Kuranda

My last day in Australia was spent in Kuranda, which is an artsy town located in the rainforest.

To get there, I took the Kuranda Scenic Railway, which I thoroughly enjoyed. We passed waterfalls and scenic views on a beautiful old train. I walked around the town and ate some lunch. Then took the Skyrail, essentially an enclosed ski lift, over the canopy of the rainforest.

I ended the day at Tjakupai Culture Park, where I learned about the aboriginal people, tried spear throwing, and boomerang throwing. I listened to the digerdoo played. I was scheduled to do another rainforest tour, but opted for Tjakupai Culture Park, which was probably a good thing, being that at all the little stations at Kuranda and the Skyrail Park, I answered EVERY rainforest question correctly! However, I knew nothing about the indigenous people. For the record, I am only at risk at harming myself, than any living being with a boomerang in my hand! :-)

Swimming with Nemo

Cairns is a nice place, great parks, friendly, accessible, but there is one main reason why it is a popular place for tourists from Australia and around the world. The Great Barrier Reef. (The rainforest would rank 2nd)

So today I swam with Nemo. For a double whammy of some poor planning on my part and a chunk of bad luck, I anticipated having access to a waterproof digital camera, but that didn't happen. And I knew from previous experience what poor pictures the underwater throw away cameras, so sadly, I am left with just a few above the seas pictures.

It was spectacular! And, no, I am not scuba certified, but you could do first time dives with the company I went with. At both locations we went to, I got to dive for an hour. I loved it. I think perhaps I should look into getting scuba certified. I also snorkeled any time I wasn't diving. As for that hideous blue suit, it's not a wetsuit, it's a stinger suit. It protects you from things like jellyfish, which it's jellyfish season here (I saw one too). For me, albeit it ugly, it likely prevented me from getting seriously burned.

I saw so many lovely fishies (we swam with several schools of fish on the dives), some stingrays, a huge turtle, and coral of every color imaginable! Not a great picture on the left, but they fed the fish at the end, so you can make out just a taste of what I swam with.

If anyone is every traveling to Cairns, contact me and I will tell you about the company I went with, as I highly recommend them (thanks to Sheila for telling me about them). We then sailed most of the way back in, which was also fun.

Once again, God amazes me with His creation! The more places I go to, the less imagination I think the people at Disney have---they simply travel more! (Along those thoughts, apparently buried in the credits of Avatar is a thank you for Skyrail in Cairns, Australia, they inspired the tree in the movie--I'll be on that tomorrow)

Koala Bears

When I think of Australia, I think koala bear. And today I got to hold one of those cuddle creatures. They are stinkin' cute!

Today was my unscheduled day, meaning every other day I am in Australia I have an activity planned. It was none the less chock full of activity. I have read about the Cairns Wildlife Dome, which sits on top of a hotel and casino. I wasn't so sure. However, it was getting cloudy (and in fact rained), so I checked it out. It was actually quite nice. The animals are basically free to roam (except the gator). I stayed for feeding tour, and actually petted most of the animals. I felt a little left out, as Cairns is a tourist destination for most Australians, who have seen plenty of these animals before or at least heard of them. Meanwhile, I am thinking no I have had never heard of a pademelon (type of kangaroo) before yesterday.

It was a fun place to go, because even though I went on this outback trip yesterday, and saw some of these animals, it's not like they pose for pictures. Most of the animals were quite accessible in there too. They had TONS of interesting birds, lizards, frogs, snakes, fresh water croc, estuary croc, turtles. In fact, although he wouldn't do it for me. One of the big cuckatoos will let tourists carry him around on their shoulders while they walk around.

Interruption of regular blogging for....

This will be a bit different.

A friend of mine posted on her blog how you can get 50 free Holiday cards from Shutterfly. Well, I was kind of excited (secretly very excited). I know I haven't sent out Christmas cards in awhile, but I have been imagining it. Last year, I kept looking at the cards, but only was ready to get some like the day before Christmas. This year with all this amazing traveling, I have some great pictures! And I really want to share them with friends and family! This promotion was the perfect opportunity to get me on board.

I would stare at all the Christmas cards everyone sent me. The cats and I enjoyed hanging them around my fireplace, well really the cats enjoy taking them off of the fireplace. I would enjoy looking at everyone's beautiful pictures and greetings. Well this is my year!

Shutterfly has a great variety of Christmas cards, Christmas photo cards and Holiday cards to choose from. If you ask me, I prefer the Christmas cards. Let me show you some of my favorites. But you'll have to wait for Christmas to see the final selection. I have already selected my picture, and you haven't seen it yet either!

I also think that with my busy schedule, I likely won't get around to scrapbooking my experience. I really want to make a photo book, as soon as I get home.

If you have a blog and want to get 50 free Christmas cards too, check out this link.

Atherton Tableland Bush Tour

Today I went on a Land Rover trip into the rainforest (I left the bush for civilization, and my first day back I went to the bush...hmmm). I am just going to post a few pictures. I did see the muskie rat (a kind of macropod), padymelon (a kind of kangaroo), various birds, and two snakes (the one pictured is highly poisonous). We saw many strangled figs (that is pictured above and what I am standing next to). We forded most of these rivers I have pictures.

Goodbye PNG

Sadly, I have left PNG!

I had a sweet send off with circle time (where the missionaries gather and pray for me, then throw flowers at me as I leave) and the McCoys driving me to the airport (and Dr. Bill almost never goes to the airport). Dr. Bill McCoy was responsible for the other side of the medicine ward, which means he was usually the closest person for me to ask a question to. He has been a missionary for years, first in Swaziland then PNG. He has an enormous amount of wisdom and love for the Lord, and is a great mentor! I learned so much from him! He was very encouraging and patient. I don't think it is a very good picture of either of us, but it's what I have. The second picture, about 10 minutes after liftoff.

I was supposed to have a 5-6 hour layover in Port Moresby that I wasn't looking forward to. However, when I arrived, Air Nuigini moved up my flight, and in fact I ended up with a relatively short layover! PRAISE! Then I feared Australian customs, but that was really a breeze!

I am incredibly thankful for the opportunity to come to PNG! What a blessing--Praise be to God! I cannot begin to tell you everything I learned! I am thankful for the kindness, generosity, patience, and encouragement I received from all the missionaries. I hope the Lord wills it that I can come back again!

I love the flowers!

CON

Saturday I was invited to help out the Chapmans invited me to help out with a social event for the College of Nursing (CON) students. It was to be an afternoon of games. We broke out all my favorite childhood games plus a few I had never played before. We did the Human Knot, Sack Race, jump rope relay, stomp the balloon, Last Couple, Flying Dutchman, etc, etc.

It was a blast to see them all having so much fun. Most of the games were new to all of them. And I am not sure if some things were lost in translation or just because they are not used to relay type games. But I noticed they took most of the rules pretty liberally. And when someone new would arrive, even if the team had the most people on it already, they were out recruiting. So we kept having to stop to rearrange the teams. Multiple teams would finish, but you could not really tell the winner. However, would you could tell was how much fun they had.

So when it was time for the balloon toss, we ran it twice. I asked Diane, if I could introduce them to the water balloon fight concept. She agreed (after all it started raining, and they were already tossing water balloons). So I completely pelt one of the students with a water balloon, and everyone gets into it. Then a HUGE balloon hits my head and just soaked me! (well deserved, I know)

Of course, any activity like this attracts a crowd. From the smallest to the oldest, we had quite a crowd watching us.

Diane and Mike have a real heart for these kids. They really love on them, which the kids really love (for most of them it's their first time away from home). I was so happy to get to hang out with them.

After all my fun their, I enjoyed dinner with several folks from the station, as the Dooleys returned from their vacation with Chinese food! This is a real treat, as they had to bring it back from 3 hours away! It was a fantastic time of eating and fellowship, even though the lights were out for most of it!

Out with a Bang

Today was my last day in the hospital in PNG. Sad face. I fly out Sunday for a few days of vacation in Australia.

I have learned so much in my time here. I have been blessed in the opportunity to serve here, and so thankful for all the patience in teaching me from the doctors, nurses, and patients.

In typical spirit, my last day was kind of a knock out kind of a day. The morning started with me giving a presentation at case conference to all the doctors. I spoke about myasthenia gravis.

Then our B ward (medical ward) decided to explode with patients overnight. We had several sleeping on the floor. So it took alot of time to get through rounds, plus I tried to write a little extra to help the person taking my place. I have been happy to see some of my patients really improve. I haven't talked too much about my patients on service here, but I have enjoyed a wide range of cases. In fact, just today, I treated a likely cancer patient (I am carrying the bone marrow biopsy home with me to the USA), a pt with thrombocytopenia (plt count of 3, no schistocytes, awaiting Crt, no splenomegaly, hgb 4--thinking it's ITP), an odd presentation of polyarthritis that is improving on steroids, cerebral malaria, pyomyositis with likely osteomyelitis, pulmonary TB, HIV, Hep B, and CHF.

When I made it to the OPD (outpatient department), my first patient ended up having a broken arm. When I got back from lunch, that was confirmed by X-ray. So I casted his arm by myself (thank you, thank you very much). I diagnosed a spontaneous abortion, and prepared her for a D+C. As I was finishing with that patient, Edith, the little girl pictured above came in.

Edith was carried 5 hours on a bush stretcher to get to me (2 pieces of bamboo with sackcloth stretched across). Her thigh has been swelling for 2 months. She went to a clinic, where they were treating for abscess, although they had no diagnostic capabilities (ie no X-ray or labs). She left barely able to walk, then fell at home, when her parents carried her in. I immediately thought she fractured her femur, but another doctor felt she likely had cancer. It turns out, we are likely both right (so far we have confirmed I am right). She has a fracture of her left femur, and she has alot of periosteal changes. I did not see any pus on U/S, which likely means this is cancer. In the picture above, she has a sweet smile, and she was so brave to smile so big, because I know she was in a great deal of pain. Pray for Edith.

Heaven on Earth

This is Mary, once a week, she cleans the common rooms of my house. Mary is the most gentle sweet spirit that I, perhaps, have ever met. She first endeared herself to me, when upon meeting her, she asked where I was from. Then she told me that she went to Florida herself with her church, which is a bit mind-blowing in itself. And she was describing Disney to me (from someone, who may have never even seen a Disney movie herself). She is telling me about a parade, then the fireworks started. She took my hand and says, "Elizabeth, I just thought heaven was coming down, with all those colors across the sky!" She gave thanks all to God. It was so sweet and genuine, and I do not think she was exaggerating at all. She genuinely thought heaven was coming to earth right then.

Mary has a difficult life, her husband left her, and she is on her own to raise three kids. But you would never know it by her spirit. She quotes massive amounts of scripture. When she found out I was leaving this weekend, she ran out to pick flowers for me. She tells me, "Me lookim yu bihan long dispela graun or heven." (I will see you later either on this earth or in heaven) Then after several goodbyes, she leaves, but runs back in, and says I just have to give you a scripture verse to go home with.

"May He grant you according to your heart's desire, And fulfill all your purpose." ~Psalm 20:4

Mr. Man

Usually my patients come in with a wasmeri or wasman (watch woman or man). In fact, it is required that if you admitted to the hospital that you have a wasmeri or wasman with you, and they do most of your direct care. This little guy showed up to clinic with no one but himself. What you should also take into account is that pretty universally, kids here are kinda freaked out by white man.

Here walks in Mr. Man, with no wasman, and is clearly scared of me. However, we were able to get out of him what was wrong. Although the picture doesn't show it really well, he has parotid gland swelling on his left cheek. He has MUMPS! Add that to the list of things I have never seen in the US.

By the way, I think that is the 3rd or 4th picture I took of him. He looks petrified in the first one, but once I showed him the picture, he got excited. So by this one, I actually got him to smile.

Rain

The internet has been down for a day or so, hence why there have been no new posts.

I always imagined that PNG would have rain every day. There are only 2 seasons in PNG: wet and dry (and I have heard it said, truly it is more like wet and wetter). As best I can tell, the locals have no specific time for when the seasons start. Rainy season starts approximately in November and ends sometime in Jan/Feb. Upon my arrival in PNG, we were in the midst of a drought, which does not necessarily mean no rain, just little rain. Most people rely on their gardens for food, and their gardens were drying up. People were walking long distances to get water. For the missionaries, our water comes from collecting tanks from the water that hits out roof. There was concerns that our tanks would run out of water.

Well, it appears in the last 2-3 days, that in fact, the drought has ended, and rainy season has begun. We have had some heavy rains, which of course, make the best noise on our tin roofs. I am so glad for the rain! Sunday I went tubing again at the river, and there was considerable difference in the water height (and my backside was grateful for the higher water table).

On the down side of the rain would be that we lose electricity pretty easily. One day it kind of flickered on and off all day. The big concern is power surges, as they can damage any kind of electrical equipment, so there is a bit of a dash to unplug everything when the power goes out. In fact, tonight the power went out just as we were sitting down for dinner. The picture is our dinner in the dark, unfortunately it looks bright because of the flash. But besides the candles, it was pitch black in our kitchen.

On the upside, power outages have led to more creative types of fun. Of course, "the Martha Stewart of PNG," Leslie, was ready to break out the creativity. She has had Reni and I hard at work at craft projects.

From a medical standpoint, I have learned the value of a headlamp! Bring your headlamp wherever you go! Clinic in the afternoon, without lights--headlamp. Call in the middle of the night--headlamp! Invaluable.

Saturday Call

I was on 24 hour call Saturday, and it was fun! The theme of my entire visit continued---learning, learning, learning.

When I take call here, as an internal medicine trained person, I am not trained in peds, OB, ortho, or trauma, so to bridge the gap there is always a back up person on with me. Yesterday that was Dr. Bill. As I intend to do many more of these types of trips in the future, I have tried not to be closed minded to learning these other specialties. However, I will say it's been fun doing new things and learning so much here, although my heart is still in IM.

The first great surprise of the day is that Dr. Bill showed up to rounds, which he did not have to do. Do you know what a sweet gift that is? How rounding works with the weekend is the Friday night person will see their whole ward and the surgeon sees their whole ward, which leaves me with the 2 wards left. In my case, it was the medicine ward (GREAT) and the OB ward (you want me to take care of pregnant people, are you crazy?!). I do want to learn, but have surprisingly not done too much OB here, so it was going to be a stretch to have me round there. As it turned out, the ER was packed when I arrived for call, and ultimately sweet Dr. Bill rounded on the entire OB ward for me!

The theme of the daylight hours was the ER. I admitted at least 10 patients, alot of kiddos and a few COPDers. What makes peds actually not that bad is these standard treatment books in PNG. It's a Sanford Guide sized book, that lists all the common illness in PNG, and standardized approved treatments. PLUS in the back, it lists all the common meds with doses by weight. Therefore, I haven't been doing any complicated math or calculating, I merely turn to the guide page and look on the table with the weight. I did end up with a really sick kid that we could not get IV access on, and ended up putting in my first IO (and later that night my second IO).

Sometime during the day, I got called that a first time mommy was in labor with TWINS! One baby was breech. Called Dr. Bill, and due to another sick kid, missed the first birth, but helped with the second. Just to make matters interesting, the OB ward ran out of OB trays, and had 2 other deliveries going on (the doctors only perform complicated deliveries here, the staff does the rest). So basically, Dr. Bill had to tell me what he needed, and I had to scour all over to find whatever he needed, mainly using supplies from a D&C kit. Mommy and twin baby boys are doing great! Dr. Bill walked me through sewing up tear in Mommy. There is a project in the US that sends these bundles for each delivery that includes an outfit and blanket, so you can see in the picture, the twins decked out in their new outfits.

Then in the evening, I got called for a penetrating stab wound to the back. When I arrived, it was exactly that, a man was drunk, and I believe got stabbed by his wife or girlfriend. When I walked, he had a BP of 60/40. I immediately realized that my finger could reach lung, and called Dr. Bill and then Dr. Kevin (our surgeon). It was a funny presentation, as I had no CXR or Hgb, you have to wait for security to find the X-ray tech at home to get that done. I did attempt U/S to look for a hemothorax, but Dr. Bill and I weren't successful in that endeavor. I asked Dr. Kevin, if he'd show me how to put a chest tube in, and he let me do it, which was fun! It was a hemo/pneumothorax. That is the top picture.

Simultaneously, another woman walks in with chops to her b/l cheeks and head. She was bloody, but really her injuries weren't too bad. And thankfully, the nursing staff can sew up lacerations here, so I could do the chest tube.

I got to sleep through the night, but then at 6 am this morning, I was called that another mother needed a C-section, so I ended my call assisting a C-section with Dr. Bill. We ended the day rounding on medicine ward together, and to leave a sweet present for Dr. Steph, we even conquered the peds ward (ok I saw like 3 patients, to his 20 or so on wards).

As my chief has always said, when your busy, you have plenty of learning opportunities (that's for you Sarah)! I am trying to take advantage, while I can!

Oddities plus a sweet addition

So there are on occasion things that just make me chuckle or perhaps go mmmmmm....I thought it was time to share a few.

First off, to some viewing this picture you see a drive train to a car (or to me it's just a car part, but I believe it has been identified as a drive train), to the PNG recyclers, they see a church bell. This bell belonged to the Hydro Church, not too far from station. I have also seen wheels and an oxygen tank (personal favorite) used as church bells.
We have fantastic security guards on station, which I am thankful for. Just last night, they were quite helpful controlled the ER crowds (in fact locking the doors to the ER---until sanity was restored). However, I cannot help but chuckle at the patch on their uniform. (Hat and left shoulder)
PNGers love to have their pictures taken, and sometimes they don't know how to smile. I was joking with this woman for not smiling, and this is the picture I got! The entire ward erupted in mayhem when I showed them the picture.

Finally (something SWEET) Jordan, who is the jack of all trades, (his wife teaches at the MK school) made a porch swing for the Barnabas House--where I live. He ran into a bunch of obstacles, but the swing was finally hung! And as someone who adores porch swings, I cannot think of any better addition to this place. This is Apa and Jordan enjoying the first seat on the swing!

And the lame shall walk...

Dr. Andy has taken an interest in talipes (clubfoot). He just says the need presented itself, and he found himself reading about it after a patient presented with clubfoot. Then he started internet searches, which eventually led to a trip in the US to learn the Ponsetti method (and meet Ponsetti himself). Now one morning a week, he has a talipes clinic. Through a series of stretching, castings, tenotomy (cutting the Achilles), then splinting, he is able to take a foot like shown above, and straighten it out to walk. It's pretty amazing work if you ask me.

The most interesting part to me is actually the splinting. Clearly there are limited resources here, but Dr. Andy found away around the fancy equipment/shoes in the US to make a PNG version. Essentially he make a wooden base with a certain incline to it, and then screws shoes to it. He said they brought back a suitcase full of shoes from the US. It works!

Call Day Notes

(Clearly I did not take this picture, but this is an aerial view of the station. The large cross shaped complex is the old hospital. The even large mass of rectangular buildings is the new hospital. Then if you follow the road that comes from the circle down to the bottom of the picture, I live just a few hundred feet out of view)

Another fun and interesting time on call, full of learning. Learning, learning, learning---this experience has been chock full of that! Of course, as per my usual in the US, all that learning came at the cost of little sleep last night.

• As some of you may know, I have a distaste for LPs (lumbar punctures, where you sample the CSF fluid). My distaste started in Africa, where I did my first LP late at night on a little baby, who seized in the middle of it. Ultimately I got it, after I shed some tears, mommy shed tears, and well baby seized (and likely cried before that). I have done this procedure a bunch of times, but just don't like it even though it is so simple. I walk into the ER in the middle of the night last night, to a toddler who needs an LP! I got it first try--and it was a CHAMPAGNE tap! (For nonmedical people, that is a good thing, it means I got no red blood cells during the tap, and tradition says that I get a bottle of champagne for doing it--which will be a tall glass of apple cider when I get home) Praise God! I was suspecting malaria vs meningitis (which can also be from malaria)
  
• I also had a fracture to cast last night, which I get some help with. BUT then today in OPD another fracture came in, and I thought I would spread my wings and cast it myself. I had Dr. Andy check on me, but I did it all myself. As you can see from the X-ray, that it was a tib-fib fracture, a kiddo fell out of a tree playing.
• I had 2 codes last night. Here a code is referred to as "going off." I find that kinda a cheeky phrase. Surprising to me, we actually do have code carts here, but really it is no where near the same as the US. Not to mention, that I have to await someone to call me, to know that it is going on. Frequently by the time I arrive, nursing staff may have been working on the patient for 10-20 minutes (imagining a code like we run in the US is the completely wrong imagery for a PNG code). What I have gathered is that my main job appears to be praying with the family.
  
• I still lack confidence with the ultrasound machine, but I am finding the more I force myself to use it, the better it is getting. Case in point, the surgeon and I needed to look at a patient's belly last night. It turns out I had more experience than him with ultrasound, and both us felt very confidence we were not missing any large fluid collections in the belly, which was what we were looking for.
• Ok my peds and ortho skills are improving, but OB is still a large void in my head. I am making some slow progress, wrote for oxytocin last night, and it worked.
• Finally, my driving on the other side of the road and this huge vehicle skills are also improving! To be fair, I really only drive like a 1/4 mile and am the only one on the road, there is a station rule that women cannot walk outside by themselves after dark. So when I am on call, I am given a station vehicle. I am still struggling with randomly hitting the horn, which is kind of annoying in the middle of the night! Opps! I haven't stalled the car once though.