Friday, October 17, 2014

A Day at Kudjip Hospital

My weekdays on Station are slowly forming into a routine. Rising to the sounds of birdsong and neighborhood banter, I don my usual scrub shirt and trouser pants combo, and set to making coffee and breakfast (alternating between oatmeal with raisins, cereal, and the occasional egg with toast). After Rachel and I spend some time in devotions and prayer, we go our separate ways - she to the MK schoolhouse, and I to the Hospital Wards.

Our usual start time on the wards is 8am, but everyone comes a little earlier on Monday mornings for Staff Chapel (hymns sung in Pidgin, with Pastor John then giving a brief invocation and prayer), as well as on Fridays for the Doctors' conference/prayer meeting. I will be presenting for the first time on November 14th (my topic is yet to be determined).

For the past month working at Kudjip Hospital, I have spent each week on a different Ward. There are four: A - Pediatric, B - Medicine, C - Surgery, and D - OB/GYN. I have done these in the order A, B, D, C - so I am currently enjoying my 4th week with our visiting surgeon, Dr. Steve Elerding. 

The Wards are completely different, each with a unique patient population and therefore, unique challenges. I have previously written about encountering death and frustration on the Peds Ward, but I did not share that the same group of patients also provided me a sense of calm in my first week of work. It was both the familiarity of working with children and their ailments, as well as brightening their morning with tickles and funny faces, which instilled a relaxed joy into my new work environment. Of course, working alongside Dr. Susan Myers (the only other Pediatrician on Station) also provided sound reassurance, as she graciously guided me through our paper charting system and usual therapeutics, then supplied countless answers while I began to see patients on my own. 
Malnutrition in an adopted child
The following week on Medicine Ward, with Dr. Erin Meier supervising, was a blurred crash course in adult medicine, but I was thankful to find recesses of medical school knowledge returning to fill in the gaps. Typical of Erin's efficient style, she threw me in the deep end seeing patients on my own (while she saw a patients in the outpatient clinic) then returned to the ward to review and revise my plans of care as needed. I am very thankful to have had some exposure to Erin's practical wisdom before she left for four months of "Home Assignment" (State-side family time and visiting churches to raise financial support).
Dr. Scott Pringle helping refresh my memory on surgical suture tying
Last week, my morning rounds were spent with Dr. Scott Pringle (OB/GYN) on the Maternity Ward. I'll admit I was a little apprehensive going into this environment, as I have had so little exposure to the pre- and peri-natal care of women. What I quickly found was that Dr. Scott has a sound medical regimen for all his post-operative (C-Section) patients as well as for the ladies needing pre-natal checks. I actually really enjoyed learning the ultrasound techniques for pre-natal measurements, and I also feel a lot more comfortable performing a pelvic exam. The more anatomy I've examined, the more accurate my determination of what's normal versus abnormal, and how far labor has progressed. This has already proven extremely useful when seeing pregnant ladies in clinic or when I'm on call.

Catching you up to the present, I have been rounding this week with Dr. Steve Elerding on peri-operative patients in C Ward. Surgery is a far cry from my training in Pediatrics, so my role has been to shadow Dr Steve, and learn what kind of things are operative here in PNG, and what peri-operative complications I need to watch out for when I'm on call. I've also enjoyed scrubbing into multiple surgeries every day, acting as Dr Steve's assistant for a range of surgeries including appendix and gall bladder removals, draining massive abscesses, placing and removing chest tubes, and taking biopsies of various cancers. Any time that Dr. Steve hasn't had OR time, I have been scrubbing in with Dr. Scott for his OB/GYN surgeries. STD's often go untreated for years in our PNG population, which eventually leads to painful internal scarring. As such, quite a number of Dr. Scott's procedures have included breaking apart scar tissue around the pelvis, or removing uterus/tubes/ovaries if they are too badly injured. I've really enjoyed working in the "Operating Theater" (as they call it here), and have thought more than once about what a Surgical career might have looked like for me.

Just another beautiful day in the OT !!
Once rounds on the ward have finished - usually by 9AM (depending on the patient number) - I have been spending the rest of each week day in the Outpatient Clinic. During the first week, I shadowed the other doctors seeing patients, taking careful notes on their "usual" therapeutic strategies, and learning a few unique management styles to assimilate into my own clinical practice. This observation time was a true blessing, and I felt entirely prepared to see patients on my own the following week.

When a patient comes to Kudjip to be seen in clinic, they first pay a small fee, then wait to be seen by a nurse. (The PNG government only covers about 30% of the Hospital's budget, so the other 70% has to be raised from patient fees and donations.) The nurses evaluate each patient on a first come first serve basis, getting a history and checking vitals. If a patient's complaints clearly fall into a simple diagnosis, they will send them away with basic medications. Those patients who have medical problems not easily diagnosed, or who are willing to pay a little extra in order to be seen by a physician, are then ushered into our waiting area.

During my first two weeks working autonomously in clinic, I was supplied with Ruth, an experienced translator. My own Pidgin was still a little shaky, and Ruth helped fill in the gaps in my medical/anatomical terminology, as well as helping translate for patients speaking "Tok Place" (village dialects). By the end of the second week, I was communicating mostly on my own, with Ruth only occasionally clarifying, so Ruth is now helping Dr Jaryl, another new doctor from Singapore. 

Ruth:  Holding bracelets made by the daughters of Craig & Misty King
- to be given to her own daughters
My exam room sits at the end of the long clinic hallway, close to the exit. It's a bit smaller than the other rooms, and was previously used by the hospital chaplains, but I love it. There's something special about seeing your name on a door for the first time, so of course, with Rachel's decorative help, we put my name on both sides! :-)

As you can see, we have made this little room a sanctuary - specially decorated for both kids and adults, with strong PNG and Jesus themes. Rachel also supplied me with stickers to give out, which does wonders to alleviate most of the kids' anxiety, and breaks the ice for a non-threatening exam. 

With the patients all lined up and ready to be seen, I call "neks wan kam", or "nekspela kam", and beckon the next victim to join me. I usually watch them walk the hall to my room, already collecting critical information on the state of their health. They are welcomed inside with a handshake (or sometimes just a finger of two of that's what they offer), I ask for their Scale Book, and indicate they sit down on the exam table. Their wasman (accompanying family member) is asked to sit down as well, and I point to my name on the back of the now closed door, introducing myself;  "Moning! Nem bilong mi Dr Ted. Yu pilim olsem wanem tude?" While I listen to them list their concerns, I am reading the notes and vital signs scrawled by the 
triage nurse in their scale book, and my mind quickly assimilates the severity of their illness and starts to piece together their usually disconnected and exaggerated symptoms.  I follow up with questions of my own, further clarifying, boiling down, and mentally making choices on our available diagnostics and treatment options for the most likely diagnosis.

Working with adults has been...interesting... Unlike most of my Pediatric patients who rely on a parent to communicate how they feel, adults have an enormous range of methods for sharing how they feel. Much of the time I am smiling and nodding as they express great concern over irrelevant matters - a stubbed toe 10 years ago, breathing difficulties they had as a newborn, or some other fact which has nothing to do with their current medical condition. Also, the language barrier doesn't help, but as I leaned from Dr Erin, you have to rely on what you CAN trust - your own vital signs and exam, a few lab values (the rest are unreliable), and if obtained, your interpretation of an ultrasound or x-ray. Of course I take into consideration what the patient reports as their history or symptoms, but much of the time I have to look beyond the "stomach pain" they have when they eat too much, or the "fever and sweats" they have when working out in the hot sun. 

In the end, I am not alone - which is one of the many reasons we chose Kudjip Hospital over other missionary hospitals. When I have a complex medical problem that I've never dealt with - massive tumors, shattered bones, a deceased fetus, tropical infections with which I'm unfamiliar - I have the other doctors to consult with. The help is not only willing, but given in the spirit of camaraderie and love shared between members of One Body. Every day I am overwhelmed with gratitude to work among these saints - God's own warriors standing firm on the Front against pain, starvation, abuse, ignorance, and death (both physical and eternal) - and I am called to live a life worthy to stand among such company.

Colossians 3:12-17
Therefore, as God's chosen people, holy and dearly loved, clothe yourselves with compassion, kindness, humility, gentleness and patience. Bear with each other and forgive whatever grievances you may have against one another. Forgive as the Lord forgave you. And over all these virtues put on love, which binds them all together in perfect unity. Let the peace of Christ rule in your hearts, since as members of one body you were called to peace. And be thankful. Let the word of Christ dwell in you richly as you teach and admonish one another with all wisdom, and as you sing psalms, hymns and spiritual songs with gratitude in your hearts to God. And whatever you do, whether in word or deed, do it all in the name of the Lord Jesus, giving thanks to God the Father through Him.
Please join me in praying every day for
the patients and staff at Kudjip Hospital

1 comment:

  1. Greetings, Dr. Ted! Thank you so much for your detailed and authentic reports. I am the pastor of the farthest north Church of the Nazarene in the world. (Our website: I am also friends with Mike & Diane Chapman. I had the privilege of serving on a Work & Witness team to Kudjip in 2009. Since then, I have continued to have a passion for the ministry of the Church in PNG. Thank you for allowing to vicariously experience life at Kudjip through your blog. May God bless you and your wife as you continue through the remainder of your time at Kudjip.