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

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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"...now chubby, and look at that all that hair! (Yes, the baby was chewing on the paper...)

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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.

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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.

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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.

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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.

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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."

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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

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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.

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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.

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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.

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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.

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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! 

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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)