A Week on Surgery

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Mi bai kamap Dokta bilong Katim

This week was my week on surgery. With Dr. Sheryl, I got to see many patients inside and out of the OR. There were several “bread and butter” straightforward cases – tubal ligation, C-sections, lap appendectomy, as well as some others that were not so straightforward. Among these was a bladder stone in a four year old child. You’ll see the x-ray I uploaded as well as a picture of the stone itself, which ended up measuring about 2 cm in length. Another surgery started as a diagnostic laparoscopy, where we stick a laparoscopic camera inside the abdomen to look around and see if we can identify the cause of a patients symptoms, which in this case were two weeks of lower abdominal pain and fever, refractory to medical treatment. Our investigation found a 2-week old appendicitis, which by this time had ruptured and created abscesses throughout the abdomen. This means that we had to make a larger incision in the patient and remove what was left of the appendix as well as open up and drain all the pus from the abscesses. One of the abscesses tracked all the way through the retroperitoneum to the right kidney.

There were a number of smaller cases, including several incisions and drainages of large abscesses on hands. I performed two of these by myself, with the attending checking in periodically. I drained another massive abscess on a woman’s breast. She was sedated with ketamine (a dissociative sedative). Most patient will moan and groan periodically while under the influence of ketamine, but this woman sang a beautiful dream-like song during the entire 10 minutes that I drained her abscess.

In case you didn’t pick up on it; there are tons of abscesses (walled-off areas of infection that contain pus) here. I’ve learned from the doctors here that even wounds that shouldn’t get infected, such as blunt trauma from car accidents, will often develop abscesses. The year-round tropical climate (no freezing temperatures to kill bacteria) and poorer hygiene (routes of infection via the teeth and feet) may be two factors that influence this.

Because a missionary general surgeon is also part orthopedic surgeon, I’ve gotten some experience casting and splinting fractures. Many of these patients are children with diagnoses ranging from simple fractures from falling out of trees, to severe osteomyelitis, an infection of the bone, that has eaten away much of the bone tissue.

As I’ve mentioned before, this hospital sees its share of machete wounds, known locally as “chop-chops”. These range from superficial cuts to devastating and life-threatening trauma. Sheryl and I were called back early from our lunch break on Wednesday because two chops had come into the ER at the same time. I got to manage the less severe of the two. My patient had received two chops: one small one to his right elbow that inflicted minimal damage and one to his right hand that extended about 6 inches and partially severed a tendon. I tied off the bleeding arteries, repaired the tendon and closed the wounds. The other chop-chop was a man who had multiple flexors and extensors (the muscles and tendons of the forearm) severed as well as his tibia and fibula completed severed on the right leg. Given the severity of this chop, it is no surprise that he had large arterial bleeds and was transfused two units of blood as two doctors worked to stabilize him. As of Saturday, he was on the surgical ward and doing fine, all things considered. Surgery is planned for this week to repair the broken bones and severed muscles in his leg.

This week, I will be on medicine. I will round on patients in the morning with the illustrious Dr. Bill McCoy. Dr. Bill has been a missionary doctor since 1986, and has been in PNG for over 20 years. He is at once perhaps one of the smartest, wisest, most compassionate, and most fun people I have ever met. Learning from him is a privilege. I will round on patients with him in the morning and then see patients on my own in clinic during the afternoon.

Bush Church

On the lighter side, I went to another bush church today. A friend that I met here in 2012, John Opa, invited me to his church at Konduk. During my trip in 2013, John was the guide for an all-day expedition to some hidden caves way up in the jungle. See my blog entry from 2013 for the whole experience of climbing a kilometer into pitch blackness.

For someone like me who enjoys weekend activities such as hiking and going to church, going to a bush church is a perfect combination of the two. It was a one-hour hike up the mountain to Konduk. As we walked in the early morning, the sun illuminated the fields of banana trees and the mountains surrounding the Waghi Valley gave an ethereal blue glow. Goats, dogs, and the occasional pig were among the traffic we encountered on the way. All of the congregation loved to greet and shake hands with the lone white man who came to their church. The entire service, songs and all, was in Tok Pisin and I was able to track with about 80%!o(MISSING)f it. When a white person speaks Tok Pisin I can understand 100%!,(MISSING) but when a local speaks it and gets on a roll, maybe 70%! (MISSING)

Food

I have no complaints about the cuisine of Papua New Guinea. Because the growing season is year-round most produce I would ever want is available at the local market: pineapple, coconuts, carrots, cabbage, onions, beans, green peppers (here they are called capsicums), tomatoes, potatoes, sugarfruit, bananas, and of course kaukau. Kaukau is the staple sweet potato that everyone grows. It’s incredibly dense and has an excellent flavor. I have a healthy appetite and one large kaukau is enough to satisfy it. The traditional way of cooking them is either to place it directly in a fire or to cook the entire thing in oil, turning it every once in a while. It is then eaten whole.

Sugarfruit is something that I had never seen before coming here. It’s a small, plum-sized fruit with an outer shell that you pick off with your fingers to reveal a white, velvety bag inside. You make a hole in this and just suck out the contents. I find that it’s best to just eat it without looking at the contents because the best way I can describe the appearance of the edible part is “moldy fish eggs”. Thankfully they don’t taste like moldy fish eggs, but are very sweet.

I had my local friend John help me open a coconut this week. After making a hole at the end to drain out the water, he took my bushknife and delivered seven sharp whacks with the back, non-sharp edge of the blade and the coconut split perfectly in two. We then sat on the grass and scraped out the meat inside.

Outside of local produce, most western food that I could want is available in Mt Hagen, the nearest large town (about an hour away). I went grocery shopping on my first day here and stocked up for the rest of my three weeks. Some differences in common food items exist. For example, milk here is sold in one liter cartons and is shelf stable, meaning you can stock up on milk and leave it unrefrigerated until it is opened. It’s also whole milk, which makes it a suitable substitute for coffee creamer, as there are no liquid creamers to be had. Some items, like breakfast cereal and cheese, are rather expensive here. I’m also adopting a mostly vegetarian lifestyle, as meat is also relatively expensive. Live chickens are available at the market, so I’m considering revisiting my butchering skills per my last time here.

Thankfully, I am an adequate cook because I might starve otherwise. There are only two restaurants within a 30 minute drive, and I don’t have a car. Fast food doesn’t exist.

Some of the finest coffee in the world is grown in PNG. Many local subsistence farmers grow coffee and sell it to middlemen who then sell it to worldwide distributors (e.g. Starbucks). A bag of good quality coffee is less than $4 USD at the store. My guest flat came equipped with a single-serve French press, so I’m all set.

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Photos

Georgina
I took Georgina's cast off. This marked the end of over 6 months of treatment for osteomyelitis.

Comments

[Martin Ely]

Very Enjoyable Blo Posts
Brian, I really enjoy reading all of your blog posts. Is this something you see in your future like the good Dr. you mentioned previously?

[Pat Lehrling]

Blessings
Your blogs share your wonderful adventures, but more importantly they confirm what I already knew. You are a brilliant, compassionate young man. Remember Dudley’s catfish and bring your wife down someday to introduce her to that treat.