1090

No, that's not a date.  Well, it is, but as a date that number is not the subject of this post.  1090 mililiters.  That's over a quart, for those who need to know it in those terms.  Not a lot of liquid, really, depending on the context.  1090 ml of gasoline would take most cars only a few miles.  1090 ml of warm water would be enough to wash your face.  1090 ml of bloody serum in a man's pericardium can be the difference between life and death.

I don't often get into medical detail here, but you need to know that the pericardium is the membranous sac that surrounds each of our hearts.  It is normally a pearly color, smooth, with just a bit of moisture inside to allow the heart to slide smoothly under it as it beats.  But Joseph's pericardium has turned against him.  Swollen, red from the tuberculosis that spread there from the surrounding lung.  Over the last few weeks, he had become increasingly short of breath, and weaker.  As the inflammation of the pericardium increased, serum began to ooze from it's inner surface, and blood began to leak from its now-engorged capillaries.  As the fluid built up, it began putting pressure on the heart.  More and more, the heart could not fill adequately between contractions, so the amount of blood it could pump diminished.  Joseph's blood pressure decreased.  Any movement became an exhausting exertion.

Joseph went to the nearby clinic in his village.  A few days of amoxicillin did nothing to reverse the relentless progress of the TB.  Finally, Joseph's relatives realized that he was dying.  They found someone who would drive them to a nearby government hospital.  There they were told that there were no doctors to see him.  In PNG, it is the privilege of all senior doctors to take "Festive Season Holiday"; basically 2 months off.  The junior doctors who are supposed to keep things going want to be like the senior doctors, so they take some time off, too.  Joseph's family headed toward Kudjip.

When they brought Joseph into the ER, I was working on another man.  I saw that the nurses were checking him.  One asked to use my pulse oximeter.  This showed that Joseph's blood was carrying adequate oxygen.  I did not fully appreciate just how sick he was.  I listened to his lungs and heard good air movement, so I left him for the nurses to "screen".  He was making a lot of noise, and I thought maybe he was just being dramatic.  A little while later, the nurse told me that Joseph was ready to be seen.  I examined him more carefully this time, but didn't find anything specific, except that his heart beat was rapid and soft.  I ordered a chest x-ray.

Some time later, I was informed that his x-ray was ready.  Here it is:

For those of you who don't know what you're looking at, suffice it to say that it's not OK.  I went and got the ultrasound machine.  It showed me that most of the volume of what appears to be the heart on the chest x-ray was fluid.  The heart was barely contracting under the pressure that surrounded it.  There was also a fair amount of fluid in the right pleural space, the space between the lung and the chest wall.  There are many things that can cause this, but here, most of the time, it's TB.

By this time all of the patients in the Outpatient Department had been seen, and doctors were starting to home.  I felt that we needed to drain some of that fluid out of the pericardium, but I'd never done it before.  I knew that Dr. Erin Meier had done several, but she had left.  I found Dr. Steph Doenges, who is on call this evening.  She had helped on a pericardiocentesis once.  She agreed with my idea of involving Erin.  After sever failed attempts, I reached Erin, who came right in.  The three of us began to assemble supplies.  It was decided that since I had never done or even helped with one before, that I should be the one to do this.  This may seem like backward logic to some of you, but it makes complete sense to us.

Erin held the probe for the ultrasound that would guide my needle into the pericardial space.  I use an intracath, usually used as in intraveneous catheter.  This is a plastic tube around a steele needle.  We found a nice long one.  I washed his chest with an iodine solution.  Ering guided the ultrasound as I guided the needle into his chest.  The needle appeared in the image.  I slipped the steel needle out of the plastic sheath, and connected a syringe.  As I pulled the plunger, dark, bloody fluid filled the syringe.  20 ml.  They say that many times you only need to remove a few ml from the pericardium in order to make the patient much better.  The patient didn't look any better.  I tried connecting some IV tubing so we could just let it run, but the blood was too thick, so I went back to the syringe.  Syringeful after syringeful came out, and was emptied into a nearby basin.  When the fluid wouldn't come any more, we'd reposition the catheter.  We worried that a random movement by me or by the patient would dislodge it, so Steph put on sterile gloves to hold it.  The patient's relative counted syringefuls, and totaled the volume.

"Wow, we're past 100 ml!" one of us commented.

A few minutes later, "hey, that's almost 500!."

Then Joseph began to quiet.  With her free hand, Steph felt his pulse.  "Stronger", she said.  We could see the movement of the heart on the ultrasound screen returning to normal.

Joseph began to talk to us.  Erin and Steph asked him about his wife and children.  A boy and a girl, ages 5 and 3.  The brother and I were counting and adding.  The tally was nearing 1000 ml.  A liter!  Now we began to have to manipulate the catheter more often, but still the flow came.

At some point someone (yes, it was me--the mood was much lighter as we watched Joseph improve from moment to moment) began to speculate as to whether the Guiness Book of World Records had a category for the largest volume of fluid removed in a pericardiocentesis.  Probably not.

We help people all day long.  And once in a while, with God's help, we do we have the opportunity, despite our limited equipment, supplies, and experience, to save a life.  Sometimes in a critical situation there isn't anything we can do, and that is miserable.  But often it goes well, and a life is saved.  That's really a lot of fun!

Thanks to Dr. Steph for her photos!

AB

My First PNG Friend

In 1974, I participated in Student Mission Corps, a Summer ministry program for college students in the Church of the Nazarene.  I was assigned to the Philippines, where I was involved in music for evangelistic services.  While I was there, 2 teen age young men from PNG had a layover in Manila while traveling to Switzerland for NYC (Nazarene Youth Congress).  They stayed the night in the home of the missionary I was staying with.  One of those teenagers was a Missionary Kid, one of the Blowers boys, possibly Larry.  The other was a national named Tarp Goma.

When I came to PNG, I was anxious to meet Tarp again.  When I asked around, I learned that he had been a pastor and an educator.  I even learned that our neighbor Tundai Goma was his little sister.  Our paths didn't cross for some time, but eventually I had a chance to visit with him briefly.

This morning, I attended the graduation of Melanesia Nazarene Bible College.  Among the graduates were members of the first class of a new Master in Ministry program.  This is an extension program from Asia Pacific Nazarene Theological Seminary in Manila, Philippines.  I knew that some of my friends would receive their Master's degrees (that was a big part of why I was there).  Tarp was one of the Masters graduates.  I visited with him briefly, and had someone take a quick photo.

The kina shell hanging from his neck is not part of the MNBC graduation regalia: it's a traditional PNG symbol of honor and prosperity, and was given to him by his daughter Grace, as he stepped off the platform after receiving his diploma.  Grace serves as secretary to the national board of the Church of the Nazarene in PNG, and works here at Kudjip.

In a few days, I'll tell you more about the graduation.

AB

Baby Allen Has A Name

In PNG, babies are often not named for several weeks after birth.  Most babies are named by the time they are about 6 weeks old.  Once in a while it takes longer.  The reason for this isn't completely clear to me, but it may be that in the country with the highest infant mortality rate in the Pacific, and one of the highest in the world, people wait to see if the new one will survive or not.  Maybe, without a name a baby seems less like an individual, and it is easier, or people anticipate that it will be easier, if the baby dies.

I've seen the parents of babies with and without names watch their babies die.  Believe me, it doesn't make it any difference if the little one has a name or not. 

Or maybe the reasons are lost in antiquity, and now it's just the custom.  Sometimes, however, a specific reason comes to light.

A few weeks ago, I cared for a little one on the ward.  He was listed on the chart simply as "B/O Anna"--Baby of Anna.  He was almost 6 months old, so I asked his mom why he didn't have a name.  Her answer stunned me.  "His father has left and is with another wife.  He doesn't care about us."

"Well, he needs a name," I replied.

"You can give him a name." 

When I looked up at her eyes in surprise, I knew that she meant it.

"Really?  You want me to give him a name?"

"Yes."

"I'll have to think and pray about it."

To be honest, I didn't think about it much.  When I have been in a similar position before, a name turned up in by Bible reading the next day that I suggested.  Other times there was an immediate inspiration, like a medical student, or a volunteer from America.  There is a little Christiana, named after our recent student.  But no name turned up in my readings for the next couple of days, and no other ideas presented themselves.

The next time I saw him on the ward, and thought about it, I got an inspiration.

"My father's name is Allen.  He is a good, kind man, a man of God."

"Alright."

And so it was settled.  The little one was Allen.  I took a photo of him, and after a couple more days he was well enough to be discharged.  There were several photos of moms and babies on my camera, and when I downloaded photos a few weeks later, I couldn't remember the significance of the cute little guy with the pretty young mom.  Just one more CLK, a cute little kid.

Then a few days ago, I was doing rounds, and saw a newly-admitted baby.  His name was Allen.  "Oh," I said.  "My father's name is Allen."

"Yes", the young mother replied, "you gave him his name."

I was embarrassed not to have recognized them, but if you saw as many cute babies as I do all day every day, you'd understand. 

He had a mild pneumonia.  He wasn't as sick this time as last time, and was able to go home after just a few days.  I remembered to get another picture this time, which helped me sort out which picture was him before.  You can see that he has grown and thrived.

Bless you, little Allen.  I pray that you grow to be the man that your namesake is.

AB

A Weekend Away

Mondomil in the distance

This weekend we went up to Mondomil for Saturday and Sunday.  This was for a little R&R, and because I was invited to preach at a church near there, at a little place called Kamang.  Kamang has been a favorite place of our son Sam, since it is the home area of his "PNG Mama", Esther Tausi.  Sam has spent a fair amount of time in and around Kamang, and refers to Esther's male relatives (at least the adult ones) collectively as "The Uncles".  The Uncles is a diverse group.  Some of them have been Jesus followers for a long time, some are notorious sinners.  At least one has been a talented marijuana farmer.  A good number of them have made commitments to Christ in recent weeks.

Kunje

I'm telling this story out of chronological order, in the spirit of "most important first."  In the service this morning, we heard testimonies from 2 people who mentioned that Sam was influential in their coming to Christ.  One is one of the "Uncles", and the second is the wife of another.  The first is the local Councillor, or elected village leader.  He said that Sam's influence contributed to the planting of the church there.  The second was Kunje the wife of Wilson, a nephew or cousin of Esther.  They had named their new baby Sam, in honor of Sam Bennett.  One day when Baby Sam was learning to walk, he toddled into the fire, badly burning his legs.  At first they intended to try to care for this at home, but Big Sam talked to them, and urged them to take him to the hospital, even giving them some money to pay bus fare and other expenses involved in going to Kudjip.  Then later at the hospital, Sam talked to Wilson about the importance of Christian fathers, and his need to turn his life around, for the sake of his son, if for no other reason.  In the next few days both Wilson and Kunje gave their hearts to Jesus.

Wilson and Sam

Kunje then asked Judy and me to stand, so she could thank us for Sam's role in their salvation.  Well, anyone who knows me knows that tears were streaming down my face.  I can't take credit for Sam, for his salvation, his love for the Lord, or his love for his PNG family--it was God working in and through him, and he made the decision to follow Jesus.  But of course, we were proud, and happy.

I preached my Prodigal Son sermon--the second time in Pidgin.  Three people came forward, I think all three committed Christians just coming to pray, not new believers.  That's OK.

+++++

Well, more about the weekend.  We had wanted a little time away, and had thought to go to Mondomil, a place we love, and have been to numerous times before.  We invited Stephen and Amy Hollenberg to join us, as well as Dr. Steph Doenges and medical student Christiana Metzler.  We went up Saturday morning, and planned a hike up "Elephant Mountain" (named for it's shape), for the afternoon.  It was too rainy to try the steep, clay-mud trails.  So we enjoyed a warm fire, coffee, hot chocolate, tea, food and games in the holiday house.

Warm fire, good friends, good coffee, good food.

Stephen, Amy and Judy

They said that it looked like I was smoking something.  I am not.  I'm using a piece of pipe to blow air on the embers.  It worked well.

Steph is knitting, if you wouldn't have guessed!

This morning we had a pancake breakfast, then headed off to Kamang for church.  I preached, and Judy and I gave the congregation a Coleman lantern for use in evening services (there is no electricity in this area).  They had prepared a lunch for us (despite our telling them in advance that we could not stay), but we had to hurry away.

The steps were slippery.

This little guy was already asleep.  I wondered if he'd heard that I was scheduled to preach and was already bored!

The very young missionaries sat on the floor.  With Amy is Christina Metzler, a medical student from California.

Christina and Amy

After the service we went back to the holiday house for a quick lunch, packing, clean-up and a fast get-away to try to beat the rain, and the risk of an even muddier road.  We were home in Kudjip about 2:30.  Here's a look at one of the views we had on the way back down into the valley.

AB

Sign, sign everywhere a sign. Do this, Don't do that. Why don't you read the sign?

This falls under the general category of mundane daily life on a mission station.  I have noticed these flyers posted on or near the garbage bins around the station.  Our maintenance crew is responsible for collecting the trash, so I suspect someone from Maintenance posted them.

Read my translation first, then go back and study the photo:

"Notice:  Please do not put dirt or plant material in the rubbish bins.  Only put plastic or metal (in the bin).  Whatever material you can make into compost in your garden, do not put in the rubbish bin.  Please pay attention to this notice.  If you continue to put these things in the bins, you will pay a penalty.  Inform everyone in your house."

AB

The Big Party

We missionaries, we really know how to party.  And some amazing people show up for our parties!  Just look at this!

Dr. Einstein graced us with his presence.  He also brought a nice popcorn ball cake that was very popular.  I thought it was odd that he'd have to carry a reminder card in his pocket.

Who knew that Dr. Einstein was such good friends with Hawkeye Pierce?  Oddly, Randy Goosen was nowhere to be seen whenever Hawkeye was around!

The party was invaded by this band of pirates!  It turned out that they were quite friendly.  Notice that the smallest pirate (Ethan Goosen) wears his eye patch up on his forehead!  The medium-sized pirate is known as Jo Radcliffe in his other life.

I believe Quinton Schmelzenbach was a blind beggar.  Maybe he wasn't blind.  Well, maybe he wasn't a beggar.  I'm pretty sure it was Quinton Schmelzenbach.  We usually just call him "Q", so that we don't have to type "Quinton Schmelzenbach" as ofter, since "Quinton Schmelzenbach is long, and hard to type.

This medieval princess is sometimes known as Allison "Alley Cat" Dooley.

Can you read their name tags?  They are "Jean" and "Gene" and dressed in blue.  You figure it out.  Stephen and Amy Hollenberg.

There was even a concession hawker.  Lydia Radcliffe didn't manage to sell much.

This, I believe, is a Gypsy fortune teller.  I don't usually patronize fortune tellers, so I wouldn't know.  She does look a lot like Jessica Myers.

And my personal favorite costume, Karla Deuel as a refrigerator door.  It is decorated, as all good refrigerated doors should be, with missionaries' prayer cards, held on with refrigerator magnets!  I do notice that our prayer card is not there.

Every good harvest party needs games.  Bobbing for lemons didn't turn out to be the most popular.

And, of course, treats.  Each family brought something to cook for themselves on the fire (most popular were "hobo dinners"), and a treat to share.  There was enough.

The foil packets on the fire are the hobo dinners.  I wanted to include a few more missionaries, and this shows Jordan Thompson in the red shirt, Scott Dooley cooking 3 hotdogs (I'm sure he was helping his kids) and Tim Deuel in the white shirt.  And of course, Hawkeye Pierce on the far side of the fire.

As you can tell, we have a lot of fun together.  We are blessed to serve with a wonderful, compatible, congenial, godly, faithful group of missionaries, and we love getting together.  We thank God for them.  I'm sorry I can't show them all.

AB

The Gas Boys

These are our nurse-anesthetists.  They are all graduates of Nazarene College of Nursing, and of the Post-Basic training program in anesthesia in Port Moresby.  They have all three proven themselves to be careful and serious about their work, and they all have great attitudes toward service to the people here.  When we have to do something after hours, it is a great blessing to have staff who come cheerfully without complaining.  They are David, Petrus and Las (pronounced "lahsh").

AB

The Big Wedding

Many of you know that we've been building up to a really big event here at Kudjip--the wedding of Dr. Becky Wallace, and MAF (Mission Aviation Fellowship) missionary Matt Preece.  Becky is with for a year, as a volunteer through World Medical Mission.  The story (many stories, really) can be found on their individual blogs at here (for Becky's now discontinuing blog) and here (for Matt's side of the story, and the one they will do together from now on).

Well, Saturday the big day finally arrived.  I'll try not to tell you too much detail, but understand that other than a skeleton crew left behind to keep the hospital functioning, all of your Kudjip missionaries, and many of our national friends were away for the day.  MAF is a much larger group than we are, and although only a fraction of their folk could come, it was an even larger group than the Nazarenes!

The wedding party and the musicians went up to Randan Ridge Friday evening, a group left at 7 AM Saturday to help with decorating, and the rest of us, in 4 more Land Cruisers left Kudjip about 8.  Most of us got back between 5 and 5:30 in the afternoon.

Randan Ridge, for those of you who don't know, is a hotel.  It's high up on the mountain to the south of the town of Mount Hagen.  The road is very rough, but once you get there, things are very nice.  They usually ferry their guests up in a huge 4-wheel drive bus.

There is the main lodge, a long, curving building, with a large covered patio within the curved part.  Beyond that is a long, winding fish pond.  There is a foot path that goes all the way around the pond.  The wedding party stood on the foot path, across the pond from the guests.

The wedding party was Dr. Erin Meier, Becky's sister Tammy, Becky, Matt, Matt's friend Mark from Australia, and Daniel, Matt's good friend and wrokmate at MAF.

Our table at the reception, with Brad and Nikolai Ballin and Cherith and Mikelle, and Simon and Esther Tausi.

Jim Radcliffe speaking on behalf of Kudjip Hospital.

Matt and Becky sharing at the end of the reception.

By the way, most of the PNG Nazarene Missionaries who blog have stories and photos.  See our blog roll on the left of the screen.

AB

Golnamne Church of the Nazarene

This morning we were off to a bush church at a place called Golnamne.  Not hard to pronounce once you practice it a couple of times.  It's the home village of our friend Apa.  We shared his story in April, 2010.  Our friends Simon and Esther Tausi (we've talked about them too many times to link to all of them) and Simon's brother Nason and his wife Neom are here, both for the recent Women's Conference, and for the upcoming National NMI Conference, and they all came along as well.

Golnamne is in an area we've never visited before.  The church people worked on the road, so it would be easy for us to get there.  The road must have been pretty bad before!  Going down a hill, at one point the mud was so slippery that even in 4-wheel drive, the steering had no effect on the direction of travel of the cruiser, and the left tires slipped right into a drainage ditch.  That wouldn't have been so bad if the ditch had been going our way, but it was clear that I couldn't continue to follow it indefinitely!  Apa is a very strong man, and he was surrounded by his strong relatives.  In a few minutes, they had brought a couple of big planks and built a ramp out of the ditch.  I drove right out, and the rest of the road went by without problem.  However, Judy and several of our friends had decided to walk down the hill.

The folks who walked down the hill arrived a few minutes after we did.

 The congregation had prepared welcome signs on the ground made of flower petals. 

The church lined up to receive us with warm handshakes and a welcome song.

 Me preaching

 Visiting after the service

Some people had no confidence in the car, and walked back up the hill.  There was no trouble getting up in the car!

Here's a little video, shot with my pocket camera of the welcome, then of the Tausis and a few other friends singing a special song in the service.  There's also a brief shot of Simon giving a testimony.  It was so moving that I wanted to share it, but I was disappointed to discover that his voice had been too soft for my camera to record.  His face and gestures say a lot.