Reflection & Stories
May 16th, 2008 Posted in Uncategorized | No Comments »Hey everyone!
I just wanted to give you guys one last way-overdue update on the last
two weeks I spent in Papua New Guinea. We didn’t have internet in Kikori
my last two weeks, but I have so many great stories that I want to tell
y’all about…so read this at your own risk; it’s long enough to be a
short novel. I’m still excited about the trip, even writing about it two
weeks after-the-fact.
Kikori is another hospital operated by Gulf Christian Services in the
Gulf Province of PNG, about four hours down the river from Kapuna. It’s
really a busy hospital–seventy beds and they are usually filled. It’s
hard to imagine one doctor being able to take care of all the patients.
There had been no doctor at Kikori for a year before Dr. Ovoi started
(and she started on the same day we did). Apparently one of the big
struggles that the hospital has is keeping physicians there—many plan to
come and never show up; others leave after a couple of weeks. Prior to
our arrival, a nursing officer by the name of Sister Sara had been
running the hospital. She was an absolute saint. Sara somehow managed to
be a mother, a wife, head of the hospital, and survive being called
three or four times every night. She confessed to us that she and her
husband want to move to an area with better schools for their daughters,
but know that they are needed at the hospital. She is an amazing woman.
The community was pretty small, but was a little more spread out than
Kapuna. There was a little store and a daily market, where we would walk
to get food for dinner every night. The church was a 45-minute walk each
way. There was an oil company about an hour up a ridiculously bumpy
road. The people were also exceptionally friendly and we became close
friends with the nurses really fast. We hung out with them in the
afternoons, had video nights, and cooked dinner with them a few times.
The friendships I made while I was in PNG really will stick with me forever.
From a medical standpoint, I really learned a lot in my weeks at Kikori.
We saw patients with all the infectious diseases, complications and poor
outcomes that we are able to prevent here in the United States. We saw
tuberculosis manifest not only with pulmonary symptoms (the worst was a
woman who brought in a /bucket/ of frank blood she coughed up), but also
in the hips, spine, and pelvis. There was a boy on the ward whom the
nurses called their “miracle boy” and had recently woken up from a
three-week coma because of TB meningitis. Many patients had
complications of leprosy, leading to horribly infected ulcers and
wounds. One two-year-old boy had an infected tropical ulcer that had
destroyed the bottom half of his leg. Another five-year-old came in with
malaria and a hemoglobin level of what we estimated to be 3 or 4
(dangerously anemic) but we didn’t have the equipment to do a blood
transfusion.
We set many fractures and sewed up a woman’s finger that had been bitten
off down to the nail bed in a fight. There were many women who came in
with injuries that had been inflicted by their husbands. One in
particular had been hit in the chest with a club and was in a complete
panic when we got to the ward to see her. When we were examining her she
suddenly stopped breathing. I was just a little concerned (!) but Dr.
Ovoi gave her a deep sternal rub and she woke up. Apparently this was
the result of hysteria and it’s really common in PNG.
I witnessed a tremendous amount of healing take place in an amazingly
short time. On my second day, a 13-year boy came in with what was
supposedly a two-week-old stingray injury—the tail had entered one side
of his calf and come out the other. His leg was infected so badly you
could smell it walking into the ward and we knew something had to be
done immediately or the boy would lose his leg. Drs. Ovoi and Manar and
myself took him to the operating room, where we proceeded to play the
part of surgeon, anesthesiologist, and nurse simultaneously. Ovoi opened
up a little bit of the leg attempting to drain what we thought would be
a collection of pus. The only thing that came out was calf muscle, red
and swollen. Ovoi then handed the knife to me and told me to see what I
could do. I’m obviously not a trained surgeon but knew that we had to be
fairly aggressive in cleaning up the leg or the boy would either die or
have to have an amputation. It was an almost surreal experience—I had
the scalpel and the charge to do whatever I thought needed to be done
(which was ?)—but in that setting I felt pretty powerless. So what did I
do? Prayed—that God would give me the wisdom and the skill in my hands
to do what needed to be done, and that He would help to heal this young
boy with such a long life ahead of him.
I ended up removing a lot of dead tissue and opening up the leg a little
bit to take pressure off of the muscle and blood vessels in the leg. At
one point I had fingers from each hand touching each other inside the
boy’s leg (sorry guys…you know I like this stuff). We washed out the
wound as best we could, packed it and bandaged the boy up. The next day
he looked worse and was writhing around in pain with a high fever, so we
took him back to the operating room and cleaned some more dead tissue
from the leg. We couldn’t keep an IV line in the boy, so he couldn’t get
the antibiotics and fluids he needed. It was an awful situation, and I
spent most of that next night awake trying to figure out what else we
could do for him. I was at a loss.
The next day I decided that I literally couldn’t and shouldn’t do
anything else for him. Apparently the father had become “aggressive” the
previous night when the nurses were trying to put yet another IV line in
him, and was walking around the ward with a 3-foot machete, threatening
to kill whoever came near his son. I would have been slightly amused at
this, except for the fact that word around the hospital was that this
man had killed his first two wives and was likely responsible for the
boy’s injury (it was thought to be a spear and not a stingray). Where
was hospital security when we needed them? I really felt helpless at
that point.
The nurses continued to do dressing changes but we weren’t any more
aggressive with treatment. All I could do was pray for the boy. He
seemed to be slowly getting better and stopped having fevers, but I
didn’t want to get my hopes up. One day, about a week later, I was
walking through the ward and saw him on the veranda in a wheelchair. I
said hey to him and he smiled the biggest smile I had ever seen. It just
melted my heart. He looked great on the day I left and I hope that he
continues to get better. That boy was living proof of the power of
prayer…it took over when we reached our limits as humans and physicians.
At Kikori, I was blessed to see a lot of life begin on the obstetrics
ward. I also sadly was witness to the last breath taken by one little
baby. A woman brought her four-month old adopted nephew—little Mick–to
the hospital. He had been suffering from some stomach illness for a week
and was very dehydrated. On top of that, he had severe protein
malnutrition from not being breastfed. We had an IV line in him for a
few days and were attempting to rehydrate him. The IV stopped working a
few days later but Mick wasn’t looking any better. We were called one
afternoon because he was having trouble breathing. When we got to the
ward, it was apparent that he was again very dehydrated and a really
sick little baby. We tried for 45 minutes to get an IV line in him and
his difficulty breathing just kept getting worse. Suddenly his little
chest was still and his life of pain ended. I cried with his aunt that
day, even though I knew we had done all that we could for little Mick.
I want to preface this next story by telling you that Airlines PNG, the
entirely too unreliable domestic airline of PNG, had cancelled every
single one of their flights out of Kikori the week before I was supposed
to leave because multiple planes were having “mechanical problems.” This
got me pretty worried, and I decided to try to fly out to Port Moresby
(the capital) a few days early rather than risking missing all of my
international connections. There were allegedly to be two planes coming
in on Saturday, so I was booked on one of those flights. Everything to
date on the trip had gone remarkably smoothly, and I prayed that at
least one plane would come so that I could safely be in Moresby. Two
hours before the first plane was due to arrive, I found out that both
flights been cancelled. I was pretty discouraged and began to wonder why
that prayer wasn’t answered when all of my previous ones had been.
At midnight that night, one of the nurses came to call and told us there
was a woman who had just come in labor with twins. The problem was that
the first twin was positioned normally (head down), but the second twin
was breech, and they needed our help. I was wondering how exactly I was
going to deliver the second baby since I’d never even seen, much less
done, a breech delivery in my life. C-section was obviously not an option.
We got to the delivery room and the mom was completely dilated and ready
to deliver. Dr. Ovoi is trained as a general practitioner and I got the
impression that she didn’t feel very comfortable doing this particular
delivery when she told me that I should do it. It was neither the time
nor the place to argue, and someone had to be in charge, so I got myself
ready. I ruptured the membranes around the first baby, and barely had
time to throw on gloves before the first practically shot out like a
torpedo (sorry for that mental picture). The first born was a girl; we
clamped and cut the cord and she was taken to be cleaned up by the
nurses. I was a little shaken up after nearly having a baby delivered
onto the floor, but had to focus and figure out how I was going to get
that breech baby out.
Before the second twin started to come, I was worried that there was
going to be something really wrong with the baby—there was a huge amount
of fluid around it, the mom hadn’t felt the baby move since that morning
and we couldn’t hear a heartbeat. I knew we at least had to get the baby
out as fast as possible. The rear end started to come down so I started
to pull. Legs were delivered, body was delivered; the shoulders and arms
came after a lot of wiggling. The last thing left to come was the
head—which would be the most difficult. I was pulling as hard as I could
on that baby and nothing was budging. I realized that every one of the
probably ten people in the delivery room was looking to me to get the
baby out, and suddenly felt completely powerless. I had exhausted
everything I knew to do, but there was no one in the entire hospital I
could look to for help. I just started praying that God would help me to
save this baby and to get it out with no harm to the baby or its mom.
After what seemed like an eternity, I finally was able to pull the head
out.
The second twin was also a little girl, but she was blue from head to
toe and as limp as a noodle. I thought we’d had a stillbirth. The nurse
suctioned out her mouth and I got chills down my entire body when the
little one started to cry. She was alive! Ovoi continued the
resuscitation, giving the baby oxygen and getting her cleaned off, while
I sewed up the mother. By the time I was finished, the little girl was
breathing normally and starting to get some of her color back. I knew
we’d done all we could for the time being but let the nurses know to
keep a close eye on her—she was such a sick little girl that I really
didn’t think she’d make it through the night.
I came around the next morning to check on the mom and see how the
little girlies were doing. I walked in the recovery ward and saw both
little babies, pink and moving all around and breastfeeding and almost
just broke down and started crying right there. Seeing both of them
there and looking healthy was such an incredible feeling, and the
gratitude of the mother and father when they offered a simple but
heartfelt “thank you” was something I’ll never forget.
That afternoon I got to thinking. “Alright God, You win.” I’ll never
doubt His plans or His timing again. Maybe the reason I didn’t leave
Kikori on Saturday was because my hands were needed to help bring those
little girls into the world. I’d sure like to think so.
I think that’s all I have in me to write right now. My time in PNG was
unquestionably life-changing. It was also incredibly humbling. Human
life is such a gift…and I was able to witness the miracles of life,
death, healing, human love and courage at their purest, without being
confounded by the technology and frills of the society in which we live.
I would love to be able to go back one day (if I survive residency
training). I couldn’t have done it without all of the support and love
you all have shown me and I thank you so much for that. God Bless!
Much love,
Kelly
