Thus far I haven't really shared about my work in the hospital so I wanted to reassure you that I am actually working too :) Kudjip Nazarene General Hospital has 4 different wards-Pediatric, Medical (adult), Surgical and Obstetric. I have and will continue to rotate through working in all of the wards except Surgical. Pediatric and Medical Ward have around 32 beds and Obstetric Ward has more than 45. In 2018 there were 55,000 outpatient visits, 7000 admissions, 2643 deliveries (376 C-sections) and 908 major surgeries. I work with a staff of over 230 from all parts of PNG as well as a team of doctors from PNG and the US (sometimes Australia and New Zealand as well).
A normal day for me involves rounding on one of the wards starting at 9am. Once this is over I go to the Outpatient Department (OPD) or to the Emergency Room to see patients for the rest of the day. I take call overnight every 3-5 days. I did my first call shift by myself on Monday.
For my doctor friends (and other interested friends), this is a quick picture into my call shift last Friday. I don’t know whether or not this is representative of a busy call (or even if my experienced colleagues would call it busy), but I found it challenging but also fulfilling.
The day started with rounds on our Medical ward. Conditions that I have seen on our Medical Ward range from CVAs (strokes) and MIs (heart attacks) to TB meningitis and malaria to endometritis and incomplete abortions. I then went from there to the ER.
My first patient was a 13yo F with one day of confusion and fever. She was agitated and did not tolerate an examination. Fearing meningitis, I gave her some ketamine and did an LP that showed a high opening pressure and mildly turbid CSF. I started her on ceftriaxone (antibiotics) and dexamethasone (steroids) and admitted her to the Pediatric ward. My next patient was a 5yo M with a large abscess of his left calf and significant swelling all the way to the ankle, indicating pyomyositis, a common condition here where an abscess extends deep into the muscle and can spread along the underlying bone. He also had to be put to sleep so I could do an I&D (incision and drainage) and was admitted to the Pediatric Ward. Dr Mark then helped me to reduce a radial head fracture in a 20yo M that we then splinted until he could come back for casting in a few days.
Later that morning I took a pregnant mother who had been admitted with mild preeclampsia (a condition in pregnancy where there is elevated blood pressure and protein in the urine that can progress to severe disease marked by maternal seizures) who had breech twins for Cesarean delivery. I was assisted by Maxwell, a PNG native who is doing his rural health surgical rotation at our hospital.
After the surgery, I had a short pause that allowed me to run home for a quick lunch. As I was finishing lunch I was called back to the Obstetric Ward for a mother who had been complete for 2.5 hours but unable to deliver the baby and now the baby’s heart rate was low. I ran back up to the hospital and was able to assist the mother in delivering the baby by using a vacuum. Both the mother and baby did well.
I returned to the ER where I had a couple more patients to see, including a pregnant mother with malaria and a hemoglobin of 5.2. She also had had a positive VDRL and rapid HIV at a rural health outpost before she had been transferred to our hospital.
I had a brief reprieve after this before I was called back to see a mother who had spiked a fever and whose baby’s heart rate was in the 180s remote from delivery. After failed resuscitation attempts and starting antibiotics, I made the decision to proceed with Cesarean section. While the team was getting things ready, the ER asked me to evaluate a patient with a large bush knife wound to the head. I had to ask Dr Mark (one of the experienced doctors here) for help again, as the skull had fractured and was depressed where the knife had cut. Thankfully the patient had a normal mental status and we were able to close the wound and put the patient on antibiotics and anti-seizure medications. We then proceeded to the OR for the second C-section of the day. Mother and baby did well.
As I was getting ready for bed I was called back to the ER for a patient with a hemoglobin of 8 who was having significant vaginal bleeding. A quick look with the ultrasound diagnosed an incomplete abortion. The patient was symptomatic from her blood loss and we had to act quickly to transfuse her and do a D&C (dilation and curettage) to help stop the bleeding. Thankfully her bleeding stopped following the procedure, her vitals returned to normal with the transfusion and fluid resuscitation and she was admitted to the ward.
I was then able to sleep until early in the morning when I was again called to the Obstetric Ward for fetal distress during labor. The baby’s heart rate had dropped into the 50s when I had arrived (normal is 120-160). With help from a vacuum, the mother was able to deliver a healthy baby within 2 pushes.
After morning rounds, I was able to go home and get some more sleep.
There are a lot of new things for me here and I am learning a lot from the very experienced staff and doctors. Every day there is a new challenge. But I hope and believe that we are making a difference for the patients here. When I was out with Pastor Apa I talked to a lot of people, but one was a man along the side of the road near the Waghi river. He yelled out hello to me and then became a little sheepish as he was holding a beer bottle that he had been drinking. I tried to put him at ease, and we began to talk. He mentioned how having a hospital like Kudjip in the region brought pride as well as helped everyone who lived there by bringing access to a higher level of care than would otherwise be available. I’m proud of our team and what they are able to do and thankful that I get to be a part of the work here.
On a run with my mentor Dr Matt (and a few kids)