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

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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.