The Last Update From PNG

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Scrubbing In

Tuesday, Wednesday, and Thursday of this week I have been with Dr. Jim Radcliffe is surgery. On Tuesday, I got to scrub in for the first time. The procedure was a biliary bypass. The patient had an inoperable tumor obstructing the bile duct from the gallbladder, so Dr. Jim incised and drained the gallbladder, incised the stomach, and then sutured the gallbladder to the stomach so that the bile will now drain into the stomach. During this operation, I got to hold retractors, clamps, and sutures, suction blood and bile, and once Dr. Jim was finished suturing the fascia, he left to fill in the patient's charts and I stapled the epidermis back together. Other operations I saw on Tuesday included two tubal ligations, a finger amputation, and a colostomy.

Wednesday was a day in surgery outpatient. This included three minor procedures and a lot of time in the outpatient clinic doing followups with surgery patients. Dr. Jim was called into the ER to insert a Foley catheter into an older man because the nurses were unable. Dr. Jim was also unsuccessful with the Foley cath AND with a small incision attempting a suprapubic catheter. The next option was surgery. The operating theatre was prepped and the man was sedated. Since the OT is closed for scheduled surgeries on MWF, none of the nursing students were there, which meant that I got to lift the man onto the operating table and hold him down while anaesthesia was administered. The surgery was quick, maybe 20 minutes. Another man in the ER suffered 5 big chops from a bushknife, several on his head and neck. One of his own tribesman had attacked him after accusing him of sorcery. Apparently, this man had not cried loud enough during a hauskrai (a very public mourning for someone deceased) and was therefore suspected of using sorcery to kill the deceased individual. The man with the bushknife acted as judge, jury, and almost executioner. This is something that we see in ER on almost a weekley basis. What a messed up place.

Wednesday was a long day in the OT. The first case was a woman who's arm had been severely chopped by her husband and she had been left for head. Dr. Jim put pins in both the radius and ulna and went about reparing all the tendons. This procedure took almost two hours. This was followed by a woman who had an ectopic pregnancy. Dr. Jim removed the fallopian tube containing the embryo as well as several huge clots formed by it. After a short lunch break, I got to scrub in for the third surgery. The patient, Sirah, is a young lady who has been working with New Tribes ministry in order to translate the Bible into her tribal language. She has been in the hospital for about a month and already underwent an entire splenectomy, yet was still not doing well; she was coughing up a lot of blood and had severe abdominal pain. Thursday's surgery was partially exploratory. The first thing we noticed when she was opened up was about six feet of dead small intestine. To remove the dead bowel required clamping the blood vessels (this required over 30 hemostats), resecting the bowel, and tying off each hemostat. This took a while and it was not even a planned part of the surgery. An anastimosis then reconnected the two ends of the intestine. Afterwards, Dr. Jim was exploring around the esophagus to try and find the source of Sirah's internal bleeding. Sirah also had venous hypertension, which led to her veins being under higher pressure than normal. One of these veins burst and blood started filling the abdomen. Between me, Dr. Jim, Dr. Eileen, and the scrub nurse Magreth (affectionately known as "Aunty"), we seemed to not have enough hands to hold the incision open with retractors, suction the blood, hold the viscera back, and locate and suture the bleed. We all thought Sirah was going to bleed out. She lost so much blood. Remember last week I said that part of the negotiations was the most intense thing I have ever experienced? That was definitely replaced by this. It was like something you see on a TV show; people were shouting, one of the nurses called the lab to get more units of blood, and blood just kept coming from Sirah's vein. The bleed was deep in the cavity, so it was hard to see, and even harder to get at with clamps and sutures. By the grace of God, Dr. Jim found the bleed and sutured it shut. Everything else that had been planned for this surgery was forgotten, there was too much risk. The whole procedure took over 2.5 hours. 57 hemostats were used (normal is closer to 15), 5 units of blood were transfused, and several liters of blood, acites, and chyme from the small intestine were suctioned off. There were two other surgeries planned for Thursday, including a leg amputation, but they were rescheduled for Friday because the three cases had taken longer than expected.

New and Old Friends

I love the community here in Kudjip. Last year, part of our team's agenda was to spend time with students from the Nazarene College of Nursing. These students come from all over the country of PNG. They spend three years earning a nursing degree and working in the hospital before being sent out to bring healthcare and the Gospel to all corners of PNG. I've been able to reconnect with many of the students that I met last year and I've been able to meet many new ones. We have passed a lot of time hanging out in the dorms and I've come to realize that these students, though they come from a completely different culture than I do, are exactly the same as American college students. They stay up until the wee hours of the morning, they download and share the same music and videos, and they have the same dorm life mentality. They even zing each other the same way we do. One of my good friends, Elijah, is affectionately referred to as "The Prophet" or simply "Proph" by every male nursing student on campus. Another friend, Henry Ian Vincent, has the unfortunate initials HIV, so he is often referred to as "The Virus". There are other aspects of dorm life that these PNGers and American college students share, but I will refrain from posting these online, for the discretion of my readers.

On Saturday, I went with four nursing students on a PMV (public motor vehicle) to Mt. Hagen. The PMV is a large van with seating for maybe 12, but many more passengers than that are squeezed inside. I had a kid fall alseep next to me and lay on me, a guy beside me was eating peanuts and throwing the shells out the window, and two guys in front of me were smoking. All this happening as this van is careening over potholes and past other vehicles on the road. It was quite the cultural experience. Mt. Hagen is the third largest city in PNG. There were literally thousands of people in the streets. Many greeted me with, "Gut monin, whiteman!" Besides a few inside one store, I was the only white person in town. We got some shopping done, and made it out without being mugged or robbed.

I mentioned Elijah Tami, the nursing student, earlier. I met Elijah last year and have been able to keep in limited contact with him over the past year. He is from East Sepik on the northern coast of PNG. His story and his dedication continues to amaze me. He grew up in a small village with illiterate parents, one brother, and five sisters. His family business is hunting crocodiles in dugout canoes and selling the meat, skin, and eggs. After finishing secondary school, he attended Papua New Guinea University of Technology in Lae where he studied applied physics (this is a big deal, considering that most students don't finish primary school, and very very few attend any sort of university). During this time, both his mother and one of his sisters become ill and died within one month of each other between April and May of 2010. His father had passed in 2003. He gave up his studies at PNGUT to come to the Nazarene College of Nursing here in Kudjip. He told me that his sister had died on the way to the hospital, because the hospital was a day's travel away (by canoe). Elijah wants to finish his schooling here, and then go on to Port Moresby for additional nursing schooling before returning to his village in East Sepik where he can be the first one to provide healthcare for the people in that area. I am so excited to see Elijah bring about this change.

Preparing for Culture Shock

This is my last update from Papua New Guinea. I leave tomorrow morning: Monday, June 24. My experience this year has been very different from my experience last year. Last year, I was part of a team. I didn't do my own cooking or cleaning, my schedule was not my own. This was not a bad thing, I loved last year's trip. The team became my family and I wouldn't trade that experience for the world. But this year it has been the opposite and I have loved it. Also, last year I was here for two weeks, and I knew it was only two weeks. Everything was a new experience. This year, the first couple of weeks were similar to last year: a new culture, new people, new experiences. But now I have settled in. I have a schedule. I get up in the morning, go to work at either Maintenance or the hospital, maybe go to the market after work, go hang out with friends (either nursing students or missionaries), then off to bed. It's a good life. It's no longer shocking to see the things that were once new to me. This has become home. I feel comfortable here.

Like I said, last year I knew the trip was only two weeks, I never slowed down enough to settle in. Coming back to the United States had little culture shock. This year, I know it will be different. Now, it has come to the point where I am surprised to see a white person that I don't know. I am used to little kids smiling and pointing at me as they shout, "Whiteman!" If someone references a car, they are only talking about a LandCruiser with four wheel drive. The nicest roads don't have curbs and are full of potholes. Tok Pisin is the common language. I've become acquainted with the local geography so that when someone talks about going to Banz, Kopsip, Kugark, or Minj, I know how far away it is. Women carry babies on their backs in large strings bags suspended around their foreheads. Fresh produce is the cheapest food I can buy. Prepackaged food is a rarity and eating an entire pineapple in a day is not unusual. To go to town requires days of planning, about $60 in transportation cost, and a 45-minute drive. The weather is dependable: it will be cool in the mornings, the sun will come out and make it 80 degrees, and maybe some rain will come in the evening. It's weird if we make it a whole day without the power going out at least once. Water must be conserved, as it only comes from tanks that hold rainwater. Internet is hard to obtain, and then it is incredibly slow. It's strange how all of this has become the norm is just 7 weeks.

I'm not saying things are better or worse here than the US. I've just become accustomed to this way of life. There are certain comforts of home that I miss, but there are also things here that I prefer here to Western culture. I just know that going home will require a transition. Last year I also only saw the good, the bright side of things. This year I have seen the good, but I have also seen the tragedies of this culture: shortcomings on the mission field, imperfections in people and the local culture, and the ugly side of human nature. This makes me realize more than ever that the world needs Christian servants to go out to underserved areas in order to help alleviate the suffering. Despite seeing the bad, many of the missionaries here have shown me hope, and I look forward to joining that global community someday, once I have some letters after my name.

The Next Adventure

As I said, I leave Papua New Guinea on June 24. I will be spending a week in Australia before coming back home: three nights in Brisbane and four nights in Sydney. This should be a nice transition back into Western culture. To my sponsors: Thank you again for helping to support me. I was not expecting to fundraise as much money as I did, and I thank you for covering my costs. I've been keeping a diligent log of my expenses. You supporters have paid for my food, transportation, and services. All souveniers and gifts have been on my own dime. It looks like I will even have a decent chunk left over from my supporters. Some of this will go to the mission hospital here, some will go to individual missionaries who have to raise 100%!o(MISSING)f their own support, and some will go to the local people. The native guys with whom I work are building a new church out in the bush and construction has been stalled due to a lack of funds. I'd like to see the work continue.

Australia is also on my own dime, all of my activitiy expenses are coming out of my own pocket: this leaves more to give to people here in Kudjip. When I found out I was going to return to PNG, I planned on spending the majority of my savings on the trip. I had no idea that God would provide for the entire trip through a multitude of incredibly generous sponsors. Thank you again for supporting me. This trip has taught me more than I ever anticipated. I'll post one final recap about my experiences when I get home.

I will continue blogging about my shenanigans in Australia. Off to the first world I go!

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