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?"

and

"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.

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."

-The Secret Sisters

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.

Peril and promise

I thought we might have an easier clinic day than most, being Christmas Eve.  Although our patient numbers were down a little, in the afternoon I limped across the line after encountering one patient in particular.  

As he made his way toward me, shoulders slumped in a defeated posture, I could tell his face was swollen and his breath was short.  I looked at the clinic book he just handed me with his name printed on the front: Luke.  The same as my twin brother.  Not even in my room yet, I knew I would struggle through this visit.

One year prior I enjoyed reading a book next to a roaring fire in my parents' living room with a beautiful Christmas tree, preparing to move my young family to Papua New Guinea  But Luke began struggling for breath on his daily walks up and down the mountains of his village.  He got medicine from the local aid post, but it didn't help and he went to a hospital a few weeks later getting slowly worse.  Worried about his cough and shortness of breath, they treated him with six months of Tuberculosis medications.  Nothing helped.  Doctors and medicines weren't making a dent in Luke's condition - and he got weaker and began losing weight.

His sister came with him into my room, bearing the body language of someone who has seen countless doctors that couldn't give them a proper answer.  Reviewing his symptoms, looking at his thin but swollen frame and going over his X-ray and ultrasound with Dr Bill, it became obvious that Luke had cancer in his chest.  Not inside his lungs, but outside of them - compressing their ability to expand and breathe and limiting how much blood his heart could pump to the rest of his body.  Luke was dying.

I explained that I couldn't cure him.  I couldn't give a medicine that would take away this cancer and a surgery to remove it would kill him in this place.  Dr Bill might, I said, be able to take away some of his shortness of breath and help him be more comfortable - but it would take several weeks of strong medicine that could leave him weak and tired, or even kill him sooner.  Luke didn't hesitate - he wanted medicine to try and shrink his tumor and maybe help his suffering.

My job in the States at this point involves sending him to a specialist, who then administers medicine in a carefully calculated and controlled fashion while closely monitoring Luke's blood counts and other possible side effects.  In the U.S. he might even get a long shot at a surgery to remove some of his tumor, enabling him to breathe easier and live longer in comfort.  But in this place, Luke gets a little IV fluid and two different kinds of poison injected into his veins, with the prayers and hopes of his doctors that he will return feeling slightly better and not worse.

 

Kudjip chemotherapy

Barimo came to the Kudjip emergency department about one in the morning and our nurse, Mr Thomas called me concerned about him.  I wish I could say I immediately got myself out of bed and up to the hospital - but I did not.  Barimo experienced epigastric pain, but his vital signs were normal so I gave Thomas his admission orders over the phone which he carried out.  "After all," I thought "what could I do differently if I were there?"  I tried to get some sleep after what had been a busy call.

An hour later, Lucy from medical ward calls me to say that Barimo is confused, short of breath and clutching his abdomen in pain.  When I arrived, Barimo looked every bit the heart attack patient, hooked up to oxygen but still cool and sweaty with a thin and thready pulse.  In a brief lucid moment, he shook my hand and said, "Hello, dokta."  I gave him morphine and prepared to give aspirin and nitroglycerin, but his heart gave out first.

I compressed Barimo's chest while Lucy and Simeon, who just returned from taking a patient to the morgue, gave him artificial breaths and adrenaline to no avail.  He died just a few minutes after saying "hello" to me.  As I made out Barimo's certificate, and his family wailed in agony, I reflected on his death.

In the US, Barimo would have received electrical monitoring of his heart, an ECG, admission to an intensive care unit and, most likely, a percutaneous procedure in which a doctor threaded a small scaffold into the artery supplying his heart that was choked off, restoring the blood flow.  He might stay two or three days in the hospital, then be discharged home with medications and activity precautions, probably to live another five, ten or even twenty years.  This kind of life-saving procedure occurs many times a day at my old hospital, which serves a population of about 200,000.  And there are multiple hospitals in Tulsa that could do the same.


Somewhere in there a patient sleeps while getting life-saving care

But for seven or eight million Papua New Guineans, that kind of care might as well be on the moon.
They can't get to a single hospital or doctor with that technology or those skills.

Why?

I'm not one to get involved with political debates - free health care, socialized medicine, mandatory coverage, etc.  But how many of those fiercely discussing such issues in the US give a second thought to bringing more healing to the developing world?  It's not perfect, but Americans can get immunizations reliably, clean drinking water at will and emergency life-saving medical care almost anywhere in the country.  But Papua New Guinea can't get a single hospital to perform at that level for its millions of inhabitants?

With so much need and such an imbalance in the distribution of resources needed to combat it, what kind of world do we live in?

A world of peril and promise.

The perils are real and the illnesses are advanced.  The poverty is extreme and the living is hard.  The stakes are high and people are dying.

But some small things can make big differences.  Some hold great promise of health and life for millions.  Like giving the right foods, having enough measles vaccination, keeping babies breast-feeding, or giving care and medicines to AIDS patients.  Every day I participate in these seemingly thankless tasks.

In the hospital, I mostly encounter patients like Barimo to whom help comes too late.  But I believe that the promises of what we can do are just as real as the perils of what we cannot.  Babies are growing, HIV patients are thriving, mothers and their children are living better because of Kudjip's staff and their efforts.  Doctors and nurses who work hard - sometimes sending healed patients back to their villages never to be seen again - but taking bodies to the morgue daily.

How long can that promise keep the perils at bay - and preserve the hope of those combating it?

Please pray for the staff at Kudjip, whose tireless efforts make big, but often unseen, differences in the lives of their patients.

Many graves

"You call me out upon the waters
The great unknown where feet may fail
And there I find You in the mystery
In oceans deep
My faith will stand"

-Oceans

A mountain range lies north of Kudjip station, just across the highlands' only serviceable road.  Beyond the mountains sits a valley filled with tropical jungle and people living in one of the most remote parts of the globe.  The name of this area is the Jimi valley.

Three weeks ago, Beron made the trip from her home in the Jimi to the local aid post for a routine checkup before her delivery.  An incredibly astute nurse, probably working in one of the most remote clinics in the world, palpated (touched) her abdomen and thought that Beron might have twins and they might not be in a good position.  He or she suggested Beron come to Kudjip.

Beron and her husband made the journey over a couple of days, and walked into our labor ward where I met them.  It turns out Beron had twins and neither of them were in a position to deliver vaginally.  I kept her on the ward, gave her vitamins and administered steroid injections to mature her baby's lungs.  Two weeks later, I performed a Cesarean section on Beron and presented her and her husband with two healthy twin boys.  Thanks to the efforts of one nurse dedicated to working in the Jimi, Beron's family is safe and whole.

 Beron and her twins - Mark & Luke (after my brother and I)

"He will bring justice to the poor of the people;

He will save the children of the needy"

About a week ago, a young lady living in the Jimi, and expecting her first baby, went to the local aid post with contractions.  After several hours, her water broke, but the baby wouldn't come out.  She pushed and pushed but could not deliver her baby.  In fact, not until three days later, after pushing with her body's contractions for almost 72 hours, could she hire a car to bring her to Kudjip hospital.  Her name is Kum.

At the time Kum arrived in Kudjip, I sat in reflective prayer during a Monday morning chapel devotion.  I enjoyed the message shared by one of our staff members but a nurse from the Obstetrics ward summoned me out.  Fighting back my frustration (our obstetric service interrupts me nearly every hour during my day), I went and discovered a very pleasant young woman on the delivery bed - but nearly fell over from the smell.

Kum forced a weak smile as I entered, but her abdomen was locked into a strong contraction creating pain.  A baby's head was lodged in her pelvis, but there was no heartbeat and the ultrasound confirmed that the baby died, probably one or two days prior.

After stabilizing Kum with intravenous fluids and antibiotics, I applied a vacuum extractor to the baby's head, but could not relieve the obstruction of her labor.  Kum needed a Cesarean.  Dr. Kevin Kerrigan, a selfless surgeon volunteering from the US, performed her surgery and delivered her deceased baby.  Kum went back to the ward, surrounded by women with their own healthy babies, to recover from her operation.  But now she leaks urine, meaning she has probably developed one of the most isolating conditions in the world, a fistula.

Lately, my heart has been breaking for the people of the Jimi.  Nearly every day I see women with obstetric complications - bleeding, infection, malaria, prolonged labors, high blood pressures.  But when the nurse tells me, "Doctor, she is from the Jimi" - my heart sinks.

I think of Lavinah, whose baby's arm presented in her birth canal during labor, then died while it took her two days to come to the hospital as her mother suffered from septic shock.  I think of Mana, whose first twin died after being born in the Jimi, and whose second (also deceased) twin wouldn't deliver until I was able to resuscitate her with a blood transfusion and apply a vacuum to the baby.  I think of other patients who arrive too late - with metastatic breast cancers, heart and kidney failure, advanced cervical cancer, or osteomyelitis (infection of the bone) needing amputations.  And I wonder what could have been if they had access to care where they lived, or if they could make it through the jungle to see us sooner.

In short, I think of the graves in the Jimi - many unnecessarily filled by the babies, children and parents of that remote area.  Some graves whose occupants I will never know about and never even have a chance to help.  Some whose occupants I know ... but knew too late.

"And I will call upon Your name
And keep my eyes above the waves
When oceans rise
My soul will rest in Your embrace
For I am Yours and You are mine"

As difficult as I find it, dealing with the problems of the Jimi, I know that my emotional struggle is nothing compared to that of its people.  I weep over the babies I can't save.  But their mothers spend a few days recovering and then make the long trek back over the same path through the mountains to their bush houses of grass and sticks.  They return to their husbands, who may or may not blame them for losing a child, and have to resume tending their gardens to have enough food to eat or sell or trade.

Where will their hope come from?  Are they condemned to an existence full of suffering and death? 

How many more graves will they dig?

Mana and Kum's babies died before they ever had a chance to hold them.  Beron's babies both survived and she is recovering well from her surgery.   A long time ago I gave up trying to figure out why things happen like that here in Papua New Guinea.  Certainly I still wonder, and I still get frustrated.  But I choose to look into the face of the suffering here every day not because I know why, but because I believe that God gave me the skills and knowledge I have for a specific reason.  I table my tears, because I have more work to do as I walk the ward.  And though I struggle to prevent my patients' suffering from paralyzing me, I know that I can only help the next one if I keep it together.

I don't ask God why these things happen.  I ask that He would send more and more people like Beron's nurse into the Jimi to care for the neglected people living there.  Slowly, I believe that those living there can receive what they need.  Until then, I pray that I would have strength to save those I can, the heart to comfort those I cannot, and the endurance to do both every day in spite of the numerous mothers and babies who are dying there.

Fears and New Days

 

"There's a rhythm in rush these days
Where the lights don't move and the colors don't fade.
Leaves you empty with nothing but dreams
In a world gone shallow,
In a world gone lean"

 -Stay Alive, Jose Gonzalez

Ten months ago I left my home country and comforts to serve in a mission hospital in the islands of the south Pacific.  There are moments I absolutely love this call.  Throughout the Gospels, Christ went to the poor and hurting places of the world to reach out to the most miserable and suffering people He could find.  In the jungles of Papua New Guinea, nearly everyone I see struggles with providing for their families and surviving in their culture and suffers from severe hardships accumulated in their lives.

But a few days ago I realized how far I am from the selfless model of Christ's example.

Margreth came to Kudjip hospital on October 31st - Halloween - though it meant nothing to her.  She had a steady back ache.  Nine months pregnant, she felt it was time for her baby to come.  Her last baby took a couple days to deliver, but arrived safely.

But in the time since her last delivery, Margreth contracted HIV.  She knew she might give this fatal illness to her little one, so she came to the hospital at the first sign of labor.

For a day she had a steady back ache but no real labor.  On her third day, I saw her in the morning and felt it was best to help her baby come rather than wait - she already looked tired.  I used medications to bring more contractions.

However, by the next morning Margreth made little progress.  I looked at her chart with scorn - a nurse overnight had not performed a vaginal exam for fear of her HIV status.  This might have delayed intervening for her or her baby.  She could have been delivered by now.  Who would avoid their duty of helping someone because of fear?

I couldn't break her water or I could expose her unborn baby to a greater chance of contracting HIV.  The baby's heart rate was too fast - a sign of trouble.  I didn't want to give her further help because it could stress the baby.  She developed a fever.  Margreth was getting sick.  Her baby needed to be born now.

It hit me.  I would soon be performing a bloody surgery on Margreth - using sharp instruments to remove her baby from her womb.  My hands would be covered in blood infected with HIV.  And the fear of that overnight-nurse grabbed my heart.

About 0.7% of the population of Papua New Guinea are infected with HIV.  In our area, Jiwaka, the number is closer to 1-2%.  Our HIV department manages the care for thousands of HIV patients, some of them moving to Kudjip from other areas to receive the best ongoing medical care they can.

Many, if not most, of the women infected with HIV acquire the virus from their husbands or partners.  Once discovered, though, they are sometimes beaten and abandoned.  Stigmatized because of their illness, many places refuse to treat them and family members neglect them.

They are left empty in a shallow world, expecting a baby - and their dream is that it won't end up "like them."

Imagine having a deadly disease, needing medical checks and daily medications, as well as being pregnant without anyone to support you through it.  You are trying to be responsible for yourself and your unborn baby, but even at the hospitals or clinics, everyone puts on extra gloves before they even touch you.

This was Margreth's reality as she labored at Kudjip.  Yet I, a healthy and respected missionary physician, still hesitated in taking the necessary action to deliver her baby safely.  What does that say about my efforts here?  Did I travel thousands of miles, leaving friends and family, to fail in the most critical final moments of God's call for me?  She did everything in her power just to stay alive and deliver a healthy baby.  I didn't want to perform surgery on her - and that taught me how far I've still to go on the road to serving like Christ.

"One of the ways the mission of God ... chisels away at us in the work of sanctification is when we engage with the hurt, the pain, and the sorrow of the world around us.  When we do that, God shows us our inadequacies, our shortcomings, and our fears."

-Matt Chandler

I prayed with Margreth for her and her unborn baby before we started.  Then I made the initial incision into Margreth's abdomen.  Every time I picked up the scalpel or a needle my heart skipped a momentary beat and I watched its point carefully.  Her baby boy delivered after some difficulty removing him.  Blood washed over my hands as I cleaned out her uterus.  Her surgery went as smoothly as I could have hoped.  All of the paper drapes and gowns were thrown away (we normally save and re-sterilize cloth ones).  I wiped the thin line of sweat from my top lip and began to make out her post-op orders.

Missionary surgeons, doctors, nurses and others take these risks every day - and most take them more frequently than I do.  I wonder if they struggle each time.  Do they still ask themselves if they are willing to take the risk?  Are they just reckless?  Do they think they'll be supernaturally protected from harm?

I think not.

I believe they are motivated knowing Christ embraced risky situations if it meant He could touch someone in great need.  Especially the marginalized and forgotten.  The truth is that engaging the neglected or isolated people of the world represents no more or less than God's call on any of us.  In various places and with varying degrees of risk and sacrifice, God's people are told to care for the hurting world.

With that knowledge, I look past my fears and see the beautiful child and mother, safely united, looking forward with hope.  I see new days beyond those difficult nights.

"But there is a truth and it's on our side -
Dawn is coming, open your eyes.
Look into the sun as the new days rise"

To find each other

"To see the world, things dangerous to come to, to see behind walls, draw closer, to find each other, and to feel. That is the purpose of life."

-The Secret Life of Walter Mitty

About six weeks ago, Nellie's parents brought her to Kudjip hospital in great distress.  She experienced high fevers for several days and then began to drift in and out of consciousness.  Once she arrived, Dr. Erin Meier treated her for meningitis but she failed to show significant response.

Around here if a patient looks infected but doesn't respond to our usual medicines, we quickly suspect Tuberculosis.  Rare in the United States and other developed nations, Kudjip hospital registered 565 new TB cases last year alone.  The average person with Tuberculosis exposes about ten additional people per year.

Nellie's condition worsened - she went comatose and couldn't communicate or eat or drink.  Dr. Bill McCoy place a feeding tube through her nose into her stomach to administer treatment for Tuberculosis of the brain.  Over some days and weeks, Nellie showed gradual improvement.

This week I've been working in our Primary Health Services department, helping in programs from Antenatal care and immunizations to TB and HIV clinics.  Our devotional on Wednesday morning happened on the TB ward.  Nellie sang in broken tones our hymns and said "Tank yu" to Tolbai who led the devotions that morning.  Her mother lovingly calmed her when she had fits of agitation in her wheelchair.

I realized as I watched Nellie and her mother what a common bond exists across the world for family.  Nellie will never have a normal life.  While she shows some improvement, she will likely have serious mental deficits forever.  Yet her mother cares for her tenderly, thankful that she is alive.

Later that day I cared for a young girl, Rose.  Rose had a cough that wouldn't go away.  I thought she might have asthma or a simple pneumonia, but unfortunately seven-year-old Rose has been living with HIV since her birth, acquiring the disease from her mother at the time of delivery.

Rose's father showed concern for her and affectionately led her around the hospital to get her X-ray taken and collect her records from our HIV department.

Rose's X-ray appeared to show a pneumonia, and her HIV seemed well controlled on her anti-retroviral therapy, so I prescribed an antibiotic and told them to see me again in a week or so.

Although Rose's pneumonia may get better, her reality means she most likely won't live beyond the age of ten or twelve.  Knowing this, her father still cares for her diligently, assures she gets her medical checkups on time and gets her supply of ART regularly at Kudjip.

Getting around in Papua New Guinea isn't always easy.  Frequent mudslides, storms and even tribal wars can make roads difficult or impassible.  However, every day pregnant mothers come to Kudjip to get checkups for themselves and their babies.

While most pregnancies will proceed without problems, the poor nutrition, difficulty in accessing medical care and risk of malaria in most women here makes the neonatal mortality one of the worst in the world.

But these women come to get antenatal vitamins, HIV tests, counseling and malaria treatment to give their unborn children the best chance of survival.

I find it easy to distance myself from patients at times.  There are one hundred and fifty new patients every day in our OPD.  The hospital beds fill up with new people every few days.  The ER sees dozens more each day.  With so many people coming through the doors at Kudjip, many faces get lost in the shuffle.

Yet each person has a unique life, a unique voice and a unique story to find.  At times, I have to slow myself down and really listen for at least one patient every day that I'm supposed to touch, hug, pray for or just cry with.

And in those times, though thousands of miles from home in a new culture and language, I feel like I find someone specific that God sent me here to help.

Co-laborers

"I beseech you therefore, brethren, by the mercies of God, that you present your bodies a living sacrifice, holy, acceptable to God, which is your reasonable service."

-Romans 12:1

When I first came to faith I used to imagine myself like one of the ancient martyrs.  Losing my life for the faith of Christ seems, to most, the pinnacle of service to God.  Not until several years later did I realize the importance of this verse in Romans.

God indeed calls some to lay down their earthly lives for Him.  However, I realize now He calls each of us to give up our lives, even if we enjoy many ongoing years on this earth.  Why should I be confident that I would lay down my life and die for my faith if I'm not willing to lay it down and live for it?

At Kudjip I enjoy the privilege of working with incredible physicians who live their lives in a sacrificial service.  Having met, learned from and loved them - I want to share them with you.  I can never put enough words to the testimonies that their lives represent to me, but I will try to give you a glimpse into how they've affected me.

Dr. Jim Radcliffe currently recovers from open heart surgery in the US, but plans to return in about three months and resume caring for the sick and needy as a surgeon at Kudjip - a position he's filled like nobody else could for the past thirty years.  He life and ministry, praying with all of his patients, speaks to his endurance.

Dr. Bill McCoy I cannot say enough about.  Bill attended my birth in Tulsa, Oklahoma thirty two years ago and has remained close to our family.  He is a large part of the reason our family moved to Kudjip and his mentorship and now friendship, along with his wife Marsha, has smoothed our transition here in humbling ways.

Dr. Susan Myers left practice in the United States and moved to Kudjip with a young family over a decade ago.  She now serves as the director of medical services and her patience with me as I learn to function in the Kudjip system reassures me in times that I wonder if I can continue here.  She has a special ministry for our children with congenital heart disease.

Dr. Andy Bennett loves on his patients and gets to know them outside of their illness.  He also works every week to correct club-feet in young PNG children who would otherwise spend their entire lives crippled.  If you need help remembering the fourth verse of an old hymn, ask Andy.  Andy's heart-felt care and encouragements remind me of my dad.

Dr. Scott Dooley runs the whole show.  I don't get to work with him much in the hospital, but it is great to have a fellow "visionary" to discuss grandiose and entirely speculative ideas with.  I'm very pleased my neighbor is back from his home assignment.

Dr. Erin Meier never let an eye-lid droop while she watched over Levi in our scariest time since moving here.  Erin works hard, plays hard and lives on purpose and I enjoyed having her as my stand-in mentor during Bill's absence.  She also sees about half of the patients at the hospital on any given day which makes for the occasional early afternoon off - thanks Erin!

Dr. Imelda Assaigo has the best smile on station.  She works toward a Master's degree in rural medicine and seamlessly became an integral part of the team here, even though she is technically still "in traning"  She also keeps me honest in my Tok Pijin.

Dr. Scot Pringle and his wife Tyronza have been here for 4 of the 9 months that we have.  He retired from OB/Gyn practice in the states and comes at least once a year to Kudjip and takes OB call every third night, relieving the pressure on the rest of us.  Scot makes me laugh and Tyronza perpetually hosts people in their home, often making us classic home-cooked meals!

Dr. Ted Henderson arrived in the last week.  I've already enjoyed a hearty basketball and soccer game with Ted.  I blog-stalked Ted before he came and in a way he has felt like a part of our team for a while.  It's great to have he and his wife Rachel as new neighbors.

Dr. Ben Radcliffe, a surgeon and Jim's son, and his wife Dr. Katherine will be here in January.  Ben and Katherine received the same Steury scholarship that Esther and I did in medical school.  Though I've not met them yet, what I know of their family and their hearts makes me think there couldn't be a better recipient.  Ben and Katherine and their young family will become our newest neighbors, rounding out station life on the "north end" and putting a couple more playful boys down here in the middle of all the girls.