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!

The highs are high

The last three days have been jam packed with orientation to the ship, wards and way of life here on the ship. It has been exciting , eye opening, exhausting, and rewarding.

I arrived to the ship a couple days after my planned arrival due to travel issues.   Karyn did not have the same issues I did and made it to Pointe Noire as planned, safe and sound.   I had two days to try to get used to the ship a bit, and then we had the BIG screening day. A screening day is how patients are selected for surgery. The public is invited to come with what ails them and see if they are candidates for surgery.  There is one big screening day in the beginning, and then many more small ones throughout the stay in each country.  Over 7,000 people arrived in line and over 4,000 of them were patients.

The crew left in a few different waves from the ship, 8 people/land rover. My car left at 0630, shortly after sunrise. The large convoy of white mercy ship trucks full of many (not all) white faces was quite the sight to see through town as many were walking the streets to work. The screening was held in a high school that was still in summer break. It was near the ship 10-20 minutes away. It was a huge compound like school with a sand yard. To prepare the school, each classroom had to be emptied of the many wooden benches. And set up for screening. It took many hands and lots of work to pull of the preparation.  

Here in Pointe Noire there is a strong media presence, also in Brazzaville, which is a 4 hour drive (I think…). There were over 18 different media groups here to cover the event. Due to this strength, the word got out into the community and the people came.  And, came. There were so many, that the line had to keep winding up and down different streets, and as more people came, more streets were taken over by the line.

I worked in an early part of screening where I took a brief health history, a blood pressure and a heart rate.  It asked questions about heart health, breathing status, epilepsy, malaria, diet/weight, and HIV.  I worked with an amazing ‘day worker,’ Bridge, who interpreted for me. Many day workers are hired to help us on ship. They are local people who know the local culture and speak both English and the local languages. We could not do with out them.  Bridge told me he knew nothing of medicine, and that this was all new. I started a tally of how many people Bridge and I saw, and quickly lost count. There were about 10-12 groups of nurses and day workers in my room which was about the size, maybe a little smaller, of a small US classroom. We all sat in plastic lawn chairs in groups of at least 3, a patient and their family, the day worker and the nurse. The room was crowded! People kept coming and coming.  I saw all kinds of health issues, many goiters, some people who had scars/contractures from burns, cleft lips/pallets (children and adults), ortho issues, and facial tumors,  to name some. Some people had to be carried in. I had one young girl, about 8 years old, with clubbed feet who was carried on her mother’s back. Her mom has most likely been doing this since her birth. Everywhere she goes. When she and her mother sat down, she was very apprehensive and fearful. The probability of her being addressed by people other than her family is very low.  Here, when people are disfigured, the community ignores them and casts them away. A big part of our job is to show compassion, to demonstrate their worth through communication, touch and eye contact. This compassion is transformative. When I interacted with her to take my assessment, her face lit up and she gave me the biggest smile.

It was a long hard day, I only got to experience this small piece of the very large operation. In other rooms, surgeons were assessing patients for surgery, patients were praying and being prayed for, and patients were given a scheduled surgery day, which is the most exciting part.  For many, a surgery to fix minor problems will put a whole new perspective on their life.  Not only was this the most exciting part, it was also the most devastating part. There is a phenomenon in medicine where the “highs are high, and the lows are low.”  This is true here.  Not every person we saw is a candidate for surgery. Many were denied.  We do not have the resources to fix all that happens here in Africa.  The sweet girl on her mother’s back was most likely denied, clubbed feet is an issue the AFM will not operate on this field service.

As I continue to process this complex day, I will wrestle with the injustices of the world.  I will try to 

understand, or rather, accept that I may never understand the finitude of life. And how, I can live in a world that has so much pain and suffering.

I cannot get lost in this. I must take hope and be thankful for the difference that can be made.  The healing is not only a physical journey, but an emotional/spiritual/psychological one. A journey in which people can find their worth even in a world filled with cruelty. I hope that those who were turned away from surgery do not feel turned away from the forms of healing, aside from the physical. I can also take hope in the transformation that will happen from the surgeries we are able to do. I am so excited for Monday, when this will become tangible.

~Photos all taken by Mercy Ships Communications on screening day.~

#sailwithus

Life has been no less than crazy the last few weeks as I am preparing to go, leaving 17 days from today. It has been a little stressful to say the least. I am not only leaving the country for the first time, quitting my current staff nurse position, packing for three months for life on a ship, packing up my apartment into storage unsure of what happens for me as I return home in 4 months. One of my friends compared my preparation to the same sort of preparation that happens for a wedding, and it is similar. It has taken me months to prepare and many to-do lists full of what is next. Immunizations, insurance, finances, mail forwarding, moving/storage, ect. It has been a little bumpy at times, like the other night when I temporarily lost all my important documents that got mixed up in the wrong pile. They were found after two hours of looking, praying and crying, in the recycle bin.  Luckily that happened before the bin was taken out and they were lost for good. That little come apart happened the same day that the state department issued a serious international travel warning. 
http://www.npr.org/blogs/thetwo-way/2013/08/02/208255213/state-department-issues-worldwide-travel-alert (shouldn't affect where/when I am going, but still anxiety causing)

Also, last week my sister and her husband's first new home that they were fixing up to move into caught fire, burning extensive damage and ruining many of their belongings. The flooring companies trailer caught fire, lighting the side of the house, causing a small amount of damage. Later in the night, the house reignited and caused extensive damage in almost ever room. They have been so excited to move in. It is heart breaking as their excitement is shattered and instead of preparing their new home, they have to prepare to move into temporary housing as it gets repaired and their items get restored and replaced.

Stress has been at a bit of a max point. My right eye is most definitely twitching. And, as I run around like a chicken with my head cut off, I am brought back down to earth with a good dose of 'life is bigger than me' moments.

Africa Mercy is on the move, sailing from Spain to The Congo as I type. This is the furthest south that the ship has sailed so as it travel's, it has sailed past all the previous countries that it has served.  Through it's journey I have been following along through facebook and instagram with the hashtag #sailwithus. In the midst of my crazy moments, I have found quiet moments to read the stories. They have been reminders of why I am going through all this stress and they have put me in my place.


Life is bigger than me. God is bigger.

Here are some links to my favorite stories;

http://alirae.net/blog/archives/721-sailwithus-togo.html

http://suzannemichelles.blogspot.com/2013/08/patient-story-jaka.html

http://alirae.net/blog/archives/723-sailwithus-benin.html

Thank you to all have helped me and supported me through these last couple weeks. I would not made it here with out you.

A Trip Back Home

Sorry it has been a while since the last post, life is a bit of a tornado right now as I am gearing up for Africa. I am trying my hardest to be fully present in this transition time.



A couple weeks ago I was able to take some time off work and travel west to visit family and friends in Colorado.  Since I moved to Knoxville three years ago I have cherished the time I get to spend with my family and friends on these sorts of visits.  I also cherish simply being in Colorado. It was a fantastic trip.

Some of the highlights were having my Uncle Deny and Aunt Carol visit from David City, Nebraska.  Spending time with my nephews. Going to the gym with my sister-in-law and brother. Meeting up with Elizabeth who was in town from Tennessee with her husband for a conference.  Going for a Harley ride with Rod.  Getting together with Quinn who was in town from Newport Beach.  Kayaking with Sarah.  Hanging out with Kirsten who was in town from Beijing. Visiting my al ma mater University of Northern Colorado. Eating Dad's bar-b-q chicken. Having many meals with many different friends filled with love, laughter and great conversation. It was a busy trip! I won't keep rambling, even though there is so much more to share! It was a trip filled with many blessings.

Here are some of my favorite photos (I have been having fun with my new camera!)

 Mason Joseph, 5 Year's old. Son to my brother Justin and his wife Tracy

Warren Michael, 8 months, Mason's younger brother

Colorado Blue Sky over the Longmont Farmers Market

My Dad (right) Grilling out with my Uncle Denny

My Aunt Carol, from Nebraska

Kendra, a neighborhood friend since we were 5

Sarah, my "adoptive" mother

Kirsten, a friend from Rainbow Trail Lutheran Camp

Elizabeth, from Johnson City

Dinner with Angela (friend from school) and fiancee Kevin

Quinn home from Newport beach

Gunter hall, school of Nursing, UNC Greeley