The Story is based off an interview with Pase John and multiple conversations with Dr. Beth, as well as, some of my first person account.
by Erin Foley
After unemployment had left Pase John unable to properly provide for his family, he left Lae in Morobe Province. As he searched, Pase was led to the Gulf Province where he found a temporary job with an oil and mineral company building bridges. The labor was hard, but he was happy to work for his wife and young children.
A gentle smile crossed his serious face when he talked about his small boy and baby girl. A sadness shown in his eyes, as well. He had not been in contact with them for months. It was hard to stay in touch when he was at his work camp in a remote area.
Laboring on the bridges a few months, the days wore into weeks and life was in a bit of a rhythm with nothing much changing. Then what started as an ordinary week of hard labor, changed dramatically as he began to feel weak. Weaker than his usual fatigue.
Both of his upper arms were losing strength at an alarming rate. That night, he tried to rest well. When he awoke on the Wednesday morning and got out of bed, his arms remained limp and now his legs were being drained of all strength.
Pase, like many Papua New Guinean men, was not tall but he had an imposing strength. His lean muscle indicated a life of demanding toil.
Doubts flickered through his mind as the extreme exhaustion came on. He knew something was wrong; this was beyond pure weariness. He alerted the base camp medic, who brushed off Pase’s concern. After a brief medical examination, Pase was sent back to his bed.
Pase awoke in the night with a terrifying revelation. Try as hard as he could, he could not move a muscle. Although he could talk, he was completely paralyzed. Panic set in as he called for help.
By the time the medical staff was alerted, they were sure Pase was dead. His heart rate was barely registering. Not a muscle moved.
That morning, they rushed him to their base camp in Tuel where they attempted to stabilize the dying man. Isaac Anley, the base paramedic, took over. He knew there was not much they could do and they needed to get Pase to a hospital as soon as possible if saving him were even feasible.
With the helicopter blades rotating swiftly overhead, Pase was strapped in with Isaac by his side. They took off and made the couple hour flight via chopper to the bush hospital in Kapuna.
Mid-Thursday morning the Kapuna staff had done their rounds in the wards. Many of them were sitting in the living room of Dr. Lin, Grandma, enjoying devotions. The singing had ended and it was more of a time of conversation when the tale-tale resonance of a distant helicopter broke the normal jungle noises. It was the second helicopter to arrive that week.
The doctors had been busy the past few days with an influx of severe Tuberculosis patients; although this was a fairly normal state for Kapuna hospital to be in. As the helicopter broke through the dense grey clouds in the morning sky, they knew there was likely another emergency to handle.
Since most patients – even extremely sick ones – usually arrived via canoe or dinghy, flights in are reserved for many of the worst cases.
The staff dispersed from their devotions and headed to the pad that sat amidst the swampy grasses in front of the hospital. Patients, families, students all came running, clamoring close enough to see the metal beast with its swiftly rotating arms. Isaac jumped out. Aided by staff, he carried Pase into the hospital.
The doctors were at a loss as to why a healthy, 26-year-old man would wake up completely paralyzed with a diminishing heart rate. ECG’s showed the heart rate was at risk of completely stopping. After a round of checks and basic diagnostic testing, Dr. Valerie and Dr. Beth diagnosed low potassium and treated to stabilize him. Then they, and even retired Dr. Lin, went off to consult every resource to figure out why it was so low.
Haunted by the terrified gaze of the dying man, they prayed as they worked.
Dr. Beth said, “His desperate look met my panicked one as I sent up probably the shortest but most effective prayer I have ever prayed. ‘God, HELP!’.”
As research and reading ensued, the three women came back together to discuss their findings. Dr. Beth found the diagnosis in books, and Grandma reminded Valerie that she had seen it once before as a student. (What a wonderful memory 89-year-old Dr. Lin has!) All of them had come to the same diagnostic conclusion: Shakhonovich’s syndrome… Hypokalaemic periodic paralysis. It was the only diagnosis that made sense with the failing heart rate.
The disease is genetic and very rare, usually showing itself in adolescence. Potassium, which helps muscles and maintains the heartbeat, does not transfer properly between membranes. This causes extreme muscle weakness when potassium levels drop or in extreme cases complete paralysis. If not treated timely the heart can stop.
The other risk of the disease is that recovery is quick and almost instantaneous. The sudden high potassium in the blood adversely affects the heart rhythm and can cause fatal arrhythmias. The patient has to be closely monitored to ensure this does not happen.
Days later, Pase was asked what was going on in his head while all of this was happening. He said initially terror. He did not think he would ever see his family again. Due to the remoteness and suddenness of his illness, his family was completely unaware of his condition throughout the ordeal.
He said once he was in the care of the doctors, could sense their concern, and had all of the tests running, his fear eased a bit. He knew they were doing everything possible for him.
Slowly they watched his heart rate improve with the potassium treatment.
Thursday felt like an eternity in the eyes of Pase and the staff at Kapuna.
By Friday morning, Pase was more assured by the doctors. Isaac never left his side, as he interpreted the English into Tok Pisin for the young man.
Monitoring him closely in case his heart rate spiked, the waiting game for his sudden recovery began.
The Lame Can Walk
Friday evening Dr. Beth did her usual rounds. While checking on Pase, he complained to her of pain in his chest. She prayed it would not be something worse and asked him where his pain was located. Without thinking, he lifted his hand and pointed to the source of the pain.
Dr. Beth, Pase, and Isaac all realized in that moment Pase was recovering.
Pase could move his hand and arms. His feeling and strength were returning. Overjoyed, they waited breathlessly to see how much he could do physically. In less than an hour, the patient sat up and swung his legs over the edge of his bed. With shaky steps, he began to walk across the room.
After monitoring his heart to make sure it was stabilized, Dr. Beth left her healed paralysis patient in joy and informed Dr. Valerie and those around the hospital of his recovery. Face alight, she came to us friends, to inform us of the miraculous healing.
Our cheers could probably be heard a long way off.
We all knew it was moments like this that kept the medical staff going. It made the hard work and sleepless nights worth it.
It’s not every day a person can say they saw a paralyzed man get up and walk. The staff at Kapuna can. Thanks to the hard work of a dedicated medical staff, the wisdom of God, and the determination of a man to live!
On Friday, February 7th, Kapuna Hospital graduated fourteen Community Healthcare Worker (CHW) students. It was the 51st class to walk up and received their certificates, marking how significant Kapuna training schools have been to the healthcare of the Gulf Province, as well as, the rest of Papua New Guinea. The goal of all CHWs is to see holistic care provided for the rural population of PNG.
The CHW students will continue putting their skills to work as they take on an intense six month internship either at Kapuna or Kikori
Hospital. After, they will distribute throughout the nation to join the local staff at one of many healthcare stations. We believe they have been set up well to take on the challenges of rural stations and are excited to see all of them in action.
Of course, Kapuna Hospital knows that our desire to see PNG healthcare improve is not a challenge we fight alone. We want to thank partners including: Interoil, who supplied transportation of material from Port Moresby; the Training Division of the Government, who gives financial and material support; Baimuru Health Center staff for their training and knowledge shared; and our family at Kikori Hospital, who worked alongside our students to teach and develop their skill.
We are blessed to have been training PNG students for over 50 years and hope we can continue for another 50.
Hello! I’m a U.S. medical student finishing up my last year of school, and I’m wrapping up a 7-week tropical medicine elective here at Kapuna.
For students interested in coming, here are some tips:
– Bring your tools: stethoscope, opthalmoscope, otoscope *with covers*
– Bring your old hospital scrubs or other clothes you don’t mind getting grubby. All your clothing should be loose fitting (culturally appropriate), and pockets are always useful. Leave your white coat at home.
– Bring a head lamp. It’s useful for difficult deliveries or surgeries in poor lighting.
– If you have extra small hands or extra large hands, bring your own gloves. If you have a latex allergy, bring your own latex-free.
– Bring eye covers/protectors, shoes covers (the orthopaedic knee high covers would be best). The masks here don’t have eye protectors, and we operate barefoot in cotton dresses.
– Bring a watch that has a backlighting function and alarm clock
– Bring a pocket size pharmacopedia and/or tropical medicine handbook.
– Bring a small bag you can carry your stuff in during rounds.
– Bring multiple pens. There aren’t many spare to go around if you run out of ink or lose any.
If you want to bring medical supplies, here are some helpful things:
– Urine dipstick test strips. The humidity spoils them quickly here.
– Glucometer with test strips
– Your own suture with needles. There are straight, round bodied, needles with eyelet holes you need to loop your own suture in here. The suture is also old and may break with little tension.
– Gloves. The disposable gloves are washed, sundried, and reused, which renders them to fall apart easily.
For general tips:
– Bring long socks. The sandflies love the feet and ankles.
– Bring hydrocortisone cream, maximum over the counter strength, or a higher strength prescription for the bug bite itchiness
– Bring energy bars. It’ll take you at least a week to get used to the diet. Dingy trips can also be long, so energy bars are useful portable meals.
– If you’re not so keen on being a vegetarian, bring your own meats like jerky. Fresh fish, chicken, and eggs are treats. You may not be keen on canned fish or beef.
– Bring your antimalarials. Take a trial dose before coming to make sure you don’t have intolerable side effects. Bring sun screen if you’re taking doxycycline.
– Spray your clothes and shoes with permethrin clothing spray. Helps keeps the buggies away.
– Bring a flashlight. Solar ones are best. If not, bring spare batteries as they’re not always in stock here.
– If you’re a light sleeper, you may want to bring ear plugs for the chorus of frogs and chickens at night.
– If you mind sleeping on the floor, bring a compact camping mat for work in the villages.
– Bring a good quality umbrella. Useful for the pouring rains during rainy season, and for keeping the sun off during hot season.
– Bring flip flops or water sandals. Quick drying water sport shoes work well.
– Bring at least 5 outfits. There is laundry machines here but it takes days for your clothes to dry on the line during raining season.
– Bringing your own laptop is useful as there are not always spare ones.
– Best way to avoid luggage getting lost is to bring only carry-on.
– Bring a small towel if you want to shower at the Brisbane airport showers.
– Exchange your currency for Kinas at the Jackson Airport in Port Moresby upon arrival. Do not exchange them at Australian airports because the exchange rate is horrible.
– If someone is picking you up at the Port Moresby airport, they will be waiting outside. Visitors cannot go inside the airport.
– Bring extra cash. The PNG websites for visa fee upon arrival is not up to date. You need to pay for transport costs by dingy which can vary with fuel prices. Toilet paper is 1 kina per tiny roll. There’s a small market and store to shop at also.
Nice present ideas to bring for the staff:
– Chocolate (bars and cocoa), nuts, yogurt making packets, tea, dried Western fruits, milk powder, cheese, butter, cooking spices
– Zip-lock bags, plastic wrap, dish towels
– Travel backpacks, compact camping mats for village work
– Leather gloves for firewood chopping, sturdy umbrellas
– LED flashlights and lanterns
Nice present ideas to bring for the villagers:
– Toothpaste, toothbrushes, floss
– Baby diapers, especially the washable, expandable for multiple ages type.
– Long skirts and bras for the women, pants and belts for the men, tops, rain ponchos, umbrellas. The clothing sold here is second hand and extremely well used by the villagers.
Warnings, suggestions, and unique Kapuna characteristics:
– Everything tends to smell and look moldy.
– Be prepared for lots of bugs of all types.
– Don’t be afraid of the stained plastic toilets. It’s mold, not unflushed stool. Be prepared to use the bush or squatting outhouses in the villages.
– Ask before you pluck a fruit tree. Trees belong to people. Same with the hens’ eggs.
– No one licks their lips when they stare at you. Don’t be afraid of the cannibalism stories; those days are behind us. They’re really quite friendly.
– Rainy season is very muddy. There are rain boots (gum boots) to borrow here.
– When you take pictures of the villagers, make sure you show them the photos. They love it.
Enjoy the people, the culture, the wonderful fruit. Learn lots about everything, not just medical things. Be patient with the languages. Appreciate the staff. There are only a handful of staff for countless needs. Eat the food and be thankful for it. Smile. Be humble. Keep a blog or journal. Take lots of pictures. Hope you find these tips helpful!