Malaria and Leprosy

Not every day do you get to care for people with these two conditions, and I would beg your prayers for healing for these two patients.

The first lady is the same lady from previous posts who had the thyroidectomy - my "not a witch, not a wizard" lady. She's got malaria really, really badly right now. We had a couple of interesting shifts with her as she cycled through the stages of malaria- peaking in some horrible moments of fever (106.5!!!) hypertension, tachycardia, full body rigor, incoherence. So our medical crew quickly pulls out all the available "welcome to tropical medicine" books onboard and pour through them rapidly to figure this one out. Oh the joys of pouring in fun drugs into somebody without the backup safety of IV pumps - yup, we're calculating gravity drip rates! (My nursing friends are cringing right now.) Any drug that comes with the warning "infuse with caution, patient should be on telemetry as Quinine bolus infusion can cause QT prolongation and develop into Torsades de Pointe"- should start by being on a pump! (that's a lethal, shockable rhythm, by the way.) And then teaching your fellow crewmates what QT prolongation looks like so they can spot it during the night. We all know what to do with the torsades- yell for help!  The conversations get interesting at that point. One of the docs onboard posed the question - "so do you have any diazepam or dilantin should she seize during the night?" Supplies are always interesting onboard and you're never quite sure what you have. Although our pharmacy is literally the best stocked in Sierra Leone- one tiny room.

Another chap came to us having just gotten over his leprosy, but I can truly say i'd never seen what that can do to a person before. Yes, the missing digits, shrivelled hands and feet, but this poor fella also has a terrible pressure ulcer on the side of his left foot from having spent months in a bed and nobody turning him. His foot also then curled inwards, so now he walks on that side of his foot - so we got him a pair of crutches and he gets around not walking on that wound, but man! Talk about eye-opening! He's also tested negative for the leprosy since, for which I was glad 'cause or else we wouldn't have been able to bring him onboard - no way to isolate as effectively as needed. We do have two isolation rooms that are currently in use. He's actually here for hernia surgery, and we're treating his wound, and he's getting a cataract operation afterwards. I think he's done quite well by us! :-) 

  Now, I've been a nurse for 9 years now and have seen quite a bit, but this one was completely new. You kind of lean on your expertise to deal with current situations (experience) and I had zero point of reference on leprosy. And this is completely wicked but all I could think of was leprosy in the Bible and wondered if I should stand around the bed yelling "unclean! unclean!" and wow, I can't believe I just admitted that and I'm giggling as I'm writing it, but it is what crossed my mind :-) (and no, I wouldn't do it!! :-)

and I can't get away

"You hem me in - behind and before;
  you have laid your hand upon me.
Such knowledge is too wonderful for me,
  too lofty for me to attain.

Where can I go from your Spirit?
  Where can I flee from your presence?
If I go up to the heavens, you are there;
  if I make my bed in the depths, you are there.
If I rise on the wings of the dawn,
  if I settle on the far side of the sea,
even there your hand will guide me,
  your right hand will hold me fast."

Psalm 139:7-10, italics mine.

I've found Paradise, it's called Bureh Beach

Swaying palm trees, cute little kids running around, crashing waves, lagoons, rivers, falling coconuts, canoes, playing in the waves with friends. Lovely!

This little girl ran after us yelling "Pady, Pady, popo me!" "friend, friend put me on your back!"

Andrew and Juan with the local kids.

Ironic, I'd say. Down with Man U. Long live Chelsea! Brendon, this one's for you!

Taxi driver with good taste.

Not a witch, not a wizard

   Our lady that I wrote about in my last post, the lady who had her thyroidectomy (ok, huge lump on her throat removed), yesterday the doc was doing rounds and she took our hands, and through a translator and with the biggest grin on her face she said, "At home they called me a witch, they called me a wizard, they said I was cursed and called me all sorts of hurtful names. Now I go back and I am beautiful. You have taken me from shame and disgrace to joy and God will bless you."

   Next lady, who also had a lipoma on her arm (huge, random growth) that we removed, went through the same routine. Both of them speak Temne, but you understand their smiles. "I am no longer called witch, I am no longer wizard."

  Tell me that's not worth coming here for. To God be the glory. There are few surpassed joys that I've had than yesterday being able to look at these ladies and tell them that God has not forgotten them.

Lumps, Bumps and a legitimate Lord

I have been remiss in writing! I must say that inspiration had flagged a bit and couldn't think of putting into words some of the stuff that I've seen, but you're just gonna have to put up with my fumbling through this one.

Ten years ago there was a bloody civil war that swept through Sierra Leone where rebel soldiers literally cut a swath through the countryside, chopping hands, arms or limbs off to induce terror or for the sheer heck of it, murdering, raping, you name it. The diamond fields were used to fund most of the munitions (watch Blood Diamond for a point of reference). The history is seared into the memories of the people here, where those who could escaped into Freetown that was largely spared from active turmoil. Millions of people poured into a city with the infrastructure designed for a couple hundred thousand. (Thus the mess outside.)

So picture the problem outside our door. Or, rather off our dock :-) Still no infrastructure, i.e., some rather dilapidated, overrun hospitals that won't touch you if you don't have money and can't pay up front, but your arm has just been shattered because it was fired upon on close range. Or you have any of the many diseases that plague any other place in the world with nowhere to take the problem to. Then this enormous white ship sails up one day, and announcements go out over the radio that this miracle ship can fix your legs, or your baby's cleft palate, or your facial deformity.

The thing that is just so deceptive about the evil one... grrr. I could just spit. If you have a physical deformity, here it is a sign that you are cursed and are evil. Therefore, babies with cleft lips are thrown out to die or cleft palates, if you have a goiter (lack of iodine in your diet so your thyroid, a gland on the front of your neck, gets enlarged to the size of a mango). Many, many a patient comes to the ship - mothers who have been thrown out of their families and divorced because they had a baby with a cleft lip/palate. The mom wouldn't abandon the "demon child" and been pitched out.

 People with lipomas are marked as cursed as well. If you have this odd growth on the side of your face or arm are ostrasized universally, thrown out of their families, if you own a shop to make a living, people will not buy from you for fear of being cursed as well. You can imagine how belief like this take root in a society where there is no medical resource and no idea how these odd lumps and bumps spread or occur, so it's just very sad and all these beliefs are perpetrated. The most wretched I still believe is the myth that sex with a virgin will cure your AIDS/HIV, so rape of babies in South Africa is a big problem. Grrrrr. But that's South Africa and I'd better not ever write about it - I'd never shut up. But I digress...

   So I had the honor of taking care of three such special patients this week that come to mind. One is a lovely lady, she speaks only Temne so there was a major communication barrier. I have a working defensible understanding of Krio and can sometimes make myself to be understood, but Temne sounds like Klingon to me and no such luck there. (Although we do come in peace :-)  heehee....
But I digress..

   This lady has a goiter, lump the size of a large mango on the front of her neck. We had to check preoperatively to see if she was pregnant (standard procedure for women between certain ages) but she told us flat out - no contact with a man since her husband left her because of this deforming lump on her throat. A few hours later she's back on the ward, flat neck, small dressing on her throat. Awesome! and thanks to Dr. Blair's fabulous hemi-thyroidectomy technique, she'll probably go home and be able to be with her children again. We hear this happens a lot - so they go back and can reintegrate into society, and have a story to tell.

Another gentleman about 40 years of age was sitting on his bed doing bead work, using his toes to secure one end of the thread and threading it in complicated little patterns with shiny beads, and I wondered what was up with his arm because it was curled right under him, deformed as if he was born with it or had had polio - so I just asked. He raised his shirt sleeve and proceeded to pull his bone around from where it should have been in a stationary position. When I asked what happened, I was told flat out the rebels shot it at close range, shattering the bone and since there was nowhere to go with the problem it just healed in place. He was lucky to survive really, and you can imagine the suffering the poor man went through in the healing process. Now, this was ten years ago - you can imagine how long you suffer with these injuries.

Another kid we took care of this week had an eye in not so good a shape. You could see it was shut and a bit shrivelled, and he is blind through it, but causing him intense pain. He is 21 and I read on his H&P exactly what happened. When the rebels came through his village, he was running through the forest to escape and a stick pierced him in the eye. He's been in pain every day since. Until yesterday, when Lord Ian McColl (yes, he's an English lord, how cool is that?) fixed it for him. The eye had to go of course, but he replaced it with this thingie (ok, can you tell I don't do eyes) that looks like a plastic eye sheath, which Lord Ian said will hold the shape of the eye socket in place, and then when he returns from England in a few month's time he can replace it with a glass eye. Cool, huh? So this poor kid who'se been in pain since he was 10 years old gets to go home today.

Now isn't that just lovely?

Sal y Amor / Salt & Love

  I'm submitting for your enjoyment the movie some friends and I made this past week to submit it to the Africa Mercy International Film Festival. We won the award for best drama :-) It had to have 5 people or less, a bottle cap, and the phrase "It's a trap!"

I'm not sure what program it will play with, let me know if it does or doesn't play. (I can post but not view video onboard. )

I don't know if the subtitles are on or not, go with it.... it's in italian and spanish :-)

Further quirks and vagaries of patient education

  The m/v Africa Mercy has day volunteers who staff our units as translators, help clean the wards and when time allows, patient education on varoius topics such as handwashing, teeth brushing, malaria prevention, breaking the cycle of food contamination, etc. They have applied for the position through their local churches and come with recommendations from their pastors and are generally a blessing and a a bit of a stress to work with for reasons of various cultural differences.

   So I came across a day volunteer who had taken the good initiative to grab the patient teaching folders that hang on the walls of the ward, and he was teaching on diarrhea. Good for him, showing this self-motivation. This was a  ward of about 10 post-operative (male) hernia patients who seemed to be attentively listening and commenting at appropriate intervals; the teaching was in Krio, so there I had a bit of an idea as to what was going on, but not much.

   I went about my business to return to 10 glazed-over expressions and patients in various states of unconsciousness - so I peeked at the day worker's papers to see what topic he had decided to cover next: breastfeeding! Somehow he thought it necessary to teach 10 men about how to breast feed and when to introduce food to "your tiny new baby"?!?!?!  Going through the motions of breastfeeding and all :-)

   What a laugh :-)
     

Listing

Today we're listing to port. Here's the proof. And you find yourself walking portside with more momentum than you originally intended.

Missionaries of Charity

This morning two carloads of us piled in to go visit the patients at the Missionaries of Charity located in Freetown. This is a mercy ministry founded by the order of nuns started by Mother Theresa, who are now in 188 different countries around the world. There are four nuns who work here, taking care of up to 80 something patients with HIV/AIDS, tuberculosis, developmental delays or children who have just been abandoned by their families.

There are two crewmates who go every week who organize for us to go, and you sign up and pitch up on Wednesday mornings, to relieve the nuns who work 24/7 to care for these people.

As we arrived at the Sister's of Charity, the patients were congregated under the porch, sheltered from the downpouring rain (still rainy season here) and waiting for us to get out of the car, whereupon they flood you in hugs and handshakes like you're their long lost sister. There's this language barrier that only allows you to take the conversation so far and so deep, but you tickle tiny babies (whoo are too tiny) and walk around with ten year-olds glued to your waist, talk with mamas and there were groups of men there as well, but I didn't go that far.

We started off by singing songs, yes, "Shake your body for Jesus" featured again, to much laughter and giggles, and lots of other Krio songs that you just hum along or try your best and have fun with it anyways. I'm pretty sure the ten year old who was glued to me had TB or the nastiest bronchitis I've heard in awhile. Whatever it was it was a coarse cough. One little girl who has everybody's hearts broken has a tumor pushing her spine out of place, over the thorax. She's already lost her ability to walk and can only raise her arms so far. The "if only's" scream at you... if only she were at home... if only there were a surgeon who could do that here... if only it were caught sooner. She looks maybe 3.

So we sang songs and used the five color book to share the gospel and did a craft, today it was making necklaces out of the five color beads:

Gold: to remind you of heaven, the beautiful place God has prepared for his children, where there is no pain, no hunger, no suffering - the suffering here is so palpable and acute, when you mention this place, it means something! My comfortable American existance at home would never necesitate such a place. I can be quite comfortable in this life at home. Moment of Conviction!!
Black: the black of the sin that keeps us from getting to heaven, God's perfect place.
Red: Jesus' blood, shed for us so that we can have a pathway to heaven
White: He washes us white as snow. (side note: here we had to come up with another picture, them never having seen snow!)
Green: to remind us of growing to be more like Jesus.

The Lord bless these amazing women who have dedicated their lives to the people of Freetown and the surrounding areas. To look after those who would otherwise be on the streets. We were not allowed to photograph them or the patients, but they are there. White habits with blue stripes; picture Mother Teresa.

Brilliant child

A shameless plug for my beautiful niece. Lionel writes to me that if she comes into the room and he's watching soccer, she yells "Goal!"

She's only 1.

Brilliant child.

Hiccups, worms and juju

I stand corrected on the Juju! I found the waist band of string this time, on a tiny little boy, maybe 8 months old. I was showing his mom how to put on the Pampers diaper that she obviously had never seen before, and there it was... on a boy. So I asked a day worker, one of the Sierra Leonian locals who works for us as translators, and he said it was traditionally for beauty for girls,and to ensure you have "a good shape of your torso." Who knew.

Also, a local believe is that hiccups are caused by worms. A patient got a hiccup spell and flagged down his nurse, demanding "worm medicine!" Who knew. Nothing to do with that irritation of the diaphragm, it was worms all along! :-)

Losing your juju

So at home if you've "lost your mojo" or "lost your juju" you've just lost your 'it' factor, your particular piece of suavity (yes, it's a word, work with me here) or your panache. (I think that one is a word.)

In Sierra Leone if you've lost your juju there's a good bit of flapping and yelling going on, 'cause your juju is a piece of jewelry that women wear around their waists, usually tiny beads all around with a few charms to make it jingle.

Now, there's a range of surprises you get working in a hospital ward, where most people's gowns flap to the four winds and nobody seems to care much, but I must admit the juju is a new one on me. One of your tasks getting patients ready for the O.R. is to remove any jewelry from their body. Never expected the most bedecked to be the sweet three year old girls with two rounds of tiny, shiny beads around their waists. You don't want to be losing this juju!

Ward church

    Sundays are a special day for those patients still onboard, and as we have a few long-termers at this point, they've probably had the pleasure of attending a few times.
    Imagine with me if you will, the patients from five wards cramed into one. Two rows of beds, maybe 6 beds in each row facing each other. Between them, 4-5 chairs all facing forward, so the empty beds become long benches as well. And they pack in, patients, caregivers, the little children, nurses, and an odd IV hanging from the ceiling. There's only space for about 10-20 other crew members to sign up for space. Then the music starts and the sermon translated from English to Krio.
     I loved the welcome, "We do not care if anybody is Christian or Muslim, we were all made by God and we are here to thank Him"... translated "we no go for put anybody in a corner, but we all made by papa God and we come to tenki." To which everybody, including muslims there as patients, said an Amen!
    After a few lines i just couldn't sing anymore because you look down and see the children who've been burned the worst singing the loudest, "Tell papa God Tenki!" or "Tell Papa God thank you!". Just a-dancing... "clap your hands for Jesus, clap your hands for Jesus" and "Stomp your feet for Jesus, stomp your feet for Jesus" and my favorite "Shake your body for Jesus, Shake your body for Jesus" and the whole congregation just wiggles. Hysterical!!!!
    The kids use the ward service as a general hug handout, going from one set of arms to the next willing set, crew being readily willing to cuddle these cute kids - heads with bandages rolled around them, another hopping about on one leg.
   At the end of the service (a beautifully presented simple talk through the five color book) one of the patients who was leaving that day stood up, and with tears in her eyes thanked those who had cared for her, just crying, and sang us a song on the spot "Oh happy day" getting to leave after her mastectomy and a diagnosis of cancer that had been a death sentence on her life, reversed!

Spinning tops and patient education

    I got schooled today... schooled, in the fine art of spinning a top, by a five year old. I personally blame my lack of fine motor skills on the swaying ship... port, starboard, port, starboard.... but then the kid was on the ship too, so oh well, there goes that excuse! Sparks of joy in the middle of the workday. This little one also speaks no English, but is finely honed in the art of mimicry, so if you laugh, he laughs, anyone says anything, he repeats it. So cute! Little things...

    There was also the sweetest 8 month old - and baby squeaks are the same in every language... baabaa, gooes and dribbles everywhere. Teething on everything he could lay his hands on and doing very merry rounds amongst all the nurses who could't just leave that big-eyed baby there just looking up at you! He was probably wondering who all these crazy white women were for all we know... so sweet.

    Part of the fun and very different from home is how we really lump all the patients together on the same ward, men, women and children. Apparently they get all depressed if you separate them, and they just don't understand what medical isolation for infection control purposes is. There's nothing quicker to send them into depression and that part is really sad, actually. So if you have to do something private with a patient like a dressing change, you hang up a curtain around the bed, but boy it had better come down the second you're done! And they let you know!

    It's all very communal to say the least.  A great example is when you're trying to teach the patient in bed 13 about what to expect for surgery... if he speaks one of the tribal dialects, he usually stares up at you with a blank look of confusion - until the person 3 beds over volunteers to translate and yells the instructions over at him in Krio, Temne, Susu, Limbo or any of the various other dialects there are around. Then bed 8 offers his opinion on the matter, bed 7 tells him how it went for him, bed 11 starts yelling at bed 8 and general confusion ensues and you hope the poor patient you started with isn't so overwhelmed that nothing is registering at all. You can't help but laugh. The other end of the spectrum is that the patient very politely says "yes, yes, yes", smiling to your every question until you realize he don't speak English and he just doesn't want to be rude by telling you he didn't understand a word you just said.
    
   It works the same way with people offering directions in the streets by the way, if they don't know the way to something, they wouldn't dare be rude enough to say that they don't know, so they merrily and in full confidence point you in what ends up being the opposite direction and then tell you to ask from there..... sheesh. Hilarious until you drive around for 4 hours to get somewhere half an hour away!

 
  

  
  

It's been a month!

     I can't believe that today I've been here a month already. What an adventure, experience and opening of the eyes. I thought I had seen poverty and hopelessness, and I am not discrediting what I have seen in the past, but this is a whole 'nother level.

     Did you know that the average life expectancy for Sierra Leone is 45 years of age? 45! It's because the infant mortality rate is triple that of the nearest country on the list. Which means that the monkeys we saw in the sanctuary have a better chance of makin' it than the children we passed on the streets on the way here. It breaks your heart. It is a hard prayer to pray, to ask the Lord to break your heart for what breaks his. Actually, you pray it in ignorant bliss and good intentions and then he opens your eyes. Oh Lord. I had a moment of complete breakdown this week just crying my eyes out for those outside the ship - what is to happen to them? Unless the Lord intervenes and I mean, in a big way, what is to become of them? There are 5 major hospitals in the country. Five. And about a dozen or so provincial hospitals. I mean, if the ship is part of the answer, and I believe it is, great, but soooo not near enough. How do you even go about changing people's minds and educating them on the truth of how disease is spread when they stand and argue with you that HIV/AIDS is a myth perpetuated by Americans to keep them subjugated and scared. That germs don't exist because whoever heard of such a ridiculous thing as being so tiny that you can't see it.

What is with the penchant of throwing acid in each other's faces? What is with the throwing children into fires? Maybe I've become desensitized to it at home, we still attack each other, with gun violence being a common enough thing, so the difference is what gets me? Talk about needing Jesus.

So thank the Lord that we can be here for those children with those burn contractures, but how much more important that they come to know the Lord.

A prayer request you can all be active on: One lady came to us with a facial tumor who had tried many, many things to get rid of it, including going to the local witch doctors who tried quite a few hideous experients on her to take it away (as well as all her money). She came to the ship and was able to have it removed, and also came to know Jesus on board. Hallelujah! But she will now be going back to her village where her family has been warned that she will now be killed because she has "shamed" the witch doctors. We might never hear what has happened with her, and there is no option to not go back. She is overcome with joy yet there is this real threat. Please keep her in prayer.

The stories like this abound. Another prayer request: Please pray for the healing of wounds on board. The level of filth off ship is staggering. I learned in the MTW disaster relief training why this is probably going on in a lecture on water safety. The streets are also the toilets. It partially gets washed away by the streams, part of it dries, turns into the general dust, blows into everything... even wounds. So wounds take a looooong time to heal here. Even if crew get cuts on our feet, they just don't heal without antibiotics! Everything onboard gets bleached many, many times a day, but it's still a problem because you can't keep patients until their wounds are all completely healed, so we see lots of readmissions with wound infections.

There! You have your homework! I expect all these patients who've been here awhile with these wounds to go home soon, so thanks for your prayers beforehand, and thank you Lord for their healing.