A Day in the Outpatient Department – Part 2

On my return to the office a young female came in with pelvic pain that was worse with sitting.  After a brief history she laid down on the exam table.  “Are you pregnant” I asked in Pidgin.  “No,” was her response.  She looked pregnant and had something firm in her abdomen.  Off to ultrasound we went.  Hmmm . . . that’s a head . . .  and there’s a heart beat.  “Yep, you’re pregnant and about 36 weeks.”  “I know” was her smiling response.  Well, I guess I botched my Pidgin on that visit.  I will keep working.

No time to wallow in language doubts I headed back to my exam room.  A middle aged female came in with years of pelvic pain and vaginal discharge.  It did not take long to figure out she had PID (Pelvic Inflammatory Disease) from prior STD exposure.  This is far too common in PNG with promiscuity, domestic violence, and rape.  I gave her antibiotics to treat her symptoms.  Hopefully not too much scarring has occurred and the pain will resolve.

Then the watchman (a friend or family member who comes to the hospital with the patient) of a patient I saw last week came in asking my advice on his esophageal cancer as the patient was too weak to get to the hospital.  “Could your surgeons remove the cancer?” he asked.  Dr. Jim Radcliffe and I explained that the surgery would either kill him or prolong his suffering.  The best we could do was remind him of his hope in Jesus.

Next came a child vomiting water with occasional blood.  He also has watery diarrhea.  Off to the lab.  Mom and Dad return later with the blood test which looks alright.  Medications given for dysentery.  His parents are happy with his care.  His dad, it turns out, is the pastor of a Nazarene church a few miles up the road.   I cheerfully turn to my translator and say “Hey, one of my brothers in Christ.  Can you see the family resemblance?”  The dad and I laugh.  They head home with their fears released.

A new mother with Chronic Migraines, a young man for a school physical, then an elderly woman, deaf and blind from cataracts.  The afternoon was flying by.

I poked my head out the door for the next patient.   “One pela kam” I called.  A 30 year old female stood up and slowly walked down the hall.  She had temporal wasting (loss of muscle and fat), was pale, and moved slowly.  “Man, she looks sick,” I thought.  TB?  She sat down in my room.  “I’m here with a cough, short of breath, my belly is swollen, and there’s something on my back where I was stabbed one year ago,” she says.  She had fluid in her abdomen on exam and a hard mass on her right posterior chest wall.  Cancer.  We made our way to the ultrasound room.  I scanned her back and abdomen.  Liver cancer with ascites (fluid in the abdomen).  I sat facing her and her young husband.  “I am truly sorry,” I said and explained, “You have cancer of the liver.”  I paused as she and her husband sat in shock.  I slowly went on, “There is no cure.”  Tears began to stream down her face and the husband’s face tensed.  I was fighting to hold back the tears as I talked.  “Have you given your life to God and trusted Him?”

“Yes,” she replied, “my spirit is in His hands.”  I asked if I could pray with them.  They nodded yes.  I slowly began to pray in Pidgin.  They headed home to see their pastor and will come back if they need us.  She probably has 3 months or less to live.

No time to morn I moved onto the next patient.  A young man with  seizures. Then an ultrasound  of a pregnant patient that is 28 weeks.  “Congratulations.  You have twins!” I said with a smile.  One of the labor and delivery (L&D) nurses poked her head in the ultrasound room.  “Dr. Nathan we need you in L&D.  We have a laceration that needs suturing.”  No time to celebrate with this patient for now, off to L&D.  And so my day ended.

It’s not always easy but I am thankful for the chance to show the people of PNG the love of Christ.  Sometime that means sharing in their brokenness and pain and other times celebrating life with them.  Sometimes that means using my skills to help ease their suffering or being able to heal them.  Each one of you who is partnering with us through prayer and finances is also helping to treat every person that walks through the hospital doors. Thanks for all you are doing.

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The Two Mr. Js

It can be hard to find balance in what we share on here.  Truthfully, practicing medicine in a developing country is hard.  Little kids die because of dehydration due to diarrhea and vomiting.  If they make it to the hospital soon enough, we can give them fluids and save their lives.  Others times, it’s too late and despite all our attempts, the child still passes away.

Just a couple weeks ago Nathan did all he could far a man in the ER, but the man still suffocated as Nathan worked on him.  Nathan did some research to see what he missed.  Was there something more he could have done?  The answer was that with the resources available here, there was nothing more to be done.  We are one of the best, if not the best, supplied hospitals around, but there are still many limits in resources.

So while, we want to share with you the challenges, so that you can be praying, we also want to share with you the miracles.  The patients who seem to have little hope of surviving, but then we see the Great Physician step in and bring about healing.

Last week, Nathan was working in the outpatient department and saw a man standing with his family waiting to see Dr. Susan.  He looked so familiar, but Nathan could not place where he knew the man from.  After helping another patient and stepping back into the hall for another patient, this man smiled a broad grin that made him instantly recognizable.  Mr J!

A while back we mentioned him on the blog.  He had paralysis that was slowly creeping up his body.  His arms and legs were no longer moving and the concern was the paralysis would reach his chest and cause his lungs not to work.  We did not have the equipment that could breathe for him, so it would mean certain death if that happened.

Despite these challenges, Mr. J always had a bright smile when Nathan walked onto the ward.  And then one day the paralysis stopped spreading.  Dr. Bill explained to Mr. J that it was as if God drew a line on his body and said “Stop here.”  Just before Nathan began working on a different ward, Mr. J was able to move his pinky, which seemed a miracle in itself.  To see that God had healed him to the point of being able to walk into the hospital with his family was an incredible site.

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Mr. J was happy to share this picture to show all those that prayed that he is walking!

You may remember the other Mr. J that we asked prayer for last week.  Nathan came home and said it was worst way to die he’s seen yet.  Mr. J had accidentally drank pesticide and while he was not yet dead, the effects of the pesticide would cause a slow and painful death.  A few days later, Nathan went back to see the second Mr. J and could not find him on the ward.  Perhaps he had gone home, but the more likely scenario was that he had passed away.  On his run Friday morning with Dr. Bill, he found out that Mr. J had recovered enough to go home!  It was such a unexpected outcome when we were almost certain he had died.  Thankfully, Mr. J had quickly recognized his mistake and spit much of the pesticide out.  While it did burn his mouth and throat, it did not cause severe damage to his internal organs.

We are so grateful to be working with the Great Physician.  God can do what we can not and while we do not know why he chooses to heal some and not others, we trust that in both life and facing death, he brings comfort to the weak.  We are grateful he is giving us the opportunity to walk with people here in their joys and their sorrows.  And we so appreciate your prayers through it all.

If you would like to be able to help provide the equipment and medicines needed for the hopstial, please visit the Nazarene Hospital Foundation’s page.  The government supplies available to us often run out and it because of organizations like NHF that we are able to continue treating patients with the medicines and equipment that they need.

Prayer Request

Pesticides are commonly used around here.  Sometimes they are taken out of their original bottle and put into an unmarked bottle.

Yesterday Nathan admitted a patient  that is a member of one of the local Nazarene churches.  Mr. J had been out working, was thirsty and grabbed what he thought was water.  Instead it was pesticide.  I won’t detail what this does to a body, but it is quite painful and often times fatal.  It can take nearly a week before the person passes away.  We don’t know what the outcome will be for Mr. J.  Please pray for him and his family as the doctors are doing their best to help him.  Pray for wisdom for the doctors.

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Nathan’s Notes – Christ is Risen

I walked briskly up the dark gravel road dodging mud puddles heading toward the hospital from our home.  My mind was racing over the scenarios I would find on arrival at B ward.  Minutes before I had received a phone call asking me to come quickly to the internal medicine ward, they were doing CPR on a patient and needed me.  There really is only one way to prepare for this kind of emergency,  to pray.  My pace did not slow down but my mind calmed as I talked with God   With 50 feet left to my destination I could hear the loud wails and knew there was nothing more I could do, the patient had passed away.

I slackened my pace and calmly walked onto the medicine ward.  One of the nursing staff met me at the door and filled me in on what had happened.  Mrs. K, 70y/o female, was admitted earlier that day for an obstructed small bowel.  She then aspirated and fell into respiratory failure and the staff had valiantly attempted CPR.  Despite their care she slipped away.  Would I talk to the family please?

After briefly reviewing her chart I met with the family and explained what had happened to their mother.  Next I asked the family if Mrs K had give her life to Christ and trusted him.  There were affirmative nods all round the large group gathered round her bed.  We talked about how we were sad she had passed away but glad she was now with Christ and that she had no more sickness, or pain, and was happy in the presence of Christ. My heart ached for the family’s loss.  They had not had time to say goodbye given the sudden parting of there mother.  In PNG culture it is very important to say good bye and mend any hurts.  I then prayed with the family in Pidgin and English.

I left the family, signed the death certificate and left the hospital with a heavy heart.  As I walked home alone down the dark road I continued to wrestle with the events of the last half hour.  I didn’t know Mrs. K, but it still hurts to lose someone under your care.

After completing my night’s work I had some time off the next morning.  I was listening to Matt Maher’s song Christ is Risen and reflecting on Mrs K’s story.

Christ is risen from the dead,

We are one with Him again,

Come awake, Come awake,

Come and rise up from the grave.

O death, where is your sting?

O hell, where is your victory,

O church, come stand in the light,

Our God is not dead, He’s alive, He’s alive!

 

O death, where is your sting?  The heaviness was replaced with joy.  In the midst of pain and death, there is hope.  Our God is not dead, he is alive!  He’s Alive!   Happy Easter.

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Sunset at the hospital

Nathan’s Notes – Day 1

It was a beautiful March morning in 2017 as I entered B ward of Kudjip Nazarene Hospital.  The sun was softly streaming through giant windows.  The walls were a clean white.  On the nurses station was a sign “We treat, Jesus Heals.”  Thirty some patients were patiently waiting to see one of the two teams of doctors.  Today was my first day on the ward and I was working with Dr. Bill, a long time physician at Kudjip.  We began examining patients and talking about their treatment plans and progress.

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Our first patient had altered mental status with episodic fevers.  His presumed diagnosis is Typhoid with improving encephalopathy (infection of the brain).  We are encouraged as family has noticed he is acting more like himself.  My mind is racing.  “Typhoid?  I think the last time I read much on this was medical school 11 years ago.”

The 2nd patient has a diabetic foot ulcer after stepping on a nail.  Looks like he needs further surgical detriment to remove the dead tissue around the wound.   Okay, I’ve seen a lot of this in rural Oregon, but how do I counsel a low sugar diet in a country that is totally carb based?

The 3rd patient has fever of unknown origin.  We think typhoid but the test we have to confirm this is very unreliable, only slightly better than a flip of a coin.  She is possibly improving.  We will check a blood test and get a follow up chest X-ray and reevaluate later.

Forth, another possible typhoid and, no, typhoid is not an epidemic, this is typical life in the highlands.

Fifth, liver cancer.  We are trying to make him comfortable and get him home.  We will talk with the chaplain later today.

The sixth patient has ascending weakness.  We think post viral.  Could be Tb of the brain but we have no CT machine to evaluate this.

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In spite of challenges, he greets Nathan with a smile every morning

Next, the seventh patient has HIV and dysentery (bloody diarrhea).  Presumed opportunistic infection.  Symptoms slowly improving.  Hopefully we can get her well enough to get on some meds for her HIV.

The eighth patient has TB  and seizures.  Unclear if the seizures are from his TB or his medications or both.  Seems to be doing better on his new anti seizure medicine so we will monitor a little longer.

And the ninth has weight loss, with presumed adrenal insufficiency and TB.

I glance at my watch its only 9:30AM.  Most of the problems I’ve seen are rare in the USA and would not cross my mind in evaluating a sick person in Oregon.  And so the day went, one new problem after another.  “We Treat, Jesus Heals.”  We do our best to help each patient and share the love and hope we have in Jesus Christ.  Some patients will get physically better and others won’t.  We pray all learn of and see the love of Jesus.  Only in Him can we hope to truly heal the broken.

Club Foot Clinic

 

Ryan’s family (not his real name) travels for over an hour to bring him to see Dr. Andy.  He was born with club foot and if left untreated he would have to learn to walk the mountain trails walking on the sides of his feet.  And he would not be allowed to marry, all because of a treatable condition.

Andy and Judy Bennett have been serving here in Kudjip for well over a decade.  In that time they started a club foot clinic, together helping children born with club foot receive the treatment they need to be able to lead a normal life.  On March 19 they left Kudjip, headed for the States and then on to another country to work.  Everyone gathered at the circle in front of the hospital to pray for them and see them off.  It was a bittersweet time, to know God has exciting plans for them, but they will be greatly missed by everyone here in Kudjip.

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Waving until their vehicle is out of sight

The final two Fridays the Bennetts were here, Nathan was able to work in the club foot clinic with them. This gave him the chance to meet the children and get more hands-on experience in treatment as he prepares for future continue the work the Bennetts began.

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Dr. Andy and Judy are now gone, but Ryan will still be able to receive treatment.  As God has led us to walk the road of disability in our own family, he is now opening the doors to minister to other families touched by disability.  Because of our faithful prayer and financial partners, many more children will continue to receive the gift of walking in the years to come.

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In Silence

Statistics.  Our culture knows statistics.  There are numbers for how many births every year and what the most popular names for those babies were.  Numbers for how many deaths and what was the cause of death.  Everything is documented.

It’s a different story in a very rural, developing nation like Papua New Guinea.  PNG has one of the highest infant and maternal mortality rates in the world, but any statistic you find would likely not show the whole picture.

“People live and die in silence,” said Dr. Scott while giving a hospital tour.   No statistician keeps track of every birth in the Jimi Valley.  The man who died in the Sepik Province is mourned by his family, but his death by cancer is not added to the total tally.

But it is these individuals that matter here at our hosptial.  Each person is given the best care possible.  Each person has not only their physical needs cared for, but they are treated with dignity and respect.  The people of the country know this is true and will often travel for hours or days in order to be seen at Kudjip Nazarene Haus Sick (Hospital).

It is not in silence that people live and die here at the hospital.  It is surrounded by those who see God’s imagine stamped on each life that walks through the doors.  Would you pray for the nurses, doctors, administrators, maintanence staff and others as they give the best care possible with limited resources.

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On the pediatric ward