It's been a little while since my last post, so there's a lot to catch up on. I'll try to keep it short, for your sake and for mine.

I mentioned last time that we were going to a coffee plantation for a tour. It turned out to be a very good time. I'll spare you most of the details, but it was very cool to see such a huge plantation. If I remember right, it is almost a thousand acres, and right in the middle of it is a large hill with the plantation house at the top. It is a beautiful home with a huge main floor that is completely open and lined with windows. In the middle of the main floor is the stairways leading up and down to the bedrooms. The view of all the coffee fields and mountains in the background was really something. We tried to take pictures, but they really didn't do it justice. Here it is anyhow. Also in this picture are the drying fields (the tarp is wrapped up because it was drizzling) and part of the processing building/office.We also got to see how the coffee is processed, which is actually pretty interesting. Larry, the orthopod who owns the place, and his wife were very nice and are obviously enjoying their "retirement." They only spend a couple months a year here, but they are really doing a lot for the workers and the way the plantation is run. When they took over the place a couple years ago it was evidently not being run too efficiently and there was some degree of mismanagement that I'm not privy to. At any rate, they made it an attractive place to work by paying their employees more than they could get elsewhere, then proceeded to hold them to higher standards (no domestic violence, for example) and make lots of improvements. Part of the deal is also giving them a practical education. They also buy coffee from independent growers, aka the average village guy with a couple dozen trees in his backyard. This is evidently a bit lower quality, but they sell it as "tribal coffee" which has its own appeal I guess. It seems like a pretty cool thing they are doing. Oh, and apparently the coffee they grow is pretty good. They sell it to people all over the world, including Starbucks.

Also in the past week, we got a Jeep tour of a small part of the old Highlands Highway which connected the north and south coast (I think). It was a bumpy ride on a gravel road, but pretty enjoyable with some good scenery. Along the way we saw quite a few little thatched houses seemingly pretty isolated. In many of their gardens were miniature versions of the same houses. I assumed they were for pigs or chickens, but when I asked, I was told they were grave houses, or motmots. Some were more elaborate than others, which is related to how important the person was. Due to the bumpy ride, I didn't get any good pictures of these, but hopefully I'll have another chance.

Now for what you've all been waiting for: the freaky medical stuff you'd never see in the States. First, I'll give you a little warm up with stories that have no accompanying pictures. I started in the adult ward this past Monday, which has been a good experience. It is much different from peds, where I saw a bunch of diarrhea/dehydration, malnutrition, and pneumonia. The biggest difference is probably all the folks with tuberculosis (TB). Freaky Thing #1 - Hanging out with TB patients minus a mask and negative pressure isolation. It's a darn good thing my immune system works, because otherwise I'd be hacking up chunks of bloody lung right now. I guess that most of the docs here haven't even seroconverted yet (a positive PPD test meaning that your body has been infected/exposed and has mounted and immune response) which really suprises me. Okay, I can't think of anything else right now that is truly freaky, so we'll get right to the pictures.

First we have a nice xray of a young lady's (in her 30's) pelvis . Any takers on the problem? Even med student Ben picked up on the dislocated left femur and the piece of acetabulum (hip socket) that was definitely not where is should be. Apparently this lady was walking along a hill, began to slip, grabbed a tree branch, and the soil came loose bringing down the lady with the tree awkwardly on top of her. After seeing all the washouts that happen here, this story is pretty believable. Also, the husband would have had to be Hercules to inflict this damage himself. Listen to me, already jaded by the amount of domestic violence I see here.

This reminds me of non-pictoral Freaky Thing #2: domestic violence where you wouldn't expect it. The other day I was helping one of the docs cast a lady's arm which had been fractured. Nothing out of the ordinary. Then I started talking to the woman's husband who had known and worked for a missionary from the great state of Nebraska for many years! I was having a good conversation with this fellow when I casually asked him how she hurt her arm, expecting to hear she had fallen on something or been in a car accident. He sheepishly looked at me and said "Uh, it was a bit of a domestic issue." What?!? I didn't really know how to react to this, especially after such a nice conversation. After a bit of awkwardness, he asked me if domestic violence was a problem where I came from. I answered very matter-of-factly "Well, we have domestic violence in the States, but it is dealt with pretty harshly. We really don't tolerate it." This guy was going to have no repercussions at all, which is pretty awful if you ask me. The hospital does charge a domestic violence fee and a fighting fee (for chopchops), but that seems pretty minor. This may seem like it would negatively impact the woman later, but it is actually quite the contrary. Family structure is very important, and medical fees are often shared by the entire extended family. They are not happy about having to absorb extra fees, and will crack down on this activity (hopefully). So, back to the hip lady.

After my astute observation, Josh and one of the visiting surgeons, Kevin Kerrigan (who is a really cool guy and retired Navy), helped to set the hip. Unfortunately, it was very unstable due to the acetabular fracture, so we had to put it in traction. Now, for those of you who have never seen it before, orthopedic traction involves putting a pin through a bone and attaching a simple device that basically pulls constantly via a given weight on the end of a string. Anyway, I've seen this done once in medical school. I was helping Kevin set up for it, thinking I'd just stabilize the leg like I'd done before. Imagine my suprise and delight when he handed me the syringe with the local anesthetic in it and said "okay, now just make a nice wheel where you're going to start, and another one where you'll be coming out." Freaking awesome!, but also Freaky Thing #3, medical student performing orthopedic surgeon's job. Here's a picture of me with a hand crank drill going through the lady's tibial tuberosity (right below her knee). Notice the stupid grin on my face. Also, this would be done with a multi thousand dollar power drill back home. In fact, on the one I'd seen before, there was a hand crank in the kit, but the orthopod performing the procedure just laughed and made some reference to it being "Stone Age." Well, welcome to Bedrock!

Freaky thing #4: a little girl's clavicle sticking out of her skin, then sitting in a trash can. Originally I was going to post these pictures as well, but it is just taking too long to load all of these, so I'll just have to describe it to you. Basically, this little girl had gotten an infection either in her clavicle or right above it in her skin that was never properly treated. As a result, the skin over her clavicle had eroded, along with part of her clavicle closer to her shoulder, and about half of it was just sitting exposed to air. I'm talking about a little girl with a bone sticking out of her chest. Definitely freaky. Dr Susan took care of her while Josh, Dr Jim, and I were taking care of a chop chop. When we finished, I looked over to see Susan dropping the dead and exposed half of the clavicle into the trash can. Pretty crazy.

I'm really enjoying all the things we are getting to do here. It's really improving my procedural skills, which definitely need some work. As Dr Jim says, I'm a little ambisinistrous, or equally poor with both hands! He is joking (mostly). My physical exam skills are also getting quite a bit better, as we have less imaging to rely on, and I'm much more responsible for patient care. Today I felt two of the biggest livers I've ever seen. Both have liver cancer (most likely from hepatitis B) and will not live too much longer. Both would also be on transplant lists in the States. One dude's liver took up almost half of his abdomen and could be seen even before it was felt. It is definitely good to know what abnormal is, and I'm seeing way more of that here than I ever would have back home.

Caleb is doing well, though there is not quite as much for him to do here. He has been playing non-stop with his trains and track that we packed for him, and we're worried that he is getting a little obsessed! He relives many of the Bible stories and even some events of the day through those trains. One day he said "Don't worry James, I like God, I will be with you, I will protect you, said Gordon." That made me laugh, and made me a little proud. It's good to know that all the Bible stories we tell him and read to him are soaking in. You can never start too early.

One more piece of news. Earlier I wrote about the hydopower here on the station. Well, today I met Thomas, the super hero that goes down to fix it when it's "buggadup." He was in the hospital because we have been running on generator power since a big rain storm last night cause some problems with debris in the hydro generator. Dressed appropriately in huge yellow golashes, he was standing in front of our big circuit box talking about how we should be switching back over to hydro power, but we weren't. All of a sudden there was a really loud noise, all the lights went off, the breakers all tripped, and then the lights came back on. Thomas jumped just like the rest of us! We all started laughing and he said, "Well, I guess I fixed it!" He is a really nice, funny native guy who loves to speak English, which he is pretty good at. I actually met him once before, but then I didn't know the extent of his super powers.

Now, in an effort to end things on a happy note, here is a picture of me with Sampson. He's a kid with transposition of the great vessels, meaning his aorta and pulmonary(lung) artery come out of the wrong heart chambers. He would have died in utero, but he also has another heart defect (ventricular septal defect) that makes the blood in the two ventricles mix. Here, there is nothing to do for him, so unless they can somehow find a way to get him to Australia and get a cardiothoracic surgeon to operate for free, he will likely not live a long life, and will certainly be very limited in what he does. You may be able to see his blue lips from the very low percentage of oxygen in his blood. Normal O2 sats for you or I would be in the high 90's, but little Sampson lives in the 50's and 60's. On the up side, and the only reason his condition isn't Freaky Thing #5, is that I saw a lady in the States with the exact same heart defect. Normally, those kids are operated on as soon as possible, but this lady was over 50 years old and had evidently not had good medical care as a child or else was a poor candidate for surgery. In spite of this, she lived a relatively normal life. She was blue, had some characteristic physical findings, and was on a ton of meds, but she was alive. Sampson does not have the benefits of an easy life or state of the art medications, so the chances of him living to his 50's is almost zilch. However, it gives me at least a little hope for him.

Well, I said this would be short, but here I am writing a novel. In my defence, these pictures load so slowly and I just write while I'm waiting for them to load. I just remembered I have another story and picture which actually belong to Josh, but I'll save that for later. Now it is after midnight on Friday morning and time for me to get some sleep. I'm on call this Saturday and Sunday, so we'll see if I can rustle up any more stories.

Well, I must apologize for my lack of updates in the past week. Part of the reason is that I have just been quite busy. I was on call last weekend and then this past Tuesday, so I have been turning in a bit earlier than usual this week trying to catch up. Combine that with Stephanie wanting to check out the housing situation back in Omaha, and you have not a lot of internet time for me. Another thing is that I am finally getting into a good routine and things just don't seem as strange to me anymore. I have to keep reminding myself to take pictures of weird chest xrays or rare (to me) conditions, because it just doesn't shock me anymore. Along with that, though, comes a comfort level that allows me to just enjoy it a bit more.

Before we go any further, I need to announce some good news (for those who hadn't heard): Stephanie and I are expecting our second child sometime around Oct 30th! We wanted to keep it a bit quiet until an ultrasound had been done, and today the three - or four, I guess - of us stopped by the hospital on our way home from the river and I got a good look at the kid. Now, my ultrasound skills are improving but are still limited, and are not helped by an U/S machine that is dated and a probe that has seen better days. That said, I could see all the major body parts, and could even see his little hands and feet waving and kicking. Of course, the heart was visible as well, and it was beating like crazy. So, Stephanie is around 11 weeks, and intern year should be very busy indeed! We are looking forward to being near family in Nebraska, and we're hoping and praying that this one can wait until closer to the due date to come say hello. We will welcome your prayers in that regard as well!

With that out of the way, we can move on to more of the experiences PNG has to offer. One thing that is fairly common here is the keeping cassowary birds as pets . Cassowaries are the PNG equivalent of the Ostrich or Emu. Basically a really big, flightless bird that kills people in the wild by jumping at them and tearing out their bowels with huge claws. Sounds like definite pet material to me. Well, they are commonly used in some parts of the country to pay the bride price at weddings, and are supposedly very sought after and tasty to eat. One of the ladies who works at the hospital, named Anna, has the biggest cassowary around. She invited us out to her village to have a look and take some pictures, which is exactly what we did. This doesn't really do the bird justice in terms of size, but you can see a bit of the color that makes them pretty distinct and cool-looking. Anna's bird was around 5 ft tall and pretty intimidating. It is kept in a little bird shed that is probably 4x4ft and 6ft tall. The funny thing was, they were just handing it banannas and grabbing its beak like it was nothing! That's Anna's husband, Joel, in the background feeding the bird. He told us he was very greatful for our willingness to come and help the people of his country. He said he had nothing to give us, but is sure God is pleased with the missionaries who come and will bless them accordingly. That was pretty humbling to hear, and it gave me just another good example of how appreciative and warm the people of this country are. Quite a bit different from what we're used to in the States. After this, we took a picture with their family, and they gave us each a pineapple from their garden to take home with us. We had some snacks in Stephanie's bilam (knitted purse) that we gave to their kids, and then we were off. Caleb, however, was not too happy with giving away our snacks, and proceeded to throw a fit as we left the village! Oh, well, he'll learn sometime.

I'm trying to pick out some of the good medical stories from the past week, but they're sort of blending together. There was one gentleman who actually spoke very good English and is pretty well educated, but it turns out has TB and HIV. He also has the distinction of being the first person in whom I caused a pneumothorax! A pneumo (for short) is basically when air gets into the chest cavity between the inside of the chest wall and the lung. Now, when I admitted this dude, he had pretty much a white-out of his right lung . We ultrasounded it, and sure enough, there was a ton of fluid in there. I was working with Dr Erin, who is in her first year post-residency, and she is really cool about teaching and letting me get my hands dirty, so to speak. We did a procedure to take some of the fluid off, called a thoracentesis. Now, we don't really have all the nicely packaged kits and sets all the time like back home, so we were doing this under less than ideal conditions. I stuck a needle into his back and pulled back the plunger on the syringe, evacuating a good amount of fluid from this poor guys chest cavity. Then, when we were pulling the switch to empty the syringe, we told the guy not to breath. Well, he did, and he got a pneumo. So I guess it was only partly my fault! We did have some stop-cocks available which I should have been using, but I guess that's a learning point for next time. In spite of all this, the guy was actually breathing better after the procedure than before it thanks to all the fluid we got off. Another satisfied customer! Here is his post-thoracentesis CXR. The nice white plateau in the right lung is all fluid, and used to take up almost the entire right side. The thick white line that is more vertical is the edge of his lung tissue. Outside of that, my friends, is the air. Hey, nobody's perfect! The effusion has recurred, however, leading us to believe it is probably TB. The positive HIV test I ordered, as mentioned earlier, added further weight to the TB theory, along with the quality of the fluid we drained off in the first place. Here, we unfortunately have to rely a lot on clinical judgement regarding who has TB and who doesn't. Anyway, before we could start this guy on TB meds, he left the hospital AMA (against medical advice) to go testify in a court case regarding recent elections here. He promised to be back Friday, but I won't know if he made good on it until I'm back in the wards on Monday.

Okay, now I need to get to the story that some may have heard from Stephanie's emails. She may have stolen my thunder a bit, but I promised the pic and story in my last post, so here it is. Josh, my good friend and fellow med stud, was on call a couple weeks ago with Erin as his backup. They were called to the labor ward for a preterm labor. They had just examined the lady and were standing outside the curtain talking briefly about what was going on, when they were quickly called back in by the nurse. This is what they saw. The baby and placenta was lying there on the bed , still contained in the amniotic sac! What you're seeing here is mostly placenta, with the baby's head and face pressed up against the membranes. The woman had (evidently) abrupted, meaning the placenta had separated from the uterus prematurely (i.e. before the baby is born) and the little baby came out in all his glory. They snapped this picture quite quickly before then breaking the sac and resuscitating the baby. This little guy was around 28 weeks gestation and weighed about 100 or so grams (~3-4 oz) less than Caleb when he was born. Unfortunately, this guy didn't make it, and died about a week after he was born. It probably would have been a different story in a major US hospital with access to TPN, ventilators, continuous monitoring, etc. We have lost a few premies here recently, some bigger than Caleb was. It's just a good reminder of how blessed we are back home, and how much further we have to go here.

Now for some happy stuff. This is a little guy named Nathaniel . Erin saw him in clinic about a week and a half ago, and this is the picture she took. He has what's called Burkitt's Lymphoma. Common in Africa and PNG, it is a cancer caused by the Ebstein-Barr virus, the same one that causes mono, the "kissing disease." It primarily affects the face in a characteristic way, and is pretty easy to diagnose. Untreated, this tumor will take over his face and eventually kill him. Fortunately, it is also highly sensitive to chemo, and the chemo used is pretty easy to get our hands on and not to technically challenging.

This space gives me a chance to comment on his mom's tatoos. Evidently, they don't really have any significance at all. No relationship to what tribe they come from or who they're married to or anything! They just sit around and tatoo themselves for fun. Back to Nathaniel

Thus, 10 days later , he looks like this. Granted, he still doesn't seem too happy to be in the same room as a white skin, but his tumor is down, and after several months of chemo every few weeks, he has a good chance at a normal life. The problem is really going to be making sure he completes his chemo course. People here don't have a good concept of medicine or how the body works. As soon as he is looking normal, there is a chance the family will quit taking him to the hospital. Hopefully he will complete his course, or do well regardless.

In more domestic news, Caleb has learned a new trick . I think the picture says it all.

He just busted out the eye brow at dinner one night totally unprompted. I, of course, was thoroughly impressed and made sure he knew it. This pleased him greatly and provided an entire evening of entertainment. He is honing his skills, and will be ready to flash the eyebrow upon command when we return home to you all.

Shortly after the eyebrow trick, Caleb came down with some hopefully not too exotic disease and has had a good fever for the past 3 days. We're not on malaria prophylaxis, so that is always a possibility. I'll keep you posted on this front. While he's on Motrin, he's been a pretty good sport, and we all ventured down to the river in the valley. It was quite muddy, and Stephanie about lost her flip flops on numerous occasions! I was carrying Caleb's stroller - it's a loner from someone around here - and unfortunately missed a couple of good photo ops of Stephanie ankle deep in mud. There were some native boys there fishing we got pictures of, but I'm not sure how indiginous nudity is handled on this site, so they will remain omitted. Until next time!

Caleb Update

Hey everyone, just wanted you to know that Caleb is feeling better. He was finally without fever yesterday (Monday) all day but was feeling pretty darn cranky. Today he was well on his way back to normal. Tomorrow he should be feeling pretty good. I'm not too sure what it was that he caught, and I guess malaria is still a possibility, but my bet is on some good old fashioned butt-kicking virus.

While I'm here, just a few tidbits about PNG culture -Polygamy is still very culturally acceptable in tribal culture. It's one of the biggest obstacles to Christian living here by the natives -Wives of the same husband are brutal to each other! Chopchops aren't only for drunk men. -No one in the hospital stays alone. Everyone travels and stays with a watchman, usually a relative. Many times, security has to ask people to leave, since we have to limit the watchmen to one per patient (for lots of reasons) -People have a given name and the name of their father. In the case of men, this is handy and works fine for medical records. In the case of women, many times they take their husband's name as their last name, or their husband's last name, or keep their father's name. Sometimes, they will give different names at different visits. Since there are no social security numbers, female medical records are often alphabetized by first name. -No one here has any clue about cause and effect when it comes to health. I can't tell you how many times I've gotten a complete history about a car wreck or something, only to find out that it was 10 years ago and really has no bearing on the cough the patient is now experiencing. -Every man here is expected to own a pig. If you have no pig, you're not a man.

There you go.

More adventures

This was a pretty busy week here for me, so there is plenty to write about. As mentioned earlier, Caleb is feeling better, but I think now he has caught a little cold from me, so he's been wiping his nose on everything! We got together with almost all the missionaries on Friday night for a "game night," we went to Suicide Rock this afternoon, and I saw the worst chopchop injury of my short time here. I suppose I'll start with the medical stories.

I was on call Friday night, hanging out at the above mentioned game night, when I was called down to the ER by Graham, the nurse who was staffing it at the time. I've gotten to know Graham a bit, and I always kid him about making a mess of the ER with blood and pus and people everywhere. He is (at least in my limited experience with him) what we in the States would call a "dark cloud," meaning he is always busy with more/sicker patients than usual. Well, that night was no exception. Graham said a guy came in, was pretty unstable, bleeding quite a bit, and that a limb had almost been amputated by chopchop . Now, in medicine here, everything from the nurses on the phone is understated, so I expected to see someone half dead when I walked in.

He was actually not looking too bad, except for a blood stained shirt with vines wrapped tightly around his right arm. He also had some makeshift bandages on his left forearm and right foot. He was, of course, covered from head to toe in dirt and blood. I asked Graham what had been amputated, and he said the right hand, though he hadn't seen it yet. One reason he was so worried was that his blood pressure (per Graham) was 60/40, and there was no way to know how much blood he had lost. When I came in, though, he was screaming in pain, and I knew pretty quickly that his bp wasn't nearly that low. At any rate, we got an IV going pretty quick and started assessing his injuries. His left forearm was open with his ulna broken and clearly visible. His right foot had a large lac across the bases of his toes, cleanly breaking all his metatarsals (long thin bones connecting the ankle to the toes). He also had some more superficial cuts on his face and fingers. Nothing terribly exciting. Finally, though, it was money time, and we took the homemade bandage of his right hand. What we saw was straight out of a horror movie. He had a cut from a bush knife (a.k.a. machete) that almost completely severed his entire right hand from his arm, save his thumb. The guy had obviously tried to catch or stop the (evidently pretty hard) swing with his hand, and his hand lost. The chop went diagonally down from the webspace between his thumb and first finger all the way through his ulna on the opposite side of his wrist. It was hanging on by just some skin and sub-q tissue. At this point, it was just full of old clotted blood, and was not really bleeding. I called my backup and subsequently the surgeons, and we got the thing cleaned off and packed for surgery the next day. Normally, even with open fractures and pretty severe chops, we just assess the patient's wounds, clean them out, stop the bleeding, and loosely sew them shut so the surgeon can look at them in the morning and do a definitive repair later. The big question with this guy was whether we should just amputate what was left of his hand right there, do the usual clean and sew, or just pack it and bandage it together. The final verdict was to just pack it and see in the morning what was alive and what was dead. For the other wounds we did the usual to await repair sometime this week. Internet is extra slow tonight, so here is a picture of his hand after we cleaned the clots out a bit. Ask me later if you'd like to see the rest of his injuries.

We all thought the hand would die for lack of blood supply, save for a strip of skin we could use to help close the wound after amputating. The next morning though, the family was insistent that they wanted him to keep his hand if at all possible, even if it would be non-functional. Now, I must take a little time out to say that in the States, this guy would have gotten a STAT surgery consult and a hand specialist, if he were at a big enough hospital, would have operated on him for untold hours repairing all the tiny nerves and arteries and tendons, resulting in (possibly) a mostly-usable hand. Sorry buddy, but this isn't Johns Hopkins. So on Saturday morning, after rounds, I went over to watch part of the surgery. There are a few more good pictures from that, including the finished product, but time tonight is limited. As I was saying, the family wanted to keep the hand, and amazingly, there was a reading from the pulse oximeter in his middle finger. so, it was decided to make an attempt and give the hand the benefit of the doubt. In a pretty delicate surgery, Kevin and Felix (a native doctor doing the equivalent of a fellowship month) repaired a major nerve, artery, and tendon, hoping to give him the ability to feel and pinch with his thumb and first finger. They also pinned some of his wrist bones back together and sewed his hand together. The end result actually looked pretty good. However, the pulse ox was not getting good readings from his fingers in the OR after the surgery, so we'll have to wait and see if it survives.

As to why/how the chop happened, it was apparently relatives who were quarreling pretty seriously with this young man about land. I will never understand how in a culture where family is so important, it is not uncommon for family to chop each other in pretty brutal and life-threatening ways.

In another call Friday night, I saw a woman who was in a state of shock, almost catatonic. She had put her one-year-old twins to bed in the customary way, hanging a few feet off the ground in a large bilams from a hook on the wall. It is a bit like a hammock, but the kids are snuggled in there pretty well with cloth or blankets or things. Well, the little girl twin somehow managed to get out, and fell maybe a meter onto a mattress (in PNG, this = straw mat). The family said she heard the noise and went in to find her little girl dead. At this, she started wailing, then collapsed and went into this semi-responsive state. I felt just terrible for this poor lady and her family. There was nothing I could do for them but offer to pray with them, which they accepted. Especially with such terrible loss, it is nice to be at a mission hospital where I can offer God's comfort even when there is nothing medicinal to offer. After praying, the woman slowly began to respond and went home to with her family shortly after. If you think of it, remember this poor broken family. I hate to think about what life would be like if we lost Caleb.

In other news, the man with TB and HIV whose chest xray I posted earlier did end up coming back to the hospital, but he died in the middle of the week. (And no, it wasn't from the pneumo) I don't know if starting TB meds earlier would have helped him turn the corner soon enough or not, but he was looking pretty ragged when he came back. I think the worst thing for him was finding out he was HIV +. After that, I think his will to live kind of dwindled.

Moving on to the non-medical, we have really been enjoying our time with the missionaries around the station. They are without exception good, honest people who are doing their best to live out the calling they feel in their lives. Most of them also have a pretty good sense of humor and are fairly laid back, perhaps from living in this culture. Even though I missed much of the game night, it was really fun to have everyone together playing games. One nice thing that's not as common in the states was all the kids and teenagers playing games with us. It is just really nice to see families enjoying leisure time together.

Today, as mentioned earlier, Stephanie, Caleb, and I made the trek out to Suicide Rock with a couple of the missionaries. It is a spot a couple miles from our house where the river has cut a nice little waterfall out of the rock with outcroppings on either side. There you jump into the river, and the current takes you a couple yards down stream where you pop up and can stand shortly after. Then you make your way to the edge and climb back up some pretty darn slippery rock. We all made it back safely with the help of Sam, one of the missionary kids (he's a senior in high school... kind of hate to call him a kid). Even swims-like-a-rock Ben jumped in and had a pretty good time. Caleb, of course, stayed only in the calm water and definitely did not jump off any cliffs. Our camera, unfortunately, did take the plunge as Stephanie was taking pictures of our friends with their camera. She stepped back and kicked the darn thing off the ledge and into the water. I was already down stream with Caleb, so I was able to hand him off and jump in, rescuing our camera with Herculean effort. I'm not sure it was worth it, though, because as of now it is still drying and refusing to work. We'll see what happens, but I don't think there will be any more picture posting for awhile!

And now, I would just like to give a couple of shout outs to our friends who sent us packages with snacks and treats we are thoroughly enjoying! The Huebners, the Majewski's, and the Olathe Kumors: you guys rock!

Babies, big and everywhere!

Hey all, time for another quick post. The week has kind of flown by, so I'll just give you a couple of highlights.

I started in "B" ward this week, which is all things OB. I have now completed two weeks in Peds (A ward) and three in Medicine (C ward). It's hard to believe I've almost been here 6 weeks already! I have been feeling bad for my friends Josh and Sarah who were only able to be here such a short time. A lot has changed for me in the past 3 weeks since they left, and I just hope they can make it back sometime to get the full experience. But back to the OB ward. Rounds in the morning go pretty quickly, because if a mother is just a routine post-partum recovery, they aren't seen by a doctor. In fact, if a mother is in normal labor and has a normal delivery, a doctor may never see her at all. The nurses in this ward are very capable, and handle everything that is routine. Part of the reason for this is that, let's face it, women have been giving birth successfully for ages without doctors around. Why let us in and make things complicated? The second reason is the sheer number of births. With everything else to do in the hospital and all the outpatients to see, there just isn't time for a doc to sit back in B ward and deliver babies all day. This brings me to the best story of the week, which is actually two in one.

There I was on Tuesday morning, my second day on B ward, when we saw a woman who had a bit of slow progressing labor. She had also had a problem with retained placenta (placenta was not delivered within 30 min after baby) with her last delivery, so it was a patient we needed to be aware of. We had just finished rounds, and after checking the woman, Dr Niles let me rupture her membranes, my first AROM. We were then about to leave for clinic, and Niles said, "Hey Ben, why don't you stay and deliver that baby?" I was more than happy to, since I didn't get too many deliveries in the States. Sister Sylvia, the head nurse, was going to be there and help me out if needed, so I was feeling okay about the whole thing. Pretty soon, though, it started getting crazy. Women just kept coming in, all in very active labor. Before long, there were about 5 women ready to have their baby any minute, and only 3 birthing stalls! The plan was then to just deliver as fast as possible and get the place cleaned up and ready for the next in line. My lady was cooperating, and as soon as Sister Sylvia came back in the stall with me, the lady started pushing and the baby was out in no time. This was my first unassisted delivery. No picture, though, because our camera was still on the fritz. It was a shame, too, because that was the biggest baby I've ever seen! The final weight was 5.4 kg! (or 12 lbs for you metrically challenged) Fortunately, the actual birth was very smooth, but she once again was having lots of difficulty with the placenta. After about 10 minutes, the placenta started to separate, but didn't completely, so she started some pretty significant bleeding. When the placenta still could not be delivered, I called Niles back to help out. By the time he got there, she had lost probably 2 units of blood, so Niles manually extracted the placenta from the uterus. In other words, the guy was about elbow deep, pulling out pieces of placenta. He told me that now that I've seen it done once, I'm up next. (in medicine, there's this "see one, do one, teach one" thing)

So anyway, we finish with that lady, who is not helping the crunch on space, and we have to hurry to the stall next door where a lady had just delivered a baby, but no one knew she had twins, and the second was coming out breech! Niles wanted some equipment to resuscitate the baby after it was born in anticipation of a difficult delivery, so a nurse went to quickly assemble what we needed. While we were waiting, I noticed the woman standing by the bed begin to moan. Now, I had just assumed she was the watch-woman (wasmeri) who was accompanying the woman giving birth. I quickly realized my mistake when she squatted down and began really moaning. Then she started screaming, "It's coming! It's coming!" Someone threw a clean tarp down on the ground for her to lay on. When she did lay down, the baby's head was almost out already! Niles jumped over and literally caught the kid, cut the cord, and hurried back over to deliver the breech baby. I just stood there flabbergasted saying, "the things you just don't see anywhere else..."

Sorry, that story turned out to be a little longer than I expected! I was a bit disappointed in the lack of pictures as well, but I don't know how many of you would appreciate a picture of a baby's feet sticking out of a vagina. (You must forgive me, it's getting late.) So the other major news is that our camera is now fully functional! Well, almost. The date and time don't really work, but hey, it takes pictures. I definitely won't complain. I learned after the fact that the thing to do when your camera gets wet is 1)don't turn it on immediately to see if it works, and 2)take the batteries out ASAP and open it up to dry. If you are unfortunate enough to drop it into salt water, you're actually supposed to take all the batteries out and then rinse it in fresh water before drying it. Well, we did just about everything wrong. We definitely did turn it on right away (it actually worked for a few seconds) and we forgot about the little watch-type battery that is for saving date/time for about a day before finally taking it out. Somehow, though, it has pulled through and it's condition has been improved from critical to stable. I'll take it.

Today, Dr Andy was kind enough to give me a real day off to go to Mt Hagen to drop off the Batdorff's at the airport and do some grocery shopping. (Dr Niles and his wife Patti, a PT, who were here volunteering for almost three months. I'm not sure who will be in B ward with me tomorrow... probably Scott Dooley who just returned from furlough.) Stephanie, Caleb, and I went with our good friend Judy Bennett (Andy's wife and Sam's mom), and our new friend Gail Dooley and her daughter Olivia, who is just about 5 or 6 months older than Caleb. All in all it was a good day. The ATMs weren't working this morning, so we had to borrow money from Gail for groceries, who was very gracious about the whole thing. At BestBuy (the grocery store), Stephanie and Gail did the shopping while I walked around Caleb, which was fine with me! After one lap around the store, Olivia decided to hang out with the cool kids and came with us. Caleb actually held Olivia's hand (those of you who know big-personal-bubble-Caleb can appreciate the magnitude of that breakthrough) and the two of them had a great time running around the store. Caleb informed me that Olivia has brown eyes, just like him and mommy. Sniff... my little boy's growing up!

We again went to the Highlander for lunch, where I had a burger complete with a fried egg and a piece of ham that was intended to be bacon. It was delicious! Caleb and Olivia had fun in the shallow part of the pool, and fresh off my liberating Suicide Rock experience, I put on my trunks and joined in the fun. Hopefully soon I'll get those pictures loaded up and on here. Stephanie went off with Judy to run some errands while Gail and I watched the kids at the pool, where they discovered the ATMs were functional. So, fortunately, we were able to pay off our tabs we had accumulated since Stephanie's last fateful trip to town where her bank card and money were lost. After that, it was off to the open market and then back home. It was a really weird sensation pulling up to the station this afternoon... this place really has become home to us, albeit briefly.

In other news, two weeks ago there was a huge landslide not too far from here that cut off the only supply line for a very large chunk of the highlands. As a result, there are all sorts of problems coming up, mostly as a result of diesel shortages. The implications are huge, starting with doubling or tripling of prices for public transportation vehicles, meaning people can't afford to come to the hospital or transport their home-grown coffee or vegetables to sell. There are also now starting to be food shortages in Hagen, with increased prices, limits on how much of certain products we can buy, and nil stock of a few things. This will soon affect the hospital, especially with regards to things like oxygen and medication. When the hydro power goes out, the hospital is powered by a generator that runs on diesel. Thankfully, we have adequate stores for now, but that will run out eventually as well, especially if diesel cannot be purchased and the vehicles on station are needed for various things. There is lots of mixed news about the progress being made towards starting to find a solution. This is when some parts of Melanesian culture can get a bit frustrating. Remember these people in your prayers.