Friday, 30 September 2011

Going mobile

Nazarene Health Ministries started a cervical cancer prevention program some years back.  Pauline is a community health worker who runs the clinic.  Women come to the White House for pap smears on Tuesdays and Thursdays.  She screens 20 patients or so every week, or about 6000 since the program began.  They pay 4K (about $1.50) for the test.  Pap smear slides are mailed to Meripath, a non-profit organization in Australia that provides pathology services to more than 20 cervical cancer screening programs around PNG.  After 2 months, patients return to the clinic to get the results.  Those with abnormal pap smears are referred to me.  I examine them and look for signs of cervical dysplsia, early changes that could someday become cancer.  A simple procedure can cure the patient long before her dysplasia progresses to cancer.  Every time one of those procedures is done, a woman's life is saved.

The biggest challenges to the program are information, transportation, and follow-up.  Many women do not know that they need to have a pap smear or about the services that we provide.  Some are afraid to come for an exam.  Others are unable to travel to Nazarene Hospital because the road is bad or they don't have the money.  We also depend on women to follow up at the clinic for results.  If they don't return or have a working phone, we have no way to notify them of their need for treatment.

A few months ago, we began to dream about how we could expand our program and reach more women in outlying areas.  Primary Health Services is the division that provides services such as prenatal care and immunizations to the surrounding communities.  Mr. Gabriel is the director.  He agreed to do a pilot project in which PHS would partner with one of the local health centers for a mobile pap smear clinic.  He selected one of the bigger and more remote health centers at one far end of our valley.  Nondugul turned out to be the perfect place to start!  Pauline's husband is from that village and she sometimes works at the health center on weekends.  Mr. Gabbie and Pauline made a visit to Nondugul to talk with the health center staff about cervical cancer and the proposed partnership.  They were just as excited about the project as we were, and began recruiting patients almost immediately.

On Friday morning, Pauline and I met at the White House to gather up the supplies we would need.  We spent some time in prayer as we waited for the rest of the team to arrive.  Mr. Gabbie, Pastor Kiap, and a reporter from one of the local newspapers pulled up in the green PHS cruiser.  We loaded our stuff, recruited one of the nursing students to join us, and headed out to Nondugul.  The fog was just beginning to lift as the cruiser climbed out of the valley and to the surrounding foothills.  The view was spectacular.

We arrived at Nondugul health center about 45 minutes later.  We were greeted by the on-duty staff.  John is a Health Extension Officer (PNG equivalent of PA) and is also in charge of the health center.  Sister Lucy looks after the labor ward, and would be helping us for the day.  The health center was much bigger than I expected.  There is one building for immunizations and outpatient visits, another inpatient ward, and also a building for the labor ward.

We set up for our clinic in the maternity building.  The spacious postnatal ward was rather empty.  Apparently there used be some beds in there, but some rascals recently broke in and stole almost everything.  The room was quite a nice place for the women to gather and wait to be seen.  Pauline welcomed them, explained what cervical cancer was and why they needed to have a pap smear.  She also explained what we would be doing, as many of the ladies had never had a pelvic exam.  

Sister Lucy and Elijah the nursing student began registering patients.  Pauline and I armed ourselves with head lamps and speculums.  We moved to two smaller rooms, one with a delivery bed and the other with a mattress-less bed frame, where we would do the paps.  Sister Lucy was the first in line--she wanted to be an example for the rest of the women!  Once things got started, we really moved... 76 paps smears in just about 3 hours.  WOW.  I would have never believed it could be done!  Thank the Lord for helping us to go quickly so that everyone could be seen on that one day.  Of all the women that we examined, my second patient of the day was the only one to have an obvious cervical cancer.  The others will follow up in December for their results and referrals.

We concluded our visit with a wonderful lunch provided by the staff of Nondugul health center.  They were so appreciative of our visit, of the service that we provided for the women of their community.  They were ready to recruit more patients and asked when we could return!  HEO John also requested more information so that they could continue to educate patients about cervical cancer. 

What an awesome day.

Well, my preliminary assessment is that our pilot project was a cervical cancer smashing success.  In just one morning, we were able to screen as many patients as Pauline sees at Kudjip in one month.  And many of these ladies would have never made the trip to Nazarene Hospital just for a pap smear.  Of course the project will be ongoing.  We will be returning to Nondugul in December to notify the patients of their results, and those with abnormal paps will need to come to the hospital for further care.  But we are on our way in the fight against cervical cancer.

Mr. Gabbie hopes to continue the mobile pap smear clinic as one of the regular PHS services.  Once a month, a team of CHW's, nurses, and doctors will travel to a different health center to provide cervical cancer education and do pap smears.  Improving access to screening will increase detection, allow for early treatment treatment, and ultimately prevent new cases of cervical cancer.  And most importantly, lives will be saved.

"Jesus went through all the towns and villages, teaching in their synagogues, proclaiming the good news of the kingdom and healing every disease and sickness.  When he saw the crowds, he had compassion on them..."
~ Matthew 9:35-36a

Thursday, 29 September 2011

"P" is for Party Ward

Earlier this year, NHM divided the hospital employees into teams.  The purpose of the teams was to encourage a sense of community among the staff.  Sister Sylvia and I were put in charge of Team D(+), which includes the nurses and community health workers and cleaners on our ward, Sister Alfreda from pharmacy, and Chaplain Lucy.

We try to have some sort of team event every few months.  Back in July I hosted a movie night.  We watched "Gifted Hands."  Everyone was totally inspired by Ben Carson's story, a black American who grew up in a life of poverty and became one of the leading neurosurgeons in the world.

Well, it was time to have another get-together.  Sister Sylvia and I started planning some weeks back.  She consulted the other D-ward staff and they decided to have a team dinner.  Somewhere along the way, our "get together" turned into a mumu.  D-ward really enjoys a good party, so I have renamed it "Party-ward."

Last Saturday, the ladies gathered together to make the preparations.  Veggies were chopped, cooking bananas and kaukau peeled, chickens plucked and stuffed.  Everything was piled together in a dug-out pit; hot stones were used to cook the food.

Around 7PM, Team D gathered together under the hauswin or "wind house" (PNG style gazebo).  We ate by the light of candles, firelight, and a torch until the batteries ran out.  Wow... what a meal!  We topped it off with pineapple upsidedown cake, which was my contribution to the feast.  I also introduced my friends to an American tradition--toasting marshmallows over the fire.  That was definitely a hit!  Following dinner, Sister Sylvia and Sister Pata said their thank yous and made a presentation to Mr. Albert.  Our one male nurse on D-ward had recently gotten married.  His co-workders had collected money to buy a cooking pot for a wedding present.  He was so surprised!  The evening concluded with a time of worship and devotional by Pastor Philip.

It was such a fun time to be together with my co-workers.  It has been really neat to see how they have grown together over this last year.  We have worked and played, laughed and cried together.  D-ward has not only become a team, but a special kind of family... serving together to share the love of God with the mamas and babies entrusted to our care.

"A new command I give you:  Love one another.  As I have loved you, so you must love one another.  By this everyone will know that you are my disciples, if you love one another."
~ John 13:34-35

Saturday, 24 September 2011

Kids in clinic

Here are a few snaps of some of the kids I saw in clinic this week...

The first little dude is Waitman--or "White Man."  I wonder why his parents gave him that interesting name?  His smile was infectious!  Speaking of infectious, he was diagnosed with a mild case of pneumonia and was sent home on a course of antibiotics.  If you happen to be wondering about the scarf around his neck, our patients tend to wrap whatever body part is hurting.  Mom must have thought that Waitman had a sore throat.

Natalie is the second little girl.  She is probably about 6 or 7 years old.  Her papa brought her in to clinic because she had a hole in the back of her neck.  Sure enough, she was born with some sort of anomaly or cleft of her soft palate.  If it hasn't been a problem before now, it probably won't become one.  But just in case, she is headed off to see the pediatric surgeon in Mt. Hagen.  Oh, and I suspect her smile has something to do with the can of Coke she was drinking.

On Friday, Dr. Andy had quite a line-up for talipes clinic, a.k.a. Foot Club.  Some of the casts get quite a bit of wear and tear, as you can see!

Saturday, 17 September 2011

Jane Austen Fan Club

The other day, Karla and I were talking that it was time for a gals' night out.  We decided to call a meeting of the Jane Austen Fan Club, since #1 there are several adoring fans and #2 it is just a lady kind of thing to do.

Charis, Joani, Judy, Karla, and Maggie gathered at my home on Saturday evening.  Unfortunately Lydia was ill that day, so she and her mom held a meeting at a satellite location (the Radcliffe home).  We drank tea out of fancy cups and refreshed ourselves on scones with butter and jam.

The single ladies swooned over The Man himself--Mr. Darcy.  Charis, who is a medical student from the UK, entertained us by quoting Jane with an authentic British accent.  We then settled down for a showing of "Emma," disrupted only briefly by a power outage and the pounding of rain on the metal roof.  I must say, Mr. Knightly gives Mr. Darcy a pretty good run for his money!

It was such a sweet time... lots of laughs and lots of fun :).  Let's do it again soon!

[spoken in your best imitation of a British accent]
"It is a truth universally acknowledged, that a single man in possession of a good fortune, must be in want of a wife."
~ Jane Austin, Pride and Prejudice

Thursday, 15 September 2011

Life and death

As doctors at a rural mission hospital in a not-so-developed country, we come face to face with life and death on a daily basis.  I think maybe God gives special grace to missionary doctors to deal with it.  I praise Him for that gift!

But sometimes I am just struck by the reality of my job.  This has been one of those weeks.  I thought I would share with you a few of the stories...

LIFE :).  I had just finished up a c-section when Sister Silvia notified me about a laboring mother with fetal distress... that means that the baby is in big trouble.  I evaluated the patient and heard the fetal heart rate dip into the 80's with very slow recovery.  To do a c-section would take at least 30 minutes to start and get the baby out, and this little one didn't have that kind of time.  Dr. Jim arrived and delivered the baby with the help of a vacuum device.  Baby boy was a bit floppy at birth and did require some resuscitation, but was well recovered by rounds this morning!

DEATH and LIFE.  Jackbee was brought into the labor ward a couple of weeks ago.  She was unconscious, the cause later identified as hypoglycemia or low blood sugar.  Dr. Bill examined the patient and diagnosed her with liver cancer.  Jacbee went into labor and delivered a skinny IUGR baby; he weighed just 1400 grams.  Mom was transferred to medical ward, went into a coma, and died several days later.  D-ward staff fed and looked after the baby until grandmother arrived to take care of him.  I started her on medicine to help with lactation, but she is not yet producing breast milk.  Still praying!  In the meantime, we are feeding the baby with formula.  He is getting fatter and is now well on his way to 2000 grams :).

LIFE.  Elis is from the Jimi Valley, one of the more remote places that is still in our province.  We see some really sick people from there.  Whenever you are talking to another doctor about a patient and start the story with "she is from the Jimi," you know it is going to be bad.  Elis delivered her baby at home.  The baby delivered just fine, but the placenta did not.  Mama also lost quite a bit of blood.  Her family took her to a small health center near the village.  The nurse was unable to remove the placenta, so he referred her on to Kudjip.  By the time Elis arrived at the hospital, she was in shock.  We gave her blood, removed her placenta, started antibiotics, and treated malaria.  Both mother and baby are doing great today!

LIFE or death?  Matina was about 28 weeks when her water broke.  We admitted her to the ward, gave her antibiotics to treat infection and steroids to help the baby.  She went into labor several days labor and delivered a baby girl.  The little one weighed just about 1100 grams.  At this gestation and weight, she is not likely to make it.  She was just not ready to be born.  I imagine she will be transferring to the heavenly nursery in the next day or two.

DEATH.  When a patient dies in the hospital, Gola processes the chart and types up a death certificate for the doctor to sign.  A batch shows up in my office every couple of weeks.  Last week I had six death certificates to sign:  one woman who collapsed and was dead on arrival to the ER, on child on pediatrics ward who died of pneumonia, and four nursery babies.  Most of the babies had died from complications related to prematurity.

LIFE.  Hellen's story is similar to Matina's.  She was about 31 weeks when her water broke.  She went into labor several days after admission and delivered a baby girl.  The baby weighed only about 1300 grams, and had about 50% chance of surviving in our nursery.  After 2 weeks, she is doing well and even starting to grow!  Thanks to the Lord.

LIFE.  Last week we celebrated yet another 2000 gram party... for baby of Anna!

LIFE and DEATH.  Janet was admitted to the hospital a few weeks ago.  She was 29 weeks pregnant and bleeding--ultrasound confirmed the diagnosis of placenta previa.  That means the placenta comes first and covers the cervix.  This is very dangerous for both the mother and the baby, as mom can loose blood quite rapidly.  Janet stabilized after her initial bleed, so we watched and waited and prayed.  On Wednesday morning she began to bleed again, this time quite heavily.  Even though she was preterm (now 31 weeks), we could not wait any longer.  Dr. Andy did a repeat c-section.  Janet did really well.  The tiny baby girl weighted only 1300 grams, and unfortunately was just too small to survive.  I couldn't stop the tears when Janet thanked me for all that we have done to take care of her.

"I eagerly expect and hope that I will in no way be ashamed, but will have sufficient courage so that now as always Christ will be exalted in my body, whether by life or death.  For me, to live is Christ and to die is gain."
~ Philippians 1:20-21

Happy Independence Day to PNG

September 16th is Independence Day for Papua New Guinea.  The country turns 36 this year!

The celebration in PNG is bit different than July 4th, at least in the rural area where we live.  There are no fireworks or parades.  (Did you know that if you throw a piece of bamboo into the fire it cracks like a firework?  Minus all the brilliant lights and colors.)  Sometimes there are games like rugby or basketball, but things are pretty quiet this year.  I did see a few patients and family members wearing shirts with the colors of the flag.  We had a lovely presentation of the national anthem by the staff and students on D-ward!  It really was beautiful.  And Dr. Jim serenaded the entire hospital with the same tune on his trumpet.

Happy Independence Day, PNG!

National Anthem of Papua New Guinea

O arise all you sons of this land,
Let us sing of our joy to be free,
Praising God and rejoicing to be
Papua New Guinea.

Shout our name from the mountains to sees--
Papua New Guinea;
Let us raise our voices and proclaim--
Papua New Guinea.

Now give thanks to the good Lord above
For His kindness, His wisdom and love
For this land of our fathers so free,
Papua New Guinea.

Shout again for the whole world to hear--
Papua New Guinea;
We're independent and we're free,
Papua New Guinea.

Saturday, 3 September 2011

Stephoscope: September 2011 Newsletter

Dear Friends,

I just returned from a wonderful week in Singapore!  Erin and I traveled there for a regional mission training.  It was great to get away, visit with friends, and be inspired!  Just what the doctor ordered for "bush fever" :).

The feature story on page 1 of this month's newsletter is pretty cool.  Taylor, John, and Kevin are three college guys who set out to bike their way across America--to raise awareness and funds for Kudjip Hospital.  What an incredible journey!  I have also included an update on several of our heart kids.

Please be praying for Matthew, Becky's CBHC co-worker.  He was in a serious accident a few weeks ago, and is lucky to be alive.  The road to recovery will be a long one for him.

I can't believe it is already September.  Home assignment will be here before I know it!  Check out page 3 for my latest schedule.

Hugs from PNG,
~ steph


This past week, Dr. Erin and I traveled to Singapore for a special training.

We arrived on Saturday evening and were picked up at the airport by Sarah and David Lehman.  Since our meetings didn't start until Monday, we were able to spend a day with my long time friends.  And that one day just happened to be my birthday!  Erin and I slept in and enjoyed a morning swim in the pool.  Sarah made blueberry muffins for breakfast.  Fresh blueberries--what a treat!  That afternoon we attended the Bible study that Sarah and David lead.  This year's theme is "Conversations with Christ."  After dropping our suitcases at the hotel, we all cruised down the Singapore River in a bum boat.  It was my first time to see the merlion, the symbol of Singapore, at night.  What a great day, and special way to spend my birthday!  I wonder how many times Sarah and I have celebrated together over the years?

Our meetings began on Monday.  In addition to Erin and I, nine other missionaries from four countries around the region were also participating.  Over the next four days, we focused on the mission of the church--"making Christlike disciples in the nations."  There were times for worship, discussion, and team activities.  And of course... lots and lots of good food!  

On Monday night we ate at a hawker center.  A hawker center is a Singaporian-style fast food smorgasbord where you can taste food from India to China and everywhere in between.    It really reflects the cultural diversity of Singapore.  This month is Ramadan, a special time of fasting for Muslims.  We visited an area where they gather to break fast after sundown.

After more meetings on Tuesday, we finished the day with a mini-version of The Amazing Race.  We divided into three teams.  Following the clues, we traveled by foot, taxi, and bus around the city.  Our stops included a Hindu temple, ice cream shop, and 25 minutes in IKEA.  It took us 5 minutes to find something to buy, 10 minutes to walk through the store to the check-out, and another 10 minutes in the check-out line to buy the $10 item.  A bit overwhelming for this FOB (fresh out of the bush)!  The race ended at a Mexican restaurant where we feasted on fajitas and chips and salsa.

Wednesday was one of my favorites.  We spent a few hours of prayer and meditation at the beautiful botanical gardens.  From there we all headed to Arab Street.  Erin and Letitia and I walked together, admiring the intricate designs of the Persian carpets.  Some of them take years to make by hand.  Several of the carpet sellers we talked with were from Afghanistan.  Since I have traveled to Kabul, I especially enjoyed connecting with them!

The meetings finished up on Thursday.  Erin left for vacation in the U.S. early Friday morning.  I spent the day shopping in Chinatown and wandering around the mall.  I moved back to Sarah and David's with my suitcase and all of my new purchases in tow.  That evening we went out for a fabulous Italian dinner.  Saturday was my last chance to get a fill of the city for a few months.  We visited the Dali exhibit at the lotus-flower-shaped ArtScience museum and stopped for a scoop of chocolate ice cream.  It was a great week!

"Therefore go and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, and teaching them to obey everything I have commanded you.  And surely I am with you always, to the very end of the age."
~ Matthew 28:19-20