Immersed, Sink or Swim

You don't know what you don't know, until it's staring you in the face. That's the eye-opening reality jarring my conscience 100 times a day here at Kudjip Hospital. As I wrestle to make a definitive diagnosis or select the right treatment, each decision may well determine whether a patient lives or dies. As you can well imagine, this is stressful. But I've been here before so my instincts (so far) have been on the right track, and I have wonderful career missionary docs all around me who are more than happy to answer my questions. For this, I find myself frequently praising God. Also, the Holy Spirit has continued to massage a balm of next-level peace into every moment, leaving no room for anxiety or fear. I believe that I owe a debt of gratitude to a great number of faithful prayer warriors - thank you all!

After taking a day to unpack and settle into our mission house, I covered call on Saturday which entailed rounding on the Peds Ward and then covering the ER for the day. Normally rounding might take 30-60 minutes depending on the number of patients, new admits, discharges, complexity, etc. For my first day back on the Peds Ward, I invested a painstaking 4 hours getting to know all of the children - pouring over each hospital chart and skelbuk (medical history booklet), completing a thorough history and exam, and then writing fresh orders for the weekend. I was honestly surprised with how long it took me, but doing it right the first time ensures optimal patient care, and it was arguably an excellent way to immerse myself back into the medical system here - the usual diagnoses and treatment pathways for meningitis, tuberculosis, severe pneumonias, typhoid gastroenteritis, sepsis/DIC, severe malnutrition, congenital heart diseases, malaria, seizures, etc.

I was pleased to find my Tok Pigin fluent, and brought with me "Jesus Loves You" stickers and bracelets to gift all the children and caregivers. Folks know "Dokta Ted" is back when they start seeing kids with stickers on their foreheads all over Station. What can I say, they love "bilas" (decorations) here, so why not adorn them with the name of Jesus?! 

On my own in the ER that afternoon I felt exhausted and overwhelmed. Still shaking off jet-lag, I found myself disgusted with the violence of a beating one man gave his wife with a stick - they were both present in the ER, and "it's just the way things are here..." I then exercised my use of the Ultrasound machine for a possible bowel obstruction and was reminded of how little I know about internal medicine and surgery, which shook my confidence a bit. Finally, I was saddened and frustrated by the lack of early cancer recognition/management (common here) as I examined a sister-in-Christ, just about my age, dying of metastatic breast cancer. It's never fun to see and smell a fungating mass of cancer growing beyond the skin. After telling her there was nothing we (or anyone) could do, we prayed together with some of her family members, and I encouraged her to spend her final days giving testimony to God's grace. Can there be a greater mouthpiece for God's message of love than one who yet praises Him during their darkest hour? 

During a moment of journaling and prayer later that afternoon, perhaps to balance out from expressing frustrations, I jotted down a list of favorite things:

• The jovial chatter and lilting laughter of locals walking by
• Tropical rain showers on a tin roof, and amazingly loud window-rattling thunder claps
• The sound of tropical birds, especially the very loud Friar Bird, which might be considered annoyingly loud except for the PNG Highlands nostalgia that I experience every time I hear it
• Similarly nostalgic, the distinct body odor of the nationals (odd I know, but it's a potent confirmation we are really in fact here and not just dreaming!)
• An exhausting early morning F3 bootcamp workout, unusually out of breath at this mountain altitude, but rich in the company of missionary friends and a beautiful sunrise
• Many hospital staff with enthusiastic greetings, side hugs, hand holding, rejoicing with our choice to return (in the words of our resident surgeon "we love repeat offenders")
• Returning to my Mowgli roots, climbing trees with the kids

I returned to the pediatric ward with Rachel, Pennie, and Solomon on Sunday morning before church to share a devotional with all the patients, caregivers, and staff. Standing up with my "Buk Baibel" I read from Romans 5:1-5 and encouraged them to lean upon God in their time of difficulty - to even rejoice in their suffering as the Lord will respond by conferring His peace and hope. Amid my own struggles, I also found encouragement in these verses:

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 put us to shame, because God’s love has been poured out into our hearts through the Holy Spirit, who has been given to us. (Romans 5:1-5)

We are now half-way through our first full week here, and the number of extreme medical scenarios that I have already seen is mind-numbing. Please join me in praying for Steven Francis and James Bill (pictures below), two babies on the ward who have congenital heart defects which we can not repair, and from which they will eventually succumb. Please continue to pray for me to have peace in the mayhem (mostly in my head) of successfully diagnosing and treating challenging patients. Please continue to pray for Rachel as she begins teaching a music/art class for the missionary kids, all the while making delicious meals from scratch and homeschooling P&S. And please pray for Pennie and Solomon who of course have contracted a terrific cold, hacking their little lungs out. Did I mention how much we LOVE being here?! Haha, that may not have come through in much of this post, but it is true. God designed us perfectly for this place, for this work, in this time. Praise HIM! :-) 

THE PEDIATRIC WARD

THE OUTPATIENT DEPARTMENT 

(my clinic room & the waiting area)