Saturday, December 19, 2015

Jan 4th Report

For those who have been interested to hear about our time in PNG but we haven't been able to connect directly yet, our church will host us on the evening of Jan 4th at 6pm for a time of dinner and sharing about the ministry at Kudjip.

We will have dinner and childcare available from 6pm to 8pm.  We plan to share some of our experiences and stories, but to allow time for personal interaction and questions as well.
Please RSVP and let us know if you plan to come, and if you will bring children - how many and the ages.

What:  Crouch Papua New Guinea Ministry Report

Where:  Believers Church, Tulsa

When:  6pm, Monday, January 4th 

Thank you for your continued prayers for our family and efforts.

Saturday, December 12, 2015


"And I feel I should know this place as a road winds on in a wide open space
The wind plays a haunting tune as I make my way through a night all alone"

Yei, South Sudan

My heart sank as I walked into the delivery room at Bet Eman hospital.  Despite crossing the Pacific and Atlantic oceans, despite trading grass huts for skyscrapers and grass huts again, despite having left Papua New Guinea and journeying to the heart of Africa - the sight in front of me felt crushingly familiar.
The week before, the young lady I now worried over had delivered a healthy but small baby by cesarean section. She had a low blood count but was able to leave the hospital for her village.  Unfortunately something went terribly wrong - infection or some other malady brought her back to the hospital with a hemoglobin count of 3 and unconscious.  Her brother, John-Mathias, discovered her ill at home and brought her to us.
As she lay unconscious with a pulse I could barely feel and no blood pressure picking up, the clinical officers and I quickly elevated her legs, gave her IV fluids and prayed that a family member would be able to give blood of her type.  She wasn't bleeding and an ultrasound didn't show any free blood around her operation sight making me think she contracted a hemolyzing infection dropping her already tenuous blood count.
Amazingly, the lab tech, Innocent, found that her brother was a match.  He began drawing the blood as I went back to the delivery room.  That is when my heart dropped.  She took her last few agonal breaths and I knew we wouldn't be able to get the blood in time.  We tried resuscitating her but Rose died just as her brother's blood became available.
The clinical officer, Gloria, put her arms on John-Mathias' shoulders and comforted him.  I breathed deeply and fought back tears as I walked under the brilliant African stars to my apartment.

My visit to South Sudan felt fast, furious and amazing.

Fast because of the jet lag and busy 7 days, furious because the intensity of the place proved every bit as real as I suspected.  Amazing because despite the loss, need and challenges, I witnessed the undeniable faithfulness of God lived through the lives of people He called to live among the South Sudanese and bring them their best measure of His grace.

About 5 years ago, Jeff and Elizabeth Perry followed God's call to one of the most remote corners of the globe, along with 8 of their 9 children.  Jeff and a colleague Dr Poole and now Dr Matthew Loftus work at Bet Eman hospital to show God's love and bring health to women and children.  Every day, I saw Jeff fill the roles of physician, administrator, teacher, husband and father.  I enjoyed their family and got welcomed into their home by Elizabeth and the kids.  I just pray that the small measure of service I could bring helped them.

Me, Dr Joel Watson and Dr Jeff Perry

I thank God that the last couple of years at Kudjip gave me some clinical skills to bring to bear at the hospital and enjoyed exchanging ideas and "war stories" with Jeff.  But as I sit in the Entebbe airport in Uganda I am more grateful that the struggles of South Sudanese or Papua New Guineans are not won or lost in my hands.  As much as my heart breaks for those, like Rose, that I can't physically heal, I feel at peace knowing that my brief glimpse into their lives pales compared to the heart of God that beats and breaks with theirs.  That His comfort will be shared with her family through those who continue to feel and give His love at Bet Eman.  That because He is good, I can trust Him and see the Peace that South Sudan so desperately needs take an increasing hold in the lives of its people.

Laiki was brought to the delivery room by two nurses from the nearby St Bakhita delivery ward.  She suffered a seizure during her labor and the sisters quickly got her to us.  One of them, Sister Florence had a familiar look to her and when I asked, "Yu stap orait?" this Papua New Guinean nurse now working in South Sudan nearly fell over.
Laiki was still confused from her seizure and had a dangerously high blood pressure.  Recognizing she couldn't cooperate with her first delivery, I called our OR team to prepare her for Csection to attempt to save her and her baby.
As she fought us in her post-ictal delirium, we managed to get her to sleep.  Her blood pressure stabilized and out came a beautiful crying baby.  Over the next few days she recovered and cared for her baby.  She and I may arrive at our respective homes about the same time tomorrow night.  And I know that those miraculous healings will continue at Bet Eman because of God's consistent heart to live among the needy and hurting of our world.

So despite the distance between PNG, the US and South Sudan; despite the new languages and faces, despite the hot dust in lieu of the dense jungles, I felt that familiar, compassionate presence of Christ.

Wednesday, November 25, 2015

Do speak and pray

Since coming back to the US for our first furlough, we've been blessed with time to spend among family and friends that we haven't seen in a long time.  Times of reconnecting have been sweet:  sitting on porches watching children play together, having lunch or dinner and talking about lives now lived across oceans, late-night movies and sleep-overs.

We've also had the chance to do a lot of things we never realized were such a privilege until living in Papua New Guinea.  The park, the library, the Oklahoma Aquarium, going out to a restaurant, the State Fair, riding an elevator, having a root beer float, hunting and fishing.

Several people asked what the biggest difference between PNG and the US is.  It would seem obvious: skyscrapers instead of grass huts, steady employment instead of subsistence farming, schools, cars, roads, reliable running water and electricity.

But the thing that overwhelmed both Esther and I after just a few days here is actually the pace of life.

In PNG we would hope to get one thing done in a day.  Not an errand off station, but just one thing like "get extra light bulbs from maintenance."  If that happened the day could be called successful.  In the US, it feels like several things all need to be happening at once or everyone gets worried about "being behind" or "not getting anything done."

Two days after we landed I went to the AT&T store to get two new mobile phones set up for us on a "go-phone" plan.  After walking in the store, I waited about three minutes until a "customer service representative" could help me.  As we looked at phones, she charged the old phone I brought with no battery power remaining.  She then collected two new sim cards, put them in the phones, activated the account and printed a receipt as well as information about the new service from her tablet.  The entire encounter took about 15 minutes and I left with working phones for both of us.  During our transaction she kept saying things like, "Sorry for the wait" or "This just takes a while" when the printer delayed for a moment.  I wanted to shout, "Yes, sometimes it does - but this is NOT that time!"

No wires.  No stamps.  No waiting for printer ink.  No waiting for the "cell phone guy" to come back with the key to the cabinet containing the sim cards.  No watchman guarding the vehicle outside.  No children going with you on every errand (thank you Mimi and Papa).  Yet none of it moves fast enough for us.

Sometimes I've found it difficult to move from the hustle and bustle of working in a mission hospital with a slow culture around me to having a time of rest amid a culture of busy-ness.

The time that seemed like it might stretch forever before we came home has been evaporating.  So many things that need to get done, ought to get done and some things we just want to get done.

But I've managed to enjoy extra time around the house and with the kids during the mornings while keeping myself a little busy.

In my afternoons, I've been largely studying for my public health course through the London School of Hygiene and Tropical Medicine.  As a life-long learner, I love this course because I feel like I'm learning things I can apply to my work in PNG as well as having the "opportunity" of learning a new topic every couple months.

 I've also picked up a little work in a rural emergency room as well as a local hospice agency and giving a couple lectures at the In His Image residency.

We spoke at Believers Church last Sunday, and were reminded again of how grateful we are to be part of this body.  We felt encouraged and touched by the leadership in giving us a time to share our heart and stories from PNG.

We also had the chance to share with In His Image friends and family at a bible study last week.

These times of sharing about our ministry seem intimidating at first, but once we're surrounded by those who have loved, prayed for and given financially to our ministry the nerves are calm and an atmosphere of family takes over.

Speaking of family.  Last week we enjoyed Levi's birthday party and we were joined by his cousin, Eva, whose special day is only a couple days before his.  This week we plan to celebrate Thanksgiving and indulge in the American traditions of turkey and pecan pie.

Next Thursday I will take a 10 day trip to East Africa. 
The purpose of this trip is two-fold.  Partly I will be trying to help a colleague and fellow medical missionary who currently works at a Mother-Baby hospital there.  I will also be looking into this hospital, people and country as a potential field for our future.  While we return to PNG in January, our hearts have been stirred toward Africa since we met there over 10 years ago and have felt God asking us to explore and consider if and when we might transition there at some point.  Pray for safety in the current climate, a spirit of discernment and service during my time there and for Esther who will stay back in the US with our kids working on some of her US citizenship application.

Thank you to each of you that has partnered with us in prayer and in giving for our ministry at Kudjip hospital and during our first furlough here in the US.  We love having the opportunity to serve the Lord in PNG, to connect with and encourage our family at home and explore prayerfully where He leads us for the future.

Feel free to contact us if you are interested in hearing more and connecting in person.

Monday, September 28, 2015

Sorrow and love

Most mornings, after the insects and birds wake me up, I try to spend some quiet moments on our back porch preparing for my day. The kids are usually asleep and I sometimes read through passages of scripture or listen to music. And every morning I look out on the village of Kuplang with a small mountain rising from its tea fields to catch the first rays of morning sunlight from behind me.

The past couple months have seen very little rain in our area of the highlands, and the situation has begun getting desperate. Fires roam unchecked around us, burning homes and gardens.

This morning I looked out on my usual landscape and saw that “my” mountain had scorch marks and blackened trees, like so many around us. Gardens are now just ashes, as are the homes around them. Some of our Kudjip staff family recently suffered the loss of homes, and even personal savings. They now live in a nearby village trying to piece together their livelihoods.

As our family watched another unchecked fire on the mountains around us last night, Esther said, “It's amazing to just feel so helpless.”

  Photo: Dr. Ben

In two days, my family of five will board a plane bound for the U.S.

In some ways it terrifies me.

When we left nearly two years ago, I honestly didn't know how long we might stay in Papua New Guinea.  When we tore down decorations in our Tulsa rental home, sold our cars, packed a few belongings into crates and said farewell my mind started making excuses.  Excuses to move home sooner - in some ways, almost praying that God would give us an 'about-face' and return us to the States.

Then the work in the hospital started.  And our daughter Lucy was born.  And adventures in the mountains of this rugged country took hold.  And it seemed obvious that we could be here forever.

But patients died.  Children and babies and mothers lost their lives while literally in my handsLevi got sick and I honestly didn't know at the time if he might join their ranks - the longest night of my life.

As reality set in, my heart hardened a bit.  My blogs decreased.  I struggled to diligently catalog the plight and losses encountered by the people of this incredible country.  It seemed like the sorrows of this place started to eclipse the love that brought me here in the first place.

This morning I cried, looking at my scorched mountain, knowing that in a few days I would leave this place to its ongoing struggle. I can't control the rain, and many times, I can't control what ultimately happens to my patients here. Any grandiose thoughts I once had about my own abilities are long gone.

I don't know what difference I make in the middle of this. But I feel an overwhelming sense of both sorrow and love at the thought of leaving.

Sorrow because as much as I've invested in this place the past two years, its difficulties remain. The mountain stands scorched. The hospital goes on – every day bringing healing to some, and crying with others. The people continue to piece together their livelihoods amidst challenges – challenges that most of the world doesn't see or consider.

Love because of the beauty of the people around me. My ex-pat colleagues, my Papua New Guinean neighbors and friends, my patients and their families who continue their own journeys in this place. Who every day take the blended steps of joy and heartache along these scorched fields, trusting in the faithfulness of a kinder tomorrow.

But one morning, as I look on my burned mountain, the rain will come again …

“O Lord my God, who dwellest in pure blessed serenity beyond the reach of mortal pain, yet lookest down in unspeakable love and tenderness upon the sorrows of earth, give me grace … “
-John Baillie

Thank you for joining our journey these past two years, and as we look to continue in Papua New Guinea in 2016.

Saturday, July 11, 2015

Burden and wonder

"Turn my eyes to see Your face
As all my fears surrender
Hold my heart within this grace
Where burden turns to wonder

Lately I've not been able to get this song out of my head.  I didn't know why, but the words kept creeping into my day.  In the past week or two, I think I've needed it.

I've struggled on several fronts.  

In June we didn't get the vaccines that we needed and I despondantly looked into our empty freezers again this week after asking sister Leah if we'd received any.  Still no, which means hundreds of babies are going without vaccines through no fault of their mothers who are still making the effort to get here.

Two mothers came to see me last week at about 5 months pregnant whose water had already broken.  One of them asked me to give medicine to complete a miscarriage for her, but after seeing the baby's heart-beat, I kept her in the hospital to see if we could protect her long enough to give the baby a chance to live.

This week we delivered three ladies in desperate situations.  Toy's baby has congenitally acquired resistant HIV infection, Lineth's baby has anencephaly and Grace's baby has already succumbed to prematurity.

Kudjip "NICU" and "Ventilator" - a nursing student bag-breathing for Grace's baby

On Monday, Levi began having coughing fits and wheezing.  Dr. Bill graciously came to see him that evening while I was knee-deep in Obstetrical complications at the hospital.  After his scare last year, every cough or sniffle he gets sets me on edge.

One of Esther's patients a few weeks ago told her, "I pray that Lord would just take me, I am so miserable"  For better or worse, I think Oipa's prayers are being answered because he is deteriorating and I can't help him anymore.  But his daughter still takes care of him and I know she dreads what is now inevitable.

Esther's COPD patient, Oipa

At times I feel like the work here is just a string of fears and burdens.  Sometimes, I walk to the hospital every morning as the sun crests above the mountains around me, and with every step I dread walking into the nursery and finding empty cribs.  Or empty beds where I've admitted patients who don't survive.  Or empty freezers where I should have vaccines to protect the vulnerable children of PNG.  And the next step becomes a burden as I'm tempted to go back to my house, my family or my home country where I don't experience the same fears.

Enter grace.

A little boy named Joshua came to Kudjip nearly eight months ago.  His family lived near our hospital, but he fell ill while visiting relatives and was admitted to the nearby government hospital.  After some days, Joshua died and the family brought his body home on a public motor vehicle.  Incredibly, though, while passing our hospital, Joshua began breathing again and was brought into the emergency room, where Dr. Andy Bennett resuscitated him and admitted him to our pediatric ward.

For several weeks, I saw Joshua on weekends, paralyzed and unable to eat or communicate due to what was likely Tuberculous meningitis.  After some time, Joshua wasn't in the hospital when I made weekend rounds.  Bed A7 became another empty bed - confirming in my mind those fears that I carried to the hospital that morning.

"I will fight to follow
I will fight for love
Throw my life forever
To the triumph of the Son

My mentor, Bill McCoy, wrote an incredible book collecting the stories of his patients in thirty years of missionary service.  But the story that moves me most is his own.  In it, he relays the familiar tale of a little boy walking along a beach full of stranded starfish.  As the boy tosses them into the ocean, a stranger berates him saying that he can't make a difference given the number of doomed starfish on the beach.  The boy replies as he throws one back, "I made a difference to that one"

About two weeks ago a grandmother brought a child to my room.  It was one of those days full of fear and burden - a day that I just wanted to be home.  I looked in the record book to find what their concern was.  Apparently this boy had one or two isolated seizures in the past few weeks.  I asked the grandmother if the child had seizures in the past.  She said he did last year, for several weeks, after staying in the hospital here for some months.

I flipped a couple pages back.

I turned the book over to see the name on the front.

Joshua sat before me,  smiling in his grandmother's arms.  At first I couldn't believe it.  I turned the book over and over.

"Is this the boy who died at Hagen and came here last year?"

"Yes, that's him"

I asked Joshua to walk to me and he took several unsteady steps across the room before falling into my arms laughing and smiling while his grandmother enjoyed my surprise.

The traditional moral of the story is that I should have an attitude like that little boy - hoping to touch the lives of a few even if I can't make a difference for the many.  But the beach is too full of starfish and I can't keep that up.  I see fears and burdens everywhere, and if I think I'm the one making a difference I will lose heart.
The truth is that I am a starfish - whom God mercifully threw into the life-giving waters.  When I surrender to this idea, my burden becomes wonder.  Wonder that a loving God would count me worth His son.  Wonder that He's given me some abilities to potentially help others away from their own fears and burdens.

"Your love has won it all
You took the fall
To embrace my sorrows
I know You took the fight
You came and died but the grave was borrowed
I know You stood again
So I can stand with a life to follow
In the light of Your name

Saturday, May 9, 2015

Thick skin

Will your grace run out
if I let you down.
Because all I know
is how to run.
Before moving to Papua New Guinea, I started writing blog posts as a way of communicating with those helping us to get here. After more than a year living amongst the highlanders of this island country, seeing their joys and griefs, I realize it's become something different. After a particularly difficult patient, I find that writing their story helps me to absorb who they are, or were – and how to cherish their life while moving forward in my work.

16 months ago we moved here and nearly every patient broke my heart. I came home at the end of call or a typical work day and spent time in prayer, searching for reasons behind the suffering I saw. I admit, after dealing with almost identical stories of abuse, disease, neglect and violence I developed a thick skin. Not every patient touched me. My calluses got thicker and the tenderness that I approached each day with started to wane.

This helps, actually. If I walked to the hospital every day, full of its struggles and loss with bare skin I think I would wear out and return home.

But every once in a while, I think God likes to carve an opening in my thick skin, and in brief moments, He reminds me of the needs of the people here as well as my reliance on Him in trying to help them.

Last week a young woman brought who I thought was her son into my clinic room. Manuel had been having cough and diarrhea for almost two weeks. He looked dehydrated and showed some early signs of malnutrition. I usually wonder, in a young child, if the mother is taking care of them or may have passed on HIV to the baby. I asked, “Is this your baby or did you adopt him?” And she replied “I adopted him last week. My sister, his mother, died two weeks ago in this hospital – you tried to help her but she died and now I take care of him.”

All my thick skin was useless.

As I looked at Manuel and remembered his mother, Ruth, the barbs of reality hit my heart.
I admitted Manuel and he seemed to do well. I went back to his mother's chart, remembering her distinctly but wanting to see if there was something I missed. I looked at her lab slips, an old Xray, her treatments. In it all I saw several things that I might have done differently – but probably not at the time. Of course, in the US things would have been very different, but for the resources we have here, I don't know that her care could have been better. In the physical, medical world I sought answers. But Ruth's story didn't end well, and all the medical answers in the world wouldn't bring me peace as I looked at Manuel, with sunken eyes and a slightly swollen belly.

I knew then and there that I would be writing their story down, but it took nearly a week for me to know how.

You see, I have this idea that I should try and do justice to someone's story or life if I choose to share it with others, particularly on the internet. Part of that represents my wanting to honor their memory, but part of that, I now realize, is selfish. I grew up on stories from the mission field and having followed in those footsteps I feel that I have to tell good stories to others.
As I struggled with Manuel and Ruth's story, I nearly decided to keep it, in fact nearly decided to stop sharing my patients' stories at all.

But this morning as I read, I realized that sharing the lives or stories of my fellow highlanders doesn't have to be long-winded, eloquent or inspiring. Their lives and stories are worth knowing and hearing, and I'm just the one privileged to experience them, even if it hurts at times.

Open your mouth for the speechless,
In the cause of all sons of passing away.
Open your mouth, judge righteously,
And plead the cause of the poor and needy.
-Proverbs 31:8-9

These words resonated with me. And I realized that with all this thick skin, it's been harder to find where Christ is. In the midst of the patients and babies we lose, the stories of abuse and battered women and a culture in great need of transformation, I've lost sight of the reason I came here. I've turned this opportunity into a job. And I learned, through Ruth and Manuel's stories, that every once in a while I need my thick skin to be broken and to feel brokenness. Because in those times, I don't have to look for Christ – He comes to me.

And those moments of comfort send me back to the hospital, praying that I'll be more sensitive and careful with the stories I get to take part in.

"You are a Savior -
You take brokenness aside
and make it beautiful"

Saturday, April 4, 2015

The penitent thief

Tonight I preached my first sermon in Pijin.

Several of the "cell groups" around Kudjip conducted special meetings in the run-up to our Easter service tomorrow.  Veteran missionaries Dr Bill McCoy and Dr Jim Radcliffe each took a night of sharing.  With some trepidation I accepted the invitation to share as well.

For a couple of weeks I considered what I might share on.  The center of the Biblical story revolves around this time we celebrate in Easter.  Should I reflect on Christ's teachings, His death, His resurrection?  What part of His story did I feel drawn to?

In the end, I could not escape one of the peripheral figures in the crucifixion.

You see, there were three crosses.  Christ and two criminals died together.  So often I think only of Christ's death and how it affects my life or those around me.  But I forget about the two individuals who experienced that moment more closely than anyone else.  And one created a testimony that has lived on for generations.

In Luke 23:32-43, the physician apostle details what happened around Christ as He died.  Bystanders mocked him, leaders scoffed at him and soldiers tore his clothes.  He hung upon a tree, bleeding and suffocating whilst begging God to forgive his executioners.  Even another victim of the same agony berated him.  

In the midst of it, one person spoke truth.  A truth I couldn't let go of more than two thousand years later - as I lay on a neighbor's porch looking across the mountainous jungles of the Kane valley in a remote corner of the globe.  A person whose story and life go unnamed, but whose heart I realize I must learn from.

One of Jesus' Golgotha neighbors, a man without a name and simply labelled a "criminal" sees the real Christ.  He knows his own past of hurt and sin, but recognizes Jesus and becomes the first saint in his new kingdom.  He never preached a sermon, healed a sick person or planted a church.  But he saw his own place of need and accepted the great forgiveness that God offered him.

The penitent thief - who hung next to Jesus, suffering the punishment of his society for crimes he committed during his life.  Yet received a grace far beyond the agony of the cross he bore, while others mocked the perfect man beside him.

"'Do you not even fear God, seeing you are under the same condemnation?
And we indeed justly, for we receive the due reward of our deeds;
but this man has done nothing wrong.'
Then he said to Jesus, 'Lord, remember me when You come into Your kingdom'"
-Luke 23:40-42

When our first-born, Anna, was about two years old we began reading through a children's bible every night before bed.  One night, as we looked at the illustrations depicting Jesus dying on the cross, faces from the crowd pointing and laughing stood out.  My two year old said, "Look at those bad people laughing at Jesus" and I agreed.  Then the words of a hymn came to me:

"Behold the man upon the cross, my sin upon his shoulders
Ashamed I hear my mocking voice call out among the scoffers"

I had to correct myself and my daughter.  Those people weren't as bad as they were blind.  Really, I am among the scoffers who see Christ's death as a sacrifice only in hindsight - when I in fact take the time to recall it.

Above Kudjip station

So which cross am I going to carry?  The cross of Christ I don't presume to undertake and I believe God set it aside for His son alone.  That momentous burden could only be taken by Jesus.  But I look at his companions in crucifixion.  And I know my cross - the cross of one deserving death, who needs redemption.  I remember that Christ said I could not follow Him without a cross of my own.

So I carry the penitent thief's cross as I attempt to serve others in gratitude to Him who rescued me.

Thursday, March 19, 2015


"It started out as a feeling, which then grew into a hope.
Which then turned into a quiet thought which then turned into a quiet word.
And then that word grew louder and louder, until it was a battle cry."

In 1890, a Swiss physician named Courvoisier noted that patients who had a painless yellowing of their skin and eyes along with fullness in their abdomen most likely suffered from a cancer in their pancreas.  His name accompanies this particular constellation of findings to this day, and it represents an ominous sign for a patient, and usually precipitates heart-sinking in their doctor.

In January of 2003, this particular finding was burned into my memory.  I remember vividly the night that my mother and father sat all of us down in their living room and explained that it looked like my father had pancreatic cancer.  He underwent a procedure to relieve some of his discomfort, but faced radical surgery.  Even then, before starting medical school officially, I knew enough to be very scared.  Few survive pancreatic cancer, even with the best care.  I prayed furiously leading to the day of his surgery, and when the surgeon sent word that the surgery didn't go exactly as planned, I cried.

I looked at my father on his hospital bed as he recovered from his operation.  I cried with my sister, Christy, at his side.  I remembered the things I learned from him - a strong work ethic, respect for others, appreciating a job well-done, compassion for the sick and service to the poor and needy.  I remember him saying, while we each tugged on various fencing around our property, trying to rip their concrete bases from the ground, "You should learn to respect working with your back and sweat, because many people you meet won't have the chance to make a living with their brains like you do."  Then he would climb onto our 1953 Ford tractor and we would work until after sundown on the remaining posts.  Lessons that shaped who I was then and who I remain today.  I remember his great passion for teaching medicine - and feared that I would never get to learn that art from him.

Miraculously, every biopsy report from his surgery came back all clear.  Samples sent to the military research hospital confirmed - no evidence of cancer.  Some months later, he went back to medicine and teaching and we never bothered about his cancer again.

Fast forward 13 years.  It's Monday morning at Kudjip, and a man in his late 50's enters my room.  His abdomen is mildly swollen, his eyes are bright yellow and his skin has a sallow appearance, even for someone with dark complexion.  

I put my hand on the right side of his abdomen, and that heart-sinking begins.  Joseph had pancreatic cancer, and no options in the remote mountains of Papua New Guinea.  I sat down and explained his illness to him in no uncertain terms.  He took in every word, asked a few questions.  The space between us felt thick with discouragement.
Earlier this month, my father arrived at Kudjip hospital to visit us, along with my mother.  They hadn't seen their grandchildren in over a year and spent five glorious days enjoying them.  My dad came to work alongside myself and Dr. Bill McCoy - his first ever student in medicine and my medical mentor.  Dr. Bill attended my birth nearly 33 years ago as a physician-in-training under my dad.  Last year he delivered my child, using the skills my father taught him decades ago.  He has mentored me as I take these steps into serving as a physician amongst the people of Papua New Guinea.  And for an incredible week the three of us attended patients together and discussed dreams of healing the world's ills.

Then the opportunity I secretly prayed for arrived.  As I took call for the hospital, a nurse called from our Obstetrics ward.  "Doctor, we have a fetal distress"  I arrived in the ward to find a mother struggling with labor pains and a baby who, by listening to its heartbeat, seemed stressed from the process.  I quickly gave her IV fluids and placed a catheter to drain her bladder.

"Let's go to the OR"

I telephoned my dad who had probably just fallen asleep at our neighbor's house on station.

"Dad, we have a C-section, are you up for it?"

"Of course, I'll be right there"

Before I could even get the car down our road, he met me near the hospital, having walked up in the black of night.

We went to the OR and scrubbed as the nurses prepared mom and our anesthetist administered a spinal block.

I wondered, after more than forty years of doctoring but almost a decade without delivering babies, if my dad would be up for a C-section.  But it seemed second nature to him and within a few minutes we had a crying baby out on the nursery table.  Stunned at first, he quickly picked up.

The whole time my father stayed here, I couldn't shake the concept of legacy - passing on the baton of medicine as a ministry to the sick, poor and vulnerable.  Carried down through three medical and two biological generations.  

Back in my office, I prayed for Joseph and prescribed some medicine for his pain and nausea.  As he prepared to leave, he stopped himself at my door, put his hand on my arm and said, "Doctor, if God decides to take me home, that is OK.  But I am glad that I met you, and that you explained everything to me so that I don't have to be worried."  He turned out the door as tears welled in his eyes, and promised to come see me again in a few weeks.

I have no idea if Joseph will receive the same kind of miraculous healing that my father did.  I've long since given up trying to piece together the ins-and-outs of God's sovereignty in the face of this suffering.  But I know that my time and prayers helped him, and the memory of his hand on mine expressing his thanks keeps my heart tender to those around me.  And that, too, I believe is a part of the great legacy I inherit and hope to pass on.
So what kind of character, values and faith do I want to give to my children?  Younger doctors I might one day teach or mentor?  My patients?  

The same kind I received, I think.

Sunday, March 1, 2015


A while ago I blogged about several of my patients who suffered from placenta previa.  Three babies born small who died in our nursery before they reached a month of age.  I struggled during that time to see how my efforts here made a difference.

Then I met Getruth.  Getruth experienced bleeding during her pregnancy at about seven months.  When I scanned her abdomen, I thought I might fall through the floor.  Like Dambo, Grace and Moreen before her, Getruth's baby was too small to survive and the placenta obstructed the birth canal.  I kept her in the hospital, and fought the urge to avoid her bed during daily rounds.  Fears of failure and another little life lost surfaced.

Then she bled again, and it was time for Getruth to have a C-section and deliver her baby.  The baby was small, smaller than one of my previous patients who died.  And I shadow-prayed for this little life to be spared, but harbored all kinds of pessimistic thoughts about him.

"I called, you answered and you came to my rescue.  And I want to be where you are."
- Hillsong

But fast-forward a couple months and Getruth's baby first survived and then thrived.  After gaining enough weight and breastfeeding well, they went home together.  A couple weeks after that, Dr. Susan brought this little miracle to my exam room, proving that at least this one had been rescued.

Wednesday afternoon, just as I prepared to leave the hospital for home, one of our emergency room nurses found me in my clinic room and said, “Dokta, plis hariap, emergency”

I got my stethoscope back out of my bag and went to the ER. One small patient occupied a bed at the end of the room, with two nurses trying to start intravenous lines. As I approached, no obvious injuries appeared but the child didn't move and her chest barely rose and fell with her labored breaths. When I turned her toward me, my un-gloved hand found the reason for her condition – a significant head injury in her left parietal bone that left blood on my palm. I put my stethoscope to her chest and realized her breathing motions were ineffective, agonal, and she didn't have a pulse. I started chest compressions while asking nurses to bring equipment to intubate and medicines to try and restart her heart.

4 year old Esther walked along the side of the highway about a kilometer from the hospital when a passenger van turned on its side in one of the many unsafe stretches of road. The vehicle collided with her. Having seen the accident, her very young mother was the first to be brought immediately to our hospital with her, but I was told more would be coming.

I placed a breathing tube and gave Esther medicine to try and restart her heart. After several minutes without any response, I quit resuscitation efforts on Esther and focused on patients arrived in a second vehicle - clutching limbs and heads, dressed in bloody clothes. Jacklyn with a large hematoma in her flank, Rebecca with a head injury and Bobi with chest pains I quickly gave intravenous fluids to and checked Xrays. Then two more children arrived, a one-month-old baby who appeared very well and a child in mental shock who wouldn't move his right side. After assessing both of them, I realized that no other victims had life-threatening injuries. I admitted three to the hospital, and sent others home after repairing some lacerations and removing glass from injuries. Only after an hour or so did I realize that sobs still sounded from outside. Esther's family prepared to take her body home. I made my way to the road and put my arms on their shoulders as they sobbed over the tiny draped figure in the back of a pickup truck. They departed to return home, still crying, and I crossed the dusty path back into the hospital to check on a few of my obstetric patients.
Eight accident victims, three recovering in our wards, four home already and one who I couldn't save.

During my time at Kudjip hospital, a visiting physician talked about how to avoid “burnout” This phrase gets used in medical schools and residencies, as well as amongst practicing physicians. It describes the idea that the compelling forces of compassion and sacrifice which propel one to train as a doctor become eradicated by various things – insurance companies, paperwork, long hours, demanding patients and loss of family and quality time.

Interestingly, one of my mission field coordinators called this idea “compassion fatigue.”
It made me think more about the idea of “compassion” What is it?
Compassion in its Latin root means to suffer with. But what does that look like? I can't suffer with my malnutrition babies because I am not malnourished nor a baby. I can't really suffer with their parents when they die from dehydration, because they aren't my child, though I can imagine what it would be like to lose one. I can't truly suffer with Esther's mother, because it's not my child that was killed by a tragic accident. My heart breaks for her, but certainly not in the same way.

Compassion propels me into medicine, doesn't it? So what does it mean?
Because I see the suffering with those around me afflicted with disease – I want to take action. But how can I really suffer with my patients? I'm a western-born, highly educated and comparatively affluent white person – while they are remote villagers for the most part, subsistence farmers who hack their way through a tropical jungle to see me in the hopes I have medicine for their illness, or that of their family.

So I'm not really suffering with my patients. I see their suffering, and I want to act.
All too often, in my setting, my action doesn't help. Or I guess wrong, since I have no real diagnostic testing to work with. Or I don't have the medicine, the surgery, the specialist that I need to relieve the pain I see.

Bai mi make wanem? (What will I do?)

I console.

Of course my compassion would fatigue. I see suffering perpetually and I have limited tools or answers to bring to bear. If I perpetually felt the depth of loss my patients feel I would quickly despair. I feel the suffering of those around me in general terms, but I acknowledge I will never have the ability to truly experience it.

Instead, I console. I stay with the lonely ones. Those left behind after the baby dies from obstructed labor, or the child inevitably loses the battle against tetanus which ought to have been prevented by an immunization, or the elderly man passes away because I didn't appreciate his surgical abdomen quickly enough. I stay there, in the loneliness of those left, trusting that God will give the peace I can't see or feel. Because of His limitless and perfect compassion.

I am compelled to care for the patients here at Kudjip because of compassion. When I don't see their healing, I recognize I cannot feel the true depth of their suffering – but I can remain with them and offer the consolation that I would want in their place. And I believe that whether I relieve suffering or console a lonely heart, God blesses both.

“Though the fig tree may not blossom, nor fruit be on the vines; though the labor of the olive may fail, and the fields yield no food; though the flock may be cut off from the fold, and there be no herd in the stalls -

Yet I will rejoice in the Lord, I will joy in the God of my salvation.
-Habakkuk 3:17-18

Monday, February 2, 2015

The greater miracle

"All those people goin' somewhere
Why have I never cared?"

-Brandon Heath

A couple days ago, when one of Ted's patients deteriorated, his mother's sobs broke aggressively into the routine of examining babies, writing orders, and checking drip rates.  He was admitted the night before with severe acute malnutrition and bleeding, probably from septicemia.  Ted saw him first, changed what seemed the most likely circumstances to try and save his life, but told the mother that most likely he wouldn't survive.

The rest of ward rounds felt surreal, as she sobbed into her baby's bed and Ted and I monotonously gathered more charts and saw the rest of the patients.  After rounds, he went back to comfort the mother and Chaplain Lucy arrived to share in her grief and pray with her.

Later in the morning, as the pile of waiting patients' health records grew, I stopped myself at patient number eight for the day.  His book showed the picture of a child, hastily scribbled out with the word "adult" written next to it.  James told me it actually belonged to one of his two sons, and I mentioned he did a good job getting them their immunizations.  James went on to describe the feeling of "fullness" in his abdomen for months.  

This bothers me.  In PNG, people may have an illness for a week or two, in which case it is most likely Malaria or some other acutely reversible phenomenon; or they have it "long-time true" meaning it is something which won't kill them.
If someone is sick for "some months" I start to think of Tuberculosis or Cancer, and I pray for Tuberculosis because I have medicine for that.

I took James to our ultrasound machine and my fears were confirmed - a large tumor in the right side of his liver, an extremely common condition owing to the high prevalence of Hepatitis B infection in Papua New Guinea, usually acquired at birth.

We went back to my exam room and I outlined his illness for him.  I told him he had cancer, that I didn't have medicines or surgery to offer him, that his illness would kill him, and that I didn't want him to spend all of his money going to witch doctors promising a cure for him.
James took it all in and asked two questions that took my breath away:
"What did I do that made this sickness happen?"
"Will I make my family sick with this?"

What could I say?

What made you sick?  The fact that you were unfortunate enough to be born in a mountainous island country with neglected people and a health system that can't guarantee immunizations to its people.  Instead I told him "Nothing you did made this happen."

Further, having just received the body blow of a terminal cancer diagnosis, James' first thoughts went to his wife and two sons.
"No you will not make your family sick." 
"Thank you - I didn't want to go home and make them sick"

I prayed with James, prescribed some medications to help with his pain and nausea and told him to return to me in a few weeks.  After I showed him out and closed the door, I went back to my desk and pinched the tears from my eyes as I prepared for patient number nine.

After a long day full of draining fluid from lungs, lancing abscesses, refilling medications and ultrasound scanning pregnant patients, I was again stopped in my tracks in the late afternoon on patient number 44.

Jim came from another province with a "chronic sore" in his leg.  He walked clutching a stick in his left hand and smelled of infection.  His condition started nearly four years prior and he had been to many hospitals around the highlands.  His sister brought him to Kudjip.

I said he might need surgery to remove some infection in his bone.  Could he come back in the morning for an X-ray when the hospital opens (we had stayed late and our X-ray technician was already home).  His sister explained they were from far away and couldn't make it back anytime soon - could I admit him to the hospital?

At the end of a long day, I wanted to stand firm on hospital policy and I knew that our medical ward had recently been filling up a lot.  I said sorry.  He would have to find somewhere to sleep and return.  In other words, go away.

"Give me Your arms for the broken-hearted
The ones that are far beyond my reach
Give me Your heart for the ones forgotten
Give me Your eyes so I can see
I went on to patient number 45, the last patient of the day. But halfway through speaking with her, my heart dropped into my gut.  I couldn't focus on what she was saying and the words on her health book blurred a little.  All I could see was an image of my last patient, clutching a walking stick and struggling his way back down the stoney roads - turned away again, in a time of deep need.  The tears came in earnest and I excused myself.

I went quickly to the front of the hospital looking for Jim.  I scanned our patio area and business offices.  He wasn't there.  I checked at the dispensary but, I realized, I hadn't prescribed any medicine so he wouldn't be there.

I had lost him.

But I knew I couldn't send him back to the jungles of Papua New Guinea, simply hoping that he could return for his testing and treatment later.
I went past the emergency room and the outpatient waiting area.  Finally, I saw him hobbling toward the gate to exit the compound, still clutching his stick and struggling to walk.  His sister, Josephine, stood talking to one of the security guards asking about places to sleep, but with a worn expression on her face.

I choked as I told them "Wait - don't go away.  Stay, sleep in a bed at the hospital and see me in the morning for your tests."

"Which was the greater miracle?  The suspension of natural law for the sake of physical healing, or the conversion of the human heart by absolute love?"
-Michael D. O'Brien

The next morning Jim's X-ray showed infection of his femur.  He might get some help by taking an extended course of antibiotics, but I would need to see him in a month and check his leg again.  Josephine and Jim both thanked me and she added "God bless you" in English.  They gathered their things and began again the slow walk toward our security gate, this time with medications and a day to return written into his book.

I've seen some miraculous things at Kudjip.  Patients who shouldn't live that were rescued from the brink of death.  Pregnancies or babies that should have been lost but survived.  Patients with Luekemia that received life-saving medications and left cured.
But I've also seen a devastating amount of heartache and physical healing that never came.

I will admit that the thing I'm impressed by the most are the moments in which a human heart is changed.

Sometimes in the patient, like James, who gracefully accepts the terminal cancer diagnosis well beyond their control.  Sometimes in the calming touch of a nurse or chaplain toward a grief-stricken parent whose child dies in the hospital.

And sometimes, painfully, in the merciful conviction of this doctor's heart when my fatigue or frustration would otherwise deprive a suffering person from receiving what small help I might give at the end of a long day.

I know I haven't got enough strength to care for all of PNG.  And at times I long to live and work in a place where doctors have the time, medicines and technology to meet the needs of their patients.  But other times I feel God's impression on my heart so clearly - to show compassion on broken lives in spite of my failing strength.  And then I know the heart that really needs changing is mine.

Monday, January 19, 2015

Kinder tomorrows

"Black clouds are behind me,
I now can see ahead.
Often I wonder why I try - 
hoping for an end.
Sorrow weighs my shoulders down
and trouble haunts my mind.
But I know the present will not last,
and tomorrow will be kinder."

At eight in the morning on Saturday, I began rounds on our postpartum ward.  I prepared for a hard day of call, anticipating a lot of work after a very busy week following the holidays.  I wasn't disappointed in that aspect.

After seeing a few patients a nurse summoned me to our pediatric ward to evaluate a patient "going off" - a phrase the nurses use here when it seems that a patient is close to dying.

Waity came to Kudjip with mouth sores creating pain with eating.  Unfortunately, Waity was adopted a few months ago and didn't breast-feed, leading to a vicious cycle of infections and diarrhea causing malnutrition.  Two days prior, I thought Waity would die in the emergency room - the nurses couldn't get any intravenous fluids to him and he wasn't conscious.  After placing a metal catheter into a bone of his leg, I was able to give him antibiotics and fluids.  The next day Waity looked miraculously better.

But it wouldn't last.

Waity's frail body couldn't tolerate the infection, despite our best efforts to fight it off.  Now, as I looked at his family gently patting his hand I knew the worst was coming.  The nurses resuscitated Waity but without success - he passed away and the all-too-familiar sounds of howling grief filled the ward.

A little boy further down the ward from Waity named Franky also struggled through the day.  He had Down's syndrome, as well as a congenital heart defect causing his breathing to be labored.  His six-month old lungs and heart worked hard to get him enough air, even while receiving medicines and supplement oxygen in the hospital.

I explained to his family that his condition was incurable.  He might improve a little by getting medications and oxygen for a while in the hospital, but eventually he would die from his heart condition.  I prayed with his mother almost every day.

Every tomorrow I hoped would be kinder for Franky - but every day he struggled to breathe unless connected to his oxygen.

After rounds a couple days ago, as I packed up my stethoscope preparing to go to our outpatient department, I took a last glance down the ward.  Several families whose children were sick came from a long distance away and didn't have friends or relatives to get them food during their stay.  I saw Franky's mother gather additional food from her bag in the corner and walk up and down the ward, handing it out to parents who, like her, hoped that their children would improve.

Some hours after Waity passed away, Franky took a turn for the worse as well.  I had nothing else to offer him.  I couldn't bear to stay in the ward listening to another mother let loose her grief.

Now Franky is in an eternal peace, breathing easily without any pain, but his mother feels his loss as she makes the journey back home without him.

Yesterday I went on to lose two more patients: Ruth - whose leukemia got the best of her, and Elizabeth - who suffered a tragic death after developing Guillan-Barre syndrome, a condition normally survivable with the use of ventilators.

My first few months at Kudjip, I looked at my call days as learning experiences.  So many of the diseases were new.  I performed multiple procedures and even some surgeries.  Calls concluded and I felt I learned a good deal.  But then the adrenaline rush of practicing in a mission hospital wore off.  And I got to the end of my calls remembering the faces of the patients whose last moments I could only watch and pray through.

And I just hope for the next day to come - so I can recover from the realities of the hurting people here in Papua New Guinea.  And one of my colleagues arrives to face whatever the hospital has for them.

"For we will surely die and become like water spilled on the ground, which cannot be gathered up again.  Yet God does not take away a life; but He devises means so that His banished ones are not expelled from Him."
-2 Samuel 14:14

Yesterday, Rachel struggled through the labor of her first child.  Her body's contractions weren't effective and after a few hours without progressing, I gave her oxytocin, a drug to help strengthen them.  After some time on this, it seemed there was no way for her to deliver her baby.  I went to talk to her about performing a non-emergent C-section because of her failure to progress.

But her baby wasn't happy with the labor.  Heart tones that sounded out at 140 a few moments ago suddenly dropped to 60, and stayed there - a bad sign.  I turned off her oxytocin, gave her fluids and oxygen and checked her cervix, praying that she was ready to deliver quickly.  Seven centimeters - not enough to help her with a vacuum.  We mobilized our OR team but I knew it would be at least fifteen or twenty minutes before we could operate - and Rachel's baby may not have that long.

 Sister Vero got the OR ready while brother David raced in to provide anesthesia, I placed a catheter to drain Rachel's bladder.  The movement helped the baby come down and she could nearly deliver.  I pushed the remaining cervix around the head of the baby and told her to push.  The baby was coming down but its heart rate was still just 60, far too low.  I took a risk and applied a vacuum extractor to the baby's head, pulling skyward while Rachel pushed.  In a minute, the baby was out on the bed, screaming and crying - beautiful sounds on the obstetrics ward.
"Mother, listen to my heart,
Just as one beat ends, another starts.
You can hear no matter where you are"
-Punch Brothers 

Three other babies delivered safely at Kudjip yesterday, and I couldn't help but consider that though we lost four lives there are four new healthy babies in our postpartum ward.

They won't be a comfort to the families who have lost loved ones.  But for this missionary doctor - I think of those four babies, I look at today's beautiful sunshine, I enjoy the presence of my wife and children.  And even though I won't forget the faces of those lives I couldn't save yesterday,  I continue to hope for kinder tomorrows.