Letter from Papua New Guinea

Hey all! I hope you are all well. Any more news from home/ rest of the world? I'm exhausted after the last few weeks and half asleep at the moment. Patients keep coming and they seem to present more sick each time. I'm tired of seeing people die, of seeing babies die before they've even had a chance in this world. I know some of the deaths cannot be avoided because the patients were just too sick, but some of them are preventable and I can't control the feeling that if I or someone else could have just been there sooner instead of doing whatever we were doing elsewhere in the hospital, they might have had a chance. But we can't be everywhere, we can't do everything. I've been surprised at how much I enjoy working and playing with the kids and the babies. Sometimes they are little rays of sunshine in my day. Dare I say it, I think I would like a family and children of my own one day but I cannot begin to imagine the loss if that child dies. I got called to a 3 week old baby yesterday who I'd been treating for sepsis/pneumonia. She hadn't responded and the baby had continued to have severe respiratory distress and had just gotten weaker and weaker. She had already died when I was called, but in fact I was surprised that she had fought as long as she had. Seeing her pale lifeless body in her mother’s arms as tears poured down her face was too much. Sorry is such an inadequate word but it was all I had. I'm not sure how much longer I can do this but, as I think that, I remember that these people do it every day. I can go home in a few months back to my life, they can't. They are already home, this is their life. So I'm trying to focus on the positives. Last week we had a 10 year old boy rushed to hospital after having been in a house fire. He has quickly become my favourite patient. He had 1st and 2nd degree burns all over his back, right arm and left hand. These had been treated at the local health centre and it was now 4 days since it had happened. He came to us in pain, dehydrated and very short of breath and hypoxic. He had noisy breathing and a hoarse voice so in all likelihood he had airway burns and swelling that were making it hard to breathe. Listening to his chest he also had evidence of inhalation injury. A week, lots of steroids, antibiotics, nebulizers and oxygen later and he is doing well. He is so strong, no matter what happens or how much pain he's in I go and see him and he smiles and gives me the thumbs up. He's an amazing kid, one of the rays of sunshine. The other night we had a woman who had been accused by a teenage boy of being a witch. He took his bush knife and slashed her across the right side of her face, cutting through her skin, muscles and jaw bone right up to and through the mouth and cutting out some of the teeth too. When our surgeon Laura and I got to her she was conscious but not fully. Blood was everywhere and pooling in her mouth. I managed to intubate her and Laura set to work controlling some of the bleeding quickly realizing that if the knife had gone a few millimeters deeper he would have cut her jugular vein and she would not have survived the journey to hospital, one which took her over a mountain and through a river. Almost five hours later she had her muscles repaired and jaw wired and skin sutured so that her face and mouth once more resembled a face and a mouth and today she is doing well, in pain but alive and doing ok. At the same time that all this was going on we had a young boy who had developed heart failure and was deteriorating fast. After being relieved by our anaesthetist who took over ventilating the young woman, I went to check on the boy. I was so close to intubating him but in the end held off - we had no no-one else who could ventilate and at this time we had no idea if any critical care services were functioning at the other hospital where we would need to refer him. If I'd intubated I would have been sending him into the unknown. We transferred him later that morning (by this time it was 3am) to Mendi and he arrived safely and in not too bad shape. But it was an agonising few hours wondering if it was the right decision. The next day we had a young girl was rushed in who had eaten poisonous mushrooms earlier in the day. She had dropped her conscious level and had started to repeatedly fit. We managed to stop her fitting and again had a sleepless night wondering whether the decision not to intubate was the right one and what I would do if she remained unconscious, I wasn't sure. It's been a while since I've dreaded going into work but I was dreading going in the next morning. But when I did I had the best surprise: she was awake, talking and smiling at me. Today she was discharged home. So I'm trying to focus on the positives, for all the fights we lose there are some we win and it's a great feeling when we do. Lots of love, missing you all.

Jenna BROOME is an accident and emergency doctor working in Tari, Papua New Guinea on trauma and gender based violence programmes.