I'm Back

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A brief life update for those of you with whom I’ve been out of contact for a while: I’m halfway through my fourth year of medical school and am planning to pursue a general surgery residency later this year. I have been married to my lovely wife Abigail for a year and a half. She is in her first year of pediatrics residency in Chicago. Ok, you’re up to speed.

Greetings from Kudjip, Papua New Guinea!

It’s hard to believe that it’s been four and a half years since I was last here. On my two previous visits (summers of 2012 and 2013) I was a lowly pre-med college student who didn’t know a lick about anything medical. Now I at least know enough to be dangerous. I’ll be here for just over 3 weeks. One week on surgery, one week on inpatient and outpatient medicine, and the rest of the time on peds.

I arrived yesterday, just after noon, and truly hit the ground running. I dropped my bags off in the guest flat where I am staying, took a much-need shower, and headed to the hospital. I worked with Dr. Erin Meier in the Outpatient Department and Emergency Room (the line between these is relatively thin, as doctors will bounce between one and the other frequently, depending on patient needs). Within my first hour I was sewing up a chop-chop (slang for machete injury) several inches long. I saw several patients with tuberculosis (TB) – a disease that we learn a lot about in medical school, but don’t see terribly often in the US. My day ended with draining an abscess on the back of a young man’s head.

This morning I was to report to the peds ward at 8:00 with Dr. Susan Myers, but I got a call at 7:20 saying that a C-section was getting ready to go in the operating room (OR). So before my first day was scheduled to start, I already was scrubbed, gowned, and gloved as the first assist on a C-section! It’s quite surreal to be standing in the very OR where I witnessed my first ever surgery (in 2012), scrubbed into surgery for the first time (2013), now as the first assist and actually have a sense of what’s going on. The rest of the morning consisted of abbreviated peds rounds and outpatient clinic with Dr. Susan.

The afternoon was also spent in outpatient department (OPD) and ER with Dr. Imelda Assaigo. Dr. Mel, as she is known, is a native Papua New Guinean who was a rural health registrar (what we call a resident in the US) at this hospital for a number of years. We saw numerous patients together including a woman who was nearly 9 months pregnant and getting her first ultrasound. The ultrasound was routine except for a discovery of twins!



A word on the practice of medicine here. Compared to a hospital in the United States, this place does not have a lot. That being said, the doctors and nurses here do amazing work with what they have. Here’s a general overview of resources:

Imaging: x-ray and ultrasound. No CT scans, no MRI. The only CT scanner in the entire country is in the capital city, which is only accessible from here by plane.

Labs: complete blood count (CBC) and some basic chemistries (e.g. potassium, AST, ALT, bilirubin, creatinine, etc), urinalysis, CSF analysis, some serology for syphillis, malaria, and HIV. What’s nice about not having excessive resources is that they are efficiently utilized. If you want a hemoglobin, you just order a hemoglobin – not the entire CBC. If you suspect liver disease, you order an AST or an ALT – not both. However, there are many tests that this hospital does not have that would prove useful. For example, we have a patient on peds who we suspect may have elevated parathyroid hormone (PTH), but a simple lab test for this would need to be mailed to the capital city and then flown to Australia – at a cost of almost 500 kina – about $150 USD (compared to 6 kina for a CBC or 2 kina for just a WBC count).

Surgery: Currently, there is one surgeon on station right now. Another will be returning from furlough in a couple of weeks. But surgery here is very broad – a general surgeon will take care of most anything that he or she can take care of, including orthopedics, urology, GYN, etc.

This hospital also performs over 300 C-sections per year. These, on top of all the other surgeries, would be too much for the surgeons to handle alone, so all of the other doctors (family medicine, pediatrics, and ER) comfortably perform C-sections.

Facilities: There are four wards – peds, medicine, surgery, and OB. Each ward is a long hallway with about 30 beds total and a nurses station in the middle. Remember this next time you complain about not getting a private room on your next hospital stay. The ER has 6 beds. There are now 2 ORs. There is no official ICU as such. The sicker patients go to the same wards as everyone else.

Like I said, given the limitations, I’m continually blown away by how much these doctors are able to do. Most of all, they all demonstrate a bulldog tenacity: if they can't order a lab here or perform a procedure, they will not stop until they can find a place to process that lab or find a provider elsewhere who can perform that procedure.



Life outside the hospital here leaves little to be desired. It’s sunny, high 70s-low 80s pretty much every day, fresh fruits abounds, and people are friendly – what more could you want? I’ve been very blessed to reunite with many friends that I haven’t seen in years. Dinner last night was hosted by Jordan and Rachel Thompson (and their two adorable sons), and tomorrow I’m planning on dining on kaukau (the staple sweet potato) at the haus of John Gari – one of the guys from my work crew in 2013.

Travel

I took the long way in getting here. I flew from Chicago to Qatar, to Singapore, to Papua New Guinea. I left Chicago in 2017 and didn’t arrive in PNG until January 3, 2018. I was able to spend much of my 11-hour layover in Singapore touring the town, which included Gardens by the Bay (which boasts an indoors Cloud Forest with the world’s tallest indoor waterfall), and authentic Chinese food (i.e. fried squid) on the streets of Chinatown.

That’s all for now. I will have more details about life here in a future post once I’ve had time to get settled. If you're new to my travel blog, feel free to look at entries from my 2013 Papua New Guinea trip - it'll give an idea of the background (culture, geography, language,etc.) of the country.

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Photos

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The front of Kudjip General Hospital - I helped build this walkway with my workcrew in 2013.

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A textbook example of digital clubbing - I've never seen it this prominently in a patient (it indicates chronic hypoxia)

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My first of many chop chop repairs

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Squid from a vendor on the streets of Chinatown in Singapore - only cost SGD 3.70!

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The world's tallest indoor waterfall inside Cloud Forest, Gardens by the Bay, Singapore.

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Inside Cloud Forest, SIngapore.