Language barriers

I had the last weekend off, so a couple of friends and I decided to go out in town. We headed toward the grand marche, the large open air market, but along the way stumbled upon a celebration in the soccer field and decided to check it out. We were at the gate looking around trying to figure out what was going on, the french speaking ticket seller was not much help. Nor were all the french speaking locals handing in their tickets. Luckily there was a man that spoke English at the gate to help us buy our tickets and he explained that there would be live music, singing and dancing, that we would enjoy seeing their culture, so he invited us to join. He said he would be in one of the groups performing. It sounded good to us! We paid our 1000 CFA and headed in. 

The music had already started, so we were standing in the back, taking it all in. Then our English speaking friend from before found us and told us he had a spot where we could sit and see everything. So he ushered us to the very front row! We sat under a fancy looking tent with who looked like very official people. It is not unusual in Point Noire to see people dressed up in dresses and suits, but the people we were next to took dressed up to the next level and were looking sharp. We were the only white people there, so everyone was staring at us. This is not unusual here, but I am still not used to it. There was electricity wired to the field to power the speakers and amps, and it also powered the media team with their cameras, which were pointed at us 93% of the time.

Many people there had flags and t-shirts with a specific man on them, so we thought that maybe we were at some sort of political thing. We had heard earlier that we wouldn't be able to take a cab close to the grand marche due to roads being shut down for a government function. So we guessed what we were at had to do with that. Then Solveig, my Norwegian friend, decided to text a friend back in Norway to look it up for us. She said that the man was the founder for a religion, that he was sort of the "profit" for this group. So, we put five and seven together and decided we were at some sort of cult like religious group.... We had a lot of fun listening and dancing to the music, and took comfort in the fact that there were a lot of kids present. So we went with it! Plus we felt if we had left from our front row seats we would be acting very impolitely! We enjoyed all the music and laughed a lot at the cameras in our faces, and I was even asked to dance by one of the guys in the crowd (the camera caught every second of that!) Thankfully there was no "koolaid" to be drank, because we maybe would have jumped right on that band waggon! "Note to self: Learn French!"

The language barrier is so difficult! Here is a youtube video (please know there is very explicit language) that perfectly describes how I feel most of the time in Congo! Me in Congo

Here is a link to the group Guy Emile Loufoua Cetikouabo

I sort of feared an impending electrical fire

Our friend, guy in yellow fourth from the left

Note the camcorder

D Ward

Here on the AFM, there are five different wards filled with patients. I work in D ward, where all the "Max Fax" patients go.  Things involving the head turn up in this ward. In Tennessee, we called these types of patients "OMFS." There, those were are favorite patients because all the OMFS residents were always very polite and nice on the eyes. Here on the AFM, they are my favorite patients to care for, because the transformations that happen post operatively are so dramatic.  When a massive tumor is removed from a patients face, one that has most likely been growing for years, the transformation is incredible. The face is such an important part of human life, we all value faces, it is what we innately look for in each other. When this part of a person is disfigured, they become unseen and ignored.  My favorite part of my job is during dressing changes, the patient will hold up a mirror and see them see themselves, tumor removed, they look in awe at the reflection. It is beautiful. It makes my soul dance!

It took me a bit to get used to the flow of the work here. I have only had one job until now. So everything I know, is what I was taught at this one (actually two) facilitates. I had to learn where things are, how to chart, the flow of the orders, and the time management of the patient load. To be honest, I was not loving it at first. I felt scattered, and inefficient. I think many nurses can agree, that it is really frustrating to feel like a new grad again. Many of us are control freaks and a little OCD with our work. When that gets thrown off, it is not fun! This is exactly how I felt as I was trying to get used to this new way to nurse. Thankfully, the thing about nursing that is universal, no matter where you are, is the way nurses care for their patients. I stood firm on this and struggled to get my groove. By the second week on the ward, I had my rhythm and fell in love with D ward.  The pictures below are from the weekend D ward and I hit it off. It was about a week ago.

All pictures here were taken by the Mercy Ships communication team :)

Picture story; screening day

We are lucky on the Africa Mercy to have many talented photographers. They are able to capture so many moments in beautiful ways. Here are more pictures released from our communications team on board from screening day. I picked photos of people I saw on screening day, or have taken care of since then, and general photos of how the day was from my perspective. 



 

 

 

 

 

 

 

 

 

 

 

 

 

Worship in the Ward

On Sunday mornings, the chaplain team puts together a worship service on the wards. It gives the patients an opportunity to worship, the crew is encouraged to join too. It is probably one of the most powerful spiritual experiences I have ever had. When I feel moved, I begin to show physical signs of emotion and will tear up. My eyes were full of tears as I worshiped in B ward.  Many patients made their way from their post op beds to hobble down the hall to join in.  Most had their bandages/dressings/drains/IV's still intact. The worship was full of singing, clapping and dancing. It was powerful. I loved it. I couldn't understand any of the songs, but I didn't need to. I am moved by the spirit of the Congolese people, they are unstoppable! They refuse to complain of pain and to show any signs of weakness.  The two year old boy I cared for was quickly sitting up post extubation, trying to get down off the bed to walk. They eat as soon as we will let them, usually within hours of many surgeries (depending on what was operated on). They were present, clapping, singing, and worshiping with smiles.

I saw many patients I knew from D ward. Including two mamas with babies in D ward. One Mama was Mama to the little guy I had been taking care of. The other was of a little girl who had a similar tumor as the little boy.  The little boy was awake and alert breathing with ease.  Clapping along with the service. The little girl however, was still struggling to breathe. Her tumor was not a surgery we were able to provide, it was growing too fast and she was too sick.

Karyn was at the service too and experienced the worship in a similar way. I borrowed her writing, because she captured what I was feeling so well.  

The most heart wrenching sight however, was directly in front of me - I simply couldn't escape it.  I'm not a crier, at least not in front of people, but I had to bite my lip more than once to keep it from quivering during that time of worship.  I would love to say I just had some dust in my eye, or try to chalk it up to the "new away from home environment," but I'm pretty sure the Guy upstairs was trying to let me know He was present.

In front of me sat two women - both mothers of young children who had been looked after in D Ward.  Both exhausted from sleepless nights as they made sure their child continued to breathe.  Both just beginning a journey neither expected to face when they brought their child into this world.  One mother held her son who had just received a life saving surgery during the week to remove a tumor from his oral cavity.  It had grown so much that it was blocking his airway and breathing had become a tiring task.  I have never seen retractions as impressive as the ones he experienced.  When I first met him he could barely keep his eyes open, as he was using all his strength to pull air in and push it out of his little body again.  There wasn't really a word that could adequately describe his "noisy breathing," it was like nothing I had witnessed.  But when he went quiet, the still in the air made all of us hold our breath, until he startled himself and struggled to continue to inhale.  I honestly believe his surgery could not have waited another day.  And there he sat perched on his mothers lap - eyes wide open, breathing easy for the first time in months.  He was quickly learning how to become the wiggle worm healthy little boys are supposed to be.  And there sat his mother - eyes closed clapping the loudest to the music - rejoicing and worshiping a wonderful God.  She just had this committed faith that was amazing to watch pour out.

My eyes wandered a couple feet over and there stood another mother with her young baby wrapped on her back.  Just two days earlier, she had learned that there was nothing Mercy Ships could do for her child.  Her child also had a large tumor in her mouth that seemed to progressively worsen.  Her battle was quite similar to the other child's in that each breath in was just as difficult as it was to push out.  Her body often sat limp against her mother, as she couldn't lay down because the tumor would push against her airway and breathing would be impossible.  Over the weekend the nurses on the ward worked tirelessly to keep her comfortable, wanting so bad to free her from the pain she endured.  And there was her mother, bouncing her child in her Sunday dress, clapping along with the music.  She wasn't angry or pleading with the Lord, but instead expressed her love for Him.  There was this trust in her eyes that was simply overwhelming.

Two extremes sitting side by side, each with a strength that made me wipe that dust from my eyes.

Read Karyn's whole story here

The next morning, the little girl gave up her struggle. She simply could not continue to breathe with such effort any longer. Her nurse that day was a blessing to her and to the ward, please read her story,  here.

Babies on their Mama's back

The wards opened up this week. It has been busy! We are all learning how to work in this new environment. The new to Mercy Ships nurses are learning how to be a nurse on the wards. The day workers are learning how to do their jobs, translating, cleaning and helping. The seasoned Mercy Ship Nurses are learning how to work with the new day workers and nurses. And, we are all learning the Congolese culture and way of life. It has been a bit bumpy, not horrible bumpy like driving on an earthquake ruined road, but more like a bumpy old dirt road with ridges that you can't drive too fast on.  It is good. We are building relationships with each other and learning to work as a team.  A big part of learning how to be a ward nurse is learning how my nursing practice fits into this global nursing community. Each country does things pretty differently. Some countries manage more nursing care than I am used to, and others manage less. For instance, some nurses in other countries  all the ventilator changes and vent management. In other counties, nurses do not listen to their patients with a stethoscope, that is left for the doctors to do. To complicate the learning a bit more, different languages, cultures and accents are also thrown into the mix.   The nurse that was orienting me was from Norway, so I was trying my best to learn the wards from her while I was having to really focus on what she was saying in her very thick accent! In the midst of the challenge, it's a lot of fun, we are learning to be gracious and patient with one another. There is usually a lot of laughing as we blankly stare at one another when trying to explain different practices.

As the week passed by the wards filled up with many different patients. Some who have already been discharged home.  Some surgeries have been routine, plastic surgeries, tumor removals. Others have been a bit more dire. Sometimes a tumor will start to grow within ones mouth in a way that is slowly begins to suffocate them. I was told that sometimes patients like this make it to the ship just in time, as their airway is nearly occluded. The walk up the gangway and go strait into the OR for surgery. Others, sadly, do not make it in time. This week we took care of a 2 year old little guys who had a tumor growing in his mouth in this way.  He stayed two nights pre-opperatively and was gasping for air with stridor and great work of breathing.  He finally went to surgery after what seemed like years to the nurses that had to hear him breathing with great difficulty for two days. It was a relief. The surgery went great. The tumor was removed! Post operatively though, he began to struggle and his respiratory status diminished. He was taken back to the OR to be intubated. In orientation, our charge nurse told us that ICU patients are quite rare, and that last field service there were 3-4 total ICU patients in the 10 months. This little guy started us out with a PICU patient week one. I was able to take care of him the day that he got extubated. He did great! He was ready to do all the work on his own! It was nice to be in a PICU role right off the bat. It was different. But I think I will get used to it. A lot more independence. I was making all the vent changes as we were weaning him tp be extubated.  The drips were mixed and ran very differently, morphine was ran at a rate of 1ml/h, and mixed at a concentration of 13mg/50ml, so for the 12.7kg child, 1ml/h was 10mcg/kg/h. I guess this is the English standard.

After he came back to his bed from being extubated, he was agitated and fussy. He was coming out of all of his sedation and was trying to become oriented to what was going on around him. He was difficult to console. He kept being an alligator in his bed, rolling over and over, getting all his wires and tubes tangled up. His mama crawled into bed with him trying to console him. We gave him extra pain meds. I tried all my toddler nursing tricks, showing him my flashlight, giving him my badge to play with, and gave him toys to play with. NOTHING worked, he was done. Over it! My 8h shift came to an end as he was still in the midst of his crying. I hated to leave as he was so upset. It is always difficult to leave a shift on a bad note. When it happens, I feel as if I am leaving the on coming nurse in a huge mess. But, I was exhausted from all the newness of the ward and worn out from trying to console him for the last 3-4 hrs.

Later after dinner, while I was walking my dirty plate up to the dish drop off cart, I passed the nurse in charge for the evening shift. This is one fun aspect of living and working in the same place, we are able to check in with one another often. I asked for an update on how he was doing. She told me that after about another hour or so of crying, his Mama picked him up and tied him to her back, like all Mamas do here.  The Mama's have a piece of fabric about 2 yards long that they wrap around the childs bum after shifting them to their backs, they then bring the two ends around to the front, tuck the top corners in and loop the botom corners around each other twice and then tuck them in. It is amazing to see! I cannot wait to learn how to do it my self. After she did the, he was instantly asleep.  It was such a relief to hear this! It was one of the moments that I have had many of since I've been here, an "ah, so that is how it is" moment. I am sure I will have many of these as I learn how to be a nurse in Africa.

I will post pictures of all this soon. I am waiting for them to be released! I will post them as soon as I can!