Kudjip Nazarene Hospital is part of the Nazarene Healthcare Mission and has very strong links with the Samaritan's Purse. It is located in Wagi valley (still 1500m above sea level) and is surrounded by mountains on all sides, which makes for fantastic views. It rains at least once a day on average, even in the dry season. The hospital itself sits in a compound with a school of nursing and houses for the missionaries and visiting doctors and volunteers. The station is loosely guarded by security guards. There is an ongoing hydro-power project providing employment to over 100 locals. This involves construction of a reservoir and dam to supply power to the compound.

The hospital has 4 main wards of general medicine, paediatrics, obstetrics & gynaecology and surgery. Each ward has about 30 beds which makes the capacity of the hospital just over 120 including outliers and an additional rehabilitation ward. The outpatient department sees about 200 patients a day. There are 8 full-time doctors on staff at Kudjip. Most are American family physicians. Jim Radcliffe is the only surgeon around. Additional doctors and support is provided by visiting doctors and volunteers.

4 chaplains work within the hospital, 2 full-time and 2 part-time. They try to see all the inpatients, but they also have a room in the outpatient department for counseling and praying with any patients who might require they help. Joint activities include devotion on Monday mornings at 0730hrs, prayer meetings on Thursday evenings after dinner and teaching presentations given every Friday morning before ward rounds. Because all the doctors here are believers and missionaries, prayer during clinic and before every surgery is common practice.

The hospital receives many volunteers through church links and Samaritan's purse. Everyone is thus comfortable with having students, foreign doctors and other volunteers and observers around.

Aims of my elective

In Kudjip Nazarene Hospital I hoped to:
- gain further experience in tropical medicine and surgery
- learn how medicine is practised in resource-poor settings
- develop skills in practical procedures
- see firsthand how a mission hospital works and how doctors integrate the Christian faith with their daily work
- see different pathology from the UK.

Notable moments

Just 3 days into the attachment, I got to perform my first lumbar puncture, on a lady who had come in several times for intermittent headaches and isolated seizure-like activity. LP was the only resource here available to differentiate between the main differentials of multiple sclerosis, TB meningitis, syphilis and prion disease. There were several LPs to perform during my time here, including on children.

The general surgery is really general surgery. From abdominal to orthopaedic surgery, elective and emergency procedure, one surgeon does it all. On my first day in theatre, I had to assist in a salpingo-oophorectomy for a ruptured ectopic pregnancy. There was also a drainage of a liver abscess, which very quickly filled the operative field with white pus when we went in to explore.

While on-call, they asked me to see someone at 0230hrs. He had advanced tongue cancer with dysphagia. He had been treated with chemo/radiotherapy in Lae, but when discharged, he asked for a referral to Kudjip and travelled here straightaway, hoping for a magic cure. Unfortunately, due to legal reasons, we are not allowed to admit patients not from our province. I felt terrible, but knew he was palliative anyway. I prayed with him and referred him to Mt Hagen in hopes that they may continue radiotherapy to at least shrink the tumour enough for him to eat for a little while.

There was a road traffic accident, which involved 4 people. The driver, deceased at the scene, was a police commander, who was drunk, along with 3 sisters. They lost control of the car and it plunged into a ditch. The 3 sisters came in altogether. 1 had multiple rib fractures, lung contusions, a haemothorax and T4 fracture. She died soon after a chest tube was inserted due to respiratory arrest. Another sister had multiple facial lacerations and a mandible fracture. The last went to theatre soon after she came in for repair of deep lacerations in her arm. Out of 4, 2 survived.

An important difference between the work here and in UK is that laboratory tests are expensive and difficult. Even within the first 2 days of being here, I'd been told multiple times that unless it will change management, I was to avoid tests as much as possible. This would prove to be great training in the following weeks to really think about diagnoses and treatment plans. Too often we order pointless tests in the UK, having the luxury or a good healthcare system with a large budget.

Leisure time

Work generally finishes by 1700hrs everyday. On weekends, only the on-call doctor is required to be in hospital, so I had quite a lot of free time stuck in the compound. Fortunately, the path toward the hydro-power project was a decent hike which led to a fast flowing river complete with rapids and deep pools to swim in. A quick dip in the river served as the best way to cool down from the heat of the sun, which was exactly what we did on a lazy Saturday morning.

Many hiking opportunities presented themselves. One notable example was to a set of caves which probably have only been visited by a few people. This was proper jungle trekking, with muddy trails, slippery clay and grass taller than most of us. We started at 0900hrs. We only got to the caves at 1300hrs. It was my first time caving. Make-shift harnesses and straps form safety lines for a 5 metre rock and waterfall descent. This was just the beginning. There were plenty more edges, rocks, crevices, and ledges to traverse. Most of the surfaces were covered in bat dung. Yet, it was a thrilling experience.

Church

The Nazarene church right outside hospital runs very similarly to a Ugandan church I had been to previously. The songs in the beginning are very simple, with only a few lines of Tok Pisin or English lyrics. Most of the service was held in Tok Pisin, with the preacher using a lot of repetition and emphasis. I did not understand what he was talking about except to say there was much about saying, “God blessim yu”. The whole service lasted about 90mins.

Concluding remarks

Kudjip Nazarene Hospital allows the resident/medical student an introduction to tropical medicine/surgery and mission work that is as comfortable or hardcore as they would like. Opportunities here to develop clinical judgement, practical skills and holistic care are abundant. Confidence is gained from the encouragement to manage patients independently. Yet support is excellent from the best, most caring and committed collection of doctors ever to be assembled in any hospital I'd been to. There were only few instances where the standard of medical care was questionable. But most of these instances were due to lack of resources or expertise. The doctors here try to run the hospital at very high standards, to the point that patients arrive from different provinces and hospitals just because they have heard about the standard of care here.

In a country where 40% of hospitals have no consistent clean water supply and most people have no access to electricity, the infrastructure on station displays the tremendous effort and commitment of the missionaries and locals to develop the area. In the span of just a month, beyond just an introduction to tropical medicine and surgery, this experience has strengthened my faith, fuelled my passion for mission work, encouraged me to pray with patients and taught me to wait on the Lord.