Sunday, 25 March 2018

Set Free

I love many things about working in the maxillofacial ward but what I love most is the way my patients faces are changed and improved almost immediately (apart from some swelling). Someone who has a cleft lip repair looks beautiful straight away, other repairs take a longer time to heal and swelling to decrease before they look ready to face the world. I’m practiced at looking at faces full of distortion or blown out by a tumour. You learn to look past it to the beauty of the person behind the face. I have learnt a great many things working with these patients, but the attribute that stands out the most is how courageous each of them are.

This last week we had a patient who wasn’t physically deformed from the exterior but his jaw had been locked closed (ankylosis) at the age of 7. His teeth were clenched together and he hadn’t been able to open his mouth at all in 19 years. 19 years. He is now 26 years old and had been unable to chew food in all that time and so he was malnourished and very eager to have it fixed.
When he came for admission it was found that his blood type was very rare and the lab couldn’t find a crew member to match him. In order to complete a safe surgery the team came up with a plan for him to give a blood donation that would be saved for him later if he needed it and in another few weeks he would come back and have his ankylosis release. In the meantime he was disappointed, upset and unable to go home due to distance and earn money for his family.

Eventually the time came for surgery. He was admitted the night before and the surgeon came and discussed the surgery with him. When he came back to the ward post-op he was a bit unsettled after the anaesthetic drugs but he calmed down and slept during the night. When I came in the morning he was sleeping soundly but was woken by the surgeon on ward rounds, shaking his hand. We explained we were going to take the bite block out of his mouth that was holding his jaw wide open and we put a mirror in front of him so he could see how wide his mouth could now open. We aim for two finger widths between the front teeth. Give it a go. Put your index and middle fingers together and put them between your top and bottom front teeth. Most of you would probably be able to put three finger widths in but it’s not actually necessary to open that far.

Well, after we did this with him, he started crying. At first it was silent joyful tears streaming from the corners of his eyes and then came the sobbing. I looked around at the faces surrounding his bed. There was about 6 people on a vision trip from the Netherlands, 2 pharmacists, 2 surgeons, 1 local surgeon, 1 translator, 3 hospital physicians and me, plus the 4 ward nurses, 3 other translators and 1 visitor. I looked around at the faces surrounding him and saw Sandy, our lead pharmacist. Her eyes had pooled in joyful tears which caused my professional fa├žade to break and tears to pool in my own. After this he started sobbing, he started shouting out, “I can’t believe it, I can’t believe it! It’s a miracle!” He was raising his hands in praise to the heavens, high-fiving people, shaking people’s hands, celebrating! The crowd of people around him celebrated with him. 

He’d been set free.

Sunday, 18 March 2018

Bundles of Blessings

It’s been a while since I last wrote. The things that have been taking up my time are updating paper work for Guinea field service, creating new Nursing Observations sheets, making the nursing schedule for D ward, doing nurse evaluations, keeping track of all the patients and an eye on my two maxillofacial surgeons. The two of them have worked tirelessly these last weeks mostly doing all-day OR cases. Despite some late finishes causing three patients to stay safely intubated overnight, all have recovered really well and continue to improve. I have been so thankful for such an amazing team standing and working around me. The OR (theatre) team is amazing, talented surgeons, anaesthetists and OR nurses and my ward team (doctors, nurses and day crew) are strong and competent. I know I can walk away at any time and they will be just fine. So, amongst some days where my head is full of to-do lists of mostly paperwork, I’ve sometimes pushed it aside and sat down to play a few rounds of Jenga with a patient. It is always these moments that make me feel the most fulfilled because it’s the relationships that really matter.

We have four patients in the ward at the moment who have been on the ward for weeks. Despite me feeling bad about them staying so long due to infection or delayed wound healing, they have been so gracious and positive and thankful. They are such strong people and I am so blessed and challenged by the way they live their lives here. I love watching them interact from their beds, translating for someone or just having a joke and laughing. They are true heart-melters. God has been teaching me about learning through the journey, not reaching the destination. As I go on ward rounds each day with the team, I look at the patient’s individual post-operative day count increasing and God reminds me that He is still present, working through the journey. I wish that all the patients would have uncomplicated recoveries and short stays and be able to go home quickly but life isn’t like that. Some journeys are longer and more complicated. So we continue to pray that these patients would be encouraged in the waiting period. That they would meet Jesus in that ward where we do nursing care but also colouring and Jenga (among other things) and that he would heal their bodies and their souls. 

Thank you to those of you who prayed for sweet, courageous Adama. She has now been in the AFM hospital for more than 100 days after a complicated journey post-op. A week and a half ago we were so blessed with having a surgeon here who did a large surgery to remove the infected tissue and hardware and flap some muscle and skin up into a defect. So far she has recovered really well and I feel so hopeful for her future. She will need another surgery before she can be discharged but we are in such a better place now.

We also have a 2 month old baby of a patient in the ward at the moment. Due to the fact that his mama was in surgery all day, he got passed around (as his papa didn’t mind having some time off) and the female day crew enjoyed bathing him in a blue tub on the floor of the ward, although they did comment on his loud set of lungs. When he is hungry, he’s starving! I took him for a cuddle and ended up keeping him asleep in my arms as I continued working for almost two hours. What a sweet little bundle of blessing for my day.

Friday, 16 February 2018

The Parker Brothers

Looking around my maxillofacial ward over the last few weeks since I arrived I have seen all sorts of things that warm my heart. I would even boast by saying that every day I’ve witnessed something that infused joy into my soul. I will tell you about some of them.
It is hard to explain how it feels to work in my little D ward.

Back in 2016 Madagascar, but the ward looks the same

In the photos above you can see what part of the ward space looks like. In my first couple of weeks back on the ship, beds 1-5 were full of male patients. Two of them had stayed longer than expected and when we came for ward rounds one morning, myself, Dr Gary Parker, a physician and translator, a patient named Ali, proudly proclaimed that his new last name was Parker (after Dr Gary). Then the row of males became the Parker brothers. Ali would even sign his colouring pages- Ali Parker.

Ali also helped us translate for a language that only a very few of our day crew translators speak. So instead of the usual two way translation from English to French, it became English to French to Fulfulde using Ali for the last translation. (I always wonder in the last translation what gets said and how much it changes!) So in the morning ward rounds, we’d make our way to the Parker brothers side and Ali would hop out of bed to translate or just lean forward from his own bed and talk across his ‘brothers’. What a gem.

Ali Parker is to my left

Sometimes I would look across at these Parkers brothers who all had bandages wrapped around their heads, some of them had nasogastric tubes hanging from their faces, lips dribbling salvia as they recovered from having major maxillofacial surgery. One day I looked over to see two of the men in their 50’s laying in their beds facing each other and giggling. I mean, eyes pinched closed and floppy lips pulled tight as they laughed about their private joke.

The day the Winter Olympics started, one of our Hospital Chaplains walked into the ward to let us know the opening ceremony was on the TV and to change it for the patients. I looked over and saw most of them involved in watching the movie Up (Pixar animation) that was playing. I suggested that perhaps we ask the men on the Parker brothers side whether they would prefer to watch the movie or the Olympic Opening Ceremony. Much to the surprise of the Hospital Chaplain, when he asked the 50 year old man which he would prefer, the patient said, “Cartoons!”

Alicia and Mama Sabine

On the other side of the ward we had one of the most beautiful, joyful, bright women I’ve ever cared for (pictured above). She had come to the ship also with a big mandible tumour and had it successfully removed. On the ward the patients are fed post-op with nasogastric (NG) feeds of Ensure supplement for 7 days. On day 8 post-op, the NG comes out and the patient gets to drink the Ensure supplement before being able to start a soft, no rice diet the following day if their inner mouth incisions have healed. It was post-op day 8 for this lady so her NG had been removed and after being given a bottle of Ensure to drink, she bowed her head and said grace over her ‘meal’.

Two other patients in the ward have had one of the most painful procedures for a cleft palate repair called a pharyngoplasty. Dr Gary describes it as the worst sore throat you could ever have. These patients are so brave. This week we had an 18 year old boy have his cleft fixed with this procedure and then a 15 year old boy, Junior, had his fixed with the same procedure the following day. They typically have a morphine infusion for 1-2 days post-op and normally takes several days before they stop hanging their mouth open and pooling saliva. Well the 18 year old progressed quicker than we expected and today when he saw Junior try to take a drink of water, he leaned in and said something to encourage him, because he knows how it feels and he gave Junior a thumbs up. It was such a kind, big brother thing to do.

This week I also sat in a meeting room surrounded by some of the best surgeons, doctors and nurses and hospital ancillary staff I’ve ever met. We discussed a patient who has a condition that is life threatening. The meeting was to decide whether we should do surgery or not. The aim was to discuss the patient’s case from every angle. The most beautiful part about the meeting was looking around the room and knowing that everyone has this patient’s best interest at heart. No one is paid to do their job, so no one has anything to gain except a good outcome for this patient. It felt so pure.

I love all these things and more of the every day events that happen around me each day at work. It is such a blessing.

Saturday, 27 January 2018

I'm Back

Where to begin? I returned the M/V Africa Mercy (AFM) 7 days ago and it’s almost like I never left, except a few things have changed. Most noticeable; there are new curtains in the dining room and a huge change in crew members.

My first day back in the ward for doctors rounds was Tuesday. I was met with a big hug and grin from Dr Gary Parker, the Chief Medical Officer and Maxillofacial surgeon. I stood back on ward rounds that day (there were enough people standing around the tiny space; a second maxfax surgeon, local maxfax surgeon, medical student, pharmacist, two physicians, day crew translator and acting maxfax team leader). Instead of focusing on what the day’s plans were for each patient, I watched the patient’s faces as the team made their way around the ward, stopping to greet each patient, shake their hand, ask them how they were and make a plan for the day. There were smiles and praise hands and head bows in thanks and for some reason it’s all those simples gestures that are unspoken that make me choke up the most. There is just so much beauty in serving others and seeing them blessed.

The following day I was in the ward when the Hospital Chaplaincy team came and did devotions with the patients. They share a little word of encouragement and sing a couple of songs. The 26yo serious man from bed 1 who I was yet to see smile, was up and dancing to the singing and drums, a slight smile tugging at the corners of his mouth, head wrapped in bandage from his surgery four days prior.

I hope in the coming months I’ll have hundreds of big and small stories to write here. At the moment I’m in transition. Transition back into the world of maxillofacial surgeries and leading a team of ward nurses as best I can. Transition back into a ship community I left 18 months ago which has changed significantly. Transition into the country of Cameroon and learning about her people. Transition into speaking French and trying not to say Malagasy phrases instead!

While it’s early days to have photos of patients I have already met, I’ll leave you with some photos of previous transformations this outreach.

This baby, Paul, got fattened up and had his first surgery.

This mama's life has been forever changed.

And now just a few of the new place I live.

Above right is the ship Captain- an Aussie.

Below you can see Harmattan is in full swing, which blows sand from the Sahara Desert into the sky of West Africa.

The AFM dock space.

A happy Deb, back at work in the hospital she loves the most. I'm missing family and friends from home, but glad to be back in the place God has called me.
Thanks for joining me on this journey.

Sunday, 24 September 2017

A New Season Ahead

I’ve been back in Australia for over one year now. It’s been full of ups and downs.
In the first eight months of being back in my home town, I couldn’t see much purpose in being where I was except that God had called me to be there. So many days I struggled with loneliness and a lost sense of purpose. In my mind there’s nowhere to go but forwards and so as the days ticked on, I tried new things. I found a new job where I could be challenged and learn new skills, I found a new church that I love and I knew I was where God had placed me, in a season of waiting. I felt challenged to live in that waiting, as uncomfortable as it was. I struggled and wrestled and still do some days. It’s hard to live in a state of discomfort, both physically and mentally. I’ve done a lot of both this year as I’ve struggled with body aches and often constant discomfort, but the mental anguish is harder. It has been way harder than I thought it would be to return to the same town I grew up in. It has been hard to live as a single 30 year old female in a town full of married friends who are now busy wives and mothers. I have made myself as useful as possible, hanging out washing, bringing it in, bathing kids, feeding them, babysitting, playing in parks, having tea parties and generally hanging out. In the process I have loved all of it and tucked away lots of very special memories.

I have lived with one of my sisters since coming home who has been studying really, really hard to pass her emergency medicine trainee exams. As hard as it has been to watch her struggle through endless days of study (up to 11 hours a day on her days ‘off’), it has been an incredible privilege to support her and help her get through them as well as she can (and she passed them both!!!!!!). Basically it means that I kept the house clean and stocked with food! She has also been a pillar of support, understanding my passion for providing healthcare to those whose countries aren’t providing it for them and knowing how it feels to come home to an empty, dark house at the end of the day.

I have enjoyed so much about being back in Australia. I have been around for my newest nephew’s whole life! I have been so blessed to have most of my family close around me, available to hang out almost any time.

We’ve all been through waiting seasons. They aren’t fun, but one of the many books that I’ve read during this period challenged me to ask myself what I was learning. At the time I was actually stumped, but as time passed I realised I was learning all sorts of things; endurance, how to trust that God has my future, how to live and still praise Him in the discomfort, to look for places to serve now, to choose joy and always be thankful.

The sister that I’m living with will be moving from this town at the beginning of next year, leaving me without furniture (because I own nothing!), a house and my favourite housemate ever. As disappointing and sad as this felt when I heard the news from her, I was excited for her and had always felt like our time together was an unexpected blessing. I wondered quite a lot about what my next step would be, what would I do with my time and passion, where would I live if I stayed here considering I always felt it was temporary, but I also felt like I didn’t have to have the answer yet. I needed to wait. So I waited.

Then one day I got a message from a friend on the ship asking me if I’d like to return and fill a position that had a gap. After much consideration, prayer and people closest to me discussing it, I’ve decided to go! (insert emoji with ear to ear grin!!) I will be the Ward Nurse Maxillofacial Team Leader to finish off the Cameroon outreach from the end of January to June 2018 and I’m really excited! So excited that this week that I went and got three vaccinations!
Before this year finishes though, I’m heading to the Liverpool School of Tropical Medicine in the UK, to do my Diploma of Tropical Nursing. It is a 3 week crash course in all things tropical nursing so despite the fact that I’ve seen worms come out of the body in many places and all sorts of other creepy crawlies, it will increase my knowledge and I am excited to learn more.

I won’t return home until the week before Christmas so I must get organised before I go! Once I return there will be Christmas celebrations, New Years, a new niece entering the world and lots of packing and goodbyes.

As I sit here and think about the year that has passed and the new season ahead, all I can think is: I have a lot to be thankful for and excited about!!


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