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Sunday night I was walking around the station at sunset. I walked past the ER and saw Dr. Bill inside with several nurses, leaning over an exam table. I went inside to see what was happening. Remember, this is Sunday night, if something is happening in the ER, it is actually an emergency, not someone needing a bandage changed. A little girl (2 months old) had been brought in and was clearly underweight and having severe difficulty breathing. Dr. Bill was hesitant to make a diagnosis, but suspected meningitis, possibly with other complications. The baby gasped for breath, exposing her ribs each time she inhaled. She was clearly not aware of her surroundings, as her eyes floated around the room, unable to fixate on anything. The nurses could not get an IV started in the girls hands or foot, the veins were just too small. Dr. Bill drove a needle into the baby's tibia and started pumping all sorts of drugs into her. I asked what chance she had of surviving, and Dr. Bill said he wouldn't give her 50%! (MISSING)If she were to be admitted to the paeds ward the next day, it would be a miracle.
I left the ER after Dr. Bill prayed with the mother. This whole ordeal created a somber tone for the rest of the night.
The next morning, before I went to work with Maintenance, I walked through the paeds ward and was happily surprised to see the girl's mother sitting next to her. The baby girl was much more responsive and her breathing was fairly normal. I talked to Dr. Bill later in the day and he was obviously very surprised and excited at the outcome. Last I checked, the baby and her mother were still in the paeds ward; she has put on weight and is alert and acting just as a baby should.
Tuesday was another story. Dr. Bill and I were practicing missionary orthopedics (anaesthetizing the patient, and then using brute force and periodic Xrays to position the bones correctly - no surgery necessary), when two parents bring in their 3 year old son to the ER with pigbel - necrotizing enteritis. This is too common of a disease and really only occurs in the highlands of New Guinea. Trypsin inhibitors in the staple sweet potatoes keep meat contaminated with Clostridiumperfringens from being digested. The result, if left untreated, is death of the bowel, which leads to death of the individual. This usually occurs in about 2 weeks. The boy was unconcious and within minutes of being there he went into arrest. Dr. Bill and Dr. Erin, along with five nurses, were scrambling. They inserted an NG tube, an endotracheal tube, a tibial IV, did CPR, and were contracting his lungs for him. I took over for Dr. Erin doing CPR. She still heard cardiac activity at this point. Dr. Bill was suctioning all kinds of discolored fluid from the NG tube, an indication of dead bowel - typical of advanced pigbel.
After two or three minutes, Dr. Erin listened to his heart again - nothing. I continued CPR, Dr. Bill continued suctioning, the nurses continued injecting epinephrine into the IV. A few minutes later, Dr. Erin listened again. Nothing. It was over.
Dr. Bill said that if the boy had been brought in 24 hours earlier, the outcome would have almost certainly been different. This is a common problem here. People come to the hospital when it's too late or almost too late. This boy had been showing classic pigbel symptoms for two weeks and the family lived just down the road in Minj. If they lived a valley or two over it would have been one thing, but down the road? With public transit available to the hospital? What's the excuse? Dr. Bill was bothered the rest of the day by this. He said he wanted to ask the parents what the were thinking, though then was not the time, as they were grieving and it was already too late. It's a cultural thing, I suppose. I guess that I am just used to the US where we go to the doctor if we think we feel a lump, not wait a year until the tumor is the size of a fist and festering, (I have seen this, too).
Today (Thursday) I spent the day shadowing Dr. Jim Adams, a volunteer family practitioner from Edmonton, Canada. Dr. James spends two months every year since 1995 doing missions work through World Medical Mission, while still running his practice in Canada via the internet. The most dramatic thing that we saw today was a man in the ER whose bicep had been sliced through by a bushknife. He had stolen coffee from a coffee plantation when some security guards caught him. He had lost several liters of blood by the time he arrived and was going into shock. Dr. James began suturing him before Dr. Jim Radcliffe, the only resident surgeon here in Kudjip, came in a finished the job.
Tuesday and Thursday of this week I have been able to practice missionary orthopaedics. There is no orthopaedic surgeon here, so when someone has a distally broken humerus, for instance, one person stabilizes the shoulder, another pulls the patients arm with all of their might distally, and the doctor pushes the elbow into place. We then take another Xray, see our progress, and repeat as needed. The final step is adding a cast. That's all there is to it. Mostly brute strength. I've been taking pictures of this whole process. Dr. Bill says that if I show tell any orthopaedic surgeon in the United States about this method, he won't believe it without pictures.
My Tok Pisin skills have come in handy. I've been able to serve as an interpreter between visiting doctors and patients. The actual paid interpreters think that this is great, they don't have to work as much. When I start talking to native hospital staff in Tok Pisin they are so happy that a short term volunteer has learned their language and they compliment me on my abilities.
My work with the Maintenance department continues to go well. We will be building a wall out of concrete and river rock beginning tomorrow. I've been getting buddy-buddy with Jordan, the director of Maintenance, and I showed him some picture of the woodworking projects that I have done back home. As a result, I was able to get away from my landscaping job and work in the carpentry shop. This was a lot of fun. I got to design and build a wooden form for making concrete flower boxes. The tools are a little more crude here (i.e. the table saw is a circular saw place upside-down into a plywood table and the fence for the table saw is a board that I nail directly into the table) but it is so neat to be able to utilize one of my gifts. Since I have no formal medical training, I am not always of use in the hospital, but in the wood shop, I get to be my own boss because I know exactly what I am doing.
Also, my chicken butchering went well... for the most part. The head came of with more difficulty than I had anticipated. I now fully understand the term "running around like a chicken with it's head cut off". Don't worry, I have a video of the entire process. The chicken was quite small, but when shredded and placed in a crockpot with barbecue sauce, it was delicious.
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Aunt Phyllis
non-member comment
Quite proud of you. You have grown tremendously. I thank God for you, your talents, and your education.