Benjamine

Let me tell you about one of my first patients I got to take care of on the plastic surgery ward when I got to the ship. She boarded the ship just a couple days after I did, and went to surgery just before I walked onto the ward on my first shift back on this floating hospital... I had heard rumors of this sweet, giggling, bright young girl who was sure to capture everyone's hearts. Her name is Benjamine.

When I first met her, she was being rolled into the ward on a stretcher after her surgery, drowsy and bandaged and vulnerable. I smiled and held her hand, and her calm, trusting eyes met mine. Not a word was said, and words were not needed. I was instantly attached.

Benjamine was burned badly at the age of 6 when her clothes caught on fire, leaving her with burns to much of her upper body. She came to us with contractures to both arms, her chin, and neck. Her right arm was stuck with the elbow in a bent position and the arm adhered closely to the body at the axilla. Her left arm was similar although not as severe. Her head was pulled down with her mouth stuck open, as if her chin were glued to her neck. Her teeth grew outward since she had grown in this position for so long, yet the smile that shone through her disfigurements was so bright that the whole room grew warmer and happier because of it.

Her surgery was aimed to fix most, if not all, of her contractures. Benjamine had one if the biggest surgeries of this block of plastics patients. The contractures of both her elbows, both axillae (armpits), neck, and chin were all released using a large portion of the top layer of skin from her right thigh to graft the sites... All in one surgery. To prevent recontracture, she was in splints that kept her arms extended away from her body straight out to the sides with elbows extended at all times.

So here she comes, rolling onto the ward, arms straight out, no way to scratch that itch on her nose, as we scramble to move beds to find one that has enough room on either side for her arms to fit. I can't imagine the feeling, but I can try, and I must say that this girl is brave. I knew it from that first minute. No doubt she gets it from her mother, a strong, loving, trusting woman who was at Benjamine's side every step of the way. Through days and nights of pain, of nausea, of fear, of frustration. Through IV's and a nasogastric tube for feedings, through long, painful dressing changes and exercises, and even through a second surgery. We knew that her healing would take time, and were so happy to see her progress and heal bit by bit.  

I was so happy to be there when Benjamine finally was able to start taking her first slow, intentional steps down the hallway after days of being stuck in bed. I was there for some of the first dressing changes that took 2 hours and multiple nurses and lots of pain medication... and I was blessed to see these dressing changes get better and better until only her right arm needed wound care, and the changes only took 20-30 minutes and no pain medication. I saw her flop into bed with her arms stuck outward, relying so heavily on the nurses and her mother to help her with any task - from getting into bed, to eating, to scratching an itchy nose, to going to the bathroom. And I saw that progress to doing exercises with her arms raised above her head into positions she had not been able to do for years, to see her running around the hallways, reaching out and tickling people any minute she could. I was so blessed to be present for the whole healing process of this beautiful girl.

As Benjamine was healing, I don't think many of us knew just how much she could heal our hearts in the process. How she might change us more than any surgery could ever do. How she could smile and make you forget whatever it was that was troubling you just moments before. Or giggle and make you instantly laugh along even if you didn't know what was so funny in the first place. Or how much joy you could experience from that tight, sincere, I'll-never-let-go hug that greets you every day and fills you up until your heart is so overpouring with joy that you must share it with everyone around you. That's love. To bless those around you and to share joy each and every day, regardless of your background, where you came from, what you did that day, what your struggles may be... Benjamine loves us and blesses us daily.

She was finally discharged this week from the ward to the Hope Center where she will stay and return to the ship as an outpatient for her speech therapy, physical therapy, and wound care until she is all healed and ready to go home. I already miss walking down the hall to work to find her hiding behind a corner waiting to jump out and scare an unsuspecting victim. I will miss hearing her giggles resounding through the wards. I will miss hearing her voice, silent for so long until she slowly but surely began to speak. And now she speaks not only in Lingala, but in English a little bit too! I will miss her daily hugs and the love she so freely shares with us all. 



 I have loved seeing the transformation in Benjamine, from a silent yet strong little girl stuck in bed and reliant on others to help her with each small task, to an outgoing, talkative young woman, confident and joyful. It is a joy to see her freely moving her arms and speaking and moving her mouth. She still has a lot of exercises to keep up with to continue to improve her range of motion, but has come so far it's hard to believe it is the same person looking back at me with those beautiful brown eyes. Those same kind, loving, gentle eyes that looked back at me as I held her hand that first day on the ward. As she goes, and as I start to prepare to leave Congo, I hope to learn from Benjamine. To trust, to share joy, and to love others unapologetically for no reason other than that they deserve love. Because everyone does, and everyone should be reminded of that daily.

Burn contracture releases on the Africa Mercy: the basics.

Since my last blog post, I've had a question raised about the burn contractures... Why do they seem to get more burn injuries here than in the states and what causes the contractures.

One of our physio therapists working with
a patient on admission to see his
pre-operative range of motion

There is a high incidence of burn injuries here due to population density and poverty, I have read that burns account for greater than 50% of injuries in children under 5 years in developing countries. There are open fires that you often see throughout the streets at night here. It's not hard for a child to wander into a flame, or fall, or for a person to have a seizure near a fire and have the unfortunate consequence of getting burned as a result. Some of our patients also have said their clothes caught on fire or have experienced acid burns. 

Luic getting his
dressing changed!

   If they survive the initial burn injury, they are among the lucky ones. Some heal on their own, some seek traditional medicine for healing, and others may go to a local hospital. Often the result we see is the same. The skin contracts and heals onto itself, pulling the affected body part in a contorted position. For example, if the skin was burned to the wrist, there is an open area where no skin remains. Without grafting of extra skin to that area, as it heals, there is less skin left on the wrist now, so the healthy skin will heal and pull together from both edges of the open area. This might cause the hand to bend backwards as the skin from the back of the hand and from the arm pull towards each other, and the wrist might contract in that position. They are left with their hand bent in a backwards position down so the back of the hand may even be adhered to the arm. This is certainly not a functional position for any practical purposes. This occurs in wrists, elbows, armpits, necks, chins, knees, fingers, feet... Any joint you can think of. 

Our job here is to try to release the contracture to restore normal function. We aim to release that hand from the arm so they can once again bend their wrist. To allow them to feed themselves, to play an instrument, to write and go to school, to high five a friend. Function is the first priority with appearance coming as our second goal.

 How does the surgeon do this? He first will release the contracted extremity and attempt to straighten the joint. Then he takes a thin layer of skin from their thigh and uses that skin to cover the newly open area to allow for movement. After a few days post operatively, we start doing dressing changes and allowing for physical and occupational therapy to start working with them to achieve the best possible range of motion and function! This can be a very long and sometimes also very painful process. With muscles and joints that have not moved in years, combined with a build up of scar tissue, exercises can be very painful. 

The physical and occupational therapists here are amazing, and work so hard to help restore function for our beloved patients.

That's the process in a nut shell! If you have any further questions please don't hesitate to ask on here or email me!  The plastics patients are now almost all discharged from the hospital with healing wounds, coming back to the ship for their outpatients appointments for dressing changes and physical therapy as needed! Since there are so few left, I am now moving back on to the ward to work with patients with obstetric fistulas, as I did in Togo. These women are amazing and I feel so blessed to get to know them! Please keep them in your prayers, as well as the plastic surgery patients in their recovery and exercises that they can heal and have amazing range of motion results!

Jessica! Sweet and so joyful!

It has been a huge blessing to work with these patients among so many beautiful, intelligent, hard-working, loving individuals. This place leaves me feeling so thankful and I am so happy to be blessed with the opportunity to serve in this capacity. And just look at the faces of the patients, so beautiful and joyful! They are so wonderful. 

3 of us dressings team nurses and our plastics team
 leader cuddling baby Frida!