get results you are dependent on the patients remembering to come back. Trying to track someone down who lives in one of the hundreds of tiny jungle villages near the station is nearly impossible.

From my perspective, I must rely on how the cervix looks and feels on exam. I have a very limited number of speculums and even if I did do a pap smear on every patient contact, I would probably have returned to the U.S. by the time the results came back.  When I do diagnose cervical cancer, the primary complaint is usually bleeding or pain. This means the lesions are almost always advanced (stage II or III) by the time the patients enters the system. I can sometimes operate if not too advanced, but usually the cancer is already in the nodes by this time. Surgery is of some help, and will usually add a year or two before the patient hemorrhages to death or dies of uremic poisoning, secondary to kidney obstruction.

Papua New Guinea does have a single irradiation treatment facility. It is a ten hour drive over some of the worst roads I have ever seen. Very few families can afford the trip. Because there are so many patients with advanced disease, the oncologist screens pretty tight. If the kidneys are already partially obstructed, the patient is often rejected for treatment. Most of the time, all I can offer is prayer for comfort or a miracle.

One such patient crossed my threshold four weeks ago. She had stage III/IV disease with tumor involving the cervix, vagina, base of the bladder, the parametrium, and nearly eroding into the rectum. She was also 29 weeks pregnant with her fourth child. She was brought into the clinic by her husband and the first wife. The patient is the second of four wives. My mission was to get her to viability before she developed kidney obstruction or hemorrhaged to death. I saw her weekly, gave her extra iron and monitored the kidneys. Unfortunately, at 33 weeks she had a major hemorrhage and the baby died in-utero.  She obviously couldn’t deliver through the vagina and I had to do a c/section. She now has significant kidney obstruction on both sides. Barring a miracle, she likely has only a few months left in her life.

Pray for us and please pray for my patients.

We miss you all,

Dr. P and Tyronza

p.s. I have requested the other three wives come in for screening.