Pics or It Didn't Happen

It's been a bit. I've been here over two months now, and that means two things:

1. A lot of the nurses I've gotten to work with and love are leaving me now...
2. Photos of said nurses and our wonderful patients are now available!

Really grateful I've been given the opportunity this year to do ward photography, which allows me to give the rest of you a little window into my work environment! I use the term 'work' loosely. As you might have heard me say, and as these pictures show, it often doesn't feel like work. It's a privilege and a joy to spend time caring for and loving on our patients, and often very entertaining!

I've probably said it before, but I think it's worth reiterating that any patients in official photos which are shared outside the organization (including these ones) have signed (or their guardians have signed) a release form permitting us to do so. Time is taken to explain to each one that they will receive the same care whether they agree to promotional photography or not. It is a weird thing for most of us in healthcare, but it is these photos that give supporters like you a way to understand the plight and transformation of those we have come here to help. We are very grateful to those who are willing to share their stories with the world, because they pave the way for us to help others like them. 

This is Aliou, and he is so stinking cute. The past month or so has seen a lot of plastic surgery patients come through our door, and many have burn scar contractures like his. As you can see, the scars prevent him from extending his arm, greatly limiting his functional capability. Contractures like his also often worsen as kids grow - our lead Plastics surgeon, Dr. Tertius Venter, spoke of one young woman he treated in Guinea who was essentially  locked in the fetal position due to her burn injuries.

Osuman here, giving Dakota a lovely braid, had a similar burn to Aliou. As you can see, though, she's had her surgery (which usually involves cutting the scar out, pulling a flap of localized, healthy skin over the joint, then transferring skin grafts from elsewhere to the rest of the arm), and her arm is all bandaged and splinted up. Movement is the numero uno danger to those grafts healing well, so the dressings usually stay intact for at least two weeks. You may have also noticed the little tube in Osuman's nose. Because our patients' diets are often lacking so much of the essential building blocks of the immune system and the healing process (proteins, vitamins, and minerals), we build them up with as much extra nutrition as we can. This includes protein supplements in liquid, powder, and paste form. New this year, we've been trialling adding an extra "meal" in the form of overnight tube feeds - which so far seems to make an incredible difference in the speed of healing.

It takes a lot to grow all that new skin, so we try to give each patient the best chance possible.

These looong extended stays in hospital, waiting for that first dressing change, mean that we get to know these patients very well. They are a family, truly and honestly...and everything that comes with it. Sleepy-head teenagers, teasing and bickering, and covering for each other when one doesn't want to drink their nutrition supplement. There are beautiful moments too, though, like a father ducking out into the hallway to eat so his son (fasting for surgery) doesn't get upset. Comforting another patient who's in pain, or a baby whose caregiver stepped out to make a phone call. Painting each other's nails, and helping each other open containers with their non-bandaged/splinted hands. It really is one big, uniquely beautiful family.

A great group of moms brought together by their children's differences

A Ward evening crew!

Beautiful Mame Diara & Tenin with nurses Amy & Alyssa

TECHNICAL (POSSIBLY ICKY) JARGON BELOW 

Last night we had the privilege of hearing Dr. Tertius speak about the plastics program, and the new procedures that have been pioneered right here on the ship. With each procedure, there is a "design" stage of surgery, where the skin for the graft or flap is selected, and the planned incisions are drawn on. The most remarkable procedure he explained is the Hemi-Scalp Flap or "Africa Flap" - developed by Dr. Parker to treat noma patients. In this procedure, a U-shaped flap of the scalp is taken, rotated down over the face, and the end sutured in over the defect. This leaves a bridge of tissue, including the blood supply, from the origin of the flap to the new site. I've done my best to illustrate this below. The flap stays in place until the blood supply is well established and the flap has begun to heal, then the excess is put back in place. The crazy thing about it, though, is that the direction of blood flow reverses in this flap after it is moved.

It's a rough drawing, but the purple arrows show the usual direction of arterial blood flow up into the scalp. Within 10 seconds of excising the flap, Dr. Tertius said, the blood begins to flow the other direction through the section of flap that is rotated.

Just wild. There's a big document here that goes into quite a lot of detail (and pictures!) about these types of reconstructive procedures, that you can check out HERE.

I have to go, my friend just arrived with scissors to help me try to DIY one of my favourite board games. So with that, I shall leave you.

À la prochaine,
        -D

Where are we?

What country are we in?

The Captain asked that question at the weekly communication meeting.

I'll give you a hint - it's not Senegal.

I may have mentioned it before, but the flag state of the Africa Mercy is Malta. As long as we are aboard the ship, we fall under Maltese and EU law. I've never technically set foot in Malta, nor does my passport carry a Maltese entry stamp, but every time I step down off the gangway - in theory - I'm leaving Malta and entering Senegal. The screening, outpatients & rehab teams down on the dock sure have a heck of a commute if you think about it that way!

Gives a bit of a different meaning to our 12 month, multiple entry, Senegal visas (which we were still waiting on up until the last couple weeks).

The Maltese flag flies from our stern, and the Senegal flag from our foremast. Another example of how this ship feels like being in 50 places at once.

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We've had some challenges with getting our regular supply shipments released from customs (which is usually par for the course). This has made for some creative meal solutions by our galley crew, but we've had an ample supply of beef, in any case. This is in part thanks to the Senegalese President's promise to provide us with a cow every day we are here. He is Fulani, a culture of nomadic herdsmen in West Africa, and so this gift is both practical and meaningful coming from him. Sadly, we have not seen any of these cows walking up the gangway...but they're getting in somehow. Our meals have been evidence of that. He's also providing us with fuel to keep our generators running - keeping the lights on in this place - which is no small contribution either. 

It is a good reminder that we are visitors in this country, here to serve the Senegalese - but at their invitation - and they have graciously welcomed us with love.

Our worship service this Sunday took place up in the open air on deck 8, under a half-moon, and was a beautiful time of old songs & new, from close to home and from afar. It's always encouraging to see the whole crew, from so many different countries and cultures, coming together in song.

Baba Oluwa Oshe - "Thank You Father God" - a Benin classic.

Hospital Update

 The ward I call home (A Ward) is full of 'visitors' at the moment - overflow from the MaxFax and Plastics wards. This is a challenge as one of the people who newer nurses go to for questions! These are not the specialties I have the most experience with, so it has been very much a team effort, with a lot of help and hand-holding from the other wards, to give these folks the best care possible.

I say it a lot, but it never gets old how happy and willing to help everyone is in this hospital. Even when we're dealing with colds (which are rampaging through the crew at the moment), everyone from the bottom of the food chain to the tip-top managers are powering through.

A few days ago we had a bit of a brutal storm rip through very unexpectedly, which caused some damage, mainly to our tents & dockspace. This one you see below, Jane, our gracious Ward Manager - who could have very easily delegated this off to any number of underlings - was right there in the sweltering heat lugging supplies around and re-organizing so we could continue our programs without interruption.

Don't worry, that's not a real patient. ;)

I promised updated photos of Saliou (the very first surgical case this year), so here's some!

I've been granted permission to do ward photography this year, which means I'll actually get to post photos I've taken in the hospital (with - of course - written consent of the patients)! Stay tuned for that. 

Also, you might have seen this photo circulating on social media recently, of all the ward nurses:

I'm there, I swear, but I'm short and hard to see. See?

I had a dear friend depart last week, and it certainly feels a bit different without her around to hang out. She is, however, returning in January, so I'm eagerly looking forward to that!

Last meal out with Suzanne (second from Left) ♥

With that, I shall sign off for now or I will miss lunch. 

À la prochaine,

        -D