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. 

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.