Obstructive Jaundice

      An elderly man walks into the clinic with painless jaundice. What would you do? After the usual history and physical, I would typically get a full panel of blood work and CT scan. Depending on the results, he may need an MRI, ERCP (Endoscopic retrograde cholangiography), or EUS (Endoscopic ultrasound) with biopsy. The only problem…. we don’t have any of those fancy tests in the middle of the Highlands of Papua New Guinea. We can check a bilirubin and an ultrasound. In the hands of an inexperienced ultrasonographer (like me), we could only narrow the diagnosis to obstructive jaundice (something blocking the bile ducts). The most likely source is pancreatic cancer, but without any of the tests we’re used to having available, how do we confirm the diagnosis and determine if he is a candidate for surgical resection? Good old-fashioned abdominal exploration. 

      After extensive counseling regarding what we may find and what procedures we may do, Dr. Ben and I took the patient to the operating theater. Upon exploration, we were happy to note no evidence of metastatic disease. Then we were amazed to find a normal pancreas. We finally identified the source of his jaundice – a fibrotic, cystic abnormality where the cystic duct joined the common bile duct. It was unclear if this was a choledochal cyst or a type of Mirizzi Syndrome. Either way, we resected the gallbladder and the obstructing lesion and performed a common bile duct exploration (a procedure I only did a handful of times in residency, but for which I was well trained by Dr. Jain and Dr. Kittur). It will be more than a month before we have pathology back, but in the meantime, our patient is recovering well. 

       Yesterday during hospital evangelism time, I met his family and spent some time praying with them. When I asked how I could pray for him, his response was, “I have no complaints, I only want to thank and praise God.” 

Paul has been a pastor in a nearby town for over 30 years. He was previously told that his problem was inoperable and that he would die of his disease. Now he is praising God that the surgery was a success. I praise God too for this wonderful man and his strong faith. I thank God for the mentors he gave me in residency who prepared me for surgeries such as this. Additionally, I thank God for this hospital and the opportunity to serve the people of the Highlands who otherwise would not receive care. Finally, I thank God for the mentors he has given me here, Dr. Jim and Dr. Ben, who are teaching me how to treat both the physical and spiritual needs of our patients in a resource limited setting.

Dr. Ben and I performing laparoscopic surgery (on a different patient)

Dr. Jim sharing with patients during hospital evangelism time. 

(Note: Patient name and picture were shared with patient's permission)

Diwai Kros

Christ is Risen! He is risen indeed! This morning, we celebrated Easter with a sunrise service overlooking the beautiful Jordan Valley and River Kane. Various missionaries read accounts from the perspectives of different disciples and women who were present at the crucifixion and resurrection. Later, we worshipped with our PNG brothers and sisters at Immanuel, the Tok Pisin church near station, where we partook of communion. As I reflected on Christ’s sacrifice for me, I realized that during the past 7 weeks while I’ve been transitioning to life in PNG, I have been trying to do many things in my own strength. Many times I have realized that I am not strong enough, I am not smart enough, I am not talented enough. But praise God, because he did not wait for us to be good enough. He sent Jesus to accomplish what we in our weakness could never do. Through the shedding of Jesus’ blood we are reconciled to God. By his resurrection and triumph over death, we are given new life. Praise God! Despite our limitations, He chooses to work through us each and every day. “But we have this treasure in jars of clay to show that this all-surpassing power is from God and not from us.” (2 Corinthians 4:7).

This beautiful Tok Pisin song has been running through my head this week:

(sung to the tune “Jesus Keep Me Near the Cross”)

1.     Mi tingting long Kalvari,  (I think of Calvary)

Blut b’long Krais wasim mi,  (The blood of Christ washes me)

Rausim sin na klinim mi.  (It removes sin and cleanses me)

Tenkyu tru long Kalv’ri (Thank you very much for Calvary)

(Chorus)

Diwai kros, Diwai kros (The cross, the cross)

Diwai kros b’long Kalvri (the cross of Calvary)

Diwai kros i soim mi (the cross shows me)

Rot I painim heven  (the road that finds heaven)

2.     Mi rabisman bilong sin, (I was a worthless sinner)

Mi kam long diwai kros. (I came to the cross)

Sori bilong God i bin (The compassion of God has)

Mekim bel b’long me klin (Made my heart clean)

3.      Mi tingting long Jisas Krais, (I think of Jesus Christ)

Mi bilip na mi stap (I believe and I am)

Wetim Jisas bai i kam,  (Waiting for Jesus who will come)

Bringim mi long antap. (to bring me above)

The English translation does not do justice to the beautiful heartfelt chords with which is sung by the people here. My heart sings out with theirs: because of the cross, Christ has made me clean and shown me the way of life.

May you celebrate the hope and joy of Easter today and all through the year.  

Surgery in Papua New Guinea

         The specimen was out and we were just starting to close the wound when the whole room went completely dark. Unfazed, we patiently waited for the five clicks and gentle hum that indicate the back-up generator is turning on. The clicks came, but the lights did not. The nursing students fumbled around in the dark for a headlamp (which I foolishly had not put on at the beginning of the case), but the batteries were dead. We finished the case by the light of the Anesthesia Officer’s cell phone. Eventually, the generator came on and I made sure to wear my headlight (with fresh battery) for the next case. Predictably, the power went out again in the middle of the case. This time we were prepared. We had moved a portable battery-operated light into the room, but the light would drift if not held, so a student balanced the light on her head as we proceeded with the case. Just another day in PNG!

          Operating without electricity has made me very grateful for the visiting I-TEC (International Technical Electric & Construction) team. Two dozen electricians, linemen, generator technicians, and support staff are currently upgrading our electrical system across the mission station. We are blessed to have fairly consistent power generated by a hydroelectric dam, but recent growth and expansion of the station infrastructure have made upgrades necessary. Even with the frequent power outages as they work on the lines, the generator has kept the power to the hospital on, until the generator overheated that day during surgery.

          Unpredictable – that is the word I would use to describe working in PNG.  Power outages are only the most recent in a steady stream of difficulties in the operating theatre. A few weeks ago, our main autoclave broke down (photo credit: Dr. Ben). Without the ability to sterilize equipment, instruments, gowns, and drapes we were forced to cancel elective surgeries and go to emergency cases only. Thankfully, parts were found for the older, smaller autoclave from the old hospital, so we are managing until new parts arrive. 

         Shortly after the autoclave issue, we discovered our supplies of atropine were critically low. Atropine is an essential drug to control secretions and heart rate in patients undergoing general anesthesia. There seems to be a widespread shortage as several of the hospitals in the Highlands are also on short supply. Again, we went to emergencies only or cases that did not require general anesthesia. Almost as soon as the announcement was made, two emergency c-sections came in: one a footling breach, the other a repeat c-section. Praise God that both cases were successful. Both mothers and babies are doing well.  What a relief when some of the I-Tec volunteers brought us a fresh supply of atropine from the States this week.  

          With all the unpredictability, sometimes it’s tempting to become discouraged, frustrated or cynical, but in all these circumstances I see God’s hand of provision as he provides just the right spare parts, the right medications, and the right volunteers at the right time. One of my friends who works with the chaplains recently told me about a patient who received Christ on the wards this week and of several other patients who are interested in receiving Bibles. I am privileged to work in a place where God's name is proclaimed and patients can come to know the ultimate healer. It is encouraging to know that God’s work is going forward, whether we have electricity or not.

Bonus Photo: Case of the week: 30+ cm ovarian mass

50th Anniversary Celebration

         Imagine taking a blank sheet of paper, telling God that you will do whatever he asks, then signing your name at the bottom, leaving the rest for him to fill in. Imagine God telling you to go to the highlands of Papua New Guinea to work in a hospital in 1964, when a hospital did not exist there. What would you do? Question God’s plan? Doubt that you truly heard God speak? This was the experience of Neville Bartle, one of the early missionaries at Kudjip Nazarene Hospital. A month after receiving this rather puzzling call from the Lord, he received a missions magazine. The cover story: Nazarene General Assembly collects funds to build a hospital in the highlands of Papua New Guinea. Three years later, after finishing his training as a laboratory scientist, Neville arrived at the newly built hospital. God’s plans are so much more than we could think or imagine!

Story after story like this was shared during the 50^th Anniversary celebration for Kudjip Nazarene Hospital.  During the week-long celebration, we heard testimonies from pioneer missionaries, the first PNG nurses, locals who helped build and staff the hospital, and long term medical missionaries who have served here for upwards of 30 years.  

It was heartwarming to see Joyce Bartle, one of the founders of the Kudjip Nursing College, reconnect with the seven ladies who comprised the first class of nursing graduates, many of whom worked at the hospital for their entire careers. 

We heard the story of Jan Watson, an Australian nurse, who felt called to seek training as a nurse anesthetist in the US at a time when there was no surgeon at Kudjip. A few years later, in 1985, Dr. Jim Radcliffe, Kudjip’s first surgeon, arrived and found that God had already provided an anesthesia provider and a PNG scrub nurse, Auntie Margaret. Jim and Margaret have been working together for the past 32 years.

Story after story of God’s faithfulness and provision. Story after story of not only the physical, but the spiritual impact that the hospital has made on this area. In the past 50 years, the hospital has grown and expanded, added a nursing college and bible college, started many rural health centers and planted hundreds of churches in the highlands of Papua New Guinea. It was amazing to look back and see the bigger story that God has called me to be a part of. I’m excited to see what God has in store for the next 50 years!