We have entered our fourth week in PNG, and every day presents new challenges, joys, and sorrows such that time frequently stands still and we experience two or three days worth of memories in a single 24 hours.
With PNG following other countries in a nationwide shut-down, Dr Mark and Dr Erin have been on double duty organizing hospital and community COVID response efforts - appropriate education being the most important, followed by equipping hospital staff with PPE (masks mainly), and coordinating an entirely new hospital protocol for COVID screening with suspect patients being first seen in the COVID tent set up outside the Station fence at the primary school. This design theoretically keeps the Hospital free to run as normal without COVID suspect cases spreading the virus from within Station.
Doctors are taking turns covering the COVID tent while the rest continue to cover the Outpatient and ER, but with non-essential domestic travel banned, only seriously ill patients are showing up (in other words, many fewer patients daily, but what we are seeing typically needs urgent intervention). While we have screened well over 100 patients in the Tent, only two have had sufficient reason for referring to another facility for testing. And as of today, we still do not suspect COVID has come to the Western Highlands of PNG.
As I mentioned, time slows to snail speed when so many new and different experiences are piling up on top of one another. Here is a list of cases I managed in a single day earlier this week (from Peds Ward rounds, to covering Outpatient Clinic and ER during the day, then Call that night):
Pediatric Ward Rounds:
A handful of typical cases - Pneumonia, Malnutrition, and Gastroenteritis
Pyomyositis (massive abscess in her thigh), but thankfully no osteomyelitis on xray
Recurrent Febrile Seizures - monthly recurrence of unknown etiology
Lumbar Puncture for a child with undefined meningitis (Bacterial vs Tuberculosis vs Viral?)
Mastoiditis (infection in bone behind ear) - ended up needing surgery to drill a hole into the bone and release the pus
Breast Abscess (untreated Mastitis) - sedated in ER and performed an incision, washed out all the pus, and inserted two drains
Machete Chop to lower Leg, +Fractures - applied tourniquet, started IV fluids, cleaned wound, and referred to our Surgery team
Metal shavings in eye (from using a grinder without wearing eye protection 🤨) - sedated in ER and removed with Swiss Army tweezers (don't worry, I sterilized them first...)
Elbow dislocation - sedated, popped bones back into place, applied cast
Older man - wasted appearance with mass in lungs - TB vs Cancer - prayed & sent to start TB meds (no option if cancer)
Younger man with swollen/infected penis - due to a local tradition of injecting cooking oil into penis to make it bigger...😑
Behcets Disease - known case - young gal with many years of painful aphthous ulcers in her mouth - given steroids and topical lidocain gel
Bell’s Palsy - half of the man’s face paralyzed similar to a stroke, usually viral etiology, recovers spontaneously
Coxsackie Virus Hand foot & Mouth - this is a more impressive presentation than the usual little blisters (oddly enough, at the time of writing this Solomon currently has had the typical HFM fever and red spots...coincidence? Or maybe I brought it home? In case ya’ll hadn’t heard, viruses are contagious... 😬🙃)
On Call - in the ER:
Two different women came in with machete chops to their arms - the first was accused of witchcraft and chopped by a man in her village (cut through flesh and bone), the second woman was chopped on the wrist by her angry husband and wore the deflated expression of “life as usual.” Sadly, this kind of violence against women is common in the Highlands. We sedated them, cleaned their wounds, and loosely closed the skin for surgery to consult the following morning.
Last night I was on call again and two different men came in with chops - the first with an impressive gash across the top of his skull, brain matter exuding from front to back (while interesting to me, I’ll spare you the gruesome closeup picture). I called Dr Nathan to come help and we sedated the patient, cleaned off the clotted blood and bits of mangled brain, sewed the skin back up over the wound, and sent him by ambulance to the surgeon in Mount Hagen. While he was able to answer a few questions prior to sedating him in the ER, his expected outcome is poor.
The second man presented later last night, apparently from the same “domestic dispute”, with a chop to the right elbow that shattered his proximal ulna. I didn’t call anyone this time - just sedated him, cleaned the wound (gauze swab catching on bone fragments), tied off a couple small arterial bleeders, loosely closed the skin with a drain in place, applied a pressure bandage, and splinted with a backslab cast. This morning he couldn’t move a couple fingers (likely nerve damage), but the Surgeon put him on the schedule to have an operative repair.
Apart from all this mind blowing medical immersion, I have filled spare moments playing with Pennie and Solomon (not as much outside as I would like due to mosquito overload at present), working on building a wooden footbridge in the workshop (will include pics in future Blog), playing volleyball and soccer with fellow missionaries, walking adventures with the family, reading Dante’s “The Divine Comedy” (have always wanted to read it, and enjoying it tremendously), and I have continued F3 boot camp style early morning workouts three days a week (slowly gaining momentum in attendance with some of the local guys - Brian Bosip nicknamed “Flex” being my primary partner in F3 victory).
With current boarder closures and airlines like Qantas shutting down international travel through May, we are currently in limbo as to when we might be able to return to the US. Should COVID come to the Highlands, further restrictions may be imposed. Regardless, we are trusting God’s perfect timing and will begin to investigate travel options around Easter. My primary care Peds clinic back home has radically altered their business model to reduce COVID exposure to healthy kids which has meant a significant reduction in patient numbers. As such they are agreeable to my extended absence in the event we can not return as originally scheduled. In addition, my younger brother John recently escaped New York city where he works as an Environmental Engineer, and has happily quarantined himself in our vacant Richmond home - of course we are thrilled to have such a trustworthy full time occupant.
We are immensely thankful for all of you and the prayer support we feel every day! As we all are facing unprecedented changes and challenges, please join me in this prayer:
With PNG following other countries in a nationwide shut-down, Dr Mark and Dr Erin have been on double duty organizing hospital and community COVID response efforts - appropriate education being the most important, followed by equipping hospital staff with PPE (masks mainly), and coordinating an entirely new hospital protocol for COVID screening with suspect patients being first seen in the COVID tent set up outside the Station fence at the primary school. This design theoretically keeps the Hospital free to run as normal without COVID suspect cases spreading the virus from within Station.
Doctors are taking turns covering the COVID tent while the rest continue to cover the Outpatient and ER, but with non-essential domestic travel banned, only seriously ill patients are showing up (in other words, many fewer patients daily, but what we are seeing typically needs urgent intervention). While we have screened well over 100 patients in the Tent, only two have had sufficient reason for referring to another facility for testing. And as of today, we still do not suspect COVID has come to the Western Highlands of PNG.
As I mentioned, time slows to snail speed when so many new and different experiences are piling up on top of one another. Here is a list of cases I managed in a single day earlier this week (from Peds Ward rounds, to covering Outpatient Clinic and ER during the day, then Call that night):
Pediatric Ward Rounds:
A handful of typical cases - Pneumonia, Malnutrition, and Gastroenteritis
Pyomyositis (massive abscess in her thigh), but thankfully no osteomyelitis on xray
Recurrent Febrile Seizures - monthly recurrence of unknown etiology
Lumbar Puncture for a child with undefined meningitis (Bacterial vs Tuberculosis vs Viral?)
Mastoiditis (infection in bone behind ear) - ended up needing surgery to drill a hole into the bone and release the pus
Outpatient and ER:
A steady outpatient stream of High Blood Pressure, Diabetes, Acid Reflux, Muscle Pains, etc.
Breast Abscess (untreated Mastitis) - sedated in ER and performed an incision, washed out all the pus, and inserted two drains
Machete Chop to lower Leg, +Fractures - applied tourniquet, started IV fluids, cleaned wound, and referred to our Surgery team
Metal shavings in eye (from using a grinder without wearing eye protection 🤨) - sedated in ER and removed with Swiss Army tweezers (don't worry, I sterilized them first...)
Elbow dislocation - sedated, popped bones back into place, applied cast
Younger man with swollen/infected penis - due to a local tradition of injecting cooking oil into penis to make it bigger...😑
Behcets Disease - known case - young gal with many years of painful aphthous ulcers in her mouth - given steroids and topical lidocain gel
Bell’s Palsy - half of the man’s face paralyzed similar to a stroke, usually viral etiology, recovers spontaneously
Coxsackie Virus Hand foot & Mouth - this is a more impressive presentation than the usual little blisters (oddly enough, at the time of writing this Solomon currently has had the typical HFM fever and red spots...coincidence? Or maybe I brought it home? In case ya’ll hadn’t heard, viruses are contagious... 😬🙃)
Two different women came in with machete chops to their arms - the first was accused of witchcraft and chopped by a man in her village (cut through flesh and bone), the second woman was chopped on the wrist by her angry husband and wore the deflated expression of “life as usual.” Sadly, this kind of violence against women is common in the Highlands. We sedated them, cleaned their wounds, and loosely closed the skin for surgery to consult the following morning.
============
Apart from all this mind blowing medical immersion, I have filled spare moments playing with Pennie and Solomon (not as much outside as I would like due to mosquito overload at present), working on building a wooden footbridge in the workshop (will include pics in future Blog), playing volleyball and soccer with fellow missionaries, walking adventures with the family, reading Dante’s “The Divine Comedy” (have always wanted to read it, and enjoying it tremendously), and I have continued F3 boot camp style early morning workouts three days a week (slowly gaining momentum in attendance with some of the local guys - Brian Bosip nicknamed “Flex” being my primary partner in F3 victory).
We are immensely thankful for all of you and the prayer support we feel every day! As we all are facing unprecedented changes and challenges, please join me in this prayer:
Heavenly Father, we praise your Holy name! Creator of Heaven and earth, you hold us in your hand now and forever. We thank you for the breath in our lungs, and the salvation that frees us from wretchedness. Send to us your Spirit of wisdom and peace. Guide our hearts and minds in your Word, and protect us from physical harm and the temptation to serve ourselves. Remove fear and refocus our hope in your son Jesus Christ. We are your hands and your feet Lord - fill us with your strength and Light, that we might obey your will and bring your message of Love to this dark world. All honor and glory are yours Papa God and we pray all this in the name of your son Jesus Christ.
Amen!
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