My last week at PMGH was very nice. I spent a day in the outpatient clinic- antenatal in the AM and gynecology in the afternoon. Similar to the labor ward, the clinics are extremely busy providing care to well over 100 patients per day. For the remainder of the week I split my time between the labor ward and the operating theatre. I was able to see an obstetric fistula repair, do another term breech delivery, and several routine deliveries. Prior to leaving I was able to thank the faculty and registrars for their assistance during the stay and exchange contact information with several of them.
Arranging travel in PNG can be a bit difficult but Maureen and I really lucked out!! While there are several private tour groups in PNG they are outrageously expensive for a developing country and were out of the question for us. Due to safety concerns, just showing up to a new city, using public transport, and traveling like backpackers is not advised (especially for two women). Fortunately, I was able to make contact with an Australian, Jane, who is teaching midwifery at the University of Goroka through one of the midwives at PMGH (Florence who I mentioned earlier). Jane got us connected with Samuel, a local who arranges tours and is based in Goroka (much more reasonably priced). Jane also offered us a place to stay on the university campus… free of charge.
Maureen and I flew to Goroka (in the Highlands) last Friday with the hope of a cooler climate, beautiful scenery, and a climb up Mt Wilhelm (the highest peak in Oceania- 4,509 meters). We were not disappointed… just required a sense of adventure. Samuel met us at the airport and accompanied us on the PMVs (public motorized vehicle) to Jane’s house on the university campus. Jane lives in a beautiful 4 bedroom home by herself so often hosts travelers or expats new to Goroka (while they make arrangements). Aaron, an Australian documentary film maker is currently living with her.
We dropped our luggage there, finalized plans for our trip up Mt Wilhelm, and made arrangements to see the Asaro Mud Men that afternoon. PNG is home to hundreds of tribes/clans many which still live/celebrate traditional village life. The Asaro Mud Men are one such group. Asaro village is northwest of Goroka and is famous for its mud men- warriors who covered themselves with mud and wore mud masks before heading off on raids. The village people now recreate this for tourists… a bit of a tourist trap but still interesting to see and the pictures are pretty priceless (Maureen and I even modeled the mud masks). We also had the village people teach us how to chew betel nut- a seed which is chewed with mustard and lime powder to obtain a stimulant effect. We weren’t much good at it and spit it out before any real effect. It was a good laugh though.
Friday evening Jane, Aaron, Maureen, and I went to dinner at 1 of the 4 restaurants in Goroka… we were joined by what must be most of the Goroka expat community. There were about 20 of us in total… people from all over the world who have been in PNG for varying lengths of time working for many different organizations. Dinner conversation was spirited to say the least. Saturday morning we met Samuel downtown to begin our trip up Mt Wilhelm. We traveled first by bus (PMV) for several hours along the Highlands Highway (another pot hole ridden road) through beautiful mountains to Kundiawa. In Kundiawa, we loaded into the back of a Toyota 4WD pick-up truck with locals (men, women, children, and 1 baby) and headed to the guest house in Kegsugl. The poor condition of the road was quite unbelievable but luckily was matched by breath taking scenery. Maureen and I bounced around together for several hours and ended at the East Kegsugl Guesthouse with sore bottoms.
The East Kegsugl Guesthouse is owned by Josephine and Arnold and is just down the road from the trail head. We slept there Saturday night after enjoying a home cooked meal (Josephine prepared over a fire) of veggies, rice, sweet potato, and fresh strawberries. Sunday morning with our packs on our backs we met our guides (Michael and John- two locals) and headed for base camp. Along the way we admired incredible gardens (the climate in the highlands provides plenty of rain and spring like conditions year round), purchased the veggies we would eat while hiking, and headed into what looked like a jungle with occasional pine trees. We hiked for about 5-6 hours (though the jungle and grasslands, passing waterfalls and interesting plant life) reaching base camp (called the A-frame) mid afternoon. We dried out our socks/shoes (Maureen and I only had running shoes…) and enjoyed the weather/scenery. The base camp is just next to one of two lakes found part way up Mt Wilhelm.
Sunday evening we ate dinner by candle light (veggies, rice, and potatoes) and went to bed early as the plan is to wake up at 1 AM, begin hiking at 2 AM, in order to summit early morning and be off the mountain by midday. After about 3-4 hours of sleep we were up, dressed, and ready to go. From 2 AM till sunrise we hiked with flashlights… a bit eerie as I had the feeling we were going straight up and was apprehensive about the trek back down. However, after a bit of reassurance and the assistance of our amazing guides (could not have done it without them) Maureen and I made it to the top!! We saw the most amazing star filled sky, the moon rise, the sun rise, the southern coast line of PNG, cities and rivers in the distance, several mountain ranges, rainbows through the mountain mist, the site of a WWII plane crash, and several mountain lakes. The trip was 6 hours of hiking up and about 5 back down to base camp. We both agree it was worth every bit of effort, wet feet, cold hands, bruised shins, and sore muscles. We rested at base camp for an hour or so, packed up our stuff, ate some lunch, and then walked the rest of the way down to the Guest House. After 15 hours of hiking we had dinner with Josephine, a cold shower, and went to sleep.
Tuesday morning, around 6 AM, we loaded into the back of a truck for the trip from Kegsugl to Kundiawa to Goroka (and the hope of a hot shower). As we traveled down out of the mountains the truck, which started with Maureen, Samuel, and I, slowly filled up. We stopped frequently picking up people and produce as they were headed to Kundiawa (they were headed for the market). Eventually, Maureen and I, deemed as taking up too much space in the truck bed, were told to sit in the cab of the truck. Although this afforded much less fresh air my sore body welcomed the padded seat. Once in Kundiawa, we boarded a bus to Goroka and arrived at Jane’s house by noon. After hot showers, laundry, and lunch we enjoyed an afternoon on reading on Jane’s deck overlooking the mountains we had just come from.
Tuesday evening we treated Jane to dinner at a second of the four restaurants in Goroka to thank her for her hospitality. As I said before Jane is currently teaching midwifery at the University of Goroka. She is a fascinating woman who has spent her entire life traveling. She has done 9 missions with Doctors Without Borders (MSF)- taking her to several parts of Africa, China, and the Middle East. I think both Maureen and I were in awe of her experiences. On Wednesday morning, Jane took us to the airport for our return flight to Port Moresby (it took us a bit to get checked in for a flight as the ticketing counter was basically in a shed and was not clearly marked).
As I type now, we are on Loloata Island just off the southern coast on Port Moresby. The idea being Highlands to Islands as Maureen has dubbed it. Loloata Island is located in Bootless Bay and is home to a small resort- currently we are 2 of 6 total guests. We will spend two nights here admiring our ocean view. The plan is to relax, read, reflect, and catch some rays before the return to reality. Maureen plans to do some scuba diving as well. Both of our flights leave early Friday AM.
Overall, my trip to PNG was not what I expected (I suppose this is the trend when traveling to a developing country). I greatly enjoyed my time in the hospital, the people I met there, and am thankful for the experience. Hope you have enjoyed reading/following along. All for now.
Thursday, April 11, 2013
Tuesday, April 2, 2013
4/1/13: I have a roommate!
The remainder of last week went quickly. I was in the operating room
on Thursday and then Maureen arrived on Friday. The case list for
Thursday included a cesarean section with tubal ligation, four tubal
ligations, a vaginal hysterectomy for prolapse, and a few dilation and
curettages. Friday was a public holiday (Good Friday) and Maureen was
scheduled to arrive midday. Skanda picked me up after completing AM
ward rounds and we were off to the airport.
We met Maureen in the international terminal. I am very glad she is
here to join me and I anticipate we will have some great memories at
the end of this trip. For those who don’t know, Maureen is an OB/GYN
who was in my residency program at Ohio State. She is two years ahead
of me so is now an attending physician. She and her husband, Dave,
live in Columbus, as he is completing a chief year in
medicine/pediatrics. Maureen and Dave have done a fair amount of
traveling together (both on medicine related trips and for pleasure).
They will be spending next year in Tanzania working for the medical
division of the Peace Corps. Maureen had quite the experience
traveling- she was kicked off a flight, re routed on two different
airlines, and arrived with no luggage…
Regardless, we went back to the hostel from the airport so she could
shower and have a rest (luckily we wear the same size cloths). As
Maureen adjusted to the time change I relaxed, did some reading, and
writing. We contacted Dave through Matt to work on the luggage
situation.
On Saturday morning, we went with Delly and her family to the Ela
Beach Craft Market. It is a market put on the last Saturday of every
month in Town. There are daily markets all over Port Moresby but most
on not safe for foreigners to wander around. The Ela Beach Craft
Market is hosted on a fenced off school yard. We wander around and
purchased a few things. Mostly it was just fun to look at all of the
paintings, carvings, woven bags, and jewelry. After we had our fill
we walked down Ela Beach to the nicest hotel in Port Moresby for some
breakfast.
Port Moresby is on the southern coast of PNG and has really lovely
scenery- green hills/mountains abutting blue/green ocean. That being
said it is not safe to walk the beaches alone or in the evening/night.
There are always a fair number of locals hanging around selling
things, swimming in the ocean, and playing volleyball. Given we were
a large group and it was midday we decided to wander around. Ela
Beach Hotel is just across the street from the beach behind a large
security fence and guards We went into the restaurant and air
conditioning for a quick bite. Maureen and I shared a plate of fresh
fruit and cream… the mangos were so delicious. After breakfast we
said goodbye to Delly and her family. Skanda, Maureen, and I did a
quick tour of the city by car and then a walking tour of the hospital.
In the afternoon we went to Skanda’s place for WiFi to make some
travel bookings for next week as Maureen and I plan to go to the
Highlands of PNG and Loloata Island. Saturday night the three of us
went to an Asian Fusion Restaurant which was quite good. Like I have
mentioned earlier the restaurant/grocery store scene has a lot to
offer. It primarily caters to the large number of expats living in
PNG as the prices tend to be relatively high. Expats have come to PNG
for mainly 1 of two reasons- to get rich off of the natural resources
(oil and minerals primarily) or to provide aid to a developing
country. In many ways these two are related… if industrialized
nations are going to come in to exploit local resources they often
feel the need to give some level of support to the people. It is an
interesting system… for better or worse.
On Easter Sunday we woke up early to go to the fruit/veg market put on
by a local university (Pacific Adventist University). The market is
run by the students and is very nice. We also sampled some local
foods which are sold outside- Maureen had a sausage, I had a large
piece of chocolate cake, we shared a chicken roti, and we purchased
iger to have for dinner later on. Iger is a local dish which usually
includes potatoes, cooking bananas (think plantains), greens, chicken,
and spices all wrapped in large green leaves and cooked in a pit of
hot stones.
After the market we went by the airport to see if Maureen’s bag had
arrived. The attendant at Air Niugini was very helpful and said it
should be arriving on the afternoon flight from Brisbane- we were just
to come back around 5 PM. We were both a bit skeptical given the
overall efficiency of this place and the jumbled up manner in which
Maureen got to PNG (there was also no tracking number involved… just
Maureen’s name). However, sure enough, when we returned at 5 PM
Maureen’s luggage had arrived!!! Maureen and I decided it was an
Easter miracle. We played some cards in the evening and for our
Easter Dinner heated up the iger on the stove and made a monster fruit
salad with our purchases from the AM (mangos, papaya, oranges, banana,
grapes, and sugar fruit).
Today, Monday, is also considered a holiday but we decided to come to
the hospital for awhile. I tried to photo document this place as
there are fewer patients around given the holiday (I will post them on
FaceBook when I return to the US and have good internet access). I
have not entirely decided what I will do this week- likely spend a day
or two in the outpatient setting, round on the gynecology service, or
maybe return to the OR/labor ward.
As of now, Maureen and I, are flying out of Port Moresby on Friday to
go to Goroka in the Highlands. We hope to hike near Mt Wilhem and
maybe see some birds of paradise. We return to Moresby on the
following Wednesday and will then go to Loloata Island for two nights.
On the follow Friday (April 12th) we leave on separate flights back
to Australia. I will try and write more about this as we are going if
I can get internet to post again.
on Thursday and then Maureen arrived on Friday. The case list for
Thursday included a cesarean section with tubal ligation, four tubal
ligations, a vaginal hysterectomy for prolapse, and a few dilation and
curettages. Friday was a public holiday (Good Friday) and Maureen was
scheduled to arrive midday. Skanda picked me up after completing AM
ward rounds and we were off to the airport.
We met Maureen in the international terminal. I am very glad she is
here to join me and I anticipate we will have some great memories at
the end of this trip. For those who don’t know, Maureen is an OB/GYN
who was in my residency program at Ohio State. She is two years ahead
of me so is now an attending physician. She and her husband, Dave,
live in Columbus, as he is completing a chief year in
medicine/pediatrics. Maureen and Dave have done a fair amount of
traveling together (both on medicine related trips and for pleasure).
They will be spending next year in Tanzania working for the medical
division of the Peace Corps. Maureen had quite the experience
traveling- she was kicked off a flight, re routed on two different
airlines, and arrived with no luggage…
Regardless, we went back to the hostel from the airport so she could
shower and have a rest (luckily we wear the same size cloths). As
Maureen adjusted to the time change I relaxed, did some reading, and
writing. We contacted Dave through Matt to work on the luggage
situation.
On Saturday morning, we went with Delly and her family to the Ela
Beach Craft Market. It is a market put on the last Saturday of every
month in Town. There are daily markets all over Port Moresby but most
on not safe for foreigners to wander around. The Ela Beach Craft
Market is hosted on a fenced off school yard. We wander around and
purchased a few things. Mostly it was just fun to look at all of the
paintings, carvings, woven bags, and jewelry. After we had our fill
we walked down Ela Beach to the nicest hotel in Port Moresby for some
breakfast.
Port Moresby is on the southern coast of PNG and has really lovely
scenery- green hills/mountains abutting blue/green ocean. That being
said it is not safe to walk the beaches alone or in the evening/night.
There are always a fair number of locals hanging around selling
things, swimming in the ocean, and playing volleyball. Given we were
a large group and it was midday we decided to wander around. Ela
Beach Hotel is just across the street from the beach behind a large
security fence and guards We went into the restaurant and air
conditioning for a quick bite. Maureen and I shared a plate of fresh
fruit and cream… the mangos were so delicious. After breakfast we
said goodbye to Delly and her family. Skanda, Maureen, and I did a
quick tour of the city by car and then a walking tour of the hospital.
In the afternoon we went to Skanda’s place for WiFi to make some
travel bookings for next week as Maureen and I plan to go to the
Highlands of PNG and Loloata Island. Saturday night the three of us
went to an Asian Fusion Restaurant which was quite good. Like I have
mentioned earlier the restaurant/grocery store scene has a lot to
offer. It primarily caters to the large number of expats living in
PNG as the prices tend to be relatively high. Expats have come to PNG
for mainly 1 of two reasons- to get rich off of the natural resources
(oil and minerals primarily) or to provide aid to a developing
country. In many ways these two are related… if industrialized
nations are going to come in to exploit local resources they often
feel the need to give some level of support to the people. It is an
interesting system… for better or worse.
On Easter Sunday we woke up early to go to the fruit/veg market put on
by a local university (Pacific Adventist University). The market is
run by the students and is very nice. We also sampled some local
foods which are sold outside- Maureen had a sausage, I had a large
piece of chocolate cake, we shared a chicken roti, and we purchased
iger to have for dinner later on. Iger is a local dish which usually
includes potatoes, cooking bananas (think plantains), greens, chicken,
and spices all wrapped in large green leaves and cooked in a pit of
hot stones.
After the market we went by the airport to see if Maureen’s bag had
arrived. The attendant at Air Niugini was very helpful and said it
should be arriving on the afternoon flight from Brisbane- we were just
to come back around 5 PM. We were both a bit skeptical given the
overall efficiency of this place and the jumbled up manner in which
Maureen got to PNG (there was also no tracking number involved… just
Maureen’s name). However, sure enough, when we returned at 5 PM
Maureen’s luggage had arrived!!! Maureen and I decided it was an
Easter miracle. We played some cards in the evening and for our
Easter Dinner heated up the iger on the stove and made a monster fruit
salad with our purchases from the AM (mangos, papaya, oranges, banana,
grapes, and sugar fruit).
Today, Monday, is also considered a holiday but we decided to come to
the hospital for awhile. I tried to photo document this place as
there are fewer patients around given the holiday (I will post them on
FaceBook when I return to the US and have good internet access). I
have not entirely decided what I will do this week- likely spend a day
or two in the outpatient setting, round on the gynecology service, or
maybe return to the OR/labor ward.
As of now, Maureen and I, are flying out of Port Moresby on Friday to
go to Goroka in the Highlands. We hope to hike near Mt Wilhem and
maybe see some birds of paradise. We return to Moresby on the
following Wednesday and will then go to Loloata Island for two nights.
On the follow Friday (April 12th) we leave on separate flights back
to Australia. I will try and write more about this as we are going if
I can get internet to post again.
Wednesday, March 27, 2013
Update on 3/27/13
Update on 3/27/13:
Overall I had a pretty good birthday weekend. On Saturday, Delly (one
of the registrars), along with her husband and daughter- Evelyn, came
to pick me up. Our plan had been to go to the craft market but turns
out it isn’t till next weekend. Instead we went to the “mall” which
consists of a few shops and a grocery store primarily catering to
expats living in Port Moresby. The grocery store, Food World, was
actually quite extensive (compared to my time in other countries you
really can buy most anything here… just have to do a bit of looking).
I was able to find an ATM, drink a coffee, and get a SIM card with the
hope of WIFI. Evelyn was very entertaining and I am quite envious of
her energy.
Delly is considered a senior registrar here which is about equivalent
to my level of training. We spent my entire first week on labor ward
together. She is a very skilled physician and delightful person. The
training system in PNG is a bit different than the States- it actually
takes longer!! After secondary school (high school), trainees enter
directly into medical school for 6 years, then they become a resident
for 2 years (this involves rotating on all services, similar to a
general intern year in the US), then on to service years (which from
what I can tell involves 1-2 years working in an undesirable location
as a generalist), and then onto specialty training where one is called
a registrar- OB/GYN here is 6 years. After completion you are called
a consultant (equivalent to an attending physician in the US). I
still haven’t entirely ironed out whether everybody has to do service
years. Most of the registrars are married and the majority of them
start their families during training. Delly said that on average
physicians are in their early to mid thirties when they have completed
their training.
On Saturday night, Skanda and I were invited to dinner at Florence’s
home. Florence is a midwife working for the WHO teaching midwifery at
a local university. She is from Australia. Along with her husband
Filipe (who is French) and son Archer, Florence has lived in several
different places doing humanitarian work. The evening starting with a
riveting game of Go Fish (Archer is 5) and ended with a conversation
about Florence’s work in Darfur. I really enjoy talking with her and
feel as though we are kindred spirits. She and Filipe were actually
in Timor-Leste at the same time as me in 2010… she too got dengue.
Sunday morning (my 29th birthday) Florence and Archer came to pick me
up for a swim at the Aviat Club. Archer surprised me with balloons, a
birthday horn, and a present… I pretty sure it’s because I’m such a
good Go Fish player. At the Aviat, I was able to do some lap swimming
(which felt great as I haven’t exactly been able to go out for a run
here) and play with Archer. We then went back to Florence’s place for
lunch and so I could use the internet (I was able to get Wifi working
at my hostel for a short period of time but it is very spotty… and
slow). For those that were able to get through- I appreciate the
birthday calls, text messages, and emails from home!! Sunday evening
Skanda, Professor Mola, 2 of the registrars, and I went out for a
birthday dinner (and Mom don’t worry I was even able to have birthday
cake). I hope being 29 is as good as being 28… and that it lasts
awhile… 30 doesn’t seem possible.
I decided to spend my second week in the operating theatre… which to
this point I am happy to say has been an excellent idea. There is one
registrar assigned to the operating theatre (which is Frank currently)
and a different attending physician each day. There is supposed to be
a resident as well… but they haven’t seemed to show up… lucky me .
The operating theatre handles all of the obstetric and gynecology
cases. There are 2 operating rooms, each with a dedicated anesthesia
and nursing staff (however… they don’t show up till 10 AM sometimes).
Anyways, overall the facilities are basic but serve their purpose. I
have never seen supplies conserved to this extreme- who knew 1 piece
of suture could be used to do an entire tubal ligation from start to
finish.
Each day’s case list is quite long… Frank and I start at the top and
just power through. The consultants are present- sometimes scrubbing
in to help and sometimes not. The most common procedure done is tubal
ligation… I think we are single handedly sterilizing PNG. No, in all
seriousness, there is a huge push for family planning here given the
poverty, lack of education, and overcrowding. Most days there are
6-10 tubal ligations completed under local anesthesia with a bit of
sedation. The remainder of the case list so far this week has
consisted of several dilation and curettage, several exams under
anesthesia (primary for advanced stage cervical cancer), a few
cesarean sections, several exploratory laps for ovarian cysts (think
the size of a watermelon), and a few hysterectomies. (and it is only
Wednesday!) The registrars have great autonomy here and are very
competent. The general principals in the OR are similar to home… with
a few modifications (the most drastic- there are no emergent, or even
urgent, cesarean sections- but with no fetal monitoring I’m not sure
what I was expecting). Today a cesarean section which was being done
for “fetal distress” was postponed till after a hysterectomy (I was a
bit anxious to say the least… but in the end the baby was ok…
luckily).
Regardless, I am looking forward to the rest of my week. Oh and
Maureen arrives not tomorrow but the next day (Friday March 29th)… I
had the hostel attendants make up her bed and bring in extra towels
Yah to not living alone anymore.
Overall I had a pretty good birthday weekend. On Saturday, Delly (one
of the registrars), along with her husband and daughter- Evelyn, came
to pick me up. Our plan had been to go to the craft market but turns
out it isn’t till next weekend. Instead we went to the “mall” which
consists of a few shops and a grocery store primarily catering to
expats living in Port Moresby. The grocery store, Food World, was
actually quite extensive (compared to my time in other countries you
really can buy most anything here… just have to do a bit of looking).
I was able to find an ATM, drink a coffee, and get a SIM card with the
hope of WIFI. Evelyn was very entertaining and I am quite envious of
her energy.
Delly is considered a senior registrar here which is about equivalent
to my level of training. We spent my entire first week on labor ward
together. She is a very skilled physician and delightful person. The
training system in PNG is a bit different than the States- it actually
takes longer!! After secondary school (high school), trainees enter
directly into medical school for 6 years, then they become a resident
for 2 years (this involves rotating on all services, similar to a
general intern year in the US), then on to service years (which from
what I can tell involves 1-2 years working in an undesirable location
as a generalist), and then onto specialty training where one is called
a registrar- OB/GYN here is 6 years. After completion you are called
a consultant (equivalent to an attending physician in the US). I
still haven’t entirely ironed out whether everybody has to do service
years. Most of the registrars are married and the majority of them
start their families during training. Delly said that on average
physicians are in their early to mid thirties when they have completed
their training.
On Saturday night, Skanda and I were invited to dinner at Florence’s
home. Florence is a midwife working for the WHO teaching midwifery at
a local university. She is from Australia. Along with her husband
Filipe (who is French) and son Archer, Florence has lived in several
different places doing humanitarian work. The evening starting with a
riveting game of Go Fish (Archer is 5) and ended with a conversation
about Florence’s work in Darfur. I really enjoy talking with her and
feel as though we are kindred spirits. She and Filipe were actually
in Timor-Leste at the same time as me in 2010… she too got dengue.
Sunday morning (my 29th birthday) Florence and Archer came to pick me
up for a swim at the Aviat Club. Archer surprised me with balloons, a
birthday horn, and a present… I pretty sure it’s because I’m such a
good Go Fish player. At the Aviat, I was able to do some lap swimming
(which felt great as I haven’t exactly been able to go out for a run
here) and play with Archer. We then went back to Florence’s place for
lunch and so I could use the internet (I was able to get Wifi working
at my hostel for a short period of time but it is very spotty… and
slow). For those that were able to get through- I appreciate the
birthday calls, text messages, and emails from home!! Sunday evening
Skanda, Professor Mola, 2 of the registrars, and I went out for a
birthday dinner (and Mom don’t worry I was even able to have birthday
cake). I hope being 29 is as good as being 28… and that it lasts
awhile… 30 doesn’t seem possible.
I decided to spend my second week in the operating theatre… which to
this point I am happy to say has been an excellent idea. There is one
registrar assigned to the operating theatre (which is Frank currently)
and a different attending physician each day. There is supposed to be
a resident as well… but they haven’t seemed to show up… lucky me .
The operating theatre handles all of the obstetric and gynecology
cases. There are 2 operating rooms, each with a dedicated anesthesia
and nursing staff (however… they don’t show up till 10 AM sometimes).
Anyways, overall the facilities are basic but serve their purpose. I
have never seen supplies conserved to this extreme- who knew 1 piece
of suture could be used to do an entire tubal ligation from start to
finish.
Each day’s case list is quite long… Frank and I start at the top and
just power through. The consultants are present- sometimes scrubbing
in to help and sometimes not. The most common procedure done is tubal
ligation… I think we are single handedly sterilizing PNG. No, in all
seriousness, there is a huge push for family planning here given the
poverty, lack of education, and overcrowding. Most days there are
6-10 tubal ligations completed under local anesthesia with a bit of
sedation. The remainder of the case list so far this week has
consisted of several dilation and curettage, several exams under
anesthesia (primary for advanced stage cervical cancer), a few
cesarean sections, several exploratory laps for ovarian cysts (think
the size of a watermelon), and a few hysterectomies. (and it is only
Wednesday!) The registrars have great autonomy here and are very
competent. The general principals in the OR are similar to home… with
a few modifications (the most drastic- there are no emergent, or even
urgent, cesarean sections- but with no fetal monitoring I’m not sure
what I was expecting). Today a cesarean section which was being done
for “fetal distress” was postponed till after a hysterectomy (I was a
bit anxious to say the least… but in the end the baby was ok…
luckily).
Regardless, I am looking forward to the rest of my week. Oh and
Maureen arrives not tomorrow but the next day (Friday March 29th)… I
had the hostel attendants make up her bed and bring in extra towels
Yah to not living alone anymore.
Friday, March 22, 2013
Week 1- 3/23/13
Sorry for the delay in posting… the internet situation around here is a bit ridiculous… no internet at my hostel (not surprised) and no internet at the hospital (surprised). Can you imagine no internet at OSUMC?? Anyways, I have arrived safely in Port Moresby, PNG and have completed my first week at the hospital… which has been interesting to say the least. I will try and hit on the high points.
I left LAX Tuesday, March 12th after a very informative 4 day conference on gynecologic cancer. I flew overnight on Virgin Australia to Sydney and then on to Cairns. I’m happy to say my 15hr trip from LAX to SYD involved having an entire row of seats on which I stretched out and slept soundly for 10 hours (may have been a bit behind). When I arrived in Cairns I was greeted by a dear friend, Dan Foster, who I worked with in Dili, Timor-Leste in 2010. Dan is currently a resident in Australia and lives with his girlfriend Lani in Cairns. I stayed with them for an evening and had some time to catch up/reminisce about our time in Timor-Leste. Dan took me to the airport Friday, March 15th for my flight to Port Moresby. Much like my flight to Timor 3 years ago, after just 1.5 hours in the air I went from the western world to a developing nation.
It took a bit to obtain a visa and get through customs at Port Moresby Airport… and then there was no one there (I was expecting Professor Glen Mola to pick me up). Having read heaps of things about how public transportation is not the safest for expats in PNG I surely wasn’t about the hail a cab or take a bus. I sauntered over to the Digicel stand and while purchasing a SIM card for my cell phone (not that I had any numbers to call once my phone was working) was approached by a man in a hotel uniform. Clearly he could tell I was a bit out of place. I told him I was just waiting from Prof Mola to pick me up. Now Port Moresby is a city of about 300,000 people so I did not expect this man to know who I was speaking of. However, he quickly explained the Prof Mola had done surgery on his mother, how he was a great doctor, and he would just give him a call. Shortly after Prof Mola and Skanda (an Australian OB/GYN who is working at Port Moresby General Hospital, PMGH, for about 6 months) arrived to pick me up. Sigh of relief.
From the airport we drove down pot hole ridden streets to my accommodations. I am staying in a hostel across the street from the hospital called the CWA. I have a private room with two single beds (one for Maureen when she arrives), a private bathroom, and shared kitchen facilities. When I arrived there were two ladies from Australia in one room, a Timorese doctor in another, a PNG doctor in another, and a biologist from Finland in another. The room is clean and very comfortable aside from the lack of AC. Just a bit hot/humid for this Midwest girl… but I am able to sleep at night with the ceiling fan on.
I dropped my bags and proceeded to PMGH for a tour of the OB/GYN department with Skanda. The department is set to the back of the hospital facilities. Overall, I would say the facilities are adequate and serve their purpose… nothing fancy. There are 4 wards- Ward 9 is the gynecology ward, Ward 10 is the antenatal ward, Ward 11 is the postnatal ward, and of course the labor ward. The operating theater and special care nursery are attached to labor ward. Each ward is open (Florence Nightingale style- no private rooms) with curtains between beds.
The remainder of my first weekend involved dinner with a group of expats (primarily nurse midwives from Malawi, Australia, and several European countries all working for the WHO teaching local midwives), some grocery shopping, visiting a local fruit/veg market, a swim at the Aviat Club (think country club pool with no golf course- Aafke, an OB/GYN from Finland who has worked at PMGH for 6 years and her husband took me), and trying to adjust to the time change.
I decided to spend my first week on labor ward (with plans to do GYN/OR and outpatient work the next two weeks). Every day begins with morning report (generally involves some sort of didactics for the residents, registrars, and medical students) and then ward round. Labor ward at PMGH has 24 beds, a small waiting room, and a triage room with 2 beds (although I have not really seen this triage room used- mostly mothers just labor on a bench until a bed becomes available). PMGH does about 12,500 deliveries a year… that breaks down to about 35 deliveries a day. It is an extremely busy unit staffed by residents/registrars and midwives with one attending (called a consultant here) overseeing.
Women labor without epidurals and without fetal monitoring. Some have IV access some don’t. There is one external fetal monitoring machine for the entire unit which is wheeled from bed to bed when there is concern for fetal distress (I won’t get into the nitty gritty details of L&D as this blog is for a diverse audience… but for those interested we can talk more later). Week one involved several cases of pre eclampsia, 2 cases of eclampsia, 3 vacuum deliveries, 3 twin deliveries (2 of which were undiagnosed and came from the antenatal unit- ultrasounds are not done routinely), 2 breech deliveries, only 1 cesarean section, and a few post partum hemorrhages. Antenatal care is spotty at best and doesn’t include things like accurate dating, determination of blood type, or determination of GBS status… just to name a few things. Doctors, nurses, and midwives all do each others’ jobs- everyone delivers babies, everyone starts IVs/draws blood, and everyone administers medications. To give some idea here are a couple stats for the month of December- there were 1066 deliveries, 11 of which were breech, 70 of which were vacuum assisted (really no forceps), and only 42 cesarean sections (rate of 3.8%). So yah… all in all it is an interesting place.
The staff at the hospital are lovely people and very helpful. Overall, everyone I have met is very kind and anxious to go out of their way to make me feel welcome. In the evenings I have been reading, writing, and wishing I had internet. I do have a cell phone (# 70596397) so feel free to call or text… it is a bit lonely- given concern for petty crime it sort of feels like I am on house arrest. I go from my hostel to the hospital (generally accompanied by someone) and back again. I look forward to Maureen’s company in less than 1 week.
I spent my Friday night having dinner with Aafke and her husband at their home. As I mentioned before Aafke is an OB/GYN who has been living in PNG and working at PMGH for about 6 years. Her husband (I can’t spell his name) is a professor of political science and works at the university. They are originally from Finland but have worked all over the world… primarily spending 20 some years in Africa. Aafke completed her training in England but has not worked in the western world at any point in her career. Needless to say they have great stories. Her husband is the first person I have met since leaving that knows exactly where Iowa and Ohio are (due to holding the first primary and being a swing state, respectively). It is always interesting to hear what others think of the States... Regardless we had a very nice meal and I appreciate their company.
As for the rest of my weekend… I plan to go to the craft market with Delly (one of the residents I worked with in labor ward) and hopefully buy a SIM card to set up WIFI at my hostel. A group of us may go to the fruit/veg market on Sunday morning to buy groceries for the week. Oh and I will turn 29 tomorrow… bummer. All for now.
I left LAX Tuesday, March 12th after a very informative 4 day conference on gynecologic cancer. I flew overnight on Virgin Australia to Sydney and then on to Cairns. I’m happy to say my 15hr trip from LAX to SYD involved having an entire row of seats on which I stretched out and slept soundly for 10 hours (may have been a bit behind). When I arrived in Cairns I was greeted by a dear friend, Dan Foster, who I worked with in Dili, Timor-Leste in 2010. Dan is currently a resident in Australia and lives with his girlfriend Lani in Cairns. I stayed with them for an evening and had some time to catch up/reminisce about our time in Timor-Leste. Dan took me to the airport Friday, March 15th for my flight to Port Moresby. Much like my flight to Timor 3 years ago, after just 1.5 hours in the air I went from the western world to a developing nation.
It took a bit to obtain a visa and get through customs at Port Moresby Airport… and then there was no one there (I was expecting Professor Glen Mola to pick me up). Having read heaps of things about how public transportation is not the safest for expats in PNG I surely wasn’t about the hail a cab or take a bus. I sauntered over to the Digicel stand and while purchasing a SIM card for my cell phone (not that I had any numbers to call once my phone was working) was approached by a man in a hotel uniform. Clearly he could tell I was a bit out of place. I told him I was just waiting from Prof Mola to pick me up. Now Port Moresby is a city of about 300,000 people so I did not expect this man to know who I was speaking of. However, he quickly explained the Prof Mola had done surgery on his mother, how he was a great doctor, and he would just give him a call. Shortly after Prof Mola and Skanda (an Australian OB/GYN who is working at Port Moresby General Hospital, PMGH, for about 6 months) arrived to pick me up. Sigh of relief.
From the airport we drove down pot hole ridden streets to my accommodations. I am staying in a hostel across the street from the hospital called the CWA. I have a private room with two single beds (one for Maureen when she arrives), a private bathroom, and shared kitchen facilities. When I arrived there were two ladies from Australia in one room, a Timorese doctor in another, a PNG doctor in another, and a biologist from Finland in another. The room is clean and very comfortable aside from the lack of AC. Just a bit hot/humid for this Midwest girl… but I am able to sleep at night with the ceiling fan on.
I dropped my bags and proceeded to PMGH for a tour of the OB/GYN department with Skanda. The department is set to the back of the hospital facilities. Overall, I would say the facilities are adequate and serve their purpose… nothing fancy. There are 4 wards- Ward 9 is the gynecology ward, Ward 10 is the antenatal ward, Ward 11 is the postnatal ward, and of course the labor ward. The operating theater and special care nursery are attached to labor ward. Each ward is open (Florence Nightingale style- no private rooms) with curtains between beds.
The remainder of my first weekend involved dinner with a group of expats (primarily nurse midwives from Malawi, Australia, and several European countries all working for the WHO teaching local midwives), some grocery shopping, visiting a local fruit/veg market, a swim at the Aviat Club (think country club pool with no golf course- Aafke, an OB/GYN from Finland who has worked at PMGH for 6 years and her husband took me), and trying to adjust to the time change.
I decided to spend my first week on labor ward (with plans to do GYN/OR and outpatient work the next two weeks). Every day begins with morning report (generally involves some sort of didactics for the residents, registrars, and medical students) and then ward round. Labor ward at PMGH has 24 beds, a small waiting room, and a triage room with 2 beds (although I have not really seen this triage room used- mostly mothers just labor on a bench until a bed becomes available). PMGH does about 12,500 deliveries a year… that breaks down to about 35 deliveries a day. It is an extremely busy unit staffed by residents/registrars and midwives with one attending (called a consultant here) overseeing.
Women labor without epidurals and without fetal monitoring. Some have IV access some don’t. There is one external fetal monitoring machine for the entire unit which is wheeled from bed to bed when there is concern for fetal distress (I won’t get into the nitty gritty details of L&D as this blog is for a diverse audience… but for those interested we can talk more later). Week one involved several cases of pre eclampsia, 2 cases of eclampsia, 3 vacuum deliveries, 3 twin deliveries (2 of which were undiagnosed and came from the antenatal unit- ultrasounds are not done routinely), 2 breech deliveries, only 1 cesarean section, and a few post partum hemorrhages. Antenatal care is spotty at best and doesn’t include things like accurate dating, determination of blood type, or determination of GBS status… just to name a few things. Doctors, nurses, and midwives all do each others’ jobs- everyone delivers babies, everyone starts IVs/draws blood, and everyone administers medications. To give some idea here are a couple stats for the month of December- there were 1066 deliveries, 11 of which were breech, 70 of which were vacuum assisted (really no forceps), and only 42 cesarean sections (rate of 3.8%). So yah… all in all it is an interesting place.
The staff at the hospital are lovely people and very helpful. Overall, everyone I have met is very kind and anxious to go out of their way to make me feel welcome. In the evenings I have been reading, writing, and wishing I had internet. I do have a cell phone (# 70596397) so feel free to call or text… it is a bit lonely- given concern for petty crime it sort of feels like I am on house arrest. I go from my hostel to the hospital (generally accompanied by someone) and back again. I look forward to Maureen’s company in less than 1 week.
I spent my Friday night having dinner with Aafke and her husband at their home. As I mentioned before Aafke is an OB/GYN who has been living in PNG and working at PMGH for about 6 years. Her husband (I can’t spell his name) is a professor of political science and works at the university. They are originally from Finland but have worked all over the world… primarily spending 20 some years in Africa. Aafke completed her training in England but has not worked in the western world at any point in her career. Needless to say they have great stories. Her husband is the first person I have met since leaving that knows exactly where Iowa and Ohio are (due to holding the first primary and being a swing state, respectively). It is always interesting to hear what others think of the States... Regardless we had a very nice meal and I appreciate their company.
As for the rest of my weekend… I plan to go to the craft market with Delly (one of the residents I worked with in labor ward) and hopefully buy a SIM card to set up WIFI at my hostel. A group of us may go to the fruit/veg market on Sunday morning to buy groceries for the week. Oh and I will turn 29 tomorrow… bummer. All for now.
Subscribe to:
Comments (Atom)
