I’m afraid this will be a series of vignettes, rather than a nice story. I hope you don’t mind.
After a nice week-long break, staying at home and doing all the odd projects that seem to accumulate, I started work again in the clinic on January 2. One of my first patients was little Jen, a 12 year old who has been sick with abdominal pain and fevers for about 3 months. Another local clinic had diagnosed her with typhoid. Now, mind you, typhoid is endemic in PNG. It’s everywhere. But most people carry it around harmlessly in their gut and it doesn’t really bother them. One of the first blood tests developed for the detection of typhoid is called the Widal test, developed in the late 1800’s. The person’s blood is mixed with a solution containing antibodies, and if the person has or had the infection, the blood has a typical clumping reaction. The down-side is that in order to diagnose a current infection, you need to keep re-testing your patient every few days for up to 14 days. Without giving any treatment. On top of that, quite a number of other diseases cause this same reaction. And in an area where typhoid just “hangs out” all the time, well, it means the Widal test is pretty much useless. A one-time test is nearly always positive on everyone here. More than that, the test kit is frequently re-used, so there is rampant cross-contamination of specimens. So Jen’s family spent about the equivalent of 3-day’s wages for this test, which was positive (like everyone else). She was given a medicine called chloramphenicol. This drug was outlawed in the USA because of its tendency to mess with your blood and bone marrow. When Jen didn’t get better the first time, they gave her more chloramphenicol. Still she didn’t get better, so she took even more. When I saw her on the 2nd, I did a more reliable blood test that tests for current or recent infection (IgM and IgG for typhoid). Both were negative. But she was positive for 2 different types of malaria. So not only was she treated with a harsh drug for a disease she didn’t have, but she was not treated for a dangerous disease which had been ravaging her poor body for 3 months. She was given the proper medicine, and I asked for her to come back in 2 weeks. When I saw her again the fevers and abdominal pain were gone, but she was still feeling weak and tired. The laboratory at the hospital has been closed most of the time since November, so all I could do was spin down her blood in a thin tube. It revealed that not only was she anemic, but she had a drastically increased number of white cells. This is what blood looks like in someone whose bone marrow has been damaged by chloramphenicol. Poor little girl. The good news is that many children who suffer from this type of medicine-induced leukemia and anemia recover quite well. I will be seeing her again soon.
On the 17th a young woman came with chest and abdominal pain. She has 5 children, the youngest being 17 months old. She has been coming frequently for help to the hospital for over a year, but this is the first time I have seen her. Nearly every time she has been given amoxicillin, Tylenol, and sometimes antacid tablets. As soon as I looked at her abdomen it was obvious what the problem is. Her liver has failed to the point that it is hard. So hard, in fact, that the blood cannot flow into it normally, making the veins in her skin over her liver big and blue and swollen. This liver failure is a condition called cirrhosis. Hers has been caused by a virus that has been slowly destroying her liver probably for a couple of years. By now her body can no longer clean the toxins out of her blood, and because of the hardness of her liver, fluid is now collecting in her belly and in her legs. She is very sick; and what’s worse-there is very little that can be done. She is dying of liver failure. Someone had given her TB medicine a few weeks ago, which was making everything worse. Taking away the unnecessary medicine should make her feel better, not to mention giving her medicine that will help her kidneys take up some of the work that her liver can no longer do. Anyway, I asked her if her husband was around, so we could test him to see if he too was infected with the virus. Sure enough, he was right outside with the younger children. After she went out, he came in. But he looked horrified. After sitting in the chair, I noticed he was shaking and wringing his hands. He was choking back sobs, and said he had never been in a health care building of any sort, and was absolutely terrified. After a bit of consoling, and explaining that all I wanted was a simple finger-stick blood test to see if he also has the same virus that his wife has. If not, we could give him a vaccine to help prevent him from also becoming so sick. He was greatly relieved, and when he tested negative I went with him to the area where they give vaccines, and told them that he is pretty scared of all of us. I was glad when I saw that the lady there was kind and cordial, and he was vaccinated and out the door in just a few minutes. I will see this family again in a few weeks. We’ll see how Mrs. is doing. She is not likely to survive very long.
On the 25th I was asked to do a chest xray on a 19 year old girl who was having trouble breathing. She is very thin and was breathing very shallow and fast. When I did her xray, it showed that her left lung had collapsed, and the air trapped in her chest cavity was pushing her heart way over into her right lung, and a little puddle of fluid had begun to accumulate at the bottom of the left side of her chest. This is a condition known as a pneumothorax. Her trachea (windpipe) was not in the middle of her throat, it was being pulled over to the right too. No wonder she was having trouble breathing! So I quickly went to find the health care officer in charge of her care. This “health extension officer” was out at the front of the hospital with a couple of her children, and her mouth was full of betel nut. When I told her she said, “OK, well the doctor will see her tomorrow.” I was frustrated, but not surprised. Sure enough the doctor came in the next day and put in a needle used for IV’s and drained out some air. Not much. A repeat xray showed very little improvement, but the poor girl was breathing just a little easier. There is nothing I can do to force anyone to provide proper care for her. And this kind of story is repeated by the hundreds around PNG every day. It’s very sad.
Just a few days ago a young couple came in; Nancy and M. When I began to ask her questions, she would silently turn to M. to answer all the questions for her. I asked what was going on, and he said that she could not hear. When I asked how long this had been going on, he said she had suffered from progressive hearing loss since she was a baby. When I asked if she had any illnesses or drainage from her ears as a child his reply was “Oh, her mother dropped her soul in the river when she was a baby, so now she doesn’t have a soul.” I’ve heard similar stories before, and it always takes me a minute to formulate an answer. When I looked in her ears, both eardrums had been completely destroyed from chronic infections, and there was visible extensive scarring.
The family had never sought treatment, because they assumed it was due to her soul falling out. Simple antibiotic treatment would have relieved an enormous amount of suffering for her as a child, not to mention preserving her hearing. I am trying to see what I can do for her, but most of the damage is too extensive. But more than that, I fought to communicate to them that she still has a soul. Her soul is in far more danger than her body. But they could not comprehend my explanation. More than that, the doctor was in the hallway asking for another xray, and several people were just outside the door- all impatient to come in. So this young couple was uncomfortable in the room– not comprehending me and just wanting to get out of the way. Thankfully, they are to come back in a few weeks. Oh, that the Lord would open their eyes (and their ears) to understand truth, instead of the lies they have always known and thought to be truth. Thanks be to God, we serve a Savior Who can still open blind eyes and deaf ears!
