The Epic Trek

This past weekend was one we have been looking forward to for weeks! With only 3 weeks left of surgery, our time here in Guinea is quickly coming to a close. We planned a trip to Dalaba, roughly 8 hours by taxi upcountry, and where I spent several days between Christmas and New Years. Because of the protests that are happening here in the city, we were cleared to go by the captain with the stipulation that we needed to get out of town by 0630 or we wouldn’t be able to go at all. The deadline of 0630 was put in place because leaving any later would risk us getting stuck in riots that were planned for the day. We talked several times of coming up with a back up plan, but instead persevered and a fantastic friend agreed to come in to work at 545am to let me leave a tad early from my night shift. I handed over my patients, sprinted out to change and grab my pack which I had put together the night before. We made it to the major market and began bargaining for a taxi to get us out of the capital city to the next small town to find a shared taxi to take us upcountry. We bargained, and were jumping in a taxi to head upcountry. Laura set her bag in the backseat keeping her eyes on it, and before we knew it some guy off the street had jumped in, was going through her bag about to pocket some of her cash. Our taxi driver saw him just seconds before we did, and several men had him out of the car, searched, and the money returned before we even knew how to react. Theses two men, Elijah and Erun, refugees from neighboring Sierra Leone--quickly earned our trust. I mean who doesn’t want to essentially hitchhike with two guys who just protected you? We made it to the next town about 1.5 hours out of the city and found out that there weren’t any taxi’s heading upcountry. After spending about half an hour negotiating prices, lots of arguing, chatting in English, French, and Krio, throwing in mangos and a banana to our deal and making them laugh a few times with our ridiculous proposals we all headed off on our adventure. The ride was fairly uneventful, and we picked up a few randoms along the way. My favorite passenger was the man who was heading upcountry to sell firewood and his 6 live and feisty chickens that were promptly shoved into the trunk next to our backpacks like it was nothing out of the ordinary. 

Post night shift riding in a taxi------     

We arrived in Dalaba around 5pm. Hot, tired, very very dusty, and ready to settle in and make our plans for the weekend. We bought dinner off the street and settled outside to eat our first of many meals of avocado and cheese on delicious crusty bread.  

      We met our guide Lamarana the next morning and headed off to market to pick up food before our daylong trek. Here in Africa it is normal to carry things on your head, not on your back. So we really were quite a site hiking through the streets with big ole packs on our backs. Three funny looking fotay’s (white people)

Our walk was gorgeous through the countryside. The topic of many of our conversations  were our patients. How amazing they are, how they persevere through so much, how they have so much stacked against them from day one and how they still come through against all odds. The beautiful hills of Guinea are breathtaking, and it’s easy to place each of our patients in their home environment. Working in the fields, preparing the evening meal, carrying babies on their backs, and selling goods in the market. 

A family we met along the way in front of their hut 

We found a small lost sheep along the way, and took a moment for a snuggle.

                

These guys are known as "thief" sheep because they will steal things straight out of your home. Notice their "collars" and the sticks that they so happily sport that prevent them from entering through doorways.....crafty little guys!

Apparently one of the things the French brought to the “cold” upcountry Guinea was Pine Trees---I don’t think I will ever get over this. A pine tree forest, in West Africa--how odd, right?

Our dirty, dusty feed after day one of trekking

A few ladies who sold us crafts in their village

Spending the night in the village we sat out of the front porch and had a long chat about the world. As we talked, the idea of how we fit in the world came up. This village, on top of a mini-mountain in Guinea has no electricity. It doesn’t having running water, or a toilet. But it exists just fine, it functions off the earth. God gave them everything they need in the trees,bushes, and animals to survive. They don’t have many of the things we in the west would call “necessities” but it’s their normal, they are happy and it works.......

A major conversation of that evening under the stars included the idea that we were “sitting on the edge of the world”. This village has no idea or need to know what is happening in the US right now. If we told them about the bombings in Boston, or some of the headlines on CNN what would they think? If we told someone in the US about the comings and goings of this particular village in Guinea, would they care? The answer is no, probably not. We both share this earth, but have virtually no interaction. We three girls could be the ONLY American’s to ever come through that village. The only three to ever step on that particular soil, the only ones to ever sleep in that house and use that squatty potty. Letting that soak in is kind of life shattering, huh?

Our home for the night

We planned to sleep in hammocks and sleeping bags, but after carrying them roughly 25 miles up and down mini-mountains we found out that it wasn’t exactly an accepted practice to sleep outdoors, particullarly because we were female. So instead, we swept some mouse poo off the bed and slept on top of our hammocks.  

A group of ladies on their way to the market, goods stored on their heads and babies on their backs

On our last kilometer of our trek back to the hotel a motor bike flew by and as we turned around we say someone hop off and start running toward us. It was Alhassane, a patient from the beginning of the outreach. Laura and I knew him, but Lydia became a quick friend to him. He invited us happily to his home, and was so excited that we accepted his offer. He brought us into the compound and through his front door, pulling up chairs and immediately offered us something to drink. It once again put our lives in perspective, Alhassane had literally a desk with his books on it, and a mat on the floor in which he slept, and he was offering us, the rich westerners, something. As we visited he asked about those nurses who were on the ship back in the fall by name. Remembering them, asking how they were settling back into life in their home countries and asking us to greet them.  As our time came to a close we gave him all the sunscreen we had, being Albino is West Africa is not easy. It is literally impossible to buy suncreen here. For those with African skin there is no need for protection, leaving the large population of Albino people scorched from the sun.  

Along the way we may or may not have had a small run in with bed bugs. I was not completely educated in this fastidious little creatures, but Lydia was an expert.  She had self-diagnosed with Laura’s help and upon returning to the ship, the first priority was stripping down, bagging up all of our stuff, showering, and then researching. Now I do not advise looking up bed bugs unless you want the heebie jeebies. It turns out those resilient little guys could essentially survive an atomic bomb and go nearly all of eternity without food.  After devising a plan to wash our clothes at roughly 122 degrees F we realized that our packs were going to be a different story. Apparently it is not advised to wash backpacks at such a high temperature, so our alternative---freeze it. We placed our packs, hammocks, and sleeping backs inside jumbo garbage bags and froze them for about 7days in one of the ships walk in freezers. These bug bites are far worse than being attacked by mosquitos I am fairly certain. A patient even commented on my nickle sized welt marks on my hands and arms! 

On our way back we piled into a shared taxi with 6 other people (because 7 people in one car is normal, right?) The ride back with “Tante” (our new auntie), Binta, the momma with no identification, the driver, and a chicken strapped to the taxi was one speedy and efficient ride. We bought several kilos of delicious mango’s as snacks for less than one dollar. As we sped along the bends and winds in the road, we were just three girls traveling together across the beautiful Guinean landscape. These are the adventures that we will look back on and think about the fun times when we were in our 20’s and living on a ship and serving the people of West Africa.  

Today is Dr. Gary’s Birthday!

This morning on the wards we took a small time out to celebrate Dr. Gary’s Birthday. A week ago when I had told the patients that Dr. Gary’s birthday was coming up, they were all so excited. We decided to make cards for him, and it was quite a sight. ALL of the patients were up and out of their beds. For several hours they bent over construction paper, crayons, stickers and markers writing and drawing beautiful things for him. For those who know how to write, there were beautiful messages speaking life upon him. Thanking him, saying he was sent from God, wishing him many more years. For the majority of our patients who have never had the opportunity to have an education they drew him beautiful pictures and attempted to write letters and numbers that they copied off their neighbors page. Today we handed him those cards all bound in a book. In addition to the book, the patients all decided to have the day workers write “joyeux anniversaire” on their bandages and head dressings so that as he did rounds to check on them they all could point at their bandages and smile boldly. We sang him Happy Birthday in English which was followed in French by our patients and dayworkers. They all clapped, cheered, came forward for hugs and hand shakes, thanking him and sharing blessings on him in their native languages. I just couldn’t get over the moment, standing there watching the 16 patients and all their caregivers coming forward to thank the man who has changed their lives, who has given them a second chance, who has given them the opportunity to be treated as a human, given the opportunity to be loved and accepted. Dr. Gary, one of the most amazing men I know, has helped hundreds maybe even thousands of people celebrate many more years of life throughout his 25 years onboard. He has added countless years to many, and for some he has been the person that gave them the opportunity to simply live to their next birthday by removing their tumors. So here’s to one more year and Dr. Gary’s day of birth! 

Breaking News--not really, but kind of......

So there’s this small-small piece of news that I have stewed over sharing for last few weeks. I don’t really know how to go about telling it in a way that does it justice, so I’m just going to put it out there......Are you ready? One, two, three------I am coming back to the ship for another outreach. Big deal right? After hours and hours of prayers, conversations with friends and family, and just listening to my heart, I have re-committed to another 10 glorious months aboard the Africa Mercy. This time sailing with the ship into the Republic of Congo. After almost nine months on this floating vessel, I have realized that this place is ingrained in me, has captured my heart, and I just simply am not ready to close this chapter of my life. I absolutely love our patients, the African way of life, and this melting pot of a place with crew from all over the world. I have made amazing friends, have poured into amazing patients, and have learned so much about this culture, and myself. Even single ounce that I have given has been returned to me ten-fold. Patients and friends have crossed all borders and have become family, people who I will never forget.  The idea of working in a Western hospital sounds amazingly unappealing, and I was honestly getting a belly ache simply thinking about it. As much as I miss people and the comforts of home, I know that God has put it heavily on my heart to stay. I’m not sure of the exact reasons I feel so strongly, but I just do. I feel certain that this is the correct place for me to be and to continue this season of my life......So I’m stepping out, jumping, leaping, lunging, skipping, falling, whichever mode of transport you choose, and trusting in His plan for my life. All of that said, logistically I’ll be home June 11th through July 23rd for a jam packed 6 weeks of catching up with friends and family, sharing my experiences, doing life alongside people I love, and soaking up every second before returning to the ship in a new role. I am honored to announce that I will be a Clinical Ward Educator this coming year. Fancy title, all to say that I will working on a team alongside two other amazing women to orient all of our new nurses coming through this place. We are responsible for equipping them with everything they need to be successful during their time here. I am so excited to share my passion for this place, to share my love for these people and this way of life. I am beyond jazzed to make the transition period one in which people feel supported, encouraged, and ready to do what they were called here to do from all sides of the globe.  Another aspect of my job will be focused on Community Health Education--I’ll share more about that later, but basically I will be working with a small team to develop a curriculum to educate local nurses in the Congo. Our program will consist of both classroom and ward time, and essentially we are striving to empower and educate local nurses to enable them to care for their own people. Exciting stuff right? So there it is---the big news of the day. I know that I can’t do this on my own and I am going to continue to count of the support, prayers, and words of encouragement from all of you amazing people at home. So thanks for keeping tabs on me, for loving me, for standing behind me day after day and most of all for caring about me enough to let me go fulfill my dream......

Two Teeth

They have been mentioned in Christmas songs as something a child longs for (“All I want for Christmas is my two front teeth”)  and we all have that dreaded picture in the first or second grade with a crater between your canines that people think is super cute when you are seven. However, somewhere between ages seven and twelve it becomes very awkward to be missing those pearly whites. Of course they are import for eating, and one of the first things people notice when they look at you. However, during my entire career as a nurse and quite possibly my entire life, two little teeth have never caused so much trouble. Tonight on the wards, two teeth- two small, jagged, pointed, bottom teeth that reached clear up the the underside of her nose were the source of three separate 15 minute conversations shared between three doctors, three nurses, four translators and six languages. “Mama” as we call pretty much any woman over the age of 30, was born with a cleft lip. Because of where she was geographically placed on this earth, her lip has remained split, for 51 years. She was admitted today for surgery tomorrow to bring her upper lip together and radically change her appearance. The first conversation was between her and her nurse just minutes after she came onto the wards as they went through what would take place in the next 24hours. “Mama” who has exactly 5 teeth came to the ship with a dream to leave with a full set of pearly white chompers to go with her new lip. Unfortunately that is just not a service we can provide. We are able to take out rotted teeth or crooked teeth, but we can’t replace them due to funding and supplies. The nurse explained all of this and Mama seemed satisfied, but not for long. The anesthesiologist came by later and she, full of joy and feisty spirit, asked him the same questions. To her dismay, he came and got me--who gave her the same answers. A few hours later Dr. Gary came by, and I asked him to set her mind straight so that she wouldn’t wake up disappointed by what we had enforced earlier in the evening. The conversation went something like this. Dr. Gary asked her would she like him to take out those two bottom teeth while she was asleep tomorrow. Yes, she exclaimed! Get rid of them! Wait, no, don’t unless you’ll replace them......will you replace them?.......are you sure you can’t?.......what if I want someone else to put new ones in?...That would be just fine, said Dr. Gary.  But, I’m just a farmer, how could I afford that, Momma asked? Then without hesitation she added, well-- I am the third wife of my husband, which means he loves me most, maybe he’ll pay for my teeth when he sees how beautiful I am!? A few second pause, she changed her mind again...No leave them, she said- just in case he wont pay for it, even though I’ve won his heart she added. Dr. Gary asked, is that your final decision? Yes--wait, no, okay--final answer, out they go!! By this point we were all laughing, watching her animatedly go back and forth. We received consent by her thumb print on the piece of paper, and quietly the humble Dr. Gary added, I think this was a longer consent process than what we have for patients who are about to have half their face removed!! But it was all worth the time and laughs, because today after 51 years, she had her lip made new-bringing together two pieces of flesh that have never touched in her life--and when I saw her tonight after her operation she was absolutely beautiful.....

The tube feeding situation of 2013

Well, we are in Africa, right? These past few weeks I have been reminded how amazing lucky we are to have what supplies we do. After smooth sailing for 6 months, we finally ran out of Ensure for our tube feedings. (Yes, here in West Africa we put that vanilla flavored drink you would give to the elderly or nutritionally deficient down feeding tubes) We had been making do for a few weeks with canned Pediasure (same idea, but designed for kids) and supplementing it with a few other things in order to give our adults the required protein and nutrients.---we moved to mixing up powdered ensure just 3 weeks ago and then just a short few days after that---bam, our blissful operation came to an end--We have now been successfully making our own tube feeding concoction! Yes you heard me, smoothie king would be put to shame by our mixing skills. Milk, peanut butter, sugar, liquid vitamins, a little fiber and a blender are all it takes to give our patients the required nutrients. Creative--yes... Functional---Not exactly. The peanut butter we use had to be bought locally in a large tub and is much more textured than something of the creamy variety you would purchase back in the states. This seemingly small task of feeding our patients often leaves us with the biggest frustrations of the day. As a nurse, we like efficiency, knowing we can hook up a bag and trust that it will deliver all of what we intended to our patients not run back 10 times to “mix it up” so that the peanut butter will flow through the tubing. The second problem with this method stems entirely from it’s composition-because the African diet is not typically strong in the dairy group we have had a few lactose intolerance problems----our answer to even this curve ball---make it with SOY! As we mix up liters of NG feedings a day, the common phrase is “if only my friends back in the ICU at home could see me now”. Never in the Western world would we mix our own feeding--it comes it’s own pretty little plastic bottle ready for attachment to a patient--easy as that. It’s things like homemade nutrition that cause “Africa Mercy Problems”......every single day here is an adventure---and I absolutely love it. See my friend Anna’s blog HERE  for a creative poem pointed at the tube feeding situation on board. 

Added note: Saturday we found out that the container of supplies from Texas sitting in customs may have ensure on it---best. news. of. my. week.  

My Starfish

You may have heard this story before--but I want to take the time to share it again with you all, and let you know what it has meant to me this week......

The Starfish Story

Original Story by: Loren Eisley 

One day a man was walking along the beach when he noticed

a boy picking something up and gently throwing it into the ocean. 

Approaching the boy, he asked, What are you doing?

The youth replied, Throwing starfish back into the ocean. 

The surf is up and the tide is going out.  If I dont throw them back, they’ll die.

Son, the man said, don’t you realize there are miles and miles of beach and hundreds of starfish? You can’t possibly make a difference!

After listening politely, the boy bent down, picked up another starfish,

and threw it back into the surf.  Then, smiling at the man, he said-I made a difference for that one.

On Wednesday, My starfish, “T” returned. He has returned for a second surgery to move around the excess skin left behind by his massive tumor. If you don’t remember him, check out his story HERE (or just read the majority of my blogs in November/December) We all knew this day was coming, I even put it on my calendar to mark the momentous occasion. Sadly, only 5 of us nurses on the ward were here to witness his miraculous recovery. The nurses have almost completely changed over, and the man that made such an impact on my life and many other lives we now have to explain to those who are caring for him. The man we saw struggle, whose hand we held in the tough moments and the joyful moments, the man who came to us literally skin and bones, who we fed and gave air, the man who faced death, and won--The man who is a legend here, is meeting an almost completely new staff. On the day he arrived, I was working a stretch of night shifts. I was told at dinner, that he had in fact arrived, so I rushed down to the wards to greet him. As I bolted into the ward, he happened to look over and gave me such a heart warming smile. I rushed over, hugged him, and was told through a translator, “ Hannah--He has searched the ship high and low for you today! He wants to know, where have you been?” The answer to which was, In my bed sleeping so that I can watch over you tonight!”  He felt this was okay, and we just stood for a few minutes in each others presence. Being the man he is, he loves to ask about the nurses who were here before, “The Emily’s? Andrea? Ann? Beth? Becky?” he smiles when I tell him they are well, that they are back in the US, working and enjoying life. Normally caregivers are only allowed on board for patients under the age of 18, or in special circumstances where language or other things pose a problem. T of course, is a VERY special circumstance. So I knew that “Momma T” must be around somewhere. In true Mercy Ships fashion, I ducked down to look under the bed, and there she was, sleeping soundly. I left the ward, and told him I’d be back at 10 pm. Early into my shift Momma T woke up, saw my feet, and instantly called out.  I ran over and dove under the bed without even a second thought. Hugging her, being showered with kisses, and again having those heart strings pulled knowing that she is my family. That both T and she are a part of me that I will carry around forever. That I have made an impact with them and them with me. It wasn’t until after I climbed out from under the bed and was moving to the other side of the ward to check on patients that it struck me how odd that would have been to anyone who didn’t work in this place. That in the west caregivers don’t sleep below the beds, and you definitely don’t hug and kiss them, or call them anything remotely close to “Momma”. I left work Thursday morning on a high-- my beloved T was back, and he was having surgery that day after a quick X-ray to show them exactly what would need to happen. When I came back into work Thursday he was sitting in his bed, face untouched by surgery. I gave him a puzzled look, and through motions he told me they wanted another picture. I confirmed with the charge nurse, and he was in fact going for a CT scan the next day at the local hospital. That things just didn’t look “quite right” on the X-ray. My heart instantly broke into a million pieces, I sat down on a chair to receive report from an evening shift nurse, and despite my best attempt not to, tears began streaming down my face. I don’t think she really knew what to do with me, but she just listened, gave me a hug, and told me it was okay to cry. T went for his scan on Friday, and I still don’t know the specifics of what the scan showed because I was off for the weekend, but what I do know is enough; the tumor is back. That it is growing alarmingly fast, and that It may be close to vital structures. All of our pathologies told us that it was benign, but with this growth rate, we are afraid that it might be something else. This knowledge still sits on my chest like a load of bricks. How can it be? How can this be happening? Why is this happening?---we thought that we beat this, that we gave him a new lease at life, that he was given his second chance. To be honest, I don’t know. It’s still raw and painful, and I’m just not really sure what to think. I do know that everything that touches our lives passes through God’s hand--but to be honest I have NO CLUE what God is doing with this--the purpose and the plan of this tumor returning. All I can do is pray. Pray for God to give T peace, to guide our hands and give us wisdom, and to ask for strength. To give me faith and strength to trust Him when I can’t see HIS plan--that he is still good even when my heart feels so heavy and unsure, full of doubt. T is going in for surgery today. He is booked for 4 hours, and the plan is to explore and see what we can do. I went to visit him this morning- As I gave him a hug and Momma kisses I honestly just wanted to sit down on his bed and cry. But I didn’t, because I have to hold it together. I need to be strong and I need to be faithful. So, If you don’t mind, please ask for strength and wisdom for us today. That we can figure out what to do for this man, and even that God just takes care of this. I know that at some point our Western medicine fails, and this is where I am--on my knees with my arms outstretched, holding it up to God. 

The difference a cleft lip makes......

Looking at these two lovely babies what immediately jumps out at you? Do you notice the baby on the left or do you instantly gaze at the one on the right? Perhaps the first thing your eye picks up on is that one baby is very malnourished and one appears healthy. Do you notice the stark contrast in size, can you count his little ribs, see his loose skin? From simply looking at this photo can you tell that they are the same age? Can you tell that they are in fact TWINS? Simply looking at this photo can you see how the momma has had to struggle to keep one baby alive while the other is plump, healthy and happy? The reality is this beautiful twin brother and sister have had very different paths. The little girl has gained weight from day one, where the little boy has had to fight for survival. Because he was born with a cleft lip he cannot create the suction that is necessary to breast feed. Babies with this deformity have to have milk hand expressed into their mouth, or be fed using a spoon---either option is not easy. No matter how much the mother wants to give her baby nutrition it is simply not possible. Even with the most determined mother many of these babies die of malnutrition, dehydration, or pneumonia from aspirating milk so frequently.  This lively pair were seen at our screening day, and were instantly enrolled in our infant feeding program with our amazing dietician Jess. She works hard with these families. Teaching them proper techniques for feeding, providing them with supplements, and tracking their progress closely over the months getting them to a goal weight leading up to their operations. 

Gaining Weight!!! This is a photo of the twins mid-way through their participation in the infant feeding program.

Looking at this same pair they don’t look quite so different--not nearly as shocking. I want you to understand that those beautiful chunky rolls are the representation of insanely hard work and their momma honestly deserves an award. The babies were such a joy to have on the ward, and through this simple surgery “A”’s life will be forever changed. He will continue to gain weight, to live a life without the stigma of having a split lip, and will be given the same opportunities as his twin sister. 

Ready for surgery! Pretty amazing stuff, right?

The Twins with Mom and big sister

Jess with the twins--- notice the beautiful new lip on "A"