We get our food several different ways. An older gentleman stops by the house a couple times a week with vegetables for sale. He used to only sell asparagus, but now has a variety of things like carrots, broccoli, onions and tomatoes.
Once a month I travel into Mt. Hagen with Gail Dooley and do a day long shopping trip. In Hagen we are able to get more Western style foods and meats as well as stop by the market for produce.
Then there is a market just down the road from the hospital at the rot bung. “Rot” (pronounced with a long o) is road and bung (pronounces with a oo sound) is a meeting, so this is where the roads meet. There aren’t many roads in PNG, so this rot bung is rare and busy. Nathan usually goes once every week or two and takes one of the kids. Recently, though, we made a short trip as a family.
This umbrella market has all kinds of produce available as well as the flip flops we got for the kids.
In the small stores we can get boxes of eggs (we go through about 6 dozen a week) and boxes of milk. The milk comes in cartons that are stored on the shelf and don’t need to be put in the refrigerator until they’re opened. There’s a little store where people can pay to have their cell phone charged which is important for the many people who don’t have electricity in their homes. A little movie theater plays lovely American films like Rambo.
The clothing market is outdoors and has used clothing from Australia for sale. I’ve found some great things for the kids and me there, but usually pass on the winter snow suits hanging on the line.
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.
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.
Dr. Sheena has been our dentist here at the hospital for the past two years. She came with Samaritan’s Purse. When she first arrived there was little dental equipment, but Samaritan’s Purse donate hundreds of thousands of dollars worth of new dental equipment. The dental x-rays here were the easiest I’ve ever had taken thanks to this equipment.
In a couple of weeks she’ll be heading back to Hong Kong, Canada and the United States as she prepares to move on to her next mission station. She will be greatly missed, but we had a fun farewell party for her down by the river.
The kids had a great time playing in the clay along the edge of the river.
And playing on the surf board with friends
And digging in the dirt
And getting wet. Except she wasn’t so sure at first. She wouldn’t put her right foot in the water, but instead held it up in the air. When it would finally lower down and touch the water she’d hold it up with her hands. Finally, she gave up keeping her right foot dry and just started playing. She had more fun than this picture would suggest. 🙂
Our Saturday was full and a lot of fun with friends. First we started out with a community service project of picking up garbage on the road just outside the hospital station.
When we first arrived this road was dirt and just beginning to be paved with concrete ditches put in along the side. I’ve been told it used to be one of the worst stretches of road on the way to Mt. Hagen where we do our grocery shopping.
A variety of interesting things were found.
And we had some beautiful views along the way
And an adorable little Thompson helper
And my little helper was eager to go.
And then we were back at the station
But the day wasn’t over yet. We had a hot dog roast and then a party for Sheena before she leaves. The pictures at the river will be coming soon!
Mistakes happen, especially when learning something new. Kudjip Nazarene General Hospital has very few diagnostic machines. Thankfully, we do have an ultrasound machine. Unfortunately, I have not been trained in the use or interpretation of these machines. So . . . mistakes happen!
One night as I walked into the Labor & Delivery ward at the hospital, a nurse asked for an ultrasound on a woman who was in labor. This mother was quite large in her pregnancy and the nurses thought they heard two heartbeats, so we suspected she may be having twins. A look at the ultrasound images would let us know if this suspicion was correct.
I scanned the mother’s abdomen with our ultrasound equipment. After looking at the images, I congratulated the mother with the news of twins. Several hours later, the surgeon decided she would need to have these children by C-section. The surgery staff delivered baby #1. Because of the ultrasound diagnosis, they looked for baby #2. They, the mother, and I were surprised that there was no baby #2!
I realized that I never did see both babies in the womb; I just saw the same baby at two different angles! Mistakes happen and everyone had a good laugh. And the mistakes continued.
We suspected our new patient’s baby was in a breach position. I did a quick ultrasound to confirm our diagnosis. The baby’s bottom was down and the head was up. As I ended the scan, I was glad to see that, despite the breach position, the baby’s heartrate was good. Because of the breach presentation, the mother was sent to OR for a C-section. An hour after the delivery, Dr. Jim Radcliffe (her surgeon) saw me in ER and congratulated me on my fine ultrasound notes. “However,” he said with a smile, “this mother had twins!”
“Wow!” I replied, “So that’s where the other twin went!”
I continue to grow in my ultrasound skills and understanding of tropical diseases and their treatment. Each day brings new challenges and opportunities to learn.
A few months prior to coming to PNG, I received a notice from the Oregon Department of Motor Vehicles (DMV) that my license was about to expire. I hopped in our minivan and drove to the local DMV, presented the notice, paid the small fee, had my picture taken, and walked out with my updated driver’s license. A small miracle happened on that visit – an often hours-long task took less than 15 minutes!
Since arriving in PNG, I have driven the station’s Land Cruiser on a couple of occasions. Because I am a resident of PNG, I needed to get my PNG driver’s license. After a 45-minute drive to Mt. Hagen, we arrived at the police station where I asked for an application. “Are you from Kudjip?” asked the police officer. “Yes,” we replied. The police officer’s face spread into a big grin. “You work with Dr. Jim. He saved my life!” (Dr. Jim Radcliffe is a surgeon who has spent over 30 years at our hospital.)
A clerk helped me with the paperwork and asked me to wait while the application was processed. Thirty minutes later, the application was completed. Two more steps were required – a photo (I was assured the photo machine was in working order) and a trip across town to the police barracks to pay for the application fees.
After a quick lunch, we were on our way to the barracks. Bureaucracy is different in each country. Some countries don’t offer the luxury of completing a task in the same location. In this case, our excursion to another office had a nice perk; we had the pleasure of meeting a fellow missionary who works with the Wycliffe Bible translators.
As we returned to the police station, we were hopeful that our task was almost completed. The application was processed and I had my application fee paperwork with me. The final hurdle was to have my picture taken. We were encouraged that the progress was going well, expecting another DMV miracle.
Imagine our dismay when we were greeted by a long line of people waiting to be served at the police station! Our hopes for a miracle were fading. An officer poked his head out the door and told us to come back tomorrow since all the blank ID cards were gone!
I didn’t get my plastic driver’s license that day, but I can legally drive as I have paid the application fee and have the paperwork with me. We will have to return to Hagen another time to get my actual plastic license.
I am reminded of our cross-cultural training. We were continually told to be flexible. Please continue to pray for us as we serve the Lord in PNG. Also pray for the work at Kudjip Nazarene Hospital as each day brings new challenges, experiences and the need to be flexible.
It came as no surprise that, for Mother’s Day, I was gifted with some creepy crawlies. Insects are prized possessions in the world of my kids so, of course, they would be great gifts to others. They caught three caterpillars at their friend’s house and were quite excited to present these creepy crawlies to me. As far as bugs go, I was happy to receive caterpillars instead of mole crickets or preying mantis or giant snails!
Nathan also made these candle holders with electric candles. I saw similar candle holders, made from wood, in the States just before we left for PNG. While I really liked them, luggage space was an issue, so we left the craft fair without them. I was quite surprised when Nathan presented me the bamboo versions. I enjoy their beauty as they flicker in the evenings. A matching bamboo vase came with them. I will fill it with the felt flowers I love to craft.
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.
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.
Banana spiders are found hanging around in all sorts of places. This particular one was in a garden and I was by myself. If the kids would have been with me, I would have gotten a picture with their hand near the silly thing. Instead, I had to be the brave one and use my own hand. I was probably a lot farther away from it than they would have been, but for all their interest in bugs, they are not fans of getting close to spiders either.
Apparently, these things can be fried and eaten. I’ll just trust those who’ve done it (Emma!) to believe that it’s possible and at this point my kids aren’t excited about the idea of tasting one either. They’d rather play with the other live creepy crawlies that do not resemble spiders. These are pretty fascinating to look at as long as we don’t accidentally walked into their web.