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.)
- 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!