An Amateur's How-To for a Mercy Ships Farewell

     In an attempt to laugh off the fact that we're leaving this ship in less than 72 hours, I have put together a lighthearted list of what to do when you're about to leave the Africa Mercy. This is not an exhaustive list, and certainly not authoritative, but it makes me smile. And after a few rounds of goodbyes it actually seems to be pretty accurate!

     1) The night before your departure date gather an embarrassingly large group of friends and go out to dinner on the town. Helpful tips: Make sure one of you speaks the local language. And ask what entrees they still have BEFORE all 18 of you have ordered, or they will return a half hour later and say they no longer have any chicken.

     2) Stay up late that night to eat treats and play games in the mid-ships lounge! (Beware of quiet hours, as your laughter may disturb nearby family cabins after 10pm...boo)

     3) The morning of your departure have one last communal meal, preferably out on Deck 7. If you're going homemade this takes some prep work, as you have to make all of your market runs ahead of time, but it's worth it!

     4) After all the procrastination has been squeezed out of the process, you MUST pack. So open your room for public packing time! Not only will you have company for this usually stressful task, you will be able to pack lighter because your friends will free you of any items you were wavering on taking with you...the most common things back home are priceless here (i.e. face wash, tea)

     5) When its time to disembark for good, walk down the gangway one last time and say a final farewell on the dock, surrounded by your friends. Rainbows and goodbye songs are an added bonus!

Trusting Who holds the Plan

Confession: I have been trying to write this blog for nearly a month, the blog about leaving the Africa Mercy. And, Confession #2: it is still like pulling teeth to write. But it must be done...
    
     It has started; the beginning of the end of this chapter in our lives. We have one week left in West Africa. This nagging reality has begun to creep unbidden into the margins of my thoughts. I cannot change it and I cannot wish it away. If you had told me back in August that four months would go by this quickly I wouldn't have believed you. It sounded so endless back then. And as the months have passed, I have tried to be present, to linger, and to enjoy this time as much as possible.  I have bottled up each patient, every experience, and all these new friends in a little nook in my heart that didn't exist before and will now be forever changed. But there our departure date stands - like a brick wall, with the ticking of Time propelling us ever toward it. In a few short days we will be going home.
     But to what 'home'...? Certainly we have family and friends that we are excited to see - I wouldn't have you believe that I don't miss them terribly, I do! They are what I am looking forward to returning to most. And bonus, it's the holiday season :) Which means when we arrive everything will be infused with an extra dose of cheer and all those cozy feelings that make this time of year so lovely. If we had to pick a time to return this was it, right? But that still doesn't mean we are returning to a home.
     Literally, we have no place to call our own. When we left to join Mercy Ships we had just finished our contracts in Baltimore, so we packed up our apartment and drove across the country to put the rest of our belongings in storage. We also have no jobs waiting for us. As travel nurses we go contract to contract, and we have yet to sign on with our next assignment. So the idea of home has turned into this elusive thing in my mind that doesn't quite exist anymore. And if I'm honest, it makes me nervous not to have a concrete plan in place as this journey comes to a close.
     I have done a lot of talking about this with gals onboard over the past couple weeks, and last night at our weekly community meeting one of our fellow crew members even spoke on the idea of Plans. We all have them. We talk about what we're doing today, we think about what we're going to do tomorrow. Some of us even try to foresee the next ten years. The problem is that sometimes we get too caught up worrying about our plans, which not only robs us of the present, but when you boil it down, it is the opposite of trusting God. 

     In Luke chapter 12 Jesus gives this incredibly simple, yet challenging command: "Therefore I tell you, do not worry about your life, what you will eat; or about your body, what you will wear..." (v. 22) There is no clause giving potential reasons that worry might be excusable - if I don't have a job, if I don't have a place to live. Do Not Worry. Even when you don't know the plan.

Flash back to my early twenties: 

     I had a perfect life plan all set in motion. I had the best job, lived in my favorite city, and was dating the person I thought I would marry. All seemed set for years of happiness when I did the biggest face plant of my life. Pride caught up with me and I found myself single and broken hearted (rightfully so). My plans had just been smashed to bits by yours truly. Now what??

After crying myself to sleep for a week, I had this crazy idea. 

I need to quit my job and I need to move. Now. 

     This was the scariest thought, and indeed it didn't feel like my own. It roused a series of backlash questions from the Worrier in me: "Where will you live? What about your current lease? What about your boss, what will she say? And how will you ever find another job like this??"
All of the unknowns loomed large, but the more I prayed the more it became clear that
this is what I must do. So I did. 

And in three weeks time:

I resigned and was still given a great reference by my boss, 

I found out an old college friend was moving to the area and she took my spot in the house 

(and thus my lease), 

I had a phone interview and was offered a job near my friends and family, 

and one of my dear friends offered to let me live in her spare room for next to nothing.

In short, each and every one of my worries was taken care of. 

Each and every one.

"Consider the lilies, how they grow. They do not labor or spin. Yet I tell you, not even Solomon in all his splendor was dressed like one of these. If that is how God clothes the grass of the field, which is here today and tomorrow is thrown into the fire, how much more will He clothe you?" (v. 27-28)

Flash forward to the year 2012:

I am married to the man I love, 

We have lived in cities I never thought I would see, 

We have worked in some of the most prestigious hospitals in America, 

And we have nearly completed our time onboard the Africa Mercy, an organization I have wanted to work with for over five years. The story of how we got here alone is testimony of God's provision

(Here is how The Journey Took Shape; it still blows my mind)

We have been able to touch the lives of patients we would never have encountered, and  

we have worked with some of the most amazing people, people we would never have met had I stayed where I was comfortable. I could never have foreseen all of the beautiful ways God would use me or stretch me, and none of it would have happened had my 'plans' worked out.

So even though I have been known to worry about a thing or two and I am liable to do it again at some point, I choose to trust the One who has brought me this far. Because really, if He has promised to take care of my needs and has proven to take care of them time and time again, 

won't He continue to pave the way?

November Max-Fax Stories

     As we wrap up another month here on the Africa Mercy, I am overwhelmed by all of the amazing patients who have come and gone. I wish you could be a fly (or something less contaminating) on the wall of D Ward so that you could see their transformations. Daily I am reminded of the parade of miracles we get to witness, which makes the occasional hard times worth it. Here are a few that stood out for me...

     If I'm honest, I've had a couple favorite gals :) One of them I shall call Toulie, a girl no older than myself admitted with a large jaw tumor. I had the privilege of caring for Toulie after her hemi-mandibulectomy. This is a procedure that involves removing half of one's jawbone, as well as the teeth connected to that bone. Since the mouth has suddenly been turned into a raw battlefield of healing, a Naso-gastric tube is required for nutrition over the first week of recovery. There is also a drain out the bottom of your jaw, a large incision down the front of the chin and an enormous gauze head wrap involved. This is your typical hemi-mand, and this was Toulie's case. 

     But what stood out about her is that from post-op Day One, she greeted me with a grin. And every day after. If it weren't for the gauze, suture lines and multiple tubes inserted in her, you wouldn't have been able to tell she had just had extensive facial surgery. She never so much as grimaced, let alone shed a tear over the pain she likely felt. By the middle of the month, she no longer had a drain or NG tube and was eating soft foods, so she was cleared to discharge to the Hope Center! On her final day, I got to teach her to apply her pressure dressing, holding the mirror while she practiced putting it on and taking it off. She hugged me and left with a grin on her face. And when I visited her at the Hope Center the next week, she greeted me with an even bigger smile.

     Another endearing couple of gals were Grandma H and Binta, her teenage granddaughter who stayed as her caregiver and translator. Sometimes we don't have Pular-speaking day workers, so generally my words would be translated to French for the granddaughter and then she would translate into Pular for her grandmother. It was this game of telephone that my patient assessment info and teaching had to go through. The first day I took care of Grandma H, both she and Binta were kind but quiet, just smiling and staying to themselves.

     By the next day, they were suddenly my buddies! Anytime I came to talk with Grandma H, she wrapped my hand warmly in hers. And Binta turned out to be quite the teenage linguist. She showed me her coloring book, which was actually functioning as a notebook; it was full of words and phrases she'd been collecting. With her small English she began animatedly explaining them to me, writing out new words for me in French and Pular. She asked about my family, so I pulled up Facebook on our ward computer and showed her my mom, dad and sister, whom she said were all "so beautiful". It was such an epiphany moment, like this unseen gap was bridged - I became a girl just like her, with a family that I too loved. 

     This next young woman completely stole our hearts! I will call her 'B', and she took over our ward like a storm. 'B' had a large intra-oral tumor removed, which required her to have a tracheostomy in order to breathe and receive nutrition via a nasogastric feeding tube for several days. But though the trach made her speechless, you could literally hear her through her body language. And she was hilarious! At any opportunity, she was literally up and dancing, tubes and all. The joy and life that she radiated were absolutely contagious! (I'll tell you more about her in my next post, she's amazing)

     I'd like to finish with one of the most well known and prayed for patients on the ward. Here he will go by 'T', and he spent over a month with us. He is one of the faces I vividly remember from Screening Day. Even then, before I knew anything about him, his gaze wrung my heart. He sat there with a handkerchief draped around his head, partially concealing the enormous tumor that had taken over the right side of his face. What you cannot see is how the tumor has stretched his lip and emerged through his mouth, hanging about five inches below where his chin would be. 

     Anyway, 'T' came to us in October for pre-op care. He was extremely malnourished, only able to consume liquids plunged into his throat via syringe. From the beginning our surgeon explained to him the very risky road ahead. Before he could even have surgery, he would need to get stronger. So a gastric feeding tube would be placed to his stomach in order to give him appropriate nutrition. And because his airway might very soon be compromised, he would need a trach inserted in his neck.

     Long story short, T accepted the odds and lived on the wards for three weeks before any incision was made. As he began to build his strength, his tumor began to grow exponentially, now receiving all the nutrition it had been lacking. But he pressed on. And when the day for surgery came, we all prayed, day and night. The waiting was tense, as though everyone was holding their breath. This was the first time I questioned whether a patient would make it or not...

     But he DID come through, in the most remarkable way. Not only did the surgeon remove all of the tumor, but he was able to save T's right eye. 'T' spent one night in the ICU and the next day was on the ward again, back in his old spot. It was as though God took all of our worry and fret and just turned it on its head, saying 'See? I told you I had this.' Soon his trach was out, and shortly after that he began to use his new mouth to eat. Last week he was cleared to go to the Hope Center, this man that I thought would surely be in the hospital through Christmas. His recovery is unprecedented. The only word I can think to describe it is miraculous.

Holding on with Open Hands

     As we near winter (or at least what would be winter if we were in the Northern Hemisphere), I am becoming more and more aware of the passing of time. When Patrick and I first arrived in Guinea it was August, and the holiday season felt like a lifetime away. There was so much to adjust to and so much to learn. It was overwhelming enough looking ahead to the next day, let alone four months! So it is difficult to come to grips with the fact that November is nearly gone and our departure is three weeks away.

     There are so many memories, so many things that I want to carry with me. If I whittle it down, the thing that is so hard is the inevitability of letting go. As if we haven't said goodbye enough this year, we will soon be saying goodbye to our friends, our patients, and this way of life. Yes, it has only been a couple of months, but being on this ship, living and working in such close quarters with everyone, has knit us together in ways that I never anticipated. These people are like my second family, and I ache to think that when we leave it will never be like this again.

     This morning a few of us gathered for a post-Thanksgiving day brunch. We went around the table sharing what we were grateful for. It was lovely. One friend's response stuck out to me in particular. She said that she was thankful for her time on this ship, and the gift it has been to know each of us. Because God brings people, relationships, into and out of our lives just when we need them - not ours to keep, but gifts to be held with open hands. So this entry is for them, the friends both here and already gone; gifts that God has placed in my life for this season. For them I am so thankful, and because of them I am forever changed...

Hannah - Always there with a listening ear or much-needed hug.
Love this girl like a sister :)

Jen - Our soft spoken Italian with a heart the size of this ship

Noemie - A gal who took true joy from friendship

Andrea - Refreshingly real, genuinely joyful

Michelle and Rachel... enough said

Maura - Wears love for her patients on her sleeve!

Beth - So genuinely reflects the heart of God

Jasmin - I'd claim this Aussie for America if she'd let me ;)

Ann - Loves like she means it and has a laugh that can fill a room!

Maria - So easy going, with a contagious sense of adventure!

 The 'Other' Emily - Absolutely radiant in every way

Becky - The warmest smile and most tender spirit

A Day in Dubreka

     For weeks Pat and I have attempted to get to a small region outside the capitol called Dubreka, known for its' beautiful waterfalls and lush landscape. Each time plans have fallen through for one reason or another, but it seems the third time was a charm! So on Friday we hopped into one of Mercy Ship's Land Rovers with a few guys in pursuit of adventure :)

Pat, myself, Ben and Cody, totally pumped!

     Our first order of business was to do some hiking. So once we arrived at the town itself, we turned down a small road leading into the valley. We parked in a quaint neighborhood and started walking up and in.

Only my husband brings a guitar on a hike :)

     We found a small river and hiked upstream with it on the right as our guide. It was absolutely beautiful, and the air was surprisingly fresh under the shadow of the trees.

     In about an hour we waded across to explore the other side of the valley. We found ourselves on a wide dirt road, and enjoyed a leisurely stroll with the sun breaking through the clouds.

Juan, Cody and Pat, who played us some strolling tunes :)

     Pretty soon our stomachs started talking, so we headed back to the car for lunch. After a quick bite we hit the road again in search of the famous falls. We came upon a promising sign that advertised "Site Touristique" and "Cascade", so we took a hard right and hoped. Fifteen minutes later we arrived at a small hotel and a long stair, and at the bottom was the most lovely waterfall I've seen since Niagara.

     A large pavilion was built parallel to the falls, allowing access along its' entire right side. So of course, the boys had to try to get as far in as possible :)

Contemplating the best method of entry

     Thankfully the ledge that led to the falls continued underneath it, and the rocks behind opened a bit. In other words, no one was washed away :)

Pat following the guys as they disappear beneath the falls

     After the impromptu "shower" we all headed down the steps and went for a swim in the waters below! The current was surprisingly strong, and the water surprisingly cool. I haven't been in fresh water like that since the States...it was the perfect end to the perfect day.

My best friend and I post swim :)

The He[art] of nursing, Africa style

     I have been working a lot this past week (hence the lack of updates!). This is not a complaint at ALL; on the contrary, it has been an awesome opportunity to measure what growth, if any, there has been in my nursing since we've come to live and work on the Africa Mercy. After all, it's been nearly three months, so I'd say it's time to check in :)

     Among other things, I've realized what an impact you can make without your voice. For those of you who have followed our journey, you know I had some reservations at the beginning about communicating with my patients effectively (for a reminder, here is That Blog). I thought that because I couldn't speak with my patients, I couldn't communicate with them. Turns out I was so wrong! This past week there have been so many patients and family members to remind me that love transcends language. Here are just a couple examples:

     In bed D8 sits a beautiful girl named Agnes. She is fifteen years old and every bit a teenager - some days happy and interactive, some days sullen and tearful. And she is amazing. Last week she had a surgical procedure to repair her cleft palate (the roof of her mouth, which had been open to her nasal passages). She has been receiving nutrition via a naso-gastric tube ever since. But what has been so amazing has been the relationship we have developed. After our first day together, we were buddies. We have laughed, cried, and even painted "Agnes loves Emily" and "Emily loves Agnes" signs for one another. Mine hangs above her bed and hers is pinned to my cabin wall, reminding me of the responsibility and privilege it is to genuinely care for each patient I am assigned.

     In D11 is the most adorable baby I've ever seen (I'm sure I've said that way too often, lol, but it's always true!). Her name is Batouli. She is three months old, has the most beautiful almond-shaped brown eyes, and had a teeny cleft lip repair a couple days ago. I was told in report that her mama seemed somewhat distant and disinterested in baby before surgery. So I decided to spend the shift doing a love experiment. Every time I passed them, I loved on that baby; tickling her little toes, blowing her kisses, cooing and making faces like a doofus. Each time I would also compliment mama, telling her how beautiful her baby is, what a good job she is doing (all in English, no translation). And you know what? Mama began to smile. Mama began to hold baby again. Mama came back. Maybe it was fear of the surgery or of this place, but it has passed. Now I catch her cooing baby on her own. And when I come by, we make silly baby noises at Batouli together.

     In D15, there is a 5 year old patient who is about the cutest, most well-behaved little boy you could ask for. He takes his medicine without a fuss, he plays kindly and picks up after himself - he is a dear. But behind every good boy is a great mama, and his is great. She can't be any older than I am, and she is absolutely beautiful - warm-hearted, always smiling, and genuinely loving toward her son. And for some reason, we have clicked. She greets me with a hand-shake and finger-snap every day, and she has nothing but smiles for me anytime I even glance her way. The other day we sat next to each other for a few moments in the middle of the ward: two young women perched on stools watching a Disney movie, saying nothing, holding hands. With that simple gesture she told me that she trusts me, and there are no words for the weight of that.

     I suppose what I'm saying is that I feel free to love my patients well here. Despite the limited resources and the crowded wards and the paper charting, I can be the nurse I want to be - one who cares for the heart as well as the body. Where I come from, none of the above examples would be considered "vital nursing". There is no quantifiable benefit for affection, no evidence-based practice for caring. And that's because there IS no way to quantify Love or Compassion, no way to value the effect of ministering to someone's Spirit. But I truly believe that our acts of love will echo through Eternity - which makes them priceless.

A Wave of New Faces

     When preparing to come to West Africa, one of the things I thought of least was the types of patients I would care for. I knew they would be surgical patients, and with my float pool history I had done surgical. But when I found myself on the Maxillo-Facial unit, I realized this was an entire branch of surgery I had never encountered before. This was the world of cleft lips and palates, mandibular tumors, muscle flaps and skin grafts. And I had better learn fast.

     After nearly two months I have been blown away by the creative ways a face can be mended. It's still difficult to put into words everything I'm experiencing here, but one of those things is the miracle of truly innovative surgeries. So as we pass the halfway point of our time here on the Africa Mercy, I am reminded anew of the privilege it is to witness this work everyday.
     Here are just a handful of this month's stories, with more to come.

One of the sweet little missy's I cared for...always smiling :)

     This first gentleman I will call "O". He spent the better portion of four weeks recovering on our ward. His health history included an enormous Rt mandibular tumor, which had been removed during a  previous surgery in Cuba...along with the right half of his jawbone. His face was caved in on the right side due to this lack of bone structure, making it difficult for him to eat or speak. There are large scars down his forehead and chest...I'm honestly not sure what they did to him.

Finishing up O's dressing change

     After explaining the many risks, the surgeons took his trapezius (a muscle of the upper back) and moved it to his right neck/chin/lower jaw. In the medical world, this is called a flap. And it's the biggest flap I've ever seen. He returned with extremely low blood pressures and a difficult airway, but he had returned. His head was wrapped in a giant head-to-chin dressing, his back sported an incision nearly two feet long over the muscle donor site, and a tube had been inserted at the base of that incision to drain any excess blood. Needless to say, his care was acute for many days, and dressing changes were no small affair. Over the coming weeks we watched his body slowly begin to knit itself together. But one of the most noteworthy changes he want through had less to do with his body, and more to do with his heart.

"O" shakin' it on the unit

     When "O" first arrived he was quiet, removed, and even a bit grumpy at times. He didn't want to talk to anyone, the children irritated him, and he would sleep with the blanket tucked over his head in the middle of the day. But as he watched us work and diligently care for him day in and day out, he began to soften. He began to try to communicate. He began to laugh. And he began to stand with head bowed when we had change-of-shift prayers.
     On his day of discharge, he was the definition of joy! He was dancing around the unit, shaking hands and hugging everyone. I now come onto the ward, look at bed D6 and expect to see him there. We miss him already.

"O" and I on his last day

     This next patient really stuck with me, even though she was on the ship only a couple of days. You know how you can just look at someone and tell that you would be friends if you had been born here, or they had been born there? That was Miss "M" for me. She had such a sweet spirit about her, so warm and kind. And she seemed to know what I was saying even before the translator could arrive at her bedside. This woman was intuitive, and I like that in a gal :)

A knowing glance

     Miss "M" had a cleft lip repair at age 7 or 8 when Mercy Ships was last in Guinea! However, as she grew up, the bridge of her nose became increasingly flattened due to the pull of her lip's scar tissue. So this time, the surgeons rebuilt her nasal passages by using cartilage from behind her left ear. She was on the D ward maybe two days recovering, and then she was all ready to go! I wish I had a photo of her after her bandage was removed - you couldn't see a single scar.

Me and Miss "M"

     One of the more difficult things about some of the procedures done here is that they are the first of two. This next young man, "A", had a full-thickness defect to his upper lip. In the hopes of maintaining the continuity of his lip (the vermillion border), they performed an Abbe-Estlander flap. They literally rotated his lip - the defected portion was removed, and then a graft was taken from under his chin to replace the skin to the right side of his face/above his lip/to the left of his nose. The idea is to allow all of this new skin to innervate, and in five months time the surgeons will rotate his lip back to its rightful place.

"A" and Clementine

     After surgery he just stared at his face in the mirror, shaking his head...this is not what healing is supposed to look like. But thanks to the continued education and support of everyone involved in his care, there is hope for the finish line that is still ahead. On the day before he left for the Hope Center, "A" taught me how to make friendship bracelets (well, retaught...I was 10 years old once upon a time). He made one and tied it on my wrist. He then pointed at it, pointed at himself, and in the little English he knew, said "To remember me". I won't be here to see him return for the second surgery, but I will remember him.

     All of these patients are no longer on the ward; a whole new set of faces has taken their place. And they are just as hopeful, just as resilient, and just as endearing as those that have left. I look forward to telling you about them too :)