Chaplain at Reading Hospital trains hospital staff in Papua New Guinea

In a remote area of Papua New Guinea, the staff at Nazarene General Hospital serve relentlessly.

The 134-bed facility is the only medical center in the area, which has a population roughly equal to Reading.

Its workers treat nearly 60,000 patients every year, performing major surgeries, overseeing births, and providing lifesaving treatments.

But life isn’t always the outcome.

“I was present when a toddler passed away from respiratory distress,” said chaplain David Troxler, who recently took a mission trip to the hospital in the highlands of the island nation. “It has an impact, how the staff handle a difficult death, a patient they’ve seen and cared for.”

For those who treat injuries for a living, failing to save a life presents its own kind of wound.

Helping hospital staff manage the stress of “critical incidents,” like the tragic death of a patient, is why Troxler, a chaplain at Reading Hospital, made the trip to Kudjip, Papua New Guinea.

The mission trip

Troxler was part of an 18-person mission group from the Church of the Nazarene who headed overseas from March 1 to March 14.

The team, based in Philadelphia, was split in two groups — Troxler’s group was tasked with assisting at Nazarene General Hospital.

Another group built an outpatient clinic in Bana, Papua New Guinea.

Troxler said he trained chaplains, nurses and administrators at the hospital in stress management techniques.

Troxler trained local chaplains and hospital staff in Papua New Guinea on how to manage emotions after tragic deaths and other high-stress incidents. (Courtesy of Tower Health)

He said wards there can often contain up to 30 people without significant dividers, and families often stay with patients and help provide basic care, like food and laundry.

Troxler noted that Papua New Guinea is a young country.

“Something like 40 percent of the population is under the age of 25,” Troxler said. “There are children everywhere; we saw that in quite a few places.”

The country is also diverse, with over 800 languages spoken among the populace.

“Basically, every village and every mountainside has a different language,” Troxler said. “There is tribal warfare still going on. We didn’t experience that when we were there, thankfully, but (the hospital) does get people who are caught up in machete fights…Those can be especially difficult times to deal with.”

Reading Hospital chaplain David Troxler makes the trek to Nazarene General Hospital in Kudjip, Papua New Guinea. (Courtesy of Tower Health)

Managing the impacts of tragedy

Troxler trained chaplains and hospital staff at Nazarene in “critical incident stress management,” or CISM, an evidence-backed method for first responders and emergency workers to manage the emotional turmoil that accompanies particularly stressful “critical” incidents.

He said that he first learned CISM during the COVID pandemic, when staff at the Reading Hospital connected with Johns Hopkins Hospital to receive training.

“COVID was obviously causing a lot of stress,” Troxler said.

He noted that hospital workers often acted as “surrogate families” for patients during COVID, since visitation was difficult.

“We did everything we could to be supportive to patients at those times,” Troxler said. “But it took a toll on staff.”

The R.M. Palmer Chocolate Factory explosion in West Reading in March 2023 — which left 10 people injured and seven dead — was another incident that required CISM care for staff at the Reading Hospital.

“We do (CISMs) on a regular basis,” Troxler noted. “Often for a pediatric death, or a significant community event, like a house fire, the stress has a multiplying effect on staff, especially when they’ve built rapport with the patients and their families.”

CISM involves ad hoc “debriefings,” or meetings with staff, Troxler said. They follow a set format that allows workers to share their experiences and come to terms with their emotions.

“We talk about what people experienced when they first heard about a (critical event), their initial thoughts and feelings” Troxler said. “We talk the worst moments. Sometimes the worst moment is seeing a loved one that is suffering because of the patient.”

He said one case that required a CISM involved a nurse who recently had a baby and was treating an infant who died in the neonatal intensive care ward.

“She’s having her own emotions by seeing what was going on with this other infant,” Troxler said. “So, it’s processing how we deal with our own emotions.”

The goal, Troxler said, is to work through the emotions surrounding tragedy in a way that allows staff to keep providing the care that patients rely on.

He said much of the process involves positive reinforcement, like acknowledging the skillsets of staff members and how they contribute to care.

“Everyone that cares for patients has different roles, but we have one purpose together,” Troxler said.

CISM debriefings usually involve seven or eight staff members but can be done in larger groups or even one-on-one, Troxler noted.

Lessons from overseas

He said he taught chaplains in Papua New Guinea how to build a rapport to better support staff and encourage CISM.

“One chaplain came to me afterward and said, ‘we’ve never had training for chaplains here in Papua New Guinea,” Troxler said. “They were thrilled. I think (the training) is going to pay dividends for them in the long term, they’ll be able to share (the training) with other hospitals.

He noted that the trip came about after he met with a doctor at Nazarene General Hospital while taking an online class in 2023.

“That’s how the conversation started,” Troxler said. “There had not been a mission to (the hospital) since before COVID. So there was a plan two years in the making to get a team to go.”

Troxler said the trip made him realize the commonality inherent in the work that medical professionals do, no matter their location in the world.

The journey also reminded him of the value that chaplains add to the medical setting.

“We’re in the background until we’re needed,” Troxler said. “We provide treatment and care that touches aspects that medical care doesn’t. The spiritual aspects of life. Those questions of purpose in life. We deal with that.”

He noted that no one comes to the hospital on a good day, and chaplains are tasked with making a difference at a time when something has gone wrong.

“People have life-changing questions when a tragedy happens,” Troxler said. “We only have this time in between when they’re admitted and discharged to help provide people with something they can take home besides medicine and therapies. Some value and purpose in their life.”

Troxler noted that he would love to go back to Papua New Guinea or other places to teach CISM, but he doesn’t have any trips planned yet.

Chaplain David Troxler inside the chapel at Reading Hospital. (Courtesy of Tower Health)