Thursday, March 26, 2015

Diving into D

Kudjip Station Doctors
Over the last two weeks, I have been re-immersed into the world of Obstetrics and Gynecology. What I had requested was a little more exposure to the decision-making processes that dictate how and when a mother delivers her baby. The physiology and pathology, surgical interventions, and even the medicines used, are a far cry from anything I have learned in my training as a Pediatrician. Fortunately, I’m not too far from medical school to have forgotten the basics that all med students learn, so over the last 6 months, I have been building upon that knowledge base – whether scanning pregnant bellies in clinic, or helping with deliveries overnight while covering call. However, what I recently realized is that just occasionally thinking about these things isn’t enough – I needed immersion in order to really see and manage enough of the in-the-moment critical decisions to feel comfortable with it. The bonus is that we currently have Dr. Scott Pringle here on Station, an OB/GYN from the States with 30+ years experience under his belt, and who is a fantastic teacher.

My days have started rounding on those mothers admitted to D Ward who need to be seen by the doctor. Many mothers come to Kudjip and vaginally deliver their babies (without complication) into the very experienced hands of our nursing staff. These mothers rarely need more than a Doctor check when they arrive, and sometimes not even that if they deliver quickly. So, the mothers I see have had some complication in their delivery process – required a C-section, have blood pressure issues, are sick with infection, had a miscarriage and require a D&C, or maybe are requesting tubal ligation. So, every morning I’ll roll the cart down the row of beds, stopping at those with a chart, and sit bedside asking questions, reading vitals, and writing orders for the day. The Pediatrician inside of me always craves to also examine the newborn babies who are invariable bundled at their mother’s side, and sometimes I’ll take a little peek and share a smile and word of congrats. Even the smallest attention means so much to these mamas.

After rounding on the Ward, while Dr Scott is checking my orders, I head back to the Delivery rooms, where a line of very pregnant ladies are waiting to be checked. The new ones get a full work-up – questions, ultrasound, and vaginal exam – while the repeat offenders (who haven’t delivered yet) just get a vaginal check to determine progress. Performing pre-natal checks on my own in clinic has become second nature to me, and I feel perfectly comfortable scanning their belly for the important measurements. The D-Ward ante-natal checks are not too different, except now I'm wrangling a much larger baby and a mom who is occasionally squirming with contractions. More importantly, being close to their delivery time, I am seeing, feeling, and learning precisely what the next course of action is to be. Is it safe for the baby to allow normal progress, or are medications needed to help the uterus open? How long have the contractions been going, and where is the baby’s head? Are the baby and placenta in the right position for a vaginal delivery? How long has the mother’s water been broken? These, and MANY other questions, have been on my mind as I check each mother.

I delivered this little guy yesterday using a vaccuum, and was subsequently splattered with amniotic fluid ...excellent way to start the day!   :-)

Many times, even after 2 weeks, I’ll have a question for Dr Scott – something on ultrasound I haven’t seen before, or just reassurance that I’ve written the correct order. Choosing the wrong pathway in this process can easily cost a life – an outcome I have seen enough times in my months here. The burden of this responsibility, I hesitate to consider myself yet ready to undertake, but that is why I have chosen to learn more. Someday, God may ask Rachel and me to serve somewhere that Dr Scott isn’t a phone call away. What I learn now may save lives in the future – what an amazing responsibility. In the meantime, while thankfully I always have the back-up of well-experienced doctors here on Station, this new knowledge will help guide me for those 2AM calls from D Ward. 

Please pray for my brain - 
that God will make me a sponge for this life-saving knowledge. 

Please pray for our D Ward staff - 
that, despite being bone tired and covered in all sorts of bodily fluids, they are filled with wisdom and joy in bringing so many new lives into the World.

Please pray for all the mothers and babies - 
for healthy outcomes, for open hearts to the Gospel while staying with us, and healing for those who lose babies.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~

A big THANK YOU to our dear friend, Dr. Maggie Landgrebe, who generously purchased a new digital scale for the D-Ward babies (just arrived on the shipping crate yesterday!). 
All the staff are SO excited to start using it!

Monday, March 16, 2015

All About My MK's...

I realized last week, that there have been many instances in my blog posts when I reference “my students” and the “MKs” and speak of them in vague, generalized terms. So…I thought it would be nice to introduce you all to the amazing kiddos that I get to spend my days with!
As I have mentioned in previous blogs, I am one of two teachers at the MK Elementary School. Ms. Judy Ralph teaches the 1st to 3rd graders in her classroom, and I teach the 4th to 6th grade students in my classroom. This post will feature my 4th, 5th, and 6th grade students, but as I will soon be taking over all the younger grades as well, a future post will feature our 1st – 3rd grade friends.  :)

                                                                  Miss Olivia Dooley 
Olivia is in the fourth grade and is nine years old. She was born here at the station hospital in Kudjip and has lived in PNG for all nine years of her life. Her favorite class in school is Reading, “because it’s more fun than Math.” : ) When she grows up, she would like to be a pre-school or day care teacher. Olivia’s favorite part of living in the Western Highlands of PNG is the weather – “it’s always sunny.”
Her preferred activity to do in her free time is playing outside.Fun Fact: Olivia’s favorite animals are owls and pigs. 

                                                                Miss Emma Goossens
Emma is in the fifth grade and is ten years old. She was born in Tacoma, Washington and has lived here at Kudjip for about four years. Her favorite class in school is History, because she “likes learning about things in the past.” When Emma grows up, she would like to be a chef. Some of her favorite parts of living here in PNG are: “climbing trees, going barefoot, and riding on the sides of the cruisers.” Emma’s preferred free time activity is “playing outside.”
Fun Fact: The animals she likes the most are tigers and alligators. 

                                                                 Miss Lainie Peterson
Lainie is in the sixth grade and is eleven years old. She was born in Oregon, and has lived here on the Kudjip Station for about two years. Lainie’s favorite class in school is History, because she “likes learning about the past.” When she grows up, Lainie would like to be a 3rd or 4th grade teacher. Her favorite parts about living in PNG are: “getting to swim in the river and all the different tropical plants.” When she has free time, Lainie prefers to “read, draw, and play outside.” 
Fun Fact: Her favorite animal is a horse.

                                                                 Mr. Jerome Stoller
Jerome is in the sixth grade and is thirteen years old. He was born in Cairns, Australia and has lived at Kugark, the Swiss Mission Station 20 minutes away from Kudjip, for the past ten years. Jerome’s favorite subject in school is History, because he “likes learning about all the wars.” When he grows up, Jerome would like to be a carpenter. Jerome’s favorite part of living in Papua New Guinea is “all the animals here.” When he has free time, Jerome prefers “playing outside and swimming.” 
Fun Fact: The Hardy Boy Series are his favorite books to read.

Me and my kiddos!

Thursday, March 12, 2015

Changing Seasons

Dear Family and Friends,

Rachel and I have sailed beyond the halfway mark for our year in Papua New Guinea, and while every day I find my schedule full of new experiences and tasks, I have recently been dedicating part of my time and thoughts to what lies beyond our return to the States.

I recently registered to take the Pediatric Boards in October, which means I have also started taking my Boards studying seriously – no more occasional glances at the review books, but now I am earnestly plowing through the necessary material on a daily basis. Better to be ahead of the studying time curve, than behind it!

With scheduling the Boards, I have also been thinking about what kind of work I’ll be doing when we return to Virginia. Rachel already has her teaching job waiting for her, but what kind of Pediatric work do I want to do? And for how long? A pediatric emergency room or a local urgent care center seems appealing – shift work would provide more flexible scheduling, and I wouldn’t be bored handling emergency cases and doing some small procedures. Alternatively, I’ve also thought about joining a general Pediatric clinic and experience all that primary care has to offer – runny noses, vaccines, preventive counseling, maybe even some continuity of care? I’ve always enjoyed the idea of being there for a family while they raise children. Here’s the problem, continuity only counts if you’re planting your roots for a while, and while Rachel and I envision at least a year or two Stateside, we also know that God has missionary work in our future (still waiting to discern whether that'll be part-time or long-term.)

While thinking and praying about what work I’ll find in the next season, there’s a lot of other little things to do in the meantime – applying for my Virginia License and getting a DEA#, updating my resume, contacting all the likely practices, hospitals, and physician recruiters, then prayerfully following every lead the Lord provides…and that’s only for the work-side of things. We’ll also need to arrange our return flights, find a place to live when we get back, and sort out our financial things. It’s all a little overwhelming to think about, but God has so smoothly orchestrated every other transition in our lives, I’m happy to testify to an unshakable peace and a heart filled with joyful assurance. God is in control, He knows best, and we get to come along for the ride! 

One of God’s powerful truths that Rachel and I have learned over the years is the concept of living seasonally. We could never possibly hope to understand where or how God will place and use us in the next season of our lives, but we will joyfully serve now, in this season, where we have been planted. Our lives are not our own (flesh, time, money, work, thoughts, desires, future). They have been bought at an eternal price, and so we freely trade our will, for His will – whatever He needs of us. In this freedom, we have enjoyed boundless happiness and blessing, and no matter what the World throws at us, God promises the same eternal peace and joy for all of our future.

Matthew 6:33-34
But seek first His kingdom and His righteousness, 
and all these things will be given to you as well. 
Therefore do not worry about tomorrow, 
for tomorrow will worry about itself. 
Each day has enough trouble of its own.

Luke 12:32-34
Do not be afraid, little flock, 
for your Father has been pleased to give you the Kingdom. 
Sell your possessions and give to the poor. 
Provide purses for yourselves that will not wear out, 
a treasure in heaven that will not be exhausted, 
where no thief comes near and no moth destroys. 
For where your treasure is, there your heart will be also.

Romans 5:1-5
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 disappoint us, 
because God has poured out His love into our hearts 
by the Holy Spirit, whom He has given us.

Romans 12:1-2
Therefore, I urge you, brothers, in view of God's mercy, 
to offer your bodies as living sacrifices, 
holy and pleasing to God - this is your spiritual act of worship. 
Do not conform any longer to the pattern of this world, 
but be transformed by the renewing of your mind. 
Then you will be able to test and approve what God's will is - 
His good, pleasing and perfect will.

Philippians 4:4-9
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 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. 
Finally, brothers, whatever is true, whatever is noble, 
whatever is right, whatever is pure, whatever is lovely, 
whatever is admirable - if anything is excellent or praiseworthy - think about such things. 
Whatever you have learned or received or heard from me, 
or seen in me - put it into practice. 
And the God of peace will be with you.

And Others:
Matt 19:29-30Luke 9:23-24John 15:5-17,

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~


Rachel has been sick for over three weeks with back-to-back 
illnesses. Being the rainy (and slightly colder) season now, we’ve seen a LOT more viral illnesses going around, and it seems they all like Rachel very much (hard to blame them!). She may be on the tail end of all this, but please pray for renewed strength and joy as well as physical healing. Have I mentioned she has become an AMAZING cook here in PNG?

We have new neighbors! Dr’s Ben and Katherine Radcliffe have returned to PNG for a two year assignment, and will be living in the house next door with their two boys, Simeon and Matthias. Katherine is a family practice doc, and Ben is a surgeon. Ben’s father, Dr. Jim Radcliffe, is Kudjip Hospital’s longest-standing physician, and is also a surgeon. We enjoyed having dinner with them the other night, and look forward to many more!

I’ve recently had some new and review patients
who I captured pictures with:

This is Kenneth (before and after TB Meds). He's a very nice CLTC student, who I diagnosed with TB shortly after starting work at Kudjip many moons ago – now happy, healthy, and about 40 pounds heavier (all muscle).

This is Bepi, who came to me with worsening abdominal pain. Her Skelbuk read that Dr. Jim had surgically removed a tumor from her abdomen a year prior, and pathology had been sent off to the States. I took her to the ultrasound room, and found her lower abdomen full of invasive cancer – the same ovarian cancer that had been excised last year – now unresectable (can’t be surgically removed), and therefore, terminal. Back in my room, my heart broke in sharing this news with Bepi – she had come alone, and her resigned expression spoke of a hard life, now harder. I wanted to give her hope, and as we talked about Jesus (she is a believer), I found tears in my eyes – the first time with a patient here. It’s not that Bepi’s case was any more terrible than many others I’d seen, but there’s something special about the Love of Jesus conquering the darkness of death – which she was showing me in her smile.

This is Papa Andrias, who I’m sure has entirely lost his marbles. He was previously a policeman, well respected in the community, visited America twice, and he tells me he is “wan hundren seventee yiars ol”! He came for a blood pressure check, but I couldn’t stop staring at his ear lobes, which were pulled up and over his ears. I asked to take a picture, and he insisted over and over that I share his picture with the “whooool wold en di intanet” – which I promised I would!

This is Eleisha (then and now pics), who was very sick and admitted for a long time on the Peds Ward over the holidays. He now looks great, and all the credit goes to God!

The garden and flower beds are coming along nicely, and we have started reaping the harvest – fresh flowers for the table, and plenty of salads. Now if we could just have a little less rain, and a little more sunshine! :-)

Oh, and I built a hammock for our back porch. I was a little uncertain the stitching would hold, but the foam mattress on top both spreads out the weight, and adds comfort. Quality time with Jesus doesn’t get any better!

Monday, March 2, 2015

Sharing Mark's Heart

Dear Readers,

I am most honored to share with you the most recent Blog Posting of my friend and colleague, Dr Mark Crouch, who just eliminated all reason for me to attempt writing anything of my own. :-)

Please enjoy this:  CONSOLATION

But, because I know you wouldn't let me get away with just reposting someone else's Blog (no matter how perfect), here are some recent pics. 

Love and Peace, Ted

Little Teddy returned for a check up!

 My little neighbor John John - super cute.

Baby "Rachel" on A ward - a VERY happy ending to what seemed might be another sad tale. She was admitted with bronchiolitis, and one morning after explaining to her mother she wasn't doing well, and praying over her, she stopped breathing! I was happy to be there at that moment, to supply masked breaths, turn up the Oxygen, and suction her chest, but having seen so many other babies succumb to similar illnesses, I wasn't optimistic. But, with high flow oxygen and a very astute mother, the baby survived! She then adopted the Namesake "Rachel" after my own dear wifey. 

 Stephanie returned for a check-up! Having been on Synthroid for three months, her parents were delighted to share all the ways she was developing and growing.

Say hello to Merolyn, who I met the other week while rounding on D Ward (newborn babies). The story is sad, but has a happy ending. One day on rounds, she admitted to me that her milk supply had run out. Upon a LOT of further questioning, she finally came around to saying, in a very quiet voice, that her wontok (family supporters) had not come to the hospital in almost a week, and she had run out of food 4 days prior. The poor girl was literally starving! and her baby was going the same direction because her milk supply was drying up. Not cool! So, when I came home for lunch that day, Rachel helped me pull together a dozen hard boiled eggs, a hand of bananas, and some canned tuna. That afternoon, we discretely brought the goodie bag to Merolyn, and prayed with her. Within 2 days, baby was gaining weight again, and they went home shortly thereafter. The (happy) End. :-)