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.
Wednesday, March 27, 2013
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.
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