Time for Goodbyes…..

IMG_5186 4Tonight we leave the Africa Mercy and will fly from Douala, to Brussels, Belgium, then on to Paris – about a 9 hour jaunt. Steve is in the OR, and will work right up to “quittin’ time!” I was scheduled off today, but one of our wound care team is very ill with a GI infection and dehydration, so I was able to work a few hours this morning to help cover all the dressing changes that were scheduled.  I was really happy to do this, as I got to say goodbye to several of the patients. The first on our schedule was one of the first patients I treated when we came to the ship in January, Dieudonne. He had 4 toes amputated back at the end of November due to gigantism, and his foot “debulked,” and the wound from his surgery healed quite well – but when he first came he also had a chronic neuropathic wound on the bottom of the same foot that he had been treating for 2 years; we continued to try different wound healing approaches with no improvement. Two weeks ago, Dr. Tertius took Dieudonne back to the OR, removed a good bit of tissue from the bottom of his foot, then covered it with a split thickness skin graft. Today as we removed the dressing for the first time (we usually don’t change graft dressings until Day 14 post-op), his graft was well-adhered and there was no sign of infection – hallelujah! It was bittersweet saying au revoir to this sweet man. There were several others, as well. Rose is another of my favorites  – a sweet deaf-mute woman who had a huge neurofibroma removed from the right side of her face, and now has a wound on part of her skull where the bone is exposed that we are trying to heal. Her brother is her caregiver, and is an English speaker (part of Cameroon is English-speaking; the other French-speaking). Rose always has a sweet smile and a hug to give, and her brother is so kind.

So I mention Rose especially as one of our patients who needs prayer. The Africa Mercy will be in dock for 11 more weeks; when it pulls out, there will be a number of patients left behind who we have not yet been able to achieve full wound healing. Today, the ship is praying as a whole for another patient, Adama. She has undergone 5 surgeries since coming to the ship and has been here since August, I believe. She has battled delayed healing and multiple infections, and without a miracle, will be one of the ones left behind without being totally healed. I cannot imagine how hard this will be for the patients and their families, but I also cannot stress enough how hard this is for the crew who have labored for healing with these sweet, brave patients. IMG_5225 2Four of the current “Wound Care Wonder Women” on the dressings team: Kirsten Murphey (CT), Kelsey Sax (Washington, DC), Bethany Brown, our incredible team leader (CA) 🙂 Absent from this photo is Anna-Karin Bergman, from Sweden, whom I have really connected with in the last few weeks. She is recovering but is still very weak.

At this point in the field service (month 7, basically) the crew is tired. Cameroon has been a hard field service, for several reasons. This was the first trip to Cameroon for Mercy Ships, and there have been struggles. Some of that comes from distrust of the people here and misunderstanding. Some believe we are paid by the government to come here, or that we are here to take advantage, or “experiment” on the patients. Some have been told that we will steal their shoes, or replace their eyes with goat eyes. Some of the struggles have been in getting the right patients to screening for the right services. There has been a large rate of “no-shows” for scheduled surgeries – which is incredibly sad when you think about the numbers of people who were turned away because there were only so many slots available.

So I would ask, that as we leave, you would pray for rejuvenation for the crew here – for energy and strength to finish this field service strong in early June. For trust and relationships to be built between Mercy Ships and the Cameroonian government, and the people here that we desire to serve well.

And I also ask you to pray for a 16-year old young man, Juspin, that I helped care for this week at the Douala Hopital Generale. He suffered severe burns on 40% of his body Sunday night. Someone had just brought in a container of fuel into a dark room, which exploded when Juspin ignited a lighter in order to see. His head, face, neck, hands, arms, feet & legs received the brunt of the blast – only his torso was protected by his t-shirt and shorts. The removal of his dressings and subsequent scrubbing of his wounds and reapplication of dressings was time-consuming and painful – fortunately he did receive sedation. But his family has no finances to pay for further care, and the system here is not like it is in the US. I am not sure how much longer they will allow him to stay at the hospital, but without finances, they cannot provide him with the dressings, medications, or even IV fluids that he needs. He has about a 50% chance of survival with good care. Please pray for Juspin.

IMG_5230 2Jody, an AWESOME Occupational Therapist. One of the treats in my job has been the opportunity to work alongside so many selfless and excellent OTs, PTs, nurses, and physicians. Again, everyone who serves on Mercy Ships does so at their own expense. I am amazed by and thankful for how many wonderful people give up their time and resources to serve the people of Africa. IMG_5232 2Julia, from the UK – our infection control specialistIMG_5233 2This is Adam. Adam is one of our housekeepers. Every day, each time I saw him, he called me by name (and I love the way my name is pronounced here, “Ahhhn-Marie”). I have discovered the power that speaking a person’s name aloud has here – on days when I struggled or was down, this often was enough to lift me up and make me feel valued. Malachi (Chaplaincy) and Sanzy (Ward Day Crew), in the next 2 photos below, always did the same 🙂 IMG_5238 2IMG_5212

IMG_5239Laura and Steve. Laura and her husband (another Steve) are serving here from Flagstaff, AZ. Laura is a PACU nurse by trade, and her husband is on board as a carpenter. But because there were no PACU slots when they needed her husband’s skills, Laura came to serve with the housekeeping crew. Twice the PACU has pulled her off house-keeping duties as staffing needs have arisen.Team photoThe “Plastics Team” – Dr. Tertius Venter, far left, as well as the nurses from the OR and wound care team, and OT/PT staff. Anna-Karin, my buddy from Sweden on the dressings team, is in front of me.IMG_5214IMG_5171This is Josue (Joshua), who is full time crew from Ghana. Josue runs the gift shop (“Ship Shop”) and Cafe. He has been so patient trying to teach us rudimentary French!

Anne-Marie Jones, Wound Care Team Nurse, working with Leon.From January – working with patient Leon 🙂

So apologies for all the “selfies” – just so important to me to document or acknowledge as many as these wonderful people as I can (while I can remember!!!!) Today has been quite bittersweet and we have been so touched by the heartfelt goodbyes from patients, and crew from all over the world.

And finally, from Steve: (I keep bugging him, “What do you want to say in the blog!!??” “Being on the ship is unique for many reasons, but one of the primary things that sticks out in my mind is forming friendships quickly. And I experienced something very real today. A surgeon whom I met last year and I were able to reconnect, and during that brief time, he asked specifically if he could pray for me right then and there about an issue of concern. That is what sets this place apart. The Christian community and love that you experience here is life-changing.”

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Ok – throwing this one in for kicks as a reminder of home…. Wednesday when I made our stretcher for the first patient, this was the pillowcase I pulled out (the linens here are all donated and mostly well-used 🙂 ). Appropriate, as Steve is a WVU alum 🙂

Go Mountaineers!!!

Psalm 121

A song of ascents.

I lift up my eyes to the mountains—
    where does my help come from?
My help comes from the Lord,
    the Maker of heaven and earth.

He will not let your foot slip—
    he who watches over you will not slumber;
indeed, he who watches over Israel
    will neither slumber nor sleep.

The Lord watches over you—
    the Lord is your shade at your right hand;
the sun will not harm you by day,
    nor the moon by night.

The Lord will keep you from all harm—
    he will watch over your life;
the Lord will watch over your coming and going
    both now and forevermore.

We’ll be back in our NC mountains next Wednesday!!! Thank you and God bless for being a part of this ministry and journey!

Love,  from Anne-Marie & Steve

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A Little Off-ship Excursion – and Lessons in Cameroon Life

Those in the OR still work long hours every day, and work for the inpatient dressings team has ramped up quite a bit. We continue to add new patients daily while still recovering those who had surgery up to a month ago, changing most of their dressings every other day. It is so encouraging to see some of these difficult grafts and wounds finally heal, after weeks of dressing changes and nutritional support. Each day we discharge one or two patients to the Hope Center, where they will continue to be seen in the outpatient clinic until ready to go home.

I just came from the ward, where a group of 4 children (patients) are squealing with laughter as they play Hungry Hippos. One of them is using her elbows to play; two each have one arm fully bandaged and extended in splints – straight out from their sides, which makes it interesting getting through the narrow doors to the bathroom and hall :). Despite the immobility and the discomfort, they find joy in play. So much fun to watch them play soccer with balloons in the ward hall! And the staff nurses and day crew and caregivers play right along with them. BTW, I am not a pediatric nurse, but have learned to do a good bit with the children here (since the vast majority of my patients are <15 years old…by the way, “age” is very fluid here – I was told that after a baby turns one, they really stop counting.) But I never cease to be amazed that, an hour after a painful tedious dressing change in which a child cries so hard, they are smiling and want a “high five” from the very nurse who caused them so much pain.

Meanwhile, every Monday and Wednesday evening, there are soccer or volleyball games on the dock between various hospital and Mercy Ships staff  & crew. It gets crazy – last night there was a group playing traditional music and dancing while we were cheering the teams on!

Steve and I also “played” this past weekend, with 5 other crew members – a plastic surgeon from South Africa who lives in Holland and has a French name :), and four other nurses – two from the US (Indiana & New Hampshire), one from the Netherlands (Holland), and one from Germany. Off-ship trips are encouraged as work schedules allow to give the crew a “break” from ship life, and to experience the host country and culture. So off we went early Saturday morning to a chimpanzee refuge ( a very dusty, bumpy 3 hour ride). IMG_2765

On the way there, our guide, Caroline, gave us such great information about the economy and state of the country. Once we left the city of Douala, which seems to go on forever, we passed native houses made of mud and sticks, and others made with cinderblocks – openings for doors and windows but no actual doors or windows to close. Many “houses” were simple three sided structures similar to shelters on the Appalachian Trail, where vendors live and conduct business selling palm oil, yams, or plantains on the side of the highway. There are some larger houses scattered about, unfinished and abandoned, that stand vacant with rebar sticking out.

Many people were out bathing, or washing clothes and dishes in the river. And many were walking up and down the highway (no shoulder or median or sidewalk) trying to sell something (palm oil, plantains, bananas, yams, rebottled soda or water) to make a living.

We stopped at a rubber plantation on the way – rows & rows of trees where the latex literally drips from scars they have made with machetes on the trunks. The rubber plantations, we were told, are owned by the French, and the Cameroonians who work them earn very little. IMG_2761

Rubber Plantation

Caroline made a statement that really saddened but stuck with me: “Cameroon is a very rich country, but very poorly managed.” There is oil here, as well as other abundant natural resources, but also a great deal of corruption. The unemployment rate here is 62%. Those fortunate enough to have jobs cannot afford to do anything to jeopardize them. Caroline explained to us how thankful she & her husband are for Mercy Ships – they own their own tour business, and once Mercy Ships pulls out of the dock in May, they will have very little income, just as they had before last August. We have a young man working day crew (local Africans who work on the ship) in the OR, earning ~ $10 per day – he has a PhD in computer science…. but there are no jobs. It also costs to send children to school – there is no free education here. So many people here cannot read or write. (Day crew are the only ones getting paid on the ship. One recently told us that the first thing she bought with her pay was a phone – and it will be the first to go in May 😦 ).

During our trip, we were stopped 6 or 7 times by police, or the military (we are not allowed to photograph them) and our “papers” (passports) checked. Caroline would explain to the authorities that we are with Mercy Ships, and what we are doing here in Cameroon – sometimes it made a difference and we would then get an enthusiastic reception from what had been fairly tense and terse before.

Caroline pointed out papaya and mango trees as well as palm, coconut, and cocoa plantations along our route. Throughout the whole landscape we saw scattered fires as the workers burn the undergrowth, so they can till the soil for more planting. The air both days was thick with smoke and haze, and in the middle of the rubber trees, the smell of rubber was so strong, it smelled like a tire store! IMG_5144

Palm Trees (for oil)

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Papaya Trees

The chimpanzee refuge was interesting – a place where orphaned chimps are brought to be raised in a protected environment (the mothers are hunted and killed, sometimes for food). The young ones were sweet and cuddly; the older ones quite aggressive – we had to remove all jewelry, glasses, hats and hold onto our phones/cameras for dear life. I tucked my phone into my bra and pulled the top of my shirt up so it was completely covered, yet as we walked into the forest a few minutes later, one chimp grabbed my hand, then jumped onto my back and ripped at my shirt to get my phone – guess it had been watching closely! At any rate, it was fun to be in “the jungle” and play with the little ones.

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To make a long tale shorter, after seeing the young chimps as well as the adults (from a safe distance – we were on a boat; the adults are released onto a nearby island where they are fed 3 times a day and expected to live until they are 60 or older) we had a wonderful afternoon seeing the countryside, swimming in the ocean, enjoying a fresh fish and plantain dinner, and relaxing at our “resort” Saturday evening. The power went out during dinner and remained off all night, so sleeping in a cinderblock room with no air movement was quite warm – Steve ended up sleeping outside :). Sunday we took a boat ride up the Sanaga River, where we met some Pygmy children, watched our boat driver (paddler) set shrimp traps (pictured below) and others swimming, then visited a waterfall where the river comes into the ocean.  IMG_5110

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Ingenuity in recycling 🙂

Steve and Seido, our Muslim tour driver (his emphasis, not mine); Dr. James Fouche enjoying lunch; our resort dining room.

We enjoyed one last ocean swim before heading back in our trusty Toyota van (they fit up to 19 people in one of these – 4 short rows of 4 and 3 in the front seat!) And more cultural lessons from Caroline were enjoyed :).IMG_5126

I am going to just finish this post with more pictures (as I’ve run out of steam, and the pictures say more than I could, anyway) – but first, a huge praise report: my headaches have lessened in frequency AND severity – I carried injectable Toradol on our little excursion this weekend, but did not have to take it. Thank you to those who have prayed specifically about this!!

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Boarding the boat for our Sanaga river excursion…. and yes, we did have to bail a bit.

 

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IMG_5165Back in Douala, motorcycles everywhere, with up to 5 people (left, above)…or carrying lumber, blocks, pipes…or occasionally propane tanks (top photo if you didn’t notice it before). Safety, anyone?

Caroline, our guide; Seido; and relaxing at our “resort.”

Rebecca (USA) with her coconut; Annika (Holland) getting her hair REALLY braided 🙂

Thanks for reading!

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The Sacrifices We Make

Psalm 103 

Bless the Lord, O my soul,
    and all that is within me,
    bless his holy name!
Bless the Lord, O my soul,
    and forget not all his benefits,
who forgives all your iniquity,
    who heals all your diseases,
who redeems your life from the pit,
    who crowns you with steadfast love and mercy,
who satisfies you with good
    so that your youth is renewed like the eagle’s.

 

Steve and I commented to each other recently that the “honeymoon is over,” meaning we’ve really settled in to life on the Mercy Ship, and the newness has worn off. As with anything in life, there are hard days, and disappointments, and treatments/approaches to care that are so different from what we’re used to…. but we continue to love being here and being a small part of helping to change lives.

Homesickness is always a struggle for me – and yes, I can get homesick even when my “main squeeze” is right here with me :). I cannot imagine doing this for 2 months without him being here. Actually, Mercy Ships has a policy of limiting time you can serve to 2 months if you have left a spouse or family at home – they fully realize the importance of marriage, family, and togetherness. Anyway, I am so blessed with friends that reach out to me “out of the blue” (ha!) when I need it most, and pray for me when I am struggling – thank you – (you know who you are!)

Last weekend we enjoyed a day off of the ship – went into downtown Douala to the flower market (incredible tropical flowers and arrangements!), a local souvenir market, and to the “Super U” (a supermarket). I ate swarma, which was yummy, and we were able to purchase a few trinkets to take home to friends.

For those of you who have not had the opportunity to visit a developing country, it quickly becomes obvious that you are not at home, and we are incredibly blessed to live where we do. The poverty can be rampant, and the lack of infrastructure evidenced in the roads, buildings, and housing. Safety often seems to not be on anyone’s agenda. And it is a good and humbling twist to be in the minority for a change. BTW, the security folks on the ship stay on top of things and make it very clear what areas off the ship are off-limits for safety reasons; we have to sign out to let them know our planned whereabouts. There are shuttles from the ship to the approved areas that travel on the hour or half hour. And we have Gurkhas providing our security, screening everyone coming and going!!!! We are very safe on the ship! But as with any travel in any city, robbery is a risk you take when you go out and about.

A Different Kind of Nursing

I think I’ve mentioned before that the patient wards on board the Africa Mercy are quite small, and each have 20 beds, spaced only about 2 feet apart. Each bed is slightly elevated, so that a mattress, on which the caregiver sleeps, can be placed beneath it (Yes, they sleep beneath the bed – have about 4 inches from their nose to the bottom of the patient’s bed 😦 ).  Most of you have been in a hospital back home, where it is a rare thing anymore to have even 2 beds in the same room. That is largely because we do not want a “clean” patient rooming with anyone who is potentially infectious. It also has benefits in providing each patient with more privacy. And if a patient is diagnosed with an infection that is easily spread to others and/or difficult to treat, we can keep them in the same room and institute “contact” or “droplet” isolation precautions (for which we wear gowns and gloves, and masks if needed, to provide any care). Only if they have something which is highly contagious and spread easily through the air for long distances, like tuberculosis or chicken pox, are they put into special isolation rooms. Infection control, as you can imagine, has the potential of being a huge issue here. Since we’ve been here, we’ve had 4 wound care patients diagnosed with methicillin-resistant staphylococcus aureas (MRSA). At home, we have a great number of MRSA-positive patients – on any given day, half if not most of our wound patients will potentially have MRSA. Here, it seems a miracle that we’ve had so few. But because these folks have not been exposed to constant use/overuse of antibiotics, they have not developed the problems with antibiotic resistance that we have in the States. All patients are screened for MRSA here before they are accepted for surgery, and antibiotics are used sparingly and only after a culture has determined what the infecting organism is, and what antibiotic will be successful in treating it – they never blindly give a patient a Z-pack or Keflex. When we bring a patient to the treatment room for a dressing change, and we note that there is more drainage, or redness, or swelling, or odor associated with the wound, we quickly culture it. If, when we receive the report 2 days later, the patient is shown to have an infection, the appropriate antibiotic is prescribed. If, however, they have MRSA, we also quickly place them in an isolation room. Now imagine: You’ve been in a 20 bed ward for 2 weeks with 20 patients, 20 caregivers, 5 nurses, 5 “day crew” (translators, aides), and doctors, PTs, wound care, chaplains, dieticians, and visitors floating in and about all the time. (The wards are always hoppin,’ especially during the daily praise and worship time with music, drums, dancing, and a message!) Now you are told that you have a contagious infection, and you are whisked off to an isolation room, where you hardly see anyone – maybe the nurse a few times a shift. This is really tough for the patients, especially the kids. And there they must stay in that isolated room until they have no further evidence of MRSA, or they are discharged to the Hope Center. Below are 2 of our patients that we treated for quite a while, all gowned up. It was actually the older gentleman’s birthday, and one of the nurses made him cupcakes and they were “let out” of their rooms for the event. He later told one of the day crew that he had never celebrated his birthday before 🙂 . Crazy white people!  Nurses stand with a plastics patient on his birthday.

So in the States we would probably struggle a bit with being on a ward, having our medical issues laid out for all the ward to see, not to mention our state of undress, toileting, etc. There are curtains between the beds, and we often have to remind the doctors to pull them before they start to examine patients. And there is no segregation based on age or sex.

One of the biggest jobs the nurses have is to distract patients – from their pain, discomfort from splints, therapy, etc. In the States we went a bit overboard with the idea that no one should suffer pain, and unfortunately, we’ve created a bit of a prescription drug mess because of it. In my most recent job in the States, we did not think of changing a post-op patient’s dressing, in most cases, before they got an IV dose of morphine or Dilaudid. It’s quite different here – most often when we pre-medicate a patient for a dressing change, they are getting acetaminophen (Tylenol) or ibuprofen (Motrin) by mouth. For the first dressing change, which is usually quite painful, they might get a codeine pill or a tad of liquid morphine orally. These patients, especially the kids, are so tough and brave. The physical therapy alone can be grueling. As such, there is a lot of “play therapy” (My SLP friend Melinda Kuehn would be right at home 🙂 ).

So as the nurses work and play with their patients, relationships are built, and not only with the children, but also with the parents and caregivers. And strong relationships develop between patients and caregivers, as well.

When a child (or any patient) comes to the Mercy Ship for surgery, a caregiver has to accompany them. That often means that the family back home is making huge sacrifices. These parents leave their livelihoods, their spouses, and remaining children at home, all for a chance at having their child in need helped by Mercy Ships. One young girl who came to the ship last August, from a couple of days distance, did not have a parent willing or able to come with her. Instead, a neighbor who recognized the girl’s dire need and the great opportunity brought her to the ship and stayed 2 months. When it was time for the girl to have her 2nd surgery, the neighbor had to return home, where his family had almost starved in his absence. Another neighbor then took his place, and stayed with the girl until she was well enough to return to her village.

And we think we make sacrifices to come here to help.

Life and Healing, Continued, on the Mercy Ship!

Psalm 40:5 – Many, LORD my God, are the wonders you have done, the things you planned for us. None can compare with you; were I to speak and tell of your deeds, they would be too many to declare. (NIV)

As I write this, there is a large group of crew members gathered around one of the TVs in “midships,” (a communal area) watching the opening ceremonies for the Winter Olympics in South Korea, and everyone is loudly and enthusiastically cheering their respective countries! We did miss the Super Bowl, but there was a Super Bowl party the day after, and everyone was warned not to peek at the sports news.

So we are truly “in the groove”….. it’s hard to believe we’re half way through our service here! Steve continues to work LONG days in the OR, whereas my days aren’t quite as full, and I have more time off.  I was excited this week because I was able to donate blood – something I haven’t been able to do in the States for over 10 years! We livDonating blooded in the Azores during the Mad Cow disease scare, and that has kept me, Steve, and both of our children on a list of unacceptable donors (though I’m told that may have recently changed). My blood type is B-positive, which is in high demand here. Often during  difficult surgeries involving a lot of blood loss, the lab puts out the call for B positive crew members to make their way down to donate – and it is delivered warm to the OR! (So even the housekeeping, galley crew, engineers, and security folks get to help save lives!) Kathy, the head of the lab who drew my blood, offered to take my picture with my unit, but I didn’t take her up on it….. but here is Deb, one of the other crew nurses, with hers:

Last week I was able to visit the Douala Hopital Generale to visit several burn patients being treated, and observe the burn nurses there. It was a 45 minute ride from the ship, and I was ablDrivinge to see a lot of the city of Douala on the ride. It is typical of a city in a developing country, much different that a city you would drive through in the US. Namely, there are TONS of motorbikes (have seen several with 4 people on them! And no helmets….), and no traffic lights or signs, despite sometimes 6 lanes of traffic – everyone seems to drive how and where and when they see fit. And the roads are often full of humongous pot holes (one of which we recently drove into and got stuck in for a while 🙂 As you can imagine, there are a lot of accidents, and driving here is not for the timid. (Thank goodness for our day crew drivers!!!)

The hospital was so interesting….they do amazing things with seemingly outdated equipment and such limited supplies. The nurses I worked with were both male, excellent at what they do, and asked many questions (mainly, “How would you treat this wound?” to which I was only able to offer small suggestions).  Interestingly, there are probably more nurses here who are male than female.

(BTW, I did not take any of the four photos above  – took them straight off of Google images).

On Thursday I attended a surgery by Dr. Tertius Venter (pictured below, from Capetown, South Africa) Tertius1and his plastic surgery colleague from Holland in which they placed a scalp pedicle flap over a cheek (a full thickness flap of skin that is partially cut from the scalp with it’s blood supply still attached, rotated down to the area needing the graft, and sutured in place). In three weeks, the pedicle will be cut and the remainder resewn in it’s original place. (I’ll let you google “pedicle flap images” if you are interested in seeing what this is….) They do this type of graft often – one patient the wound care team is currently seeing came with severe contractures of both hands/wrists (her father tied her hands behind her back and poured boiling oil over her as a punishment some years ago). Dr. Tertius released the contracture, and made a pedicle from the skin in her groin, and attached her wrist to the pedicle.  Yes, she has her hand sewn to her groin for the next 3 weeks, and we dress the pedicle every day! This beautiful young woman had her right hand/wrist contracture surgery in the same fashion late last fall, and returned this month to have the left one done. Her name is Marie 🙂

A Little Bit about the “Noma Belt”

Each Wednesday evening after dinner on the Mercy Ship, a medical in-service is presented to the crew. These presentations are given by our volunteer surgeons and have been fascinating. As Dr. Tertius  explained recently, diseases, tumors, and other deformities seen here have usually progressed so severely that Western medical textbooks have no information on their treatment….often these surgeons are “sailing in uncharted territory,” and have had to learn by experience what works and what doesn’t. As a result, they have pioneered techniques and procedures to help the people here. As such, even the postoperative care is very different, and unlike how we would “do it in the States.”

This past Wednesday, Dr. Gary Parker (pictured below; a maxillofacial surgeon originally from the US who has served on the Mercy Ships for over 30 years, with his wife and kids) presented on the treatment of Noma (http://www.facingafrica.org/what-is-noma/). Here in Cameroon, we are in the “Noma Belt,” part of Sub-Saharan Africa where the poverty and malnutrition are so rampant that this disease, which comes from normal mouth bacteria, reeks havoc.

DR_GARY_PARKER_USA_MAXFAX_SURGEON_RP003_HIBefore coming to Cameroon, I had never heard of this horrendous disease, which is 90% fatal. Survivors are left with severe deformities that honestly look like something out of The Walking Dead. This disease of poverty and malnutrition is never seen in the Western world (with the exception of the concentration camps during the Nazi Holocaust of World War II). If you are interested – and be warned – the images are quite graphic and disturbing – here are additional links/videos on the disease: https://www.youtube.com/watch?v=EF6cScuMLJA and https://www.youtube.com/watch?v=6Y4wvsfTubI

But Dr. Gary’s talk was on giving back hope to the survivors, who otherwise go through life alone, in hiding, or with their faces always covered. He and others here on the Mercy Ship literally rebuild faces – recreate lips, noses, cheeks, eyelids, and bony structures. I do not have photos of a current Mercy Ship Noma patient to share today, but if you have clicked on any of the links in the preceding paragraph, you saw how devastating and disfiguring the disease is. Here is a former Mercy Ships patient that Dr. Gary treated: Noma

Goodbyes…and Hellos

Have I mentioned the “revolving door” on the Mercy Ship? Every week, crew membCMA180123_EYERS_BOW_EN001_MIDers  leave to return home to the UK, the Netherlands, Germany, Australia, the US (again, over 40 countries represented here!) Though many are here for the whole 10 month field service, the majority of nurses are here for 2 months. Tomorrow one of my wound care team co-workers, Dasha Eyers, leaves to return home to Florida, and I will miss her!

She has been such an encouragement to me, and I have learned a lot from her…and most importantly, she truly demonstrates the love of Jesus in all she does here. This was Dasha’s first time on the Mercy Ship, but she plans to return!

That’s Kirsten Murphy on the far right, another of the “wound care wonderwomen” :).

Sweet Smiles

I want to leave you with pictures of “R,” who is one of my favorite patients. R came for treatment of gigantism, and originally had several of his toes amputated and his foot “debulked” in late November. But his right leg was still much longer and the foot was larger than his left, making it very difficult to walk, even with crutches. His wound also had difficulty healing. Last week Dr. Tertius took him back to surgery and removed his lower leg. While this seems tragic, he will most likely have much better mobility and a chance to heal now, and once he is fully grown, will probably get some type of prosthesis. Though I cannot understand R’s language, he communicates beautifully with his huge smile.

Isn’t that beautiful smile worth so much……

Proverbs 15:30  A cheerful look brings joy to the heart, and good news gives health to the bones. (NIV)

Healing on Many Levels

Please click here first 🙂

A week or so ago screening took place for the next round of plastic surgery patients that will be treated on the Africa Mercy here in Cameroon. I’m not sure how many patients came in hopes of receiving treatment (it lasted ALL day) or how many we ended up accepting, but it was enough to completely fill the plastics surgery schedule for the next 5 weeks. Meanwhile, surgeries continue on patients with hernias, cleft palates, ameloblastomas,  thyroid goiters, etc. Plastics is just one service.

In addition to other types of surgeries, there are opthalmologists who perform cataract surgery (children and adults – a real issue here) on up to 40 patients a day.

Eye patient Aser Roger before at the eye clinic

AND….we have a full dental clinic off the ship that has treated over 5,000 patients since the ship arrived in Cameroon last August. Likewise, we have a Ponseti clinic off the ship that treats children with club feet. (The Ponseti method is a non-surgical method of correcting club feet through manipulation and casting).

There is soooo much going on through this ministry. And though it’s only a drop in the bucket, this is happening: “Changing lives, one life at a time.” We learned last night during our weekly Thursday evening briefing that of the world’s 7.6 billion people, 5 billion (2/3!!) do not have access to safe surgical care. But Mercy Ships has provided just that to well over 30,000 patients since 2007.

(So this week the post hopefully won’t be as long (my son told me last week’s post was too long, so he didn’t read the whole thing 🙂 I understand.)

I want to talk about how it’s not JUST surgery that we do here. In the States or other developed nations, if you go in for surgery, you are most likely to have a good outcome because the care is good, yes, but also because most likely you are healthy and well-nourished. Surgeons do not do elective procedures on patients who are malnourished, because you cannot heal if you are malnourished. As a wound care nurse, I and my co-workers preach relentlessly to patients and their families that they must consume good proteins and carbohydrates in order to heal. Not so much a problem for us in the developed world. But take Paul Pascal (below). He came to Mercy Ships in such a state of malnutrition that the staff marveled that he was alive. He was in desperate need of cleft lip/cleft palate repair (as this had impacted his ability to take in nourishment), but before Mercy Ships would consider operating, they admitted him for feeding, to boost his nutritional status, and get him to the point that he would in fact be able to heal. Watch the transformation 🙂 :

Once he plumped up, off to surgery he went, with a wonderful outcome:

During a medical inservice presentation recently, the current plastic surgeon, Dr. Tertius Ventner, was asked why we have such a high complication rate on our plastics patients (we are still following multiple patients who had surgery in Nov/Dec, who in another place would have long been healed). His answer was that one of the main reasons is the malnutrition issue.

Which brings me back to the fact that we don’t just bring people of the ship and “surgerize” them. The day after the screening, those patients who have been scheduled for surgery returned to our outpatient tents, where we did basic pre-op teaching, and provided them with packets of MANA (gotta love that name!), a nutritional supplement, that they are to take 4 times a day until surgery. Most are admitted to the Hope Center during this time where they get nutritious food, and will be brought to the Ship the day before their surgery. And for the entire length of stay, they and their caregivers are fed nutritious meals three times daily.

And that’s not the only daily bread that they get 🙂

35 For I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me, 36 I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me.’ 37 Then the righteous will answer him, saying, ‘Lord, when did we see you hungry and feed you, or thirsty and give you drink? 38 And when did we see you a stranger and welcome you, or naked and clothe you? 39 And when did we see you sick or in prison and visit you?’ 40 And the King will answer them, ‘Truly, I say to you, as you did it to one of the least of these my brothers,[a] you did it to me.’ Matthew 25: 35-40

Yesterday we discharged Dieudonne, a patient who had debulking of his right foot and toes for gigantism. We’ve been doing his dressing daily since I arrived on the ship, and daily he has tried to teach us French and Fulfulde as we work on him. (He just laughs at me….. no more foreign languages sticking in my brain 🙂 ) At any rate, as he left, he clasped my hands and through a translator said, “From the bottom of my whole heart I thank you, and ask God to bless you, and increase your knowledge and skill so you can continue to bless others.” This message was for all of the nurses. And you can bet it made me cry. He blessed me far more than anything I did for him.

I love the following words about volunteering on the Mercy Ships:

“Nothing worth doing is easy. The lives you help save aren’t the only ones that will be changed. You will also be transformed. You will work hard, long hours. You will be pushed to your limits. Your heart will break with compassion for those you are serving. But it will be tremendously fulfilling every single day.”                               (From https://www.mercyships.org/volunteer/life-on-board/ )

TRUTH.

Nurse Nia Johnston cuddling a caregivers baby on deck 7.

Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will. Romans 12:2

 

Surgery on the Africa Mercy!!

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Psalm 115:1

Not unto us, O Lord, not unto us,
But to Your name give glory,
Because of Your mercy,
Because of Your truth.

It is so hard to believe that we have been on the Africa Mercy for two weeks (tomorrow night). Time flies when you are having fun, they say, or very busy! We have settled into a routine, Steve working Mon-Fri from 8am until 5 or 6pm; me, working 8 am until we get all the dressing changes/wound care done that is scheduled for that day (usually 4-5pm). It’s really kind of funny – we get up in our little cabin on deck 3 at 6:30, shower etc, then walk out our door, up 2 flights to deck 5 directly into the dining hall, where we eat breakfast together, then head back to the hospital on deck 3 to begin our shifts. Some days we are able to meet up for lunch, but most often, we don’t see each other again until we are back in the dining hall for dinner. Then we read, answer emails, FaceTime with family, etc., until bedtime, around 10 PM. I am off again this weekend, so we are heading into Douala with another OR nurse and some others who have been here the whole field service (since August) and know the area well. We’ll have lunch and see the sites! This will be our first foray into the local cuisine :).

I mentioned last week that this post would be devoted to Steve talking about the OR, but first I want to make sure you know how this all works (and because I can’t seem to stop writing….). Although this is a surgery ship, we don’t bring folks on for things like emergency appendectomies, gall bladders, or knee replacements.  The Mercy Ships’ mission is to change lives, one at a time.  So the Mercy Ships admin people notify the country’s authorities that they are having surgical “screenings” on certain days, and folks come from all over the country for a chance to get help. I’m not sure how the word gets out, but it does. For instance, this past Tuesday we had screening for the next round of potential plastic surgery patients. We saw a multitude of folks with things like I mentioned last week – severe contractures, polydactyly/syndactyly (more than 5 fingers or fingers that are fused/webbed together), neurofibromas, lipomas, gigantism, etc –  (you can google images if you’d like, but ignore the “small stuff” that you might see at home). These are severe deformities that cause the person to be shunned from their villages, or cause marked functional limitations. Below is a woman with a lipoma, before and after her surgery. We see some pretty impressive tumors on the folks here, since they don’t have an opportunity to get them taken care of when they first appear.

Last week I posted pictures of Paul Bernard, who had burn contractures of his right arm surgically released. I finally found “before” pictures of him, so you can see how functionally limited his right arm was prior to his surgery in December:

One precious 5-year-old (though the size of a 3-year-old) girl that was screened Tuesday has been scheduled for surgery in 2 weeks. She has feet that are pulled up laterally to the outsides of her ankles; her toes are missing or all deformed. She was wearing soft lace up sneakers on them, but basically walks on the distal parts of her legs, not on her feet.  I’m not sure if her issues are congential or from some type of poorly healed trauma, but they can fix that here through surgery and rehabilitation – and the healing and rehab will take months. Though it sounds like that would be an orthopedic issue, she will require lots of skin grafting and release of unhealthy tissue, which makes it a plastic surgery case. I don’t have pictures of her, but here are photos of Cameroon’s first Mercy Ship patient, Justine, who had severe problems that the orthopedic surgeons were able to correct….Incredible!!!

So enough of my rambling……off to surgery we go with Steve!CMA171201_OR_CHONG_SURGERY_MCB_BRANCHEAU_ST002_MID

Oh, it must be “Funky Friday” in the OR!!  If you look at the gentleman (Anesthesiologist) in the background of the above picture, you can see that he is wearing unusually colorful clothing for the OR.  Everyone is encouraged to dress in non-traditional scrubs on Fridays just to break up the normal routine. Let me back up and give you a glance at a typical week in the OR when it comes to meeting with the entire OR staff, including surgeons, anesthesia personnel, OR nurses, PACU, day crew, and interpreters.  Every Tuesday morning (see photo, below) all OR staff assembles in the narrow hallway.  The OR director arranges for someone to lead us in a few worship songs, followed by a short devotion from one of the OR staff or a ship Chaplain. Someone typically leads the group in a time of prayer, followed by everyone meeting in their designated operating room to have a team briefing to discuss each individual patient we will be operating on that day.  Every team brief ends in one of the team members praying for our patients and for us to provide the best care we can that day.

AFM OR Funky Friday 10 Nov 2017 (2)Tuesdays are also a time to introduce new arrivals to the ship.  On Thursday evenings folks who work in the OR are encouraged to meet in the Cafe area to have dinner with their coworkers.  It is a great way to get to know folks.  If you are a little on the antisocial side of things, it can also be considered a forced social hour, that often reaps very positive outcomes, like it or not!!!

Friday mornings, with everyone dressed in their funkiest scrub attire, we meet in the OR hallway for a time of goodbyes.  There are usually several people that leave the OR crew each week to go home, so time is spent thanking each individual for their service in the OR, and they are presented with a certificate.   I guess that covers the basics for OR staff routine.  Now onto the work atmosphere and the procedures being  performed on a daily basis.Funky Friday 12 Jan 2018 (1) - Copy

I want to start out saying that anyone who works in a service-related field will probably relate to what I’m going to say more so than others.  The United States is a capitalistic society where most professions/industries are based on money.  We all like making money and having material blessings, but sometimes it is easy to get lost in that world.  It’s a great feeling to take time to care for someone without time or financial constraints.

I want to spend some time comparing and contrasting a day in the life as an OR nurse in the United States vs. on the Africa Mercy.  In both places, I typically start my day with a shower (limited to two minutes on the ship), a quiet time reading my Bible and praying, then some breakfast.  In the states I never eat breakfast with Anne-Marie, but I do on the ship!!  In the States, I usually drive to the hospital and have to be in the OR by 6:30 AM, but on the ship I walk from the cafeteria to the OR arriving at 8:00 AM.  In the States, I find out what room I will be working in that day and I start getting equipment and supplies together for my first case.  I work with an OR tech that day and may not see them for the first 20 minutes I’m there.  When I do see them, we get our morning pleasantries out of the way, talk about what we need for our first case, and usually express our opinions (positive or negative) about the surgeon we will be with that day. The anesthesia folks do their own thing getting their machines and drugs in order. We don’t see the surgeon until he comes in the room to do the procedure. On the ship we all (anesthesia providers, surgeon, and 3 OR nurses) meet in the OR for our team briefing.  We spend about 10 minutes discussing the things we will need for each patient that day and end the briefing with prayer.  In the States, we are rushed to do many things during the course of day, because “time is money!!!!”  On the ship we are encouraged to do our jobs in a timely manner, but never in a rush.  Surgeons in the States do a great job taking care of their patients, but spend minimal time doing it, for the most part.  On the ship, there is really nowhere else to be, so the surgeons spend a lot more time with their patients.  In my entire career (37 years), I have seen very few physicians pray with their patients in the States.  I see it every day on the ship!!

So, if you missed my main point, the biggest difference in working in the States and on the Africa Mercy is that this is a Christian environment, not based on making money, but providing surgical intervention that is literally life-changing and life-saving.  Positive feedback for the OR staff in the States is very limited, especially from surgeons, but on the ship it is an everyday experience.  On Thursday, we had finished our work for the day and our surgeon was on his way our of the room when he stopped, turned around, and told everyone what a great day it was and how he enjoyed working with all of us. I also had a surgeon apologize to me after a procedure because he was teaching two other surgeons, which made it harder for me to pass instruments and hear what they needed.  Wow!  When we pick patients up to bring them to the OR, we always pray with them with an interpreter. Wow!  Most days we listen to Christian music in the ORs!! Wow!!!  Friday a patient being wheeled into the OR reached up and gave me a huge smile and a high five!  Wow!!  We were transferring a patient from the OR to the recovery room (PACU), and before we left the OR, he held up his hand to stop and said something.  All of the staff thought something was wrong, but the interpreter told us he wanted to pray for us!  Wow!!!

Note the bowed leg in the photo above.

I won’t go into depth about the actual surgical techniques or procedures, but basically everything is different here, in Africa, and working with surgeons, nurses, and anesthesia staff that bring in ideas and techniques from so many different countries.

Additionally, the surgeons that come to the Mercy Ships spend a great deal of time training local surgeons to do the procedures being done here. There are fishing lessons going on here!!!

As we said last week, God’s presence is felt here daily.  And His faithfulness is amazing!

Lamentations 2:22-23 –

22 The steadfast love of the Lord never ceases;
    his mercies never come to an end;
23 they are new every morning;
    great is your faithfulness.

 

Ok – so that’s it from Mr. & Mrs. Jones on the Mercy Ship this week. If you are a praying person, please pray Psalm 90:17 over all those working in this and other ministries!

Let the favor[a] of the Lord our God be upon us,
    and establish the work of our hands upon us;
    yes, establish the work of our hands!

Thanks for reading! Next week will feature another patient or two, and will talk about the holistic approach taken with all the Mercy Ships patients. God bless you all!

 

Welcome to the Mercy Ship!

You guys back home continue to have record cold and snow….. meanwhile, it’s a balmy 91 and hazy here:) Wow… wow….wow…. I really don’t even know where to start. I guess I’ll start with the beginning, and orient you to the ship a bit. This first post may be a bit long.

Steve and I entered a different world, or actually, multiple different worlds, beginning Sunday night when we arrived in Douala. We were picked up at the airport, along with 12-15 others from around the globe, and driven to the ship (NOT a boat; that’s reinforced :)) where we walked up the gangplank, through security (supplied by an independent group from Indonesia) and into the reception area. Dinner had been saved for us, so after eating, we had a brief orientation in the dining hall, then were taken to our respective cabins (around 8 or 9 PM). Steve and I have a small room with a double bed, desk, and sink, and a shared toilet/shower with the cabin next to us. We were more than happy to hit the bunk after 22 hours of travel, and fell asleep quickly and deeply! So unfortunately, I have an issue with migraine headaches which many of you know about – and at 1:37 am, I awoke with the worst I’ve ever had. I only want to mention this to be honest with our experience and also let you know how God works here. Guess I hit all my triggers…..messed up sleep pattern and stress being big ones, but none of my medications even touched it and I was fairly worked up with the pain and vomiting. I cannot give my husband enough credit for taking such good care of me. After 3 or 4 hours with no relief, he contacted the Crew Nurse on call, who unfortunately couldn’t do anything but let him know that the Crew Doctor would be available at 7:30 am.  So….at 7:30, Dr. “O,” pictured below with his wife Lynda, made a cabin call and gave me an injection of Toradol in the hip (nice first meeting!) Turns out, Dr. O and his wife, who are from the Netherlands, are the ones in the adjacent cabin, sharing our toilet/shower :).

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(Funny….he didn’t recognize me Monday afternoon as he only saw me and my hip in the dark….I’ve since gotten to “work” with him several times and he is delightful). Ok, so all that to say: I missed orientation and my first day of work as I was sleeping all that off and didn’t get up until after 3 PM. Steve, meanwhile, was off to orientation at 7:45 am and then a full day in the OR. There is a method to their madness of immersing you right away! And I can tell you that today, Saturday, we finally are over jet-lag.

Steve was on board for 2 weeks last year, when the ship was in Benin, so I have had good help in getting me oriented to the ship (still in progress). There are 8 decks, with the entire hospital on the 3rd deck. We literally walk out of our cabin, through a door, and into the OR or onto the wards. I’m not sure how many people live on board, but it’s a lot….many families, lots of singles. Forty-five kids, many of whom have been on the ship for years and will tell you that they love it here. They have school M-F, which is accredited, and it is fun to see them running through the common areas in the afternoon/evenings with so much energy. The great majority of folks here are young; many have been on board for several years, though the ones we flew in with will be here ranging from 3 weeks to 3 months. New people arrive every week, and others leave. They come from all over the developed world to work in the kitchen, the housekeeping department, HR, and of course, the hospital – the OR, the wards, radiology, lab, supply, the eye clinic, dental clinic, outpatient center….Additionally, there is the “Day Crew” – local Cameroonians who work on board in every area of the ship, as translators, transporters, chaplains, admin assistants, housekeepers, cooks, etc. And EVERYONE greets you with a smile. The attitudes here are so positive.

Meals are all taken in community in the dining hall ….very much like college. There is plenty of food but the hours are strict, so you don’t want to get there late! They are very good stewards with the food and there is little waste. They literally weigh scraps so they can encourage folks to take smaller servings (only what they will eat).

Ok….if you have any questions about the ship itself, or life on board, please comment and I’ll answer! Want to get to the “good stuff!”

God has perfect timing in all ways….. I was scheduled off on Tuesday, so was able to recuperate fully and get ready to jump into work on Wednesday. While Steve is working in the OR (next post will be devoted to what he is doing there), I am a “Wound Care Team Nurse,” meaning that I perform dressing changes specifically on the plastic surgery patients, and occasionally consult on general surgery patients for wound care. There are 4 or 5 of us, with 2-3 working each day, 5 days a week. Two are here for the full field service (10 months); the rest for 6 weeks-2 months, with folks rotating in and out. Right now, the plastic surgeon, Dr. Venter, has been on leave for several weeks, so the patients we are doing dressing changes on have had complications and extended stays, but he returns Sunday night and I am told that we will get really busy.

So for plastics, much of what we are dealing with are large skin grafts, and these mostly for burn contracture releases on kids. Severe burn injuries are very common here as in any developing nation, and because these patients get very limited treatment at the time of their injury, they develop scarring and contractures which severely restrict movement and function. And without Mercy Ships, they would live with these limitations forever. A major thing that is stressed here: we are not here to take away scars. Scars are signs of survival. We cannot make people physically “normal” or completely take away scars. BUT we are here to improve function, and appearance, if it interferes with the ability to live normally.

This is Paul, a very rambunctious 12-year-old, who had contracture releases on his right arm. He is quite the jokester and quick to laugh. He’s endured some tough dressing changes and physical therapy over the last 2 months, but now has the use of his right arm and hand.

People with deformities are outcasts here, especially if that deformity is genetic or has grown on a person rather than come from an injury. Below are before and after photos of Leon, a patient who is now living on the outpatient ward, who comes onto the ship 3 times a week for dressing changes. He had what is known as keloids (overgrown scar tissue, a genetic issue). I had the pleasure of working with him twice this week.

Leon’s home is 7 hours from here (if I heard correctly through the translator). He left a wife and 7 children at home, and once he is discharged home, will have to wear a compression garment for 2 years to prevent his keloids from growing back. Such a sweet man, and quick to smile, now.

We are not allowed to take pictures of patients, so pictures I post of patients come from the Mercy Ships photographer and permissions have been obtained from the patients to share. I will try to post a couple with each post, to share patients’ stories whom we are actually working with, and the common things we see.

Whew (sorry for the length of this! I could write for hours!)

So….for the most important part of ALL of this: the God-part. He is here. We see Him in every department, every ward, every face. He is bringing people here, the patients as well as the workers, to do amazing things in, and for,  and through, and by them. Steve took this photo of a picture posted in the OR hallway that illustrates part of this:

IMG_2709He has been with me through 3 migraines, one of them pretty horrific, and has worked through my husband to comfort me. I have had more time for my quiet time, Bible study, and prayer than I ever have at home due to normal daily distractions – and I know that He is with me. I am working on trusting Him and not being anxious about my job here, or when the next headache will hit. We are being prayed for by my sweet friends at West Asheville Women’s Bible Study Fellowship, Webster Baptist Church, as well as friends from our military days and many family members – especially my aunts and cousins on Dozier Rd. in Appling, GA …and others I haven’t mentioned 🙂 It is such an encouragement to know that is happening. And how amazing is it to be able to text and email and FaceTime all the way across the world!!!!??? (A bit different from our experience in Japan in the mid-1980’s :))

That’s it for now…and I’m sure enough for now! I’ll leave you with a glimpse of the joy and beauty of the people here…..

as well as a HUGE THANK YOU to those of you who sent us here, who are praying, or even just reading and following along. God bless you all!Maeva, plastics patient, after surgery.