Going, Going, Gone-akry

I'll be back on board the AFM in under a week, in my cosy little bunk, with 7 square feet of (shared) living space. 

Though Harry does not appear thrilled about those living conditions, I'm actually quite looking forward to it. I find the close quarters help keep me more organized and to follow a better routine. I read more, I exercise more, and I get up earlier. I spend more time on the important things and less time scrolling through memes online. Although, there are some pretty great Mercy Ships memes.

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Can't. Wait. For mangoes (that actually taste like mangoes). 

I realize I promised more of an inside-scoop on Guinea before I leave, so let's dig in a little bit to the culture and landscape.

As far as geography goes, Guinea has a little bit of almost everything. Much of the country is an intermixing of forest and savanna, with some mountainous regions and some plains, and the Niger river irrigating the northeastern grasslands. Deforestation and reckless mining practices have been profitable for a select few, but have left some parts of the landscape scarred and contaminated. Bauxite, iron, diamonds, gold, and uranium deposits have certainly made it a hot spot for many international mining companies.

There certainly are a lot of different types of Francs. I've been to 3 different countries that used 3 different types of Francs, and Guinea has yet another. While many Central and West African nations have joined together in economic partnerships to share the "CFA Franc", Guinea has used its own since 1959.

Due to its low valuation, the smallest denomination of currency is a 500 Franc note, while the highest, 20,000 Francs, is worth only about $3 CAD. 

Like most countries in this part of the world, Guineans themselves represent a diverse array of ethnic groups; which in turn means many different languages are spoken within the country. French is the only official language, but Susu, Malinke, and Peul are some of the others more commonly spoken. Being a bit closer to North Africa, Islam is by far the most widely practiced religion. 

~

Well, I think that's all I have time for tonight! I'm on my first of three night shifts here at home before I have a couple days to pack! The next time I post I'll most likely be in Conakry, gently rocking on the...

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À la prochaine,

-D

There And Back Again

Well, it has been a while, hasn't it.

I have no memory of this post.

I started writing this post about 3 months ago, and promptly got so wrapped up in life that I put off completing it for entirely too long. 

When I got home from Cameroon (back in June), on my first day back at work, I got hit with some kind of respiratory virus that put me out of commission for a good long while. I had to leave half-way through a shift (which I hate doing), because I felt so lousy I was worried my legs were going to give out. Turns out I had a fever. My colleagues kept razzing me that, "Oh no! You've got malaria!" It definitely wasn't malaria - I'm pretty sure it was Strep - but regardless, I ended up missing enough work to throw my bank account into mild disarray. Cobwebs and crickets and the like. 

Fortunately, there's someone who always provides just enough, just in time. My parents very unexpectedly upgraded their vehicle, offering me their old one to replace mine (which was NOT going to survive another winter). I managed to sell the thing, all 365,000 km of it, somehow, about 2 days before my rent was due. Can you say, "timing?"

Things are a bit more copacetic now, so I'm finally starting to look forward to and make plans for January, when I shall be returning to the good ol' Africa Mercy. 

Therefore, as is tradition, let's learn about this year's field service location:

                 Guinea

Population: 12.4 million
Official Language: French
President: Alpha Condé
Independence from France: 1958
Capitol: Conakry

The nation of Guinea (sometimes referred to as Guinea-Conakry to distinguish it from its next-door-neigbour, Guinea-Bissau; or slightly further neighbour, Equatorial Guinea; or its other-side-of-the-world-not-neighbour-at-all, Papua New Guinea) hangs out on Africa's western prominence, just south of the Saharan desert regions.

Guinea is currently ranked 175th out of 189 countries on the Human Development Index - a ranking which takes into account education, life expectancy, and relative wealth. It will be the lowest-ranked country I've yet visited, by over 10 points.

If I had been born in Guinea:
   I would have had a 50-50 chance of being married before the age of 18 (Guinea has the 5th highest rate of child marriage in the world), and I would likely have had 5 children by now. I probably would have had one of those children as a teenager, and my kids would have a 1 in 10 chance of dying before their 5th birthday. Only 2 or 3 of my kids will get to attend secondary school. And, of course, all of this depends heavily on whether or not I was born in a wealthier, urban region, or an isolated, rural area.

Unfortunately, the most noteworthy thing to happen in Guinea in recent history was the devastating Ebola outbreak in 2014. The death of a one-year old boy in a small Guinean village near a large bat colony is believed to have triggered the outbreak, eventually spreading into neighboring Sierra Leone and Liberia. Initial cases were misdiagnosed and poorly contained, as Ebola had been essentially non-existent in West Africa before this. The resulting delay in quarantine measures allowed the disease to take root in densely populated areas, and led to the largest Ebola outbreak in recorded history. Two years later, when the epidemic was finally quelled, over 11,000 lives had been lost.

Although this epidemic was overwhelmingly dire, it did have one positive outcome: a vaccine has finally been developed that shows a high degree of effectiveness in preventing Ebola. The vaccine was created in Winnipeg, and would have likely have taken decades more to formulate and test had there not been such widespread infection. The vaccine must be stored frozen below -60°C, which presents a challenge for rural areas of Africa, but has been used effectively to help control a more recent outbreak in the DR Congo.

Now. There is no Ebola in Guinea at this time. I'm explaining this because you seem nervous.

Maybe I was a little bit concerned, but that's not the same thing. 

This was the whole reason the ship ended up spending two years in Madagascar. There is a very limited capacity to isolate patients on board, and it is certainly NOT equipped to deal with such a highly infectious disease. The benefit we could have provided would not outweigh the risk to the patients and crew. 

Now, however, the dust has settled. There have been no new cases in West Africa since early 2016, and the WHO has declared the epidemic over. Additional screening precautions will still be taken for every person entering our dock space - temperature checks and further investigation if you've traveled in a high-risk area. Similar screening takes place at most country borders, checking for fever or possible exposure; not just for Ebola but other endemic viruses as well (Zika virus, Lassa fever, Yellow fever, etc).

All that is to say, it's fair to be a little bit concerned, but there are very stringent measures taken to ensure the patients and crew we take on board are safe from infection.

~

I think that's enough about that; for now. I'll dive a little deeper into Guinea's culture and geography in a later post. 

As usual, January still feels AGES away, though it's creeping up closer and closer. I'm hoping to have a couple events before then, including the usual, annual brunch extraordinaire; as well as a screening of the National Geographic docu-series that was filmed back in Benin.

Stay tuned...

À la prochaine!

-D



Data Sources:
2018 Atlas of Sustainable Development Goals (World Bank)
Human Development Indices and Indicators - 2018 Statistical Update (UNDP)

That's A Wrap

Well, the Africa Mercy's field service in Cameroon is wrapping up.

Literally.

Here we have one ICU bed, ventilator, monitor, and all other accessories included. Shipping time to Guinea - approximately 3 months. Taxes not included.

This last week was a busy one, with 3 patients unexpectedly requiring additional minor surgery, and only getting discharged on Monday, the rush was on to clean, pack, and secure the whole hospital for sailing.

While many nurses left the week prior, those of us that remained (about 20 of us) spent the week scrubbing and re-scrubbing every single itty-bitty surface on the whole dang deck. No bed spring or cupboard hinge would be left unturned; no trace of MRSA would survive our antiseptic onslaught!

The fumes get to you after a while...I still have a bit of a strange tickle in my chest when I take a deep breath. A bit of ABBA and some good company, though, and the time flies by! If I ever find out who stuck all that tape to those partitions at the back in this picture, though...I tell ya. I spent a good 2 hours and half a bottle of Goo Gone on those things!

Once everything was gleaming and glistening, we began to pad and wrap and tie down every bit of equipment, stowing the smaller items in boxes and cabinets. Our syringe-driver infusion pumps got a little nursery made up just for them in the spare ICU bed. Here we see Mary rocking one of them to sleep.

And...then we smothered them with pillows and mattresses.

The nice thing about packing up a hospital ward with all kinds of fragile equipment is that there are also plenty of soft, cushiony things around to protect said equipment.

Now that everything is safely stowed and secured, no worry of it rocking or rolling about, the final preparations are underway for the ship's departure from Cameroon. Within the next few days it will set sail, making a wide berth around high piracy risk waters, before making a quick stop in Senegal in preparation for a future field service (2019-2020). Then, the ship will continue to Las Palmas, Canary Islands for dry dock maintenance. After that it will sail to Guinea-Conakry for the next field service.

I'm writing this as I prepare to go on stowaway watch for a couple hours from 0200-0400. I figure it'll help me transition back to Eastern Time. The bow and stern of the ship each have a night watch for the days leading up to the sail, to ensure no uninvited guests attempt to sneak aboard via the mooring lines...or more creative means. A couple years ago two stowaways were living in one of the lifeboats for several days before they were discovered, and then the ship had to sail all the way back to turn them over to authorities. Obviously not ideal for anyone involved, so we certainly want to prevent that. For watch we get a spiffy orange hat, a radio, a flashlight that weighs about 5 pounds, and - inexplicably - a slingshot? The SSO didn't explain what we are expected to do with the slingshot, nor is any ammo supplied, but he did say we aren't supposed to take aggressive action. That's what these fine fellows are here for.

I must try to get a little bit of sleep in before my watch. I'll be flying home soon - in fact I'll probably be in the air by the time this is posted. It has once again been a whirlwind of a time, with new friends and old, and I'm already counting the days till my return.

Once more, Africa...

À la prochaine.

Love, D.

MVP's (Part 2)

Without Grumbling or Complaining

0200. I'm gently tapping the shoulder of a man, sound asleep, lying on a mattress on the floor under his wife's bed.

He doesn't wake. Man, I wish I could sleep that soundly. I tap a bit more. We need his help.

"Désolé, Papa. Nous avons besoin de ton aide."

I hate waking people up - it's possibly my least favourite part of my job. Honestly, most days, I'd rather deal with bodily fluids than have to interrupt someone's slumber every hour or two. This fellow, however, doesn't complain, doesn't grumble, doesn't even hesitate. The moment his eyes open, he's nodding and grinning and scrambling to his feet.

Well, to his foot.

Papa Cristel, you see, has an old leg injury on one side. Because it didn't heal well, and he never bears weight on it, it is contractured - permanently pulled into a flexed position. He gets around with a bulky, wooden crutch. Unfortunately, because of his age, and the nature of his injury, this wasn't something we could fix. We offered him a nice, shiny aluminum crutch to use, but he quickly went back to his sturdier, clunky, wooden one.

Papa Cristel was here with his wife - one of our women's health patients. She had some complications and had to be readmitted. The night she came back in (she hadn't been feeling well), another patient just happened to notice the ship vehicle arrive to pick her up and asked to come along. That patient was seriously sick with a high fever and low hemoglobin, and it was almost by chance she ended up back on board. Both women spoke Fulfulde, that one pesky language from the northern regions of West Africa that only four of the hospital day crew could speak. We always had someone during the day, but never at night. Papa Cristel, however, speaks French and Fulfulde, so he became our go-to any time we needed it.

He gladly translated not only for his wife, or the other women on the ward, but would even thump down to the other wards in the night when anyone asked; always with a smile, a chuckle, and without hesitation. Even at 2 in the morning.

He deserves far more recognition than this measly blog post.

Papa Christel with his wife

---

Good & Faithful

There wouldn't be a blog here, because there wouldn't be any Africa Mercy, without the Day Crew. These 200+ local workers are hired by our Advance Team before the ship's arrival, and supplement nearly every department on board and ashore. Those who have experience translating and/or a good handle on one of the less common languages will usually be placed in the hospital, dental, HOPE Centre, or medical capacity building programs. Others will work in the galley or dining room, transportation, engineering, or as part of our deck crew. 

I worked with some fantastic nurses on A Ward this year (have I mentioned the 'A' is for 'Awesome?'), but the Day Crew will possibly stand out in my mind even more. 

A Ward Nurses & Awesome Hospital Physician Sarah

A Ward Day Crew (and nurses!)

Last Friday we said farewell to most of our Day Crew, as the hospital was closing down for pack-up. It was a little tearful, but, in true West African style, it was also incredibly raucous. They put on a tremendous show of energy, colour, and rhythm. They showed, in a big way, their gratitude to us, and their genuine love for their country. Cameroon is a country currently in turmoil due to conflicts between Anglophone separatists and the Francophone majority, but in that room we saw nothing but a powerful unity. 

During the Day Crew celebration, our Managing Director shared some details of conversations she had had with Cameroonian government officials. This was the first time Mercy Ships has visited Cameroon, and as such there were some hurdles to clear, including some resistance from said officials. In this one particular meeting, however, the Minister of Transport shared that before the ship arrived, he thought there was surely no real need for the services we offered. He saw pictures of the types of conditions we would tackle, and believed there were few, if any, people suffering from them in his country. As he received reports and coordinated with us to transport patients from upcountry, his eyes were opened to the hidden needs of his people, and the thousands we were able to help. In the end, he, and many other government officials, thanked us for the work we did here, and left an open invitation to return.

Africa Mercy leadership team along with ministers of the Cameroonian government

Merci, Cameroun, for welcoming us to your shores, and for joining us in serving your people. 

À la prochaine. 

-D

MVP's (Part 1)

Warning: This post has some gnarlier-than-average pictures, if you're squeamish, proceed with caution.

There are always a couple of more memorable individuals I have the privilege of knowing for their brief time on board. I get a tiny glimpse into their lives, and they probably won't remember me a few months from now, but they have captured a piece of my heart, and I won't be forgetting them anytime soon.

A Noma Life

As a child, Aicha was afflicted by a disease called Noma. 

Noma is one of those diseases that is essentially non-existent in developing countries, where sanitation, decent nutrition, and dental care are just the norm. It usually effects children in the poorest countries in the world, and has a 90% mortality rate. Bacterial infection in the oral mucosa leads to a painless, but incredibly fast necrosis (death) of the surrounding tissue. In short, this disease eats your face off, sometimes in a matter of days. If treated quickly with antibiotics, it can be stopped, but the lost tissue will never grow back. The 10% who are lucky enough to survive this initial onslaught are horribly disfigured for life. This disease doesn't happen to the kind of people in the kind of places where reconstructive plastic surgery is an option. It also so happens, as is true of many of the conditions we treat on board, that such disfiguration is widely viewed in these parts as an outward sign of an inner evil. It is a scourge on all aspects of one's life. 

Tahina, a patient with Noma I met in Madagascar.

Flash back to 2009. 

Aicha, then 5 years old, was living with her Fulfulde-speaking grandmother and uncle in the Extreme North region of Cameroon. Her father and mother had abandoned her. When she became infected with noma, her uncle brought her to the nearest hospital - a scarf wrapped around her face to hide the devastation. She was incredibly malnourished as well, and weighed only 24 pounds. The infection was treated and she received nasogastric feedings, saving her life, but she was left with a gaping hole where her right cheek used to be. 

Hôpital de Meskine, where she was brought, is run by an American non-profit, and provides care regardless of the ability to pay. They knew the best plan for Aicha was specialized surgical care, but they are only equipped for minor surgical procedures. One of the surgeons volunteering at this hospital happened to have worked here on the ship a few times in the past, and knew Dr. Gary Parker, our resident expert in these matters. The next field service for the Africa Mercy was planned for Lomé, Togo; some 1,500 km and two countries away. Although it was an incredibly long journey through Nigeria and Benin, the hospital team was able to arrange for Aicha to come to Togo and receive reconstructive surgery from some of the top surgeons in this rather niche specialty.

Aicha in 2010 

Fast forward to a few weeks ago. A slender, bubbly, cropped haired teenager is grabbing my arm, pulling me from the corridor into D Ward. "Tantie! Tantie Haousa!" (Auntie Haousa - the nickname she gave me). "Travaille ici aujourd'hui?" In my broken french, I explain no, I'm not working today. I'm working in the office instead. But I promise to pop my head in every time I pass by. She shakes her head, a mischievous grin on her face. "Non! Travaille ici!" I make note of her nail polish - she would remove & repaint them 2 or 3 times a day. "Désolé, ma copain." Not today. We hug, and I linger, cherishing the moment. There's always one patient; one I don't want to let go of.

Aicha a few weeks ago

Later that day, as I passed the ward again on my way to lunch, I see her gazing at the TV while another patient ties her very short hair into many tight bunches. She's preoccupied. I'll come back after lunch.

She was discharged while I was eating lunch. I never really got to say goodbye.

A selfish thought, of course. She loved *all* the nurses, and all of us loved her; I'm sure she had a lovely send-off. Perhaps, as well, it's better off this way. Easier to move forward, not looking back. The more time patients spend on the ship, the harder it can be for them to leave this bubble and return to the real world.

-

A couple days later I was sorting through piles of patient charts, ordering all the pages before they are to be scanned for our digital archive. I came across hers, and, for the first time saw the above pictures of her from 8 years ago. I was never actually assigned to her; had never looked in her chart. I couldn't believe those somber, apprehensive eyes could possibly be the same girl.

After her visit to the AFM in 2010, Aicha left the ship looking like a whole different person - and not just because of the reconstruction. Her face was whole again, but her eyes had a twinkle that was a lot more familiar to me.

Her eye, as it happens, was the reason Aicha came back to the ship here in her home country, 8 years later. You can kind of see it on the photos above, even before the repair. Her right eye sags a bit, pulled down by the tight scar tissue below. The graft healed quite nicely for her; though it is darker than the rest of her face, it is still pretty good lookin' compared to the alternative. As a young woman, she now holds her head high, obviously confident in her natural beauty and radiant personality. As her graft had healed and the swelling dissipated, however, the skin below her eye was pulled further down, making it difficult to close or blink. 

The solution was a relatively simple procedure this time around, and it's easy to see that this girl is gonna go places. She is fluent in French now, excelling in school, and just so darn charismatic it hurts. I had a good little cry that night I knew I'd probably never hear "Tantie Haousa" again, and another good little cry writing this post. I can only hope and pray that this tenacious soul continues to defy the odds, and that she continues to bring joy and laughter into the lives of those around her.

Aicha (right) with nurse Alex & baby Mas-Oudatou (cleft palate patient)

Love you, Aicha.

À la prochaine,

-D

Update: BBC's Pidgin division produced a news story on the Ship's service here in Cameroon, and you might catch a glimpse of Aicha teaching me and another nurse a clapping game:

A pretty typical day

"You're doing so good!"

I put on a probably-unconvincing smile as I give a thumbs up to my patient who is halfway through the litre jug of oral contrast dye he needs to drink before his CT. I give the Day Crew helping to coax this process along a knowing glance as I check my watch again. 0945. He's supposed to have the scan at 10. It's taken over an hour to get this much in to him. Our odds don't seem favourable.

Papa E. has been on A Ward for a couple weeks now - when he arrived he urgently required a gastric tube to decompress his stomach. He came for a hernia repair, but this hernia had progressed from something inconvenient and benign to something potentially life-threatening. Part of his bowel had become incarcerated in his hernia - meaning it was pinched off, blocking circulation and the normal flow of digestion. His belly was the size of a beach ball, and tight as a drum.

Bowel obstructions are part of a normal day at work for me, but my patients aren't usually this frail. Usually they show up at the hospital within a couple days of the onset of pain, nausea, and vomiting. I suspect Papa E had been suffering for at least a few weeks before he came for his hernia appointment. He is so malnourished, but even after his hernia was repaired, the affected section of bowel removed, and all that air & fluid that had built up above the blockage removed, he's still barely eating. "I'm full!" he complains, pointing at his still-somewhat-distended stomach. What he really needs to bolster his strength and healing is TPN (IV nutrition), but unfortunately, though we've reached out to local hospitals regarding this, we can't find a reliable source. TPN is incredibly expensive, and we absolutely take it for granted at home. It's quite commonly used in complicated cases of obstructions or bowel surgery, giving the patient nearly all the nutrition they need without putting any workload on the guts.

"Nearly there!" I halfheartedly encourage papa as I fill up his cup once more. He's getting this scan because he just hasn't been progressing as he should, and his belly is still full of fluid. He glares at me like I have two heads and ignores the straw being pushed towards his mouth by the Day Crew. 

A couple hours and one failed attempt to use IV contrast dye later... Papa is back in his wheelchair beside his bed, frowning again as I now try to get him to drink some Ensure nutrition drink. He's surprisingly spry (when he actually agrees to get out of bed), considering he hasn't really eaten in weeks. As I mark down his meager intake for the morning, one of our General Surgeons rushes in to the ward. I expected him to confirm our suspicion - ascites related to liver disease.

"When was the last time he ate?" Uh oh. Those are never encouraging words. "He's just had 1/2 a cup of ensure - that's about it since the oral contrast. He refused lunch." 

"Keep him NPO. There's something...infection..." he vaguely says. "We might be taking him back to theatre."

Our hospital physician pops in a minute later. "Did you hear about the scan...looks like maybe a leak?"

"Uhh...Dr. Hank didn't mention that." 

Leaks (bowel leaks) are bad. Very bad. People can very quickly go septic. I couldn't help thinking, "that doesn't make sense - he can't be leaking. He's not nearly sick enough to have a leak." 

"Whoops. You didn't hear it from me," Dr. Sarah says as she steps back out to find the surgeons. 

After half an hour of people sticking their heads in and out of the ward with questions, trying to decide how soon they could start surgery - nope, we're doing it tomorrow - nope, now we're back on for tonight - nope, now it's ASAP. Here's some bupivicaine, we're gonna do nerve blocks again. Dr. Hank finally sat down with my charge and I to discuss the plan, and the challenges this new development posed. His biggest concern was the recovery time - we are only doing surgery for one more week, and the hospital will be closed down two weeks after that. Papa's incision would have to be left open, packed regularly, and slowly heal up from the inside. "Could we VAC it?" I piped in.

"We have VACs?" he replied, slightly surprised. "I was thinking in Africa mode. Lovely! Yes! Let's do that!"

VAC wound therapy (AKA negative-pressure therapy) can reduce wound healing that would otherwise take weeks to mere days. It's papa's best hope for a speedy recovery. 

We scrambled to get things ready as we waited for Chaplaincy to talk things over with papa. We are so fortunate to have them - when there are difficult conversations that you would otherwise have to have through a 3rd party, translating, it can feel impossible to really emotionally support your patient. Our team of chaplains, local Cameroonian day crew, take over that role for us here on board. Meanwhile, my fellow nurses were prepping some last-minute bloodwork, a type-and-screen in case papa needed a transfusion. In the midst of the chaos, I gave a rushed report to the oncoming afternoon nurse, my shift nearly over.

"Can we pray with you, papa? Before you go?"

Papa nodded, smiling weakly.

"In Pidgin, or in English?"

About 6 of us, translators, chaplains, and nurses huddled around as the half-recognizable Pidgin prayer was spoken, then the OR nurse, Carmel, helped papa shuffle down the hall. 

-----

A couple hours later, my shift over, I've showered and headed to dinner. Carmel (who's probably the most Canadian sounding Canadian on board), sits down in her scrubs for a quick dinner break. I got a quick update on how the surgery was going, but just ended up with more questions than answers. "There was so much fluid in his belly...still not sure where it's from. But he's doin' good. Just lyin' there, sleeping." She shovelled food off her plate then headed down to scrub back in. 

I went to bed early, papa constantly on my heart as I went about my nightly routine. It's weird knowing that these urgent situations are going on constantly just down the hall from my bed. At home, I very much compartmentalize my work life and my personal life. When I leave at the end of an exhausting shift, my responsibilities for those 12 hours are done. I try not to carry that stress home with me, or I would just be stressed ALL THE TIME. 

Here, though, I can pop in on my patients any time of day or night. They're so close. And I don't get stressed out here - I love being at work. My brain is still wired to close off the work sector when I'm not there, though, and it's so easy to go about my days off overlooking what's going on on the other side of that big steel door. 

-----

It's a couple days later now. Papa is recovering well, but has a long way to go still.
I was shifted to D Ward today to help with some Maxillofacial patients - a very different scene from my usual! Lots of drooling babies and patchworked faces. It was a good shift though - I got my post-op patient to smile despite suctioning up her nose. So, I'll take that as a win.

I guess the point of this whole rambling post is that there really is no such thing as a typical day on the ship. Each day is like a box of chocolates.

And that's all I have to say about that.

À la prochaine.

The Be-Guinea-ng

First off, sorry. I can't resist puns.

Now that that's out of the way, I want to talk about the work that goes on before the ship even arrives in a country. Exciting things are happening this week in preparation for the next field service in Guinea, during which I'll again be serving for a few months (Jan-March)!

This will be the 6th time that Mercy Ships has visited Guinea (not to be confused with Guinea-Bissau or Equatorial Guinea...or Papua New Guinea); the last visit being in 2012. Interestingly, when we return to a country or region a few years down the road, there are some patients who we've asked to return for additional reconstructive work - things that we just can't get done within the limited time we have in each field service. Sometimes these years are needed to allow the necessary bone growth and healing before one final corrective procedure. I've heard amazing stories from Dr. Gary Parker (who has served with Mercy Ships for almost 30 years), who, by the way, is almost certainly the most humble and genuine surgeon/chief of medicine I've ever met. I was floated to D Ward yesterday, and amidst the chaos while he was rounding on all his patients, he stepped aside to where I was pouring meds and shook my hand; "I'm Gary, nice to meet you." Can't say I've met many surgeons who would even notice when a new nurse showed up in their work setting, let alone single them out to make sure he knew their name. Back to his stories, though. There are patients he operated on 10 or 20 years ago, babies whose cleft lips he's repaired, who have brought their own children to him for the same procedure decades later. And he remembers them.

The man is a legend.


Back to Guinea, though.

The reason it's very much on my mind is due to the departure of the Advance team this week to begin preparations for our field service.

 The advance team will begin the process of selecting then renovating clinic and screening sites, establishing immigration and port authority agreements, a berth space for the ship to "park" in, and interviewing & hiring over 200 day crew who will be our backbone once we arrive. They will also liaise with local hospitals and professionals to identify other needs that we can help address with our Medical Capacity Building programs.

Shortly after the ship's arrival in Guinea in August, the Screening Team (pictured above) will begin the arduous pre-screening process; assessing thousands of potential patients to determine who we can best help in the time we have. Of those many thousands, 2,000-3,000 will be given an appointment card to return and meet with a surgeon who will then make the final decision if surgery is in the patients' best interest.

Meanwhile, in Cameroon...

The last Women's Health surgery was last week, and our ladies are slowly trickling out of the hospital. A few have been re-admitted, unfortunately, due to inexplicable infections. Far more than could be coincidental - but despite a hospital review board, in which nurses, team leaders, surgeons & hospital physicians all scoured each case to find some common denominator, we just couldn't put a pin in the cause. They've all begun to rally, however, and we're happy to see them progressing in the right direction. 

Although there will be no more dress ceremonies in this field service, the memory of those joyous celebrations echoes in all the work we do. We still see the odd familiar face here and there at the Hope Center or on the dock for their follow-up appointment.

We're transitioning into General Surgery, now, which means our Women's Health team is going to be a bit scattered, mingling with the other wards.

I feel your pain, Mary.

We have an amazing team, though, and I'm just being over-dramatic. Most of us will still be working together.

If you can call it working...

À la prochaine.

Whispers & Weavers

I sat on a bench, surrounded by patients and their caregivers, some familiar, some not. I found myself getting frustrated with the murmuring going on all around me. Why aren't they paying attention? This is good stuff! The Day Crew of the Hope Center were telling the story of the ten lepers. Of the one leper who returned to thank Jesus for his healing. Asking good questions - and getting great responses from the audience. Why didn't Jesus just heal them on the spot - why send them to the priest? Why did only one, the Samaritan, return? The parables that are shared in the Hospital and Hope Center services always seem to revolve around healing. I suppose it is a subject that everyone here can relate to in some way. I wonder if it is wise to put such an emphasis on it though.

There are so many other important things Jesus taught us...but maybe the story isn't really about healing. Maybe that's just the top layer of a much deeper point. But - ugh. Why are those guys chatting again??

I turned in my seat to notice a few clusters of people in the crowd, their heads huddled together as they spoke. Abruptly, I remembered the same phenomenon in Benin. I'm an idiot. They're translating. 

There are just so many different languages in this part of the world that one or two translators with microphones simply won't do, and it's incredibly inefficient to wait through the 5 or 6 or more it would take to cover all the languages needed. Instead, the translation process happens much more organically. The people who share a language sit together, and one or two among them, who also speak French, translate quietly as the speaker continues. It is the United Nations of  the developing world - many different cultures all hearing the same message at the same time in their own tongue.

Perhaps this, too, has a deeper meaning to it - or this could be a bit of a stretch - but bear with me.

My initial irritation at the noise in the crowd was a little self-righteous. I was preoccupied with the apparently disrespectful behaviour, the distraction to all those around me trying to listen. In reality, however, half the audience would be unable to listen, to receive the message, if it weren't for this noise. I (for the second time in this exact circumstance) completely misjudged the situation. I was looking at it from a western perspective. A Canadian perspective. One in which politeness is so emphasized we don't even turn around and hush the people talking during a movie - we just sit there and stew about it till the credits roll. All the while, my annoyance is distracting me more than the noise itself.

It is very easy to look at the surface of cultural norms that are so very different from our own and see only rudeness or disrespectful behaviour, when the reality is often the complete opposite. It takes time, patience, research, and sometimes a willingness to make a fool of yourself to get to a place where something very foreign can be seen with a modicum of understanding and respect.

I am slowly inching my way there, but it isn't easy to overcome preconceptions that are so ingrained in my worldview. I am trying, though, trying to learn to challenge my assumptions when I read a headline or meet a newcomer from another country.

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The discussion carried on, and my distraction was shifted to these little yellow birds flitting in and out of a nearby tree; long strands of grass trailing behind them. The birds were familiar - there are often a few to be found on the upper decks of the ship - but their current preoccupation was new to me. I marveled as I noticed the structures they were constructing with all this grass. Southern Masked Weavers, I now know they're called - and I was a bit entranced with their grace and ingenuity. It seemed to echo the work we are trying to do here. We aren't building permanent edifices, or trying to change the structure of the tree. Instead, we create a temporary retreat - a place to hide from the rain, from prying & judgmental eyes, to be loved, cared for, and to emerge with new purpose and potential.

After the meeting concluded with a beautiful poem, written by one of the Hope Center Day Crew (which, I might add, rhymed in both English and French!), we had more joyous singing and dancing, followed by some somewhat bitter-sweet goodbyes. Many of our fistula patients were here for their last few days, awaiting one final follow-up appointment before they would leave Douala and travel far north, back to their homes. I'll almost certainly never see any of them again, except in photos. One patient excitedly ran inside then back out to show me photos of her in her dress at the ceremony. A truly beautiful woman (as all of them are), who has an easy smile, one that shows in her eyes. A beauty that I hope she now knows can never be taken away from her - no matter what the future holds. A beauty that fills her, inside and out, in the knowledge that she is loved.

It always comes back to love.

À la prochaine.

A Family That Floats Together...

This post is going to be a bit of a cheat, because I'm not going to write anything. Instead, I'm just going to let you listen. I sat down with one of the long-term crew to get a different perspective of life here on the ship, and we recorded our conversation for your listening pleasure.

If you want to read more about the Barki's wild and wonderful life, check out their blog:            barkisonboard.wordpress.com

There were half a dozen kiddos in the vicinity, as Jamie was supervising computer time while we chatted, so I apologize for the background noise - but I think it makes for a more authentic experience. Quiet moments can be rare and hard to come by around here! It starts out rather noisy, but it does get better as it goes on. I promise.

*EDIT* I forgot to ask Jamie her favourite new word that she's learned since being here - I can't say I was surprised that she picked "Azafady." Click here to learn why...

I'm still just figuring things out, so feel free to give me any criticism or suggestions you might have, I'll do my best to improve and build on this early process. I also recognize it was a bit longer than the popular vote suggested on facebook, but I think the conversation warranted a little more time.

I've got an actual blog topic rolling around in my head, so stay tuned for that post sometime soon.

Till then, à la prochaine!

Right-Side Up

Greetings, from across the pond!

I've been on board the Africa Mercy for a week now, and it probably goes without saying that every week here is packed with eventfulness.

My week consisted of 1 day of orientation/unpacking, 4 day shifts, 1 dress ceremony (where we celebrate the healing and the beauty of our fistula patients), and 1 Canadian Crew night out! Dr. Sherif Emil, a pediatric surgeon from Montréal who is here right now treated (most of) us Canucks to a lovely dinner; all the hosers in one place. You can read all about Dr. Sherif's experiences in the OR here.

Dr. Étienne (L) & Dr. Sherif (R)

It has certainly been a whirlwind of reconnecting with some old friends, seeing some just in passing, and meeting a lot of new and wonderful crew. Oh. And have I mentioned how it still feels weird but wonderful to call a physician by their first name? One of the many ways the communal nature of this workplace reveals itself.

Right now, the singing of day crew and patients is reaching me in my cabin (through several steel doors), and that sound will never cease to put a smile on my face.

Smiles and singing and dancing abound in a dress ceremony from a few weeks ago.

We also had the opportunity this week to gather together with all of the medical teams to hear and share stories from the past month or so. Most were pretty humorous - language and cultural barriers lend themselves to creating ridiculous situations. Like the woman who couldn't understand she needed to stand on the weigh-scale in admissions and repeatedly squatted down on it. One story in particular, however, stood out to me:

Patient D is a man with severe ankylosis - a condition that causes fusion of joints. His jaw was so severely fused that he'd been unable to open his mouth for 19 YEARS. When he was recovered from surgery and had his tight bandages removed for the first time, his reaction was one of pure glee. They had some video of this which we were able to see during a community meeting - and this is no exaggeration. His hands were raised in the air in joy, he repeatedly stretches his mouth open and closed, and though he is difficult to understand (speech is understandably affected when you can't move your jaw for that long), you can hear the release of almost 2 decades of pain, locked away in his own body. Apparently, this went on for over an hour.

It has taken no time to remember why I love it so much here.

Lives are turned right-side up like this every day, and it is just so humbling to be able to witness it.

Just a short little update for you today; more to come.

Á la prochaine, my friends.