June 2: Filling the pantry

June 2 ^nd :

Today was the get-acquainted day. The airport folks have not seen my wallet, but they will ask around and keep an eye out. We are trying to cancel cards, but cannot dial US 800 numbers on the cell phone we picked up from another missionary for a handful of kina, so I have left 4 AM messages on my mother's home number.

Drove into town this morning for a shopping trip to stock our cabinet for the next month. We looked around, bought pottery at the Christian Bookstore and woven baskets from the street vendors (now residing in the freezer, to kill all the bugs), and spent ridiculous amounts of money to buy groceries – pasta, carrots, corn, green beans – all the staples, as well as replenishing the curry powders and spices that are mandatory for cooking any more in our house. Noted after getting home that most of the pasta we bought was gluten/dairy/egg free vegan pasta made mostly from corn meal. It's very good. Tonight was pork loin medallions and penne with a coconut curry sauce and fresh pineapple.

Kumi came with us – one of the nationals – and helped guide us around to the right places, as well as putting the face of legitimacy on our business, so to speak. Or at least that was my initial understanding. There's a great deal of reverse discrimination in certain aspects of the culture – for example, Diane our American driver made certain to hold on to Kumi's hand when we left or entered a shop to indicate he was with us and therefore did not need to be patted down on exiting. On the other hand, my white skin and fragmented Tok Pisin meant I was a stranger and therefore got the higher prices for bags and baskets. We negotiated – or rather, I walked away and came back and Diane badgered the women and we walked away and came back – until the bag I wanted went from 50 kina to 35. But there's no bargaining. They say that, but what they mean is that you don't counteroffer. It's just a matter of deciding whether you want to pay their final pris .

Mount Hagen is a city like so many other third-world cities I've encountered in the travels I've done: dirty, noisy, full of people – and like it was in Nicaragua, I feel the curious sensation of moving within a bubble that is created by my essential strangeness . My skin is the wrong color, my voice the wrong timbre. I will never blend in here, not if every word I spoke was perfect. It is a curious sensation.

We had to wipe the dust off of the groceries before putting them away. Angel marvelled – he, whose only brush with a culture like this was in taking the wrong road in Mexico – and moved like a man unsure of where his next step would take him. His discomfort and anxiety were obvious, at least to me, and the little things like covering my money with my hand did not come so much as second nature.

We had dinner at the Western hotel, and drove through a gate in the wall to get there. We ate by the pool – burgers and fries and chicken nuggets – a little oasis that was a welcome relief from the press of the streets.

And then the market: hot, crowded, filled with trencher tables covered in fresh produce. Everywhere you looked there were vegetables – some familiar, some not so much so. We bought carrots and peppers and potatoes and onions and sugar fruits and leeks and some peanuts still lingering on their stems, fresh off the peanut plant. And pineapple and bananas as well. Elsewhere, oranges and nectarines and kaokao , the national tuber, which looks like a mutant potato and apparently is some variety of yam. We have it all in bags and bags, rinsing now to wash it all later, since nothing is safe for our delicate GI tracts fresh out of the ground or off the farms. The debate seems only to be whether it's soap and scrubbing or a dilute bleach soak to render it safe.

I had my tour today of the hospital: four wards, some operating theaters, and an outpatient clinic. The ER is a tiny five-bed affair that sees a lot of trauma. Everything is done differently here. We don't have much IV stuff, Erin tells me. Lots of PO antibiotics and casting supplies. Don't order labs like you do in the US. And I get to thinking: When was the last time I needed electrolytes to tell me what was wrong with a patient? It's been a while, although I check them on everyone. And our labs are limited indeed. A CBC, basic electrolytes (nothing to replace them with, IV wise), some liver functions, amylase and lipase. That's about it, and most of the time we can get most of them.

There's no ICU. There's no Q2h accucheck. Erin tells me that when someone codes, they're pretty much going to die. You can do some epi, some code drugs, try to intubate. But it's pretty much futile. Four wards: medicine-OB-pediatrics-surgery. Four concrete-floored rooms with bare-frame beds lining the walls, patients occupying each one almost solidly. No curtains between beds, no pretense at privacy. No air conditioning: the window slats are open to let the breeze through. It is still warm here in the Highlands, and humid. The air clings to me. I stare – rudely, perhaps, although it is my job to stare and to evaluate – and the patients stare back. Mutually evaluating. There are oxygen condensers and IV poles and white bandages. In the OB ward, there are three delivery rooms, side by side, with curtains for privacy. We cannot get to the OR. And I realize that I have left my stethoscope in the United States – so much for being helpful. Tomorrow, I will find out what kind of charting will take place on these people who are being given the best we can offer them under the circumstances.

Erin tours me through the hospital and then waves goodbye. Meet at 8 tomorrow and we'll round. You'll be with me in the morning, and Susan in the afternoon. I am “Doctor Nykki”, which settles comfortably around my shoulders, but it is the only comfortable thing about this place suddenly. One week peds, one week medicine, and two weeks of OB. They're pleased that I can do c-sections and seem ready to let me plunge in without auditions. They do D&C's in the delivery rooms under conscious sedation. There is no suction for such a procedure; it is done by curette. Oh. I am on call for Friday, which appears to be a national holiday, and the clinic will not be open, so it will not be a good day to be on call.

Baptism by fire. I do not know exactly what to pray for, today – for strength, and goodwill, and humility, and brilliance. That I know when to ask for help and what to do about it when I get it. And I wish I had not forgotten my stethoscope.