Disease vs Accident

 My mother frequently asks me whether I am seeing patients with injuries or illness/infections. Usually, I respond both. However, unless I pause to reflect, it’s easy to lose sight of the breadth of work that fills up a day. This blog recounts a day of work for those who want to know a little more of what my days look like (this day was a while ago but I wrote some notes on that day).

Every day at 8am I round somewhere in the hospital, usually on our Medical Ward (adult patients) or on our Pediatric Ward, but sometimes in the Nursery or on or OB Ward too. On this day I am rounding in our Medical Ward. My first patient is a young teenager suffering from tetanus. His friends had done a circumcision for him without proper sterilization or tools (termed a “bush circumcision”). We were trying to control his spasms with antibiotics, magnesium and diazepam, and he was slowly improving.

View out the window of a small church I recently visited

Our wards are large rooms with beds lined up next to each other on both sides of the room. Rounding involves moving down the room from one bed to the next. My next patient is a young man with significant burns on his back due to an explosion. Another patient has pancreatitis, likely due to a gall stones. A small frail lady with weights hanging from her leg is one of the patients who has been here the longest, due to a femur fracture that requires traction for 4-6 weeks. I next see a young lady with a new diagnosis of HIV who came in very sick and weak due to secondary infections. Next to her is another young lady with leptospirosis, a disease that comes from contaminated water and can significantly affect the kidneys and liver.

Moving to the other side of the ward where our oxygen cylinders normally stay, I have several patients with pneumonia, COPD and/or heart failure. Unfortunately, we see a lot of older adults with chronic lung disease that eventually leads to heart failure. The lung disease is sometimes from smoking, but more frequently it is from the cooking fires that burn every day in their haus kunai (the traditional cooking houses made out of bamboo with thatched roofs from a durable grass-kunai).

 

On this particular day, I am also rounding in the nursery. Our nursery is a small, hot room off the OB Ward. There are 4 warmers on one side and several other cribs on the other side. The warmers can, and frequently do, hold two babies. The room is usually full of mothers feeding or looking after their infants. Our resources are limited for caring for early preterm infants, but we do our best. Our nurses are some of the best at finding IVs, even in the smallest patients.

A video of a Ribbon-Tail Astrapia (Bird of Paradise)

After rounds in the nursery, I head to the ER. I am on call, so I will be covering the ER for the rest of the day. My first patient is a young man involved in a car accident with severe back pain. Xray shows that he has a stable transverse process fracture of his spine. Luckily, it is stable, without fractures to the other parts of the bone, and he will likely be ok with a back brace and pain control. My next patient is a young female from a long way away who has had pain in her chest and SOB for 6 months. Ultrasound shows me that she has a large pleural effusion (fluid in her chest puching on her lungs). By using a large needle, I drain a lot of her fluid and give her the diagnosis of pleural tuberculosis. Now with the right treatment, she will hopefully improve.

The rest of the day is busy. I see two wrist fractures that need to be straightened, a young lady with severe heart failure secondary to rheumatic heart disease, a pregnant patient with a high fever, a couple of COVID cases, someone with chest pain, a young baby with meningitis and a patient with typhoid. I also have a young man with severe back pain and weakness of the lower extremities. His blood work is consistent with an infection, and he has a fever. My most likely diagnosis is a paraspinal abscess, a very serious condition that can lead to paralysis of the lower extremities of the body. In this case we were able to start antibiotics early enough to save him much of his motor function. I also have two children that came in very sick. While it was initially not clear, we started a workup for infection, including doing spinal taps for possible meningitis. Eventually it came out that they had eaten some beans the night before. Here in PNG there is a type of bean, that if eaten in large amounts and not cooked properly can lead to cyanide poisoning. We do not have the most commonly used antidote in the US, however, we do have two medicines that work well in preventing toxicity from cyanide poisoning. Both children quickly improved with the treatment and were able to be discharged the next day. Finally, I had a young female with a confusing constellation of symptoms-fever, joint pain, and rash, who was also found to have kidney disease and a blood clot in her leg on further examination. We are unable to do the blood tests here that would make clear her diagnosis, however I highly suspect a type of vasculitis, perhaps Lupus. We are trying to obtain labs for her while continuing her on steroid treatment.

Call shifts vary a lot here. Some nights I am at the hospital most of the night between the labor ward and the ER. Some nights I get to sleep most of the night. This night is fortunately calm, with only a couple of ER patients. Early the next morning, though, I get called for a woman who has been in labor for a while and pushing for more than 2 hours. She is getting tired and the midwife is starting to worry about the baby. One good pull with a vacuum and the baby comes out, much to everyone’s relief. The mother is exhausted but incredibly grateful. I tell her she did the hard work, I just provided a little extra help. She asks me my name. Confused, I tell her. She tells me that she will name the baby Daniel as well. My heart is touched by her gratitude. It is moments like these that make all the hard work worth it. I’m so grateful to be here, serving and working in PNG. Thank you for your support in making this possible.

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A couple of personal updates. I am currently on my way to Australia for a short vacation. I am very grateful for this as it has been a busy summer, and we have been short staffed. A couple of months ago, I got a puppy named Stella. I am taking care of her with my neighbors the Myatts. She is very sweet, and I have loved having her here with me. Finally, PNG recently completed its election season. There was a lot of tension and some violence, however, I am very thankful to God that things have not been worse. Thank you for your prayers for the people here and for my work here.