Monday, April 29, 2013

Sweet Moments

There are so many sweet moments and precious memories from my time in Africa. I wanted to share a quick video that captures a small bit of the story I shared in January about my patient who we called "Mama". She recovered well after her surgery. Since she lived so far away from the ship, she spent several weeks at the Hope Center until her wound completely healed. I always enjoyed visiting with Mama at the Hope Center and getting hugs when I passed by her on the dock at the outpatients tent.

Enjoy this video by Josh Callow a videographer aboard the Africa Mercy.

Sunday, March 24, 2013

Looking Back

As this season comes to a close, I enjoy looking back to reflect on all that has happened. In one week from today I will drive away from the ship not knowing if I will ever return. I will say goodbye to patients who will remain in the hospital for several more weeks, goodbye to the amazing dayworkers who have helped me to communicate with my patients and farewell to friends and coworkers who will continue on with the work.

It is amazing to think back on the many patients who have come aboard the Africa Mercy for surgery. Although my unit focuses on the same type of maxilla-facial surgeries throughout the entire field service in a country, the other wards change depending on the surgeon specialty from orthopedics, to VVF (Vesicovanginal Fistula Repair), to plastics. When I first arrived there were many children in casts, soon to be replaced by a room full of chattering ladies, and now many burn patients are here for plastics surgery.

As I prepare to leave in a few days I am reminded that things constantly change. This has been a consistent part of my experience here on the Africa Mercy with crew members and patients arriving and leaving every week. It is strange to no longer hear the female voices chattering or see the ladies walking together down the long corridor while singing. Many of their stories touched my life even in the few times that I floated to work on “B” Ward aka the VVF ladies (November-February).
The ladies enjoying some spontaneous singing!
 Although these ladies did not have the outwardly visible defects such as my patients, they still experienced rejection from people including their own families and husbands. These women’s stories are all similar with marrying in their teens or early twenties. Usually during their first pregnancy they had a long, complicated delivery which lasted several days. During the difficult birthing process these ladies developed a fistula so that they began to constantly leak urine. The saddest part of the story is that they gave birth to a stillborn child. So many of these ladies lost the dream of ever being able to have children, and many were rejected by their husbands and kicked out of the house. Some of these ladies lived for 5, 10, 15, even 25+ years suffering from the constant leaking of urine.

The ladies enjoying some sunshine during Deck 7 time.
It was beautiful to watch these ladies build community with one another as they shared the same room together with 20 women who shared the same story. Unfortunately I cannot report that the surgeries were successful for all of the women, but thankfully some of the ladies went home dry with a new opportunity to be accepted by their community and family. All of them left knowing that they were not alone in this experience.

Before the ladies went home, they would have a dress ceremony to honor the women. They received a new dress and everyone celebrated with singing and dancing on the wards. It is a beautiful sound to hear so many African voices harmonizing and singing together!
The ladies in their new dresses getting ready for the dress ceremony

Lots of dancing and singing during the dress ceremonies!
Although these ladies have gone home, new patients are arriving for the hope of a new opportunity. Currently the plastics surgeons are repairing burn contractures for patients who did not receive adequate medical care after being burned.

It really is amazing the work that is done here on the ship.
Nana was a very special lady who
always made me smile!

Friday, March 22, 2013

Flexibility and Creativity

Two ingredients for success on the Africa Mercy are flexibility and creativity. Flexibility is probably obvious when one realizes they will be sharing a cabin with 5 other people. By the way it hasn’t been that bad or maybe I’ve just lucked out with some awesome roommates!

It is impressive how many resources are available to care for patients here in the hospital. We receive multiple shipping containers throughout the field service to keep the hospital supplies stocked. So when there is a delay in the arrival of a container the supplies can become very scarce and rationing begins.

Recently we have been running low on various supplies while awaiting the next container which has increased my gratitude and appreciation for how many resources we do have here.

One item that we have completely run out of is Pediasure/Ensure for tubefeeds! This becomes a problem with the many maxo-facial patients who require tube feeds for the first seven days after surgery! This is when flexibility and creativity become very important.

We are now making our own tubefeeds!! Who would’ve ever thought! Now during my shift I use the blender to whip up some yummy tubefeeds consisting of milk, peanut butter, sugar, fiber, and multivitamins! I never thought making my own tubefeeds would be part of my nursing job description.
Making some yummy tubefeeds!

So what happens when all you have is crunchy peanut butter? It is really time to get creative because the crunchy kind clogs the tubing. So thanks to my creative coworker and resourceful charge nurse Deb, she collected a strainer to strain out the chunks after blending the tubefeeds! She also found some chocolate protein shakes for the patients on full liquid diets!
Thanks Deb for finding us some more supplies!
One other area of flexibility is after work hours. Since everyone lives in the same place that we work we try to be courteous of people’s time off from work. So what happens when you run out of medicines for patients after hours? Well I walk down to pharmacy and to retrieve the needed medicines from pharmacy!
Midnight Pharmacy Run
So here aboard the Africa Mercy we do a little bit of everything which keeps the job interesting with problem solving, flexibility, and creativity.

Wednesday, March 20, 2013

Public Transport and Fast Food

To really experience and appreciate the culture one has to leave the ship and spend time in the country. This past weekend I embarked on quite the adventure of traveling upcountry to Dalaba located about 300km (186 miles) from the port in the mountains. Good thing I didn’t count on google maps for the time estimate of travel to be 3 hours and 45 minutes! Turns out the estimate does not account for many factors when taking public transport.

So here is what I learned from my travels this weekend about public transport in Africa:

1. Patience is key when making a long trek! Who knew we would spend 13.5 hours on the way there and about 10.5 hours on the way back! Good thing we planned to travel all day to get to Dalaba.

2. The taxis don’t leave until every seat is sold. Waiting, waiting, waiting…. That’s right we had the bright idea of leaving the ship at 6:30 to get to the market at 7am. The only problem is no one else decided to arrive to the market until after 10am to go to Dalaba. We waited over four hours even before getting on the road.
Anna and I "patiently" waiting for the taxi to leave!
3. The back of the station wagon taxi is not a good place for tall travelers and people prone to car sickness. You cannot sit up straight or stretch your legs out while facing forward. You also feel every twist and curve of the road in the back, especially when the driver constantly swerves to both sides of the road while trying to avoid the many potholes.

4. Important Lesson: do not dehydrate yourselves for fear of not finding a bathroom. First it is a terrible idea to be dehydrated especially when traveling all day in the heat. Second the car makes many stops where one can find a public squatty potty behind the local mosque or town center. If all else fails, you can always walk up to a random person’s house along the way and ask to use their outdoor facilities as we did with the help of one of the ladies in our taxi.

5. A typical station wagon by our standards would fit seven with two people in the front, three in the middle, and two in the back. We had 12 people in the taxi on the way back! Thankfully the middle seat is much more comfortable even with four people wide rather than being in the back. Two men shared the passenger seat and three women sat in the back while holding one baby and a toddler!
Don't forget about all the luggage that has to be strapped down on top of the taxi!
6. The people in your taxi become your community. Everyone offered us whatever food they bought along the way. Each of the women also took turns holding the baby including myself. No carseats here, which makes it easier for changing diapers in momma’s lap and keeping the baby content and well fed!

7. Remember patience is key! You make many, many stops along. We stopped over 11 times on the way to Dalaba during our 9 hour car ride. The driver made a personal stop, we dropped one passenger off along the way, then picked up another soon after. We made two stops for prayer, two checkpoint stops, and four stops to add water to the radiator to keep the car from overheating! Don’t forget about the meal stops!

8. As for food, this trip provided a whole new meaning of fast food. Nothing is better than after many hours of traveling in the hot car with no air conditioning than for someone to pass by selling cold water and drinks when stuck in traffic. Window service also includes the opportunity to purchase tissues, extra cellphone minutes, food, and even clothes!

Any place we stopped had small food stands along the road! Interesting their idea of fast food is much healthier here with many people buying fresh fruits along the way.
African Fast Food
9. Don’t forget that you don’t have anyway to keep your meat cold; instead you just strap a live chicken on the back of the roof so that the it stays alive until you arrive back home! We even saw a goat riding on the top of a taxi in between the luggage!

10. Just when you think your trip is going to be more successful coming home, alas problems happen that you can’t predict such as the car breaking down. So an hour outside of the port in Conakry our car pulled over due to an engine failure. Everyone sat along the road for an hour waiting for who knows what to happen. After waiting an hour we grabbed our backpacks and took another taxi home to the ship!

During my travels I counted my blessings of how grateful I am for roads back home with minimal potholes, having my own car with air conditioning in the summer, and not squishing as many people as possible into a vehicle. It seems though that traveling here is always an adventure because you never know what to expect!

Sunday, March 10, 2013

Risky Business

After hearing so many words of caution over the years, it can be a bit unsettling to go against these revered words of advice. For example I’ve always avoided semi-trucks as much as possible. Now my walking path through the port has me weaving in and out of 18 wheelers driving past and occasionally backing up only a few inches in front of me.

The view from the Africa Mercy looking out towards the city,
 you have to walk through the multitude of 18-wheelers to get into the city.

By the way it turns out that a great place to nap and escape from the hot sun is to string a hammock underneath the semi-truck! Who knew?

I am used to nicely paved sidewalks in order to avoid cars. In Conakry there are few sidewalks. So I follow behind the lead of the Guineans in front of me who walk on the road as cars narrowly pass. I have realized that the idea of personal space or lack of it also carries over into driving a car. I’ve found they drive a lot closer than I’d personally like.
When crossing the street it feels like a game of leap frog trying not to get hit! You better not step out in front of a car because they will not be stopping for you! So I’ve thrown out the idea of crosswalks and cars yielding for pedestrians!

Leap frog anyone?

Buckle up or Ticket? Being a nurse I definitely know the value of seatbelts, but there are many times when there are no seatbelts to be found in the local taxis. So you don’t even have the option to buckle up, especially when the driver swerves crazily in and around other cars.

When in Africa how many people can fit into a taxi? The answer is “Always one more!” Don't forget, you can always stand on the back or top of the car too!
Why not catch a ride on top of the taxi next time?!?
Motrobikes are found all around the city. Helmets? No way. Children? Most definitely. It is common to see a whole family with mom, dad, child, and a baby on the bike. I watched one time as a father placed his 10 month old in front of him on the bike. Thankfully she grabbed a hold of the bike, but still a baby on a bike!

I definitely respect and see the reason for caution at times. Maybe we go a little overboard and become too protective in the States. Instead here in Guinea almost anything goes. So next time you think you see a crazy driver just imagine what it would be like if everyone drove like that at the same time with everyone swerving in and out of lanes.  It becomes risky business!

These things have started to become a little more normal in daily life, but at times I have to think that I would never do this back home! I guess this is part of life while living on a boat while docked at a port in Africa!

Wednesday, March 6, 2013

Hope for Healing

In January, a little boy and his uncle arrived on the dock hoping that Mercy Ships could repair the damage to his face. At six years of age he has already been rejected and shunned by many who believe he has an evil spirit, yet he still has a smile and playful spirit like any other child.  Mamadou* quickly won the hearts of all of the nurses and hospital staff, including my own. Here is his story about a ravaging infection called Noma.
Most of you have never heard about this horrifying flesh eating bacteria because it is not a problem in the western world. Here in Africa where some of the poorest people in the world live it is a real fear and problem. There are many reasons this bacteria flourishes in impoverished areas including a lack of nutrition which decreases the immune system. These children often live near livestock and trashpiles while playing in refuse and dirt with no access to clean, running water.
The story is similar with each of our Noma patients that at a young age they fell and scraped their face while playing outside. The skin became infected and parents watched in horror as their child’s face “melted away.” This particular necrotizing bacteria targets the facial tissues of the lips, mouth, cheeks, and nose particularly in children. It can be treated with antibiotics within the first 48 hours; but if it passes this initial period there is nothing that can be done except wait to see how much damage the infection causes. Because it usually affects those living in the poorest conditions, they do not always have access to healthcare or the knowledge of the critical window for these children to receive antibiotics. Without treatment 90% of children die from Noma.
So Mamadou’s story begins around the age of 2 when he fell and scraped the left side of his face. Soon Noma ate away part of his lips and cheek on the left side. Unfortunately soon after this event Mamadou’s father died. When his mother remarried, the step-father believed Mamadou was cursed and caused his father’s death. Thus his step-father did not want him.
Thankfully Mamdou’s uncle saved his life and has been caring for him these past couple of years. His uncle brought him to the ship hoping that Mercy Ships could transform Mamdou’s face so he wouldn’t continue to face the rejection he has experienced from people including his own family. Mamadou is currently in the middle of multiple surgeries as it is a long process to recreate lips and cheeks with moving skin grafts around from different places.  So far things are going well, and Mamadou is currently at the Hope Center awaiting another surgery at the end of March.
Although Mamadou came to receive surgery to restore his face, I hope that he receives something more. Love is what we hope to show to all of our patients. It is God’s love that has motivated so many people to come volunteer and even pay their own expenses or raise funds in order to be here. So in a life where this boy has been rejected by so many, he entered a different world on this hospital ship. There are many nurses who lovingly care for Mamadou while blowing bubbles, chasing him on the deck, pulling him in a wagon, or just kindly holding him. I hope that the love he has experienced here will transform his life. I pray that it would undue all the shame and rejection he has experienced. Even more than that, as I hope and desire for all of our patients that eventually it will allow them to know and understand the love of Jesus.
Mamadou’s story represents those of so many of our patients. I have found so much joy in caring for Mamadou and other patients as I witness the transformation process of bringing hope in healing. With Mamadou only being six years old, the rest of his story is left to be written.

*Name has been changed for this story  

Here are some pictures taken by Mercy Ships photographers: 
Mamadou's face slowly being transformed

Playing on deck 7 with a crewmember's child

Piggyback ride while I work
Watch Out: Mamadou will run you over

Bubble time
Mamadou's precious smile

Saturday, March 2, 2013

Joy in Thankfulness

In a western world where we are driven by entitlement, ingratitude flourishes. When we finally receive the thing which we believe we deserve, it does not always bring us the joy that we anticipated. Why might this be? I believe it is because we do not always receive things with an attitude of thanksgiving.

What is so different here in Guinea, in a place where many people make less than a couple of dollars a day? People don’t hold on to the few possessions they have quite so tightly, and entitlement doesn’t seem quite as prolific as back home. I am amazed with watching how people willing share from the little bit they have.

How does this affect my experience as a nurse caring for people in Guinea? More often than not, I have been overwhelmed by the humble attitudes of thankfulness and appreciation from my patients and families. You may argue that they are receiving free medical care and surgery, so who wouldn’t be appreciative. There is still something so unique and different in this work environment, when many times a day I hear the words thank you. As you look into their faces you see the genuineness of their words in their smiles and gestures.
I cannot fully describe the expression of their appreciation, but I think part of the reason is patients don’t come to the ship feeling entitled to surgery. Thus they are so grateful and thankful for the opportunity that we provide. One recent example from this past week is a patient’s father who came to visit during the evening shift.  As the father entered the ward and saw his daughter, he immediately grabbed my hand and told me over and over again “Merci, Merci Beaucoup” during his entire visit.
I am discovering the joy that comes from a thankful heart. Maybe this is why on the outside it may appear that people in Guinea do not have much, but when you look closer there is still joy in their lives!
Do you find yourself feeling entitled and not really being satisfied after you received what you thought you deserved? Maybe we can learn from the people here in Guinea who have so little, but find joy in receiving things out of thankfulness rather than entitlement.  

This is Mama from the January post "Giving Back."
She expresses her appreciation everytime I see her whether
at the Hope Center or while on the dock for an outpatients appointment.