Tuesday, September 4, 2018

Unresectable



              Cancer stinks. No matter what form or what stage, there is nothing nice about it. We see plenty of cancer here in the highlands of Papua New Guinea: oral cancer from chewing betel nut, rampant cervical cancer, childhood leukemias, lymphomas, breast cancer, colon cancer, pancreatic cancer, and the list goes on. There are many people who we can help, but unfortunately, many of our patients come too late. Sometimes we can identify metastatic disease during the medical work-up, but due to our limited diagnostic capabilities, we often don’t discover it until surgery. The past few weeks have been a discouraging litany of such cases. Our current series started with an elderly woman who presented with an incarcerated umbilical hernia and bowel obstruction. We fixed the hernia through a small incision, but her obstruction did not improve. On re-exploration, she had metastatic pancreatic cancer that involved several loops of intestine.  
              Later in the week, we attempted resection of a large kidney cancer (Wilm’s tumor) in a 10-year-old boy. Unfortunately, the tumor involved the major blood vessels and after a three-hour struggle, we had to abort the surgery. With limited chemotherapy and no radiation therapy options, we were very discouraged that we could not surgically remove his disease. 
The next case was an exploration for a right upper quadrant abdominal mass of suspected gallbladder origin. Instead, we found colon cancer that had widely metastasized throughout the abdomen. 
             This week, I performed a pelvic exploration for complex ovarian cysts and uterine mass, only to find ovarian cancer coating all the pelvic organs including the rectum. 
Most recently, I was consulted on an elderly woman with history of gastric ulcer disease who presented with symptoms of a perforated ulcer. At surgery, we discovered gastric cancer that had perforated through the mesentery of the transverse colon. 
              Even more discouraging than finding unremovable cancer is the conversation with the family and the patient once they wake up from anesthesia. There is no easy way to break the news that the patient has a terminal illness. Palliative care is all but nonexistent here. Fortunately, we know that death is not the end. We can point patients to the hope found in Jesus and help them prepare for eternity. 

Friday, August 17, 2018

Teamwork


  
Recently, we hosted a volleyball tournament between the missionaries of Kudjip and Mission Aviation Fellowship (MAF). We had a great afternoon of volleyball followed by our monthly joint worship service. One of the MAF pilots took the opportunity to speak about unity among believers, in short: teamwork. How frequently the devil tries to drive wedges between team members based on pride, emotions, and difference in abilities or ideology. But the speaker reminded us that we are all members of the same body, and as long as we are connected to the head, Christ, we can all function together to fulfill his purposes.  I am so blessed to work with a great team of physicians, nurses and ancillary staff here at Kudjip Hospital. Without each person’s unique talents, knowledge and experience we would not be able to continue God’s work here as effectively as we do. I especially appreciate our surgical team. Each person is gladly willing to step in for a teammate who is sick or has urgent family needs. As Solomon stated: “Two are better than one, because they have a good return for their labor: If either of them falls down, one can help the other up.” (Ecclesiastes 4:9-10) Thank you, Lord, that we can help and encourage one another. Thank you for teammates who support me when I am weak. As an African proverb says: “If you want to go fast, go alone; if you want to go far, go together.” 

Saturday, July 14, 2018

Emergency!


           Every medical sub-specialty has certain life-threatening emergencies that doctors are trained to respond to.  Surgery is no different. Among the many urgent surgical cases we perform, there are a handful that are true life and death emergencies. Recently, I made a list for our surgical registrar (trainee) of the surgical emergencies we see and treat here at Kudjip. We have treated each and every one of them in the last two weeks, starting with one day when we saw 5 emergencies.
          Going into that operative Tuesday, our schedule held 4 elective cases. Little did we know what was about to come. Early in the morning, Dr. Ben was called for a patient with tension pneumothorax –a collapsed lung with increased pressure in the chest that compresses the heart. He quickly placed a chest tube to decompress the chest and allow the collapsed lung to re-inflate. 
          Next, during rounds, we were consulted on two emergency surgical patients. The first patient had a closed head injury from a rubgy match and was starting to show signs of right-sided paralysis. He was immediately taken to the operating theater for a craniotomy (drilling holes in the skull to release blood that was putting pressure on the brain). The second patient was a young man with tuberculosis who developed a pericardial effusion with signs of tamponade (fluid surrounding and compressing the heart). Dr. Ben performed an emergent pericardial drainage procedure on him.  Finally, we were able to start our scheduled cases—removing lumps, draining pus, and excising cancer—typical surgery day cases. Between our regularly scheduled cases, we also drained a dental abscess that had grown so large it was extending below the patient’s jaw to her neck. This type of abscess, called Ludwig’s angina, can lead to life-threatening blockage of the airway. At the end of the operative day, our fifth emergency patient arrived in the ER with a ruptured spleen after blunt trauma. That is when I sat down with our surgical registrar and made the list of the major surgical emergencies we treat. We had seen 5 of the 8 in less than 12 hours! 
             Over the course of the past week, we completed the list with several c-sections for fetal distress, a ruptured ectopic and a patient with an ischemic arm.  That man presented with a crush injury to the arm. The muscle swelling and bleeding around his fracture site cut off the circulation to his hand (compartment syndrome), so Dr. Ben performed a fasciotomy to release the swelling in his arm. 
          It has been a crazy two weeks of surgery, but praise God for his provision through it all. Please pray for all our patients as they heal from surgery and for our surgical team to get some rest after two crazy weeks of emergency surgery. 

Saturday, July 7, 2018

Birds of Paradise

Trekking to the coffee grove
         Papua New Guinea has long been a favorite destination for serious birders. This group of islands holds myriad species, including 42 different types of Bird of Paradise, which can only be found in this region of the world. Dr. Bill and Marsha McCoy, two of our long-term missionaries at Kudjip, are terrific birders and they have shared their enthusiasm (and binoculars) with many people over the years. Soon, the McCoys will retire and return to the States, but before they do, they are rising up a new generation of birders: showing us their special birding sites, introducing us to local guides, and imparting birding tips that they have gathered over the years. 
Ragianna silhouette
Ragianna close-up
Credit: Australian Geographic

         Recently, Bill took a group of us on a sunrise expedition to a village less than 20 minutes from Kudjip. After arriving at his local friend's house, we trekked a short distance into a coffee grove that is shadowed by tall pine trees. High in the trees, silhouetted against the early morning light, we saw nearly a dozen Ragianna Bird of Paradise dancing, displaying their ornate feathers, and calling to their mates. It was amazing to see so many so close together. 


Erin spotting the Superb
Bird of Paradise
Superb close-up
Credit: San Diego Zoo
 If that wasn't enough, we later found a Superb Bird of Paradise flashing his characteristic neck feathers high in a tree. Although we weren’t close enough to see the stunning blue plumage characteristic of his mating dance, we were all enthralled by this small but showy bird. No one was happier than Erin, who has heard the call of the Superb many times in her 10 years in PNG, but never actually saw one until this trip. 

Bill mentoring Matt
Bill definitely ignited a new enthusiasm for birding in this group of younger missionaries. Hopefully we can carry on his legacy for many more years to come. 



Friday, June 29, 2018

Never Say Never



         For the past two weeks, we have been running a neurosurgery/spine unit on surgical ward. Often patients with brain or spine injuries have a poor prognosis in our resource-limited setting, but a few of our current patients are proving us wrong. It started when a young man, David, broke his neck in a tree-felling accident two weeks ago. When he first arrived to the hospital 10 hours after his accident, he was quadriplegic—unable to move all four extremities. We put him in cervical traction—Frankenstein-esque bolts in his head with weights hanging off the bed—to stretch out his spine. Praise God, it worked! Within the first 24 hours he gained back sensation to his arms and legs. In the past year, I have seen one other cervical traction patient who succumbed to pneumonia in the first 72 hours, so we were very vigilant when David started showing signs of respiratory compromise. Lying in bed all day with a paralyzed diaphragm, he was unable to cough or clear his lungs— something you and I take for granted. By God’s grace, he pulled through. The next day, we were overjoyed when he wiggled his toes. Again something we take for granted, but for him it was a sign that the spinal cord damage was not permanent and he has a good chance of regaining motor function. This week, he was able to lift his hands enough to hold his own breathing exercise bottle. It is absolutely amazing to see how God is restoring the lame before our eyes. 

       In the past week we have also treated a man with a depressed skull fracture from a chop to the head. Dr. Ben removed a large bone fragment from his brain and replaced the missing bone with a metal plate. Anton still has paralysis of the right arm and weakness of the right leg, but he is slowly regaining the ability to walk again. 





Henrisa using her right arm!
         A few days later, a 5 year-old girl was brought in with an abscess near her spine and hemiplegia (paralysis of one side of the body). For the first several days, I was discouraged when she showed little improvement after surgical drainage and medications; but recently, Henrisa has started moving her right arm and leg again! God is truly answering prayers. 
           In all these cases, I have seen God’s amazing provision—miraculously providing what we need when we need it. Two days before Anton came, Ben discovered that skull plate (our only one) in another orthopedic set and made a comment to the nurses, so they were ready when he needed it. While searching for a cervical collar in the Emergency Room the night David arrived, I noticed a pediatric collar in the cupboard, and would you believe it was the PERFECT size for our 5 year-old patient the next week. The only pediatric collar we have... perfect fit. I don’t think it’s a coincidence. 
Please join me in lifting these patients up in prayer as they continue on the long road to full recovery. I am confident that God will provide all that they need. 

Friday, June 8, 2018

Bikhet




Three weeks ago, Kira, my cat, broke her front leg. I don’t know how it happened. When I came home for lunch one day, she was hobbling around and crying. Although I considered letting it heal on its own, it was quite angulated at the fracture site. So, with the help of my friends at the hospital, she got a shiny new fiberglass cast.  I was satisfied that her leg was straight and protected from further injury or the pain of being jarred accidently. She was not thrilled to have this heavy, awkward boot attached to her leg and weighing her down. She stumped around like a pirate on a peg leg but the weight prevented her from jumping up on her favorite chair. Within 24 hours, she had slipped her injured paw out of its purple prison and was happily washing it in her favorite chair again. But the effort of extracting her paw had angulated the fracture again and every time she was accidently bumped, she would cry out in pain. 
Again, I considered letting her heal on her own, but it pained me to see her in this sad state, so I applied a smaller, lighter, tighter-fitting plaster cast. She had more mobility with the new cast, but she still didn’t like dragging along extra weight and was intent on removing the offending object. The next day, she disappeared for close to 24 hours, vowing not to return until she had removed the plaster cling-on. Afraid that she would be easy prey for the stray dogs that frequent our neighborhood, I searched desperately for her and finally gave up fearing the worst. But after a night out in the damp, her cast was soft enough for her to extract her paw and finally she returned home. Her leg was more crooked than ever, but finally I gave up and left her to heal on her own. Now, three weeks later, there is strong callus at the healing fracture site and she is running, jumping, and catching critters again with her crooked leg. Whenever I tell this story to my PNG friends, they laugh, first at my attempts to place a cast on my cat, but secondly at her “bikhet” (stubborn) ways. Then it struck me, how often have I stubbornly refused to be helped? I can think of several times in my own life when I was broken (emotionally or spiritually) and God tried to provide a support, but I blindly rejected it thinking it was a burden at the time. I preferred to suffer through on my own not realizing that someone who loved me and knew the situation far better than me was trying to ease my pain and help me heal. In my struggle against his loving arms, I likely caused myself more pain and distress than if I had just accepted the help. Who knows how many ugly subconscious scars I carry now because of my stubborn pride.  Lord, help me to trust you and accept your correction and guidance in the midst of my brokenness. Amen.


Tuesday, May 29, 2018

Little Is Much When God Is In It


Working on the MK school
       For the past week, a short-term team from West Texas has been helping out around station in innumerable ways. Their main project was assisting in the renovations of the MK elementary school, but God used all their special gifts and talents: including painting wooden puzzles for the pediatric ward, teaching Sunday school, and providing professional haircuts to the long-term missionaries.


Barbara shared her
amazing painting skills 
      On Sunday, I took 4 of our visitors to Kopsip Nazarene Church, just up the road from station. The congregation there was thrilled to learn that two of the visitors come from the same home church that sent Sidney and Wanda Knox, the very first Nazarene missionaries to PNG in 1955. The first Papua New Guinean Nazarene church that was started by the Knoxes continues to this day and is the mother church of more than 500 Nazarene churches spread across PNG. Sidney and Wanda Knox have become missionary legends here among the Nazarenes in PNG and our national brothers and sisters were more than excited to share this connection with our visitors.


Pastor Benny with Susan and Sam,
who prayed for him at General
Assembly
     Pastor Benny then shared the following story: In 2005, he was supposed to be a delegate to the Nazarene General Assembly in Indianapolis, but he only got as far as Port Moresby, the capital of PNG. He was not allowed to travel on to the US because his visa had expired the previous day. He was extremely discouraged until he received a message from the secretary of the General Assembly saying that his predicament had been shared at the assembly and thousands of his brothers and sisters from around the world were praying for him by name. He felt very overwhelmed and grateful that God had blessed him with the prayers of his global family. During the duration of the General Assembly, he remained in Port Moresby and a new church was birthed that week! The other two visitors who were with me had been at that General Assembly in 2005 and remembered praying for Pastor Benny. God has an amazing way of connecting his people around the globe.
     The sermon on Sunday was from John 6, the story of Jesus feeding the 5,000. It still amazes me how a story that I have heard so often will take on new meaning when I hear it in a different language amidst a different cultural context. The story came alive to me again as the preacher described what the disciples must have felt seeing the great need and not having anywhere near the resources to meet it. They started giving excuses and other suggestions instead of trusting in the one who had performed countless miracles before their own eyes. Then there was the boy. Was he on the way home from the market with food to feed his family, or were the loaves and fish a little snack his mom had packed for him? Either way it was a huge sacrifice for him to offer his food up to Jesus. Then consider Andrew: “how far will [5 loaves and 2 fish] go among so many?” The small amount of food was truly a drop in the ocean when there were 5,000 hungry men present. But Jesus “already had in mind what he was going to do” (John 6:6), and he turned that drop into an overabundance. The boy may have worried about losing his lunch, or the food he was taking home to his family, but he likely ended up eating his fill and taking home more than he had started with. Whatever little we have, when placed in God’s hands, can become much, much more and have an impact beyond our wildest imaginations. When that boy started out with his little meal that day, I doubt he thought he would feed 5,000 people. But Jesus changes everything. What do you have? What do I have? What talents and resources have God blessed us with that we can place back in his hands and see multiplied to benefit many more people?
I am reminded of the song, “Little Is Much When God Is In It.” The chorus goes:

Little is much when God is in it,
Labor not for wealth or fame;
There’s a crown, and you can win it,
If you go in Jesus’ name.


      On several of the short-term trips I’ve been on, I’ve been struck by the enormity of the need and I wonder what difference we made. How does painting a building or handing out a few pills really change people for eternity? But this Sunday, seeing how God orchestrated several special connections between people who live worlds apart reminded me that He has in his mind what he is going to do. Instead of doubting him or offering alternative solutions, we simply need to offer our 5 loaves and 2 fish and watch Him feed the multitudes.


Kopsip Church