The Long Haul

"She doesn't want to go? Why not?"

I'm confused. My patient, Marthe, has been stuck in an isolation room for over a week. The hospital is already a bit of a windowless pit, but at least there are other patients and caregivers to chat with. The iso rooms cut you off from almost all of the community the other patients share. Marthe had a massive tumor removed from her back, and required extensive skin grafts to fill the space left behind. The chance of infection is high with such a large surface area of tenuous tissue, and Marthe ended up with an antibiotic resistant infection, which could easily spread to other patients with healing wounds. She's finally been cleared to go to the Hope Center as an outpatient, to get out of that windowless room and have some freedom & fresh air, and she said "no." 

After

Before

My translator rattles off some Fon, and as Marthe replies, I catch a glint of defiance in her eyes, but there's something else there too.

Love. Beautiful, compassionate, self-sacrificing love. After a brief dialogue, I get Marthe's response:

"She say that, she don't want to go until the other girl can go too. She don't want to leave her alone."

Next door, in our other isolation room, was a young woman and her daughter, who also had trouble with slow-healing wounds and infection. Although they couldn't physically interact, and it was hard to even see each other, Marthe and the mother would usually spend the day sitting in their respective doorways, keeping each other company.

Marthe knew (from firsthand experience) that once she left, momma next door would be lonely. We do our best to help keep our isolated patients' spirits high; Chaplaincy sits with them for a few hours, the day crew chat and play music for them sometimes, off-duty nurses with hearts of gold come in to blow bubbles and play with the young ones.

But despite our best efforts, there is still a very isolating effect to, well, being isolated.

"I'll...talk to the charge nurse," I tell her, feeling skeptical, but also humbled and astonished at the simple act of kindness I have just witnessed.

As it happens, I'm on a ship full of professionals who place a higher value on such kindness than expediency or quotas, and so, Marthe stayed.

Momma on the left, Marthe on the right.

A day or two later, momma next door made sure Marthe looked her best before leaving the ship, and this beautiful friendship moved out of our steel, fluorescent-lit corridors and into the sunny rooms of the Hope Center.

Marthe's story was recently shared on the Mercy Ships Canada website. In that article, it says that we hardly saw her smile, and yes, that may have been true at times. She had a long and difficult journey. But she sure could celebrate when celebration was called for!

Marthe's long-awaited discharge from hospital!

What else have I been up to, you ask? Well, quite a lot of different things, actually. Our Women's Health program is over, and the last of our 30 or so fistula patients went home in their beautiful dresses a few weeks ago now.

Giving our ladies an Africa Mercy send-off.

D ward is still full of maxillo-facial patients who have had tumors removed or cleft lips/palates repaired. Sometimes flesh-eating diseases have taken away most of our patient's faces, and grafts are used to reconstruct them. I have worked over on D ward on and off, but most of my shifts are still on B ward, which is now full of general surgery. Fairly standard, simple procedures, like lipoma removal and hernia repaires. These are not so foreign, as they are seen often enough at home. The only difference is time. Lipomas at home would be identified and removed very quickly, often in a doctor's office or as a simple outpatient procedure. Here, like everything else, they are left for years or decades, so they get bigger and are a little more complicated to remove. Hernias are pretty much hernias, wherever you go. We have had some fairly young boys with hernias, who were pretty darn cute.

There's a few other patients we have on our wards right now are what you might call "long-termers." These are patients who ended up with some set-backs, or required multiple surgeries to fully restore their function. Large facial tumors often require part of the mandible (lower jaw) to be removed, and a temporary metal plate is put in place to keep the jaw stable. Eventually, once the tissue has healed well enough from the first surgery, a second may be performed to take bone from the hip or ribs and graft it onto the jaw. We've had a few of these come through last week, several months after their initial operation, and most recover well within a few days.

One of our returning patients, here for a bone graft.

One or two, though, are having a tough time getting well enough to go home. Patient J, who had a massive facial tumor removed back in the fall, ended up with an infection in the wound after the second surgery. He had to stay in isolation for several weeks, and just now, as the wound is nearly completely healed, he's begun to have severe nerve pain. Facial nerves are the bane of the max-fax surgeon's existence. Most other tissue can be sliced through without consequence when trying to dissect the good from the bad - but nerves are delicate, touchy things, and they often end up embedded deep within the tumor. Removing the tumor usually means restoring dignity, freedom, and often saving the life of the patient. If any of the facial nerves get damaged in the process, though, they may have difficulty speaking, chewing, smiling, or even blinking. Damaged or irritated nerves can also cause severe pain, which can be unpredictable and incredibly difficult to control. In J's case, this pain has crept up out of nowhere, when everything finally seemed to be going right. We're doing our best to get it under control, but it is going to be tough these next few days.

On a lighter note, a bit of news. I've decided to return to the ship during the next field service in Cameroon! You probably already saw that on Facebook, but just in case you didn't, I'll be back on the Africa Mercy next March. Apparently I miss it already...and I haven't even left yet! I'm particularly excited because we will be starting a fistula clinic in Cameroon, and the women's health program
will be much bigger than it was this year.

In the mean time, as our numbers are dwindling here on the ship, and the end of the field service, and my time here, is coming to an end...my head is full of incredible stories that I need to get written down before I lose all the precious details!

Hopefully more blog posts incoming.

A la prochaine,
-D

Babelfish

I wrote a bit about language before I arrived, but I think it's worth revisiting now that I've been here a while.

While in Mada, French was common enough in the city to get by, but in most of the country, Malagasy was the prevalent language. Thus, a little French helped, but it was better to learn some Malagasy words, and most of us had at least the basics down pat. Misaotra, Madagascar, for having such a beautiful language! I miss it! I was a "casualty" during our last fire drill, and a couple of our Malagasy crew that are still with us carried me down the stairs on a stretcher to the hospital. It was so wonderful to hear them bantering back and forth! I had to resist the urge to smile and say, "Tsara be!" (very good). I was supposed to be unconscious. With a head injury and a hemothorax. It was a fun time. ;)

At least we made out better than that guy in the back!

The fire drill was quite the experience...we learned first hand how genuinely impossible it is to navigate in a smoke-filled room. But now I'm on a tangent.

I'm supposed to be talking about language.

There were a few regional dialects in Mada, but NOTHING like the linguistic diversity in Benin.

Map showing the major dialects of Benin. 

Fon (or Fongbe) is the predominant language in the south of the country, and many Beninoise do speak fluent French, but as you can see, there are MANY more languages. And the older a person is, and the more rural their hometown, the less likely it is they know very much French. While we have an incredible and talented day crew, there are only so many of them that can speak certain dialects. Bariba, for example, which is fairly common in the north, is only spoken by 4 day crew in the entire hospital. When you're trying to schedule for 4 different wards, plus outpatients, rehab, and the OR...well it's just plain impossible to have one of them available all the time. So, when we have Bariba-speaking patients, we often end up trying to cram all of our teaching into the morning shift the day before they are discharged home, in case there's no translator available the next day.

Patient M (on the left) speaks Bariba, but she had her
own sign language she tried to use all the time.
It mostly consisted of wagging her finger at me
the air and putting her hands on her hips.
She's a bit of a sassy one. I love her.

Alternatively, it's not unusual at all to have to borrow another patient to use as an intermediary translator. Sometimes we have 3 or 4-way translation going on to get a message across! You certainly have to be patient while waiting for the day crew to translate what you said into French, then a patient translates that into Bariba, then another patient translates the Bariba into Fulfulde...and then the whole process goes backwards to get the patient's response back to you!

Patient M, a rare exception who speaks excellent English!
Although I'm so used to speaking to my patients in French I often forget! 

The Ward church service for patients is another place where the diverse array of languages is very apparent. The service is usually led by one of our chaplains in English (though her native language is Dende, I believe), then translated by another chaplain into Fon. Although the sound system is usually deafeningly loud, you might sometimes catch a murmuring in the seated crowd. The patients aren't distracted or chatting amongst themselves, but will seat themselves in groups around one patient or caregiver who can translate the Fon into their regional language. I've mentioned it before, but this is another one of those heartwarming examples of the supportive and caring relationships we often see forming in our wards.

Sometimes, however, the language barrier can be quite isolating. We pluck patients up out of their homes and communities and bring them miles away where there may be very few who speak their particular dialect. It was definitely a struggle with patient B, pictured above. None of our translators speak Fulfulde (her language), but when she first arrived there was a younger woman in the next bed who was able to convey things to her, and kept her in good spirits. B had to stay about a week longer than her, however, and it was a tough week. We did our best to communicate with gestures and the occasional help of a caregiver from another ward, but for most of the day she had no one to talk to. She smiled very rarely, but when she did, she did so with her whole face. Half the time I think it was a, "boy these yovos (white people) are WEIRD" smile, but a smile none the less.

The one time she consistently smiled was during our routine walk/sing/dance in the hall time! The best way to get African ladies out of their beds is with a good djembe beat! B danced her way into the dress ceremony last Sunday, shared her story (which was translated by a patient to a day crew and summarized for us in English), and I had the honor of presenting her with a parting gift bag.

The bags contain items that are both practical and symbolic, as they start a new chapter in life. Soap, moisturizing lotion, and a mirror. Soap, to represent the cleansing of sin, and the washing away of the smell that used to haunt them. Lotion, so that they may have smooth skin like a bride preparing herself for the Bridegroom. And a mirror, so that they can see the beauty that is (and has always been) inside and out.

Debbie, one of our fantastic Charge nurses, handing out a gift bag in Mada

I am thinking of patient B often this week as she will soon return to her farm in the north to tend to her cows. I hope she finds new joy and peace in her life from now on. And I hope, as we urge all our fistula patients to do, that she shares her story to help raise awareness about the condition, how it can be prevented, and that there IS help available for those who suffer from it.

Oh dear. I've run off on another tangent. It's almost like when I ask the day crew to translate, "are you having pain," and the patient prattles on for a full minute in response. It's a very common reaction to simple yes or no questions, somehow. Oh well. I suppose I should wrap things up for now.

A la prochaine!
-D