Scars

"On the girl's brown legs there were many small white scars. I was thinking, Do those scars cover the whole of you, like the stars and the moons on your dress? I thought that would be pretty too, and I ask you right here please to agree with me that a scar is never ugly. That is what the scar makers want us to think. But you and I, we must make an agreement to defy them. We must see all scars as beauty. Okay? This will be our secret. Because take it from me, a scar does not form on the dying. A scar means, I survived." - Chris Cleave, Little Bee

This is Benjamine before surgery, all smiles!

Benjamine on screening day, before coming onto the ship.

We see so many patients here, especially our plastics patients, with scars covering large portions of their bodies. They are not seen in a positive light. When they come to the ship, they don't sit around and compare their scars, telling stories of adventure and toughness that led to this "battle wound", as we sometimes do back home. They hide, they try to cover these burn contracture scars with a blanket. The scars are disfiguring, they limit movement, they prevent a normal lifestyle. The scar is the enemy. It may be the reason why they can't walk normally, or eat without drooling, or participate in school without being outcast. Our patients tell us what they hope to be able to accomplish after surgery. Some say to they'd like to be able to write, some to wash their clothes, to be able to play games with their friends. These things seem so simple, and yet we can't imagine a life without them (although it might be nice not to have to wash our clothes..). 

Baby Frida with one of the wonderful nurses, Lindsey!

After these surgeries, our patients will have better range of motion, will be able to move their arm or leg in a way they couldn't before. They can move their neck and chin and close their mouth. They will no longer be a slave to their scars. They will have new scars as these wounds heal... But the scars have a whole new meaning. They tell a story of where they have been, of what they have endured and persevered. They represent their strength and courage. They are beautiful. I am thankful for these scars because it means they have healed, they have overcome. They are alive and they are a blessing. I know that I feel blessed by each one of my patients' lives, in different and beautiful ways.

I love this quote from the book Little Bee, we have it up on the wall in the dressing change room. There is so much significance and beauty in this message. I challenge myself, and anyone reading, to see the beauty in every scar. On others you come across each day, and also on yourself. Learn of their survival, listen to their life story, and be blessed by each encounter.

Gaella after surgeries having fun with the cameras :)

Congo!

Hello from Pointe Noire, Congo! I've now been here three weeks and am finally getting around to writing my first blog entry. It's been nice being back on the ship, although I'm still adjusting to ship life in some ways (cafeteria style meals at specified times, 2 minute showers, bunk beds... Community living) :) The work on the ward is amazing as expected. I'm on B ward again which is currently the home of plastic surgery patients. Lots of burn contracture releases, interspersed with some neurofibroma and lipoma removals. My assigned patients the other day ranged from age 5 to age 63. And I couldn't be more happy about that. We have babies to play with and carry around as we are calculating and dispensing medications. Our patients have splints and dressings covering healing wounds but won't let that stop them from running around to give out hugs and kisses, it won't stop them from singing and dancing, and it won't stop them from worshiping throughout the day. As always, I struggle to describe the feeling and privilege it is to do this work. These patients and their caregivers are so selflessly generous with their love, it makes me fill up with joy. And all I want to do is just to love them and share that love with others. It puts life into perspective when you are taking care of a young child with burn scars over large portions of their body which have caused their limb(s) or neck or affected area to contract restricting movement for much of their young lives. I see the transformation before and after surgery.  It often begins with fear and uncertainty and shame, then slowly progresses to understanding and relief, then miraculously turns into gratitude and praise.  I see some children on the ward now recovering from surgery and going through painful exercises and dressing changes.  While there is some amount of reasonable complaining or crying involved, there is more often a resounding joy, playfulness, and love exuding from them that is simply impossible to ignore. 

Nume! A charmer and cuddle bug, and a blessing to the wards. He had a lipoma removed from his back and lost a lot of blood in surgery, almost losing his life post-operatively. This occurred just before I arrived on the ship. I am sooooo thankful for him and his recovery, and tear up frequently thinking about how he may not have been with us if it weren't for such capable hands caring for him. He has a smile that will break your heart.

This is Chadrac. He may look sweet and innocent here, but he is often up to no good! He is very mischievous and constantly scratching off his dressings! Pretty cute though, huh? :)

 This is Benicia! She's 10 years old and very sweet. She will give you a hug and many kisses upon seeing your face every day. She had a burn contracture release to her right axilla (arm pit) and is doing well in recovery!

Some of the amazing plastic surgery patients and the nurses/physical therapist! Just a few of the wonderful people I get to take care of and work with!

learning how to have hope

living life
with joy.
marriage at a young age.
followed by pregnancy.
after all, that is what the role of the woman is,
to bear children.

prolonged labor,
3 days, maybe more...
no money to pay doctors,
maybe no hospital to go to.
or just too long of a wait for care.

finally a surgery to take the baby out.
the pain of labor for many days,
and now a painful incision,
are no match for the pain to follow.
a stillborn baby.
maybe the only child she will ever have.

awake in the hospital,
alone.
confused.
in pain.
with no child.
and now a new problem.
why am I leaking urine?
this has never happened before.
but it will not stop.

A constant leak
a stench that cannot be hidden.
no husband will lay next to a woman who leaks
and smells.
so alone.
No community will accept this condition
The only acknowledgement
is a hurtful word
or maybe abuse.
So very alone.

What to do but hide?
But to feel ashamed,
and hopeless.

Years go by with no answers
no help
no hope.
How do you cope?
What keeps you moving,
believing,
living?

There is just no end to the suffering of women with obstetric fistulas. The pain is indescribable. I can't even begin to imagine how they have lived and survived.  They are warriors and they are so beautiful. There are some women that we cannot help and that is so heart breaking. It is such a challenge to maintain hope when we cannot turn their lives completely around and give them a whole new life to begin upon leaving the ship. 

Mother Teresa was quoted saying:
"Being unwanted, unloved, uncared for, forgotten by everybody, I think that is a much greater hunger, a much greater poverty than the person who has nothing to eat."

These women are unloved and alone for so many years. What I am learning is that they come to the ship with hopes of physical healing, but also can experience healing spiritually and emotionally. They are loved more than they maybe ever have been before.  I know that I cannot help but to love them so much. They have incredible hearts, beautiful smiles, genuine hugs. Life has been very hard for these women. They are ashamed, depressed, hidden. They don't smile. They are quiet and unsure. Slowly the trust builds. They are cautious but trusting at first, and then reveal their loving and gracious selves as time goes on.  I am so blessed to have met and cared for these women and spent so much time just loving them. I feel at peace and truly feel God's love and presence whenever I am with them. It's an amazing and beautiful feeling.

Praise God for bringing them to the ship, for placing them in my path, and for blessing us all with their lives. While they understandably have many struggles with understanding why they have been burdened with this life, most of them have proven to remain hopeful and continue to worship and glorify God.  They are faithful. Despite their past hardships and as some of them face future hurdles, they praise God and place their hope in Him. They give so much more to us than we could ever give to them.  I am learning more and more from them to be thankful and to praise God in every situation, when we feel blessed, and most importantly when we struggle.  I just hope that I can always remember each of these ladies, the impact they have had on me, and the perspective on life they have and that they inspire in me.

James 1:2-4 (NIV)

² Consider it pure joy, my brothers and sisters, whenever you face trials of many kinds, ³ because you know that the testing of your faith produces perseverance. ⁴ Let perseverance finish its work so that you may be mature and complete, not lacking anything.

John 13:13-17

Isaiah 40:31 (NIV)

but those who hope in the Lord will renew their strength.
They will soar on wings like eagles; they will run and not grow weary,
    they will walk and not be faint. 

poetry

I was working on the ward today with Max-fax patients.
One of my patients (actually 3 of them had the same surgery) had had a hemimandibulectomy with an iliac crest bone graft to cover the titanium mandible. Basically, a tumor of the jaw was removed with half of the lower jaw, then a new jaw line was built with titanium.  After 3 months, they return to have a part of the hip bone removed to cover the titanium to prevent the metal from eroding through the skin of the face later. Pretty incredible surgery, actually! :)
Anyway, one of these patients was just hanging out today, she was very quiet and staying in bed mostly. The bone graft sites are very painful and hurt to walk on.  I went by her bed to see how she was doing and give her medicine.  She quietly pointed at the notebook next to her bed.  She had written on 2 pages in French.  I asked one of our dayworkers, Fred, to translate it for me.
This is it! Enjoy :)

I have been saved by people sent from God called MERCY SHIPS.
My eyes are full of tears every morning I wake up.
I ask myself if the God that made me is the same that created the healthiest and strongest?
But now He answers me by cleaning (wiping) my tears and letting me know that He will always be with me, He will never forsake nor abandon me.
He will do all things for me.
The work He has started He will continue and surely finish.
I do not know how to say thank you to this savior ship and its personnel on board.
My mouth is too small to thank you, only the Most High can.
I am so so so happy about my healing.
BRAVO MERCY SHIPS.

the significance of a dress

Over the past month, I have had the incredible blessing to care for women with obstetric fistulas. This group of patients has been heavy on my heart since the moment I read about their condition before leaving for Togo. 

The majority of cases we see are VVF's (vesico-vaginal fistulas), of which there is a fistula, or hole, between the bladder and vagina, causing constant leaking of urine from the vagina.  There are also women with recto-vaginal fistulas, in which both stool (from the rectum) and urine leak uncontrollably.  These fistulas occur almost always as a result of prolonged, untreated, obstructed labor during childbirth.  The prolonged labor can last anywhere from 2-10 days, and the infant's head presses against tissues, causing them to die from lack of blood supply, creating these openings to occur.  In some cultures it is a sign of weakness if a woman needs to go to a hospital for childbirth, in other cases they just cannot make it to a hospital that will help them in time, or cannot afford the care.  This can also occur as a result of marriage and conception at a young age (13-15 years) before the pelvis is fully developed.  In about 95% of these cases, the baby dies during labor and the woman is often left unable to produce children again.  Many times, the husband and/or other children of the woman will disown her as she smells of urine constantly, and she is ostracized and cast out of her community. Alone, ashamed, and devastated.

Our team leader, Karin, who is so amazing and educated on VVF ladies, shared a story with us just prior to screening day for the ladies.  She told us about a previous patient who had read about this story in the Bible:


Luke 8:40-49

[40] Now when Jesus returned, a crowd welcomed him, for they were all expecting him. [41] Then a man named Jairus, a ruler of the synagogue, came and fell at Jesus' feet, pleading with him to come to his house [42] because his only daughter, a girl of about twelve, was dying.
As Jesus was on his way, the crowds almost crushed him. [43] And a woman was there who had been subject to bleeding for twelve years, but no one could heal her. [44] She came up behind him and touched the edge of his cloak, and immediately her bleeding stopped.
[45] "Who touched me?" Jesus asked.
When they all denied it, Peter said, "Master, the people are crowding and pressing against you."
[46] But Jesus said, "Someone touched me; I know that power has gone out from me."
[47] Then the woman, seeing that she could not go unnoticed, came trembling and fell at his feet. In the presence of all the people, she told why she had touched him and how she had been instantly healed. [48] Then he said to her, "Daughter, your faith has healed you. Go in peace."

The patient told her story after finally finding help for her problem.  She had been leaking urine and had prayed and prayed for many years for a cure.  She had felt like giving up and just really felt that this story was significant and felt she needed to pray for at least 12 years as this woman in the Bible had suffered for the same amount of time. She stated that she stood there in the 12th month of her 12th year and was finally dry (not leaking anymore).  There was not a dry eye in the place, and there wasn't a dry eye as Karin retold the story to us new VVF nurses. What a blessing to relieve these women of their years of pain! We got to pray for all the ladies on our list for screening day together.

Meeting the ladies has been an even bigger privilege than I could have ever imagined! They come to the wards with faces that reveal years of shame and solitude.  They are uncertain, scared, and rarely smile. After surgery, some healing, prayer, worship, and lots and lots of hugs, they start smiling and their personalities emerge.  These ladies are among the most beautiful, patient, loving, incredible women I have ever met.  Never before have I felt so much love just from walking into a room and seeing beaming smiles and waves accompanied by genuine, strong embraces.

 When they are "dry" (no longer leaking), we have a dress ceremony for them.  Our amazing patient life coordinator, Clementine, buys dresses for them, they get done up with new dresses, jewelry, and makeup, and parade down the hall singing worship songs and beaming from ear to ear.  The joy is palpable.  They tell their testimonies, are gifted with symbolic items, and we celebrate their lives and the bright future ahead. There is no way to experience this and not be moved to tears. They are so deserving of happiness, good health, love, and of course, new dresses.

Joy

My patients! The reason we are here and the source of so much happiness and joy! I thought I'd finally take some time to tell you about some of them.  This post will be on my plastics patients, who are almost all out of the hospital now (good for them, sad for us who love them so much!)

This first group of children were our first family of kids on the ward. Running around, playing with the nurses, practicing with our stethoscopes, using calculators as cell phones, putting stickers everywhere... the ward was so loud and happy.  We'd be gathering meds while holding a child in our arms with another tugging at our pants, grabbing our pens and stethoscopes, tickling the backs of our knees, giggling. Never a dull moment. These two brothers were so mischievous and all over the ward! They rapidly wiggled their way into everyone's hearts. Every time I would come onto the ward, they would look up and start yelling my name (kind of...)  "Mollo! Molloo!" and run at me with hugs and jump into my arms. I gladly accepted the new variation of my name, and actually find myself missing it from time to time.

This was one of my first pediatric patients.  She had come to the ship in 2010. She was badly burned as a baby.  The story I have heard is that she crawled into a bag of twigs and other garbage items to be burned while nobody was looking.  They put the bag in the fire as planned and she was inside.  By the time they saved her, she had been badly burned.  The whole village felt responsible and maybe this is why she had maintained so much of her beautiful character and does not seemed to be shy or ashamed of her outwardly appearance. In 2010 the ship did a surgery to release burn contractures and reconstruct her face.
This time around, her right eye was removed (she could not open and close her eyelid completely anymore, and this provided a better appearance), they created more of a nose from a rib graft (so cool!) and put a skin graft over the eye area.  She was running around, tickling the nurses, playing games with us, and teasing us constantly.  She has an amazing, infectious smile and laugh that leaves you giggling.  She will never look "normal", but from the time she came to the ship in 2010 to now, her outwardly appearance has improved a lot.  Her inner beauty is, however, undeniably perfect and has never required any repair.  :)  She sees so much more joy and beauty in this world out of one eye than many of us ever do with two.

 

 This next patient is one of very few that spoke English pretty well.  I was so happy to have time to get to know her and have good conversations with her.  She is so so lovely! She had a neurofibroma on her face near her eye that we removed and then basically gave her a face lift to help with the drooping of her skin and eye on that side. She was so full of love and joy, and always had such a beautiful smile.  She was incredibly patient and gracious and so thankful for all of her care.  I got to teach her how to knit! She picked it up so quickly and we had so much fun doing that together.  With each dressing change, her appearance approved and that smile just got bigger and bigger.  When she left, she looked for me, and I gave her a huge hug and my heart just sank to know I may never see her again.  How bittersweet.  I miss her and her beautiful, calming presence!

This next little one is undeniably one of the cutest patients we had on our ward! Just look at that face!!!  She had badly burned her feet and was left with burn contractures of her ankles and missing toes.  We did a release of the contractures to straighten her ankles and make it (hopefully!) easier for her to walk and balance, especially as she continues to grow. She has a laugh that will get you laughing and you won't even know why.  She loves to be carried, thrown up in the air (and caught), and she loves to tickle attack.  She is now discharged and running around on her personal boots fit just for her! SO cute!

   These are only a couple stories to tell, but there are so many.  I will try to do more another time.  These patients are so dear to me.  They have such trusting and loving hearts.  They so quickly and easily become a family on the ward and accept us foreigners with big smiles and hugs.  They take their medications, nutrition supplements, and go through painful dressing changes and don't complain (except maybe during the dressings!!!) but instead thank us and trust us and love us.  So much time was spent just playing and loving these patients, and I feel so blessed to have had them in my life, even if just for a very short time.

Ward Nursing!

I haven't written about my patients yet because, honestly, I'm just not sure where to start.
First of all, the patients here are among the most beautiful, joyful people I have ever had the pleasure to meet in my life.  I find it incredibly easy to love them.
Being on the plastics ward has been a huge blessing. We have such joy on the ward. Everyone quickly becomes such a little family. The sense of interconnectedness is really powerful.  All the patients and their caregivers help each other. If one needs help to the bathroom, another will quickly run to help.  Other caregivers will rub the back of another patient without question. They share their food, often offering to us nurses to come sit with them and eat. This is just how it works here, and I feel that we could learn so much from them.

Let me just start from the beginning and explain how things generally work here...
The wards are set up as large rooms divided into two sides, each with 10 beds per side (it's slightly different in D ward with maxillo-facial patients, one side has 10 beds, the other 5 beds, and then ICU off of that has 3 beds and 2 isolation room beds).  The beds can be put on risers to allow for space underneath to put a mat down where a caregiver for the patient can sleep.  For pediatric patients, they all must have a caregiver present. This could be a parent, an aunt or uncle, a sibling, a grandparent, etc... Also, caregivers may be children of the patients or younger siblings that come with the parents. This is the reason we had extra little babies and toddlers running around making our shifts more exciting, crazy, and joyful.  Now that I've been here for a couple of months, I find it hard to think of going back to the states where each patient has their own private room. It seems so sad.  There is always music, dancing, worship, games, etc in the wards and my heart is just smiling all the time.  I have learned how to be a pediatric nurse at times, how to care for patients post-op from surgeries I have never seen before, learned to break communication barriers with a sticker, a smile, or a hug.  I feel such a sense of family and feel so much love for my patients and their caregivers, and feel that love radiating back at me. I get daily hugs, arm rubs, butt pats, and cheek kisses.

One of my pediatric patients was a challenge when I first had her on night shifts.  She was very reserved, always looking at us nurses as if she were very unsure about us, sizing us up. She was vomiting for 2-3 days post-op and having diarrhea, and to top it off she was on bed rest. She hated the medicine and wasn't eating well either.  Having white people care for her probably didn't help much at first.  Her stomach issues cleared up on their own and after her first dressing changes she was able to be out of bed.  She was extremely hesitant to start walking on her bandaged feet, mostly out of fear of pain.  She would sit on the floor and her mother would walk away and the other patients would tease her, then she would reach for me to pick her up and carry her to the bathroom or the bed... We kept encouraging her and once she realized it didn't hurt and was nice to have some independence, we couldn't get her to stop walking back and forth around the ward.  Soon, her personality emerged and she was far from the shy little girl in bed in the corner.  She walks around to all the different beds, talking to all the other patients and caregivers, trying to learn English and yelling out any phrase she learns on repeat.  "How are you? Fine. Thank you, you're welcome!"  Every time she sees me in the hall, she yells my name, runs to me with open arms, and jumps into my outstretched embrace. Talk about a welcome! I am so blessed!

 

This is just one patient of SO many that I am so overjoyed to have met.  The plastic surgery patients can end up staying with us for a very long time.  Some of them get infections at their wound site which really delays healing time, some just need dressing changes for a long time until they heal well enough to be let off the ship into a very minimally clean environment, some have other complications that keep them with us for a little longer.  Either way, we get very close to them and they also become very close to each other on the wards.  The other day I was looking through photos with them and they would all call out each patients' names when they saw them and laugh, including old patients from a month ago that had since been discharged.  I loved it.  This place is just so full of joy and you can feel the love all around.  God is here and is doing great things and I feel so happy to be a part of it!