Chapters

  I listen to this podcast called No Dumb Questions. In one episode, one of the hosts explained something that really stood out to me. Life isn't a series of books. It's not a collection of stories with distinct beginnings and endings. It's one long, unfolding story. It's a book with many chapters. 

  When one chapter ends, it can feel like the story is over. It can be hard to see what might come next. Like coming to the end of a book; it can feel like there's going to be a hole in your life that the story used to fill. You've gotten to know the characters; to love them, even. To love sharing in the adventure with them. It's hard to close the cover for the last time.

  But this podcast host, who was moving his whole family to a new state and new job, had realized that this major goodbye was not the end of a story, it was simply the end of a chapter. All it would take was a turn of a page, and the story would continue. Yes, the characters might be in a different place. Some may not be in the story as much. Some new ones may appear. Some may have grown. If it's a good story...there better be some character growth! But it isn't the end. It's just setting up for the next thrilling twist of the adventure. 

  I am coming to the end of a chapter. My time at Mercy Ship's has been incredible. It has been full of challenges. It has woven so many beautiful experiences and characters into my story. Some of those story threads are still unwinding. All of them have taught me, shaped me, molded me, weathered me into someone different than I was before. 

  There has been heartbreak and healing. I've learned so much about how to love. To really love. The way Jesus did. But boy do I still have a lot to learn. 

  And that is why, although there is some sadness in my heart, there is also great anticipation. 

  I don't know what is next. 

  I haven't quite turned the last page yet. 

  But I can make out, ever so faintly, the words on the page behind the one I'm on. There is a beautiful mystery in it. It's thrilling and emboldening to know that the Author has already pencilled them in. With creativity and care and so much love. 

  I can't wait to read them.

  I can't wait to live them. 

  For everyone in this little book club, thank you. Thank you for being part of my story. 

  I'll see you in the next chapter.

À la prochaine,

   -D

What It Takes

Well hello there! And hi again from Senegal!

This is me moonlighting in the lab, which has been a fun addition to my usual office routine this week. They're running a bit short staffed, and just across the hall from me, so I've been able to add 'packaging tumor samples for trans-atlantic transport to the pathologist' and 'blood bank assistant' to my resume. 

Back in December, as I mentioned in my last post, the AFM (Africa Mercy) sailed to Tenerife to meet up with big sister GLM (Global Mercy). After many of us moved to the GLM, we Celebrated Christmas and New Years while transferring equipment, unpacking, repacking, polishing, re-installing, troubleshooting, and hosting contractors to get the ship operational. Literally. We also had a little bit of downtime and some wonderful reunions. 

Now that we're a couple months in, I thought it would be a good time to talk about just what it takes to get a brand new ship ready and rolling in action for a surgical field service.

Ward Leadership Team near the end of Senegal 2022

What does it take?

It takes...this many people to pass the hospital baton from one ship to another. 

Both ships' crew gathered together on the dock in Tenerife!

It takes this many people (and a mountain) to make my heart full.

A day to explore the other-worldly plateau near Mt. Teide - Spain's highest peak. 

It takes this many wagons to keep ortho patients entertained. 

Wonderful ward nurse Caroline tests out some of the new equipment for patient recreation.

It takes this many wires and connections to get complete cross-section imaging of the body.

Biomedical technician Deborah gets the new CT Scanner working.

It takes this many toys to keep the doldrums away from the wards.

It takes 5 crash carts that we hope and pray to never need.  

Wonderful ward team leader Ansley builds crash carts from scratch.

It takes joyous reunions with incredibly hard-working Senegalese team members.

Day crew who worked on my ward last year, back for another field service!

It takes a whole lot of nurses and translators from around the world!

It takes scrubbing and redecorating to welcome patients back into the HOPE Center.

It takes 2 platforms to raise up the gangway to a traversable height. 

Actually, the platform on the left has since been upgraded with a nice, long, gentle ramp. 

It takes 2 hospital evacuation drills (don't worry, no actual patients were harmed in the process), and a TON of work to plan from scratch the best way to evacuate a 2-deck hospital with no gangway access on the OR level.

An 'intubated patient' is carried down the very steep stairs.
This is why they got replaced with a ramp.

It takes prayer. A lot of prayer. Every day.

The hospital was commissioned with a prayer walk-through of every patient space.

And then at last...the real work can begin. 

The first patient to receive surgery on the GLM.

And then it still takes energy every day to keep those cast-bound kiddos from going stir-crazy.

Play time on the patient veranda

It takes this many people to run a hospital on a ship.

It takes 3 times as many to run a ship that has a hospital on it. 

I am incredibly blessed to have been part of this ground-breaking work. It has not been easy. There have been roadblocks thrown at us from all directions. And there is still much ahead. 
It takes a lot more than what I could possibly capture in one post, or with a hundred photos. But we are here. Patients are receiving surgery. Senegalese and Gambian professionals are receiving training. 

Kingdom work is happening. 

GLM Hospital Leadership Team 2023

As I approach the end of this field service in July, I know I will be winding down for a substantial break. I don't know yet how long that break will be, where it will take me, or if I will return. 

If you are the praying kind, I would ask for your prayer for discernment and direction over these next months. 

Thank you all for walking this journey with me.

Á la prochaine,
    -D

The Middle

 Hello.

I didn't forget that this blog exists.

I've just been stuck in the middle for a while.

In the middle of a crisis, or of a break, or a journey, or a transition. Always in the middle of something.

At this exact moment, I'm in the middle of a hammock, in the middle of the Atlantic in the middle of a journey between Tenerife and Dakar. So although I'm still in the middle of something, it's at least something that gives me a good opportunity to write an update. 

Last year's field service in Senegal wrapped up well. It was a seemingly never-ending challenge, with last-minute changes and scrambles to get our patients all safely home, but God got us all safely through it. 

I also ended the year in the middle of two jobs. I was asked to step over into a new role, as Hospital Quality Manager. Officially, this starts this year, but I started helping with some of the more time-sensitive pieces back in October. I'm grateful for a job that will allow me to still spend a little time in the wards where I love working best, but without being 100% in the people zone all the time. My enneagram 5 self is looking forward to a bit less of a constant drain on my social energy. As 'HQM', I'll be 'facilitating' a lot of things...policy updates, clinical incident reviews, implementation of measures to improve patient outcomes; things like that. Lots of spreadsheets; which I don't mind.

Once I moved over to my shiny new home, the Global Mercy, I officially took over that role for the hospital here. Oh yeah, and my parents came for a lovely visit!!

Both ships sittin' pretty together in Tenerife!

Mom & Dad on the GLM

This hospital is brand new, and years of planning have culminated in these last couple months of preparation for its first field service. There's plenty to figure out still, but it's incredible to see how much has been accomplished. The obstacles have been enormous, too. COVID, immigration snafus, and the latest wrench in the works, affectionately nicknamed by our Managing Director, 'PBBPP.' Or in other words, 'Project Bring Back Peppa Pig.' 

We were without internet (and most of our information systems) for nearly a month. Some of the kids really missed their Peppa Pig, among other things. Here's where I quote the company line, to make sure I don't say anything I shouldn't. "We detected a threat to our IS systems, and our team quickly responded. It takes some time to completely assess what was impacted, and we are in the process of slowly and carefully bringing our systems back online." 

So that was fun...in the ramp-up to another 5 months of surgery we lost access to our policies & procedures that guide us (all hosted online), our digital patient database (requiring networking), printing capability, simple phone communications....the list goes on and on and on. Instead of updating our existing protocols, we've spent the past few weeks creating brand new work processes to be able to do everything we normally do without relying entirely on technology, and without compromising patient safety. 

'Ted' testing out our ICU facilities

The hospital team in the operating room as we walked through our patient flow processes from start to finish.

Gratefully, we've seen great plans fall into place in case our systems are still impacted, but also answers to prayer as the most critical systems have been restored. 

Sailing alongside the AFM before she heads off for maintenance in South Africa

And so, with great uncertainty only a week ago, we are now confidently cruising our way towards Dakar for the GLM's inaugural field service. It's a little shorter than most, with a gradual ramp-up as we're adapting all our usual processes to a brand-new environment. 

And that's not all that's new!

Some of our patients from last field service will be back for follow-up, while most will be new (our patient selection team has been working hard in-country to find the people who can benefit most from free surgery). Most excitingly, some of these new patients will also be coming from a different country: the Gambia!

The Gambia is a really unique nation which is nestled entirely within the middle of Senegal (with the exception of a tiny bit of coastline). Its flag represents the Gambia river which runs directly along the middle of this little country. I'm really looking forward to meeting and learning from the Gambian people over these next few months. The two countries have a close partnership, and are sometimes jointly referred to as 'Senegambia.' And of course, as is the case with this entire part of the world, so many people groups have homes and identities which ignore political borders. Their community is where their language is spoken, and that's never been constrained by imaginary lines. 

I'll look forward to my next opportunity to report how things are going once we're back in country and surgeries are happening!

Until then, a la prochaine,

-D

Pie.

This week, our Operations Director Jeff started the week by sharing something he attributed to Dr. Pete Friesen - a Coach & Trainer for the Carolina Hurricanes plus numerous Canadian World Championship & Olympic teams (I say attributed because I tried and failed to find any similar quotes online...so if anyone else can please share). 

He told us about the Rule of Thirds:

"If you're really working hard toward your goal, you should feel great about 1/3 of the time. 

1/3 of the time you should be just coasting along.

The other 1/3 of the time you will feel terrible and beaten down."

(to summarize, I made this helpful pie chart)

He continued:

"With this rule in mind, if you never feel like you've got nothing left to give, and just feel great all the time, you aren't pushing yourself enough. You're capable of more, and you're holding yourself back. 

Conversely, if you feel terrible more than 1/3 of the time, you aren't taking time to recharge or to recuperate. You're not taking the appropriate self-care steps. You're at risk of injury and burnout."

Now, I have never been an athlete of any sort at any level. I dropped out of most of my high school teams within a couple months. I have my excuses, but that's besides the point. Until 2020, I'm not sure I had ever seen this rule played out to its full extent; at least, not in myself. 

Only during the boredom of COVID restrictions did I find the drive to push myself to feel physically terrible 1/3 of the time long enough to be able to say, "yeah, I jog sometimes. I'm a jogger." And you know what? It felt pretty great the other 2/3rds of the time. 

Also (mostly) thanks to COVID I've found myself in a tightrope marathon; a seemingly endless balancing act between "things are ok right now, let's make the most of it," and "oh crap, here we go again." There have been times it was go time all the time, and the yellow slice of my pie chart took over. There was no time to recharge, no time for self-care. Other times the slices stayed the right shape, but the time-spans stretched WAAAY out: 1 week of insanity, 1 week of coasting, 1 week of feeling pretty good. Lather, rinse, repeat. 

Jeff's words came as a very healthy reminder of my limitations. That it's ok, even good, to feel like crap sometimes; that it can mean I'm working hard to accomplish something positive. It's pretty easy however, in an environment where your coworkers are your dinner buddies and your patients are your downstairs neighbours, to stray into one-half to two-thirds territory. 

So I must say thank you. To every coworker/dinner buddy/neighbour/friend who has told me it's time to leave the office/take a sleep-in day/book a couple more days of vacation. I think my pie consumption is slowly starting to come back into balance. 

And as I approach the end of the race - or at least this leg of the race - it has definitely been worth the whole pie. 

À la prochaine,

-D

Anniversary

I've officially passed the 1 year mark since I embarked the AFM in Las Palmas. 

It's a little crazy to think back at everything that has happened. 

I spent the first few months at the Reception desk, and then the Purser's office, managing the comings & goings of crew, the emergency team assignments, and assembling immigration records for sailing. 

I lived out of a hotel for a few solid months of 2021, both before arriving to the ship and after - during drydock! 

I went back to my happy place, the AFM hospital, and tackled a mountain of work trying to turn what had basically been overflow cargo storage for 2 years back into functioning wards and an ICU. I had a great team that started incredibly small, but grew and grew into a group of amazing, dependable, hard-working nurses. That group has evolved over the year, as it always does here, but I consider myself so blessed to have had such great colleagues with such a heart to serve. 

I reconnected with old friends, built deeper relationships with old acquaintances, and found new, lifelong friends. No...scratch that. New family. I walked with this family through joy, through storms, through outbreaks, through boredom, and through pain. We created beautiful things together, we laughed, and we cried. I nearly lost one of them. It was wonderful and it was hard. And it was so very worth every moment of it. 

We sailed back into Senegal - such a joyous day - and got to pick up the work we left off. Bringing back patients who were waiting patiently for surgery for 2 years through the pandemic. We got to see our sister ship, the GLM, visit the continent for the first time. We saw diplomats, presidents and ministers of health commit to tangible goals for improving surgical care across Africa. We saw hundreds of healthcare professionals from all sectors receiving training to help achieve those goals. We saw so much potential, hope, and joy for the future. 

We faced challenges. And boy, were there a lot of them. We faced destructive weather, electrical fires, COVID, COVID, and even more COVID. We faced the unique problems of finding safe ways to continue working on a ship in the middle of an outbreak, and trying to remember how things worked even in the before, "normal" times...2 years prior. Every department on the ship has pulled together to get us successfully through the field service thus far. 

We can and we have "done hard things" (this was the Academy's motto for the year, one that became the brunt of a few jokes as things just seemed to get harder and harder)! We have journeyed towards healing alongside hundreds of surgical patients this year. 

We welcomed women who had suffered through painful, prolonged labor, then lived with the shame of incontinence for years as a result. We got to celebrate healing for many of them. And for those who continue to live with this burden, we got to show them that their condition does not define them. That they are still valued and loved.

We welcomed men, women and children from all walks of life with hernias - often massive, painful and limiting. There are so many of them - hundreds - and they don't stay long, so we often don't get to learn what is on their hearts. But we get to see their many smiles as they come and go.

We welcomed dozens of kids with crooked legs, and got to see them walk back off the ship with them straight.

We welcomed many with masses or gaps on their face, so many wearing their disease where the whole world cannot help but notice. So many, who have felt monstrous for many years, leaving feeling beautiful and whole.

We welcomed scarred, burned, devastatingly injured patients whose healing drew their joints inward, locking out their mobility. We forge deep relationships with these reconstructive plastic surgery patients, as some of them take months for their grafts to fully heal. But their joy is all the more deeply felt as we journey through the pain and healing together with them. 

It has been...a journey. That's for sure.

-   -   -

Right now I'm on a journey back home, for the first time in over a year. It is a strange feeling, more like leaving one home to return to another. Like my heart is in a few different places, and sometimes I need to leave one piece behind to retrieve another. 

I thank you all again for walking with me through this ongoing journey. 

It's a team effort. 

Niofar (we're in this together). 

À la prochaine,

- Danita

A Tale of Two Kidneys

I had a lazy morning in my cabin today. While I was sipping my tea and pondering a certain patient's situation, I started thinking about Hemodialysis. 

I've never worked directly in a Dialysis setting, but back home a decent number of my vascular surgery patients had some kidney function problems. It wasn't unusual for one once in a while to be on dialysis, and three times a week we would wheel them in their hospital bed down the hall to the outpatient dialysis wing. I started thinking about how wild it is that someone can have completely non-functioning kidneys and be kept alive by spending a few hours every couple of days plugged in to a machine. Blood goes out a tube, through a contraption (which I barely understand) where toxins, excess fluid and other waste materials are removed, and 'clean' blood is returned back to the patient. 

That such technology exists--that we have figured out a way to replace the work of such a vital organ--is pretty mind-blowing. 

Quite a few people in Canada live productive, relatively normal lives sustained by this technology. Sure, there are some limitations. You can't really travel without being sure there's a dialysis facility where you're going, and arranging treatment there. There are medications and other precautions you must take. But over 23,000 Canadians rely on dialysis treatment to live.1

---

My mind went on this tangent because I was a little worried. 

One of our patients was having rather odd symptoms, and one of the more likely explanations was that his kidneys weren't functioning properly. 

I wondered what it would be like, compared to what I've seen in Canada, to live with kidney failure in a place like Senegal. 

Dakar is a big city with a number of pretty top-notch hospitals. And indeed, there are a smattering of other hemodialysis treatment centers around the country. Treatment is even free(ish). I say 'ish,' because you are often required to pay for physical resources (i.e., medications, implanted access ports, etc), even if a procedure itself is 'free.' Just over 1000 people currently rely on chronic dialysis treatment in Senegal. Well over 1000 are on wait lists. About 75% of those on the wait list will die before they get treatment.2

The biggest barrier, as with so many aspects of healthcare in West Africa, is resources. There's simply not enough specialists. Not enough machines. Not enough nurses trained to use them. Surgery must be performed to create an access port before treatment can happen, and that can only happen at one hospital in Dakar.2

---

Fortunately, in the case of our patient, it is not his kidneys that are the problem. The mystery of his symptoms has been solved, and, for him at least, my worries have eased. 

There's no quick, band-aid solution to the healthcare gap in low-income countries, but while I'm holed up in the hospital helping with hernia repairs and tumor removals, our Medical Capacity Building (MCB) teams are around the continent doing the real work that will make this a safer place to live. You may have heard about the visit from our enormous-brand-spankin-new sister ship, the Global Mercy, here in Dakar. While her hospital isn't quite ready for patients yet, she did draw in crowds of healthcare professionals to participate in a range of training courses--courses that can and will save lives. And our participants are quickly becoming champions of these essential skills in their own workplaces, multiplying the impact. 

Since I've rambled on for long enough now, I'll shut up and let them tell their own stories. 

The crews of the GLM & AFM assembled together after 6 weeks of service side-by-side.

The Global Mercy has since sailed back to the Canaries to do a little more prep work before her hospital doors can open, and I'll be joining her there in a few more months. 

In the meantime, we'll carry on doing our best for each patient who comes to us needing surgery. 

À la prochaine,

-D

MVPs Pt 5

Banna's eyes are full of joy. 

The first time I met her, she was walking in to the ward with one of our chaplains, and though she wore a mask she clearly carried a broad smile underneath! She entered, greeting each nurse, day crew and patient. I was holding paperwork in my hand, anxious to get it signed, but did my best to patiently respect this custom. 

Let me back up a minute. Banna's name first came up in discussion with a patient's brother. This patient, a teenage girl, needed surgery to remove a large lipoma - a fatty tissue tumor - on the back of her leg. Anyone under 18 has to come to the ship with a caregiver. Usually a close family member, this person takes responsibility for medical decisions for the patient, as well as helping with their daily needs. This girl's older brother came with her as her caregiver, however, once on the ship, he told us he had to leave for an interview at the end of the week. Back in their hometown. 15 hours away.

Now, this put us in a bit of a sticky situation. The girl's recovery would take at least 3-4 days in hospital, with outpatients follow up for a week or two after that. She needed someone who could stay with her 24/7. We asked, "Is there any family here in Dakar who could come help?" 

Yes, a sister, but she was too busy with work.

"Is there any way you can delay the interview?"

No, he would lose the job if he didn't go. 

"Can any other family member come to stay with your sister?"

Yes, but they wouldn't be able to arrive until the weekend, and then they would still need to quarantine for a week. 

The surgeons who could do this surgery would only be here until the end of the week. We couldn't delay, or the surgery wouldn't happen. 

A lot of prayer had already been answered for this patient. She required a CT before we could proceed with surgery, to determine if the tumor was even operable. Our scanner, a bit past its prime, decided to throw a bit of a hissy fit that day and not function. Our biomedical technicians worked through the entire day trying to get it functional again, and we worked on a contingency plan to transport the patient to a local hospital where the scan could be done. 

Her surgery was delayed by a day because of this, but in the end we did manage to kick the old beast into gear and get the pictures we needed. The surgeons reviewed them and decided it was safe to proceed with surgery. 

That just left us with this caregiver conundrum. 

The patient's brother had mentioned a name - someone who was at the Hope Center who they trusted -  who might be able to step in to help. 

Her name is Banna. 

We were discussing all of this with our preoperative team, and they immediately said, "That isn't going to work - she's a pre-op patient."

Slated to have hernia surgery the next week, it would have required Banna to wait until this patient was home, or until another caregiver arrived to take over, before she could have her own surgery. What's more - Banna hadn't been seen by the surgeons yet. We weren't even sure if she could have surgery. She might stay all this extra time to support another patient and then end up not being able to have surgery with us at all.

A Silver Lining

The same Friday all of this deliberation was taking place, I got an email about a surgeon's departure date. My coworker nudged me, "I guess you knew about that already?" 

I did a double take on the departure date. 

It was today's date. 

This was the surgeon who had just arrived; who was just supposed to be starting surgery Monday. Who would have been doing Banna's surgery. A family emergency had come up, and no one could fault them for leaving, but it sure came as a rough blow.

This meant about 30 patients had to be rescheduled for later in the field service. There was no backup surgeon who could fill his place. 

It did mean one good thing though: Banna would be able to fill this need. She happily agreed without hesitation to fill in as a caregiver; understanding that there was still no guarantee she could get surgery herself. We were, fortunately, able to secure a tentative surgical space for her just 1 week later, when the next surgeon arrived. 

Another family member was able to come eventually, and Banna had her hernia repaired without complication. Her smile before and after surgery was the same - even if she was in a little bit of pain. 

I hope I've managed to express even a little bit how bold and beautiful the culture of community is in this part of the world. How a complete stranger will step in, giving a week of their life so that someone can have their own life transformed. The sense of 'Niofar' (we're together, we are one). Every day I learn a little bit more how valuable that perspective is, and how much further I have to grow in it. 

My amazing team of nurses & day crew from around the world. I'm hiding behind PPE in the back row.

From the land of hospitality and dust...

À la prochaine,

        -D