Welcome to Papua New Guinea (PNG)

My first several days of my trip has felt like a collage of events/moments juxtaposed together, both beautiful and sad.

With feelings of nervousness and excitement my plane took off from Denver to start me on my journey to PNG. The feelings were soon replaced with awe, getting to see this incredible state I live in from a different perspective, the Rocky Mountains stretching to the horizon covered in early snow, and slowly giving way to the desert. I woke up to see the Grand Canyon pass beneath the plane, incredible even from 10,000 feet.  18 hours later found me staring out as lightning lit up the clouds and Pacific Ocean below. Another incredible display of the size of God’s creation and reminder of how small I actually am.

As my plane started it’s descent into Mt. Hagen, the mountains rose up on either side, so close that I could count the trees, until, seemingly at the final moment, the ground dropped away into the valley where Mt. Hagen lies. I met Don, one of the career missionaries here at the airport. Flying down the road towards the hospital, we fly past one stunning view after another of green foliage, looming mountains and numerous inhabitants at markets, walking along the road or swimming in the rivers. The sun set behind the mountains was dazzling and I couldn’t help feel how lucky I am to be here.

A couple hours later that evening, as we were walking through the E.D. for my tour of the hospital, we stopped to see a patient who was victim to a “chop-chop” injury, the PNG term for the unfortunately frequent machete-induced lacerations. The man had received two deep cuts, one on his right shoulder through his deltoid and down to his humerus and the other along the left side of his neck, through the lower part of his ear and down to his mastoid process. We clamped off a bleeder (small artery) in the neck and stabilized the bleeding till the surgeon could take him back for more definitive management in the O.T. (operating theater). As we were evaluating him, my preceptor leaned over and said, “Welcome to Papua New Guinea.”

The next day was my first true day in the hospital. Mornings start with rounds in the Wards, which for me this week is the Pediatric Ward. My first patient is a 6yo boy who was admitted for several days of fever, fatigue and abdominal pain. He was positive for Plasmodium falciparum and vivax and had a hemoglobin of 4 due to hemolysis from the malaria. My next two patients are kids with diarrheal illness admitted for rehydration, a common disease here in PNG. The next child is a 2 month old that had been admitted for a groin abscess. Infections of the soft tissue, tropical pyomyositis, are very common here in PNG and often present far advanced. Fortunately for this child, he had improved with an I+D and broad spectrum antibiotics.

 
The next two cases are particularly heart breaking. Across from the 2 month old was a 14yo girl with advance heart failure secondary to a cardiomyopathy of unknown origin, likely rheumatic fever vs a congenital abnormality. She was admitted for worsening shortness of breath and abdominal pain secondary to fluid accumulation. Without access to advanced pediatric care, her prognosis is poor. Even at a well run hospital like Kudjip there are critical drug access shortages, far more significant than our perpetual shortage of IV Zofran and LR in the States. The government helps supplies medications, but even so important drugs are frequently missing off the shelves. While we have IV Lasix for her now, we currently don’t have any PO Lasix to send her home with, a necessary treatment to prevent her from needing to come straight back to the hospital. Next to her is a 5yo M who suffered a severe TBI from a tree falling on top of him and who is currently in a coma with little hope of recovery. What is most difficult in these two situations is seeing the concern of the parents who are sacrificing so much to try to take care of their children in relatively hopeless circumstances. Even in the U.S. these would be difficult things to work through and treat, but here it is impossible. The boy’s family had to travel two days to get him to the hospital after his accident and likely that time factored into his current state. As in America, geography very much dictates health in PNG. The farther you are from the hospital, the more likely you are to experience the negative outcomes of infection, obstructed labor, trauma, and innumerable other health conditions.

After Wards we go to Outpatient clinic and start working through the the line of patients. We see babies, pregnant mother, chronic disease, acute illnesses and everything in between. All of the patient's in PNG carry around their health records from hospital to clinic to health outpost. This allows you to see what care they have received at other locations, something that would otherwise be impossible. In clinic it is common to see broken bones, large abscesses, complicated pregnancies, fever of unknown origin, dehydration, septic joints and more all within the space of a couple hours. The team of doctors and nurses are incredible and work together to keep everything moving.

I have felt very welcomed and brought right into the thick of things. This is already too long, thank you for reading this far if you made it :) I'm on call for the first time this weekend and will try to blog again after that experience. Keep me in your prayers as a lot of this is very new!