Two Ways To Live

"There are two ways to live: you can live as if nothing is a miracle; you can live as if everything is a miracle." - Albert Einstein

I'd like to share with you all the story of Olivienne.

Olivienne arrived at our admissions centre in early November, and was due to have surgery in several weeks. She would stay at the HOPE Centre in the mean time, where she'd be fed nutritional supplements in an effort to bring her body weight up (she weighed less than 90 lbs), build up her iron levels and blood volume, and improve her body's ability to heal after surgery.

She had a benign tumour inside her left cheek. While it would not spread through her body like a cancerous tumor, it still continued to grow, stretching out her face to the point where her nose was flat against her skin, her left eye was squished shut, and her mouth was gaping, held open by the bulk of stagnant tissue that almost entirely filled it.

I cannot imagine the shame and dejection she has experienced, having to see the horror on peoples' faces upon seeing hers.

As difficult as her life has been, though, Olivienne is extremely lucky. No, lucky is not the right word. Olivienne is the living evidence of a miracle. Not because her tumor was removed, or because her recovery went remarkably well.

It is a miracle she got here when she did, or she would almost definitely be dead.

A few days after arriving, she was admitted to the ward, and was having some trouble breathing. The tumor had grown so large that it was beginning to press on her airway. The tumor was also so vascular (full of blood vessels) that blood was trickling down into her throat, blocking her airway even more. Normally, someone would cough if this were happening, and force that blood back up, clearing it out of the way. But already having a very limited airway, and very litle space in her mouth, it was not possible for her to keep up with the bleeding.

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That particular Thursday night, I along with most of the crew, were sitting in the International Lounge enjoying some worship and teaching. Halfway through the service, a pager went off and a doctor ducked out of the room. A minute later, another went off. Then another. About 6 doctors and nurses left the service, leaving the rest of us glancing nervously at each other, and silently praying for whoever it was that obviously needed some urgent care.
 

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The "whoever," of course, was Olivienne. They had taken her to the OR to insert a tracheostomy - a tube at the base of the neck directly into the trachea - so she could breathe unhindered by the tumor. The bleeding from the tumor had also brought her iron levels dangerously low, so she was given several units of blood.

Two nights later was my first night shift; I was on the Maxillo-Facial ward, where Olivienne was. I learned what had happened, and was amazed at how well she was doing, in spite of it all. Around 2 AM I left to grab a bite to eat. I came back in to find the other two nurses hovering over her, their hands in her mouth applying pressure and suction, a basin full of blood on her lap. The tumor had begun to bleed again. And boy did it bleed. It took about 30 minutes and an infusion of Tranexamic Acid (which improves clotting), to get it under control.

Olivienne's surgery was bumped up to the head of the line. No one had been able to reach her husband, who was apparently in town somewhere, and we were all desperately praying for him to reach us before her surgery.

He did. The night before. 8 hours of surgery and 12 units of blood later, she was tumorless and in the ICU, on a mechanical ventilator, being fed through a tube. 12 hours afer her surgery, she was up walking around, breathing through her trach, getting her hair braided, and smiling. Although it was a little crooked, it had been impossible for her to smile a few days before. 

She now has a nose, a functional left eye, the ability to eat without choking, and can breathe on her own. She has required a few more surgeries to further repair and correct some issues, but is looking amazing. Last time I saw her, she was strolling around the HOPE Centre, grinning and nodding when I said "Salama."

Her face may never be perfect, but it is beautiful, it is strong,, it is full of love, and it is, truly, miraculous.

Hope...Does Not (in this case) Float.

As promised, may I present the HOPE (Hospital Out-Patient Extension) Centre:

Not too long ago, it looked like this:

The HOPE Centre is an integral part of Mercy Ships' work in every country they visit. While the surgical interventions provided on the ship are tremendously beneficial, they are a small part of a very big puzzle. Mercy Ships is a well oiled machine, and has figured out (over the past 37 years or so) how to best address the very large void in the healthcare of developing nations.

If we could sail the ship around, plopping down fully equipped, staffed, and funded western hospitals in every country we visit, that would be really awesome.

But, unfortunately, it's also just not feasible.

Mercy Ships' model works because it allows experienced professionals to give as much or as little time as they're able. Said professionals also bring enough money to keep the hospital running. It also brings almost all of the infrastructure needed to run a hospital. It's self-contained, and pretty much self-sustaining. It isn't ideal. It can't resolve the entire healthcare crisis in Africa. It can't reach land-locked nations. And it can't be in every place it's needed at once. But it is a start. And there's more going on than meets the eye.

Because there's hope.

Capacity Building

So. The wise powers-that-be recognized that, while they could simply perform a few thousand surgeries and move on to the next country, there is so much more that can be done during each field service. As such, an essential part of the process is capacity building: training, mentoring, renovating, equipping, and engaging the local community; giving them the tools to continue the work once the ship has to leave. 

The HOPE Centre plays two roles. It is (as its acronym implies) an extension of the ship, while it is here. But it is also a piece of a bigger puzzle that leaves the country a little bit stronger than it was before. 

When Mercy Ships selects a country to visit, it sends a team months in advance to begin preparing (in fact, we just heard last night from the advance team that is already preparing for the next field service in Benin)! This team makes all the neccesary arrangements for the ship to function when it arrives. This includes four very important things that aren't available on the ship:

• A dental clinic
• An optometry clinic
• An admissions & outpatient centre
• Lots and LOTS of extra beds.

The first three things, they can be put in a tent, or just about any old building with power. The last one is a toughie, but it's essential. Because every effort is made to reach the whole country, many of our patients live several DAYS travel from the ship. They also, however, require follow-up care, sometimes for weeks or months after their surgery. The wards on the ship contain about 75 beds, not including the matresses under the beds for caregivers to sleep on. 

If that was all the beds available, and we had to wait till our patients were 100% before sending them home, the number of people we could help would be SEVERELY restricted. 

And this is where the HOPE Centre comes in. 

The advance team finds a building (often a disused hospital, in abysmal disrepair), and renovates it to make a safe, comfortable place for patients to live, near the ship, until they are well enough to travel home.

Here's a few more before & after shots of the HOPE Centre here in Tamatave:

Believe me, it's not as serene as it looks. There are kids scurring around in every nook and cranny, and hanging off you every chance they get.

The HOPE Centre here in Madagascar is located right next door to Hopital Be, a local hospital that was also in a bit of a sorry state when the ship arrived last year:

But a solid partnership between the hospital and the ship has been established. They've received some renovations of their own:

The staff of Hopital Be are also heavily involved in other elements of the capacity building programs, such as the surgical training courses, the W.H.O. sanctioned OR safety program, as well as nurse and physician mentorships.

The obstetric fistula program has also hugely benefited from the HOPE Centre, as it also contains a secondary clinic for fistula patients. Unlike most patients, who just need an outpatient check-up every so often for a while, the fistula patients require some nursing care for several weeks until their catheters can be removed. The clinic at the HOPE Centre frees up beds on the surgical ward here on the ship within a few days, so instead of only being able to treat 15 or 20 patients in a month, we can treat around 60. That means 600 total for the field service.

My fabulous cabinmate doin her thing
over at the Obstetric Fistula (OBF) Clinic

Still just the tip of the iceberg, considering about 2000 women in Madagascar develop a fistula each year.

This is why, thanks to a partnership with the Freedom From Fistula Foundation and Hopital Be, after the ship leaves, fistula surgeries will continue in Tamatave, as well as in other hospitals throughout the country. We are mentoring Malagasy nurses on my ward and in the clinic, so that they are confident and capable of continuing this post-operative care in the clinic at the OBF clinic.

Local nurses learning the ropes.

There's a lot more that goes on in regards to capacity building that I'm not super familiar with, I've just shared the parts I've seen in action. You can learn a bit more HERE.

Azafady (remember that one?) for a really long post, but I hope it was interesting!