C/Section for Beginners

Our time in Papua New Guinea has offered many “firsts”. This past week I had the opportunity of assisting Scot in a c/section delivery. This was a “first” for me. It was a wonderful experience to be on the front line with Scot during a surgery. The woman that was operated on had given birth to the first of twins by vaginal delivery; however, the second baby was foot first and needed to be delivered by c/section.  I had mentioned to Scot prior to this that I was interested in assisting him on a surgery. He called the house in the afternoon and told me to get up to the hospital quickly.

Upon arriving at the surgical suite, I put on scrubs, shoe covers, a mask and a head covering. Then Scot showed me how to wash my hands and arms. We went into the surgery room and the patient was lying on the table with a spinal anesthetic. The scrub tech helped us gown and glove.

Next, we placed sterile drapes on the patient, and then Scot asked her name and a prayer was said for her and her baby. After this, he used an electric scalpel for the incision. It wasn’t working very well, so he asked for a regular scalpel. My job was to sponge and wipe the blood away. After he cut through the layers to the uterus, I had to hold the edges on the incision open wide and use a suction to remove pooling blood.

The uterus was opened. The baby was delivered and the cord cut. The baby was then transferred to the “baby catcher”, a nurse from D Ward. She took the baby and left for the nursery. I continued suctioning blood out of the way as Scot cleared the incision site of clots. Scot reached into the uterus and pulled out the placenta. It was huge because there were twins. When everything looked clean, I held the uterus out of the way and he began suturing. (The uterus was hard and about the size of a small cantaloupe.) There were three layers of tissue and lining that he sutured together to close the uterus. Once that was completed he pushed the uterus back in place and closed the peritoneum and fascia. After that, I was allowed to staple the skin closed and dress the wound. 

It was all very interesting and I would be happy to assist Scot again. I didn’t faint or vomit. (I think Scot expected me to.) I found it to be a very interesting and an amazing experience. I had two c/sections of my own and found being on this side of the table preferable.

Tyronza

PS. Yes, the count for sponges and instruments was done.

PS 2. Both babies were “pikinini mons”, baby boys.

PS 3. Thank you, Scot for assisting with medical terminology.

Back in PNG 2014

Saturday, February 8, 2014

Dear Friends,

It has been more than nine months since I last penned a blog article. I have been very busy with home and family responsibilities (and duck hunting/ added by Tyronza), but now I find myself at home again in Papua New Guinea and ready to expound.

Tyronza and I found safe passage around the world to our second home. This time we took 13 days to get here. We spent four days at a vacation spot in Thailand for some R&R and then a week of scuba diving off the coast of Thailand. The scenery both above and below the ocean was spectacular. Thanks for all your prayers for safe travel.

This year we plan to spend February – May 1^st in Papua New Guinea and then be at home (or at least in the states) for the summer. We will return to PNG for September and October. (Scot is needed to help cover the furlough of medical missionary, Dr. Jim Radcliffe.) We will return home for duck season. This sounds pretty ambitious for a couple of 60 year olds, but with God’s help we will get much accomplished.

At this moment, Tyronza is busy preparing supper. We are having four friends from here on the station over for supper and an evening of “Zilch” (dice game). She is making moussaka (Greek eggplant casserole) and, of course, a pineapple and plantain fruit crumble. After 40 years of marriage, she has really turned into an accomplished chef. Her “made from scratch” dishes are very good.

I have come back to medicine in a hurry. I have been in PNG for less than a week and have already performed 4 major gynecologic surgeries, 3 tubals, an ectopic surgery, 2 c/sections and 2 deliveries. I will be on call again tomorrow, so that number will likely go up before the week is over. One of the c/sections was for cord prolapse and I am happy to report both a healthy baby and mom. This year my clinic work is blessed with a full-time interpreter, Sophi. I am able to see nearly twice as many patients. The interpreter is a good thing since my pidgin has not improved.

This year, we have one new missionary doctor, Mark Crouch, but I am sorry to say, we also have one less, Stephanie Doenges. Stephanie has gone back to the U.S. to get married. The rest of our station friends are much the same, just a year older. It is good to be back to a slower lifestyle and simpler life. We look forward to a productive time on the mission field. We do miss our friends back in America, but with all your prayers and God’s help, we will soon see you again.

Please pray for us.

Scot & Tyronza

Lukin yu behain

Our time here in Papua New Guinea is nearly gone for this year. It has been eventful to say the least – new friends, new patients, and new experiences. God has placed a never ending parade of life that files before me. What a blessing it is to pray with those I treat and those I meet here on the mission field. Some I can help and others are blessed only by God’s miracles.

Hope all of you are staying safe and healthy while Tyronza and I have been away. Sounds like your weather has been much harsher than last year, but with a good bit more rain this April than last. Here it has turned off dry, no rain for the past six days. It must be a record!

Nothing else major to report. We will be flying your way soon, leaving PNG of the 8^th of May. Please pray for our safe travel. We have been missing all of you.

See you soon,

Dr. P

Maternal Mortality

It has been a while since I last communicated with you folks back home. All is well here in Papua New Guinea. Tyronza and I have been healthy and enjoying the nice weather in the mountains. We have not had any further natural disasters. The temperature here has been nice with sunny days and rainy nights. My cistern has been full, so regular showers continue to be nice. Hope you are enjoying an early spring. We have only one more month before we start back home.

I believe I have written concerning this before, but it needs to be mentioned again. PNG is such a medically primitive nation that many of their health care statistics are woefully bad! Such is the case when talking about maternal mortality. When I last looked, this sad piece of data was the worst on the planet and it seems to be sinking even further!

During my career of nearly 30 years doing obstetrics in Cape Girardeau, I never experienced a maternal mortality. I would like to believe it was because of something I did right, but maybe I was just lucky, or maybe God was looking out for my patients.

The record here has not been so stellar. The first year I came to PNG there was one death under my care. She arrived on Labor & Delivery following a home delivery with considerable blood loss. She was fully arrested and, unfortunately, so deep in shock, I could not bring her back.

The second year there was three deaths. One had postpartum cardiomyopathy. Unfortunately, there is little that can be done with that diagnosis and death is inevitable, at least in the highlands on PNG. The second patient had taken poison. That, too, was ultimately fatal, although it took 3-4 days. The third patient developed acute hepatic failure and died. We were never sure of the cause and lacked the ability to diagnose or treat the problem.

This year I really was feeling good about the situation, until this past week. The woman’s name was Nancy. She had delivered a live child in a nearby village five hours before she arrived on L&D. She had lost much blood and had a retained placenta. Her hemoglobin on arrival was 3.7 gm, but she seemed stable. However, shortly after I got 2 units of blood going she arrested. We worked on her for 45 minutes, but were not successful. I have been a little depressed over this situation, but really don’t know what else I might have done.

On a positive note, a family member is adopting the child. She has come in and is being given ”Lactogen/Lamictal” to start lactation.

You folks stay healthy. Looking forward to seeing you soon.

God Bless You,

Dr. P & Tyronza

A Miracle in Kudjip

Greetings from PNG. I hope all of you are safe, healthy and looking forward to the miracle of Spring. We are fine and enjoying the warm sunshine in the beautiful mountains of Papua New Guinea.

Some people claim that miracles don’t happen anymore. As a medical professional, I can give you first hand testimony that says otherwise. On multiple occasions, I have personally seen and experienced God’s power over the health of individuals facing impossible odds. I would like to think that my knowledge, skill and experience at these times are what made the difference, but that would be a vain lie, and I know better.

I bring you the tale of one such miracle. Her name is Aine (Annie). I first met Aine sitting on the bench waiting her turn to be seen in the clinic. I knew something was not right when I went to call her to the exam room. She was sitting over a large pool of blood and there were bloody footprints leading up to the bench. Aine was 22 weeks pregnant with a low lying placenta. She had developed a marginal separation of her placenta from the lower segment of the uterus. I estimated she had lost two units of blood. She was admitted to the hospital and the bleeding stopped. Aine received two units of blood and eventually went home on bed rest with a live pregnancy.

I did not see Aine for two weeks, but as often happens in these cases, her water broke and she returned. Her baby was still living and she still had plenty of amniotic fluid. I thought there might be an outside chance and decided to sit on the case and see where it led. She received steroids and was placed on antibiotics and monitored for sepsis. All went well for a week; however, her fluid slowly dwindled until the baby had no room to grow and develop. Because of the lack of fluid the umbilical cord was compressed and the baby died. I decided it was in the patient’s best interest to terminate and started vaginal Cytotec to effect delivery. When I came in to Labor & Delivery the following morning, Aine was in the back and looked pale and lethargic. A quick hemoglobin check was very low at 2.7. A stat ultrasound revealed much free fluid. I started two units of uncrossmatched blood and took her to surgery. The patient had a condition known as placenta percreta and had ruptured her uterus. In surgery, a hysterectomy was needed_. She remained fairly stable during surgery, but did received six units of blood and multiple liters of fluid. That night she did fine, but by morning was having difficulty breathing.

A chest x-ray showed what I already knew; Aine had developed Acute Respiratory Distress Syndrome, ARDS. This diagnosis carries a mortality rate of 50%, even with technology and a ventilator. I kept her vertical and gave her strong diuretics and oxygen. By that evening, she was covered with perspiration and her respiratory rate was over 60. Her pulse-ox, even on 100% oxygen with a mask was less than 70. I thought she would not make the night! Sometime in the night, God came and by morning she seemed slightly better. She slowly improved over the next three days until she was finally safe. She did contract malaria from the blood transfusions, but is now nearly ready to go home.

God is so good to those who are faithful. Prayer was the only tool that could save Aine. Her doctor, family, friends and all those on this station prayed long and hard, and God heard and came.

The next time you hear doubters, tell them about Aine and the night God came and performed A Miracle In Kudjip.

So long for now,

Dr. P and Tyronza