Alotau Provincial Hospital March 2006
After a month settling in, I was in the operating theatre on a Friday at 3 pm. A call comes in from our Emergency Department (ED), the young enthusiastic intelligent Service Medical Officer (MO) asked me for help with a 7-year-old child that had stopped breathing.
Critical Care Medicine Training in Alotau Provincial Hospital started, I went up to the ED followed closely by my equally young three enthusiastic Anaesthetic Scientific Officers (ASOs).
They were personally advised by Dr. Perista Mamadi (who used to be the Surgical Trainee Registrar in Nonga when we started the service back in Nonga) to wait for me in Alotau. When I arrived, we started the Critical Care Medical Services.
Dr. Perista Mamadi is currently the Chief Executive Officer of Milne Bay Provincial Health Authority.
We arrived at ED, and saw this young tall Trobriand Islander MO struggling to intubate (trying to put a breathing tube through the child’s wind pipe), he was holding the laryngoscope upside down and forcing it through the child’s tinny mouth.
I politely asked him to put that laryngoscope away, and asked for a bag and mask for ventilation (bag and face mask for support breathing).
Nobody knew where the bag and mask were and started looking for them.
They eventually found the special life-saving equipment, and gave it to the young MO who struggled to place the mask and started bagging.
His first lesson in Bag-Mask Ventilation! I taught him his first basic skill of being a Critical Care MO! Then I took him through the Critical Care Medical system that we use in initial Stabilization of Critical Patients.
Through this system we identified that this was a young boy who had fallen from a mango tree and had a fracture of his forearm, and was crying because of pain.
He was given 50 mg of pethidine intramuscular. He was still in pain just after 5 minutes, so was given another 50 mg intravenously.
Diagnosis of respiratory depression was made just by the history, so directed the young doctor to do physical examination looking for specific sign that would confirm this working diagnosis (bilateral pin-point pupils).
He confirmed this sign, so the diagnosis of pethidine overdose was confirmed, and was treated with the antidote (naloxone).
As soon as the naloxone was administrated intravenously, the child from an unconscious state without spontaneous breathing, jumped up, sat down started looking around breathing himself.
Everyone in ED room had just witnessed a life-saving miracle! They were amazed at what just happened!
The beginning of Critical Care Medicine at Alotau Provincial Hospital, Milne Bay Province of Papua New Guinea.
The young doctor developed interest in Critical Care Medicine and joined Post-graduate Anaesthesia and Intensive Care Training with us in 2007. He went on to complete his Masters in Anaesthesia and Intensive Care at School of Medicine and Health Sciences at University of Papua New.
I am proud and humbled to say here that he is now working and continuing his training in Intensive Care Medicine at Cambridge University in United Kingdom, he had been one of our very own products from Alotau Provincial Hospital Critical Care Medicine Training. We give Honor and Glory to God for his Professional journey.
He had made a lot of personal sacrifices to become the first Papua New Guinean professionally qualified Intensive Care Medicine Specialist. So, this chapter of Critical Care Medicine would not be complete without mentioning his name, Dr. Greg Tokwabilula from Trobriand Islands of Papua New Guinea.
The beginning of Critical Care Medical Services in Milne Bay.
Another Service Medical Officer in ED called me for assistance with a young male student from nearby Cameron Secondary school who was unconscious due to cardiac rhythm disturbances. I arrived at the ED and directed the young MO that we will defibrillate.
He looked at me with a puzzled expression, and I knew this would be his first defibrillation.
I reassured him and took him through the procedure successfully, the young student sat up fully recovered, the young doctor was amazed.
This young doctor immediately developed interest in the field of medicine and did his Diploma in Anaesthesia with our Alotau Critical Care Medical team, and continue on to complete his Masters in Emergency Medicine at University of Papua New Guinea. He became the Senior Lecturer at School of Medicine and Health Sciences, the was employed by Fiji School of Medicine as the Associate Professor and Head of Training for about 4 years before returning home to Papua New Guinea.
The second case with this young doctor during his time at Alotau Emergency Department was of a 50-year-old Police Officer, who was a smoker and an alcoholic. He presented to ED with severe pneumonia in severe respiratory distress, so I was called by the young doctor to assist him.
I arrived, looked at the patient, he was obese, propped up in bed, restless, confused, irritable, with peripheral and central cyanosis. Heart rate of 150 per minute, Blood pressure of 60 mmHg systolic, and 40 mmHg diastolic, with a respiratory rate of 60 breaths per minute. The nurses were holding him down, and trying their best to administer oxygen through the nasal prongs.
Holding his hands down too, so not to remove the drip that was in place.
With my vast clinical experiences, I knew this patient his in-heart failure, so I did a quick physical examination to confirm my clinical diagnosis. However, because of obesity, I couldn’t see the elevated Jugular veins, and couldn’t feel the enlarged liver.
So, I was standing there thinking what to do, if I ordered digoxin for heart failure, and it was not heart failure, digoxin would cause cardiac arrest, and if I tried to intubate with the patient in heart failure the intubation would cause a cardiac arrest.
What do I do?
I knew based on my vast experiences, that I just have to close my eyes, and ask my Helper, The Holy Spirit for His assistance.
To be continued………
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