Practicing medicine in PNG is very different than anything I have seen in the United States. The following is one weekday I had in April to try and give you a feel of what a typical week day now looks like for me.
Each day we see our patients that have been admitted to the hospital and then head to the Outpatient department (OPD) to see patients who have traveled near and far to the outpatient clinic. Our time in the OPD is often interrupted by trips to the emergency room or back to the hospital wards.
Wednesday at 9:30am I walked into the OPD and headed for my exam room. “One pela kam,” (one come) I cheerful called in Pidgin to the line of waiting patients. A mother and her 7 or 8 month old son came in and sat down in my room.
The young boy had a cough, fever, and was short of breath at times. After his exam I diagnosed pneumonia. His mother and I discussed admission but elected for him to go home. She could not stay as she had to breast feed his twin. Since he was breast feeding well, I gave antibiotics and sent him home with a promise from his mother to return in the morning.
Next an elderly gentleman came to my room. He did not know his age which is common in PNG. He had received a foley catheter a few weeks ago because he was having trouble urinating. This helped but he’s also having trouble with his bowel movements. His exam revealed a very large nodular prostate. My heart sank. Prostate cancer and rather advanced. I graciously explained his diagnosis and that there was no good treatment available in PNG. All I could offer was to pray with him and remind him of our hope in Jesus Christ.
Again I poked my head out the door of my office “One pela kam” I called. A middle aged lady slowly came into my room. She had weakness when walking for one week. I suspect she has spinal stenosis (a pinched nerve in her spine) but we don’t have an MRI to confirm my diagnosis. I gave steroids and she will come back in a few weeks.
Next came a 3 month old girl appearing very malnourished with diarrhea. Her mother was young and not mixing her formula correctly. Admitted to treat the diarrhea and teach her mother proper feeding.
Then I saw a 10 year old with jaundice and presumed acute Hepatitis. Discussed his care with his parents and sent them home. The hospital has limited tests so not sure which form of hepatitis but suspect Hepatitis A. Something we get vaccinated for in the USA.
He was followed by a 70 year old male with a Inguinal Hernia. He is not a surgical candidate as he has advanced congestive heart failure and COPD. I adjusted his meds and sent him home after an echocardiogram with the help of Dr Bill McCoy.
Next came a 20 year old male with chronic back pain. I reviewed his X-ray. Destruction of the L-2 vertebra from past boney infection with TB. I then head to the ER to help Dr Mark get a sample from a sedated child with fluid around her lungs. Was it lunch time already?
In the next, blog I’ll finish with the afternoon of patients.