Little Switzerland--Kugark

Reni and Tabae

As I have previously mentioned, my roommate, Reni, is Swiss. She actually is an missionary from EBC (a church we don't have in the US) stationed at Kugark. She arrived early summer, and will stay for 3 years. Her main job will be teaching/overseeing a girl's school on her station. However, as she is a trained nurse, she will also be fielding calls from other EBC missionaries regarding medical care, as the midwife who is currently here, is retiring. Because of that, her mission sent her here for 2 months to learn about the PNG health care system. She invited me to spend a night on her station in Kugark, where I was able to go Friday night.

Many of the missionaries here encouraged me to go, as they refer to Kugark (and actually all the EBC mission stations) as Little Switzerland, as they are very well kept, with beautiful gardens, and just have a sense you have been transported to a little slice of Switzerland, particularly as you have beautiful views of the mountains. And it is really only a 10-15 minute drive from the station.

Reni lives with Tabae, a schoolteacher, in a 2 bedroom flat. Tabae actually was born in PNG and stayed till she was 8 as her parents were missionaries. Now at 18, she has returned for the year to help teach the missionary children. Both of them are so warm in spirit and kind hearted. I felt so at home.

We spent out time touring the grounds, particularly the school. It is difficult for girls to get education here. At many EBC stations, they run schools for girls. If they complete the local program, they have the opportunity to come to Kugark for 1 year. It is a very simple school, where they learn about agriculture, some business (they learn how to sew and make bark tapas with scripture on them--which they sell), cook, and basic health. On the station, the girls tend to very large gardens (they grow almost all the food they eat), sheep (sipsips), chickens, and pigs.

We ate beautiful meals, including a wonderful picnic with rice and pan fried fruit with curry sauce. Of course, you can't go to Switzerland without having cheese and chocolate (I did get myself into a bit of trouble, as I could not taste the difference between German and Swiss chocolate).

Oh, I should also mention, a family on station has alot of cockatoo (?) birds. Then there is this other bird, which the town keeps, and I forgot the name, but it is about the size of an ostrich, but with beautiful colors over it's neck. Whatever that bird is, it hated me! It will perhaps be used as a bride price some day.

There are not too many places to go off station here, and it can be a bit of a technical dilemma. I was very fortunate to get this opportunity. And it was a heavenly retreat! Things move differently here than in the US, and it is a welcomed slower pace.

Harvest Day Party

Last night we had a Harvest Day Party with all the missionaries on station. We dressed up (there was a bush Smurf, Bride late for her wedding, a Pumpkin, Princess, Cowboy, Clown, awesome 80's chick (complete with handmade leg warmers), pirate, skier who had an accident (complete with her own casts) and I was the American flag). We ate hobo meals and PNG hot dogs. We even had a pumpkin that was carved. Games too: including bobbing for lemons, water balloon toss, lick the ice cube. It was a relaxing and enjoyable time for all!

Creepy Crawlers

In honor of the time of the year, some of my uninvited house guests decided it was their turn to be on the blog. At home, people decorate their lawns with things like cheesy blowup spiders. Well my PNG house guests, are the more lively version!

Now before you get all grossed out, frankly PNG has many less bugs than other places I've traveled to. The cockroaches make an appearance 2-3 times a day. The one pictured was taken in my bathroom. I have learned to open my bathroom draw and ALWAYS look before you reach.

Then Mr. Spider, he's running across my living room floor.

BIG Spider, well thankfully she's not been spotted at my house. She actually has been peacefully sitting outside a friend's house. I affectionately have named her Charlotte. The locals told my friend she's poisonous, but I don't know how or why. When asked, the locals just said, "Em kaikai yu." (it eats you)

Finally, the fly. He's enormous, in fact, can make the screen door creak, when he hits into it. (He is not pictured, as the internet connect is not cooperating)

Flowers

PNG is home to what I believe is one of the largest array of orchids than any other country in the world. The climate is just superb to enjoy flowers, and let me tell you, you don't even have to leave the station to enjoy the flowers.

When I first arrive, Elaine had made a little arrangement of flowers in a vase for me. I then noticed she did it at her house, and then would bring them to others. Well she got me started, now I am starting to think the table is not complete without a few flowers on it.

1st Call

I survived! It was nothing, if not varied. (at least it appears I may not be the black cloud here that I am at home).

- I assisted an appendectomy (although the Australian surgeon told me the Americans have it wrong pronunciation)
-I assisted reducing a tib-fib fracture twice (as the first time it didn't re-align correctly)
-I started someone on TB treatment
-I prayed with a patient with advanced cervical CA, whom is beyond treatment options, and only palliative care. (it was the worst cervix I have ever felt)
-Treated a likely transfusion reaction on an OB patient
-To most the next one may not seem like much, unless you remember I am not trained in peds, but I did admit a peds patient all by myself with diarrhea and likely pneumonia.
-The picture above is a deformity on one of my patients, which the family says has been there many Christmases (spelling? anyways there way of saying years)

It is humbling that despite very solid training in the US, it does little to prepare me for here. Clearly, I knew upfront I would struggle with OB and peds. But then I am also managing alot of orthopedics. Let's not forget in the US I have only treated one maybe two patients with TB. Here I have already seen 7-10 cases, and it's not just pulmonary TB. We have renal, abdominal, neuro, etc. Then I am working up a patient for a blood dyscrasais, with no fancy tests here and no hematologist. Also, typhoid and pigbel are common here, never seen that at home.

Where I am weak, He is strong.

I & D abscess

A new week has begun in the hospital, and this is my week to take over care in the B ward (medicine ward) and see patients on my own in the outpatient world.

As you all know, I am an internal medicine person that means I do no training with pediatrics or OB. Today I managed still to see about 5 babies, and to be honest, it wasn't as scary as I anticipated (or perhaps it was because I ran and found someone with each baby I saw).

This little guy has had swelling of his right leg for 2 weeks. Yeah that thing was full of pus. I did conscious sedation myself on a 10 month old for an I&D. We use ketamine here, which is all we used in Ghana. Here, for adults they also add valium. For kids, they switch to atropine. I am a bit worried he really has osteomyelitis, but he is coming back in 2 days and he was started on antibiotics appropriate for osteo (for the record he's on chlorophenicol and cloxacillin).

Nunga Church

Today was once again a rather busy day! I was invited to go out with the same bunch as yesterday to a church that is the home of one of the 2nd year nursing students, Christina. It was about a half hour to 45 minute drive from the hospital. Mike was asked to preach (which I was really proud of myself, because I understood almost the entire sermon in Pidgin, of course it is a bit easier to understand an American speaking Pidgin).

The people were so generous and kind. We had to wait outside so they would be ready for us, and they threw flowers on us as we walked in. They all sat on the ground, but brought out chairs for us. The church was maybe the size of my apartment living room and dining room combined, but there were over 50 people there. You can see how they lay out fresh flowers and food, that is common here. Not only is Christina from this church, it happens her father is the pastor, Pastor Marcus. So we were then invited to dinner after church. They showed me around their cooking house, then we all went into their house. Large platters were laid out, Graham, Elaine, and I were given one. It's pictured below--so we had chicken, banana, kaukau (staple food here--kind of like a sweet potato), green beans, corn, and greens. It was truly tasty! For the record, we didn't come close to finishing the platter, but it wasn't expected. Also, PNG might be the perfect dietary place for me, they don't use spices (or it's not spicy food). They actually hand you salt to pour on the side, and dip things in it.

I practiced my Pidgin with this sweet mother next to me (it's polite here to address most anyone by either brother, sister, mother, or father). She got a kick out of trying to teach me different words.

Romans 8:28

And we know that all things work together for good to those who love God, to those who are the called according to His purpose.
-Romans 8:28

More Pictures

PNG car wash (thought you'd like this one, Dad)

Mother making a bilum. There are many kinds of bilums and countless designs. She told me if she works all day she could possible do this in a week, but complicated ones can take 1-3 months to make.

Washing in the river

Scenic Drive

It has been a busy day here for me, because after the Suicide Rocks (see below post) I joined Elaine, Graham, Becky Wallace (we have 2 Becky's), Diane and Mike for a scenic drive. On the way, Mike knew someone from the school, Peter, and so we were able to stop at his house and meet his family. They showed us his house and church. Actually, I was given my first bilum. You can see from the pictures, that it is just gorgeous here! We saw a cockatoo. The final picture is of a church bell, yes you look and think you see part of a wheel, but no here it's a church bell! Go recycling!

I don't think it will cooperate to post more pictures now, but I am off to a birthday party and will try again after that!

Suicide Rocks

Today is Becky's birthday, and she decided she wanted to go to the Suicide Rocks and tube down the river. (She is to the right of me in the picture) I did not name the Suicide Rocks, nor do I know how they got their name. I do know they used to be rather different, but possibly a landslide or flood changed them.

Anyways we hiked maybe a half hour from station to the Suicide Rocks. It is a bit too wild for the littlest members of our party, so they met us at the end where they played in the river. It was a bit like a water park theme ride, except way more unpredictable. The water wasn't super deep, maybe waist high at most and ankle deep in the shallowest areas. You had to be careful to keep your backside up or you'd hit random rocks,which I happened to me once or twice. I flipped over twice. But it was alot of fun. We would wave at the locals as we went by, and a few of them had tubes themselves coming down the river. A few of us went a bit farther down the river at the end, and took the tubes out near a huge baptism.

More Hospital Tidbits

I have been pretty impressed with what Kudjip Nazarene Hospital can offer their patients.

1. We have HIV testing and ART treatment! They can follow CD4 counts and have the rapid test available. HIV is a problem here. They test pregnant mothers and have protocols to prevent mother to child transmission. Free testing is available to patients.
   
2. We offer PAP smears. Ok, so it might take a bit longer than it would in the US to get your results--like a month or two as the PAP smears are sent to Australia. Cervical cancer is another problem here. Two of the doctors perform LEEPs and colposcopies.
3. One of the doctors has taken a special interest talipes (clubfoot), and through a series of casting, tenotomy, and bracing has had pretty remarkable results (I will blog about that another time)
4. We are able to offer chemotherapy. I believe we have CHOP, but I will have to clarify that. We also have Gleevec for our CML patients (I believe they have around 14 currently).
5. We can do orthopedics here. I have much to learn about casting. You might this this is pretty basic, but we actually could not cast when I was in Africa.
6. The government, for all its shortcomings, is a bit advanced for its healthcare systems. (Note there are many many failings to what I am about to say) Each patient has a scale book, which basically is their medical record. It is nothing like a chart in the US, an outpatient visit may take up only 3-4 lines in the book or for that matter a hospital D/C. However it is a potential way to keep track of each patient's medical record.
7. On the same lines, the government has three standard treatment books (adults, peds, and OB). It is meant to standardized treatment for diseases and in theory the government pharmacies should carry any drug listed.
8. We can treat diabetes with insulin (you think that is simple, but again in Africa this was entirely not possible).
   

Hospital Notes

There has been many things to do, learn, and see in my short time here.

-This morning I was working with Dr. Stephanie, who threw a party for one of her NICU patients today. A party is thrown if any of her babies reach 2000 grams (4.4 lbs). She reads with them Psalm 139, all the mom's on the ward join in, and she prays for each baby on the ward, which her area is kind of overflowing (and one of the newest babies is only 800 grams). Of course, no party would be complete without cookies.

-Domestic violence is a big problem here as well as fighting. This can result in what is called a chop. Very common. Well, this afternoon I started seeing my own patients, and my first patient was a chop wound. She got her chop when the second wife of her husband and her got into a fight. She sustained essentially a knife wound (chop) to the left wrist. Her vascular supply seemed intact, but she severed alot of tendons and nerves. I loosely sutured her together with a drain, gave her antibiotics, made sure she was up to date with her tetanus, and sent her off to surgery (which she likely won't get until sometime next week).

-This patient is named Jessica. She had a baby 2 weeks ago, and presented to the hospital septic. She had alot of pus in her abdomen, which was drained, but her oxygen saturations remained low. Chest X-ray showed a left pleural effusion, which Dr. Bill has tapped twice with pus (likely empyema). She currently had a chest tube in, but its only draining serosanguinous fluid. Despite being quite sick, she is the sweetest girl. In this picture, Dr. Bill and her are joking around.

"For you created my inmost being; you knit me together in my mother's womb. I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well.My frame was not hidden from you when I was made in the secret place. When I was woven together in the depths of the earth, your eyes saw my unformed body. All the days ordained for me were written in your book before one of them came to be." Psalm 139: 13-16

Cutie

I've been busy today, but who could not post this cutie! I was rounding with Becky on the TB ward today, and Becky told me this girl presented with flaccid paralysis. With TB treatment, she is now up and running around the ward.

Dinner

Tonight I enjoyed dinner with my roommate, Reny, and my neighbor, Elaine. Elaine's husband, Graham, was supposed to join us, but got called to surgery. He is filling in for the full time surgeon, who is on furlough. Anyways, it was a very nice dinner, and amazing as I am from America, Reny is from Switzerland, and Elaine is from Australia. Isn't that fun? Three different countries together in PNG.

Afterwards, all the missionaries went across the road from the station where there is a Nazarene revival going on. We sang two songs in Pidgin. The turnout was pretty amazing, an entire tent was full of people, with many standing outside (despite the rain).

Luggage arrived

Praise the Lord--my luggage arrived! Ironically, I was pretty content in my luggage less circumstances, and I will say I feel like I have an overabundance now. But I am still happy.

The picture is not my luggage, but it is my cute room here in the Barnabas House. AND you can see the fantastic bag I found on my Cairns speed shopping trip. The curtains in my room, you can't see very well, but they have Papua New Guinea on them.

Day 1 Hospital Notes

Today was a rather fun and full day, my first in the hospital. Here's some brief notes:

- As you can see from the picture, I did my first thoracentesis (I took fluid off a patient's lung). Watched one, then did one. My patient likely has a new diagnosis of TB and completely whited out his right lung on chest X-ray.

-Saw an interesting rash, pictured above. It started in July, initially treated somewhere else with ketoconazole and steroids with partial response (but also reported noncompliance). We weren't really sure what we thought it was (sounds like a Dr. Burday consult), but decided to do steroids and erythromycin cream.
-Met my ward--the medicine ward. I will shadow this week, but next week half of it becomes mine.
-They have a reasonable array of lab tests available to us (way more than I had in Africa) including: CBC, K, Crt, Hepatitis B Surface Antigen, HIV, AFB, fluid analysis, sed rate, UA, cholesterol, AST, glucose
-Encouraged that in 1 day with patients, I couldn't speak very well, but I could understand reasonably well (particularly if I asked, "Yu tok isi isi plis."--Please talk slowly)

Welcome to Kudjip

I safely arrived yesterday afternoon to the station here at Kudjcip Nazarene Hospital.

On my plane from Cairns to Port Moresby, the capital of PNG, I sat next to a former PNG ambassador. Before I knew that, he had asked where I was from, and he had been to Delaware. He actually had watched some ice fishing in Maine (near Kennebunkport), sent time in Lancaster, PA because he was curious about the Amish, loved the leaves in Vermont (where he stayed at the chateau run by the Von Trappe Family), and he thinks that New York City is an interesting place. Small world, right?! He was very careful to make sure I found my way to the domestic terminal. Great introduction to PNG.

After I made it to the domestic terminal, it was advised I buy a phone here, so I did. I called one of the missionaries, and she realized my flight wasn't for hours. So she told me about a free shuttle to a nice hotel where I could relax and have a meal, instead of waiting at the airport. So I had a relaxing time in air conditioning at the Gateway Hotel. They were so kind, and then drove me back to the airport.

I arrived in Mount Hagan and was greeted with a very nice welcoming committee. The Bennetts (missionaries here) welcomed me with a delicious meal. I also made my first new friend, pictured below! My roommate, Reny, came too. She's from Switzerland, and is getting experience here at Kudjip before heading off to a nearby mission where she'll be for the next 3 years. And guess what, she spent time at Nalerigu Baptist Hospital in Ghana (same hospital I was at). Small world? God really knows how to make a person far from home, feel so close to home.

Before this gets too long, my first impressions of PNG are that the people are lovely, the weather is perfect (80-ish in the day, 60-ish at night), the hospital facilities are rather nice (ok not like Christiana, but also much nicer than we had in Ghana or El Salvador), the land is quite plentiful (people have the most luscious gardens).

Tomorrow is my first day in the hospital!

If shoppings were an Olympic sport, I think I just earned a gold

“An adventure is only an inconvenience rightly considered. An inconvenience is only an adventure wrongly considered.” GK Chesteron

“I would like to travel light on this journey of life, to get rid of the encumbrances I acquire each day…I come only to be myself as I lose myself.” Madeline L’Engle

I have safely arrived in Cairns, Australia! However, my luggage did not, and currently the airport has no idea where my luggage is between Philadelphia, Toronto, Vancouver, or Sydney. L I will admit I was concerned from when I first touched down in Toronto. When I left Philly, they insisted I would not have to do customs and that my bags would arrive in Sydney. Arriving in Toronto, asking 10 people resulted in 12 answers. I did have to go through customs, and my luggage wasn’t there. The baggage guy insisted this happens a lot of this particular route (comforting, I know), and that in the 8 hour layover it would be found and be put on the plane. So it was not a complete surprise this morning, when once again the carousel turned round and round, and my luggage never showed up.

This did lead to the title of my post though, let me get to that.

Air Canada insists it will get my baggage to me as soon as it locates it, which will be interesting being that it’s not like I am just down a highway. BUT they now have all the contact information I have to Kudjip Nazarene Hospital in Papua New Guinea and they say they can get it there. Something makes me a little doubtful I will see my luggage again. HOWEVER, there is still much to be praised about, because all my electronics are with me, my medical supplies are with me, I am mainly missing most all my clothes and presents for people at the hospital. Sitting in the Sydney Airport, it occurred to me, that I was without most toiletries and only had 1 additional outfit, and perhaps, even in the best of circumstances, I will likely be in this situation for a few days at the least.

I found one long skirt in the airport (this was a virtual miracle, and I have to be in skirts all the time in PNG). Then I decided I would have to find a store when I got to Cairns to get more supplies, particularly toiletries. I make it to Cairns, check into my hotel, and realize that EVERYTHING will basically shut down in less than an hour in Cairns because it’s Sunday.

I drop my bags in my room, take 30 seconds to account for what I have, and make a mad dash for the Cairns Shopping Plaza, where I heard there was a Target (TARGET, yes a TARGET!!) . I can’t figure out where to find a cab fast enough, and it’s at least a mile away. Mind you, I have already been in the same clothes for like 48 hrs. It’s hot here, and I am in jeans and a long sleeve shirt. I BOOK IT! I make it to Target as they are calling overhead that the store will close in 10 minutes (which is a half hour earlier than even I was planning on), please bring your stuff to the front. I just start grabbing things. I have to get a bag to put it in, toiletries, I get 2 tops, a pair of shorts, a bathing suit, undergarments, socks…..all in under 10 minutes! GO ME! AND when I lug all the stuff back to the hotel, EVERYTHING fits! PRAISE! But I think I deserve a gold metal in shopping!

I have been a chronic overpacker my whole life. And I already was proud, that I actually had only checked 1 bag at the airport. BUT this may be a new lesson is living with less! I am happy that I will be heading to the bush with basic toiletries and more than one outfit! I found the above quotes in a journal I brought with me and thought they were quite appropriate.

Praise that I am in Australia safely! Pray they may find my luggage! Pray for more traveling safety, as I fly out early in the morning for Port Moresby, PNG then onwards to Mount Hagan and Kudjip.

How did I end up in PNG?

Good question.

I have been interested in missionary work since I was a small girl. I particularly give credit to the camp I went to for 10 summers, Tapawingo (http://www.camp-of-the-woods.org/camp_tapawingo/COTW-Tapawingo.shtml), where we always had missionaries speaking to us from far away places. Also, my parents got me subscription to Ranger Rick, an educational magazine (think National Geographic for kids), and I clearly remember an issue about Papua New Guinea. In fact, the cover had a man very similar to the picture I added above.

By the time, I was in middle school, I distinctly remember telling my 7th grade math teacher, Mr. Cunningham, that I was going to be a missionary in Papua New Guinea. I am pretty sure I came with up PNG by spinning a globe, and that is where my finger landed. But at least one childhood friend remembers me telling this to Mr. Cunningham.

One of my best friends, Shireen, spent a summer in PNG serving with Wycliffe Bible Translators when I was in college, so it stayed in the back of my head. Since late college and early medical school, I already had this dream where I plan to work in the US as a doctor most of the year, but gradually return more frequently to missionary hospital overseas.

In medical school was my first shot at trying to go to PNG myself. Long story short, I learned alot about patience and God's timing, but ultimately spent 2 months in Ghana instead of PNG. At the time, that worked out perfectly for me. Ironically, when I made it to Ghana, I was already following the blogs of people at Kudjip Nazarene Hospital. One of the first nights in Ghana, I was in the schoolhouse, checking my e-mail, and happened to look up where one of the missionaries was on her computer, and she had up the same blog I was reading from PNG. It turned out one of the missionary doctors, a graduate of PCOM, had received the same scholarship I won to go to Ghana. Small world right?!

I actually only applied to residency programs that would give me an opportunity to do an international rotation. And as it turns out, the Delaware ACP (American College of Physicians) has a scholarship to allow internal medicine resident the opportunity to do this kind of work. Again, shortening a long story, I won that scholarship. My residency worked with me to give me credit to spend this month working at Kudjip Nazarene Hospital.

So tomorrow morning, I hop on a plane, and live out my dream! I could surely use many prayers for travel mercies!

Baibel -- and learning Pidgin

I am a language dunce.

Three years of French, I am not sure I can count to 10 anymore. A trip to South Africa, my very kind driver encouraged the group to try Afrikaans, but specifically told me that I was really nice, but butchered his language. Made it through El Salvador only with a translator always at my side. Manpruli the tribal language spoken in Nalerigu, Ghana, I could say, "I'm sorry," after two months.

However, I think I can learn Pidgin, the trade language of PNG. PNG is a tribal country, with innumerable tribal languages, and Pidgin is used for trade. I think I have a fair shake at this language mostly because it's darn close to English.

I am still a basic beginner, very basic beginner, yet I have mastered a bunch of words.

Here is what I have done. First of all, my darling Shireen, who spent a summer doing a Wycliffe Bible Translators internship in PNG, let me borrow her precious Baibel Piksa Buk (Bible Picture Book) along with all the language materials they gave her.

So like a complete dork, you can find me at night with my Bible out, a small Pidgin dictionary, and the PNG Baibel translating. I may also have been known to attempt to read said book to friends at the pool or over dinner.

Then for language skills, I actually was able to track down a CD for my computer.

I am sure I will still be horribly incompetent when I get there, but at least I am giving it a shot! Of course, it will likely mean me making a complete fool of myself--I guess that just means more to share with you.

Where is Papua New Guinea?

"Where is Papua New Guinea?" "That is near Brazil, right?" "Oh, you are going to Africa?!" "Umm, yeah I have no idea where PNG is."

I have encountered PNG being located just about everywhere on the globe. So let's start with an orientation.

I will remain in the Solar System.I will be on planet Earth.
In the southern hemisphere.
I will be right above Australia
I will fly into the capital of Port Moresby, and then fly to the Mount Hagen (part of the Western Highlands)
Kujip is located approximately a 1 hr drive outside of Mount HagenEasy right.