The Weary World Rejoices

When I saw her for the first time, she was being held on the bed, throwing her head side to side screaming. It was fear. She was afraid of needles, like many of us. The nurses around her were trying their best to keep her calm. As I walked over I saw her face and the tumour protruding from below her ear. It was big for her small 7 year old frame. The nurse looked at me, defeat in her eyes, compassion written over her face, “Every time I get her vein, she jerks and it blows.” I bent over her bed, patting her chest and wiping her sweaty brow. “Shhh….”

Once we got some medicine to calm her down and our nerve back up to gently hold her down once more, the IV was quickly inserted. The CT was ready for her. I scoped her up, still cocooned in a sheet, sweat beaded on her head, part of the tumour now scraped raw and bleeding on my scrub top. She was light in my arms, much too light for her age. Her papa walked with us and stayed by her side while her small body lay still on the CT bed, injected with contrast, moving through the scanner.

When it was done, I scooped her up again, cherishing a little cuddle as her papa and I walked back into the ward.

The next I saw them, they were back in the ward. Her haemoglobin was in the 50’s (5.something for the Americans) and we needed to give her some blood before taking a biopsy of her tumour.

She sat on her bed, dressed in the same dress I had seen her in a couple of weeks prior but the blood stain where her tumour had bled was gone. Her hair was neatly braided off her face, a shy, sweet smile appearing now and then lighting up her face.

Over the next couple of days she received blood transfusions and had a biopsy in the OR, recovering well, but we all knew our next steps would come from the histology results. With the way things are set up over here, you can’t hold your breath for the results because we’re SO far away from the countries that report to us.

She wasn’t a child who immediately abandoned her papa and her bed to play with us, but she did curiously roam around the room, quick to ask me for a balloon and just stand near. I bet if I’d had more time, she would have sat in my lap and cuddled for hours.

Recently she was readmitted to the ward because she was having high fevers. We couldn’t find the reason except for knowing that she had this tumour and wonder what it was doing to her body.

She lay in her bed, no appetite, crying for being pricked again for another test, sweating through her fevers. I think my heart broke a little more each time I saw her sweet little face, knowing what I’ve seen with my eyes in the past years in Africa.

Today her biopsy results came through.

Malignant.

That horrible, horrible word. For us on the ship it means that we don’t treat them.

Tonight I can’t get her face out of my mind. I went down to the ward to say hello, but she was sleeping and it was too late for her to be waking up again tonight. I waved to her aunty who is here with her. She smiled and waved back. I sat on a stool next to the computer where I would sit during my shift as a charge nurse and spoke to the current one working. We chatted briefly about a few other things but as soon as I mentioned the little one’s name, the tears welled up again. I sat on the stool, unable to form words, afraid the moment I did the tears would flow in a steady stream, giving me away to a ward full of patients, caregivers, nurses and day crew. The charge nurse and I looked at each other, knowing neither of us could keep dry eyes, knowing each other’s thoughts, knowing God was breaking our hearts for what breaks His. I slipped out quietly, walking quickly down the hall to the safety of my cabin to let the tears fall. There I was wrapped in a hug and a sweet prayer whispered over my heart and our precious girl.

It’s Christmas, a time of joy and hope. I know this season is full of pain for many.  A few friends have lost loved ones and I’m sure this season is one of the most difficult times of the year. There is no use pretending that everyone is happy, but we have hope for our future!

My favourite Christmas carol written in 1847 sings,

“Long lay the world in sin and error pining
'Til He appeared and the soul felt its worth
A thrill of hope the weary world rejoices
For yonder breaks a new and glorious morn.”

Praise God we have someone to hope in. When death, disease, sickness, life’s troubles overwhelm us with sadness and despair, we have the God of the universe to hope in. He has not left us alone to battle this out on our own. He sent us His son and the Holy Spirit, our comforter and friend. He told us he would never leave us, or abandon us. (Deu 31:6)

Whatever this Christmas season looks like for you, troubles or carefree, sadness or joy, I’m praying you know His abundant, overwhelming love for you.

Merry Christmas friend.

The Road Ahead is Long

A couple of days ago I went to the local hospital to work with one of the nurses who is in a training program with the ship. Here are the facts. The surgical ward where she works has 50 patient beds. There are only four nurses on the work schedule. They work 24 hour shifts as the only nurse, being helped by some nursing or medical students for some part of the day. Just let those facts sit in your mind for more than a minute.

24 hours shifts.

Minimum of 50 patients.

Limited equipment and by that I mean, they have one manual blood pressure cuff, one thermometer and one stethoscope.

There is no oxygen, no suction, no running water and no supplies on hand.

Needless to say, the hospital is run very differently from one in the western world. There are so many differences here that I don’t even know where to begin. For a start, every morning after the doctor has done his ward round and prescribed the treatment for the day, the nurse will write out a script for the patient’s relative to take to the hospital pharmacy. It might look like this: IV cannula x1, IV tubing x1, Normal Saline 500mL x2, Ceftriaxone IV x1g, 10mL syringe x1, gauze x1 pack, tape x45cm, betadine solution x1 bottle. All these things are packed into a green and white striped plastic bag and neatly tied and carefully transported, glass ampoules and all, back to the ward for the nurse to begin the treatment when she has time. The prescription paper now not only has a list of the contents in the bag but also the price of each item bought by the family. Each precious item has a price and I heard it said on the doctor’s round, if the patient has no money to pay for treatment then they can leave and someone who has money can have the bed. That’s how it goes.

The patients in the ward all have a story. One was picking fruit from his fruit tree and thieves came, thinking he had a lot of money because of all the fruit he was picking and attacked him with a machete. He had been sliced open all over his face, head, back of the neck and flanks. He had been stitched back together in the hospital’s emergency department and actually looked surprisingly good, although in pain.

Another patient had tried to commit suicide by stabbing himself in his gut, which had led to internal damage but not serious enough to cause death. One young girl had had an abortion but needed further curettage for pieces still left inside. One boy had somehow gotten a meat hook stuck in his neck. Several patients had fallen out of fruit trees breaking one or more bones in their legs or spine. One man had fractured his spine so severely they are calling it a miracle he is alive, yet he’s stuck in bed with a spinal collar on because they don’t know how to fix him. His spinal cord is being pinched and a slight slip could mean paralysis not just to his body but to his lungs, causing death. Other patients have been hit by cars or have had motorbike accidents leaving them with head injuries or fractures. Some have had hernia repairs or their appendix removed.

While we were walking around with the doctors, there was one lady sitting on the side of her bed, gasping for air and crying out. She was clearly in distress but no one seemed to bat an eye. When we asked what the problem was, they simply said “Asthma”. Someone from the family had gone to the pharmacy to get some medication. In the mean time there was nothing for us to do. There’s no oxygen standing by, no crash cart with emergency drugs, no resuscitation equipment to rely on.

I’ve seen these same circumstances now in several countries in Africa, limited to no supplies, a huge lack of running water, power, soap, suction and oxygen. The absolute basics are missing.

A few weeks ago two of our Mercy Ships crew members gave a presentation with a lot of statistics about many of the countries that the ship has been to in recent years and others close by that we have not yet visited. Seeing these numbers and graphs with terrible statistics for overall health and healthcare systems in these countries, somehow tightened my resolve to be here. The presentation continued to tell us how Mercy Ships planned to partner with the local hospitals and work alongside them, teaching and educating, running classes and mentoring. The idea is to work ourselves out of a job. Although I’d heard it before and knew what programs Mercy Ships ran, at hearing it presented again, I felt my heart jump up and down and God whisper to me, This is why you are here. I want to see lasting change. I want to see so much change that the local hospitals will be well equipped, not just with the basics like power and running water, but with supplies and the knowledge to use them. I want to see the staff educated, supported and empowered to make changes to improve their working conditions and the outcomes of their patients.

The nurses that I have worked with from the local hospital are well educated. They are creative and make the most of the supplies they have, inventing ways of doing things with their limited stock that we would never dream of. They are hard working, uncomplaining and joyful despite their circumstances.

The road ahead is long, but we have to start somewhere. People are always asking me, How long will you stay on the ship? Well, how long will it be until we can change the healthcare statistics of the nation? Of the continent of Africa? Even though I see the road stretching ahead far into the distance, there is hope. We have already begun the journey.

 

I Was Born With A Deformity

I was born with bilateral club foot.

January 1987

Club foot, if left untreated, causes the person to walk on their ankles or on the sides of their feet.

With early treatment the turned feet can be fixed with serial casting- the most common method known as the Ponseti method. This is how my feet were fixed.

Giant cloth nappies + chunky baby + plaster casts = heavy baby

Each week the casts were soaked off for new ones to be applied.

(Check out that thigh chub!)

Mum says people used to look at her strangely, pushing around a pram holding a baby kicking around two casts. She felt people judging her, as though she'd done something and hurt me.

Treatment only lasted six weeks and some physiotherapy beyond that, but that was all the time it took to fix my deformity forever and give me a normal life.

This week I have been working in the orthopaedics ward. It is full of gorgeous kids who had club feet, bowed legs, wind-swept knees and other issues. Each day this week we have seen these kids return from surgery to the ward, legs now straight in plaster casts.

From this:

To this:

I think about what they have already been through, living life in the community being teased and called names by others on the streets and at school because of how they look different. I try to imagine what my life could have looked like had I been born here in Africa and not had the money for someone to look at and fix my feet. Some of the older adults with deformed legs or feet have to crawl on their hands and knees through the streets because their deformed limbs cannot carry the weight of a normal adult body. I cannot imagine life like that, yet that is a reality for what my life could have looked like.

All it takes to fix club foot is early intervention with serial casting and on the ship we get to be a part of bringing healing to these feet and restoring hope. I love that.

The Screening Centre Opens

The screening centre opened this last Monday in Toamasina, Madagascar. This year it is different to other outreaches because we have a screening centre open from Monday through to Friday for four weeks, instead of trying to see everyone on one massively amazing but exhausting day. This gives the people in Madagascar time to hear the word, time to travel to us and more time for us to spend with them as we ask why they have come. It has still been a very busy week, with the opening on Monday seeing about 2,000 people turn up and many since.

I have been at every screening day for the last few outreaches. It is a day that I love and look forward to with great anticipation. I love connecting with the people, hearing their plea for help, giving them hope when I can say “Yes” to the next stage of the selection process and even when I have to say “No, we can’t help you, sorry” I feel such compassion that I don’t forget to pray for them, even days later.

On Tuesday I was unexpectedly able to go and screen potential patients in the line. My involvement was unplanned but I had been hoping and praying that I could have an opportunity to go. Most of the nurses available were helping out with security, so it was a big surprise to be asked to help screen.

 

The mornings here begin super early with the sun being up and already bright in the sky by 5am and darkness sets in at 5:30pm! Tuesday morning we set out in our Landrover, the sun hidden behind rain clouds that intermittently dropped rain on our heads. My white uniform shirt was clean and fresh, my black skirt and shoes reminding me of last outreach’s patient selection day and how many hours I had stood on my feet. Today would be different.

The rain came and went over the next 30 mins, at one point I thought we might get drenched but thankfully it stopped before our white shirts went see-through!

I worked alongside a translator seeing person after person, asking why they came today. I heard all sorts of medical problems, headaches, sore eyes, blocked sinus’, sore throat, stomach-aches, lumps in breasts, enlarged prostates, pelvic cysts and more. None of these things can we help. I did see some people that I could send through to the next stage of selection; hernias, cataracts, bowed legs, small mandible tumours, burn contractures, women with fistulas and lipomas.

The people stood calmly in line, patiently waiting for their turn to be seen. They seem to be quite reserved and very respectful of each other. Umbrellas were up, firstly to shield from the rain and then for the sun, as it later beat down upon us.

As I walked the line looking for orthopaedic patients, I looked into the peoples’ eyes, greeting them and smiling and seeing many smiles in return. There were mamas with their little cerebral palsy kids in their arms. As I saw them and spoke to them, oh how I wished there was something we could do to help them fit into this society. Conditions like this are not understood here and there is certainly no help for the families. There are no support services and no support groups for mamas to talk together about their life journey. I wish we could do more.

After only a couple of hours screening patients in the line, we had given out 150 potential patient tickets and each of those patients needed to be processed through the history team. We retreated behind the fence of the hospital before telling them that we were closing the line for the day and that they could return tomorrow. We retreated just in case they couldn’t take the information peacefully. We were able to walk along the inside of the fence reminding them that we could not help medical sicknesses but that we only did certain surgeries to help. One man spoke up wondering how were they to know what could be helped with surgery and what could not? I felt it was a valid question and needed a good explanation but I was unable to stay for long as the people continued to press in close to the fence to hear and I was told by security to move on. We just had to tell the people to return if they had questions.

I find every year there are patients I meet on this day that stick in my mind for months and even years to come. This time was no different, although the Malagasy people seemed to take the answer “No” much more easily than any other country I’ve been to. With each medical case that I see and do not know or understand what the sickness or tumour is, I wish that I could give them an answer, a diagnosis, a hope for future health. The best I can do is pray from them as I say “Sorry, no, we cannot help you.”

Our hospital will admit its first patients this coming Monday afternoon and surgeries begin on Tuesday. I can’t wait to meet my new friends, to see bowed legs straightened, cleft lips repaired, smiles returned and hearts healed.

Under a Blanket of Stars

We are hours away from ending this sail. I'm standing under a blanket of stars, a tropical wind blowing in my face reminding of where we will pull into harbour tomorrow.
Only about 48hrs ago did our journey become smooth. We spent days and days rocking so hard that it was actually impossible to sleep at night. The newer iPhones have a tilt metre which show you the degree at which your world is tilting. Well with our ship rocking and rolling, iPhones were out everywhere measuring our list. During the rockiest days we would consistently list to about 12-18 degrees on each side. One night bigger swell threw us from 20 to even 30 degrees.
To me the days were full of fun. The morning tip was wet a napkin to put under your cup and plate so that when the ship rocks your dinner will stay on the table instead of landing on the floor. With this dramatic rocking our meal times looked like juggling acts, catching cutlery as it slid off our plates and then we would slide right past the table as the chairs slipped with us in them, backwards and forwards through the cafe. It was a hoot. I laughed so much during this that a friend actually joked that I (my voice) was the new tilt metre. Walking through the hallways was absolutely impossible to stay in a straight line. Instead we looked like pin balls bouncing off the walls. Showering you had to turn the water off a million times as not to let the water spill over the lip as it sloshed side to side. Drying your feet was virtually impossible without falling on your face. Lying in bed as night the blood ran down to your head as your body slid down the bed and then the blood ran to your toes as you shifted down to the foot of the bed. Over and over. See why the whole ship didn't sleep for three nights!?

Thankfully I have sea legs and a stomach of iron and I enjoyed being thrown around the place (except at night). We spent time on deck 8 watching the waves roll our home and throw us around like a Lego in an Olympic sized swimming pool. We saw a humpback whale breach over and over only about 50 m away from our ship home, until it was out of sight. We saw some sort of tiny dolphin jumping behind the ship as the sun set one evening. We ate popcorn every night, laughed our heads off and sung our hearts out in praise to our King.

This journey has been preparation for the nurses to be ready for the work when the hospital opens. None of the information is new to me but it is preparing my heart. Some days I feel overwhelmed with how many patients I've seen come and go from this place, each taking a little piece of my heart. Now you can understand why my heart breaks over the Ebola situation. My heart lies in my patients living in those countries.
Tonight will end and as the sun rises in a few hours time and at the same time our ship will be pulling into Toamasina (Tamatave in French) in Madagascar. It is the city that I will call home for the next eight months.
Madagascar is the fourth largest island in the world. Her people total 23 million. 90% of them live on under $2 a day. We come here not just to give free surgical care but to love them. We will love them like Jesus loves us.