joy, shared.

 At the beginning of this field service, I got to participate in the Plastics Evaluation Day, a day where our patients who had plastic surgeries last year were brought back to the ship so we can check on their progress and see how they are feeling about the results.  I was one of a few nurses who paired off with an amazing translator and went through a series of questions for all the patients... How do you feel your scar looks? Do you have any pain? How much? How ashamed did you feel before your surgery, and now? How did you feel society viewed you before your surgery, and now? Did you feel Jesus played a part in your care? How much? And so on...

It was truly an uplifting and beautiful day. It was a reunion of sorts, and I was so excited to be a part of it. To see our family of friends come back to one place at one time. I loved watching them reconnect, so excited to see each other and share stories. I loved standing back, looking across the room at all our patients and their caregivers, overwhelmed with joy to see how they have healed. To see how their arms extended when they had been stuck to their sides. To see fingers move freely that had once been attached. To see heads turning and moving in ways that would never have been possible until their neck contracture was released.  To see the smiles. That was the best part. The smiles. The excitement to see each other, and us, again, to tell us how they had healed, to embrace us again as friends.

 

Some of the kids remembered us, and some didn't. Most were shy, having returned home where they don't encounter vazas ("foreigners"/"white people") very often, if at all.

Rosa, a long-time resident of A ward, who had led our rounds with her very own clipboard, standing on a stool to tell each patient "You have a dressing change today, yours is tomorrow..." etc.. told me shyly that she didn't remember any of the nurses. She seemed to remain curious, climbing into my arms at one point and playing with balloons while I held her.  And honestly, it's OK if she doesn't remember my name. It's OK that she doesn't remember I helped with her wound care for weeks, months of healing time.  The thing that I love is that she is healed, she is pain-free, she is happy. She and her mom are full of joy and excitement, without a hint of shame.

 

Little Fitia, who came to us with a fresh burn wound to her neck, in pain and traumatized, but who had slowly but surely healed and gained trust in us, had grown significantly, with a full head of hair. Her personality shone through, gone were her shy and fearful days when she first came to the wards. Now she confidently and bravely explored the atmosphere around her. Her neck healed beautifully, and never had the chance to contract. She did not seem to remember the pain, and no fear was in her face, only joy. And the joy in her mother's face was ten-fold. They traveled for 2 days just to tell us how good they were doing.

Our adult patients remembered us all well. They greeted us with big smiles, with hugs, with laughter. They were happy to see us and most were proud to show us how they had healed since the ship left. Let me just highlight this, repeat it for emphasis.  They were proud to show us their scars. Look how my arms can move, look how my skin has grown back, look at this spot. Where there wasn't movement, where there wasn't skin, there is healing. I am renewed. Where once there was shame, there is pride, there is joy.

Story after story stating that they were so ashamed, their peers would make fun of them, they had little chance at ever getting married before their surgery. And now? They are happy, they are proud, they think they look good and they are excited about their future. 

Isaiah 61:7

Instead of your shame
    you will receive a double portion,
and instead of disgrace
    you will rejoice in your inheritance.
And so you will inherit a double portion in your land,
    and everlasting joy will be yours.

I will end with a little story about Minette, a patient from last year. She and her father had both come in with large neurofibromas we removed. Minette's neurofibroma hung from the back of her head, ending all the way down at her waist, weighing 4.3 kg (9.5 lb).

Minette told us that before her surgery, she had felt very ashamed because she felt like she was not a person.  She went on to say that she lost her shame right after surgery. She had said, "People wouldn’t talk to me. They looked at me as if I was less than human. Feeling the love of the crew has changed my life.” She prayed to God he would heal her, and she sees the big role that Jesus had played in her care on the ship.  We could see it, too. 

Minette came to the ship defeated. She had so much sadness and hopelessness in her eyes. We prayed with her, held her hand, looked her lovingly in the eyes, had chaplaincy regularly visiting her... we just wanted to see that veil of shame lifted. It took a few days, and then her smile came out. And once that smile started, it was not to be put away again. She radiated joy and shared that joy with each person who came into contact with her. It is pretty near impossible not to feel her happiness transferred to you when you see and feel her intense joy and excitement for life. 

And that is what it's about. 

Minette has a reason to smile, and so do we.

A million reasons.

Let's remember them and share our smiles with the world.

not just a number.

I was working on data entry yesterday once I had finished all the dressing changes for the day. I was entering patient demographics: are they married? do they have children? where do they get water from? what is their bathroom like? what amenities do they have? how much schooling have they had? and so on.  What struck me was how normal these answers can seem, how looking at a paper is so much different than looking into someone's eyes.  How I can get lost in the numbers and forget the story being told. And then I started thinking about each individual patient, each person, as I was entering their answers. My heart was breaking. 

I quickly noticed that most women who have had pregnancies, have lost at least one child.  The obstetric fistula patients, one after the other, have statistics like this: 

- 36 years old, 8 pregnancies, 8 deceased children. Single.
- 31 years old, 2 pregnancies, 2 deceased children. No schooling, cannot read.
- 50 years old, 1 pregnancy, 1 deceased child. Separated. 2 years of schooling, cannot read.
- 37 years old, 5 pregnancies, 2 alive and 3 deceased children. Married. 5 years of school, can read.
- 40 years old, 8 pregnancies, 5 alive and 3 deceased children. 3 years of school, able to read individual words.

The list goes on and on. But these are not just numbers, it isn't just data entry. These are people. Each child lost is a life lost, another piece of the heart broken. I can't even pretend to say that I understand this heart break. I can't begin to understand what it is like to live in a country where fetal death is so common, where you must try not to rely on a pregnancy to bring a healthy infant into the world, for fear of disappointment. What is it like to lose a child, and know that it's not uncommon? Does it hurt any less knowing that your neighbor, or friend, or family member went through the same heartbreak? I can't understand, but I can't imagine the pain is any less intense. In fact, I think it might be multiplied. One more child who didn't survive, one more small, beautiful life lost. Because of lack of access to healthcare, because of lack of funds, because of where they were born. Why should it be so different for me? Why was I born in a country where I can go to a hospital any time I am sick?  My own heart breaks and tears come to my eyes as I, one by one, enter in these devastating numbers and say a silent prayer for the person behind the statistics. 

What words can I offer? What can I do to comfort those who have seen so much pain? But here's the thing, words aren't always needed.  So much can be said through looking someone in the eye and truly seeing them, for holding a hand, for sitting silently next to them just so they know you are there and they are not alone.  I can pray for them. I can hug them. I can see them, really see them. Look them in the eyes, let them know they are loved and they are important and that this pain will one day end. And yes, there is pain and suffering in this world that cannot be understood, but there is also good in this world. There is joy, there is love, and there is hope. There are people in this world with amazing hearts, who seem to simply exist to spread joy and encouragement. We can be these people. All it takes is one person to see you, to know you are loved. Let us fearlessly and boldly go out into this world and love each other. Let's spread hope and love across this broken globe.

in celebration of mothers

Today is Mother's Day in America. A time to celebrate our moms, the women who so often give up so much for us. I know my mother in particular just happens to be the best one out there. She is loving, encouraging, funny, intelligent, nurturing, and the best friend you could ask for. I am so thankful to have her in my life, and so happy to celebrate her on Mother's Day!

But what about all the mothers in the world who don't have children to celebrate them? In particular, I'm thinking of the ladies who I have known and loved on this ship, in Togo, Congo, and Madagascar, with obstetric fistulas. And the thousands more that I don't yet know, but am praying for always. Strong, courageous, loving women. Many of whom have had multiple pregnancies, and no living children. Who endured months of pregnancy and days (yes, days), of difficult labor, which resulted in a stillborn baby. Regardless of whether these women were leaking urine or stool as a result of their prolonged labor. Regardless of whether their husband decided to stand by her side, or as is often the case, cast her out. Regardless of whether they have previous children or not. These women are mothers to children they can no longer tangibly hold.  But they never stop being mothers. They share so much love with those around them. They encourage, lift up, care for, and love one another as any mother would a child. They are strong. They are love. They are light.  And they deserve to be celebrated on this day.

“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern. Beautiful people do not just happen.”
~ Elisabeth Kübler-Ross

 

Despite their pain and heartbreak, despite their suffering, they have found the strength to move forward. They spread joy. A single smile from one of these ladies will warm your heart like you've never known before. And when they laugh so hard that they snort? Forget about it. Or at church, when you sit next to them and put your arm around them, and they gently rest their head on your shoulder. Ask you to pray for them, and pray for you. That they can experience joy like that, and share it with me, is such a testament to how good our God is. Sometimes I feel discouraged, and I know they do too, when the physical healing is taking so long, or just isn't happening. But then I am reminded of the cross. Of how much God loves each one of us, and I tell them each: You are special. You are beautiful. You are joyful. You are loved. You are SO loved. They smile, look me in the eye, and say thank you. And that smile doesn't leave their face, and their eyes continue to shine. And I know, that they understand. They know that they are loved so much, and in turn they praise God with arms outstretched. They are an example to me of unfaltering faith. Of loving and praising our Father not only when all our prayers are answered, but trusting and following Him in the journey, regardless of where He may lead.

I am so thankful for the healing that has taken place in so many of our fistula ladies this year. But I'm more thankful for the ways He brings them, and me, closer to Him. By the way He heals our broken spirits, and walks ahead of us on each of our own paths. By the way I am consistently filled up to overflowing with God's love, and can pour out that love on these women. By the way they return this love in so many ways. By the way these women allow us into their hearts, into the place where love resides. They are the most beautiful, brave women I have known. And I am thankful for them everyday, but especially today. The world is a better place because of these women and the love they share. I wish them, and all the beautiful strong women in my life, a very Happy Mother's Day. May you know today, and everyday, that you are special, beautiful, joyful, and loved. And so much more.

“The beauty of a woman is not in the clothes she wears, the figure that she carries, or the way she combs her hair. The beauty of a woman is seen in her eyes, because that is the doorway to her heart, the place where love resides. True beauty in a woman is reflected in her soul. It's the caring that she lovingly gives, the passion that she shows & the beauty of a woman only grows with passing years.

~ Audrey Hepburn

 

 

 

Pause.

Fistula surgeries are already finishing, which just flew by! We have been so busy at work on B ward with our ladies. There has been the usual business, but we have had added unexpected issues with bleeding and other illnesses more here than in past locations. Keeps us on our toes. Needless to say, a shift can go by very quickly. I am ashamed to admit, but the problem with that is I can just get so caught up in completing all of my tasks that I forget to fully interact and love on the ladies. I feel like I am too busy to make a bracelet with them, or have a dance party down the hallways, or sit and chat with them. I feel like I am too busy to pause and take it all in. This is a lie and having recognized it, I have been working hard to not let my busy shifts keep me from truly seeing and celebrating what is happening in this hospital. Pausing. Looking around. It transforms the room, transforms my perspective. Fills my heart with gratitude.

I have written previous blog posts about these ladies, so I just want to tell a few little stories about them instead of describing what fistulas are. If you are reading for the first time, you can click here and also scroll through my old blog posts... there are a few in there :)

I had a patient this week who had a VVF repair. She came in last week for surgery and I got to take care of her the day of her surgery and educate her about what to expect from the surgery and afterwards on the ward. She was very quiet and reserved, as many ladies are... no doubt nervous about the surgery and also still unsure about this new environment and the people taking care of her.  I somehow convinced her to come on a walk in the hallways with the other patients who had already had their surgeries. I saw a smile slowly spread across her face and was hooked. She smiles and her whole face lights up, her eyes beaming, revealing a slightly toothless and altogether beautiful smile. She is so precious. Needless to say, I came back the next day to find she was unable to have her surgery that day due to anesthesia problems, but later she did have her surgery and is now on the ward recovering, and up to this point, she is DRY! No longer leaking urine. And still smiling that genuine, loving smile. She called me over to her bed the other day, removed a bracelet she had made from her wrist, and gave it to me. I was so touched, I quickly slipped it on and repeatedly said "Misaotra betsaka! Tsara be! Misaotra!" (Thank you very much, very good, thanks!) She continued to beam and was just so happy to be gifting me with something.  Pause. Realization... this woman has very little to her name. She has minimal possessions. And she gave one of the only things she has, to me. It may seem small, but this small gift is one of the biggest I have received. It was given from the heart and symbolizes the huge amount of love that she pours out to others and to this world. She is such a gift and I am just so blessed to know her and get to be one tiny piece of her journey. Pause. Remember. Be thankful.

One other story from a couple of weeks ago:
On my routine discharge teaching for my patient, I went through all of the medications with her, which she quickly understood and repeated back to me. I told her how to take care of her incision and she replied appropriately.  I told her all of our instructions... don't lift heavy objects, have others carry water for you, chop vegetables sitting not squatting, eat lots of fruits and vegetables, drink 2-3 liters of water a day, other activity restrictions... she completely understood and happily repeated back to me. Then I told her, OK, you can get dressed, the Hope Center driver will be here to pick you up after lunch.  I turned to start my next task as I was having a busy day. But I sensed some hesitation. She said something quietly to the day crew who was translating for me. I asked what was wrong.  "She says she only has one outfit which she wore here and is dirty. She could not bring any other clothes because her family cast her out. She had to sneak out to get here." ... Oh. Pause. A quick reminder that I am never too busy to pause. Never too busy to look someone in the eye. To hug them. To pray with them. To tell them how loved they are. Right, let me see what we can do. I spoke with our chaplaincy team who started searching for clothes, but were struggling to find any because the patient was so small. The nurses I was working with all started offering up items of clothing we could give her, but they would be too big.  Chaplaincy finally came back with some clothes, they said some were for children because of the size. She got a pair of pants, a couple shirts, and a dress.  Later, she put her dress on and it fit perfectly. It was so pretty! All of the nurses started doting on her, telling her how beautiful she looked and how much we loved her dress. She shyly smiled and laughed and her face lit up.  Pause. These are the moments. These are the moments where I need to pause. Take a deep breath. And never forget.

As these last few weeks are winding down, as the hospital starts to empty and the last patients have their surgeries, I need this reminder. I need to remember to pause, to take it all in. All of the beauty, all of the love, all of the miracles happening around me. This is a very special place, I have not encountered anything like it, and probably never will again. 

It's Worth It.

 This past week was my last with the plastics dressings team. It's bittersweet. I have so loved doing the wound care for all our plastics patients. In the same breath, I am also excited to rejoin the ward and start loving on all of our obstetric fistula ladies!
Plastic surgeries here on Mercy Ships have such a special place in my heart. I truly admire and am inspired by our plastic surgeon, and friend, Dr. Tertius Venter for being such a selfless, loyal, and faithful servant of God.  I love our team of nurses, physical therapists, occupational therapists, and doctors who pool knowledge, creativity, and hours of hard work to deliver the best possible, first-world care here on the ship, which is for the moment docked in Madagascar.  I love our day crew, our locally hired translators, who fill so many roles, from interpreter to cleaner to food server to prayer warrior to brother, sister, mother, father, and friend. And I love our patients and their families. They spread joy. 
But dressing changes. That can't be easy. You are inflicting pain day after day, making children cry or scream from fear and from pain. Making adults cringe when you pull off a painful dressing, or remove sutures or staples, or even K Wires. Spending long hours, working until all the dressings are finished. Bending over, straining your back and your body to reach the wounds. Why would you want this job? Isn't it hard? Is it worth it?

Yes. It's worth it.

Baby Tsanta

Yes, I cringe every time I make my patients cry, every time I hear a scream. My body tenses and my heart is heavy when I pull off a dressing to reveal an infected and painful wound. My back aches from bending all day to reach all those wounds in hard-to-reach spots, like axillas and necks, in between fingers and toes. But it's worth it.

I see tears of pain turn into tears of joy
I see fear turn to trust, and then into love
I see pain transformed to strength.
I see constricted limbs move,
  for the first time in years,
  for the first time ever.
The pain inflicted in good wound care,
  will turn into new, healed skin.
  A beautiful scar to tell the story
  A testimony.
  God's faithfulness, His love.
  How He heals all wounds.
When I remove sutures or staples,
  when I remove dead tissue,

Dyllan

  I know there will be a transformation.
  I will see healing,
  and the pain I might cause
  will be worth it.
And when my patients run into our treatment room
When they jump on the table and play with our toys
When they see me in the hall, yell my name, and run into my arms,
When I see fingers that were stuck together
   comfortably and confidently writing with a pen
   or playing the keyboard
When a neck that was stuck to a chest
   can straighten and reveal and even bigger smile than imagined
When I see arms outstretched
  that had been uncomfortably adhered to their sides
When the wounds heal
  revealing healthy skin and improved function
When the tears stop, and the laughter comes in their place,
It's worth it.
When they can bend and straighten their leg, wrist, fingers, toes.
It's worth it.
When they hold a mirror up and see their face, ears, eyes, neck,

Orlando with arms outstretched

  and with tears in their eyes,
  quietly hold your hand and say,
  "Thank you, God bless you, thank you..."
It's worth it.
I wouldn't change a thing.
I have seen the most beautiful transformations
I have seen God at work in this place
And with tears in my eyes,
I can say,
It is more than worth it.

 Two happy patients, Sahondra and baby Fitia. They brought so much joy and love to this place and are now healed and discharged from the hospital!

 In the treatment room, Georgino and I warm up with some fun with bubbles... :) Then he watches intently as I remove his dressing to reveal his new hand. I just love this moment captured as he studies the ways his fingers can move now, and gives us a thumbs up!

Me and Georgino

Ordinary Miracles.

He performs wonders that cannot be fathomed, miracles that cannot be counted. 

~ Job 5:9 ~

Plastics surgeries are up, running, and coming to an end. Whew! I feel like just yesterday I was talking with my friends here, saying how we couldn't believe we were finally starting plastics surgeries! And this week, we are saying goodbye to our friend and plastic surgeon, Dr. Tertius Venter.

our team, minus Sarah!

Our plastics dressings team is in full swing, and although surgeries are ending, we still have lots of wounds to take care of to keep us busy for several more weeks.  I am loving doing the dressing changes.

our treatment room for dressing changes!

I have gained so many valuable skills, from wound debridement to suture and staple removals to problem-solving slough and pressure sores, to (my new favorite skill) removing K Wires. This isn't always an easy job, as we often are equated with causing pain during the dressing changes, from kids to adults. I hate that part, but I love seeing the wounds heal and feel so lucky to be a part of healing and restoration for these patients! I see arms, necks, fingers, toes, ankles transform from limbs distorted, twisted, and bent into unnatural positions... released! I see them bend and straighten their arms (through pain, initially), or wiggle their separate fingers, for the first time in years. I see smiles that were limited by restricted movement of their neck and chin brightly and completely light up their face. I get to witness miracles! Every day! It is amazing to me that these daily miracles have become normal, ordinary occurrences in this place.  But they aren't normal. And not everybody can say they witness miracles. Maybe that's also about perspective. You can't witness a miracle if you don't believe in them.  I just feel overwhelmingly loved and blessed that I can see this first-hand, and that I get to be with these patients through their transformations.


 I got to work with the team during screening days just before we started plastic surgeries. It is so great to look back and see the patients who I did health histories on, who were so timid and unsure of this place, who were restricted by burn contractures.
This is Windy, who I met before he got his appointment card for surgery. He suffered burn wounds which resulted in large keloid scars across his face, neck, and left arm, and restricted movement to his left axilla and elbow. We were able to remove some keloids on his face and released contractures to his elbow and axilla so he can now flex and extend his left arm much more than before! His personality was one of the most joyful on the wards. He is extremely smart. He can speak French and Malagasy, and is learning English and even some German in school! His English was getting better and better each time I saw him. He would sing songs throughout his dressing changes, and teach us some Malagasy words as we helped him with some English words. He learned extremely fast, and impressed us all with his ability to learn and memorize all of our first and last names within seconds. He is now in the Hope Center, and without fail, whenever we visit him, he will call out our full names, run to us, hold our hands, play games, and giggle with us until we leave. His journey has been such an amazing blessing to see!

This father-daughter duo came to use, each with large neurofibromas. Jean Robert had a large neurofibroma removed from his arm. Minette, his daughter, had a 7.5 pound tumor removed, which originated from the back of her head/neck, and ended at her lower back.  Her post-op x-ray of her neck revealed a cervical spine that, instead of being straight, was compressed and crooked. It is a miracle in itself that she can walk! But the biggest miracle was the transformation we saw in their souls. 

Minette was very reserved, rarely smiled, rarely made eye contact.  She very slowly began to accept the love all of the nurses, caregivers, day crew, fellow patients, and crew of the Africa Mercy gave her daily.  Her smile very slowly began to spread across her face, and now it is apparent for all to see. She is changed. Her tumor is gone, that is obvious, but more obvious is her joy, that she now shares with all those lucky enough to experience it. 

 

 There have been a lot of extra digits removed, and fused digits separated, this year on the Africa Mercy!  These adorable twins are a cute little example! They each had 3 limbs operated on, one with two feet and a hand, the other two hands and a foot! Extra toes and fingers abound, they were certainly an adorable, dynamic duo. Dr. Tertius has been hard at work with these operations. There are polydactylys, which are extra fingers or toes, removed in surgery. There are also syndactylys, which is when two digits are fused together, separated in surgery using skin grafts to cover the spaces between the digits. While the wound care can be difficult, as they are small areas to cover with dressings (especially with the little kids who squirm and move due to fear and pain as you try to dress them!), it is really amazing to see these new digits move freely. 

Windy and Fandresena became very fast friends during their time on the ship! I told you about Windy's story. Fandresena was also a victim of burn wounds. He was left inside a burning house as a baby, but he is a walking miracle survivor. Not only did he survive the fire, but he maintained a strong, confident, happy personally through it all. His father is a big reason for that, he has instilled confidence and love into his child in such a big way! Fandresena had surgery to release contractures in his right hand and fingers. He is full of laughter and exudes joy wherever he goes. 

He and Windy hung out on the wards together a lot, always playing games and giggling together. They even got discharged to the Hope Center on the same day, and can be found causing trouble there together now! :) I hope that this friendship and bond will be a lifelong one for these two amazing kiddos.

Here's little Tsanta ("Santa"), who had a burn contracture to her neck released. Instead of her face and chin pulled down to her chest, she can now reveal that beautiful smile confidently and painlessly, and move her head up and down with normal range of motion! Just another ordinary miracle on this ordinary floating hospital ship here in Madagascar... :)