Tyronza 2016

Scot’s role at the Kudjip Nazarene Hospital Station is an obvious one, physician. And as such, is vastly appreciated and needed. The role I play at Kudjip is a more understated one.

I see my main purpose as one of support to Scot and to the missionaries serving and living at Kudjip. As Scot’s wife, I maintain house. Much like at home, only more so. In Kudjip, meals are what are prepared from scratch in the home. Dishes are washed by hand. Laundry, although machine washed (no, I do not wash our clothes at the river) and hung on an outside line. 

A trip to town is an event and a chore. I am encouraged to buy groceries for a month at a time. There is a local market for purchasing fruits and vegetables. It is approximately a one mile walk round trip and I have to arrange for someone to accompany me. You don’t want to purchase more than you can carry!

As a support to the Kudjip missionaries, Scot and I host individuals and families in our place for meals, games and visiting on a regular basis. We really enjoy the people serving the Lord in Kudjip and welcome this opportunity. There are nine long term physicians on staff at the hospital. Two are single and the others are all here with their families. There are also eight long term support missionaries at Kudjip. These are mainly families and teach, provide maintenance and constructions skills and maintain the Field Office for the Asia-Pacific Region. In addition to the long term missionaries, there is a revolving door of short term (one-three month) volunteers that come to serve at Kudjip in a variety of positions. Scot and I obviously come through this revolving door category. 

                      

On this stint in Kudjip, my mornings are often spent either assisting Judy Bennett, wife of Dr. Andy Bennett, in the storeroom or the old hospital sorting donated supplies (helping unload the containers the supplies arrive in) or assisting Joani Goossens, Treasurer for the Asia-Pacific Field, in auditing accounts or filing. I enjoy my various roles and I’m happy that I have a flexible schedule. On previous trips, I spent time at the MK elementary school and also at the Nazarene Teacher’s College helping with registration.

My interaction with the local PNG people is limited, but after seven trips here there are staff people that I recognize and enjoy visiting with. Fortunately, a smile, extremely limited Tok Pisen on my part and limited English on their part goes a long way to establishing a friendship. On this trip, my work for Joani has me in and out of the Kudjip Hospital Finance Office which is run by three very capable PNG women. I am really enjoying becoming better acquainted with them.

I am happy to be able to serve the Lord in my supportive role. I doubt seriously that Scot would come without me and his skills are much needed in Kudjip. Please continue to keep us and the people of Papua New Guinea in your prayers.

Lukim yu bihain,

Tyronza

Uterine Didelphys

Her name is Camella. I first met her in the Kudjip Emergency Room. She appeared to have an acute abdomen and was showing signs of shock with a blood pressure of 80/40 and a pulse of 118. She reported five days of pain but was now feeling weak. She also reported she was seven months pregnant with her first child. She is age 19.

A quick look with the portable ultrasound revealed an abdomen full of fluid and what seemed to be an extra (outside the) uterine pregnancy. The baby was moving, but had a heart rate of only 80. It looked to be 27 weeks and the fetal heart rate should have been about 150. A STAT CBC was requested along with a type and crossmatch for four units of blood. IV’s were started and oxygen was given. Her legs were elevated and she was prepped for an emergency laparotomy. The hemoglobin came back as 9.6, but she looked much worse!

Camella was taken to surgery and was found to be swimming in blood. I estimated blood loss of 2200 cc. She was given three units during surgery. Her uterus was ruptured and the baby had been expelled into the abdomen. The baby was dead at delivery; 27 weeks is beyond the abilities of our nursery for salvage, anyway.

On careful exam, Camella was found to have a complete uterine didelphys, or duplicate female system. I suspect she lacked adequate uterine muscle to carry her pregnancy to term and her cervix as too long to expect a vaginal delivery. Please see my drawing to explain her anatomy.

I have come across this several other times, but most go undiagnosed and deliver naturally without complication. This situation will often result in malpresentation and breech delivery and has a much greater likelihood of cesarean birth or complications similar to what Camella had.

At surgery, the pregnancy had been in the left uterus and the fundus had been pretty much destroyed. I chose to remove the left side. This should leave the right side to function in the future, though she will be at a great risk for a repeat performance. I made a nice diagram to place in her medical record and I instructed her to seek a physician’s help early on and plan on a cesarean delivery next time. She was also instructed not to allow herself to labor the next time around.

I am very thankful to have an ultrasound (Thanks to the generosity of many.) to evaluate the problem and a good lab to get the blood ready so quickly.

Camella was able to go home in four days and although she lost this baby, she is still alive and able to try for a second pregnancy. I pray everything will work out for her in the future.

Lukim yu bihain

Dr. P

ps.  Pray for Camella.

"A Little Miracle"

Her name is Maria. She is 27-28 years old with now four children. She was admitted to the Kudjip Nazarene Hospital two days prior to my arrival in Papua New Guinea. At that point, she was 28 weeks pregnant with ruptured membranes, though not in labor.

Maria showed no signs of labor or infection on admission. She was placed on IV antibiotics, IV fluids and monitored for sepsis. When I took over her care, she had no fever, her white blood cell count was normal and she still had no contractions. She was given steroids and a base line ultrasound for amniotic fluid volume was done. It showed the fluid volume to be markedly diminished and I felt the probability of making it to viability with normal development and no sepsis was small.

Here in PNG, we have no neonatal intensive care. We have no ventilator and no neonatologist. However, the decision was made to give Maria a chance to see if the amniotic fluid would regenerate so normal development could transpire. After much prayer (Kudjip has an abundance of prayer!), Maria was placed at bedrest except to go the bathroom (150 feet away from the bed). She was changed to oral antibiotics and oral fluids. She was instructed to wash her bottom twice each day with soap and water. We monitored temp every 4 hours, white blood cell count every 5 days, fetal heart rate every 8 hours, and amniotic fluid volume and fetal growth on a weekly basis.

Miracle of miracles! After one week the amniotic fluids had increased back to acceptable levels and the baby seemed to be growing. There were no signs of sepsis and Maria seems to understand what and why she needed to follow instructions. This went on day after day and week after week for one month. The baby grew to 32 weeks’ size and the amniotic fluid remained adequate despite gross leakage. All was well.

 At just over 32 weeks, Maria became septic and went into labor. Her baby, a girl, was born weighing 1,777 grams. I don’t know why all the 7’s, maybe for luck. The baby was never on extra oxygen and is now in the nursery. She seems to be growing using a feeding tube and mother’s milk (too small to suck). I think now the probability is high for normal development and survival. It is rare that babies less than 2,000 grams make it here, but this little miracle is alive and well.

Thank you, Jesus!

See you later,

Dr. P