 | You visit the earth and water it, you greatly enrich it; the river of God is full of water; you provide the people with grain, for so you have prepared it. 10You water its furrows abundantly, settling its ridges, softening it with showers, and blessing its growth. 11You crown the year with your bounty; your wagon tracks overflow with richness. 12The pastures of the wilderness overflow, the hills gird themselves with joy, 13the meadows clothe themselves with flocks, the valleys deck themselves with grain, they shout and sing together for joy. |
The picture at the top is taken from the mountain where the baptism took place. Our station is a tiny little white spot down in the valley. I can't even describe the incredible beauty of the Waghi valley - like God left a thumbprint on the earth, that can't help but burst forth with fruit. And such fruit! The land around here is rich with pineapple and banana and oranges; we get lemons from the tree down the road - pick them or they rot on the ground from such quantity - there are coconuts and beans and coffee and tea and sweet potatoes and onions...
We walked down to the market on Saturday after getting back from the baptism - outside the station by ourselves. It seems such a small and trivial thing, but it was meaningful to us. We went and bought pineapple and toilet paper and raspberry jam, looked at the kaokao (sweet potatoes) and the unidentifiable greens, bemoaned the lack of carrots and peppers, stumbled into the buoi-and-cigarettes section and back out, and walked home past the folks selling peanuts and grilled meats along the path, sipping Coke Zero and feeling very proud that we didn't need someone to walk with us.
It's dry season right now, or as we've heard it dubbed, "Less wet season". It rains almost every day - sometimes, just a gentle drizzle. Most of the time it's a pounding storm. Last night, the VSAT went out for hours - and just as Matt was getting called about it, the power went out too. We get some great rains, with mud rivers in the road and waterfalls of water into the rain cistern (if it rains, I don't feel guilty about taking a shower). The other day, we caught a rainbow across the sky. I got a few pictures before it faded, and incidentally discovered that the circular polarizer filter on my camera lens is capable of polarizing the rainbow right out of existence. It was an entertaining little physics lesson, really.
I'm finding it difficult to believe that next Thursday (the 2nd) we'll be getting back on an airplane and heading to Australia for a few days' R&R - and then back to the US. It seems like we just got here. I'm finally starting to feel like I'm something more than a burden on the rest of the station medical staff. Sister Sylvia today complimented my tok pisin and said she was very impressed at how much I've learned. I can manage basic rounds in the OB ward on my own, I did a C-section today with only a nursing student and a new scrub nurse for assistants (and she didn't bleed all over the place), and I can handle basic things in the OPD. I'm keeping Priscilla-the-translator though.
The 25-week baby is still breathing; I started feeds (sugar water) down the NG tube this morning. She weighs 800 grams and cries when I unwrap her for examinations. I keep praying, although I know the end is hardly likely to be good. Scott says he had a baby like this once who lived for three weeks, until every bit of reserve was used up. I keep praying. What other medicine do I have?
We've been out of betamethasone for a while, so I've been using dexamethasone instead. Today I was told we're out of injectable dexamethasone too, so we're using orals instead. I don't know what the data says on effectiveness, but I guess I'm thinking oral has to be better than nothing at all. My diagnostic criteria for giving steroids here are simple: patient-reported contractions and an ultrasound age of 34 weeks or less. The cervical check is a nice addendum if I get it. A different world. We give Cytotec here and check fetal heart tones every 30 minutes. There's no such thing as continuous monitoring, NST's, or internal monitors. If I want to know about contractions I get a nursing student to sit by the bedside with a piece of paper and a stopwatch, recording palpation, duration, and time of onset of contractions.
A new baby got delivered today to a mother whose HIV test on admission came back positive - she was essentially delivering when we got the news; not the best time for a C-section then. "All the medicines were started." At least we have plenty of HAART medications around here, and there's a standard protocol for what to give to babies.
Only saw a few patients in the clinic today: recheck for high blood pressure, kid with chronic cough and room air sats of 85% (pneumonia), and the girl with no periods. Her TSH is normal: 1.7. Her blood sugar is normal.
I put her back on the ultrasound machine. I still couldn't find a uterus. Scott couldn't find a uterus, although he found something that might be a very small one. What she needs is a list of endocrine tests with long names involving words like "stimulation", maybe a CT scan, a genetic study to see if she's really a male or what. We talked it over, Scott and Jim and I, whether we set her up with Surgery for an exploratory laparotomy where we cut her open and see what's inside (suppose she's a genetic male with androgen insensitivity; she might have undescended testicles which could become cancerous later) or put her to sleep to do a vaginal exam (is there a cervix?) or tell her to go to a private endocrine clinic in Port Moresby, where they can send lab work to Australia. She'd need to raise 1000 kina for testing, plus 600 for a CT scan, plus airfare from Mount Hagen to Port Moresby (and remember, only one airline flies from Hagen to Moresby, so imagine the prices), just to find out if she's really a girl.
And suppose she's not? That kind of revelation would be difficult at best for a well-adjusted Western woman living in a culture inundated with sexual liberalism. For a New Guinean girl in a culture of carefully defined gender identities and roles, I'm not certain it could be truly comprehended. We gave her the option of going; Scott told her that if she wanted to spend the money he'd arrange the referrals. What we didn't do was explain the complex genetic concerns of androgen insensitivity and genotype/phenotype mismatch. And for now, I wrote for three months of oral contraceptives, under the idea that if we give her a progesterone withdrawal bleed at least it's evidence that there's a uterus in there somewhere.
Scott did a very nice job of explaining to her our general concerns: that sometimes the bokis pikinini doesn't grow correctly, and sometimes not at all. That the body sometimes makes marasin called hormones that don't always work right. That we weren't sure if she would ever have periods or be able to have children. That there were some very expensive and complicated tests that could be done in Moresby, should she desire. That we would try and treat her here as best we could. And that once, we were perfect creatures created without flaws, but that no longer was that true - that our bodies were imperfect and didn't always work the way they should. Some people have high blood pressure. Diabetes. You have something wrong with your bokis pikanini. It's not something you did wrong. It's just the way your body is. We're not perfect.
I wonder what will happen to her.
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