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 :)