A Taste of Mango

I wake up but keep my eyes closed because my eyelids are so heavy with sleep still. I know the power has gone off because my ceiling fan directly above my bed has stopped, causing me to wake feeling overheated and sticky. With the white noise off I can hear people laughing and talking in a different language outside my window across the sandy, red dirt road. The air in my room is still. Too still to be comfortable. I guess it’s about 32C in here. The dependance I live in is just two rooms and sits across a small courtyard from the house my friend Miriam lives in. We are in Mango, Togo, 475km (295 miles) north of Lomé.

The power comes back on and my fan restarts but now I’m fully awake so I wrench myself out of bed and dress with my shoulders covered and a skirt that reaches my ankles in respect of the Muslims who populate this area of northern Togo. I unlock my door from the inside and head across the dirt courtyard to the house. The sun is blazing and a warm breeze rustles the pink bougainvillea on the wall surrounding our house block and the mango tree in our yard. The house is simple inside and a very fine layer of red dust coats everything. The Harmattan winds that blow from the end of November to the middle of March create most of the dust but also the red dust is kicked up from the village streets as only the main road is paved. 

I head to the kitchen to get a drink of water as I wake thirsty every day. The tap water is dirty so we have a big water filter and keep clean water in bottles for when the town water is switched off, which is frequently.

The next step of the day is making coffee. The power is back on but I need to switch off the kitchen fan to light the gas stove to boil water in a saucepan as we have no kettle. I mix up the powdered milk while I wait for the water to boil. There’s seems to be an extra step for everything here.

Coffee cup in hand I sit on the couch and check messages on my phone. At least Miriam’s house internet is reliable when the power is on. It’s nice to still feel somewhat connected despite being miles away from anywhere. I start replying to messages people have sent asking me how it’s going over here.

I’ve worked a few shifts in the hospital now and have an idea of what each day might look like. The hospital is run differently from other hospitals. Patients must come between 0700-0800 and wait at the front gate to be triaged and sent to the clinic for outpatient appointments, surgery appointments and new presentations. Not everyone will be seen each day as there are limited staff members and hours in a day to work. Patients are sent to the laboratory, pharmacy, radiology or up to the hospital from the clinic. The hospital has areas for emergency, men’s ICU, men’s ward, men’s infectious, women’s ICU, women’s ward, women’s infectious, isolation rooms, paediatric ICU, paeds ward, maternity/labour and delivery and neonatal ICU. The nurse’s station to all these areas (except maternity/labour and delivery) is central so it’s set up in a cross shape. There is also an operating room wing with a recovery room area, although if we are under staffed the emergency nurse will recover the patient.

The hospital is run by expatriate Baptist missionaries but employs many Togolese who work in all areas and are the team leaders and nurses each shift. There is a nursing school on the compound and the 15 nursing students work in the hospital 3 times a week putting into practise what they are learning. Each registered nurse is assigned a Nurse-aid who takes the patients’ observations, helps with tasks, restocks and also helps translate for the expat nurses like me. A patient’s relative stays with each patient. They are responsible for providing all meals for themselves and the patient. There is a place on the hospital compound where they can go out and cook their meals (cuisine). They must bring all pots and pans and essentials for cooking. They normally bring a mat or piece of fabric and sleep on this flat on the tile floor near the patient’s bed. When a patient is ready for discharge the family member goes to the caisse to pay the bill and if they don’t have enough money they must stay until they can pay. For one more night they can sleep in the hospital but after this, there is a place on compound for families to stay until they can pay their bill.

The patient population here is mostly different to Australia. So far I have seen or cared for patients with eclampsia, HIV sepsis, chronic osteomyelitis, fractures, malaria, abscesses needing incision and drainage, Burkitt’s Lymphoma, infantile fibrous sarcoma, snake bite, CHF, nephrotic syndrome and premature birth (33 weeks gestation). Most of these conditions I’ve never cared for so I have a lot to learn.

The nursing shifts are from 0700-1930 or 1900-0730 with a 2 hour lunch break, 4 shifts per week. Miriam had the bike man put new tyres on her bicycle and this is now my transport to and from work and around town.

One night last week I barely slept as the power was off and it was unbearably hot and then at 0430 the wind picked up and a storm blew over, battering my little home. The sky opened up and dumped down rain. I was fully awake despite minimal sleep and prepared to ride to work on my bike in the downpour through sandy unpaved roads. I put my work uniform and gear in plastic bags but by the time I left the house the rain had stopped, much to my relief. The cycle to the hospital required quite the effort through sludgy red mud, avoiding goats wandering in the streets, kids walking to school and motorbikes zipping past, all keeping an ankle length skirt out of the wheels and covering at the very least my knees. 

As I drink my coffee Miriam hands me the Mango + 1 recipe book. All recipes are ingredients that can be found in the small market in Mango plus 1 ingredient from a big city such as Kara (2 hours drive south) or Lomé (9 hours south). I page through the book deciding which recipes I could try this week according to the food already in the house, thankful for the recent 18 months I had in Australia cooking each night and knowing those skills will come in handy for the weeks to come.

From Ship to Shore

I’m not really sure what I should be feeling right now. After arriving to the ship at the end of January and jumping into work as Maxfax team leader, I felt like I was running a 4 1/2 month marathon. Then when we were 2 days away from closing the hospital, unforeseen circumstances caused us to extend the closing by 3 days. Oh how I wanted to cry from fatigue! But we managed with nurses offering to work and the other team leaders kindly took the extra days on-call so I didn’t have to. Then on Monday just gone, we finally discharged the last patients and we sighed a massive sigh of relief. The nurses blitzed the hospital cleaning, packing and tying down while I finished projects I had been working on and tied up loose ends for the next team leader. Before I knew it, Friday morning was here, I said a lot of goodbyes and I hopped on a plane to Togo. (The most expensive flight I’ve ever been on but it was direct and uncomplicated which I appreciate.) Now I’m sitting at a beach-side hotel restaurant in Lomé, Togo listening to Kenny G on repeat and drinking Nescafé coffee (not my favourite but it’s the only option). So, in the next few days comes the big gear shift to remote African living.

Yesterday I was met at the Lomé airport by my friend Miriam who I lived on the ship with me for almost 3 years a few years ago. She’s a pharmacist and has worked at the Hospital of Hope in Mango now for 3 1/2 years. She took the 8 hour night bus journey from Mango to Lomé with another missionary Susie, in order to pick me up and shop for supplies in the bigger stores. The shopping list has things like 10 boxes of Honey Puffs, 20L of soy milk, pancake syrup and a cross trainer exercise machine to name a few. She only comes to Lomé about every 6 months on average so it’s sort of shop until you drop and get a taxi not a motorbike back to the beach hotel. 

I only have the rest of this day and the 9hr taxi ride tomorrow to shift my mind to the 2 months of hospital nursing and village life ahead of me and to process the 4 1/2 months of working and living life on the AFM with Mercy Ships. I know it will take longer than the next 36hrs but I have to start somewhere.

The night before I left the ship the communications team gave us access to some photos from the previous month, a time when my ward was full of one year old cleft lip or palate repairs. The first few days were miserable for them and there was so much crying but by 4-5 days post-op their pain had decreased and they were smiling and happy. One little one named Oslima showed her joy by sticking her little tongue out all the time. We all poured out so much love on these babies and their mamas. What a special time.

 

There was also a woman on the ward we called Mama Sabine. She is such a special woman who loved on each of us as if we were her grandchild. Someone asked her if she was looking forward to going home after her surgery. She said, “This place is just an extension of my home.” When I went to greet her each morning she’d give me a big hug and kiss on the cheek and tell me how her night was and ask me how I was. We all adored her.

 

Another patient who was with us to the end was Lawrence. He had a bit of a hard trot with delayed wound healing and several returns to the OR which caused him to be quite downcast on the ward but by the last few days of his stay he was happier and doing well.

I wish it was easier to know how my patients do after they leave from our hospital and the ship sails away. So often I think the same as Mama Sabine said as she walked out and down the hospital hallway towards the stairs to the gangway, “See you in heaven!” What a party it will be to see each other again.
 

I leave the ship knowing I will return in the next while but waiting for God’s direction. In the meantime I follow the steps laid out in front of me, knowing a hospital on land will stretch me in different directions than the ship did but I’m looking forward to a different way of life and sharing the journey with you.

Space to Just Enjoy

Little baby Mathieu has finally been admitted for his bilateral cleft lip and palate repair after a long journey with the ship. His grandma is a straight-faced, serious woman who has cared for him well over the months I’ve known them. When we first met, Mathieu was very sick. He had a chest infection due to aspiration from his cleft palate. It is a very common problem but often causes babies with clefts to get sick enough to die. Mathieu was right on the verge of needing intubation for airway support, but he held on and with tender, expert care from my team, we got through. Grandma and Mathieu have been at the Hope Centre being cared for and fattened up by Lee-Anne, our Infant Feeding Program Coordinator.

This last week 12 month old Mathieu was admitted for his repair. I greeted both him and his grandma with a smile and a rub on the shoulder. Grandma simply nodded her head, Mathieu stared at me with his gorgeous dark brown eyes, no emotion written on his face.

Later that afternoon, I stood in the hallway outside the door of the ward talking to the screening coordinator. We waved at Mathieu, his grandma and a few other patients and I went on my way. As I walked off, I heard a scuffling behind me and someone calling out. I turned around to see grandma with Mathieu in her arms, chasing me down the hallway. I walked back to meet her and out of her mouth came a torrent of French I couldn’t catch. I brought her back to the ward and asked one of my translators for help. Grandma asked if the screening coordinator and I had been talking about Mathieu, had his surgery been cancelled? She was very concerned. I assured her I had heard of no such thing and was sure it was still scheduled for the next day. She simply nodded her head in relief.

Mathieu did indeed get his surgery the next day and came back to his grandma’s arms looking beautiful. It is not an easy surgery to recover from but little Mathieu (who has been bulked up to 8.8kg by Lee-Anne) is most content in the arms of someone, his fluffy head resting on our shoulder or chest. I held him for so long on Friday that I had sore arms the next day!

Yesterday when I poked my head into the ward, Mathieu was lovingly nestled in the arms of a nurse and his grandma, normally so serious, looked up at me and smiled when I greeted her. I looked around the ward and saw another nurse in conversation with a translator day crew, next to a patient with a board game in progress. Other patients were sitting together chatting, bandages adorning their heads, patient ID bands on their wrists, the paths of their lives intersecting on the Africa Mercy and forever changing.

Each of these patients are so precious to me. I have never worked so many hours at work in my career until these last three months on the AFM. The Ward Nurse Maxillofacial Team Leader position holds a lot of responsibility and is no joke when it comes to the work load. I have felt bogged down with tasks and although the days in the ward have been enjoyable, I feel like I always have a to-do list hanging over the spare moments of time in my day, until this last week. I lay it all out before God and asked for the space to just enjoy. That is exactly what I’ve been able to do this week. My eyes have searched for the beauty in the every day and I have not been disappointed.

A few weeks ago I turned around to see my nurse red faced and crying. I rubbed her back and asked, “Are you ok?” Her response was simply, “Adama.” Yes, Adama. She has brought almost all of us to tears at some point in her long stay. She is so brave, one of the most trusting, courageous women I’ve ever met, but that day Adama was also in tears. I took the cool wash cloth for Adama from the nurse at the sink over to Adama’s bed. She was curled on her side, eyes red, covered mostly by her blankets. Around her bed were 9 of our day crew, all with hands touching her, crying out to God for her healing, recovery and comfort.

Adama’s journey has been long and complicated with so many ups and downs that I don’t know where to begin, except to say that I have wrestled with God so much over her. The situation has forced me to my knees over and over and I don’t think I’ve ever cried so many tears over a patient here. How do you continue to have faith and believe in God’s goodness and healing when you feel like you’ve been kicked in the guts multiple times? I don’t have any answers but I do know to my core that God is good and I trust Him. He knows each of my patients more intimately than any of us ever could and not for one moment have they been out of His sight. They come into our hands for a short period and they touch our lives forever and we release them back to God.

The Cameroon field service is coming to a close. There are 4 surgical weeks left, then the hospital stays open for one week further before every single patient must be discharged and waved farewell. We say goodbye to our beloved day crew who were our voices, our guides and our friends every day. We farewell our teammates and friends who walked this crazy beautiful journey with us. The hospital is double cleaned and packed away, no longer full of life and beauty, but a stack of iron beds ratchet strapped to the floor. 

In my opinion these are the hardest weeks of the outreach. Please will you pray for us? Pray for our patients healing, physical, emotional and spiritual. Pray for our hearts, that we will be strong enough in love and thankfulness to stand through the torrent of sadness in goodbyes. Also in the weeks right in front of us, pray for no complications of patient surgeries, for healing and wholeness for those still in our care and that joy would abound in the every day.

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 façade 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.

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.

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.

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.