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.

Eleven Days of an Ocean Safari

On December 8th the mooring lines were pulled and the crew of the Africa Mercy said goodbye to Benin. There were many gathered to bid us farewell, local staff that we worked with and crew that would go to Togo to prepare for the ship’s arrival in February. We said our goodbyes and promised to stay in touch… and all of our hearts were filled with excitement for the days ahead of us.

Everyday had its fill of magnificence- few were the hours we spent inside. With all of our free time it was to the bow or deck seven or eight to see what kind of manifestation of beauty the day held. Our views were full of flying fish, dolphins, whales, water spouts, incredible sunsets- only to be followed by a sky full of twinkling stars which included a few nights of meteor showers… Pure ocean bliss.

I thoroughly enjoyed the sail- being surrounded by beauty and good company… but by the eleventh day most of us were ready to step foot on dry land again and explore beautiful Tenerife- and by our first sight of the island, I knew that it would not disappoint. Viva españa! :) View from the dock

Tour of a Beninese Public Hospital

Several weeks ago I was working with a friend of mine named Jean who was a translator during our outreach in Benin. I have always enjoyed working with the translators and hearing their opinions on aid, politics, and the current problems Africa faces. He began to tell me of the health care available to the common public of Benin, and I simply could not believe what he told me. I asked him if he could give me a tour of a local hospital to get a better understanding of the things he spoke of….

Several friends and I met Jean at a local public hospital one afternoon for our tour. He first brought us to the emergency room. Two armed guards in camouflage uniforms guarded the double doors that led to another world none of us had ever seen before: a world where words alone cannot express the brokenness and despair we saw that day.

The doors were opened and we stepped inside to be immediately hit by hot and humid stagnant air covered in the smell of bleach with constant alarms going off in the background. People were lying on the floor in all corners
of the room waiting to be attended to. A man obviously delirious after being in a zemijean (motortaxi) accident was trying to climb off his stretcher while his family member held him down. Surrounding us there was an obvious need for immediate attention, but there was almost no staff to be seen- no one in a hurry to help.

We were brought through examining rooms, and found more patients waiting. We walked toward the back of the ER to find a man on a stretcher breathing rapid and shallow breaths, his eyes rolling back in his head. He was lying there with just a thin cloth covering him and the room was full with the unmistakeable smell of death and decaying flesh. Flies swarmed and surrounded his right leg which was partially amputated from a traumatic zemijean accident and was in immediate need of full amputation. He was lying in his own excrement- left to die an undignified death. We were all so appalled by this sight and we all asked, how can this be?

One of the hospital staff, a nurse, allowed us to ask questions and answered us as we stood in shock and disbelief. This man represents a dire problem in Benin and his case is not uncommon. He was in a motorcycle accident and was brought to the hospital for medical care, but as he had no money, he was unable to receive help. Efforts were made to contact family to get funds for treatment, but until they arrived with the money in hand he would remain untouched by the hospital staff… the day we arrived was his tenth day of waiting for help.

The nurse told of us of how the hospital was severely lacking in medical supplies and in order to be treated, the patient must cover all expenses, including the medications needed. If the patient needed IV fluids, they must buy them, including the needles, IV tubing, and all. The pharmacy sells these medications and supplies at a price that many cannot afford… this problem explains the IV tubing (usually without it’s wrapping to ensure sterility) sold on the streets.

He answered our questions regarding the apparent lack of staff and told us that along with subpar working conditions, the pay was next to nothing leaving staff to go on strike. He told us the hospital is usually run with a ratio of one nurse to 50 patients or more- an appalling condition for a hospital ER.

We were brought through all of the hospital: the lab, patient ward, and various other areas, but the dying man left alone on the stretcher laid an impression on my heart- I truly realized at this point that life for the average Beninese is truly a hard life… which I knew, but this was the moment that it really sunk in.

God, help me to see these people as you do. May I not get lost in the suffering I see, but see a vision of hope and a future for them. May I practice what I preach. May I not rely on my own strength. When I am driven to frustration, may I not place judgement. Teach me how to love them- and may I choose love in every situation. God, give me the heart you have for Africa.

“You came for the lost, the sick, and the blind with salvation and hope
You gave to us freely so what will we do with this treasure we hold?
Let justice roll on like a river
Let mercy shine bright as the sun
Take care of the orphan and widow
Take care of our own flesh and blood
Because this is the way that You called us to love
To share what we have with the hungry and poor
Put clothes on the naked and heal the broken and torn
True Religion”

Lyrics by Ryan Delmore: True Religion

My Everyday Job.

Working onboard the Africa Mercy is much different that anything I have ever experienced… Patients from Benin, Togo, Nigeria, and Ghana come in hopes that they may be helped. Any given day, one can walk in the hospital to find many lives afflicted with different conditions, but all with similar stories: stories of living with a debilitating condition and the inability to find and or receive healthcare.

A boy treated this year on the Africa Mercy for removal of his tumor

Working here on the Africa Mercy, I have the privilege to witness lives being changed on a day to day basis- disfigurements being removed, the lame given the ability to walk, sight given to those blinded by cataracts. Babies coming severely malnourished, many with a cleft lip and or palate and their lives are truly saved through the work done here.

The patients not only have to cope with their physical ailment, but many times something that can be much more devastating: the attached stigma. A common view held here in Benin of those with disfigurements is that they are under the power of a curse, which many times is enough to be shunned from their community.

Before, during, and after treatment: An example of one of the many lives changed.

Something I find the most heart-breaking about my time working in the hospital are the children that have to suffer because of this. Regularly we see babies come in with a cleft lip and or palate that are severely malnourished- most of the time disabling them from being able to suck properly. Coupled with the mother’s reluctance to feed the baby (many times due to beliefs of the baby being cursed) babies present to us with six to nine months of life weighing below a normal birth weight, sometimes barely holding on to life. So much pressure is placed on these mothers, many of whom have just become of child bearing age. If the mother does decide to feed the baby, her decision may be met with strong opposition from the community. When mama and baby come in, it becomes obvious that there is a lack of bonding and much teaching is required to help these mothers take care of their babies properly. But how do you teach a mother that does not have much of a desire to learn about her child? A mother who has not yet decided whether or not she wants to keep her baby or leave it to die?

A patient I took care of with Leishmaniasis, a condition rare to the developed world, but more commonly found in Sub-Saharan Africa caused by a flesh eating parasite. We gave her treatment for the parasite and she will return to the ship for facial reconstruction.

This aspect of the work here I find the most challenging and heart breaking. How do you convince someone that life is beautiful; that life is not expendable and its value is intrinsic? I do have hope for these people and believe in the work being done. I pray that through our efforts, we may show the people here, our patients that life is valuable. We are here to serve them and love them regardless of the way they look. We encourage mother and baby bonding and congratulate the mother on how beautiful her baby is… and from time to time us nurses are given the privilege to hold the babies which we take great and obvious joy in. Our mission is to transform lives by love- and on occasion I am given the opportunity to witness this happen before my very eyes.

A tumor removed from a patient I worked with who watched his tumor grow over the years until he was finally able to receive treatment.

Everyday the work here is challenging and rewarding- and from time to time heartbreaking. Everyday I see lives being changed and through my time here, my heart’s burning desire to serve those less fortunate has been confirmed. I am thankful for the privilege to be here, all the things I am learning, and the honor of being able to serve these people in love.