Dzinye le Africa

We’re sailing the big blue open ocean… soon to arrive in Durban, South Africa. We said goodbye to Togo and the ocean has been our home for two weeks now…

friends made along the way in Dapaong, Northern Togo

My life chapter with Mercy Ships is about to finish. We will soon be in port in South Africa- where we will disembark and all go our separate ways. And I am excited for what is ahead, I feel very alive and very hopeful about the future. I believe good things are in store, but it is quite bittersweet… sad to say goodbye to the amazing people I have met and the memories I have made on this continent, but I am quite excited to see what the next chapter holds….

Jolene (another Africa Mercy nurse) and I- I don't know how we ever convinced anyone to let us take care of patients...

I’ve been thinking back over our time in Togo, remembering my time working on the wards… I came across something my friend and co-volunteer Melissa Davey wrote, a wonderful nurse who works on the Africa Mercy… it basically puts our job as nurses on board in a nutshell…

You know you are a nurse on a ship in West Africa when…

1. You walk down the hall or down a flight of stairs to get to work in the morning.
2. You realize none of your patients speak English, and your French is atrocious.

3. Charades is how you can communicate best

4. Between you and your coworkers 4 different countries are represented on this shift.

5. Some of the donated supplies for the ward are in Dutch. What does that say?

6. Give medical instructions to patients using 3 different people using 3 languages. English to French to whatever dialect is spoken up north :) Sometimes one patient needs to interpret for you to another.

7. IV catheters are 3 inches long, how can you expect me to insert that on the first try in a child!

8. There are picture instructions on how to use the toilet in the bathroom.

9. Have to give PRBC to a patient, no problem just call your roommate because she is the patients blood type and insert a 16g canula into her arm for phlebotomy. Then transfuse it directly into your patient. Now that is fresh blood!

10. You are the nurse, respiratory therapist, pharmacist, and nutritionist for the patient.

11. Mama's and Papas sleep under the patient’s bed and this is normal.

Photo courtesy of: Tom Bradley (http://tombradley.wordpress.com/)

12. Recycle, Reduce, Reuse everything. After sterilizing it. If you throw it away you very well might never see another one.
13. You have become an expert Jenga and Memory player in 2 weeks.
14. Sometimes all you want to do is grab the patient and run them back home because you know there is more care available then a ship can provide, and death is not inevitable.

15. You feel heartache and joy at the same time for little patients on the ward.

16. You get to see lives transformed from hopeless to hopeful.

17. You get to love and be loved.

18. Praying with your patients is encouraged not discouraged.

19. It hurts just as much if not more when a little life passes here then it does at home.

20. TIA becomes a quote when there is nothing left to say. "This Is Africa." How wrong is that?

21. For all the good, bad, ugly you would still rather stay, than leave...If not you then who, and if not now then when?

Jolene and I with Bella. Photo courtesy of: Tom Bradley (http://tombradley.wordpress.com/)

It’s true… Living and working on the Africa Mercy I have learned to make big use of the little that we have, to use and reuse, and to be ashamed of all the wealth and supplies I have seen wasted and have wasted myself back home… I’ve learned a little bit of MANY languages (including some European languages from using donated supplies and from the multicultural staff I worked with)… I’ve learned more about the realities in this world that are so painful to face sometimes and I have been lead to question the way I live and the things I believe…

And I must say, although I have not wrote much about this before, one of my favorite parts of working here in Africa has been my time with the day volunteers…
The day volunteers we have worked with have all been from Benin, Togo, Ghana, Nigeria, and a few other West African countries… They are brilliant people who usually speak several local languages along with English and French, and their own language of parables… Many of them have gone to University for Bachelors’ and Masters’ Degrees and are well educated and very aware of what is going on in the world around them.
Day volunteer farewell party
Most of them know what it is to be hungry, to experience living in nations that are politically unstable, or to lose family members, sometimes before their very eyes to a civil war… and they are some of the happiest most loving people I have ever met…
Dancing in the International Lounge
I remember one time I was really touched by our Togolese day volunteers. I was helping take care of a post-operative child who got part of his jaw removed from a tumor that would’ve suffocated him. We had to feed him with a feeding tube that went into his nose to his stomach. He was not tolerating the feeds very well and got up one evening from bed after his feeding and started having projectile vomit (sorry for you non-medicals that find that gross…) He vomited and vomited until nothing was left in his little belly- everywhere- on himself, the floor, the bed sheets, his dad, his neighbor in the next bed over. Soon the room was full of the pungent smell of vomit.

We got the boy some medicine to settle his stomach and I was about to gather cleaning supplies, but I could not find them. I looked over and the day volunteers were all gloved with the supplies, cleaning the vomit, cleaning the boy, making his bed, and settling him in… They are not medically trained, are not required to clean bodily fluids (and even though I pride myself on not getting grossed out easily, vomit can sometimes do the trick), but they all jumped right in, no one asked them to, but they happily did it. I was really surprised, even working with nursing students back home it was sometimes hard to get them to help clean up yucky messes. I thanked all of them, but they did not seem to think it was a big deal- they were just doing what they thought anyone would do… I truly felt like we were all a team that day, to work with and serve one another…

I miss them… they are truly great people and many of them have told me if I come back to visit, I have a place with them as long as I like, and I know they really mean it….
They have taught me to slow down, to focus on the things that are truly important, and to consider my neighbor and the things he does not have- and they have taught me all of this by example… They own a piece of my heart, a part that will always belong to them. Dzinye le Africa.

Ben- always at someone's bedside cheering them up. He always seemed to know who needed encouragement for the day

Ericvi (little Eric)- always had a smile on his face and had the heart of a wise old man

Christine- accepted me as family right away- told me I was going to stay in Africa and marry one of her brothers so I could be her sister :)

Kokou- always a friend to everyone and happy to help even when his shift was over

Jean- one of the first friends I made in Africa. Knows West Africa well (I traveled a lot with him) and likes to laugh... Ogblenachan!!!

Baloukiyem- name literally means "the enemies are fighting for nothing". Has a heart for God and the Togolese people

Amele- a beautiful woman with a lot of patience. She speaks little English, but has taught me a lot of Ewe

Dzinye le Africa

Aissa.

Noma. The face of poverty. Named after the Greek word “nomein” literally meaning to devour. Noma is a devastating disease selective to those mainly between the ages of 2 and 14 living in extreme poverty- where basic nutrition and medical attention is either unaffordable or completely unavailable. Noma usually occurs from normal bacteria in the mouth taking over when the immune system is severely suppressed- malnutrition being the culprit in most cases. Beginning as a small wound, similar in appearance to a pimple, within a few days to a few weeks the disease progresses to a severely disfiguring condition where facial tissue, muscle, and bone may be completely destroyed. Noma is easily cured with a few doses of Penicillin and if treated in the beginning stages, scarring is minimal. Without treatment, Noma has a mortality rate of roughly 90%. The 10% that do survive rarely have good function of their jaw and or ability to chew and are left to live as social outcasts.

Noma was last seen in the developed world during World War II among those imprisoned in concentration camps subjected to the extreme conditions there within…. Present-day, in the same world where Americans spend approximately 12.2 billion dollars annually on health care for their house pets, millions of African children are dying from not getting enough food in their bellies- and the ravaging diseases malnourishment allows.

…And this is where I would like to introduce you to Aissa…. Aissa is a six year old girl from Cameroon. She was abandoned by her parents- but taken in and cared for by her grandmother. Aissa is one of the 33 million children in Africa that does not get enough daily nutrition; unfortunately in her case she was so malnourished her body’s immune system was nearly non-existent making her susceptible to the devastating effects of Noma. Aissa was first brought into the Meskine hospital in Cameroon. She was found outside the hospital pharmacy, emaciated with a rag covering her face and a cloud of flies swarming above her. She was about to be turned away from the hospital as Aissa’s grandmother did not have money to pay for treatment and the hospital lacked the funding necessary, but the Medical Centers of West Africa stepped in and offered to pay for Aissa’s treatment. Had she have gone home, death would have soon ensued. Four days after Aissa's arrival to Meskine Hospital
Aissa two weeks after treatment was started
Aissa's first trip back to her village
Treatment was started and the infection was cleared, but much work was still needed as Aissa was left with a large hole on the side of her face. A couple of months ago, referred by one of our current Physician Assistants- Sarah Root, and with travel funded by the organization “Willing and Abel”, Aissa and her uncle traveled from Cameroon all the way to Togo to get free reconstructive surgery on the Africa Mercy… and that began our relationship with Aissa.

Aissa upon arrival to the Africa Mercy
Our hearts melted for her and the hard life she has had, but Aissa's hospital stay came with a good amount of initial difficulty. The ward can be a very scary place for patients that have never been away from home.... And Aissa was having a hard time coping with the change and exhibited her stress through a few seemingly unending spitting and crying temper tantrums a day. She was one of our most challenging patients- on top of our inability to communicate with her as none of our staff is Cameroonian.... Aissa was a child in need of love, safety, and acceptance. We discussed her care and made loving guidelines for her. We gave her as much love as we could while setting healthy boundaries for her... and slowly we watched her transformation.
The operating team with Aissa
As we closed the hole in her face, we watched her heart heal. She soaked up the love. Aissa's temper tantrums became much less and much shorter, she began interacting well with other children, and cooperated with her care. Mainly through charades, a few words here and there, and many hugs, we developed a relationship with Aissa. She stayed with us for quite sometime, with her bed in “A” ward- and the ongoing joke became, “A-ward is for Aissa”. It was beautiful to watch the healing process in Aissa. She now has a new face and another chance at life… And out of it all, what was the best medicine for Aissa???? Love, love, and more love. She has had a short and hard life and it seems like all she wants now is to play, to be cared for, and to be loved. She has become part of our family.

*Pictures and history prior to arrival at Mercy Ships courtesy of Sarah Root

"A-ward is for Aissa"

Aissa with Sarah Root during a dressing change after getting her graft

African Adventures

Africa is a world of extremes. A world that simultaneously holds incredible life, beauty, and wonder, along with immense pain and suffering. My life here consists of constant exposure to both sides of this spectrum at times in the same view, the same thought, the same experience.

When not working, our main objective is usually to get off the ship- to explore the world off of this floating metal box in which I live. We search the guide books, ask the locals of their opinions, their experiences to find our next adventure… to climb a mountain, to feel the water from a majestic towering waterfall pound on our skin, to feel the fresh African wind against our face- to find our next high.

The last few weeks in Togo have been full of adventure. A few weeks ago we left for a trip to Kpalime- many say this is the most beautiful place in Togo. It holds a few waterfalls that dance off of green mountains into lagoons below. Mt Agou- the tallest peak in Togo is also in Kpalime. Many people call Mt. Agou home as they build their villages along the steep hillside. We hiked this mountain on a Sunday, each step accompanied by the rhythmic sound of the djembe, African voices worshiping God in their chapels, and children shouting their greetings as we walked on by. Goats along the hillside resting in the shade, butterflies filling the forest air- every square inch of this place is bursting with life and beauty.

A young girl from a village on Mt. Agou doing the family laundry

We love Togo!

A colorful resident from Mt. Agou
We all took zemijeans to the top of a nearby peak to look out over Togo and into Ghana. The ride was about a half hour to make it up the mountain on a dirt road surrounded by a canopy of treetops with the occasional window in the vegetation to reveal a sea of green below. It was quite a memorable ride as we watched the sun go down on Kpalime to tuck itself away for the night and allow the stars to fill the night sky with their beauty. The sun coming up on Atakpame
My next weekend off we decided to head to a village 3 hours north of Lome called Atakpame. Upon arriving we asked the local people what they recommended doing and they told us about a nearby lake where hippos live. We left the following morning at 4:30- an early start, but absolutely worth it. We watched the sun come up during out 2 and a half hour ride on a motorbike. The trip entailed a stop at the nearby village chief’s house to ask him for permission to enter their lake. We got to the lake and then took a canoe to come across a hippo with her young walking on land and into the lake. I knew this was a special moment when the locals guiding us got excited about this saying that it was extremely rare to see the hippos out of water. We traveled a total of 5 hours roundtrip via motorbike to get about 30 seconds of hippos, but yet again totally worth the trip.
Hippo tracks!

Kelly and I taking a canoe to see hippos

Hippos!... From a distance
On our way back to Lome we took a local 15-seater taxi- me and six other friends. The first few minutes of this ride were pretty comfortable and spacious, but soon to change. Within a few miles I felt as though we were in a circus car, filled beyond the max capacity- the moment you believe the car cannot fit anymore people, in come several more, baggage and all. Our three hour ride back to Lome in the 15-seater van ended up providing transportation for 21 people, 2 chickens, a cat, and a live goat on the roof…. A perfect inspiration for a sing-a-long song:

The chickens in the van go, “baak, baak, baak…”
The cat in the van goes, “meow, meow, meow…”
The goat on the roof goes, “eeeehhh, eeehhh, eeehhh…”
The children outside shout, “yovo, yovo, yovo”
Christina in the van says, “Just get us there safely…”
…. Alllllll the waaaaaay to town
The passenger next to me: the proud owner of a chicken

Looking out my window: The shadow of the man tying the goat to the roof

A family that invited us in during a walk along the beach. Cooked for us and we spent the day with them.

The family's home water source. Our visit included a lesson on how to draw the water- involved more skill than I thought.

The back of a restaurant in Atakpame... showing us how to make fufu
The patients bring the beauty of Africa to the ship. A few days ago I was working the evening shift and noticed a translator come into D ward and take a small drum and leave- I smiled as I knew an impromptu African sing and dance party was about to start. This is worth dropping the task part of my job, the things that can be done later even if this means I have to stay late- to witness African community life.

A party began in B ward. Everyone with an instrument- a drum, an aya (a beaded shaker), a metal coin to beat against the floor, or their hands clapping together- they do not have much, but what they do have is put together to make the most incredible rhythmic and lively music. The women gather in a circle, each one taking their turn to come into the middle to dance and be cheered by the others. A few of us nurses joined in the circle and attempted to move our bodies as they do- barely coming close, but they all loved and welcomed this. They all took off one of the skirts wrapped around their waists and wrapped it around us- a sign of friendship, of acceptance. They cheered us on and showed us how they have a good time. My heart rejoices in these moments- to be a part of their lives, to be welcomed and accepted by them. We are very different people- with backgrounds that cannot be more different, but we can both understand a language of love, of friendship, of life.

…but even in all the magnificence it is impossible to ignore the reality of this place. Coupled with the beauty are signs everywhere that I live on a broken planet- The zemijean driver that tells me his only wish for his life is to own his own motorbike so he can make more than a day’s worth of wages each week. He now has to give what he earns the other six days to his boss. He can barely make ends meet as he makes but a mere $30 a month.

The naked starving children with sticks for legs that hold up pot bellies (enlarged from a lack of protein in their diets) sitting next to mama as she works all day at her stand selling stolen petrol to make a living.

The people willing to wait in line for hours under the African sun as they are barely in good enough health to stand- to see a few doctors and nurses from the west that may just say yes.

The Beninese man emaciated and dying of cancer who made the trip from Benin knowing the ship, his only hope, would eventually arrive in Togo waited in the streets of Lome without shelter for ten days- also during a time of heavy rainfall.

It is all a learning process for me- to learn how to take in the beauty and enjoy it- to allow the emotions felt from the suffering I see to drive my passion and not discourage. To be content with the work I am here to do. I recently was in a discussion with a few friends and one was asking the other, “But, how do you not become overwhelmed? How is it that you have not given up on this place- don’t you ever feel like no matter how much work you do it will never be enough?” And the other replied, “All each one of us is called to do is our part. If everyone does their part, all will come together as it should.”

Warm in Africa Again

Finally… my heart is warm in Africa again. After eleven days of sailing the Atlantic along the west coast of Africa with its many swells, winds, and crashing waves we arrived in the port of Lome, Togo. Warmly welcomed by drums, trumpets, and singing and dancing people- this is our home for the next 6 months- such a beautiful country full of beautiful people… yet oh so full of need.

Leah and I sweaty, but happy to be in Africa again

As soon as we pulled into port the process began of setting up the hospital to prepare for the surgeries planned for the outreach. We cleaned every square inch of the hospital, stripped and waxed floors, and set up each ward to accommodate the patients that would soon come.

The Africa Mercy Nursing Staff

During the next six months, our beds will be full of those in need of orthopedic, maxillofacial, vesicovaginal fistula repair, and some general surgeries… And I become excited for the hospital to come alive again.. to see the children in their hospital gowns playing soccer in the hallways, the rhythmic sound of the djembe accompanied by singing and dancing, the mother crying with joy as she sees her child come back from surgery with a beautiful newly formed smile… the African people bring so much life to the ship.

The process begins with screening days- where the Togolese people in need of medical assistance gather to see if there is a chance they will receive treatment. The crowds were full of those unable to see, people with massive tumors and facial disfigurements- eyes full of pain from years of rejection and isolation. Mothers were carrying their children with limbs so contorted the child has never known what it is to walk. For many living in Togo- a country where over 50% of the population lives below the international poverty line of $1.25 a day, this is their only hope for a better life.

A crowd of people waiting to be screened

My job during one of the screening days was to “pre-screen”. This is the very first process of screening. Those in line with ailments that the ship has no ability to treat are told that we will not be able to help them. This was a hard job to do- the disappointment was tangible, everyone has their own story of pain, suffering, and wishing for a better life... but this was just another “no” for people that are all too used to being told no. And so I continued my job of screening, but I knew at the end of the day I would need time to process what happened. Time to grieve the pain I saw and the people we turned away... time to pray for healing in their lives- whether that be physical or not. Time to hand the emotions felt from this experience to He who is greater than me.

There were many in line who had lost use of one or more limbs from burn contractures, those born with leg malformations severely limiting their ability to walk, if able to walk at all. I saw those whose faces disfigured by massive tumors were hidden behind a scarf or handkerchief- with just the eyes visible, but downcast to the ground as they have been taught through many years of being an outcast that they are simply too hideous to show their face in public… And I was able to be the first to tell these people, “yes, we would like to try and help you” and point them to the tent for the next stage of screening. What a joy to witness their reaction, to see their faces become full of relief and hope that this may be the day that their life is changed.

One of our first patients accepted for surgery, happy to be holding her patient card in hand

And now the hospital has been open for a full week. We have done a few surgeries already and things have been running pretty smoothly. I am so happy to be a nurse again. It feels good. It feels right.

I am so honored to be here, so grateful for the experience of being a part and a witness to the help given to the Togolese people. I want to thank the many that have prayed for me, encouraged and supported me, and helped make this possible. I have learned so much here and my life has already been changed by this experience. My heart feels so alive here- and I am now convinced that I need Africa more than Africa needs me.