Today marks the beginning of a four day Easter weekend here in Papua New Guinea, a timeframe for which the Prime Minister has also reinstated the restriction on public transportation. This week PNG has had it’s second case of COVID on the island of East New Britain, so efforts are ongoing to prevent the spread. In the last two weeks, our hospital has screened almost 400 patients since establishing the COVID tent, and we have yet to see COVID emerging here in the Western Highlands. Nonetheless, vigilant screening will continue as we pray for the pandemic to pass us by.
Meanwhile we remain busy at Kudjip Nazarene General Hospital caring for the sick and injured in the name of Jesus Christ. A few interesting cases are as follows:
CASE 1: This 2 week old infant came to me in the Outpatient Clinic with a rattling pneumonia and pus gluing his eyes shut. The clues to the diagnosis were his age since birth and the fact that his mother was having a similar discharge from her birth canal. Left untreated, Chlamydial Conjunctivitis can leave an infant blind and the pneumonia can be life threatening. Happily, we started the right meds, and his illness turned around within 48 hours (BEFORE and AFTER pictures below). His mother and father were also both treated and educated about the risks and prevention of STD’s (an all too common problem we face here).
CASE 2: A boy in Clinic presented to me with a seed in his ear canal. Perfectly round, completely obstructing the ear canal, and wedged deeply in place, this type of foreign body can be very difficult to remove. An ENT doc is usually required to use sedation and specialized instruments to extract such an object ...but of course we have neither the ENT or specialized instruments. So Dr Ted put on his MacGyver hat, and applied a tiny bead of super glue (kept in my medical bag for this specific trick of the trade) to the tip of a cotton swab. This was then carefully inserted into the ear canal, pressed gently up against the seed, and held for 10 seconds. With breath held, I said a prayer and gently retracted the swab ...and voila, everybody’s happy! 😁
CASE 3: Andrew is a 14 month old infant admitted for Kwashiorkor (malnourished), but within 24 hours of admission he developed stridor and a croupy cough. I was on call earlier this week and was awoken with the request to come and assess his worsening breathing. Apparently he’d already had a few days of this raspy breathing but it had worsened significantly overnight.
I whipped up some Racemic Epinephrine (nebulized adrenaline) to help relax his larynx, and gave him a steroid shot. Two hours later on my daily Peds ward rounds he wasn’t any better, which caught me off guard. It’s unusual for croup to be unresponsive to RacEpi and Decadron. So I reviewed his history, examined him again, and decided to get a couple x-rays. His chest x-ray came back looking fine, but the lateral neck film demonstrated a significant narrowing of the upper airway.
As suspected, the film revealed a classic “thumb print” sign, so I switched therapeutic gears to also treat Epiglottitis. This pre-vaccine-era illness is usually cause by Haemophillus Influenza B, which I’ve never seen before because most babies get their HiB shots. So while I got started adjusting his meds, all I could think about was the fact that within the span of two weeks I have diagnosed Diptheria and now Epiglottitis. May I take a moment to emphasize to you (mostly a first world audience) that vaccines save lives! Wowza. Anyway, the story doesn’t end there. I visited Andrew on the Peds Ward a few different times that day, and again many times yesterday, and remained concerned about his pinched upper airway and labored breathing. The tricky thing about swollen airways is that they can spasm if you mess with them too much, so I didn’t use a laryngoscope to view the cords, and we didn’t place an NG tube for feeds/meds. But despite ongoing IV steroids and antibiotics, the big difference one day to the next was his inability to cry or cough without the airway completely closing off. With all the working to breath, I was worried about acidemia (too much carbon dioxide building up in his body). Without the ability to cough and clear phlegm I was worried about accumulating mucus blocking his airway further. My solution -recruit surgery to consider placing a Tracheostomy (a breathing tube straight into the windpipe from the front of the neck to bipass the obstructed upper airway). With bigger minds than mine considering all the options, I waited and prayed ...and maybe pestered the surgery team a couple more times about it. So ultimately Andrew got his trach, a bunch of mucus was suctioned out, and he is now breathing easily out of his neck. Praise God! (Please keep Andrew in your prayers - that his airway swelling will resolve quickly so the trach can be removed ASAP).
CASE 4: This sweet girl is named Rita and she has been on the Pediatric Ward almost as long as I have. She suffers from Osteomyelitis (disseminated infection in many of her bones), severe enough to have required surgical removal of rotten pieces of bone. Despite the constant pain, inability to move, and bed sores, she has always returned my smile. This regular glimpse of a child’s hope has reminded me of God’s promise - Heavenly peace in the face of earthly trials - so I gave her a rainbow sticker, and shared God’s promise with her.
Today it is Good Friday. Almost 2000 years ago Jesus Christ was crucified for us, taking all our sin and shame to the grave, so we might receive eternal Salvation. As I see the world come face to face with pandemic illness and death, I have found more urgency than ever to share the Good News of Jesus Christ with those who may yet choose Life over death. Adding to the burden of urgency has been the recent death of a college classmate, who recently developed Pancreatic Cancer and died within two months of getting sick, leaving behind his wife and two young kids. Wow, that strikes home. None of us are guaranteed tomorrow - are we ready to meet our Maker? Have we lived every day leaving behind no regrets and fulfilling God’s Call to sacrificially serve others in Love? We can not do it alone. Our dependence must remain on the omnipotent power of God. Our focus must remain on Jesus. Our spirits must be tuned with the Holy Spirit. The fruit we bear reveals the source of our focus: Is it selfish and fear-driven, or does the world witness in you the Fruit of the Spirit?
But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness and self-control. Against such things there is no law. Those who belong to Christ Jesus have crucified the flesh with its passions and desires. Since we live by the Spirit, let us keep in step with the Spirit. Galatians 5:22-25
This weekend, let us all set our hearts and minds on the victory Jesus has won for us. Let us give over to Him our time and resources, and give Him control of today, of tomorrow, and however many days we have left. His power is made perfect in our weakness. Amen!
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