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 :)

Our Kindia Experience

Fair warning: it's a long one :)

Being from the Northwest, I love the outdoors. I am a huge fan of all things green, and yes, even the rain. So for our first three-day weekend we decided to get out into the countryside of Guinea and check out a region called Kindia! We planned to be joined on Saturday by a bunch of our friends, but we talked another couple into coming up with us early - Maria and Freddie, our beloved New Zealanders. And we hired our own driver, a man who went by Barry White and had a particular affinity to Akon (we soon found out). So bright and early Friday morning he picked us up outside the port, and we were off!

Road ready!

For our first adventure, we call to the floor Conakry's traffic. We had barely been on the freeway for thirty minutes when we were rear-ended - by a motorcycle driven by a police officer. No one pulled over, we stopped in the middle of the road, he pulled up to our front window, kinda shrugged, and then drove off. Lol. Thankfully he only broke our back right tail light.
This trip was off to a great start :)

Finally getting to the outskirts of Conakry

After weaving through the Capitol for over an hour we finally emerged from the city and began to breathe clean air. This is the Africa I remember - rich red dirt, lush green foliage, thatched huts dotting the landscape, and roadside fruit stands :)

Out Maria's window

We bought some of the sweetest pineapple I've ever eaten

By mid-afternoon we were in Kindia! All of our travel and lodging arrangements were made through a man named Chico, who owns a large farm in the area and hopes to begin a tourism industry. He joined us in the village just down from our hotel and after we checked in and dropped our things, he took us out to his "Agro-Artisanal & Eco Touristic Resort".
His farm hosts the Mercy Ship's Agriculture Center, where volunteers teach the local men how to farm organically. There are acres and acres of crops, pineapples, banana trees, rice pads, you name it. There are also chicken huts, where they produce over 1,000 eggs daily, and a rabbit pen where four newborn bunnies were cozied. Chico hopes to not only grow the farm exponentially, but he plans to build an authentic African hotel (huts along a small creek), a restaurant, and an artificial beach...this guy was brimming with ideas.
He walked us around his property for hours; it was beautiful.

Chico, showing us the lay of the land

Rows of baby shoots!

Our one cheesy tourist photo (Chico's idea)

We left the ranch well after dark and our poor driver had to navigate the 9km path back to our hotel in his skinny-wheeled taxi. This "road" was mostly made up of dirt, rocks, and potholes.
Oh Africa :)
We spent the evening playing cards with Maria and Freddie, went to bed early and slept in deliciously late. Saturday we woke up to the rest of our friends arriving! They planned to spend the day on the farm with Chico, so the four of us decided to find one of the famous waterfalls we had been hearing so much about. We drove further into Kindia, and 45 minutes later we came to a beautiful tree-lined path leading up to the Bridal Veil Falls.

Le Voile de la Mariee

A tree growing at the foot of the falls

A secret stair Maria found along the side of the mountain
(I thought of LOTR the whole time, lol)

Patrick & I - so much mist!!

We spent the afternoon wading in the shallow pool beneath the falls and exploring the surrounding area, which had some beautiful nooks. Toward dinnertime we drove back to our village for a bit of a rest. Then we made our way toward the farm, where we were meant to meet everyone for dinner and a drum show. I should have made allowance for Africa time and known that we just wouldn't make it in time, but boy did we try! We spent over an hour on that wretched path in the dark and rolled into the ranch around 8:30pm. Thankfully, dinner had been saved for us and the drummers had just started! So we spent what was left of the evening having dinner and a show :)
The next morning we were all up early. Chico brought our breakfast to the hotel, we packed up, and the +14 of us set out for a hiking adventure! We were about to tackle Mount Gangan - a series of various ascending plateaus that overlooks Kindia. We found the start of the path up and were met there by a guide Chico had arranged; this guy was going to compete in the Olympics this year but was injured. The man was IN SHAPE. Let's just say he did the hike in flip-flops. No joke.

Our first look at what lay ahead...

The east portion of Mount Gangan

We began pretty optimistically: the sky was somewhat overcast, the path relatively flat. About 20 minutes into the hike we even came across a natural rock slide. Locals were doing laundry and their children were laughing and shrieking as they went down their very own water slide!

The coolest natural slide I've ever seen

Soon however, the path began to incline. The switchbacks became more steep. And then they stopped altogether. The only way was up, one step at a time.

A look down

And a dizzying look up

Thankfully we persevered, and after nearly an hour and a half we crested the center portion of the mountain. Little did we know that we were in for a treat. Two small villages were nestled up there! They graciously brought out benches for us to sit on, and gave us corn and bananas to eat. When your heart is beating 200 bpm and you're covered in sweat, that kind of hospitality can just about bring you to tears :)

The first village

Enjoying the break with our guide

Our little welcoming committee :)

Soon we were on our way back down, but not the way we came. Turns out we had come up the center of the mountain and then went west into the villages. We made a loop of sorts, descending through a beautiful green valley opposite of the waterfall at the beginning.

Single file, ladies

Sweating and sunburned but still smiling!

A view from the bottom -
we came down thru all that lush green

It turned out to be nearly a four hour round trip, but it was more than worth it. I haven't tried my body like that in awhile, and it's amazing what you can do when surrounded in front and behind by friends who are determined to do it with you!
As a final hurrah before we made our way back to Conakry, we decided to stop at the Kilissi Falls. We all hopped in the car, and at the head of the path to the falls, a few of us jumped onto motorcycle taxis for the 2km drive. Again, this is the Africa I remember - riding on the back of a boda on some rutted, pocked road with the wind blowing in your hair. I have missed that :)

A glance back at Maria!

One of the three Kilissi Falls

The girls and I, on the bridge to nowhere, lol

We took off around 5pm and enjoyed one more long, Akon-themed ride in Barry's car. The four of us made it to the ship at 9pm, just in time for a good night's rest before work Monday morning! It was a definitely a full weekend, but I'm so grateful for the chance to see more of this country that we're living and serving in. I can't do it justice, but Guinea and its people are truly beautiful.

The Three Amigos of D ward

     This week was the end of an era.
     Or at least that's how it felt to those of us working on the Max-Fax ward. Three of our longstanding pediatric patients were discharged from our unit all on the same day. In reality this is a really good thing! It means their surgeries went well and our job is done. They have transitioned to the Hope Center; a secondary building in Conakry where patients stay short-term so they can easily return to the ship for daily dressing changes. Yes, it's a good thing...
     Nonetheless, they are no longer in the hospital with us, and the ward is just not the same. They hold a precious place in our hearts, so this blog I devote to them: the Three Amigos of D ward.

     First, I'd like to introduce Lamin. I cannot say enough good stuff about this little boy - so sweet, so cuddly, so endearing. He easily won the hearts of every nurse on our ward. He and his father traveled all the way from Sierra Leone for his surgery; no small feat. He had a neurofibroma over his left eye (don't look up pictures, it's not fun). In his case, his eyelids and surrounding skin were swollen to such an extent that his left eye was literally useless - you couldn't find it in there if you tried.
     His surgery was one of the first and he came through like a champ! However, it's only after surgery that the long process of recovery begins. He and his amazing dad stayed with us for nearly three weeks post-op. Lamin endured countless dressing changes, which involved unwrapping his head and peeling away the dressing over his left eye as delicately as possible, only to clean and replace the entire bandage afresh. Sad was the nurse who had to cause his shrieks and see his little tears. But he always bounced back after a cuddle and some stickers. Such a brave boy.

How could you not love this kid...

Best papa award!

Visiting at the Hope Center

     Next is the little missy I talked about a few entries ago, the feisty one with the facial burns: her name is Hawa, and there really is no one else like her. She and Lamin hold the record for the longest child's stay in the hospital, though she beat him in number of surgeries. After the second operation she became quite a pro with the whole post-op routine, but she still made us work for every medication we gave her, lol. Thankfully her second facial graft has taken well! She is now at the Hope Center with her mama, she continues to be as feisty as ever (and tough to pin down for a picture!) but I wouldn't have it any other way...

Putting on her new mask, courtesy of Becky!

"Don't bother me while I put on my bompa, Emily"

Hawa's beautiful mama (PAT!)

     This brings us to Mamadou, a two year old bundle of awesome! If my job was just to play with this little guy all day, I would be happy in my work :) He and his mama were with us for nearly two weeks as he recovered from extensive facial surgery. Mamadou was born with Tessier 4 facial clefts, meaning he had slit-like openings running vertically down his cheeks from his eyes to his mouth. I've never seen anything like this.
     He came out of surgery with steri strips (small strips of very strong bandage-like tape) all over his face in every direction, holding together the work the surgeons had done. These stayed in place for nearly a week. Once they were removed the twice-a-day wound care began, which basically involved cleaning his whole face with normal saline and painting all the little suture lines with betadine. At the same time he got a major eye infection and had thick green goobers running from his eyes down to his facial surgical sites. NOT good. So we began thrice-a-day eye cleansing and ointment application. Needless to say, he was not a fan.
     But aside from these two to three daily bothers, this little man was a happy camper. He always seemed to find a way to entertain himself, whether by "reading" to himself aloud in bed, pushing stools around the ward or kicking balloons as hard as he could. I could just squeeze the cuteness right out of him.

Newly post-op, such a trooper

Sporting his new mask with sweet mama looking on

At the Hope Center, as adorable as ever

     As happy as it is that they are on their way, it is difficult to accept that they will never be on the ward again. These three little ones are such a big part of my first experiences on this ship/hospital. When I look at their pictures, I will forever see my first pediatric patients. I will see innocence and trust, resilience and bravery. I will see little miracles.