Beautiful

We had a vesico vaginal fistula screening again at the beginning of this month.



VVF patients suffer from fistulas - or punctures, holes, tears- that are in the rectal wall or bladder due to prolonged labor or trauma in the vagina. Often times a woman who is impregnated at an early age before the pelvis has had time to form will suffer from prolonged labor. These women often give birth to stillborn children after having been in prolonged labor for three to ten days. The stress creates these obstetric fistulas.

Because they are constantly leaking urine or feces, they become outcasts in society. They not included in society because they smell, because they are seen as failures in the one thing that will give them validation in their society - to be a mother.

We have about twenty of these VVF ladies in the ward right now. Last Sunday, during ward church service, two of them were sent home because they had been cured. Dressed in a beautiful new gown, Mary stood up, she sang a song of worship and started walking outside of the hospital. Where was she going? She wandered out of the ward doors and then took the hands of a big, smiling moustached white man. She held those hands, so precious in her own. They were the hands that cured her. Dr. Steve grinned from ear to ear, a bit embarrassed, but a glimmer of a tear crept up to his eyes. Mary gave thanks to God for what He did through Dr. Steve.

From the last VVF screening, here are some healed and happy ladies. (And my friends Zoe and Doris, Liberian dayworkers - second from left and third from left - whom I have taught how to knit, and are now teaching the VVF patients)



Tonight, there was a screening of A Walk to Beautiful. The movie focuses on three to four VVF patients in Ethiopia who travel at least six hours by foot to the nearest road, then take at least a 15 hour bus journey to the city of Addis Ababa, Ethiopia. There, they meet women who have also been left by husbands, rejected in their own homes, and shut out from society. They receive physical healing, but also psychological support. (Incidentally, Dr. Steve also worked at this center for 3 years. He is not in the film, but his dog appears briefly!)

In one scene, a group of women are sitting around knitting. In fact, all of them are swaddled in colorful, garter stitched patchwork blankets. Several of the nurses turned to me during the film and smiled. My roommate Ellen yelled, 'Hey Michelle, have you been there?' To me, it was a small sign that I am in the right place right now. And that kind of 'knowing' is a relief in life, no matter how big or small that what I thought I would be doing here, is what I am really suppose to be doing. And let's not forget, after all, we are 'knitted' in our mothers' wombs!

How to fish

Synonymous to the old saying, 'Give a man a fish, feed him for a day. Teach a man how to fish, feed him for a lifetime', I like to say, 'Give someone a scarf, keep them warm for a winter. Teach someone to knit, teach them to keep others warm for a lifetime.'

I can't seem to pass through the ward without another person asking me how to knit. And since there's only one of me and so many finite hours in a day, I thought I'd train up a few new knitters from our crew.

Jane from Ireland showed up as did Laura from Idaho. Hawa, mother of ten year old patient, Kossie, also came up and sat with us. She really enjoys knitting and is glad to have something to keep her busy. She's going to be here for sometime while Kossie's legs heal. He had major surgery for very clubbed feet. She will be here for 3 months total.

In knitting, first there is doubt. Then there is success, if only in the completion of one stitch. But thankfully, no matter what, there is always fellowship:



The vesicovaginal fistula patients (more affectionately dubbed VVF ladies) are coming on August 4! I look forward to training up some more knitters for these women who have long overdue affection that I hope they will experience here on the ship.

Friend

I am sitting in the ward, knitting with Joanna, passing the time. Friend has moved over to the bed next to her. He casually lays on his side. Like Joanna, he had a skin graft from his thigh to cover a large area on his back. The wound on his thigh is intensely pink and fleshy, although over time, the black is coming back and he is healing.

'Tell me a story, Friend.' I said, as our needles clicked away.

Through his gap tooth smile, he tells me about a boy and a tribal chief. The tribal chief wife and the boy are making sleep together (having an affair). The tribal chief tricks the boy's wife into making sleep with him. Soon, everyone is exposed. Who is wrong in this situation? His eyes are beaming. Its a riddle, I'm guessing.

'Everyone?' I asked.

'No! Tribal chief is wrong. He is head of tribe. He should make no trouble!' Friend insisted. 'Tomorrow, I tell you one more story.'

The next day, I return. Before Friend launches into another morality tale, I ask him about the origins of his name, Tamba Friend.

'Tamba my birth name. When my people saw the growth on my back, they disown me in the bush. The white people came and take me. They name me Friend. So now I am Tamba Friend.' He smiled that smile of his, spreading across his face, his teeth so white and so square.



'Who were the white people?' I asked. The Swedish, he answered. He explained that they raised him into his teens. Then, they had to return to Sweden. Some time passed, and they lost touch. By some miracle, they got back in touch with Friend, after other Swedish missionaries sent them photos of Friend's back, the deformity by which he is known.

Then the war came and everything broke down.

The Swedish missionaries returned after the war and found Friend. Since then, they had lost touch after that last visit.

'Do you know the nurse, Kristina? She is Swedish!' I said. I share Friend's story with Kristina, who is delighted that her country-people helped Friend. She connects with him, and as big as this world is, it also seems to be small - she knows the missionaries! She took photos of Friend and returned to Sweden with them.

Tonight, I went to see Friend. He was doing an art project with the other patients.

'Friend, let's dance,' I suggested. He does this shimmy. It involves bouncing your heel, snapping your fingers. A sway to the left, to the right.

'No, only outside! Only upstairs, outside! Not here.' He grinned and laughed at my dance.

'Okay,' I agreed. 'Then I will come back and go outside with you.'

'Then we will dance.' He smiled again. That smile of his.

For a better tomorrow

There was a request for monetary donations to the ward for knitting supplies, crochet supplies and craft supplies last week during our community meeting. If you cannot imagine being ‘trapped’ on a ship full time docked in a third world country, imagine being a patient, in a hospital bed, where you may be unable to move around all together due to your condition. The desire for activity, socializing and learning runs deep. Concurrent with the request for supplies for ward activities, I was honored this week when I was told by ward supervisors that I could freely come to the ward to teach knitting whenever I liked.

I went first to see Joanna and then came the flood. Flood of interest, that is.

First there was Joanna, then Dehne, mother of 8 yr old Musa (boy) who received an operation, then came Felicia, whom I met during my first week, and then now Lucy, a Nigerian day worker whom I befriended. None of them knew how to knit. All of them know how to crochet. In fact, only Lucy knew what knitting was. The three others had never seen it done. This was very surprising to me. (My far fetched theory of why they know how to crochet is that since Western Africa was mainly colonized by the French, and crocheting – though not solely French – has some heavy cultivation in France. Somebody want to weigh in?)

Dehne sells mangos, coconuts and plaintains for a living. She has 4 boys. Musa is her youngest, and in 2006, he was in a bad car accident which left a deformity in his right jaw. He is the only child in the ward right now, and I can tell he is very lonely.

Felicia has noma. Noma is a gangrenous, acute infection in the face, common in African nations. It is extremely rapid, due to the hospitable environment of mucous membranes in the mouth.

There are now four ladies knitting in the ward! I was told by one of the nurses that they were up late at night, knitting by the dimmed lights while others slept. I’m known as the ‘little girl’ who comes and teaches. We’re making little knitted clutches (that’s purses, for you men folk), lined with fabric that I foraged from deck 2. A fancy button will hold it shut. Dehne, especially, is excited to learn this so that she can sell knitted items for money.

Because yarn and needles are hard to come by, I cut up some fabric, which is ‘plenty plenty’ (Liberian English) in this country. Felicia gives it a go.





Time drains away in the ward and I can easily spend 2 or 3 hours there at a time without realizing it. I have gotten use to the smells of strong body odor, medicine and bodily fluids. The language barrier is still difficult at times, but it is quite amusing that when I use my Liberian accent, they actually understand me better.

Though I teach them, I feel like I have been at their beck and call. I don’t mind this, but today it rose to near boiling point. I had barely had any time for myself in the last week or so. The last four days especially have very busy during work and off work. I had not left the ship in a week and a walk was desperately needed. Tonight in the ward, Joanna realizes that I had been sitting near Dehne and not with her. She is frustrated and raises her voice with me in front of everyone, asking why I didn’t get her crochet hook as I said I would. I firmly tell her that I cannot get everything she wants right away and that she must wait until tomorrow. Her discontentment hangs on the grimace on her face, and there is slight eye rolling involved. She asks me what I think of her clutch. I tell her it is beautiful and help her fix it a bit.

I need a needle, she says without looking up. I tell her I’ll go get her a new one.

As I get up, I slip on a spot of water and fall hard to my knees. I get up right away, despite the gasps of the nurses. I rush down the corridor, agitated. Slipping made me feel foolish, that little thing that breaks the camels back. Almost.

When I return, I give the needle to Joanna. She says, ‘Thank you.’ There is magic in those two words. Without them, returning tomorrow will be much harder, though I would do it. Gratitude is a luxury anyway when one has decided they will be in servitude of someone else’s purpose and life. Their interests become your primary interests and their wellness comes before yours.

Afterwards, I took a jog and watched the sunset. The wind cooled the sweat off my skin. I thought about my ladies in the ward. They were so thrilled at their first brush with success. Dehne buried her face her hand, giggling, when she was able to knit her first row. Felicia’s crooked smile lifted one corner, when she saw that she could do it as well. And Joanna, though it was hard for her, learned a left handed knitting method, which I taught her due to her skin grafts on her right arm.

Two days ago, Musa prodded for Dehne’s attention, and was kicking her a bit while he laid on the bed and she sat at the edge. Dehne was focused on her knitting. She turned to him, asked him to stop and said, ‘Musa, I learning. I learning for a better tomorrow.’

And that is why I will go back tomorrow, as well.

The rainy season is starting. We had our first major thunder and lightning storm last night which consisted of 3 hours of torrential downpour. Somebody might as well just have turned on a huge water hose and dumped it on Monrovia. The wind and rain reduced visibility to great degree, to the point that it was nearly impossible to see 10 feet in front of you. I watched it all from behind the reception desk as the day workers from the ship went home, trash bags over their bodies. The prepared ones had come to work with large umbrellas. They all rode home in cramped taxis or busses. I grew very concerned as I watched them leave, but Daniel, one of my Liberian day worker friends, assured me that this is common. Rainy season has to come at some point. He waved me and my worried look away with his hand and a shy smile, walking into the rain which battered against his umbrella.

When the bulk of rainy season hits in June and July, our freedoms will be more limited. There are many teams that leave the ship on a daily basis to do their work – agricultural teams, water and sanitation teams, dental teams, and palliative care to name a few. Those who work on the ship, make the effort to leave the ship when possible. When the rain hits, I imagine it will be a bit harder for us. Still there is work to be done and I rest assured, that the ‘outside world’ has a way of coming to me, even if I the weather doesn’t permit.

For example, the hospital wards will still be in full swing, no matter what. And apparently with a bit of creativity and a jump rope, you can entertain 11 year olds with a jump roping competition. Ester does this with bravado. Oh my ... the things that come with being a nurse on the Africa Mercy.



Alfred is happily seized by Keri and Ester. We don’t always tie up the club foot patients. Only the younger ones. (Yes, that’s a joke.)

Under Kaybo's skin

** Warning. The following post is about my time observing surgery and there are photos that some may find gory and graphic. So if you are on your lunch break and think you can’t hold that ham sandwich in your stomach, I suggest coming back at some other time. But I do hope you come back as this has been one of my best experiences here!**

After a couple slices of bread, some tomatoes and rice, I run down to the Women’s Locker Room to change into scrubs. I wonder to myself why they suggest eating lunch before observing surgery, since I assume some may have trouble holding onto their lunches. I pull the loose blue scrubs over my head and wonder if my lunch will stay in place, especially in the midst of riding out that stomach virus this week.

Right before 1 pm, I tell the OR (operating room) supervisor that I am ready to go. There are three surgeries going on. One involves some bone fusing that has been going on since the morning time and looks like it will take the rest of the day. Lots of blood. Everywhere. Second, a 15-minute surgery that involves removing some tongue that has been stuck to the bottom of the mouth. Third, the removal of a large egg-sized tumor from the carotid area as well as two fat packs from the patient’s arm.

‘Which would you like to see?’ she asks.

Bone fusing, tumor removing, tongue releasing. My lunch is about to give her an answer, but then I say, ‘If possible, may I watch the tongue surgery and then switch over to the tumor?’ I really want to see a surgery from beginning to end, and bone carnage is at the bottom of my list, anyway.

I walk into OR One and see that Dr. Gary has started begun. Only the patient’s mouth is in the open. The rest of the body is draped in aquamarine drop cloth. He has already freed the tongue and is now sewing the sutures. Like a skilled craftsman, and not unlike advanced knitters or embroiderers I’ve seen, his hands are swift, nimble, and very precise. He uses two forceps to sew up the suture. I am unable to see anything, and at this point am unsure if I want to see anything. It is very calm, very quick and as promised, fifteen minutes pass and he is done. The nurse asks me to step outside and wait for the tumor operation in OR Four.

As I am waiting outside, Dr. Gary comes out. I have never heard a bad word spoken against him. Gracious. Capable. Respectable. Those are commonly spoken of Dr. Gary. He is the kind of man who can smile with his eyes (which helps especially when constantly wearing a surgical mask.).

Dr. Gary stops to explain the tumor surgery to me. It is a tumor in the carotid area (neck, underneath the chin) on the left side. He has to be careful in cutting out the tumor because it is close to some nerves essential to blinking, smiling, and other functions he’s sure the patient wants to keep. It will take a while, he says. The patient has also developed two fat packs on her shoulder and forearm which causes her to look very disfigured.

When the patient is fully anesthesized, I am allowed in the room.

On the operating table is a fully grown woman with closely cropped hair. Her small feet poke out from beneath the aquamarine cloths and in passing I notice her chipped toe nails. Her head is turned to her right side and on her left, the tumor, as described by Dr. Gary. It bulges outward. The jaw line ceases at that point as the tumor hills and crests behind her ear.



Dr. Gary draws a line with a marker. This is where he will cut.



He asks Donna, the anesthestist, who this woman is.

‘Her name is Kaybo,’ she says.

Dr. Gary lays his skilled hands on the patient’s head. He says a prayer for her before he begins.

‘Kaybo, did you say?’ I ask. ‘I just selected her yesterday as my patient!’

I saw her name earlier in the week hanging on the poles for our ‘adopt-a-patient’ program and had a feeling about her. She is 49 years old. She will be here from anywhere from four days to two weeks. I had not visited her yet due to my own maladies, but here I was witnessing her surgery.

‘Well, that certainly isn’t a coincidence!’ Donna replies. Suddenly, the surgery took on a newer meaning. Here was someone I had chosen out of so many to take care of during her stay here. And, perhaps, not quite randomly, she was chosen for me ahead of time.

Dr. Gary picks up a scalpel. The first incision is small but decisive. The skin automatically splits and a layer of yellow fat tissue is revealed. There is a little bit of blood, but not much. I listen to the beeping of the heart monitor. Donna monitors her vitals.



Cut, snip, push, tuck. The movements are both gentle and firm. The tumor is revealed and blood begins to drip out. It is lumpy, foreign, and against the rest of the human body which seems to make sense, one can tell that it should have no place in this woman’s body. Yet, this thing has grown to be a part of her body and is nourished by her blood.



I remember what Dr. Gary says about his need for caution around this area of the body. Just then, he takes he finds a nerve and pokes at it. Kaybo’s mouth twitches. He’s found the nerve and it was only 30 minutes into the surgery. With this information he is able to move about faster.





Dr. Gary and his OR nurse, Steffa, proceed to cut, snip, push, and tuck some more. The tumor is coming out. I feel my tear ducts pinch. I’m about to cry. This woman’s life will change for the better without this tumor and I am so happy for her.







Dr. Gary plucks the tumor out and puts it on a cold, stainless steel tray that Debbie, another nurse, is holding.

‘Dinner?’ She jokes. Dr. Gary sews up the sutures in a neat, clean line.



Dr. Gary moves onto the fat packs. When he opens the skin, the fat cluster bursts out. The cluster is the color of flan, or meringue, or the hue of a bridesmaid’s dress for a summer wedding. He pulls it out with a pair of forceps as matter-of-factly as pulling out a ball of hair from the shower drain. He hands it to Steffa and she puts it on the instrument table. I want to poke at it, but decide not to.





After the second fat pocket, Dr. Gary looks over all the sutures he’s closed up. Kaybo’s heartbeat is normal. She’s breathing evenly. He gets up and removes his gloves, his mask, and outer gown. I thank him for the incredible experience, noting how God has made such amazing machines for human bodies. He makes a casual and humble remark about how it is even more amazing that surgeons don’t get in the way of God’s creation.

‘Wow and all before 3.30!’ I say. I mention that I’m still able to go to my practice fire drill, which I am a part of as my role on the reception team.

‘You’re not staying for OR One?’ He is already down the hallway. ‘I’m doing another surgery right now!’ I laugh, but dismiss myself. He’s in charge of one kind of life saving, but these practice fire drills are so that I can help in another kind of life saving, I hope.

As I leave, I pass by OR One. I see the patient lying down on the operating table before he is anesthesized. We make eye contact. He is very afraid.

Don’t worry, I say to him in my mind. You are in good hands.