Friday, March 24, 2023

In Stride with The Spirit

Dear Reader, thank you for meeting with us here, carving out time to hear our stories and hearts. We feel your presence in this missions work - an encouraging hand on our shoulder as we obey the Lord's call to pour out love and light into the people of Kudjip. You are a blessing to us, thank you

Now two weeks into our time here on Station, I have turned the corner from feeling overwhelmed to feeling comfortable with the work at hand. There are still many questions and unknowns, but the Spirit provides a confidence in using the resources we have to provide the best outcomes possible.

On the Pediatric ward I have rejoiced with many families in their child's recovery and hospital discharge. I am thankful for the medicines, oxygen tanks, IV fluids and especially all the wonderful staff that we have to cure all manner of disease. Typhoid and pneumonia cases have been more prevalent of late, while we continue to have a regular supply of malnutrition, meningitis, heart disease, and serious injuries. I suspect the recent spike in pneumonia admissions are of viral origin (rather than bacterial) due to slightly colder temperatures during our current rainy season ("colder" is 50's at night, 70's during the day). With no way to differentiate bacterial from viral, most children admitted with hypoxia and junky lungs get antibiotics regardless, then it's a waiting game for the lungs to clear while they're hooked up to oxygen. 

Sadly not all of our patients survive, and I've had to sign four death certificates so far. These children had very severe cases of meningitis, malnutrition, or sepsis, and had they been in a first world country, they may have survived with earlier diagnosis/treatment and ICU level care, hooked up to a ventilator with every kind of test and medication to augment their care. Here at Kudjip, most of the time these severe cases are late presentations to us, where the disease process has already had too much time to evolve. This is not an uncommon cultural problem where children are low on the totem pole so caregivers have difficulty acquiring travel funds and/or approval to get to the hospital.

Every day after Peds ward rounds are completed I circle up with the staff and holding hands we pray for the patients, their caregivers, and all the hospital staff and doctors. We ask God to do the healing of bodies and spirits here, working through us to shine His light into darkness. It is a wonderful way to start the day!

In the outpatient clinic we experience a gauntlet of variety coming off the bench of those waiting to be seen. They have already waited, sometimes many hours, to be screened by the triage nurses before the more difficult cases are passed along for the clinic doctors to see. I'm glad they have the Jesus Film showing on repeat in the large waiting area. I holler from the door of my little exam room "Wanpela cam!" and the next in line walks, limps, or is carried in. 

On my clinic room counter I keep a list of the medications we have in stock, my Buk Baibel with many specific verses tabbed for quick reference, and a few "Jesus Loves You" bracelets and stickers to give out. I also put "DR TED" on a label which I point to when introducing myself. People generally like to be acknowledged no matter where you are in the World, but it seems especially so here in PNG, and I'm sure to make eye contact as I greet them with a big smile, offering a hand to shake while taking their Skel Buk and helping them to a seat. They usually come in with a "wasman", someone who is looking out for their best interests - usually a close family member or friend. I also ensure these caregivers feel welcomed and a part of the conversation. Addressing the patient I'll say "Mornin! Nem bilong mi Dokta Ted. Mi amamas long lukim yu. Nem bilong yu __?" (Confirming they've handed me the correct Skel Buk - which contains their medical history). I'll then review the triage nurse notes, ask lots of clarifying questions, perform a focused exam, and sometimes walk them across the hall for a scan (ultrasound) to confirm my suspicions. For many I'm then ordering labs and/or xrays before making my final diagnosis and prescribing meds which they pick up from the hospital dispensary just outside the OPD. 

Some examples of clinic patients recently seen are as follows:

  • A very pregnant momma with backpain, heartburn, and other common complaints of a near-term pregnancy - taken across the hall to scan her healthy baby and confirm all is well for a soon delivery.
  • A 2 month old with hypoxia and retractions - taken to the ER for admission to the Peds ward
  • An older lady with a large abdominal mass, "heavy" to carry around the last 7 years and wanting surgical removal - found to be a complex cystic mass on ultrasound, about the size of a volleyball, likely uterine in origin. With also discovering high blood pressure and poor lifestyle choices, prescribed BP meds and lifestyle changes to get her body in a healthier state for future surgery. 
  • A 3 week old with pus in the eyes - admitted for Chlamydial conjunctivitis which without treatment would cause blindness (pics below showing before and after antibiotics) - parents also treated for STD's.
  • An older man with hypertension and acid reflux, who is convinced he has a serious condition warranting lots of extra scans and tests. I instead take the time to explain his conditions and stress the importance of lifestyle changes - no added salt, get rid of foods that make heartburn worse (which are many in PNG), stop smoking/drinking, etc. I review the meds he needs to take, and then I recommend another kind of medicine while grabbing my Buk Baibel, turning to the book of Filipi. I ask him about his faith background, and encourage him to receive this message of joy and peace, which has it's own healing power. Then I read the Tok Pigin verses and we pray together. (English translation for Philippians 4:4-7 below.)
Rejoice in the Lord always. I will say it again: Rejoice!
Let your gentleness be evident to all. The Lord is near.
Do not be anxious about anything, but in every situation, 
by prayer and petition, with thanksgiving, present your requests to God.
And the peace of God, which transcends all understanding,
will guard your hearts and your minds in Christ Jesus.
  • A boy with paraphimosis (uncircumcised foreskin stuck behind the head of the penis) - taken to the ER, given Ketamine to sleep, then easily reduced.
  • A thin middle aged woman with a distended abdomen - found to be lots of free fluid on scan, taken to the ER for paracentesis (where I put a large gauge needle through the side of the lower abdomen, and attach tubing to drain off much of the abdominal free fluid). The straw-colored fluid is consistent with extra-pulmonary tuberculosis, so sent to register and start meds at the TB office.
  • A hospital staff member with flu-like symptoms needing a doctor's signature to take the day off.
  • Two different women presenting within 10 minutes with the exact same forearm fracture from blocking the overhead "coffee stick" blow from from the abusive men in their lives - sent for screening xray and then cast placed in the Orthro room.
  • An old man, wasted and hypoxic (pic below) - chest x-ray concerning for cancer versus TB - admitted for work-up.
  • An infant with a large meningocele (pic below) - educated and sent home to grow. Without spinal surgery available, only time will tell whether this spina bifida will impair the child's ambulation or toileting continence.
  • An older boy with a huge neck mass - scanned to find a pocket of pus and turned over to our surgery team to complete a careful incision and drainage.
  • A young man with over a month of weight loss and productive cough - sent for chest x-ray which confirmed pulmonary TB (xray pic below), and sent to the TB office to register and start meds.
  • A well dressed middle aged man with a kind smile, suffering from worsening symptoms of a growing brain tumor - discussed options at length, referral letter written for a Head CT at another Kundiawa hospital, read Romans 5:1-5 together and prayed for perseverance, character, and hope. (He requested a selfie with me - pictured below.)

The list goes on and on with the most diverse presentations imaginable. I am humbled in every moment to be here and serve the many needs, and extremely grateful to my brother Mark Crouch, a career missionary at Kudjip, who guides my diagnosis and management on many of these complex patients. I am also deeply grateful to be relieved of any OBGYN duties, an important area of missionary medicine with which I am not yet entirely comfortable. Instead I am gladly taking on anything else they throw at me with open arms. 

There are far more stories to share, but you have already given your time graciously to read this long post, so I'll save them for the next one. In the meantime, please continue to pray for the work here, as we strive to unveil the contagious joy of serving Jesus through His healing and love. To God be the glory!

Chlamydial Conjunctivitis


Pulmonary Tuberculosis

The wasting of chronic disease

The power of prayer!

Wednesday, March 15, 2023

Immersed, Sink or Swim

You don't know what you don't know, until it's staring you in the face. That's the eye-opening reality jarring my conscience 100 times a day here at Kudjip Hospital. As I wrestle to make a definitive diagnosis or select the right treatment, each decision may well determine whether a patient lives or dies. As you can well imagine, this is stressful. But I've been here before so my instincts (so far) have been on the right track, and I have wonderful career missionary docs all around me who are more than happy to answer my questions. For this, I find myself frequently praising God. Also, the Holy Spirit has continued to massage a balm of next-level peace into every moment, leaving no room for anxiety or fear. I believe that I owe a debt of gratitude to a great number of faithful prayer warriors - thank you all!

After taking a day to unpack and settle into our mission house, I covered call on Saturday which entailed rounding on the Peds Ward and then covering the ER for the day. Normally rounding might take 30-60 minutes depending on the number of patients, new admits, discharges, complexity, etc. For my first day back on the Peds Ward, I invested a painstaking 4 hours getting to know all of the children - pouring over each hospital chart and skelbuk (medical history booklet), completing a thorough history and exam, and then writing fresh orders for the weekend. I was honestly surprised with how long it took me, but doing it right the first time ensures optimal patient care, and it was arguably an excellent way to immerse myself back into the medical system here - the usual diagnoses and treatment pathways for meningitis, tuberculosis, severe pneumonias, typhoid gastroenteritis, sepsis/DIC, severe malnutrition, congenital heart diseases, malaria, seizures, etc.

I was pleased to find my Tok Pigin fluent, and brought with me "Jesus Loves You" stickers and bracelets to gift all the children and caregivers. Folks know "Dokta Ted" is back when they start seeing kids with stickers on their foreheads all over Station. What can I say, they love "bilas" (decorations) here, so why not adorn them with the name of Jesus?! 

On my own in the ER that afternoon I felt exhausted and overwhelmed. Still shaking off jet-lag, I found myself disgusted with the violence of a beating one man gave his wife with a stick - they were both present in the ER, and "it's just the way things are here..." I then exercised my use of the Ultrasound machine for a possible bowel obstruction and was reminded of how little I know about internal medicine and surgery, which shook my confidence a bit. Finally, I was saddened and frustrated by the lack of early cancer recognition/management (common here) as I examined a sister-in-Christ, just about my age, dying of metastatic breast cancer. It's never fun to see and smell a fungating mass of cancer growing beyond the skin. After telling her there was nothing we (or anyone) could do, we prayed together with some of her family members, and I encouraged her to spend her final days giving testimony to God's grace. Can there be a greater mouthpiece for God's message of love than one who yet praises Him during their darkest hour? 

During a moment of journaling and prayer later that afternoon, perhaps to balance out from expressing frustrations, I jotted down a list of favorite things:

  • The jovial chatter and lilting laughter of locals walking by
  • Tropical rain showers on a tin roof, and amazingly loud window-rattling thunder claps
  • The sound of tropical birds, especially the very loud Friar Bird, which might be considered annoyingly loud except for the PNG Highlands nostalgia that I experience every time I hear it
  • Similarly nostalgic, the distinct body odor of the nationals (odd I know, but it's a potent confirmation we are really in fact here and not just dreaming!)
  • An exhausting early morning F3 bootcamp workout, unusually out of breath at this mountain altitude, but rich in the company of missionary friends and a beautiful sunrise
  • Many hospital staff with enthusiastic greetings, side hugs, hand holding, rejoicing with our choice to return (in the words of our resident surgeon "we love repeat offenders")
  • Returning to my Mowgli roots, climbing trees with the kids

I returned to the pediatric ward with Rachel, Pennie, and Solomon on Sunday morning before church to share a devotional with all the patients, caregivers, and staff. Standing up with my "Buk Baibel" I read from Romans 5:1-5 and encouraged them to lean upon God in their time of difficulty - to even rejoice in their suffering as the Lord will respond by conferring His peace and hope. Amid my own struggles, I also found encouragement in these verses:

Therefore, since we have been justified through faith, we have peace with God through our Lord Jesus Christ, through whom we have gained access by faith into this grace in which we now stand. And we rejoice in the hope of the glory of God. Not only so, but we also rejoice in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope. And hope does not put us to shame, because God’s love has been poured out into our hearts through the Holy Spirit, who has been given to us. (Romans 5:1-5)

We are now half-way through our first full week here, and the number of extreme medical scenarios that I have already seen is mind-numbing. Please join me in praying for Steven Francis and James Bill (pictures below), two babies on the ward who have congenital heart defects which we can not repair, and from which they will eventually succumb. Please continue to pray for me to have peace in the mayhem (mostly in my head) of successfully diagnosing and treating challenging patients. Please continue to pray for Rachel as she begins teaching a music/art class for the missionary kids, all the while making delicious meals from scratch and homeschooling P&S. And please pray for Pennie and Solomon who of course have contracted a terrific cold, hacking their little lungs out. Did I mention how much we LOVE being here?! Haha, that may not have come through in much of this post, but it is true. God designed us perfectly for this place, for this work, in this time. Praise HIM! :-) 


(my clinic room & the waiting area)

Friday, March 10, 2023

Overseas, Overtired, Overjoyed

We made it!!!

Thanks be to God and all of you faithful prayer warriors, we have arrived at Kudjip Nazarene Hospital.  We left our house around 7:30am on Tuesday morning (EST), taking a total of five flights from Richmond to DC, then to LA, then to Australia, then to Port Moresby (PNG capitol), then up to Mount Hagen in the Western Highlands, arriving here at Kudjip around 6pm Thursday evening (PNG time), all in all about 44.5 hours in transit. Miracles upon miracles, all the flights were on time and all our luggage made it through! 

While the kids caught a few solids naps during the trip, Rachel and I generally stayed awake to help reset our internal clocks, so you can imagine the gloriously sound sleep we enjoyed last night. We're still walking around in an overtired daze, but I'm certain some of the lightheaded feeling is joyful euphoria being back in PNG - familiar friendly faces, musky cookfire smells, lush flora, verdant misty vistas, and above all, the warm embrace of old friends. 

Our dear friends the Crouch family (Dr Mark, Esther, and kids Anna, Levi, Lucy, and Gabe) hosted us for a delicious homecoming dinner last night, and as we immediately immersed ourselves into kids wrestling and deep conversation, Rachel commented that it literally felt as if we'd never left! It's so true, and as we enjoyed a walk around Station today, meeting and greeting with so many old and new friends, I found myself grinning ear to ear and heart brimming over. It honestly feels like we're home. 

Thank you Jesus for delivering us to this Call, these beautiful people, and for the confirmation we have in our spirits. We are here at just the right time, for just the right divine appointments - to radiate this contagious joy, to share the message of Christ's love, to heal broken bodies and to see Jesus restore broken hearts. Praise Him! 

Ya'll please keep praying as we get settled, especially for Rachel as she's got to nest a bit - unpacking, organizing the house, and the purchase/cleaning/sorting of a couple months worth of groceries. We love knowing you're here with us in prayer! 

And now for what you've all been waiting for - THE PHOTO DUMP

Yu mas bilip strong long Bikpela. 

Yu no ken ting save bilong yu yet inap helpim yu.

Long olgeta samting yu mekim,

Yu mas tingting strong long Bikpela na yu mekim,

na em bai i soim yu stretpela rot long bihainim. 

Gutpela Sindaun 3: 5-6

(Proverbs 3:5-6)

Tuesday, February 28, 2023


Beloved Supporters, It's that feeling a kid gets on Christmas Eve - hopping up and down in eager anticipation, hope welling up in the sure joy to come, imagining all the rich possibilities. We are SO EXCITED to return in a week to serve in PNG!!!

Our things are staged ready for careful packing. Our prayers go before us seeking the Lord's blessing for smooth travels and Divine appointments. Our friends and family bestow final farewells and blessings. Our church has commissioned us for the Lord's work to come.

Thank YOU for your continued encouragement and prayer warrior support for these final days and the long voyage ahead! We are steadily wrapping up a thousand loose ends in our daily life, and so grateful to leave in loving hands our home, work responsibilities, ministries ...everything. God is GOOD!

For we are God's workmanship, 
created in Christ Jesus to do good works, 
which God prepared in advance for us to do.
Ephesians 2:10