VVF time

We are now in our 6 week block of VVF surgeries & today was the first of our amazing dress ceremonies! VVF (vesico vaginal fistula), is a birthing injury resulting from obstructed labor. This obstructed labor can last from 3 days up to a week. This pressure causes a hole (fistula) to form between the bladder and vagina (sometimes also the ureters and rectum) causing women to constantly leak urine and sometimes stool as well. In most situations the women ends up delivering a stillborn child. This horrible injury usually results in them becoming outcasts in their community, husbands abandoning them, etc. Many social factors contribute to this: lack of access to trained health professionals (hospitals, Dr’s, midwives, etc), lack of transportation, lack of $ for a hospital delivery or Cesarean section, cultural practices (young marriage of girls, traditional birth attendants).
Last week Monday we had a VVF screening where 67 women came to the ship presenting with urine incontinence. Many of the women were prescreened in the north and brought down to the ship. I was assisting in the screening – taking histories of the women prior to the Dr’s examination. We were able to say yes to approximately 90% of the women, and give them their cards with a scheduled date of surgery. We admitted women that night for surgery the following day.
Because this is such a specialized surgery, and does not happen in the west it’s a learning experience for all of us nurses! Because there are so many different tribal languages in the north communication can be a challenge. A typical conversation with a patient can include saying a sentence to one of our translators, who then speaks French to one of the patients that understands both French and a tribal language. This patient, who is on bedrest postop, then yells across the room to the patient you’re trying to assess. Good thing the culture of Africa is so community oriented because there is no privacy. Everyone on the ward (who understands that tribal language) knows when the lady beside them last had a bowel movement.
After the patient has their catheter removed and is ready to be discharged we have a dress ceremony for them. A new dress is given to them signifying a new life. It’s amazing the transformation – the ladies are gorgeous! The translators lead in a time of worship - singing, drumming, and dancing. The ladies have an opportunity to give their testimonies. One lady’s testimony included how she delivered 2 stillborn babies, and after the 2nd started leaking urine. Her husband left her and she was not able to work at her job. She tried farming, but people would not buy her produce. She would constantly cry, was very depressed, and contemplated suicide. She heard about the ship, was screened and able to have surgery. Another woman testified how her sister would not come near to her but rather throw things at her from a distance. They talked how it was so great to wake up on a dry bed, not in a puddle of urine, how it was great to get up and dance without urine leaking down their legs.
Dr Steve, our VVF surgeon, spoke how today was everyone’s payday. We don’t receive a paycheck here – it’s voluntary, but the stories of each changed women life was our paycheck. I think each person on the ward today agreed with that statement. What a blessing to be able to be a part of this transformation in their lives!

A day in the OR

Observing surgeries...in OR 1 & 2 is the eye rooms. Here approximately 35 eye surgeries are done each day. Majority consisting of cataract removal. You can see the cataract on the screen to the right. Our eye surgeon - Dr. Glen is training local eye surgeons.

In OR 6 with Dr Tertius (South African plastic surgeon), I was able to see the reconstruction work on these fingers below.

Here he is drilling in K-wires to straighten the fingers (after an incision along the side to release them). For any OR nurses reading this, bear with my terminology :)

I also was able to see a large lipoma removed from this patients arm.

The removed benign product.

Enough stretched skin to close it, so no skin grafts needed.

In OR 3 & 4 our Maxillo-facial surgeons Dr. Gary & Dr. Tony were working. Here is Dr. Tony (an English surgeon) doing reconstructive work on a noma patient.
The surgical slate consisted of orthopedics and plastics (which are both finished), maxillo-facial & eyes (ongoing), VVF - vesicovaginal fistula's - just starting now for 6 weeks, followed by general surgery for 4 weeks to complete the outreach.

One of our recent cases was a lady with a large jaw tumor. The tumor hung down from her jaw till her chest with 2 tumor growing out of each side of the main tumor. Seeing that is shocking, it's hard to believe it even when it's right infront of you. Her case, involving 2 maxillofacial surgeons went from ~1:30pm till midnight. With her tumor being so vascular she bled large amounts during surgery. They ended up transfusing her 18units of blood! 14 units were from crew members and the last 4 units from the local hospital. Dr. Gary, one of our surgeons made an overhead announcement asking for prayers and blood donors :) The ship was drained of B+ blood, and unfortunately they were not able to complete her surgery. She is approx 22 weeks pregnant, so the last I heard, is they believe she will be able to complete her pregnancy without the tumor sufficating her and remove the remainder after. Her recovery was amazing! She was in ICU for one night, then 2 days later was walking down the hall to the next ward for the African worship drumming & singing time. So amazing! The African music time is almost a daily occurance, and it's so neat! I love it how they randomly break out into singing, dancing, and drumming at any time.

ABWE Tchiko - May 8/9th

We had the opportunity to visit a mission hospital approx 3 hrs north of Lome. ABWE (Across Border for World Evangelism) compound in Tchiko consists of a hospital, nurses college, and staff residences. The organization also participates in ministry with church planting and setting up and running local schools.

The hospital is mostly staffed with locals who were trained in the school on the compound. The nurses receive education free with a return for service work. Pictured below is the nursing station.

Medication cupboard

IV Solution cabinet
Neonatal unit

Pediatric ward

Labor & Delivery ward/Postpartum Nursing station

Emergency area

Lab

Pharmacy

Clinic

The compound grounds were beautiful! Surrounded by mountains and palm trees!

Jessie's house where we stayed on the compound.

Jessie is an amazing woman! At 79 years old she is still going strong. At 74yrs of age, this retired principle was asked and agreed to come from America to Togo to supervise the teachers of the schools run by ABWE. It was her first time in Africa and she's been here for 5 years. Below is Jessie, Ruth and I. Jessie is holding a little girl named Sarah who's Mother abandoned her after giving birth to her at this hospital. Jessie has taken little Sarah under her wing...waiting for someone to adopt her.
Community dining hall

It's so interesting seeing our screening signs up around Togo. This was in one of the hospital windows.

A pet monkey on the compound

On Sunday we went to one of their church plants in the nearby town called Adeta.

This ministry of the Baptist hospital is really encouraging. They have volunteer surgeons coming to perform surgeries at the hospital. While we were there I met a thoracic surgeon from Vancouver and anethetist from USA. So encouraging to see these men in the leadership roles they're in, coming to Togo to give of their talents and skills. The mission of this place and organization is so encouraging. It's a beautiful place, I love the countryside and the atmosphere.

Two baby boys lives

1st little man: Marius

Little Marius was a little man who grabbed so many of our nurses hearts! He presented to the ship malnourished with a cleft lip and palate. At the beginning of the outreach on his first admission to the ship I was his nurse and able to spend time getting to know him and his Mama.

Marius was started on the Infant feeding program and given supplement formula to fatten the little guy up...and it worked :) Here is our infant feeding coordinator Hettie, teaching the Mama how to prepare formula.

The Mama's were so determined to fatten their babies for surgery, it was so encouraging to see their compliance! Story after story I would hear how the Mama's would hide their babies in their huts so the community wouldn't harrass, judge, or mistreat them. Many of the African's believe this is a curse and it's usually the Mama's fault. They do not want this curse to come to the village so they demand the Mama's to abandon the baby or in some cases to bury it alive. One woman was telling me how the Papa left her when the baby was born because he blamed this on her. She was being cursed for something, it wasn't his child, etc. So sad!

10:00 AM - daily weigh time

These prayers were not in vain. So many prayers were sent up for this little man's life, and God was faithful to answer them with giving life to this little man.

When Marius returned a few months later...he was fattened up for surgery. It was sooooo great to see the change!

I had little Marius as a patient the 2nd time he was admitted the day before he was scheduled for surgery. He had some crackles in his lungs (aspiration is so common with these little cleft palate kids), so a chest xray was done. The anethetist then noticed some trachea malformation and so his surgery was cancelled for the following day. This was sad to have to tell the Mama as she was so anticipating the surgery after all her hard work. The anesthetists reviewed the case and decided to go ahead with surgery the following day.

I met the Mama in the hallway the next day and was so happy to hear that Marius had gone for surgery! I was working the shift when he came back from surgery. He was intubated and came into ICU post op. As we were doing shift change his oxygen saturation levels kept dropping. Our ICU/peds team were doing eveything they could to try to maintain his levels....80%...65%...42%...26%...15%, and his heart rate kept dropping from over 150 to 90's..60's. He was coding. Those of us in shift change all started praying for this little man's life while the team worked on him. I was certain he was going to die right before my eyes. But God answered our prayers! Another miracle! After he was re-intubated and later given a tracheostomy. He had more hiccups in his ICU stay, but his life was spared.

This is a picture of him a few days post op with his Mama.

Meet Marius' mother - Chantel. She is a woman I will never forget! Her dedication to her son's life was so inspirational. While he was in ICU, many times throughout the day you would see her kneeling in prayer by her corner bed with her African material covering herself. She would pray & sing songs of praise to God. She fasted for many days pleading for the life of her son. On Sunday morning in ward church she would be on her feet dancing and praising God for her son's life. Just writing this brings tears to my eyes. She is an amazing woman!

Here is little Marius...out of ICU (his NG/feeding tube still in), and well enough to go up to Deck 7 for some fresh air.

2nd little man: O'Brien

Little O'Brien was the miracle baby at Easter I wrote about earlier. God allowed us to spend 3 more weeks with O'Brien before taking the little boy to be with Him. Baby O'Brien first presented with malnourishment and a cleft lip/palate. and later diagnosed with congestive heart failure. When O'Brien was in his Mama's womb his Dad said if it's a boy he would be named after the soccer player O'Brien, which did happen. I think every parent has visions and dreams of what their child could grown up to be, so it's sad when these lives are so short.

The 'why' questions always surface...why was his life so short, why was he brought to the ship for us to be a part of his life & death? why were we given 3 more weeks with him after we thought we'd lose him...only then to have him taken away? why did God choose to let us see this miracle? What was His purpose in this? In all this we know that God is sovereign. No matter what we try to do as humans He always is in control. It's comforting to know that.

It's an honor to be a small part in this mission, but also humbling to know we can only do what God has allowed us to and the rest is in His hands.

Can you lift up a prayer for this Mama?

One of my shifts I had both babies again as patients. Their beds were across from each other. I told the Mama's how we were so happy to have 2 miracle babies beside each other :) Later when little O'Brien died, Chantel (Marius' mama) grieved with O'Brien's mama. One Mama got to go home with her baby alive, the other Mama didn't.

When Marius returned to the ward from ICU all the patienst and nurses on the ward were clapping and singing when he came into the ward. When him and his Mama left we had a time of prayer in thanks to God for his life.

"There is a time for everything and a season for every activity under heaven:
a time to be born and a time to die," Ecclesiastes 3:1,2