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.)

The Empty Medicine Cabinet

While we visited the mines last weekend, we took a trip to nearby Bong Mines Hospital. It is one of two hospitals in Bong County servicing approximately 10,000 people. It will likely close unless a NGO steps up. They are lobbying for more money and the workers have gone 5 months without wages. Still, they come because it is a labor of love. In the pediatric ward, there is one nurse for 22 patients. And though it is very clean, and quite large, there is no room for improvement unless someone steps up for them financially.



And by the way, don't take your gun on the ambulance, please.



Colorful, but faded educational posters lined the walls. Tips on how to reduce a fever, prevent HIV-infection, and how to breast feed were my favorite ones.







The hospital corridors are spotless. There are 100 beds in this hospital. The surgeons and nurses that I am travelling with marvel at how sanitary the conditions are. The sad part is, it isn't as busy as it could be. Again, it is the money issue. As I turn the corner, I notice a modest cabinet with the words 'antihistamine' 'antihommonal' and other mispelled words. There should never be an empty medicine in a hospital, but there is in this one.



Outside, sitting in the shade of the overhang, under a sign that reads 'Bong Mines Hospital. Jesus Loves You.' are 4 women and their children, waiting for medical attention. It could be you, it could be me. But instead it is them. And they should not be deprived of medicine or medical care. I ask them if I can take photos of them. They say yes and love seeing their images on the digital display of my camera. In their faces and the way they hold their children, I see they are just women, like the women I know at home, who want their child to grow up, be well and do the best they can in this world.









As we leave, Debbie asks me if there's a way to take a monetary collection for this hospital. I am looking into it. While the process should not be that complicated, it is. Officials and people in places of authority tend to be corrupt. I am trying to work through a couple channels to find out how to effectively do this. We may not be able to sustain this hospital forever, but maybe we can sustain a few more lives and give someone back their livelihood.

Liberia is alive

At 7 AM on a Saturday morning, the usual bustle of the Monrovia city streets are just beginning to stir. Workers begin loading the flat beds of a coal engine train that will take us up country to Bong County, where we will visit the Bong Mines.

The engine waits patiently, and so must we, as various pieces of cargo (lumber, steel, different metals) and cars (owners of scrap metal companies, visitors, etc.) are loaded onto the flatbeds.



I've been told that we will be sitting outside during this train ride, which is part of the appeal. The missing detail was that we'd be loading the Land Rover onto the flatbed where the car will be parked, and that we'd be sitting on top of the Land Rover. There is a small red flag that comes up in my mind. I presume that they will secure the wheels of the vehicles. When I sadly totalled my vehicle in 2003, I remember the tow company throwing it on a flatbed and then securing its wheels with a belt like device. And today, they do secure our vehicle. With large cantaloupe sized boulders that they place behind the wheels of our Land Rover so that it doesn't roll backwards. And off we go.



We leave the city and head northwest into the country. Weaving through the city, the sounds of cars honking are replaced with silence, and the churning of the train. City huts made out of sheet metal are replaced by thatched roof huts. But in all cases, children run out to greet the train, to greet the Mercy Ships vehicles, and to catch a glimpse of foreigners. Their voices are joyful sounds, hatching out of nowhere, a welcome delight for someone in a foreign place.









The wind rushes through our hair. The clouds are creating big shadows on the ground, as we travel through patches of sunlight and shade. Carol scratches her face, nudges her hat and it flies off into the distance, lost to the jungles of Liberia. The foliage is vibrant, green and alive from last night's rain. Bananas and mangos dangle from the trunks of trees. Small bursts of leaves rise from a thick cluster of dark green bushes, stemming towards the sky like giraffes. Looking around, I thought to myself that it is indeed man who ruins God's creation, not the other way around. Liberia is blessed, luscious, and precious with its many fertile resources - iron, gold, diamonds and rubber.



Forty five minutes or so past. My bottom is beginning to fall asleep. The train slows to a stop. We have travelled through a long distance through the jungle, and then we arrive at a small township. We pick up a mother, a small child and a large bag of rice the size of the child.

We marvel at how people seem to travel from long distances in order to get to the train tracks. I suspect that they are waiting for different trains for purposes of trade or transportation. Also, walking along the train tracks provides a cleared path for them to travel upon.



As for us, we enjoy the sun and fresh air which we rarely receive in Monrovia and on the ship. Smiling happy and proud, here we are sitting on top of a Land Rover, trundling through the jungle on a train. From left to right: Timon (Switzerland), myself (USA), Debbie (Australia), Ester (Norway), Leena (South Africa) and Rosemary (England).



At the Bong Mines, our driver Odecious, formerly an employer at the mine, recalls the day that the LURD rebels came and drove everyone out. They captured strongholds of prosperity in the country and the mine was an attractive prosperous place. From accents, looks, behaviors and dialects, the LURD discerned between different tribe members. Odecious made it through. The others who were of the wrong tribe were shot here, the Ezekiel Valley. Over 5000 bodies were thrown in this valley. When President Ellen Johnson Sirleaf came to power, she held a memorial service here.

You would not think such a beautiful place, as it is now, was once a trench of horrors.

Leena becomes silent. She turns to me and says, 'Would you pray with me?' I nod and she utters words that come from that place that has none.



Odecious gives us a tour of the formerly prosperous mine, now a place where people scrap for metal to sell.



It is a broke down palace.





Odecious shows us some lakes in the surrounding land. There are still people living in Bong County. Before the war, people lived here then worked at the mine and enjoyed this beautiful countryside.



My ears are ringing. It is deafeningly quiet. I have been so attuned to the sounds of the engine whirring all day, the loud talking of Liberians, and the sounds of traffic that when I meet silence, it overwhelms me. Ester notices this too. We eat our lunch on a small jetty that reaches out into the lake, watching large dragonflies dart around in the air.



Odecious drives down a dirt road in the Land Rover. In Los Angeles, people drive Range Rovers and Land Rovers, but on well paved streets to go fetch their starbucks. Here, the Land Rovers rise up to the challenge and we drive over gravel, rocks, large pools of water and other things that Land Rovers were created to to.



We also visit a local hospital, which I will discuss in a later blog post. On our way back, we drive through the township to buy mangos, coconuts and pineapples. We stop off for a cold one at a local cafe.



As we return to Monrovia, I fall asleep inside the Land Rover, the warm breeze rushing against my sweat drenched clothes. Suddenly, Carol yells, 'My hat!' A man is standing on the side of the tracks, his hand in the air, her hat in his hand. He has been waiting all day for the train to come by. We are unable to stop, but she smiles at him.

Lightning strikes and it begins to rain. We pass through this patch uneventfully. I climb out of the Land Rover to breathe in my reserve of fresh air. The train rushes head long downhill. The speed picks up. I hold on with one hand to the roll bars of the vehicle. And with a smile on my face and the other hand in the air, I wave, and wave, and wave.

Liberia is alive.

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.

Bodily functions, bodily excrements

Blood

At 9.30 pm, I'm sitting behind the front desk waiting for the fourteen new arrivals. Fourteen is a big number to embark. I understand the feeling of arriving, feeling dirty, sick, excited, depressed and tired after a long flight. Some people have lost their luggage, some people haven't slept, some people may only have limited English and then some people wonder if they have lost their mind coming to Africa.

The embarkation process involves some paper work, explaining some security measures, overloading them with probably too much information about where they have to be and when and then wrapping that neatly into a precise yet friendly demeanor.

The airport driver is about 30 minutes overdue. I'm in a holding pattern, web surfing, when the blood lab technician rushes up to the reception desk.

"Do you have time now to give some of your blood?" A week into my stay here, I had volunteered to be a blood donor. I have O positive blood, the most common blood type. Just yesterday, they had taken a sample. I didn't expect them to call me so soon.

"When?" I ask.

"Could you come now?" She asks. There is a patient who is losing blood faster than they anticipated.

I'm about to jump over the reception desk counter and start drawing my own blood for her. After all, it is what I came to do, but my supervisor says, "Can this wait? We have fourteen embarkations." What?! I'm surprised at his answer.

The lab tech says. "For thirty minutes to an hour, yes. But no more."

Ok. So at least it isn't life or death so to speak, which was a relief.

The arrivals come. I get flustered because I am embarking fourteen people and trying to train a new coworker and also thinking about the man who is running out of blood downstairs. When it is over, I run down to the lab.

We also find Lisa Marie, another O positive blood donor. We're told we need two units total.



And away I go.



(Oh, I'm wearing my work uniform by the way. I don't go around wearing starched white shirts with naval epaulets on my shoulders all the time.)

And then. It stops. My vein collapses and the flow cuts off. My left arm is always a bit smaller, but they cannot draw from my right, since I only gave the sample yesterday. Lisa Marie is quickly filling up a whole unit. Fortunately, we just got word that they need only one unit and not two.

They draw the needle from my arm. The half filled bag of blood, about two cups, is tossed in the hazardous waste bin. They cannot use it because it has too many coagulants in there, I'm told. I'm sincerely disappointed and hope that they will ask me to do it again.



Sweat

Israel agrees to meet us at the reception desk and take us to try Ghanaian food at 1 p.m. It seems us girls have developed a pattern of adopting a few trustworthy male friends who we – let's face it – bribe in order to escort us to local restaurants. In return, there is a lunch or dinner date for them with six or seven (or more!) fabulous females, and we pay for the meal and gas.

After dodging about four potential accidents, we make a right onto a dirt driveway underneath a Cellcom mobile phone tower. This could be someone's backyard, a church parking log, a restaurant parking lot, or just a plot of dirt. In fact, it is all four things.

The carefully stenciled letters on the low ceilinged, square structure reads "God is King Restaurant." It is dim, there is nothing besides natural lighting for our path, although it is exceptionally dark. Flies swarm about in clusters. There are a group of women standing behind a metal counter with large bowls of stewed meats and sauces in front of them. Israel suggests we sit in the back, though we have to divide up into two tables.

Sweat beads along the small of my back, on my forehead and in my palms. Fans whir in a sluggish hum in the corners, and hot air is being pushed from one part of the room to another, with me in between. There is a gauze-like cotton piece of fabric that hangs in the window. Right after I sit down, the sweat from the undersides of my thighs dampen my shirt. My elbows stick to the plastic place mats, where splatters of chili oil stain my forearms.

Lisa Marie and I are feeling faint from last night's blood letting episode. We focus on tiny things in front of us. Grace, a nurse, looks at me and suggests we move right away and get near a fan.

We order fufu, which is a gelatinous mix of ground cassava root and plaintains. It is drenched in spicy sauce and I cannot take even one bite. We move over quickly to a table that has evacuated. Even with the fan pointed right on top of our heads, I feel like I am breathing in wet, hot air.



As we leave, we see two men roping the four legs of a young goat together in the parking lot. They dig a ditch. Israel tells us its for the blood to drain. They sharpen a long machete on the concrete. And then they strike. Once, twice, three times. The goat's tail wags in circles over and over again. I turn to Ester and say, 'At least you know your lunch was fresh.' She laughs.

Tears

The children at the orphanage put on a show for us Saturday morning. We're allowed to take photos for once, to my delight. The young girls do an elegant dance and sing a song for us. Their voices make me smile, and if their voices don't make you tear up just a bit or your heart more tender, then I don't know what will.



They really have alot of creative initiative. The boys perform a humorous skit.



My favorite little boy grabbed my hand right away after I got there. I found out that he had misspelled his name the first time I met him. It isn't Sovra but Surviva. Here, he imitates carrying water on his head. He's eight, quite mischevious, but also very clever. Before I leave, we draw a picture of a car.



And other things ...

I licked a postage stamp last night. A local postage stamp from Liberia. As soon as I licked it, I felt compunction. Where had it been? What hands had touched it? Even more, what was the glue made of? I didn't think too much of it until I woke up several times during the night, my stomache in knots. I was told by the nurse that I just needed to let it pass. Nothing has passed except for the entire day of stomache cramps during which I've been eating toasted white bread and drinking water and putting on my mother's Chinese vapor rub ointment (which of course I insisted I didn't need at the time). I wish I could vomit or have diarrhea or something. As for now, I pray that I don't keep night vigil, sitting upright with white bread and water as my friend.