Friday, January 30, 2015

Several Weekends in Review...

Since Teddy gave everyone a “Week in Review” of his life here as a doctor on station…I thought it would be nice to follow up with a synopsis of our last few weekends here in PNG. As I have mentioned before, Teddy and I are always eager for new experiences while we are here at Kudjip, and these past few weekends have certainly been fulfilling! The core event of every weekend has been hosting a Roman’s Bible Study in our home on Saturday afternoons. Several different missionaries have been in attendance, as well as some MAF (Missions Aviation Fellowship) volunteers from Mt. Hagen. We spend about an hour each Saturday discussing different sections of scripture: how they apply to our ministry here as missionaries, and how they challenge us to go deeper in our relationships with God. It has been exceptionally rewarding!


One of our weekend adventures was an outing with the Crouch Family to Banz…a nearby village/town that boasts a market, several second-hand shops, and a new restaurant called the Jiwaka Mission Resort. We drove to this new retreat center/eatery, that parts of are still under construction, and had a lovely, relaxed lunch with the Crouch’s. One really appreciates having someone else prepare, cook, serve, and clean up your food when you’re used to doing it all for yourself...all the time!

Waiting for our food...

Levi exploring...
Anna being a cutie!


Another recent weekend adventure was a picnic lunch and hike in the Fatima area, courtesy of our fellow Kudjip missionaries, the Stephenson’s, and their friends the Zimmerman’s. The Zimmerman’s teach and work at a Catholic Seminary in the Fatima Parish, and regularly attend our monthly English Lotu service at Kudjip. Our afternoon started with a lovely tour of the Good Shepherd Seminary campus, followed by a beautiful walk up to our picnic spot. It was serene walking up the steep stairway through a forest of tall pines…this place felt magical. At the top of the forest hill, was a beautifully cleared garden area with views of the whole valley. We spread out our blankets and sat down to an amazing lunch. After eating, we quickly packed up and got started on our hike. Little did we know how far and how fast we would be hiking! We had a bit of a time crunch, due to a women’s study group at Kudjip we had to be back for. I don’t think I’ve ever hiked as “hard” before in my life! Luckily, all the hard work was regularly paid off with gorgeous vistas of the mountains and very informative descriptions of the different areas we passed through by Brandon Zimmerman. About half-way through the hike, we realized the hour and marched double-time to our end destination….the next town on the other side of the huge ridge we had just hiked! It was exceptionally gratifying…even though I could barely walk the next day! We’re looking forward to another hiking adventure soon!

Touring the Seminary Campus

The walk through the forest up to our picnic spot
Our lovely picnic spot

And the hiking begins!
Teddy helping lead the charge
Stop to catch our breath & snap a pic!

Our hosts & guides...the Zimmerman's
Who says you need snow to sled!?

One of the MANY magnificent views


The last, and most recent adventuring did not take us far from home…it actually occurred in our backyard! Several guys on the station enjoy repelling and rope courses…so what to do on Saturday afternoon?? ….set up a trapeze jump 70 feet up the huge Gum Tree in our backyard! : ) Dearest readers…have no fear…these guys have all the right gear (including helmets) and know what they’re doing. Several guys from the station took turns getting to the top of the tree via the winch on one of the trucks on station. Once at the top, they were situated by Morgan, on a branch several feet away from a hanging trapeze bar…the idea is to jump up and out and catch the bar! No biggie if you missed…because Jordan was belaying from below so people could repel down the tree. I did NOT attempt this daring feat…I was getting dizzy just watching…but Teddy not only made the jump and caught the bar…but he also did several pull-ups hanging 70 feet above our house! It was a fun time! I am sure there will be future climbing and repelling expeditions. : ) 

Teddy preparing to fly...

Enjoying his ride up...
Teddy & Morgan at the top...

              And he makes the jump!!!


Anyhoo…that is just a glimpse of some of the escapades we have had over the past month.  We are so blessed to be a part of such a great mission here at Kudjip, and we are amazed at the opportunities God has provided for us to minister, as well as experience the wonders of this part of the world!

Friday, January 23, 2015

A Week in Review

Dear Readers,

As I contemplated what to write to you for this posting, my mind churned through a blur of faces and diagnoses from the last week, and I realized that I have not yet given you an adequate scope of the broad range of illnesses and injuries I encounter every day. What follows are a hodgepodge of medical diagnoses I discovered and treated just within the last week, some of which will include a short story and/or picture. My hope is, as ever, that you will feel like a part of what we are doing here, experiencing the losses and victories alongside us - and that this will further motivate you to partner with us in prayer for the work at hand - ministering the Lord's Gospel of Love and Healing.

All our Love, Ted & Rachel

~ ~ ~ ~ ~ ~ ~ ~ 

Diagnoses I see multiple times every week:

- Viral Respiratory and GI infections
- Pneumonia
- Dehydration with Gastroenteritis
- Reflux and Gastritis
- Musculoskeletal pains
- Arthritis - Osteo and Rheumatoid
- Congestive Heart Failure with Cor Pulmonale
- Hypertension
- Diabetes
- Symptoms due to Hepatitis B
- Chop Chops - sutured
- Fractures - casted
- Abscesses - cut/drained
- Hemorrhoids
- Malaria
- Chronic Osteomyelitis
- Infertility and pelvic pain in women due to chronic Pelvic Inflammatory Disease - caused by untreated STD's

- Malnutrition of every form
  ...Here's a recent pic of the malnutrition baby I blogged about in "Too Little, Too Often" chubby, and look at that all that hair! (Yes, the baby was chewing on the paper...)

~ ~ ~ ~ ~ ~ ~ ~ 

Pulmonary Tuberculosis (x3 cases) - I did a thoracentesis on the first guy's left lung which put out 1.5 Liters of amber fluid (classic TB). The second guy, named "Shark" (we had a good laugh about this), was another classic case of weight loss, night fever/sweats, and persistent cough - but he was terrified of the diagnosis and was refusing my referral to start TB meds because his sputum AFB had recently been tested negative. I sent him for a chest film, and after I showed him his lung disease on the X-ray viewer, Shark agreed to start the meds. The 3rd case was a young gal, a more vague presentation, but who's sister has recently been on TB meds. I sent her home with antibiotics and she will get her sputum tested for TB before I see her again.

Uterine Fibroid - a sweet lady with months of DUB (Dysfunctional Uterine Bleeding) and resultant severe Anemia (Hemoglobin 3.5) - transfused, and referred for Hysterectomy.

Mastoiditis - at least 3 weeks of untreated ear infection in a cute 2 year old, frank pus weeping from the ear, and a very large and swollen mastoid - out of which a substantial amount of pus flowed following my incision.

Congenital Hypothyroidism (my 2nd case) - Margelyn Topo is a cute little girl, who appears about 3, but will be 5 years old in June. Unlike Stephanie (my first case), Margelyn is early enough in her development, I am hoping the supplemental Synthroid will save her from intellectual disability.

~ ~ ~ ~ ~ ~ ~ ~ 

Coming to his bed on my morning Ward rounds, I laughed aloud as I read his name "Job War". I tried to share the irony of his name with those around me but the humor passed quickly as my attempted explanation in Pidgin went over their heads. I learned Job (now about 8 months) had been adopted in his infancy, and as is common with these adopted babies, given inadequate formula to the point of malnutrition. Job had been admitted to the Pediatric Ward for management of an acute Gastroenteritis (lots of diarrhea) and to begin reversing his malnutrition. An interesting twist to his story was that the birth mother was somehow still in the picture, and the adoptive mother had consented to her breast feeding him so long as she tested negative for HIV.

Checking in with him every morning on the Ward, I was happy to see Job was gaining strength. His birth mother had tested negative for HIV, but her milk supply was dried up, so Job was still using supplemental formula. Meanwhile, I started the birth mother on meds to augment her milk production.

One morning during the end of rounds, I heard some commotion behind me, and turning around, I noted five nurses clustered around Job's bed attempting CPR. I was confused - not 20 minutes earlier, I'd found his exam reassuring, and had helped the birth mother with some breast feeding techniques.

Weaving my way into the throng, I found Job unresponsive without respirations or a heartbeat. As I initiated chest compressions, I noted a watery mix of gastric contents filling the back of his throat - which as I turned him to the side flowed out over my wrist, hot and slimy. While calling for suctioning, and squeezing further juices from his lungs with each compression, I noted an overturned coke bottle on the bed (commonly used to hold "ORS" - Oral Rehydration Solution). It was later confirmed that one of the two mothers had given Job a very large drink of water, with a resulting aspiration of vomit. We got his throat clear, but I could hear his lungs were still full of fluid. After he failed to regain a heart beat with further CPR and epinephrine, I gave my defeated "Sorry" to his adoptive mother, who sat alone beside the bed. Once the various resuscitative tubes were removed, she held him there on the floor beside the bed, weeping.

Going back to finishing rounds was not easy. I was angry and frustrated to see another young life lost - more so because this was preventable. Since coming to PNG, I've been appalled to see caregivers turning up full coke bottles of various fluids over the open mouths of their sick infants, who then invariably cough and splutter the contents. I wanted to turn my anger toward Job's mothers, but I had no way of knowing which one was responsible, and my heart broke as I watched the adoptive mother quake with her cries. The Spirit spoke, I listened, and I went over to pray with her. After praying, I told her I didn't want to forget Job or her grief, and further, I wanted my own family and friends to understand this heartbreak - so she let me take their picture.

~ ~ ~ ~ ~ ~ ~ ~ 

Lymphoma - a pretty 9 year old girl with large matted lymph nodes around her groin - referred for Biopsy.

Tertiary Syphilis - a young man with the build of Hercules who plays for a local Rugby league - and being a single sports star has had his share of adventures with the ladies. Sadly, his promiscuity has lead to neurosyphilis, and will now suffer from lifelong weakness and numbness (among other symptoms). Lots of antibiotics.

Gout - a rotund lady with chronic gout, already on high doses of medication, but with great pains due to a sizable deposit of Tophi in one ulcerated ankle. After sedating her, I spent 10 minutes scraping large chunks of Tophi out from the ulcer. She has since returned and reports feeling much better.

~ ~ ~ ~ ~ ~ ~ ~ 

The moment Albert walked into my clinic room, I knew his condition was serious. He gave me an easy smile and firm handshake, but I couldn't take my gaze off his fluorescent yellow eyes. With the help of some labs, an Ultrasound, and my friend Dr Mark Crouch, we supplied Albert with the terminal diagnosis of Pancreatic Cancer, and asked if he knew Jesus as Lord and Savior. As with many PNG patients not following Christ, Albert gave a story of exposure to the gospel as a child, but confessed to an adult life far from God. What followed was a wonderful accounting of the gospel by Mark, and when we closed in prayer, Albert gave his heart to The Lord.

~ ~ ~ ~ ~ ~ ~ ~ 

Breast Abscess - hot, swollen, tender, and a feeling of fluctuance under the skin --> sedated, needle aspirated some pus, then cut a 1cm incision through which drained a lot more pus, placed a drain, started antibiotics, and I'll be seeing her to remove the drain at a later date.

Breast Cancer - hard mass with overlying redness to the skin, nipple slightly inverted - referred for Biopsy.

Asphyxiation - called to the ER one afternoon for an adorable 3 year old boy who was unresponsive. The mother reported a few days of vomiting and diarrhea, and then he choked on vomit 10 minutes earlier while sitting at the Rot Bung (roadside market). I found the boy without a heartbeat, respirations, or pupillary reaction to light. "Sorry."

~ ~ ~ ~ ~ ~ ~ ~ 

Peter had paid for an elective excision of a lump on his temple, present since birth, but which appeared to be a lipoma (benign fatty deposit). After sedating him, I was a little shocked to pull HAIR from what appeared to be a capsule under the skin - ultimately a sizable hairball popped out, and I sewed his scalp back together.

The diagnosis: DERMOID CYST - a benign teratoma which can include hair, teeth, eyes, nails, bone, etc (...and I am SO GLAD an eyeball didn't pop out! :-)  Haha

~ ~ ~ ~ ~ ~ ~ ~ 

Neonatal Sepsis/Meningitis - in the last week, I have managed four such cases on the Peds Ward. One died, two are recovering well, and one not-yet-named little gal has been fighting for her life (but I believe looking better!). I suggested the name "Rachel" to her mother.

Ovarian Cyst - should I congratulate you on your pregnancy? Nope, that's just a REALLY big tumor! - Referral for surgical excision.

Swollen Penis - Maybe my 5th case since coming here, a teenage boy hesitantly tells me he payed a man in his village to receive an injection into his penis. The salesman's pitch is that it makes your penis bigger, and sex more pleasurable. Well, I'm not so sure about all that, but whatever the substance is (maybe cooking oil?) causes a "reaction formation" in the area of the fluid collection, which becomes hard and painful. Dr Jim very kindly stopped in to see this young man, and after sharing the gospel, offered to circumcise him at a later date.

Sturge-Weber Syndrome - this baby's "Port-wine Stain" faintly seen over the right eye is a possible indictor.

~ ~ ~ ~ ~ ~ ~ ~ 

Scanning the old man's abdomen, I found massive Liver Cancer - a terminal diagnosis. Right there in the ultrasound room, I began to explain the disease, but his wasman stopped me. The young lady said she was not a relative of the man and did not want to be the mediator of this bad news - as it turns out, he did not speak Pidgin, but only his local dialect, so he had not understood my diagnosis. Three days later, the man returned, and a file of 6 family members followed him into my tiny clinic room.

I spoke slowly, meeting each gaze, as I explained the man's terminal diagnosis, and I would pause to allow a family member to translate to the patient. I found it odd that the old man didn't appear to grasp the severity of his cancer (or perhaps he didn't care or believe it), while I saw tears appear in some of the younger eyes. As I concluded, I said that only God knows how much time he has left, and used this as a segue for sharing the Gospel. Many of the younger relatives nodded along in agreement, and I learned that most if them shared my Faith. At the end, I reiterated that while no medicine or surgery could fix his cancer, God DOES have the power, and suggested we lay hands on the old man to ask for God's healing. Instead of my bumbling Tok Pidgin, I asked one of the young ladies to pray, which she did with wonderful clarity and conviction, and I enjoyed a great many hugs and tearful smiles as they left.
~ ~ ~ ~ ~ ~ ~ ~ 

Failure to Thrive & Gastroenteritis - Another baby, "Waity", who died due to Respiratory Failure (please read this child's story at the Blog of Dr Mark Crouch)

Juvenile Rheumatoid Arthritis - quite common here, and I saw two cases this week.

Molar Pregnancy - passing grape like clots from vagina, snowstorm appearance on abdominal ultrasound - referred to OB/GYN for evaluation

Intussusception - two and a half year old boy with intermittent excruciating abdominal pains for 6 months, but normal exam and ultrasound on presentation, and no history consistent with constipation or infection.

Lipoma - ancient lady from the Jimi with a growth on her scalp "just wants it removed" - so I did.

~ ~ ~ ~ ~ ~ ~ ~ 

Covering call one night, I was asked to come see a teenage girl with a one week history of headache, copious diarrhea, and two days of altered mental status. Dellia was from the Jimi (a very remote valley in our catchment area), who had been admitted to a small clinic near the Jimi with a diagnosis of Typhoid, but then inadequately treated. The beautiful 13 year girl old I found in the ER was breathing heavily, responsive only to pain, and still having diarrhea - I was very concerned for sepsis and acidemia, and I admitted her to my area of the Peds Ward with IV fluids and IV antibiotics. In the US, she would have been in the ICU, on a ventilator, getting blood gas measurements every two hours to monitor her electrolyte imbalances, and if her sepsis was bad enough, maybe ECMO (cardiopulmonary bypass). Without any of these interventions, I told her worried mother that Dellia was coming to us very late in the disease, and may not survive the night. Six hours later, I resigned my CPR efforts and left the Ward to the rising cacophony of grief - heading home to wash my face and get ready for another day.

~ ~ ~ ~ ~ ~ ~ ~ 

This is Jekeriah - he came back to me this week for review in clinic after a long admission for spinal injury (or possibly spinal TB). He's very slowly regaining the use of his legs - Praise God! 

~ ~ ~ ~ ~ ~ ~ ~ 

If you have come this far, thank you. 
These stories, these individuals fighting for their lives, 
are important. Please continue to pray 
for them, for us, for this work. 
~All to God's glory~

The handiwork of Nate Baranowski,
who recently visited family on Station.
(Find his portfolio HERE)

Wednesday, January 14, 2015

The Faith to Grow

Her little smile lit up the room - simple, shy, and with a joyful freedom that I rarely see among my PNG patients. The tip of her slightly large tongue rested casually between her lips, as though she always had a funny thought in mind. Her parents sat quietly, reading my face for some understanding of their daughter's illness. Apart from her protruding tongue, she appeared to be a perfectly happy four year old. I opened her medical book, noting her name - Stephanie David. As usual when I welcome patients into my little clinic room, I introduced myself, shaking the parents' hands, "Welcam - mi hamamas long lookim yu", then Stephanie's, who buried her shy grin into her mother's blouse. Also a routine with kids, I then let Stephanie pick a Sesame Street sticker to put on her hand. (Many thanks to our dear friends and family for the ample sticker supply via Care Packages!)

In reviewing her parents concerns, I was immediately taken aback when they said she is in fact eight and a half year old! They said she had been a normal baby, but then they noticed she just stopped growing in her third year. Their second child, two years younger, brought to attention that Stephanie was also failing to mentally develop as she should. By the age of three, the younger daughter had surpassed Stephanie in vocabulary and social play, and within another year, surpassed her in stature. They described Stephanie as being developmentally stuck somewhere between three and four years old - sweet, simple minded, and always happy.

A closer exam of Stephanie revealed her head and tongue slightly large, the long bones of her limbs short, a waddling gait, and indeed developmentally stuck at around 3 years of age. My suspicions were confirmed when her TSH (Thyroid Stimulating Hormone) came back quite high - suggesting Stephanie suffers from Congenital Hypothyroidism. 

I spent some time discussing the diagnoses with her very sweet parents, who were grateful for an answer. I explained that Congenital Hypothyroidism is not an uncommon diagnosis, occurring in 1 of 4000 live births, causing both growth retardation and developmental delay. If not diagnosed and treated early, as in Stephanie's case, the resultant intellectual disability is permanent, while growth can rebound when synthetic thyroid hormone is started. During the conversation, her parents repeatedly focused on her possibility for growth (but oddly, not her intellect), and I spent some time talking about how we would increase her hormone dose every two weeks to an appropriate level, then monitor her progress a few times annually. I didn't promise anything, but we stood Stephanie up in one corner of my room, and put a sticker on the wall, marking her height at the start of treatment.

While holding Stephanie on my lap, her head cuddled on my shoulder, I concluded the visit by reminding her parents that prayer is a powerful tool given to those with Faith, and we then prayed together for Stephanie. We gave thanks to God for having provided us a diagnosis, and asked for His divine intervention with the new medicine, that Stephanie would grow both in stature, and in the ability to know our Lord, Jesus Christ, as her own friend and Savior. 

I have seen Stephanie back in clinic a couple of times to get her Synthroid dose at the right level, and I can't wait to celebrate with her parents at the next visit, placing another sticker on the wall, (I'm believing) somewhere above the first.

Jesus said:
"Ask and it will be given to you, seek and you will find, knock and the door will be opened to you. For everyone who asks receives; he who seeks finds; and to him who knocks, the door will be opened." (Matthew 7:7-8)

           ...and He later said...
"I tell you the Truth, if you have Faith as small as a mustard seed, you can say to this mountain, 'Move from here to there' and it will move. Nothing will be impossible for you." (Matthew 17:20)

Many of the diagnoses I make here in PNG are not promising - in fact, most of them assure ongoing hardship. As anyone of you reading this Blog can relate, life can be difficult in many ways. Something I say all the time here is "Yu no can worri. Worri bilong Jesus. Time yu givim Em worri bilong yu, Em i bai givim yu bigpela bel isi", which reflects two verses:

Philippians 4:6-7
Do not be anxious about anything, but in everything, 
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.

Matthew 6:3-34
"Seek first the Kingdom of God and His righteousness, 
and all these things will be given to you. 
Do not worry about tomorrow, 
for tomorrow will worry about itself."

Wherever you are in life, I encourage you, my readers, to give your worries to Jesus. He died for you, to carry your burdens of sin, failure, and heartache. You were never meant to walk in this World on your own, but by Faith, in His Love, to !Rejoice! in His Peace at every moment, regardless of what trial threatens to burden you.

Alive in His Grace, Ted

~ ~ ~ ~ ~ ~ ~

A few Picture Updates:

Prayer Night at our Place! 

Uncle Bill helping me transplant the first veggies
into our new garden!

The cool reward after a long run.

Love and sunshine from PNG!

Sunday, January 4, 2015

New Year, Renewed Focus

Happy New Year!  I believe God has GREAT things in store for us! 

For me, today feels like the last day of the Holidays – the Christmas tree is down, the nativity figures have been put away, and tomorrow I’ll be going back to normal work hours at the hospital (we’ve had the clinic closed for a few days over the last two weeks). In addition, today Rachel and I started our annual 21 day Fast, a wonderful time of dedicating the New Year to God and prayerfully seeking His direction for this year – in both our personal walk and among the Kudjip Nazarene Body, in our missionary work here, and for the road beyond this year in PNG. (If you have followed our Blog from the beginning, you will remember an outline on this 3 week prayer and fasting in a January 2014 Post.)

Being the first Sunday of the month, we gathered today with all the area’s missionaries for the “English Lotu Service”. We had a lovely potluck lunch, and then it was time for Lotu. Every month, the service is hosted by a different missionary family, and as the Lord provided an opportunity, Rachel and I had volunteered to host today. We began the service by taking up the offering – during which time I joined Andy, Jim, and Bill playing “Holy Holy Holy” as a trumpet quartet. I haven’t played much since high school, but playing the low part isn’t so hard, and all together I thought we sounded quite nice. 

Rachel followed the offeratory by leading a few worship songs on guitar, which I was pleased to hear everyone enjoying loudly, and which I thought set the stage perfectly for my message. Now, I’ve spoken only a few times in front of larger groups, but something about speaking in front of seasoned missionaries, pastors, and doctors had gotten me a little nervous. My topic was “Body-building”, a closer look at how we can strengthen our membership in the Body of Christ, and a subject with which Rachel and I had grown intimately familiar while leading a Young Adult ministry in Richmond, Virginia. As such, the moment I began to speak, God settled my heart, and I thought the message turned out OK.

(If you would like to read my message notes, CLICK HERE.)

To conclude the message, I invited everyone to join Rachel and me in our 21 day Fast, turning our focus on Christ for this New Year. Additionally, I encouraged them to join us reading through a Romans daily devotional, and to meet weekly at our house to share how the Lord is leading. My hope is that in our corporate study of the Word, daily prayerful fasting, and regular meeting as a Body, we will each receive new Direction and Wisdom from our Lord, and be strengthened as a Body for the work He has set before us here in the Highlands of PNG.  

If you too would like to join Rachel and me for 3 weeks of fixing our focus on Christ, please find the Romans Devotional HERE, and we would LOVE to hear how God is challenging you. 

All our Love, Ted & Rach

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.