Sometimes you find yourself in...: March 2010

Tuesday, March 30, 2010

Some sad moments

Yesturday started off as a typical work day on the ward. I was assigned to working with the translators/floating between the wards. In ward 'A' one of the RN's asked me to come over to double check a little girls heart rate. The baby was registered under the infant feeding program awaiting cleft palate surgery. As I was checking her pulse she moved her arm purposefully and I was thinking, why is a baby making such purposeful movement then I looked up on the wall sign to see that she was 1yr2months old - I was shocked, she looked maybe 5 months old. Because of her cleft palate she was severely malnourished. A few hours later she apirated (choked) on her milk, and as she was too weak to cough to clear her throat her airway was blocked and she coded. Our code team attempted to resuscitate her but were unable to. It's kinda crazy to think how at home she would've been in PICU with feeding tubes, central lines, etc. to prevent this from happening...and for free. As the parents don't have have money to pay for health care, many do not receive the care they need and because the ship is a specialized surgical ship it has limitations and is unable to provide all the specialties we have at home. It's hard sometimes to not get discouraged and overwhelmed with the need, but rather to focus on the amazing stories of many of the patients lives that are changed.

"For you created my inmost being; you knit me together in my mother's womb. I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well.
My frame was not hidden from you when I was made in the secret place. When I was woven together in the depths of the earth your eyes saw my unformed body. All the days ordained for me were written in your book before one of them came to be." Psalms 139:13-16

"You have made my days a mere handbreadth; the span of my years is as nothing before you. Each man's life is but a breath." Psalms 39:5

Friday, March 26, 2010

Africa?

Sometimes it's easy to forget we're in Africa when you're on the ship. It's 'America' on the ship and when you walk down the gangway you've reached Africa. One of my roomates and I were discussing how really we haven't sacrificed anything being here. We have every convenience we need right here on the ship - a ship shop, bank, hairdresser, even Starbucks. The only thing is how we've left our homes, families, and income for awhile.

A typical work day - get up to have breakfast (that was prepared for you & your dirty dishes are cleaned for you), grab scrubs that were laundered for you, walk down the hall (the shortest commute ever to work) to the ward. You break for lunch prepared for you (no need to pack a lunch the night before) - a hot meal with alot of variety, including fresh fruit and veggies. The food is amazing here! You might see the evidence on me when I return home (hopefully not)! After work just throw your dirty scrubs in the bin and you have clean ones for the next day. We are well taken care of here.

Here are some pics of the dock from the ship.

Starboard side of ship/dock

Fleet of Mercy Ships vehicles/ admissions tents. Many rats find there homes under many of these containers and cockroaches on the dock as well.

Port side - beautiful view of palm trees! Togo navy ships

The Togo elections were held beginning of March. We were not allowed dock leave for nearly a week (with a some exceptions). The last elections held in 2005 were violent with riots where the army needed to be involved. Depending on which of the locals you talk to 200-700 people were killed here in Lome, thus security on the ship was so tight. I was scheduled to work most of this time, so that was alright. The elections ended up being mostly peaceful, although some riots occured with some people being injured no deaths were reported.

Below is a picture of my current roomates, all RN's: Lt-Rt Silke (from Germany), Christina & Jen (from USA), then myself, Jenny (from Austrailia), and Gwen (from New Zealand). It's great having a multi-cultural room and a blessing getting to know them.

Tuesday, March 16, 2010

Loving work!

I love my work! It took a few years of nursing for me to be able to say that, but now I can't imagine not doing it. Coming to the Africa Mercy just confirmed that again.

Below is our admissions tent, where we not only admit patients to the ward pre-operatively but also where outpatients are seen.

Post-op ortho patient. It took alot for him to smile...with effort and many different ways of entertaining him we were fortunate to get a good smile. He's sure cute!

Maaike (RN from Holland)

Physiotherapist Nick (from Austrailia) working with a post-op patient

Ponsetti casting - treatment for babies/children with club feet where the goal is to have weekly cast changes that will set the bone to grow in the proper postition without surgical intervention. Below is a little girl (premature twin - born at ~32 weeks) who, in this picture, was about one week old with club feet. She and her twin sister, both under 4 lbs were admitted under the infant feeding program in combination with the ortho condition. For the last two weeks I've been assigned to work with the little babies on the infant feeding program, so I got to be their nurse and loved it! They were soooo cute and it was great getting to know the Mother of the patient as well. It's funny to think at home they would be in the Neonatal Intensive Care Unit (NICU). They are being breastfed as well as supplemented with formula. We're hoping to fatten them up before sending them home.

These are the smallest casts I've ever seen, the ortho surgeon said the same thing :)

The little premies...cup feed so well it's amazing!

This is another little baby boy who I got to take care of in the infant feeding program. With the bilateral cleft lip and palate it can be difficult to breast feed, so the little guy was taken in to hospital to gain some weight prior to surgery.

And another one of my little patients, cleft lip

Two little boys post op from cleft lip/palate repair.

This boy was also my patient who had an infected graft site from his previous surgery. Poor little guy who was on contact precautions was unable to join in the different ward activities yet never complained. When he was discharged I met up with him in reception as he was leaving, and he ran up to give me a big hug and was thanking me...priceless. These little ones just grab my heart.

Screenings

Mercy Ships holds screenings for surgeries every weekday at different locations in and around Lome, the capital city which we're docked in. Teams will soon be travelling to the northern part of Togo to conduct screening clinics. This Thursday I will be working again with the screening team leaving at 6am for a clinic outside Lome. I have had the opportunity to participate in these screenings which is a great experience and can be a mix of emotions. It's really neat to see them on their first contact with the ship and the hope in their faces when they are told 'yes, we can help you'.

Because Togo health is a fee for service many do not have the means to receive health care, or are unable to receive the help needed for their particular condition. The specialty surgeries the ship provides are most often not provided in many West African countries. The health conditions seen at these clinics just seem so surreal! It's hard to fathom that people live like this for years. Repeatedly we hear how they are ostracized by their community and family, are viewed as cursed, or are receving a form of punishment for their lives. No one wants to do business with these individuals thus they also suffer economically. Many of them walk around with cloths covering their deformity.

On the flipside, it's difficult to say no to many more people then we can say yes too. Although there are posters around Lome and outside the screening gates with information of what we can and cannot do, many people still come hoping to receive any form of free medical care. In comparison to working triage back home, it's so sad to have to say no we cannot help you when at home this would not have been an issue.

Screening crowd

Boy with bow legs

Lady with a maxillo-facial tumor

Children with bow legs

Cleft lip/palate. Although we do many of these surgeries on board the ship, the incidence is higher in the West then in Africa. They just receive surgical treatment much sooner in developed countries.

Showing our posters to explain what conditions we can and cannot treat.

The 'Golden Ticket', a date for surgery.

When given a date to come for surgery, or to see the surgeons for a more detailed history and physical exam the patients are given multivitamins and iron tablets to prepare them for surgery.

For the first 8 weeks we are doing maxillo-facial, pediatric orthopedics, and eye surgeries. Pediatric orthopedic surgeries are being done now so the children will not be having casts during the rainy season. Most of the surgeons are short term and come for the period their specialty is schduled for.

Registering the patients into the system, then Operating room slate.

Pictured below is Dr. Gary Parker (maxillo-facial surgeon) examining a patient. Gary has been with the ship for over 22 years, is the Chief Medical Officer, and lives with his wife and children on board. I have much respect for this man who, even after all these years is still so passionate about the work he does, not burned out or bitter. He is a role model in how he treats his patients, coworkers, and staff, as well as his love for Jesus. He is also an expert surgeon, pioneering different max-fac's surgeries as many of them have not been seen or researched in the West.

Ortho surgeons examing a patient - notice how her legs are different lengths.

Monday, March 8, 2010

Weekend in Kpalime -- Feb 20/21st

Kpalime (pronounced 'paulimay') is a town about 2.5 hrs north of Lome where a group of 17 'Mercy Shippers' went for a weekend getaway off the ship. The area of Kpalime is very beautiful and lush. It was so nice to get off the ship, out of the city to a rural area of Africa to experience part of the African culture.

Saturday morning we got a taxi van to drive us out to Kpalime. Since the van did not have air conditioning we were ready for a swim in the pool at the hotel when we arrived. The hotel we stayed at cost only 4000CFA ($8 USD) a person. Although we had to sleep 4 to a room, 2 of us on mattresses on the floor, our room was good, the other girls room had cockroaches so they ended up sleeping 4 on 2 single beds :) We took 'zemi jons' (motorbike taxi's) to a beautiful waterfall! After some of us took the zemi jon taxi's for a ride up a mountain. It was a hoot, even though my zemi broke down, which did not really surprise me as that seems to be a usual occurance here in Africa. The driver attempted fixing it with no luck...so here I was on a mountain in the middle of Togo with my transportation broke down and my group ahead of me, and not knowing any Ewe (a local tribal language they spoke) or French. Somehow, someway they make things work, so the next zemi that came along, the driver stopped, spoke with my driver, unloaded his passenger and took me up to meet the group.

Sunday we hiked the highest mountain in Togo - Mount Agou. It was a beautiful hike, probably not the easiest, but record breaking for the one most sweat on. Not an inch of us, including our clothing was dry. I didn't know that the back of my fingers had sweat pores, but yeah, found out they do. It was a beautiful hike. Our guide Noel, painted us with different colors from leaves, ferns, showed us cocoa, papaya's, banana, pineapple. We hiked through a few local villages and got to see community life, church, etc. It was beautiful!!!