Big Day

This morning Judy and I both worked on things related to the move to the new hospital. I helped haul medicines from the old pharmacy to the new ones. Several others also worked on this, including Erin, Becky, Israel and Stalin. Stalin is a body builder who will compete next month in the South Pacific Games. I posted about him in September. This photo shows you how he looks in his security guard uniform.

There are more move-in photos from today here.

In the evening we attended the annual Harvest Party. Most of us don't harvest much, but we have a party anyway.

There's an album of photos of the party here.

Costumes!

This morning a number of strange people and creatures came to visit the wards. Robin Hood was there, as well as a spy, a kitty, a cowboy and no less than four (count them; four) penguins. There was also one young man quite successfully dressed as a teen-age boy. Very convincing.

I'm pretty sure that no one in any ward understood what was happening, but they all enjoyed it!

More Photos

Some of the photos I took yesterday are posted here.

Mattresses!

Judy picked up the new custom mattress for one of the delivery beds today. She got home from town late, and I got home from the hospital after her, but we really wanted to see the mattress on the delivery bed, so we went up to the storeroom and took the two-pieces to the delivery room and put them on the bed. It turns out that the upholstery place has the heavy vinyl material in any color you like, as long as you like red.

This mattress cost 280 Kina. That's about US$110. Judy has ordered mattresses for the other 2 delivery beds.

Yet More Move-In Excitement

Today I helped Judy with some work in the new OPD. I installed towel hooks by the sinks, and mounted some blood pressure cuffs. Work continues in pharmacy, and Mike has promised the pharmacy staff that they can start moving in on Friday.

The photo is of the new OR table. See more photos by going here. The captions give more details.

New Matresses

Several have asked about the cost of new mattresses. Judy will go to town to pick up the first set tomorrow, and I'll post the total cost, and instructions as to how to give toward this need. The estimate was about K200, or about US$70.

More New Hospital Move-In Stuff

I spent several hours last evening in frustration over malfunctions of Facebook, trying to upload some photos of the move prep activities. I finally got them up, and the power went off, and with it our internet access! My next job planned was to write a little something for the blog, but I couldn't.

There is a lot of activity related to the new pharmacy. Most of the shelving from the old pharmacy is being reused in the new one. That presents interesting logistical problems, because the old pharmacy has to keep functioning. The most-used meds are still on shelves in the dispensary, but lots of the less-used stuff is in boxes piled on the floor of Pharm 2 (the large storage and sorting room) while the shelves are being dismantled and then rebuilt in the new place. They are repainting them as they go, so they will really be like new.

Today (Wednesday) is my "half-day." That is a day when we are able to work at home (or at lease out of the hospital) on whatever administrative or catch-up tasks we have. Given the number of docs we currently have compared to the number of available exam rooms in OPD, we have usually been leaving the hospital after morning rounds. These past few weeks, most of us have been using that time for work on preparation for the move. Several have spent time in Pharm 2, sorting medicines, discarding the ones that we really won't use, etc. We don't want to have to move a bunch of stuff that will be thrown out eventually anyway!

Erin has been doing some carpentry work, among other things. Yesterday she helped with moving shelving. She looked right at home with a skill saw or a screw gun!

Today I will be using this time to serve as Judy's go-fer. I know that there is an exam table to be fixed, but I don't know what else. I'll have a camera with me, so I should have plenty to share by this evening. I don't know where I'll post the photos, since Facebook is functioning so poorly at the moment, but I'll put them somewhere so you can all see them.

Please keep praying for us as we move closer to the move next week. If I haven't made it clear, here's the schedule. Starting Wednesday, 4 November, we will close the old Outpatient department. We have been avoiding telling anyone to come back for follow-up for the affected days. Wednesday will be spent (after rounding on our wards) on work related to the move. Then on Thursday, 5 November, we will round on our wards, evaluating each patient for moving. Any who are critical, we will plan, along with the nursing staff, the best way to get them moved, and then during the day help with moving them to the new wards. By then the wards should be set up with all the supplies and medicines needed to care for them there. Then Friday will be available for working out problems that we discover with the actual move, and finishing details for the new OPD. Then on Monday, 9 November, we will open the new OPD. We know that we will discover problems and challenges as we go along, so please be praying about that.

*****
I did get those photos uploaded last evening. You can see them here.

Move-In Prep

Today the new operating table was assembled. It is a completely refurbished table that looks and operates like new! Medicine carts were prepared for the new wards. Curtains were hung. Shelves were being installed in the new pharmacy. Sewer was unplugged. Tables made for pharmacy. Exam tables and exam lights counted. Many things labeled and organized. Count made of rubbish tins. Yes, we need more. Much excitement as we anticipate the big move!

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The photo is of a delivery bed with a somewhat worn, but still servicable lower mattress. The upper mattress has long ago worn out, and has been replaced by a mattress from some other kind of table, mayby an old delivery table. Some of the delivery bed mattresses are worse than this. Judy has recently discovered that she can have new ones custom-made in Mount Hagen for a reasonable price. Anyone want to buy us a mattress or two? Just let us know.

Baby Priscilla Follow-Up

Do you remember Baby Priscilla? No? Well, that's because I only thought I wrote a blog post about her. Now that I look back, I don't see it. I intended to. I often have a story or two in reserve for that day that I find myself blogless.

Priscilla was admitted at age 1 day with respiratory distress and poor breastfeeding. We had to treat her as as having neonatal sepsis, with 10 full days of intravenous antibiotics. Baby chest x-rays are often hard to interpret. For wone thing, the little twerps just won't cooperate with proper positioning, taking and holding a deep breath just when the picture is exposed. So sometimes the heart can look a little large, even in a normal kid. Priscilla heart looked just a bit on the large side. There was just a little bit of increased lung density in a place or two. Pneumonia? Congestive heart failure? Your guess is almost as good as mine.

The problem was that her oxygen saturation (that's come up a few times lately) didn't improve with antibiotic treatment. After a few days of hand feeding with a dropper, she started breastfeeding. I kept listening for a murmur that would suggest that she had a structural heard defect, but the noisy peds ward isn't exactly the best place to hear a soft one.

After repeating the chest x-ray a couple of times I convinced myself that the heart was in reality a bit bigger than it should be. Finally I knew that I'd have to bite the proverbial bullet and treat her with medicines for heart failure. The tiny doses required by such a small baby present a challenge. I had them use the injectible form of one of these meds, and dilute it in a bottle of infant vitamins, and calculated a volume that was large enough to be easy to measure, small enough for a little baby to take easily.

After a few days, I had started to think that this was a mistake, and wasn't doing anything. Each morning I'd check her saturation. It would be great with supplemental oxygen, but fall rapidly if we turned the oxygen off. Then after about a week, and a little adjustment of her meds I started noticing that the saturation wasn't falling as fast, or as low. One morning about 2 weeks after starting the heart meds, it stayed in the 90s. My student nurse went back and checked later in the day and reported that it was still good.

I watched her for another couple of days. Just before discharge, in an unusually quiet moment on the ward, I heard the murmur, tending to confirm my suspicions of a structural heart defect causing heart failure. I discharged her, initially with a follow-up in about 3 days, and then after another 10 days. That was this past week.

The first thing that I noticed was her impressive growth! She was huge! And obviously well-nourished. Her saturation was 94%, and her chest x-ray actually looked a little better than the last one in the hospital. The heart size was actually slightly smaller, despite the impressive growth of the rest of her. The murmur was still very soft, but I could hear it clearly in the relative quiet of an OPD exam room.

I went over the facts of the case again with her parents. We don't know what the exact cause of her heart failure is. We may be able to find out next May, when they will do screening for the Australian heart surgery team that come annually to PNG. The problem could be something that will become less significant as she grows, and she could end up being essentially a normal kid. Or it could turn out to be a life-altering, life-shortening serious problem. For now, as long as the meds are working, we'll stick with them. They promised to come back faithfully. I prescribed a month's supply of meds, and sent them on their way.

Sometimes, even with limited resources, limited diagnostic abilities, limited skill, we get to see good outcomes. Thanks, Lord.


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The first photo is of Priscilla and her mom and dad the day they left the hospital. On the parents' faces it's easy to see the anxiety of leaving the hospital for the first time since their daughter's first day of life, hoping that the home-made concoction of medicines made up by some wild-eye'd American doctor would keep her alive.

The second photo is from this past week. They look a little more confident, don't they?

Kudjip Sky

What a beautiful sky at sunset this evening. Judy and I were out for a walk, and I had the camera!

Go here to see more photos.

You Can't Be Too Safe

I don't know why the security guard at the frond door of the wards was wearing a mask. Maybe to prevent swine flu. However, the big mystery was why he had one with an eye shield.

Oh, well. There is a lot that I don't understand, so this won't bother me too much.

Link Fixed

I'm sorry. In the story about the doctors' meeting in the new OPD, the "link" to the photos is not really a link. Here is a link that really is one!

Another New Hospital Blog

To see another story about the move into the new hospital, see Dr. Erin Meier's blog.

New Outpatient Department

We're just 2 weeks away from the actual move into the new hospital. Earlier this week we had a doctors' meeting in the new Outpatient Department. We talked about the layout of the various rooms, and about how the patients will move through the department. Many things will certainly be different than in the old hospital--architecture affects function, and the architecture is quite different.

We will have a facility that we don't have in the old place--a procedure room within the Outpatient Department. We don't have previous experience to refer to in this, so we are all trying to imagine how it will work, what supplies we will need, and what we will do there.

Another difference is that the new OPD is quite separate from the new ER, not adjacent as it is now. This will mean that most of the time one of the doctors will be working full-time in the ER.

Judy came along for the meeting because she is involved in moving supplies into the new rooms, arranging cupboards and drawers, and so on.

To see some more photos, see:
http://www.facebook.com/album.php?aid=120281&id=624758681&l=fede8f8964

Jo and Lydia Radcliffe's Treehouse

Cool, huh?

Getting Close

There are just details left to finish in the new hospital, and we're nearing the move-in date, November 5. We will be closing the Outpatient Department November 4-6 so that we can all help with last-minute preparations. We'll actually move the new patients on the 5th, and keep working on things on the 6th, especially the new Outpatient Department.

Here are some photos of the folks who have been helping Judy with stocking various areas in the new hospital with supplies. As most of you know, Judy manages the medical storeroom, where she sorts and distributes or stores donated supplies. She's been saving up the things that will be needed in the new hospital. For many things, since the old areas will remain in use right up until we actually move patients, we can't take supplies away from there. So she'd been saving up, and stocking the new areas so that they will be ready by the day of the move.

Judy has recruited people from different departments to come and help select supplies which will go into their new areas. A lot of staff members have been working to determine which cupboards, drawers or shelves will contain what items, getting them labled, and then moving the actual supplies there.

First Date

Thirty-five years ago this evening I had my first date with Judy Hunt. It wasn't my last. We went to a couple of events on campus, then out to eat at JB's, the only eatery in Nampa that was open late in those days.

In commemoration of that date, this evening we stayed home, sat in our matching recliners and watched TV. I made pancakes. Then later I sang romantic old Gordon Lightfoot songs to her (my favorite is "Beautiful"). Of course, she was already asleep, and didn't hear them. Our excitement quotient has slipped just a little bit since 1974!

The biggest difference between then and now, is that I love her a whole lot more now than I did then. I had no clue how love grows over the years of shared life. She's great!

***
The photo is Judy with AnnMarie Kia, the wife of Pastor Robert Kia, of the Emmanuel church here at Kudjip. It was taken at a recent fund-raising mumu, helping the Kias raise money to go to Brisbane to attend Nazarene Theological College. They'll be leaving in about 3 weeks.

Elsie's Walking!

It seems like I often remark that we don't know an exact diagnosis, or the exact cause of a problem. This is another case like that.

Elsie is 5. She and her mother got sick about the same time. The family did not bring them to the hospital. They were coughing, short of breath and confused. Elsie's mom died. It was still about 2 weeks before anyone brought Elsie in.

In the hospital she had fever, a cough, and was confused. Her malaria tests were negative. So was an HIV test. It was clear that there was something going in her central nervous system. We were treating what we could treat. We just had to wait, but I was quite sure that she would die.

During the times of confusion she would scream. Loud, piercing, persisting screams. I would sedate her cautiously.

Then slowly she started turning around. As she became more alert and her movements became more purposeful it became obvious that she was not moving her left arm and leg normally.

She also became more difficult to deal with. Her confused screams turned into temper tantrums. The aunt who was taking care of her was unable to deal with the tantrums in any way except hitting. I tried, and several nurses tried to help her find other ways of responding. Finally she "lost it" and gave little Elsie a beating that left bruises, then left the hospital, abandoning Elsie. Within a few hours Elsie's father showed up, and has been with her ever since.

All of Elsie's symptoms resolved, except the weak left arm and limbs. She looked exactly as if she'd had a stroke. In fact that may be exactly what she'd had. The challenge now became rehabilitation. Her left food tended to fold under when she tried to stand on it. After experimenting with several possibilities, we found a brace that would keep it straight when she stood. I thought she could use a walker. We didn't really find a child-sized walker, but as I looked through the stock, I found one that was a bit smaller than average. With the adjustable legs set to the lowest level she could hold on well with her right hand. She didn't have enough grip strength in her left hand to hold on.

She continued to throw tantrums from time to time, but her dad was able to control her most of the time. At the same time, a very cute, gregarious side of her personality emerged.

As I was trying to design some support for her left arm, she just started walking on her own! She drug the left food, but she would balance on it long enough to take the next step. But once she started walking, she started becoming very intrusive to the other patients on the ward, going from bed to bed greeting everyone! There wasn't much that we could do for her that had to be done on the ward, but she needed to complete a course of TB meds that included a daily injection. I decided to send her to the TB ward until that was done.

We'll see how well she does in long-term follow-up. I'll try to remember to report to you how she's doing.

Lupi Had a Stroke

Stroke is often not well-understood by the lay public in PNG. Sometimes we, as doctors, don't do very well at explaining it.

This gentleman is named Lupi. His stroke occurred about 2 months ago. His family brought him to Kudjip expecting that he'd be admitted, so that we could correct the problem. I sadly explained that there was nothing that we could do in the wards that we couldn't do as an outpatient.

In examining him, I realized that the use of his arm and leg were limited, not so much by weakness, as by trouble controlling and coordinating them. I asked his son to help me, and with just a bit of steadying assistance, Lupi made it to his feet. Once up, he could stand with just a little help with balance. He even tried to take a step or two. I thought that maybe he could manage a walker. After some delays I managed to get one (we have plenty, don't go sending more for a while) from the storeroom. He took to it like the proverbial duck to H2O.

Alas, they didn't have the 25 Kina to buy it (that's about US$8). I don't know how they had expected to pay his admission fees (he's from out of our area, so has to pay more) and to provide food for him and a watchman (a relative who stays with the patient) if they didn't bring that much and quite a bit more, but there it was. I couldn't stand to let him go home without the walker. They live far away from here, and won't be back very often. So I managed to juggle the fees that they had already paid, and got 18 Kina refunded. That was enough to allow them to get the walker.

In addition to the impairment of his arm and leg, the right side of his face is paralyzed. His mouth and eyelid droop. That's a real problem for an eye, because he can't close it to keep out dust, or to protect the eye from drying at night.

In the course of our conversation, Lupi made it a point to tell me that he is a Christian, and has been since he was a young boy. He also told me that his children are very worried about him, but that he's not worried! He knows that he doesn't have a long time to deal with the infirmities of life on this earth. We had a blessed time of prayer together before they left. I sent them with a supply of eye drops, and of low-dose aspirin, to try to prevent further strokes.

In the photo are Lupi's daughter and her son, and his son. Also in the photo is our nursing student Mirriam, who is from their part of the country.

Correction and Update

I had her name wrong. The little girl I wrote about yesterday. It's "Beanca." I think. Her oxygen saturation this morning, without supplemental oxygen was 93%. That's as good as mine. As this was my day for working outside the hospital, I had a nursing student take charge of my oxymeter, and promise to go back every couple of hours through the day. I saw the student this evening, and she said that the saturation has stayed in the mid-90s.

By the way, I checked her chart this morning. The saturation was 57% at admission, not 67% as I said yesterday.

Well, tomorrow, assuming that nothing changes, I'll be forced to discharge her. I'll have her come back often for rechecks.

Just Cute

You know by now that I need no other reason than pure cuteness to post a picture of a baby. This one has won my heart. Her name is Ceana, and she's in the hospital because she has severe congestive heart failure. As is usual, we can't pin down the cause, but we have hope of getting a diagnosis in the future.

In the meantime we're treating her as best we can. She was admitted with an oxygen saturation of 67% (that's very, very low, for those of you who don't know about such things). This morning her saturation was 89% without her oxygen. That's just a little bit low, if you're keeping score. If we can't get it any better, she could live with that for quite a while, but I think she'll improve more.

In a few days I'll have to discharge her. That's a good thing, except that I won't get to see her every morning!

Not So Much

Found out that we can have full access to the internet in the evenings. So new blog to follow.

No Blog Posts Until Thursday

We've been asked to restrict all internet access except email until after Wednesday, do to important large downloads needed by the field office. Lots of exciting, interesting news after that.

What Happened While I Was Out of the House Saturday Morning

All of the missionary women, young and old (sorry that Cindy Schmelzenbach was ill and couldn't be involved) came to my house Saturday morning. There had been about 24 hours of steady house-cleaning and decorating, and a building air of excitement. Judy made it pretty clear to me that I was no longer welcome, so I left and did some man stuff (more on that later). While I was gone the women filled our house, and Judy took a bunch of photos. Besides the one here, there are a bunch on an album at this link. You do not have to be a member of Facebook to see them.

Pray For the Philippines--Again

The Philippines are still getting hit by natural disasters.

In the summer of 1974 I was in the Student Mission Corps, a summer program of the Church of the Nazarene which sends college students to work in mission areas. The program still exists, but is now called Youth In Mission. That summer, I and 3 other North American college students were assigned to the Philippines, where we were teamed with The Woodland Trio, 3 young Filipino musicians. We did music for evangelistic crusades. Since the other 3 SMC members were girls, I was often billeted with Tommy, Alfredo and Carlito. It was a formative time in my life. It's when I saw missions first-hand, and came to understand the leadership and talent of local people in areas that had formerly been led by missionaries.

After that summer, I exchanged a few letters (that was something written on paper with a typewriter or a pen) with my Filipino friends. A few years later the Woodland Trio (with one personnel change) toured in the US, and I was able to see them briefly. I later heard that one of them died, and was let to believe that it was Tommy. It was actually a later member that I didn't know, but for years I have believed that Tommy was dead.

This past summer while on home assignment, after we had spoken at the Canada West district NMI convention, a Filipino man stepped up to me and said "I knew an Andy Bennett in 1974 in the Philippines--that couldn't be you, could it?" I looked down at his name tag and say "Alfredo Velasco." It was a great reunion. Alfredo is now the pastor of a growing international church in Toronto. From him I learned that Tommy was still alive and well. Later Alfredo helped me to link up with Tommy (now more often called Thomas) on Facebook. It's been fun catching up on his family. One of his sons is even my Facebook friend now.

Its the mountain area around Baguio where Tommy and his family live that has been hit the hardest by the latest flooding. I heard from his son (who lives in Korea) that he has had SMS messages that indicate the Tommy and his family are well, but they don't have internet access, so I haven't heard directly from them.

Luzon Nazarene Bible College is located near one of the villages that has been severely affected by mudslides and flooding. I don't know if the campus is directly affected.

Please be praying with me for the people of the Philippines during this latest disaster. Pray that lives would be spared, and that people would turn to Jesus as a result of this experience.

The photo is from Associated Press.

Party People

You'll notice that I'm not in the photo. Of course, part of the reason for this is that I took the picture. The other reason is that they are playing a game. I don't really enjoy playing games. That's a terrible admission, sort of like saying that you don't like apple pie, or you think they could have chosen a better design for the flag. But there it is. I've now confessed to the whole world (or at least that part of the world that reads my blog).

So the invitation was for supper and Settlers of Catan at Becky Wallace's house, with the understanding that Judy would play, and that I was welcome to bring my Mac and have my own kind of fun nearby. I can still visit with my friends. And I don't have to feel guilty for not participating in the Settlers ritual.

In the photo are Jordan and Rachael Thompson (Jordan works in construction projects) and Rachael is our high school teacher), Judy, Becky and Erin Meier.

Another New Missionary

It's now been about 2 weeks since we were joined here at Kudjip by Noah Timothy Riggins. He seems to be a pretty nice guy, so far. There are rumors that he yells at his parents if they don't wait on him just like he likes, but I think that can be forgiven for a few months. He's as good-looking as his brothers Aden and Wiley, and I expect he'll be a great friend as time goes on.

You can learn a lot more about him and his family on their blog. I'll give you a link to a Facebook album, but since it's not my album, I'm not sure that this is a public link, so you may have to be a member of Facebook to see it, but give it a try. It would even be a good reason to join Facebook, just to get to see these photos!

Good Friends

Last Saturday Judy got a phone call from Gail Dooley. It seemed that Allison was going to a birthday sleep-over at a friend's house, and Emma was feeling like she wanted something special to do. Gail had told her that she could invite a friend to stay over night, but the friend she wanted to invite was away. So Emma had asked if she could stay over night at Uncle Andy and Aunt Judy's house. Well, of course she could!

We had already invited a newly-arrived medical student to come for dinner, so it was a four-some. After dinner Emma helped me wash the dishes, and we watched The Incredibles. Then it was off to bed. Her bear friend was along (Oh, no! Suddenly I'm uncertain of his name. Cocoa Bear? Chocolate Bear? Bob? Monty?) for the night.

Alua

Today a group of us from Kudjip went up to a place near Mondomil for church. We joined Dave, Rosid, Grace and Anna Kerr, who are spending 10 days at Mondomil to practice Pidgin, and to learn about PNG culture. Follow this link for photos. The captions give you a general idea of our morning.

Not All My Patients Hate Me...

...at least not all the time.

Wedding Dress

When couples in PNG decide to get married, they face a difficult choice; church wedding or village marriage. Church weddings are usually pretty elaborate, and expensive. But Christian couples want to formalize their marriage in church, and a village marriage isn't really a wedding. It's just completing the arrangements between the families, and then they're married.

We have wished that couples could have a simple church wedding. One of the expensive parts of a church wedding is the dress. A couple of years ago, Judy shared an idea with Marilyn Willard, who was here as a member of a Work and Witness team from Medford, Oregon. Why not have a few nice, simple white dresses that ladies could use for their weddings, and then pass on to other ladies? Marilyn went home and made such a dress, and it arrived a few weeks ago.

Just the other day, Judy talked with Pastor Susan, from the Middle Ramu District, high in the mountains to the north of Kudjip. She shared that she is planning to marry Pastor Albert. She was asking a friend to make her a white "meri dress", the traditional dress of PNG ladies, but when Judy offered her the use of the wedding dress, she was overjoyed. Her response?

"Just my size!"