Madagascar!

The ship from the water as we pull into the port in Tamatave!

We made it to Madagascar!!! After many changes in location and timing, we made it to Toamasina (Tamatave), Madagascar.  I can’t believe I left the states a whole month ago! So what have I been up to? Quite a lot, actually! It’s been a whirlwind… I flew to South Africa, explored for a couple days, sailed a very choppy ocean from Cape Town, South Africa to Toamasina (Tamatave), Madagascar, started exploring our new port city, worked at cleaning the whole hospital, doing loads and loads of laundry, went on a weekend adventure, and met some amazing people along the way!

Table mountain in Cape Town, from the water

Our sail from Cape Town to Tamatave was 9 days long. This was my very first sail with the ship, and guess what? From what I’ve been told, it was one of the roughest sails this ship has ever had.  We had up to 30 degree tilts from one side to another.  At times it was entertaining, walking sideways down the hallways, our chairs sliding one way and then the other during meals, holding onto all of our silverware, plates, and cups so they don’t crash to the ground or in our laps with each big swell.  It also got a little exhausting as sleep was hard to come by for a few extremely rocky nights due to noise and continuous sliding up and down in bed! Regardless, I must say I loved to be on this amazing hospital ship as we were sailing (and, bonus: I learned I don't get sea sick!). I got to stand outside and watch the sun set over the Indian Ocean down into the horizon, lighting up the sky with amazing colors. I saw a couple whales and dolphins. I saw some amazing stars in the sky. I could stand outside and stare at the giant ocean swells for hours. It was really beautiful.

The president of Madagascar welcomes us!

  This country is amazing, and I'm so excited that I will be here for 8 months with Mercy Ships!  The culture is a beautiful mixture of Asian and Polynesian influences mixed with West and East African influences. This is reflected in the colors, the people, the food, the music.  I have found the people to be extremely welcoming and friendly.

Streets of Tamatave

Everyone tells us they are so happy we are here, and that our timing could not be more perfect.  Local Malagasy people and various NGO's alike tell us we are here at exactly the right time. Only about 2 months earlier would have been bad due to political unrest, but we are told the need here is huge.  It’s just amazing to hear that, although we as crew had no idea we would be here at this time (just a few months ago, I had my ticket ready to meet the ship in Benin, which of course never happened!), God knew and had a plan for us. His timing really is perfect, and we get to see this firsthand. 

During the sail, all of the nurses got our orientation. Once we arrived, we quickly got to work to clean and double clean the hospital and get all the wards ready to receive patients. Our whole team of nurses donned our work gear and unpacked and cleaned everything, top to bottom. We did (and are still doing) loads upon loads of hospital laundry. We set up the medication cabinets and the carts full of medical supplies. Plumbing issues are resolved, curtains are hung, and beds are made, ready to receive patients.

beautiful Mohambo beach

Over the last weekend, I got to take an overnight trip a couple hours north to a town called Mohambo. We somehow navigated the bus system and made it to a beautiful beach town. We found a bungalow to stay in for the night, found the beach, got to swim in the Indian Ocean (we cannot do this near the ship due to high shark population!), and found some great food. Not to mention, we saw our first lemurs when having a drink at a restaurant in town, hopping from tree to tree! In the evening we watched the sun set over the beach, an incredibly beautiful sight, followed by amazing star gazing (no electricity really helps amplify the glorious stars in the sky), complete with shooting stars. It was a wonderful, relaxed weekend with great friends.

Patient screening started this week. We have a site set up here in Tamatave, and this field service, screening will occur Monday through Friday for a few weeks here in town, and then continue at other sites throughout the country while we are here.  

I got to help with security on Wednesday, which is to help with crowd control, but mostly I got to play with kids in the line, drawing pictures in the dirt and blowing bubbles. It is both exciting and hard at the same time, to see people we may be able to help, but also those who we cannot. The screening team does such an amazing job, and it is so hard. I'm so thankful for their work and for the way they share God's love with each person they come into contact with, regardless of their "yes" or "no" status...

We have already booked some appointments for surgeries! I cannot wait to welcome our first patients onto the ship on Monday, with surgeries starting Tuesday! On B ward (the ward I will be primarily be working on), we will start with orthopedic surgeries, fixing club feet, knocked knees, bowed legs, and more! I am so excited to get started and have the wards full of patients, caregivers, and day crew from this beautiful country I am already coming to love.  

Thanks for bearing with my long, sporadic post! I can't wait to share more stories as the field service continues. In the meantime, I would ask for prayer requests for the screening team, that the people who show up are people who Mercy Ships can help, that they have joy in the "yeses" and strength in the "no's". For our orthopedic surgeon, Dr. Frank, as he starts surgeries this week. For great outcomes, better than we could imagine, and minimal pain for our patients. For continued energy and excitement for all of the nurses as we start this amazing journey together.  Thank you! I can't wait to share soon about some of our amazing patients!

True Beauty

What have I been up to these past few weeks? Well, I've been busy at work with the AMAZING ladies on B ward, the VVF ladies. These are women with obstetric fistulas, from prolonged child labor. Some have vesico-vaginal fistulas, a hole between the vagina and bladder, so that they constantly leak urine. Others have a rectal-vaginal fistula, a hole between the rectum and vagina, leaking stool from the vagina. These defects are caused from prolonged labor, lasting for days. The fetus' positioning for a long period of time presses on the soft tissue and creates the hole, or fistula. 

Once these women finally are able to get help, often through a C-section or "forceful" removal of the fetus, the baby is often stillborn. The ladies then wake up and they are leaking and do not understand why.  A common story among these women is that they are abandoned by their families, by their husband and sometimes previous children as well, because they leak and they smell. Through no fault of their own. They often hide out in remote locations to avoid ridicule, or taunting. They live a life feeling unwanted, unloved, and undeserving of love. It is a life I can never imagine. 

Despite their situations, these women bring and share enormous amounts of joy with all of us on board. We are so blessed and lucky to share love with them (the easiest job in the world!)... but they love us in return and show us each day. We slowly warm up to each other... At first a hand on the shoulder, then a hug, then a daily kiss on each cheek to greet one another... The trust slowly builds and soon I walk onto the ward to hear "Molly!" called out from various beds followed by joyful greetings that make ME feel so loved! (Hey, wait, isn't that MY job? To love on THEM?)

We hold hands. We knit together, play games together. We sing songs and dance together, followed of course by laughter at how funny I look when I dance for them. We rejoice when surgeries are successful, and we cry together when they don't. We pray together regardless of the outcome. We become sisters in Christ and my heart will never be the same. There will always, always be a giant piece of my heart that is reserved for the obstetric fistula ladies. They stole it in Togo, and they stole it here in Congo. They are simply amazing.

This week has been a bit rough as some of the ladies are leaking after their surgeries. We have had many successes and so much to be thankful for, but are lately struggling with feeling a bit defeated. There have been many tears shed as some patients, and us nurses at times, have felt hopeless in the physical rehabilitation of these women. We also know that we need to trust fully in God and know that He has a plan and that we can lean on Him in everything. I just pray for healing, knowing that miracles have and can continue to happen. And regardless of the surgical outcome, I pray that they are filled up with God's love and grace and peace and come to know Him better than ever. I am also asking that anybody reading this will include these incredible women in your prayers. They are such beautiful, loving, unconditionally faithful women, and have set an amazing example of how to trust in and lean on God through any circumstance, even when we don't understand why those circumstances exist. 

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!

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.