Bush visit!

So this past week has been adventurous!
Monday and Tuesday were busy with patients, including some more surgery assisting, another snakebite patient (not too sick) and a man with a puzzling presentation of ascites [medics: diarrhoea followed by rapid onset ascites, high fevers, but no hepatomegaly or splenomegaly. Then a massive thrombocytosis. PMH of TB percarditis]. I also took a history from a lady with bleeding and severe anaemia which her son interpreted and translated to a CHW, who then translated again to me!
On Wednesday I went out to an aidpost to stay with the CHW (Danwaf) based there. I went to a village called Senamrae. The drive there was eventful with flooded sections of the road and vehicles driving past with big numbers on top, telling you to pull over because a convoy of however many large vehicles was coming!
I met the family, with their 2 kids (girl age 9, boy age 3) and had a little tour of the aidpost. A young brother of mum is currently staying with the family too as his school has no teacher, so is closed. Basically the aidpost is a a couple of rooms for seeing patients in, with some basic medicines. The family currently don't have a house, so are staying in the 2 other rooms of the aidpost. They have a tap outside (although they dug a well when the tank ran dry last week) and a hut as a kitchen, where mum cooks on a fire in a hole in the ground. There is sometimes power in the evenings, with a light in one of the rooms. I stayed in the aidpost's radio room.
The family made me feel so welcome during my stay, and were so generous. They don't have much food at the moment, but shared all that they have. I don't think I've ever eaten so much carbohydrate! I helped with a clinic doing child immunisations and saw outpatients with Danwaf. In between I would play ball with the children and introduced them to 'snap' with a pack of cards I had brought (well, a simplified version of snap, where whoever turns over the matching card gets the snap! I also discovered that snap by suit rather than numbers does not work- it just never ends!). In the evenings I would sit with the family preparing food, eat together on the floor and share Bible passages and talk. We had some great conversations about PNG and English culture. Some of my favourite questions (reminding me of when I was asked in South Africa whether we have black people in England!) were 'do you have grass in England?' and 'do you have poor people in England?'! I really enjoyed talking and praying with Christian brothers and sisters with the same Father God!
On walks around the village I saw things like wild grapefruit trees, sago swamps, and a cassowary, which I had imagined to be like a chicken, but is actually more like an ostrich with a brightly coloured neck and dinosaur-esque face! I drank coconut milk from fresh young coconuts knocked from the tree, and I saw sago grubs, which are in amazing little cocoons, and which Danwaf ate raw!
That probably sounds a bit romanticised - it certainly was a privilege and blessing to be welcomed into the family's home and see their life, but it was also tough to see how hard their life is and to see the challenges they face daily in providing the first point of healthcare for people in that community. On a basic note, coming back today I had a brilliant shower and very much enjoyed sitting on chairs and using a real toilet!

Weekend

On Friday evening I went to the local youth group, where singing and Bible study was interspersed with gheckos falling from the ceiling (splat!) and a kitten of unknown origin playing with said gheckos!
I had a lovely chilled out day yesterday (Saturday) including plenty of reading, Bible study, getting up to date with my journal, eating avocado on fresh bread and baking a vanilla cake! There was some excitement on discovery of a snake on the tree outside of our house (a small non-poisonous one), so that is the 2nd snake I have seen this week! One of the kids then found a big snake skin. In the evening Addy and I had the kids round so their parents could have an evening to themselves. We had dinner and played chinese checkers (I had forgotten what a great game that is!). When they left I had a nice skype chat with one of my sisters.
Today began with Church, then a massive downpour of rain! Absolutely chucked it down, which people will be thrilled with. The river is really swollen again. This is what happens when people pray for rain!! Addy and I were just having our lunch when Dr Dan (the doc on call this weekend) rang to say that a lady had just come in the ambulance from Kiunga hospital (where there are currently no doctors) with a prolapsed umbilical cord and the baby consequently in distress. So off we went to the hospital for an emergency C-section, where I was acting anaesthetist (!). Despite a very swift procedure to get baby out, the baby boy couldn't be resuscitated and died. It is particularly sad because the lady and her husband have been married for over 10years and this was to be their first child. It is hard to know that a different outcome would have been likely in a different setting/situation.

Sorry for the delay in getting another update out.
The week started with a number of us struggling with recovering from the virus that has been doing the rounds. The hospital was thankfully fairly quiet for a few days. It was Dr Sharon's birthday, so in the evening we had a meal at one of the family's house and had cake etc, which was nice. There was also some drama upon discovery of a snake on the veranda! I was assured it was a non-poisonous variety, but I think it is the only snake I have seen outside of a zoo! In other wildlife news, we currently have a rat in our house, which ran in front of me last night! There was also a MAMMOTH wasp inside earlier, which I successfully herded out the window!
On Tuesday afternoon I took some stuff to the hospital to do some simple craft with some of the kids. Some of them have been staying at the hospital for ages, and there's hardly anything to do. So they were pretty chuffed with paper chains and chinese lanterns and things. I also decided that it counted as simple dexterity physiotherapy for the boy recovering with his buruli ulcer deformity!
On Tuesday night, the 17 year old boy who had come before the weekend with the pig-hunting foot injury was sent back to us! The hospital we'd sent him to hadn't operated because they didn't have an anaesthetist, so they sent him to us. We don't have an anaesthetist either(!), but the doctors do certain things from the textbooks. So the surgeon came on Wednesday to do the foot amputation, and I assisted! Lots of tying off vessels before getting to the bones, then making sure the stump was as good as possible. It was done under spinal block, and the sedation wore off just in time for him to be a bit too awake for my liking for when we were sawing off his bones! A couple of times I just thought about what we were doing, which was pretty crazy! See picture below.








I went straight from the hospital for dinner at the house of the MAF pilot and his wife, which was nice. Their little boy (18months) was pointing out photos of aeroplanes to me and correctly identifying different models! I managed to skype with my family when I got back, which was really nice.
Yesterday (Thursday) I assisted with another emergency c-section for a breech baby. It was another difficult surgery (not least because the spinal block didn't work very well). Another few patients from the other hospital came to us (because with the surgeon now on holiday, they currently have no doctors), including a 7 week old dislocated shoulder....thanks for that! Also a man with multiple pig-bite wounds. The doctors stayed late to sort him out a bit, while I looked after the missionary family kids, so their mum could go to a meeting. We went down to the river, which due to hardly any rain recently, looked like this:








Local people are getting a bit worried by the lack of rain now, as their tanks are running low and they are having to dig wells and walk far to get water.
It turned out that the pig-wound guy's surgery took a turn for the dramatic as he kept stopping breathing. So the surgery was abandoned, and I helped to sort out one of his arm wounds this morning under just local anaesthetic. His wounds initially didn't look too bad, but pig tusk wounds often have more damage deep inside, and we were repairing a cut tendon.
My other major task today was going through the medicines in the emergency box and in theatre, noting how out of date they are, and seeing if there are any more in-date ones in the dispensary! Welcome to Jungle Medicine!

A few more photos for you!
This is the view from the big window of my current accomodation, with the mossie screens taken down and the hatch open!









This is some of the dancing at the CHW classroom opening celebration.









This is me helping do an emergency C-section!









This is the sunset last night after a clearer day than usual.










So since I last updated...
On Thursday night I assisted with the emergency breech C-section, which was a bit hairy (baby's head was stuck) but all ok in the end! A cute baby girl, and some neat skin stitching (if I do say so myself!)
Snakebite kiddie is struggling with kidney failure. Due to her continuing effects of nephrotoxicity and coagulopathy it seems likely that she was bitten by a particularly posionous snake (small-eyed snake), which then combined with her delayed presentation to medical care. I think we are hoping to transfer her to a hospital with dialysis capabilities, but even still she may not survive.
On Friday a 17 year old boy was brought in (by canoe and then carried on a stretcher made of tree branches) after a nasty accident whilst hunting a pig in the bush. A huge chunk of his foot (his whole heel) was cut off by his friend's hunting knife and the wound is now also infected. He has been transferred for a probable below-knee amputation elsewhere.
This weekend I (and Dr Addy I'm staying with) have got colds! So we are feeling a bit rough and relaxing as much as poss. Yesterday all the missionary families came together for a meal for the househelps that some of them have, plus their families. I ate ferns!
Love to all xx

Crazy day!

So this morning one of the doctors wondered if today might be a good day to do some snakebite management teaching for me. Little did she know that within the following half hour we would get called to a patient just brought in with a snake bite!! The 6 year old girl was bitten out in the bush yesterday morning, and was pretty sick. The venom was causing neuromuscular paralysis (the risk being that eventually her breathing muscles would be affected) and blood coagulation difficulties. The local health worker had done well by bandaging the affected limb (to lessen the spread of venom in the lymphatic system) and the girl came to us by the hospital ambulance. The doctors set to work stabilising her and giving antivenom. I watched and tried to comfort the girl's mother a bit. I then helped give some more drugs when she was more stable. She is now doing well, although her kidneys are still struggling a bit.
The day continued with patients presenting to outpatients, and me also going to the lab to see positive TB tests.
Some engineers came to fix the MAF planes today and I'm pleased to say that both planes are now working! The plane that came with the engineers also came from a different part of PNG, and brought us some vegetables (the local greens here are currently not allowed to be sold because of all the fuss about the river; it's ridiculous). I tell you, you have never seen someone so happy to see broccoli - it was like vegetable Christmas!
A lady has now been brought in with premature but non-progressing labour, and the baby in breech position, so I'll soon be off for her emergency C-section!

A busy few days!

Hi all!
Well thanks to the wonders of Skype and the power being on I just spoke with my daddy on his birthday! Great to see and hear my parents and brother back at home!
Saturday started with the little boy with the injured shoulder in theatre. Under anaesthetic we could examine his shoulder movements and work out that it was not dislocated, although his xray did show a fractured humerus. After seeing a few more patients I moved accommodation. My new accommodation is going well - I'm now living with Dr Addy who is one of the missionary doctors (and who I heard speak at a CMF meeting many years ago!). She is Indian, although her parents were missionaries in PNG for many years. She has been at Rumginae for 14years now.
I received a warm welcome, with my room nicely made up and flowers put in it, and a yummy cake in the oven! I also now have the joy of fresh bread, as she has a breadmaker! So much better than the rubbishy white bread I had to get when I arrived! There are also very few ants!!! (altho earwigs and the odd giant wasp!)
I sorted out my backpack which had grown mould due to the humidity (97% again today!) and in the evening I went for a swim in the river! I had a rough first night as the bed 'mattress' is really thin (essentially a thin slice of foam) so I had bad back pain and hardly slept. I now have another mattress underneath, which is much better!
On Sunday I tried 'sago' for the first time, which is the local staple food. It has a complicated and labour-intensive making process, involving (I think) cutting down a particular tree at a particular time, cutting open the branches and scraping out the inside, which is then washed, the liquid drained and the sediment from that collected ! The resulting powder is cooked to make a sort of plain doughy cracker.
In the evening I went on a youth secondary school gospel outreach, which was really good. Hundreds of young people from the school and some people from the town too. Some singing, dancing, testimonies, dramas and Bible readings etc and a hilarious drive back. I was packed into a dodgy bus behind a huge spare tyre and we drove back through the pitchblack jungle in the pouring rain! At points the driver was leaning out the window to see, as the windscreen was so useless!
Yesterday began with an emergency surgery for a suspected appendicitis. It ended up being very complicated and challenging. After an hour of unsuccessfully trying to insert a spinal anaesthetic we accepted defeat and went for a ketamine anaesthetic instead. The patient then promptly stopped breathing, and after being stabilised required a lot of assistance with his breathing for the rest of the operation. He also kept flailing around and needed to be restrained a lot (turned out he is an alcoholic, which explains why he kept needing so much ketamine). I was scrubbed in an assisting with the surgery, which was also difficult in itself, with plenty of pus and difficult anatomy and a very large inflamed appendix. So the appendectomy took 4 long stressful hours!
Other patients that day included a pregnant girl with pre-eclampsia (medics: no antenatal care, lots of oedema, eye problems, clonus - the lot!).
Today started with more surgery! I assisted with tubal ligation, then we had a skin closure of a healing ulcer and a sort-out of an abdominal stitch abcess. Also saw a lady with some kind of bowel to skin fistula! Then this afternoon was festivities, with the opening ceremony for the new CHW classroom block. The building was decorated with leaves and balloons and there were lots of speeches and some traditionally dressed dancers. The building was built with funding from Japan, so we had the Japanese ambassador!
We now have the MAF pilot back, as well as the family whose house I stayed in at first, so that's cool.
Much love

some photos!

this is my current house










this is the view of the river from my veranda.









this is the view on a sunny day!










this is the MAF plane parked outside my house
.

I've had another busy couple of days at the hospital. Update on the fish situation is that the governor came (in the middle of a staff training vasectomy role-play) to look at the dead fish in the fridge. I personally found the whole situation very funny, and had to try hard to keep a straight face! It actually turns out though that he is also a paediatrician (not sure what the relevance is of that and fish, but anyway) so we got him to see a little boy on the ward who has been very sick and we're not sure why. He has some kind of haemolytic process going on (for medics: he had a HB of 2, then a blood transfusion got it up to 10 and 3 days later it was 5 again) and has gotten weird soft swellings on his skull and his eyes have become very prominent, suggesting a tumour in his head is pushing them out. Anyway, mr governor suggested a differential diagnosis of a particular tumour related to osteomyelitis (Pott's Puffy tumour if anyone is interested). He also took a blood sample for doing a blood film which we can't do here as he was going to the capital later in the day. Anyway, little kiddie is basically very sick and was essentially only for palliative care, which is some comfort with the following situation development...The parents have been saying for a few days that they want to take the boy away and 'do customs' which is basically traditional spiritual and magic rituals. However, as a Christian hospital, the hospital has a rule that patients cannot receive treatment and also go do customs. They have to choose to either put their trust in God (through the hospital care) or in customs. So if patients choose to go do customs, they are not then allowed to come back to continue their treatment. The family left the day before yesterday, which is sad.
Yesterday (Thursday) I was on the maternity ward ward-round and saw a little girl be born, then learnt a bit about snakebite management, which included looking at some preserved snakes in jars! I then learnt some more about Buruli ulcers. I was feeling a bit low in the evening - just a bit tired and emotional for no particular reason. I got some nice messages from friends and family though, and made some caramelised vanilla bananas (new combo. verdict: YES) and got an early night. Have felt better today, so thank you everyone for your prayers and support.

Today I spent some time with one of the teachers at the CHW (community health worker) school attached to the hospital. So I learnt about what they do etc. I also examined a lady with a huuuuuge spleen! She is the very anaemic lady after a ruptured uterus, who now appears to have malaria, with tropical splenomegaly. She also gave me a new record BP reading, of 60/20. My other record here is 200/140 in a lady with renal failure who was in clinic earlier in the week, having run out of her medication a month ago! This afternoon an adorable little boy came in with a fractured/dislocated/both shoulder. This happened 3 days ago, but today he came to us by a 3hour canoe trip! As our xray machine is broken, we sent him off to another hospital for xray before returning to us later to fix it. We heard that he was on his way to us by radio from one of the outstations earlier.
This weekend I will be moving from my current house into accomodation with one of the missionary doctors, (my house's family are returning on Tuesday), and hopefully next week our MAF pilot will be returning from a conference, so that will be good.
Much love xx

Sunday-Tuesday

Hi all!
So Saturday night and Sunday it rained A LOT. I couldn't believe the sky had any left!
Sunday morning Church was a special ordination service for 10 pastors. This was actually really cool, and I enjoyed singing along to some Pidgin songs too. However it did mean sitting on the wooden floor for nearly 4 hours - ouch! I also had to use the worst toilet ever! It was a standard icky hole in the ground, but so much worse: 1) because it was mildly flooded, 2) because someone had just pooed next to the hole, and 3) because I was not wearing shoes!! (you rarely do here). I used water, a handwipe and antibacterial gel to wash my hands and feet, then washed and changed as soon as I got back to the house!!!! I then sorted out a bit of an ant infestation where they had gotten into a box and chewed through some foil wrapping. I do not like the ants.
On Monday (yesterday) I had my first proper day at the hospital! I went on the ward(s) round and saw lots of patients - lots of TB, pneumonia and various ulcers. One old lady had a very advanced ulcerating anal cancer, and there is a young boy who came in fitting a month ago with TB and meningitis and is yet to regain consciousness. Other interesting patients include a couple of albino people, and a little girl with a congenital heart defect (ASD and VSD for any medics! and she has amazing clubbed fingernails!). The ward round is actually pretty amusing as there is no privacy at all - all of the patients in the ward are involved in each patient's consultation! The hospital chaplain is also on the ward rounds, which I think is cool, as he then knows the patients' situations and is able to chat and pray with them afterwards.
On Monday afternoon I went to a staff TB meeting as they are going to start doing 'treatment supervisors' for when patients go back to their viallges and need to make sure they keep taking their medication. After this I helped to hang up a guy's arm in traction for overnight, as he has broken and dislocated it but it is really swollen. Our xray machine is broken, so he had to go elsewhere the next day, but the swelling needed to go down a bit first to help with the fixing!
Today I went to market at 6.45am!! I managed to buy some bananas, pineapple, potatoes and some kind of pumpkin thing that resembles an odd-shaped marrow! There were not the usual greens for sale because they grow on the riverside, and apparently people are not eating those right now. Which leads me onto the promised update on the fish-river-fridge situation: Currently, the company responsible for the leak has said they have tested the water and it is fine (but they would say that...), but the local people are saying it is not ok and they should get compensation (but they would say that...). The doctors say that the fish shouldn't be in the outpatients dept. fridge (but they would say that...!)
My main wildlife contamination worry is that this morning, I found an ant on my toothbrush. not cool.
Anyway, back to today. I had a very good day in theatre! I was scrubbed in assisting on a little boy having a skin graft onto his arm as he had lots of flesh cut away due to a Buruli ulcer. This was my first experience of doing a skin graft, my first experience of a ketamine anaesthetic, (indeed, my first experience of anaesthesia being done from a textbook!). It was also my first surgery done with an insect crawling out of a bundle of supposedly sterile instruments, and my first surgery done in a theatre with a fly-swat on the wall! It was a long and tricky procedure, but really interesting and a great experience to assist in! There was then another skin graft on an ulcer (done under spinal block), then a clear-out of a uterus of a lady who had miscarried at about 12weeks pregnancy.
All very interesting and stimulating stuff so far, and so varied. I'm enjoying getting stuck in and being able to get involved :)
Lots of love to all xxx

update

Hi all! Sorry for the delay in getting an update out, but i am now on a laptop and ready to update you!
So my journey went smoothly (London -> Abu Dhabi -> Manila -> Port Moresby -> Kiunga -> Rumginae!) and I arrived here on Thursday morning (9hrs ahead of UK here). Highlight of the plane food was probably the tuna and raisin pasty I had for breakfast on one of the flights....hmmm!
It is very warm and wet here!
For my first couple of weeks I am staying in a missionary family's house while they are away on leave. All the houses are sort of bungalows on stilts, and I have incredible views over the river. The other lady missionaries have their houses next to mine in a row, and I have been dining with somebody different each day so far! There are tiny ants EVERYWHERE, so I've been making all my food ant-proof in tupperware boxes (they can chew through packaging!). The first evening I thought I had seen a snake in the grass [read: swamp] but it turned out to just be a wiggly stick. Smooth.
I have an MAF plane parked outside my house! [www.maf.org] However we won't have a pilot this week until the MAF family return, so hopefully there won't be medical emergencies requiring evacuation to here (altho planes elsewhere can step in if needed). I'll hopefully get to go up on a medevac at some point though! Last week, 2 of the doctors went on a medevac to a guy who had been shot with a bow and arrow. He wasn't brought here in the end, but they have had news that apparently he is doing well.
The hospital is just over the little airstrip, and is also on stilts with wooden walkways! I had a bit of a tour on Friday and will get stuck in this coming week. A little gem for you: [note: a 'billum' is a string bag, a 'pikinini' is a baby] a 'bladder' in pidgin is 'billum for pisspiss' and a uterus is 'billum for pikinini'! Also, there was a big dead fish in the outpatients fridge because there has been some kind of leak into the river and people are worried that fish are dying, so the fish is waiting to be seen by the authorities. I'll keep you updated on the fish-river-fridge situation!
This morning a lady showed me around the station a bit more, and showed me how they collect rubber from rubber trees! I also met some of the Community Health Worker students, who come here for 2years training before returning to their villages to apply what they have learnt.
One of the missionary doctors gave me some homegrown peanuts, so I was impressed with myself for successfully shelling and roasting them! Yumyum. I was also pleased that my plan to keep ants away from my pineapple was successful! (in a bowl sat in a dish of water. genius!)
I can pick up internet on my kindle here which is unexpected and rather cool! I can't do big messages or blog updates on there (use one of the dr's laptops for that), but am very much appreciating picking up various messages! Thanks everyone!
Lots of love xxxxx
(will try to upload some photos soon!)