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Published: January 9th 2018
Life on Station
Kudjip Nazarene Hospital (now officially known as Nazarene General Hospital Jiwaka) is part of a large mission station in the Highlands of Papua New Guinea (the elevation here is about 5200 ft.). There are quite a few missionary families that live on station, as do many of the national staff. One of the great things about this is that everything is within walking distance. My guest flat is about a 3 minute walk from the hospital. To walk to the houses on the other end of the station takes maybe 7 or 8 minutes. The other missionaries on station are great company. I’ve been invited over to dine with several times with different families and it’s always a wonderful time.
My quarters consist of a two bedroom flat with a kitchenette. The water is supplied by the rain and collected via the roof and gutters to be stored in huge cisterns. Drinking water is purified with a filter. Because the temperature is so consistent year round, there are no heaters or air conditioners. Even the windows of the house cannot truly close, only shut like blinds to block the wind. This means that I can always
hear the singing of birds and the chirping of insects. Speaking of insects: it’s just a way of life here. Cockroaches are not uncommon visitors (thankfully I haven’t seen any in my flat), spiders and ants abound, and flies are an ever present force (especially in the ER and in the wards). It’s more about learning to cope with them than try to vanquish them. Weekend Adventures
This weekend consisted of a hike through the jungle to sliding rock, going to the market for produce, going to a native church, and swimming in the river. The church I went to on Sunday was Mise Church of the Nazarene. It’s about a 10-15 minute walk from the station, across the river. When I was here in 2013, my work crew consisted of five guys and they all attend Mise Church. The entire service was in Tok Pisin and I was the only white person in the congregation of about 60. On the walk home, I talked about Biblical truths with my friend John as we munched on the sugarcane that he cut from his field.
As I mentioned, the common language here is Tok Pisin (literally meaning “bird
language”). It’s incredibly easy to learn as much of it is rooted in English and I remember it well enough from my previous time here that I’m able to communicate with patients without translation. For details of the language and examples of vocabulary, see my blog from 2013. Hausik
Life at the hospital (or “hausik” – “house sick”, as it’s known in Pisin) has a nice rhythm to it. Rounds start at 8:00, there’s an hour break for lunch, and the day usually wraps up by 5:00 (unless you’re on call). But don’t be fooled! We stay busy the entire workday. The ER, outpatient department, and wards are right next to each other, so going from one to the other is easy and quick (which is good since we always bop back and forth).
I’m on surgery this week, which has been great. The only surgeon currently on station is Dr. Sheryl Uyeda who has been here for over a year now through World Medical Mission’s Post Residency program. It takes a certain type of personality to be a missionary surgeon, and Sheryl certainly fits that – great sense of humor, has a balance of
confidence and humility, and is always go-with-the-flow. The previous long-time surgeon, Dr. Jim Radcliffe was here for 32+ years and just retired a few weeks ago. Jim’s son, Ben, is also a surgeon here, though he and his family are currently in the US and expected to return to PNG soon. Many of the patients currently on the surgical ward are orthopedic cases (femur fractures, broken shoulders, etc.) currently in traction. Other patients have had things such as osteomyelitis (an infection of the bone), trauma, car accidents, and rectal cancer, just to name a few. Unfortunately, some of the surgical patients are the result of “chop chops” (machete wounds).
Today in the OR we did a removal of ovarian mass, inguinal hernia repair, and laparoscopic appendectomy. I got to be first assist on all of these cases and do all of the fun things we do in surgery – cut, buzz, sew, tie, and staple. Even though today was my first day in the OR with her, Sheryl certainly entrusted me with a lot, which is great.
When not in the OR, I’ve spent a lot of time in the ER this week. I enjoy sewing up different
lacerations and have gotten to do a good many of them. Just this afternoon I got to sew a big lac on a thumb, which included removing the entire thumb nail and sewing the subungual (under the nail) surface, before putting the nail back on and temporarily sewing it in place so that it heals correctly. Another big gash that I repaired on a man’s foot went all the way through the tendon of the big toe. I also got to log my first thoracentesis (draining fluid from a lung).
Last night I was on call with Dr. Imelda. Call starts at the end of the work day (5:00 pm) and goes all the way until 8:00 am the next day. We had quite a busy evening: from 5:00 pm until midnight, we only had about a half hour of rest in which we could eat dinner. Most of our time was spent in the ER, seeing a little bit of everything – appendicitis, mandibular abscess, severe malaria (jaundice, fever, anemia), spontaneous abortion, possible meningococcemia, and allergic reaction. The peds ward even filled up at one point and we had to turn patients away and tell them to go
to the next nearest hospital (about an hour away). After midnight, we only got two calls and I was able to sleep some.
Another big difference for me in the hospital practice here is charting. All of the inpatients are on paper charts and all outpatients carry their medical information with them in a small booklet called a skel buk (scale book). They bring these booklets with them and we can review past medical history and treatment, write clinic notes, and prescribe medicine all in one spot without having to store and dig through records. This makes for more efficient visits. Some visits that would take 30 minutes in the US because of charting and insurance only take 5 minutes here.
Another thing here is that treatments are often administered in a shotgun pattern. Because it’s sometimes impossible to confirm a diagnosis, treatment for a suspected infection may include several different antibiotics because there’s no good way to know for sure which organism is causing the infection. There are no cultures, Gram stains are unreliable, and infection sources are everywhere. Even injuries such as blunt trauma (which shouldn’t get infected) are treated with antibiotics
because if left untreated, a majority of those injuries here will develop pyomyositis – a pus pocket in the muscles. It’s difficult to explain why certain things like this come up, but the thought is that it’s better to be liberal with antibiotics that to deal with preventable complications.
I will continue on surgery this week before switching to medicine next week. It’s no secret that I’m not a fan of the practice on internal medicine because, in my opinion, it’s too much talking about things and not enough hands-on time. Well that is not the case with internal medicine here. Sure you need to know how to treat different things and manage patients medically, but all the family practice doctors do procedures nearly every day. We rarely refer patients to other providers in the hospital here (except surgery). If a patient has a problem – you take care of it. Like I mentioned in my previous post, all of the physicians here do C-sections. Physicians also serve as their own radiologists – interpreting x-rays and performing their own ultrasounds. Quite a broad practice.
Tot: 0.659s; Tpl: 0.019s; cc: 8; qc: 50; dbt: 0.0149s; 1; m:saturn w:www (22.214.171.124); sld: 1;
; mem: 1.4mb