Solemn Rejoicing

“Emmanuel shall come to thee O Israel.”

Performed by JJ Heller

Several weeks ago a young lady named Ludy came to our hospital. Ludy had been to see us once before with contractions early in her pregnancy. We treated her with steroids and a medicine to ease her contractions and sent her home. Within a few days, Ludy started having contractions again. She knew her baby was coming. On Thanksgiving day, she made the return journey along the stones and across the rivers of Papua New Guinea and arrived at the hospital just in time to deliver a premature baby.

She was small, but cried vigorously. She swaddled her up and settled in for the long night, wondering if she would survive.  Her daughter weighed only 1.03 kilograms (2 pounds, 4 ounces). We placed her in our warmer, started some intravenous fluids and medications to help her breathing and prevent infection.

Working in the newborn nursery at Kudjip brings me such mixed emotions. So often, babies who ought to live die under my care. Other times, babies thrive and their mothers receive their bundles of joy after some tender time in the hospital. I have learned to think of babies surviving in terms of their birth weights. Between 1kg and 2kg, I give them a percentage. A 1.5kg baby I would say has a 50% chance to live. I gave Ludy's baby a 3% chance (1.03 kg) to live.

“O come thou dayspring, come and cheer

Our spirits by thine advent here.

Disperse the gloomy clouds of night

and death's dark shadows put to flight”

Esther and I recently disagreed about this ancient hymn, now a common Christmas carol.  She felt the song was in conflict - urging us to rejoice but always written and performed in a somber, minor key. 

While true, I noticed that the words speak about a messiah who is yet to come. Israel, indeed the world, groaned without Him.  Families were divided by occupying kingdoms, refugees filled the middle east, people were oppressed by rulers, mothers and babies died in childbirth.  The carol represents a command, not a feeling.  Rejoice not because the savior is here, but because we have the guarantee of his coming.  Rejoice in the midst of the unknown.   Rejoice solemnly, but with hope.

Every morning, the first patient I see is Ludy's little girl.  For a week or so, she lost weight and couldn't feed.  Then, miraculously, she began breathing well.  She took small amounts of mother's milk offered through a feeding tube.  Her color improved.  She gained some weight.  Each morning, I rejoiced a little more when I saw Ludy caring for her tiny baby in our nursery.

This morning, Ludy's daughter weighs 1.38kg. Every day she is beating the odds. Every day she is bringing a little more light into that nursery room. Every day she is putting death's dark shadow slowly to flight. Ludy and I enjoy her, and our solemn rejoicing holds more and more hope.

I don't know what will happen next.  But I am grateful that a savior came to absorb the burdens of His broken world.  And I choose, in the midst of these challenges, to rejoice in anticipation of a time when tears will be gone, pain will disappear and death will be a distant memory.

Merry Christmas to you and your families as we celebrate our Savior's birth.

Silent Hearts

You liberate me from my own noise and my own chaos

-You Speak

“Dr. Mark – the patient is going into arrest”

Nearly every day I hear these words from one of our nurses. When I do, I generally drop what I am doing and accompany the nurse back to the hospital ward, harboring all kinds of doubts about what will come next.

Usually, a patient lies on their bed, with nursing students around them trying to give them artificial breaths and chest compressions while family members look on in fear. As I arrive, a small opening appears and I go to the bedside. Sometimes I tell the nurses to give medications, sometimes I take a turn giving compressions, sometimes I put in a breathing tube.

Then during a pause in our efforts, I kneel at the bedside and place a stethoscope – that quasi-mystical symbol of the medical profession – on that patient's chest. In this moment the nursing students are quiet, the staff stop speaking and the family members hold their breath with their eyes all fixed on me.

And I hear nothing. No heartbeat. No familiar sounds of life.

I look at the patient's mother, father, son or whoever is standing watch over them and I say, “Em i dai pinis” - “They are dead.”

And the wails of the family erupt. Sometimes they throw themselves onto their deceased loved one or onto the ground, howling for them to return. I lower my head, say thank you to the staff and attend to my other patients while the students return our resuscitation equipment to its place and the family grieves.

Lately I have struggled with the number of patients who die here. Every day I left the ward thinking, “What can I really do, in the end?” Medically, I had nothing else to give and each day people kept losing their fights and dying. I grew tired of putting my stethoscope on silent hearts.

But one morning, as I sat looking over my garden and the mountains of PNG in the distance, I realized something.

Every moment that went quiet, while I listened for signs of life in a dying patient, meant an opportunity to listen for something more. Those moments take on an intimate sacredness. I can use those times to close my eyes and let Christ fill up the silence.

It is there that I will know you and you will know me

One afternoon, our midwife Sylvia came to let me know about a patient who recently arrived from a rural health center named Stella. Stella was expecting her first baby in a couple weeks. She couldn't have been more than eighteen. She felt contractions for a couple days and went to her nearest facility, but despite hours of pushing couldn't deliver her baby. They sent her to Kudjip.

The nurses evaluated Stella and came to get me. “Doc, I can't find a fetal heart tone”

As I wheeled the ultrasound machine next to Stella, she gave me a soft smile, despite her pain. With her contractions a baby's scalp was visible, but had an unnatural color. I placed the ultrasound probe on her abdomen, looked for a minute and then told Stella the news – her baby had died.

Her cries filled the room - the entire ward. And I wanted to run away.

But I stayed with Stella, her mother and our nurse Theresia. Stella pushed. I pulled with a vacuum. Theresia coached and supported her. We delivered Stella's deceased child after a very difficult process requiring some extensive suturing. I dripped with sweat and removed my surgical head-light to complete some paperwork.

The baby lay silent next to the bed and Stella slept under some anesthetic.

And I paused. The nurses had left. Stella was quiet. Her mother had gone out. There were no cries. I stood by her bedside listening. And I felt like I knew God's heart – as He felt the loss and grief that filled that room. Yet with a mingled affection for Stella who had survived this ordeal, would wake up and recover, and who could one day find restoration and hope again.

A few days later I sat on Stella's bed with her and her mother. I explained to her that I felt she would have children again, that they would likely be healthy, that she hadn't done anything wrong to make this baby die and that I wanted her to come straight to the hospital the next time she was in labor. These bereaved ladies smiled while holding my hands in theirs. And in a quiet moment I could only think, “sorry” and went on to my next patient.

Someone needs to be able to think medically when the noise and chaos drowns out everything else. Someone needs to direct the nurses in what medications to give. Someone needs to determine if we continue our efforts. And finally, someone needs to pronounce that patient – dead or alive. I have to be in that moment.

But Christ chooses to be there.

He chose it two thousand years ago, and keeps choosing it today. In the places of the world where babies die before they see a sunrise, where families are divided by conflict, and where children watch their mothers succumb to AIDS.

He enters to speak in that moment when someone's heart goes silent.

A man to fish

'Jesus said to Simon, "Don't be afraid; from now on you will catch men."'

-Luke 5:10

Just as I assumed my call responsibilities a woman named Elis came to the obstetric ward in the late afternoon. She was from a remote part of our province and had been brought to Kudjip along with her “wasmeri” (or guardian) after several days of difficult labor in deep jungle. Her water broke some days before she came, but because of the difficult road, she and her family could not get a car to bring her to the hospital.

When I examined her, it became obvious that her baby had died some time ago and that her body was in shock from an aggressive infection. The smell was unbelievable.

During the long hours of that evening, she endured perhaps the most devastating delivery I have ever seen and nearly bled to death. While I tried to stop the bleeding, nurses around me poured intravenous fluid and oxytocin into the large veins in both of her arms. She received blood transfusions overnight and just about every medicine I could think of to fight the infection. I honestly didn't believe she would see the dawn.

About five in the morning, another lady was sent to Kudjip for a prolonged labor. Vero had been laboring without much progress at a small health center and the nursing officer there appropriately sent her to be taken care of at Kudjip. When I arrived, her baby's heartbeat sounded strong but she was struggling to deliver. After some coached efforts and a little medicine to improve her contractions, she safely delivered a vigorous healthy baby girl.

I checked on Elis, and discovered that despite blood and antibiotics, she was still in shock with a dangerously low blood pressure. I was afraid to clean out her uterus, called a curettage, because her infected womb could rupture if I did so and she would likely be killed in the process. Dr. Erin arrived and assumed her care, packing the uterus and giving yet more medicines and blood to keep her alive.

For Vero, her difficult labor was recognized and she was appropriately and safely referred and delivered at our hospital. For Elis, through not fault of her own, the prolonged labor resulted in the death of her baby, and may yet still claim her life as well.

Such is the nature of childbirth in many of the remote parts of the world.

Some years ago, Kudjip hospital partnered with Samaritan's Purse and New Tribes to conduct maternal health education in Hewa, a remote mountainous jungle region accessible only through planes and helicopters. Susan Kopf, a New Tribes missionary and nurse, had been feeling the burden of the mothers and babies dying there for years. After the visit, one of the village women, Jennifer, became skilled at deliveries and has since delivered over twenty babies in this remote jungle village. (See the full story here)

Last week Jennifer, Susan and three other Hewa ladies came to Kudjip to learn more about safely delivering babies. For most of them, it was the first time they had seen a permanent building. I had the wonderful privilege of teaching them about obstructed labors and then showing them a normal delivery in our maternity ward. These ladies will go back to their village and apply what they have learned in an effort to stem the growing numbers of young lives claimed in childbirth there.

 

“Give a man to fish, and you feed him for a day. Teach a man to fish and you feed him for a lifetime”

I have always had a burden for teaching. I loved this opportunity to share some of the knowledge and skills I use everyday for the ladies who come to Kudjip to have their babies. But I'm even more excited that what I've done will go into the jungles through these village birth attendants and, perhaps, bring God's healing there and lead the lives of the Hewa people to the one who can teach them to fish for men.

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UPDATE:  Susan posted the following on Facebook shortly after these brave young women returned to their village.

Rise Again

"You take what is, and You make it beautiful ..."
-Lauren Daigle

I  arrived at the hospital Thursday morning and started seeing the babies in my nursery. Most Papua New Guinean mothers don't name their children until they are a few months old, because so many of them die that they want to be certain the child will live before naming them. So baby-of Susan lay in her incubator, but I could tell she wouldn't last through the day. Born only 720 grams, she may have had a chance to survive in a country with Neonatologists, NICUs and fancy gadgets and toys. In a district mission hospital in PNG, I knew what would be coming for a few days. But each day, the baby lived and sister Sylvia and I prayed that we might, beyond hope, see a miracle.

Shortly after, the nurses got me for one of our patients who had been to the restroom and returned bleeding heavily. Pong had come to the hospital the previous day bleeding from a placenta previa. My history with this condition is terrible. Her bleeding slowed, though, and I had given her steroids to try and help her premature baby survive. After my previous experiences, I thought we could delay her operation and give her baby every chance to come out strong and healthy. But now Pong was bleeding again and I quickly performed an ultrasound. I could barely discern the flicker of a pulse in the baby's heart. I knew we would be too late. The operating team quickly took Pong to surgery, and while she survived, her baby died.

As I went back to the maternity ward, I noticed a nurse swaddling Susan's baby into wraps, preparing to send the infant home with her mother for burial.

I finished maternity rounds, too drained to collect all the staff together from their myriad tasks to say our usual morning prayers.

I went to the outpatient department deflated.

And on my desk was paperwork. Actually, seven pieces of paperwork. Death certificates from the past 10 days of patients that I had taken care of in the hospital. Patients who lost their fights.

B/o Joyce, 1 day, Infant, Birth Asphyxia.

B/o Meti, 16 days, Infant, Prematurity.

L.K., 40 years, Housewife, HIV.

M.M., 30 years, Farmer, TB/HIV.

J.P., 2 years, Child, Malnutrition.

A.A., 4 years, Child, Typhoid.

N.M., 5 years, Child, Malnutrition.

“I thank Thee that this Christian way whereon I walk is no untried or uncharted road, but a road beaten hard by the footsteps of saints, apostles, prophets, and martyrs.”

-John Baillie
 

A couple hours later, Grace came to my door. Grace and I first met two years ago, when she came to our maternity ward bleeding heavily in the eighth month of her pregnancy from placenta previa. She delivered her baby who lived in our nursery for a few days, but eventually died from prematurity.

Today, Grace was seeing me for a follow-up visit, now expecting her second child. Her blood pressure had been running high and I was monitoring her for the development of pre-eclampsia. Today, her blood pressure measured 160/90 and her lab tests showed that she had developed pre-eclampsia. She was still premature.

I had to find Bill, my mentor, a couple times that day because I could tell my frame of mind wasn't the best to make some of these decisions. It became obvious that we needed to deliver Grace prematurely (again) by C-section (again) and pray that her baby would be strong and healthy. So I admitted Grace to the hospital, planning to do her surgery the next day.

In the morning, Grace and her husband Simeon were in the delivery room. I confirmed her diagnosis with lab tests and confirmed the baby's presentation with an ultrasound. Bill came to talk about our plan with Grace and Simeon and we prayed together that this baby would live. A few hours later, I recruited one of our surgeons, Dr. Ben, to help with Grace's operation.

During surgery, Grace's blood pressure reached 210/120, but she had already received doses of medicines to protect her from seizures and she did well.
Her baby delivered crying and screaming, a small but vigorous boy.

I prayed that he would be able to feed and grow, and not succumb to being born early, like his older sister two years ago.

But the next morning I was terrified to walk into the hospital.  I remembered those seven stark reminders of patients who lost their earthly fights under my care.  I remembered the three babies we lost, including Grace's, a couple years ago from this same illness.  I thought about Pong, now recovering on the ward with no child because I didn't deliver her baby quickly enough.  I settled into my chair to read, trying to summon the courage to face the fate of this day.

"Though a righteous man falls seven times, he rises again."
Proverbs 24:16

I went to the hospital to see Grace's baby sleeping comfortably next to her.  He was small, but perfect in form.  As I finished rounds, Grace smiled broadly as she cradled him in her arms and nursed him.  Her husband Simeon found me later in the morning with tears crowding the corners of his eyes, took my hand in his and simply said, "Tankyu, Dokta Mark"

"With every morning light,
again we are redeemed."

-----------------------------------------
Update:

A few days ago an older woman found me in the emergency room.  She had a baby with her and a gift of a new bilum (bag) that she made for me.  It was Grace's mother holding her grandson that I got to be part of bringing into the world several months ago.

We hugged each other and she gave me the bilum and I shook hands with this miracle baby.  Like I said, many parents in Papua New Guinea do not name their babies for a few months, because so many of them die.  But at 6 months old I assumed this little one had been named so I asked the grandmother, "Ol givem wanem nem long em?"

She smiled a bit wider and said, "Mark"

Doing nothing

"Jesus replied, 'The Son can do nothing by himself.  

He does only what He sees the Father doing, 

and in the same way.'" 

John 5:19

On Tuesday afternoon we finished seeing our outpatients a little early so I went to the emergency room to find out if I could help there.  A young man lay on the center bed with his leg in a crudely made splint and a bloody bandage over his knee.  I asked his father standing over him what happened.

The night before, he had been riding his bicycle when he was struck by a vehicle.  The family members quickly took him to a nearby hospital.  Unfortunately, all of the doctors from that hospital had walked off the job, and the nurses did so the next day.  As a result, his open leg fracture was treated with just some gauze and a crude splint, rather than any kind of stitches or reduction or surgery.



As I explored the wound and saw bone and tendon damaged, I worried he needed surgery.

I always cringe when a patient needs surgery, because I know how hard our surgeons, father-son Drs. Jim and Ben Radcliffe, work every day serving the people of Papua New Guinea.  I know Jim had heart surgery last year.  I know Ben has newborn twins at home.  I know they both have big hearts and struggle to see people suffering with a problem they can solve, yet still draw a line protecting their own time and energy and families.

I hesitantly asked Ben to take a look and tell me if I could drain and splint the wound.  He was on his way to the emergency room already, preparing to repair a limb injured by a bush-knife during one of the many fights in our area.

Unsurprisingly within 30 minutes, both Jim and Ben were putting together broken bodies in our emergency room, like they have so many times before, working into the late afternoon and evening again.  Seeing the two of them in tandem struck me.  A snapshot of this verse from John.

I don't know what is around the corner here.  I know that in a few days, Jim will go home and Ben will be alone, carrying the surgical burden of hundreds of thousands of patients here in the highlands.  I know that we have three doctors on furlough and that the four of us left will see many more patients, deliver many more babies, and take more call than usual.

But I know that God has protected the ministry here.  I know that folks at home will pray for and love us at distance.  I know that those with broken and hurting lives will still come through our gate and doors.  And I pray that we can have discernment to see how we can still make a difference, and the stamina to help those who need us most.

http://www.asiapacificnazarene.org/medical-missions-in-papua-new-guinea-who-will-pick-up-the-baton/

Asking questions

"From that time many of his disciples went back and walked with him no more.

Then Jesus said to the twelve, 'Do you also want to go away?'

But Simon Peter answered Him, 'Lord, to whom shall we go?

You have the words of eternal life.'"

-John 6

It was Monday afternoon and I had just put my books away, having taken an afternoon to study for some upcoming exams.  I returned to the hospital's outpatient department because I could tell there were still patients needing to be seen in the late hours of the day.  I would be taking call that night and I usually like to get a feel for the land, trying to detect early problems and solve them in daylight, rather than facing emergencies in the night when many of my support staff are at home.

Stay & Wait

I saw a few patients before checking on the maternity ward.  When I went, I recognized Mata - a Papua New Guinean lady who I'd seen just a few days ago for pain and discharge during her pregnancy.  I'd previously thought that Mata's baby looked OK and treated her for an infection in pregnancy, but asked her to come back today.  I could tell almost immediately that Mata was not improving, that she was getting worse.  A repeat examination confirmed, this time beyond doubt, that Mata's water broke and she now had infection which had reached her womb.  Although her baby was alive, it was very small - about 6 months.  Mata was already getting sick with fevers and pain and I knew she was in danger.  So together we decided to deliver her baby at 24 weeks gestation in an effort to save her life.  I gave her medication to start her labor and we both knew that this baby would never live to see a full turn of the earth.

I was summoned to the emergency room to see several patients, one of whom had an abdomen that looked like it housed a small beach ball.  I could tell that Simon had a liver tumor and it was now obstructing his ability to eat and he was losing weight.  I talked to Simon, explained that we couldn't cure him, prayed with him and his family and gave him some medications to treat his nausea and pain.

As I finished his paperwork, sister Nellie from Maternity ward came to get me to see a patient quickly.  "Dokta, mipela nidem yu kam hariap"

As I arrived at labor bed number five, a young lady certainly no older than 18 lay on the table.  She seemed quite relaxed and I wondered what Nellie could be so worried about, until I examined her birth canal.  As soon as I did, blood and clots hit the bed.  I felt one foot of the baby, and the edge of her placenta.

My heart rate crept up as I gave the nurses near me instructions: place a second IV site, call lab to bring a unit of blood, get a delivery tray, bring the suction machine.

Even without an ultrasound I could tell that young Dora was about to deliver a breech baby through a marginal placenta previa.  I could also tell that this foot, perfect in its form, was far too small to be a term baby.  And all the while, she was still bleeding.

As items became available and we gave Dora medicine to improve her contractions, I asked her to push.  One small foot became two, which became a trunk and shoulders, and then the difficult task of trying to safely deliver this little one around her placenta.

Dora's baby wasn't breathing and I rubbed and dried this tiny child the best I could while Nellie gave some additional breaths with, as is commonly the case, a breathing mask a little too big for it.  We got a cry, and Nellie took the baby to try further resuscitation in our nursery.

I turned my attention back to Dora, who was still bleeding.  I delivered her placenta and then massaged her uterus while a nursing student gave oxytocin and cytotec to stop her bleeding.  After what seemed hours, the bleeding stopped and Dora's heart rate decreased from about 140 to maybe a hundred.

Having convinced myself that Dora would survive, I went to Nellie in the nursery to check on her 1100 gram baby.  And I saw something I had never seen before.

A young man, also about 18 years old, stood inside the nursery, alongside several breast-feeding mothers, his dread-locks hanging toward his shoulders and his eyes fixed on the isolette that held Dora's tiny baby.  It was Dora's young husband - and he was the first father I had ever seen come to our nursery.  He wept uncontrollably.  I asked his name, and after several choked efforts he replied, "Joel."

I explained that I couldn't save his baby, that we would do everything we could with our medicines, but that I thought certainly the baby would die.  I told Joel that Dora was safe at the moment and she would need to receive blood and stay in the hospital for a while.  We prayed, and as we both looked at his tiny baby struggling for life, he managed to choke out a small "Thank you"

As I left maternity ward, I noticed a nursing student cradling a small bundle in her arms away from Mata's bed.   And I went home with a sunken heart.

After several weeks working at Kudjip, I found myself asking a lot of difficult questions.  Mostly they centered around me or the hospital.  

 What am I doing wrong?  How can we make our nursery better?  How can I keep these babies from dying?

Eventually, the questions turned into bigger ones no longer focused on myself.

Why are these things happening? 

"He is already half false who speculates on truth and does not do it.

Truth is given, not to be contemplated, but to be done.

Life is an action, not a thought."

-F.W. Robertson

I used to spend a lot of time asking questions.  And I wondered for a long time why I couldn't answer them properly.  I still do, sometimes.

But now I know that I don't have to get the answers to all of my questions before knowing what to do.  I could let my confusion paralyze me.  I could ask questions of the stars and miss the world and lives around me.

The same night that Mata and Dora lost their babies, Susan came to Kudjip with strong contractions expecting her third child.  It was just past midnight and I had just finished stitching a stab wound in the emergency room when Nellie came to get me again.

Susan was eight centimeters dilated but her baby was breech.  We mobilized our surgery team, and within 30 minutes Susan's baby was born and vigorously cried in my arms.

It seemed so commonplace, so routine, that I nearly missed it.  For Joe our anesthetist, Roselyn our scrub nurse, Shekaina the nursing student and myself Susan's baby girl was just "another day at the office."  But for Susan, that new life was a miracle which could just as easily have been lost.

And I realized, as I watched Susan warmly smile and cradle her baby girl, that having the answers to my big questions didn't make any difference to the two of them.  I could ask my big questions forever, or I could focus on the only important question left:

To whom shall I go?

Wearied

 "Marimari kisim bek mi"

"Grace brought me back"

-OneBell

The last few days at Kudjip have been hectic.  Some of our doctors left for furlough or conferences leaving a bit more work for the rest of us.  On top of that, our highlands regional referral hospital closed its doors after all of the staff there walked out on strike.  Needless to say, the patients are streaming in ...

The same weekend that three of our doctors left, I took an emotional hit on the wards.  A little girl came to the hospital with spastic movements and seizures - my second case of tetanus in two years.  The next day, I saw a familiar face on the ward.  One of our nurses, Josh, suffered a seizure at home after a severe headache and was paralyzed lying on the floor.  Since his graduation from nursing school last year, Josh and I have played soccer together.  But now, it seemed he had a sub-arachnoid hemorrhage, and I could do almost nothing to help him.

Then the never-ending stream of patients - some using up their savings to make it to Kudjip from far reaches of the country.  With bone infections, HIV, Tuberculosis, heart failure, tumors, meningitis, cancer and a myriad of other ailments.  By the end of most work-days I was just ready to sleep, but needed to be available for call a few nights as well.

But each morning I lost a little more heart as my patients still suffered seizures, or children died in the night or in my hands the next morning.  And I wondered where the strength would come from for more of the same work.

"You have not wearied yourselves on my behalf"

-Isaiah 43:22

I remember working long hours in residency, spending day after day in the hospital and many nights as well.  Juggling paperwork, checking on patients, going to the clinic, grabbing a few frantic bites to eat and coming home many days drained of my energy.  I remember thinking that medicine must be an ungodly profession to demand so much.  I remember planning on the glorious days after my training was over when I could have a more reasonable schedule.

I wonder now where I got the idea that God would call me to something with a "nice schedule"

 "Thou hast willed that through labour and pain I should walk the upward way; be Thou then my fellow traveller as I go."
-John Baillie

As I continued working through the crowds, I remember praying for strength and encouragement to come.  I knew I was wearied, but I trusted that my weariness was on His behalf.  And I put another foot in front of the other, shouldering bigger loads than usual, but realizing that a grace beyond me kept me going.  A grace that brought me back to the same wards, the same emergency room, the same stony ground - but with a new strength.

Karapen is a pastor in our area who comes to the hospital every couple of weeks or so.  Sometimes Karapen needs medicines or a new problem looked at.  This isn't surprising given his age, which I would guess to be about 70.  But many times I think he enjoys the fellowship and company of the doctors here.  Karapen has planted churches throughout Papua New Guinea.  And during our short-staffed week, he came to my room needing a new supply of medicines because he was going to help open a church in Enga, a remote province requiring a significant journey for this faithful servant.  I wrote his prescriptions and tried to encourage him, but I could feel the line building up as the minutes ticked away.

But Karapen, as usual, slowed me down.

I wrote some time ago about looking for the one patient each day that I should minister to in the midst of a streaming line of hurting and needy people.  That day, I was grateful that for Karapen - I was the one.

He set down his cane and put his weathered hands on mine and prayed that I would have strength for the work of the hospital, and then prayed for my entire family by name, asking that God would give us grace to continue the work here.

And that grace met me.  In the smiles around me.  In the patients who could see my fatigue and put their arms on me and pray for me.  In the nurses who pick up extra work (in spite of their pay cuts) to make things a bit easier for the doctors.  In the miraculous recoveries of my patients.  And most of all in the felt presence of that fellow traveler, who at times interrupts my labour and pain to show me that my weariness is truly a part of the upward way.

Josh - healed, now back to work.
 

Tetanus no more.

An open apology

Most of the time I write a blog post, I imagine that the people reading it want to know about the stories and lives of my patients in the hospital. On some occasions I branch out. And lately I've struggled with something a little different.

My fellow missionaries.

Not the ones who serve alongside me at Kudjip. I mean the cadre of missionaries around the world – of whom I know a small collection – working to improve lives and share God's love in a myriad of ways.

By nature I feel I am a competitive person. At four years old, I joined my first soccer team – the Hawks. We had uniforms of silver with black vertical pinstripes, black shorts and black socks. I played goalie for one game and let in a bunch of goals. I quickly got out of the goal box into “midfield” - though positions at that age are laughable in soccer. We barely had a winning season.

I can't remember anything else about being four, but I remember my first team. Throughout my life I have LOVED soccer – the competitive nature, the teamwork, being outside in all weather and how the skills were so international.

In high school, once I stopped messing around being a rebellious teenager, I crushed my school work and standardized tests, carrying the same attitude into undergraduate studies and medical school.

 

Clearly one of my proudest moments

In some ways I like this nature – it pushes me to excel, to accept challenges and to hit problems head on and work hard.

But there is a downside, and I'm learning it, albeit slowly.

I struggle comparing myself and my ministry to other missionaries frequently. Competing with my co-laborers.

We have friends serving in parts of the world that I can't even mention. We have friends serving in parts of the world with the worst health statistics in most categories. We have friends serving in battle zones - in the backyard of ISIS. We have friends in some really difficult places. And recently I've encountered various “movements” which emphasize certain parts of the world neglected by missions.

Why do I find myself disliking these movements?

Because the place I work is surrounded by tropical jungle and lush gardens? Because the majority of this island is “Christian”? Because the temperature varies from 55 to 85 degrees? Because my mission field isn't in the 10/40 window or on somebody's list of tough-to-reach places? Because I'm not the “best” missionary I know? 

 

Our rugged mission field

Sadly, yes.

So I've had a bit of a bad attitude. I haven't acted on it much, but isn't it wrong to even harbor ill will toward your brother in your heart?  More importantly, I'm realizing the effect it has on my own ministry here. Am I minimizing the kinds of things I can do to show God's love among the PNG highlanders because I'm too preoccupied with how my efforts stack up against someone else?

This week I've sat down and joined my hands in prayer with patients who won't survive a year, a month or even a week. I've prayed for them full of nothing but tears. I've told people they have HIV and that their lives will never be the same. I've told a young mother her child is dying of cancer and there's nothing to be done for them. I've told a husband that his wife and mother to his four children will not live through her hospital stay – and been sadly proven right within a couple of days. I've pushed the last few breaths into the life of a young man that I know would have survived if he lived in a country with intensive care units.

But are none of them considered “high priority” because they are not on somebody's list or in the "window"?

 So close ...

 In my exam room, the operating room or walking the wards surrounded by the sounds of grieving family members - have I allowed myself to believe that?  And to question if my time and energy is worthwhile in this place?  Sometimes, I have.

(Note: obviously this is not necessarily the belief of those involved in difficult places or these kinds of movements, but my own personal challenge)

So I apologize to my comrades around the world for having a bad attitude - thinking that my ministry needs to compete with others.  But also to my ministry here in PNG because I've let that competitive spirit skew my perception of the sacred work that we've been given to do, each in our different ways to different people.

And going forward, I pray that I can learn to better appreciate whatever way God allows me to bring genuine healing and hope to people, families, the mountains of PNG and, in some way, the world that He desperately hopes to restore.

“O most loving God, who in the Person of Thy Son Jesus Christ didst manifest Thy love to man by relieving all manner of suffering and healing all manner of disease, grant Thy blessing, I pray, to all who in any corner of the world are serving in Christ's name:

All ministers of the gospel of Christ:

All social workers:

All missionary workers abroad:

All doctors and nurses who faithfully tend the sick.

Accomplish through them Thy great purpose of goodwill to men, and grant them in their own hearts the joy of Christ's most real presence.”

-John Baillie

Unnoticed

"Then the woman, seeing that she could not go unnoticed, came trembling and fell at his feet."

Luke 8:47

We are back in Papua New Guinea, and the familiar sights and sounds are a comfort as I sometimes find my mind wandering to my family and friends back home.  The tropical mountains around us, the rain and misty clouds rolling down in the valleys, our house and garden, our neighbors.  The nurses and staff who smile warmly when they see me, almost surprised that I am back among them.  The hospital, my HIV patients, the smiles of mothers as I examine their babies every morning.  The crowds of people who wait hours to be seen by one of our doctors, some of them traveling many miles over dangerous roads.

Lucy arrived at Kudjip with a scarf wrapped around her head.  She paid her fees at our business office and joined many others waiting for her visit, her patient record book in her hands and her bilum in her lap.  As she sat there, patients in front of her were called to various rooms, received their care and went to the dispensary for their medicines or to the lab to get further testing.  And each time, she moved a little closer to the row of doctor's offices, keeping her scarf positioned over her as she shuffled down the line.

When I went through residency, I spent two or three nights each month being "volun-told" to our program's domestic medical missions outreach, Good Samaritan.  With only a couple of hours in the evening to work with, young doctors found themselves grappling with crowds of patients, most of whom needed a comforting shoulder and listening ear more than just medicines or lab tests.  During those hours, when I already felt the fatigue of my long hospital hours, I struggled to see how I could minister in the midst of the craziness that bringing medical care entails.  I get so busy and wrapped up with ordering the right tests and giving the right treatment (or in Papua New Guinea - clamping arteries, setting bones and delivering babies) that I forget sometimes what my medicine is supposed to include - a way of ministering God's love to those I see.

But one night, working on the van, I shared with the nurses an idea I felt God give me.  I couldn't "dig in" to every one of my patients.  I might have compassion for, but I couldn't love the crowd.  But I felt in every day that I practiced medicine, I would get one patient to listen to, to cry over, to pray with.  Since then, I've looked for "the one" - the person who wasn't supposed to see any doctor that day except me.  That God put in my path so that we could comfort each other.

As Lucy approached the front of our waiting area, I called her to my room.  She sat down and handed me a book full of doctor's visits at various hospitals around the country.  She had been seen for pelvic pain many times and got no relief from different medicines and treatments.  Her scarf slipped and I noticed a black eye and cut on her lip that had been somewhat hastily sutured the week before.  As we talked I felt sure - she was the one.  Unnoticed, perhaps until this moment, but I couldn't just send her away with pills.

After examining and scanning her, I knew that Lucy had pelvic pain from repeated infections.  As I slowed down to hear her story, she said that her husband had many other women, that she struggled to keep their children going to school and maintain their garden to feed them, that he got violent with her sometimes.  We cried and prayed together - and a very small smile crept to the corners of her mouth as I said, "Amen"

"When I’m bowed down with sorrow I will lift up Your name
and the foxes in the vineyard will not steal my joy"

 -Good to Me

Then she was gone, and I was calling the next patient waiting to my room, as the crowds all shuffled forward again.

Jesus lived an incredible ministry of touching crowds - feeding thousands and healing all who were oppressed and sick.  But to me, some of the most inspiring moments of his life were the ones in which he slowed down for one in need.  Someone that He would not allow to go unnoticed, but make a radical and personal effort to change them.  Jesus for the one.

A big part of my heart looks at the crowds.  The vast numbers of people needing help.  The people who get just a short time in our hospital compared to their incredible lives happening in villages all around us.  I want to make a difference there and change their country.  

How many people today, in PNG, South Sudan, England, America or around the world are lining up at a doctor's office with real hurt and need.  How can I make an impact there?

I don't know how to change that world, but I am so grateful for the opportunity to touch the one.