Journey from Port Moresby General Hospital to Madang
While doing my first year Residency Medical Officer training at PMGH in 1991, I discovered this Medical Speciality called Critical Care Medicine which was already a sub-speciality of Clinical Medicine in the developed world.
Every time one of our patients succumbed under our care or at the Emergency Department, our senior and experienced team members explained to the relatives and us the junior members that we cannot do much because either the disease process had overwhelmed the body, and the medical treatment cannot help the body to recover (sik em winim marasin), or there was a delay in bringing the patient to the hospital.
Even those patients that have been admitted to the wards few days earlier, and were put on treatment for the working diagnosis were no different, same reasoning
Then I asked myself, “if I cannot help these patients, then I am no different to a nursing officer. What’s my purpose as a Medical Officer?”
As someone who was brought up in a rural village environment which is challenging, I am used to challenges. Hence, I took up the challenge of finding out whether we had done everything as was explained by our senior/experienced team members. I used knowledge and skill that is an important tool for quality assurance, which is audit. So, I took it upon myself as an important aspect of my profession to do death audits and now incident audits too, (Morbidity and Mortality Review).
Through this process I discovered what was already a subspecialty of Medicine called Critical Care Medicine.
So, what is Critical Care Medicine?
Critical Care Medicine is the speciality of Medicine that uses the basic knowledge of Human Anatomy (body parts and their relationships), and Physiology (how these human body parts work together). By knowing this, the doctors and nurses do what is required to help the body to restore itself during an insult (chemical, trauma, infective etc.).
If the insult is not too serious, the body itself can restore itself without the need for doctors and nurses.
However, if the insult is serious, and the body itself cannot restore itself, THEN DOCTORS AND NURSES ARE NEEDED TO RESTORE THE BODY PARTS AND FUNCTIONS!
This is Critical Care Medicine! Do the right thing at the right time to help restore HOMEOSTASIS!
Even doing the right thing LATE when the body has collapsed WILL NOT RESTORE THE NORMAL ANATOMY AND PHYSIOLOGY!
People will die, even in the best of hospitals.
THIS IS OUR BIGGEST CHALLENGE IN PNG AT THIS VERY MOMENT AND WILL CONTINUE TO GET WORSE AS IN ALL OTHER AREAS OF HEALTH SERVICES!
Therefore, I felt that it was my personal mission to establish this subspecialty in our beautiful country.
God Himself chose me for this mission.
When you discover God’s plan and purpose for you, he himself will make it happen, you just have to be obedient!
So, I left PMGH immediately after I successfully completed my Masters in Anaesthesia and Intensive Care in 1997, and went on this mission.
1998 in Madang, I started basic sciences knowledge teaching for our senior Anaesthetic Technical Officers (Mr. John Yakom and Mr. Max Yabri), and together we convinced the Anaesthesia and Intensive Care Society of PNG to introduce Diploma in Anaesthetic Science at SMHS, UPNG for our Anaesthetic Technical Officers.
Max Yabri became the inaugural Coordinator for this course, basic knowledge of human body parts and how they work. This knowledge is the corner stone for a Critical Care person.
“Lack of knowledge my people perish ” Hosea 4:6.
Critical Care Medicine Speciality is just the basics, as explained above. It is not Intensive care Medicine or Emergency Medicine or aero retrieval medicine or whatever sophisticated branch of medicine.
Just the basic knowledge and skills that all doctors and nurses should have, however, it is not as easy as you may think. Because as in everything, the more you do, the better you become. It covers, retrieval Medicine, Emergency Department, Operating Theatre, Intensive Care Medicine, acute bays of each major medical specialty (surgery, internal medicine, O&G, Paediatrics).
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