May 16th, 2008 by INMED
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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. Ovoid 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 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!

April 24th, 2008 by INMED
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What a week it’s been here in the Gulf of Papua New Guinea!  I’ve really learned what village life is all about this week.  Our team of seven left on Tuesday to go on patrol to villages along the river and on the coast in order to give children routine vaccinations and treat sick or injured patients in the village.  Since travel in this part of the country is by boat only (or dugout canoe in the case of the natives), most of the sick aren‚t able to be brought to Kapuna hospital.

It was quite an experience to say the least, but overall, a good one!  We stopped at three villages a day, and we spent the night in whatever village we happened to be in when the sun went down.  When we reached Old I‚Aire (our first stop) our boat pulled up next to an old, half-submerged log sticking out into the water.  I found out that this was their dock and was contemplating how get off of the boat and up onto land carrying my bag without getting wet when what I swear was the entire village ran to the river bank to greet us.  The adults were clothed but all of the children were naked, carrying bow and arrows made out of local plants.  It was wild.  I somehow made it up the log and was looking forward to standing on solid ground when I realized that the walkways through the village were nothing but logs suspended over the muddy earth.  As it turns out, all of the villages are designed this way because the ground is essentially swamp and muddy all the time.  Y’all who know me will be very impressed with the fact that I only slipped once in four days in the villages.  Someone was definitely looking out for me.

Each village was much different than I expected! I imagined that most people would live as they did in my experiences in the small towns in Mexico, with people living in shacks and eating food with little nutritional value. The villages in PNG actually seem very untouched by the rest of the world, and with the exception of the people’s clothing and nails in some of the houses, everything that the people survive on and with comes from the land around them.  The villages were actually quite beautiful; there were coconut trees and beautiful flowers growing everywhere and all of the houses were raised on log posts above the ground.  I was amazed to find out that all of the houses are built completely by hand (the logs for the framework/floor/and material for the walls are all cut with an ax).  Some of the houses were actually pretty big; since the material comes from the land, the size of the house is not dependent on the wealth of the family but only on how much work they want to put into it.  The people cook over fire, sleep on the floor, bathe in the muddy river water, and use these dreadful, long-drop toilets built in the bush.  I felt like I had stepped back in time.

Over the course of the week I did get to eat some interesting food.  The staple of the PNG people is a food called sago, which is basically the inside of the sago palm tree scraped out and beaten with a stick until the pith separates.  They take that and cook it inside a banana leaf and flavor it by adding coconut, banana, or even grubworms (thankfully, I didn‚t have to eat any of the latter!).  We also had dried fish, crabs (every day!), oranges, banana, coconut, and some kind of weird thing from a tree that looked like a Christmas ornament and tasted a little bit like wood.  We also snacked on sugar cane (my favorite).  I stayed up late telling stories with the nurses on the last night, and they told me I was becoming a true PNGian, and they were proud of me for eating all the village food.  They said I even ate foods that they wouldn’t eat…haha.

The friendliness of the village people was amazing to me.  We didn’t know a soul in the village on the first night, but immediately after we arrived one of the men came and offered his house to us for the night (he then told us to wait outside while he ran in and made sure it was okay with his wife).  I loved seeing the patients when we held clinic.  The kids would run over and play with my hair and sit in my lap (until I pulled out their injections) and we were really able to treat a lot of patients.  We saw many with probable malaria, pneumonia and bronchitis, and injuries from wild pigs and bush knives.  I also got to see a lot of pregnant women and do their antenatal checkups.

I was reflecting yesterday on my village experiences this past week.  Y’all know that I love being outdoors and don‚t mind getting dirty and all that, but that at the end of the day I really need my hot shower and comfortable bed.  Knowing that I was going to be thrown even further out of my comfort zone, I was a little nervous what the week was going to be like.  In Ephesians 6:7, Paul writes this:  “Serve wholeheartedly, as if you were serving the Lord, not men, because you know that the Lord will reward everyone for whatever good he does.” Now I’m not necessarily a vocal complainer, but in my head this week I pretty frequently thought about how horrible the heat was, how dirty I felt, how I hadn‚t washed my hair in four days, etc.  Over and over again, though, I had the same response to these thoughts “it’s not about me.”  Realizing this made the work so much easier.  I think that, as humans, it’s very easy for us to get wrapped up in our own needs and desires, but as Christians we are called to serve with the same humility as Christ served.  When we give up our own self-interest, we can really serve with joy, love, and kindness.

The cool thing is that we’re not alone in our struggle to serve and do God’s will.  Christ gives us the power to lay aside our own personal needs and concerns, and once we figure out how to serve others, we’ll gain the desire to do it more.  Over the course of the week, working in the heat and dirt stopped bothering me (as much).  Isn’t it neat how that works?

The hospital has been fairly busy this weekend.  Yesterday I got to help reduce an ulnar/radial fracture in the arm of a little boy who had fallen off a roof, and spent two hours cleaning out wounds of a man who had been attacked by a crocodile while washing in the river.  He was really lucky to even be alive.  Last night Manar and I hosted a little dinner party for some of our new friends and I got to practice cooking PNG-style (and decided I can‚t wait to have French fries and ice cream when I get home!).

We had church this morning (for three hours!) and I was asked to stand up and share my experiences from the village patrol.  They had a special prayer for Manar and I as we are leaving tomorrow to go work at Kikori hospital for the next two weeks.  It is so cool to me how much the community has welcomed and included us in everything.  I’m really going to miss a lot of the people here but am excited about working at Kikori (very busy and lots of babies!). Thank you all so much for your continued prayers! I miss you all but will hopefully be in touch soon!

April 14th, 2008 by INMED
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Hey again! This will be the last update from me before I head out into the real bush, the swamps/jungles of the Gulf province of PNG. We are taking a team out “on patrol” as they call it to visit a few villages up the river. Kapuna hospital does this once every month or two in order to reach people that live too far to come to the hospital for basic health care. I think we’ll probably be treating a lot of malaria, diarrheal illnesses, giving vaccines and doing check-ups for children and pregnant women. Our team is made of Manar and I, who will function as the two doctors, three nurses and one or two nursing students. Seeing as how we’re only taking one of our wood-bottomed boats (supposed to hold eight people and all our supplies) I’m a little nervous we’ll be bailing a lot of water out of the bottom. I’m pretty sure we’re exceeding whatever weight limit it has. It’s exciting though because it will give me a chance to see (and live) how most PNGians live. I’ll pretend I’m on Survivor. Right now we’re supposed to be back on Friday but that could always change.

We had a nice relaxing weekend and didn’t spend as much time in the hospital. Saturday afternoon the girls had a volleyball game using a net hung between two bamboo poles. They’re much better than I am…although I had a whole audience of locals and patients laughing at me when I missed a serve at the beginning of the game. After I got warmed up, though, I did okay.:)

We were also lucky to have a woman named Debbie stay with us over the weekend. She’s a mission worker from New Zealand who works with her husband down the river doing Bible translation, and is probably the most talkative person I’ve ever met. Since she’s been in the country on and off for about twenty years, she was able to share a lot of stories about her work and about the culture of PNG in general with us. It’s great to be able to learn from the lives of so many people I’ve met on this trip so far. She also loves to cook so I didn’t have to do a thing involving the stove all weekend. She’s coming back in a week, so I told her that she could stay for as long as she wanted!

Today I finally got to see and manage my own patients on hospital rounds, which was nice now that I’ve started to figure out how this tropical medicine works. We treat a whole lot of patients for malaria, but we treat based on their fever pattern and a few other signs and symptoms, not based on a diagnostic test. Because of this, it seems like there’s a lot more malaria than there probably actually is, but since chloroquine is plentiful and cheap we go ahead and treat all of these patients anyway. I’ve gotten to do a lot of dressing changes and we drained an abscess in an infected hand yesterday…but of course I’m still waiting for more babies to be born! We had a short little education session for all the new moms today which was kind of cool, and talked to them about breastfeeding, when to introduce new foods, and hygiene. We also give all of the new moms books for their baby which contain a vaccination chart, doctor’s note section, and growth curves to keep a record of weight and height. You’d think that these would be lost or ruined in most households, but it’s amazing to me how many parents bring these books with even their teenagers to the hospital…there’s really much more well-child health than I was expecting!

Being here a week I’ve really gotten to see how God has been working in the healing of a lot of patients. We had a couple of children in particular last week who were so dehydrated and not able to wake up and drink that I thought they probably wouldn’t make it. Over the weekend one recovered enough to be sent home today and the other one was awake and eating. I thought that was pretty cool considering we don’t even have IV hydration supplies at the moment. It just goes to show that prayer and God’s healing are very present and powerful here with our really limited resources.

Well I’m off to head to the market to see if they have anything interesting to buy. They mainly just sell food, but it’s really cheap so I like going to look around. You can buy a huge bunch of greens for about 10 cents, and a whole crab for the equivalent 30 cents! Unfortunately I can’t recognize most of what’s for sale and so I usually stick to the basics.

April 7th, 2008 by INMED
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Hey again (or as they say here, “goodnight!”). It’s been awhile since I’ve sent y’all anything and I know that some of you are probably worried I’ve gotten lost somewhere in the jungle or been picked off by a crocodile, but I’m just fine. This electricity-only-after-dark thing really limits the email time. I’ve been busy working at the hospital this week…there have been a couple of babies born (!) and we make rounds to see patients at 7AM, 11, 4, and 9PM. It’s raining right now and, being the wet season, rains at about 5PM every day…otherwise it’s consistently in the upper 90s with what I swear is 100% humidity. I’ve figured out I’m a lot tougher than I thought I was!

I’m learning a lot about the way medicine is practiced here. Basically, when a family member gets sick, the family picks up and moves from their village to Kapuna. Sometimes they travel up to a day, by canoe or by foot, to get here. We have people of all ages just hanging out on the wards and it can get kind of crowded…but it’s neat seeing how families in this culture take care of each other. We unfortunately have a lot of sick little kiddies right now…Dr. Lin says there’s a diarrheal epidemic in this area. It’s really scary to me how dehydrated some of them are…their parents carry them around like limp little noodles and they hardly wake up. I therefore spent a lot of yesterday going to find bananas and giving the kids ORS (oral rehydration solution) because the parents are reluctant to do it when the baby is crying and I don’t think really understand how important it is.

One of my favorite patients is an older man who came in to the hospital because he had jumped off a ladder on a nail. We took a look at his foot and saw that he had an awful infection…it was swollen and you could see pus coming out of the hole where the nail had entered. Dr. Lin decided we needed to drain the abscess so we took him to the old operating suite. Our sterile equipment consisted of old latex gloves washed in disinfectant, and a scapel and forceps wrapped in an old towel. We drained an absolutely enormous amount of pus from his foot (don’t worry, I have pictures) so I’m hoping that helped to slow the infection. What is kind of frustrating to me is that we couldn’t put him on the antibiotics he needed because the hospital just doesn’t have them…and those that are here are often expired or need to be rationed among the different patients. Apparently the government provides funds for the medicines, but they have to be shipped by boat up the river…and the boat has supposedly “been coming” for three months. I’ve learned that this is common in PNG… patience is key!

The patients here are really different than American patients in that they don’t demand anything from us; they’re just grateful for any care we are able to give them. I always ask them what they need before I leave the ward; one lady just wanted a green coconut (they’re filled with this sweet-tasting water) and the man with the foot infection wanted books and magazines. Seriously…he’s a teacher. I took him a couple of books that I’d brought with me and some that are on a bookshelf in our house and by the time I went back the next day he’d already finished four!

One of the highlights of the afternoon was going on a run up the river to a neighboring village. Manar (the other visiting doc from England) is a big runner and runs everyday so I figure I should tag along every once in awhile. Anyways, the village kiddies think we’re the funniest thing to hit Papua New Guinea when we do this, and have decided that it’s great fun to run with us…so we literally had 80 half-naked kids running barefoot behind us and giggling the entire time. I felt like Forrest Gump.

I also found out I’m really going to be put to work in all kinds of ways while I’m here…which is great for me since we have a lot of breaks throughout the day (it’s amazing how much free time a person has when you take away internet, cell phones, music, TV, the mall, etc). My newest task is to teach keyboard to some of the school kids! I said on the first day that I wanted to serve Kapuna in whatever ways they needed, so I’m excited to be able to do just that.

Tonight Rita and Wendi, two of the staff nurses, came over to cook dinner with us (well, I watched them cook). They’re hilarious and I was excited they wanted to hang out. Afterwards, we went to the office here and watched “A Walk to Remember” (great movie) with the rest of the nurses. Friday and Saturday nights are apparently video nights since there’s no other source of entertainment.

The friendships and time I’ve had to fellowship with the others here at Kapuna has been really great. The nurses and nursing students have devotionals on Monday and Friday mornings and it’s great to hear them share what’s on their hearts. I also have had some great conversations with Dr. Lin. In case I haven’t mentioned it, she is an absolutely amazing (84-year-old) woman. She met her husband in medical school in New Zealand and afterwards, both feeling called to do mission work, moved to New Guinea. I can’t imagine the boldness they must have both had since at that time many of the natives had never even seen a white person. Her husband passed away in the ‘80s and she’s been working here since then. She has such an amazing heart for the people here and she’s often running off to find bananas for the patients or giving them money to go buy food in the market. Matthew 25:40 says “…” ‘I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.’” I don’t know that I’ve ever met a person who exemplifies this verse as she does. She told me that they’ve really been struggling to find doctors to come work at the small gulf hospitals and one of Kapuna’s sister hospitals, Kikori, hasn’t had a doctor for quite some time because people will leave after a month or two. I understand this…I think that leaving life as most of us know it and moving here would be more difficult than I can even now imagine…but I pray that they do find someone called to this life.

Anyway that’s all for tonight…continue to write me if you want because I love getting your emails! Please continue to keep me in your prayers and God Bless y’all!

April 1st, 2008 by INMED
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So I made it safe and sound to New Guinea…on the other side of the globe! I left life as I know it last Wednesday to fly across the US, to Brisbane and then to Port Moresby, the capital city of Papua New Guinea. The international airport had three gates…but I made it with my luggage (no small miracle) and was picked up by a wonderful woman who is friends of the family at the hospital and lives in the city. She gave me a ride to the hotel where I spent the night (because apparently taking a taxi can be rather dangerous). In asking about her family, I found out that her husband was recently diagnosed with cancer and is undergoing radiation therapy so keep them in your prayers. On Saturday, I flew from Port Moresby to Kikori, a small small village on the gulf. It was almost surreal flying over the country, because when you looked down there was absolutely nothing except jungles and snaking rivers, and the occasional man fishing out of a canoe carved from a log. At the airport, I was met by Barb, another wonderful woman who works at the hospital here. I had understood that they would be bringing a vehicle to meet me and bring me back to Kapuna (where I’m at now) …this vehicle was actually a fifteen-foot wood-bottom boat with a motor on the back. We sat underneath a tarp as it was raining and took a four-hour boat rider up the river! Crazy stuff. I asked Barb if there were really a lot of crocodiles around the river, and her response was this..”yes…that’s where faith in God comes into play.” Nice.

When we arrived at Kapuna last night, we were greeted with a warm reception. Lucy, one of the hospital nurses, gave me a gorgeous lei made of real hibuscus flowers. I’m staying in a house called “treetops” house with Dr. Manar, who came from England a week ago. The house is the coolest thing…very Swiss Family Robinson-esque if you can imagine…it’s on stilts and is open to the outside, but we have running water, a stove to cook on and even a washing machine in there. When you look out the windows you see coconut, banana, lemon, and guava trees. It’s amazing.

Last night we ate dinner with Barb and her husband Colin…cooked pumpkin, banana, sweet potato and egg…I have a feeling I’m going to eat a lot of new things here but it was delicious. Dr. Lin, who was until recently the only doctor at the hospital, came to join us. She is 84 years old (that’s right) and has been living here since the 1950s. I can’t wait to get to know her and hear her story. We were called over to the hospital around 9PM for a four-year old who was “breathing fast.” I got over there and the boy was breathing but not responsive…apparently he had been like that for hours. Here in the US we would have called the pediatric rapid response team, but apparently they have no such thing here. Imagine that. Dr. Lin, Dr. Manar and I examined him and started him on antibiotics thinking (actually they thought:)) that he likely had pneumonia (even though his lungs were clear) or meninigitis. I was really worried about him but amazingly he was semi-awake and eating this morning. It’s so different how medicine is practiced here…I definitely have a lot to learn.

This morning we went to church with the local community. We sang various worship songs, none of which I knew but which were praising God all the same. Different people came up to share their testimonies or something that had happened to them last week, and even I, as a new member of the community, was called to say a few words! The people here at Kapuna are some of the most welcoming people I’ve met…I absolutely love them. It was also cool to me to see how they worship with such pure hearts even though their worship service is by no means fancy. God was definitely in everyone’s heart this morning.

We were called from church for a delivery… I of course was really excited but the baby had just been born when we got there. I don’t know really what I was expecting, but the delivery suite basically just has a table in it…no monitors, no IV poles, and no anesthesia. They do have a few of the basic drugs in case of emergency. I just wonder what happens when there’s a complication…no C-sections are done here. For mom and baby’s sakes I hope I don’t have to find out! What was really neat is that we pray and sing the mother a song after every delivery. There’s another woman in labor right now…and I’m on call so hopefully I’ll get to do the delivery later tonight!

Alright, that’s all I’m going to write right now. I’ll try and keep you guys updated as often as I can….I’ll be here at the hospital in Kapuna for a week or two at least…and then I’ll either go on patrol to see patients in the villages or go work at Kikori hospital. I want to thank you guys all again for your support and prayers… it truly means a lot to me and I know that prayers were a big part of the reason I’ve ended up here safely.

March 30th, 2008 by INMED
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Hello! My name is Kelly Hankins. I am a medical student at University of North Carolina School of Medicine, and I’m starting my INMED service-learning experience at Kapuna and Kikori Hospitals in Papua New Guinea beginning in April 2008