Thoughtless Thursday - The patients

Ok so I know it's Friday- but it's been a busy week and I figure it is close enough for a thoughtless Thursday - Enjoy








Giving the Very Important people a run down of the laboratory



Before surgery



Above: Awaiting swelling to go down post surgery

The kids- too too cute







Above: Premie twin bub mentioned in previous blogs. Such tiny little casts

Below: Screening days





Me trying to create or keep order during screening

Kpalame adventures

The Mountain we hiked

So please forgive me I wrote this earlier in the week but have only just found the internet to be working fast enough to post it. Sadly pictures are a luxury you'll have to have one of this week (slow internet connection)- which is a shame as the veiw from my adventures was spectacular:

Wow the election curfews are now over- Yay we are aloud off ship.

No mucking around we planned a weekend away at Kpalame- a village at the base of some mountains about 2 hrs drive North West of the port of Lome.

Scavenging bread and nibbles from the last couple of days we were prepared with enough food to go (can’t just duck into eat anywhere here).
15 of us met our taxi driver out front of the port. 19 of us crammed into his van about the size of a Tarago van. In true African style 4 random Africans jumped in with us for the ride. The drive north took us out of the busy city, past a rather large political demonstration into lush green landscapes dotted by small villages. The villages though so close to the city are very primitive mud huts with thatched roofs. We are stopped at countless check points along the road- though our driver familiar with the area charged straight through one apparent check point with rope across the road. Apparently it is a fake checkpoint locals set up to get you to stop and buy something at their village or pay them a toll/bribe to get through.

One thing I have learnt is that people are out to milk you for all your worth if your skin is white and sometimes it gets super frustrating. We arrived at our pre booked hotel only to find that they hadn’t booked our 4 rooms and that they wanted us to pay a much higher price (about 3 times the quoted amount). After much discussion they agreed we could pay the previously agreed price if we ate 3 meals in their restruant – not happening given we planned to be up a mountain for most of them. After much negotiation or frustration they found us rooms at a local hotel next door and once again tried to hike the price up- so we walk away and sure enough they came to the party. Actually we ended up at a very nice hotel with some lovely hosts so all the drama was a God send anyway. We soon discovered we had 4 rooms as booked and though each was supposed to bed 4 people they only had one double bed or king per room. 4 in the bed :). Borrowing sun-mats from beside the pool we made several beds on the floor and were set.

At midday we embarked on a 5 hr hike up a very steep mountain nearby. Our guide for the day set a flying pace and about an hour in 2 of us had nasty heat exhaustion and several others weren’t doing so well. After several discussions with the guide and a break (with some miracle electrolyte drinks) we were back on track. The view the whole way up was amazing. It was like trekking through the thick growth of the jungle – thankfully we had our guide. We passed through three villages on root. All the villages were built into the mountain side. Gatherings of mud huts in close proximity. Some village children joined our walk . They kept directing the guide to local landmarks like a cool stream where we could dunk our heads in water, an avocado tree, cocoa bean- which by the way when not ripe are really citrusy in taste to suck on though grossly bitter if you bite. The local man are constantly armed with either a machete (often used for farming purposes) or a gun hopefully more for hunting than protection but who knows- interesting world.

When the going got really tough and a few got sick the guide just found a random local in the bush who could walk a couple of us girls back to his village and then give us a motorbike ride to the hotel- that met a resounding NO from all of us- helpful though the guide was you can’t be serious or can you.

Continuing on we passed by many women with huge tin bowls on their heads and babies tied on the back- how they make it up the incline is a miracle to me. The kids continued with us to the next village where we stopped to relax. Kids came from everywhere and we whipped out some balloons I had thrown in- that was cause for some fun.

Continuing on we watched huge dark clouds roll in across the plains- within moments our guide was cutting us all banana leaves for umbrella’s. Seconds later we were drenched and sloshing in inches of mud. It didn’t take long for the mountain to turn into a slip and slide. At one stage there was no seconds between lightening and huge bangs of thunder. Yep we were right where you’re supposed to be in a storm- right in the middle of the bush. Been soaked to the skin with rain instead of sweat was a nice change J. The pictures speak for themselves of the view!!! And we didn’t even make it right to the top cause of the storm.

Saturday we wandered around the local markets before heading to a waterfall- even that was a hike and a half!! Again the pictures speak for themselves- and hopefully next week there won’t be any parasites to make this a bigger story- one can never be sure in the waters here :).

This week has had some absolutely crazy days at work. Aside from the usual hospital patients and the new admissions we were inundated with screening patients on Monday. About 50 people with facial tumors came on board to be screened and scheduled for surgery. One poor women has about 5-6 giant tumours the size of a man’s fist all around her face. Cute little kiddies with cleft lips and palates rolled around under foot. Many were scheduled for surgery in the coming weeks. Some will likely get the news of cancer- looking at their biopsies today. If the cancer is contained maybe something will be done to remove it but if not they will be for palliative care. Some patients will find out they are HIV positive- it may not discount them from surgery but where metal plates need to be put in their body further tests need to be done first to determine how advanced their disease is and how likely their body is to reject the metal. One a 14 year old girl with a deformed leg will miss out on surgery – she is in the early stages of pregnancy where anaesthetic is too risky. By the time the baby is born the ship will have left- for her the bad news was probably a double whammy. But in all that little kids keep going home with legs cast from transforming surgery, cleft lips toddlers meander the wards with their little cats whiskers- sterry strips in a cross shape over their newly repaired lips, and adults admire newly created faces post tumour removal. Proud parents of the children lurk close by to encourage little ones with double leg casts who can’t stop trying to scratch through their casts- I can’t imagine how frustrating 2 cast legs must be- but then again I have never had my legs on almost reverse and tried to walk or had painful club feet. They have a road ahead but they have a hope they never imagined.

Well that'l do me- in usual ship style I have what is hopefully the flu and not malaria so i'm going to take my hot and cold sweats to bed for some ZZZZ.

Discarded Treasure

Sometimes I feel I start my blog all too often with tragic stories. I hope you can see the joy in them too- but this is reality here far too often. Today’s blog is really no different.

Today I sat in ward church. Patients came in from the other wards to crowd B Ward. Some from the maxillofacial ward post op with nasogastric feeding tubes, dressings and scars from surgery already performed. Others sneak in faces draped with some form of head covering masking large tumours- awaiting surgery tomorrow. From B Ward the patients are manovoured into position for church- many have had bilateral osteotomies (bowed legs sawn through and repaired). There bare double leg casts of a variety of vibrant colors. Next come a group of mums from A Ward- there babies are in the infant feeding program. Some have cleft lips and need feeding up before surgery. There are tiny twins- apparently 10days old- though suspectedly born at about 32 weeks. All blanket no baby. One twin is fine and just needs feeding. The other had club feet and yes at 10days old and 8wks premature this tiny one has leg casts- caught so young casting should repair the club feet quickly.

The ward is packed- I sit next a little girl. She is 8 though only the size of a 5 year old. She is very non responsive. She has recently had both legs operated on and cast for bowed legs. I met her earlier in the week when a HIV test came back inconclusive- we hope it’s a false result as can be the case with inconclusives. She quietly cries- before conveying she is in pain from her legs. Like an angel she takes the pain medicine. She also has malaria and shivers and sweats throughout the service. She keeps looking at her hand- seemingly amazed by the IV lines going in even though they have been there for days. It is so beautiful to be able to sit and stroke her head to try and comfort her to sleep. So much more beautiful when you know her story. She was found dumped as a baby- the translator says in the trash- whether that literally means in the trash or dumped like trash we are not sure. We can never know her parents story as to why they discarded this little one- was it her deformatity- perhaps. Some nuns found her and she has been living in an orphanage ever since. The sisters brought her to the ship for surgery. She’s had a hard road and probably has a hard road ahead but to be able to have the function in her legs restored will save her much rejection and suffering in life.

The first boy to have surgery, a 14 year old with a large facial tumor which distorted his eye socket and cheek (about the size of a mans fist), left to go home today- excited to show his grandma whom he lives with his new face. All week he has had a small mirror beside his bed and when he thinks no one is looking he sneaks a peak at his new face- like a little child discovering themselves in the mirror for the first time. How much do we take for granted what we see in the mirror every morning- a little less than pretty though it may be before coffee and a shower .He looks great. Before coming to the ship he had dropped out of school- too ashamed to go. He snuck between his Grans house and his fathers house in the early morning or late evening when it was dark. Too ashamed to go into public he lived as a hermit. Today he looked confident as he walked down the gangway with his Dad looking very proud beside him. He can go to school, get a job and likely marry and have a family someday- leaps and bounds ahead of the boy who came to the ship less than a week ago.

The election here has been relatively peaceful. Both parties are declaring victory at this stage and a recount is underway. There are many road blocks and the borders to Benin and Ghana are closed as are most businesses in town. Large gatherings of people and protests are certainly going on in Lome where we are but we are told so far they are peaceful. We have been in lock down on the ship since Wednesday and continue in that phase. Enough patients were admitted on Wednesday to keep the operating rooms in action until next Wednesday when hopefully normality will resume. Prayer for a peaceful resolution would be great.

We had a bush dance (or barn dance or Kaile - many names many countries) on Friday night in our compound on the dock. It was lots of fun. The local dock workers and some Asian seaman from the neighbouring ship watched on in amusement. They probably wonder why on earth a couple of hundred people would want to work up such a sweat in the intense humidity. There wasn’t bush or barn in sight but there were plenty of cockroaches getting squished during our jig.

The rollacoaster tragedy and fun

How you can nearly overlook a person...so easily here. At the eye screening a lady turned up to the church along with the other 1000 or so patients. Seeing she had nothing wrong with her eyes she was not attended to....she was clutching her stomach and came with an older man. Somehow she got inside the compound to where the eye team were-Perseverance probably like the men who lowered a lame man in the bible in to Jesus presence. Her story is traumatising. She has a fistula- the smell was apparent. She didn’t want to sit as she would leak urine. How did she get it? Most women get a fistula through prolonged child birth causing a tear in the bladder. This young womens story gradually came out. She was recently to be married and to stop women enjoying the pleasures of sex and potentially straying they are often cut- Yes female genital mutilation. It seems this women was cut so badly that the valve on her bladder was destroyed. I can’t even begin to imagine to brutality and pain of the immediate cutting- no anesthetic too. Since then her husband rejected her and she was left. How God must look down in anger at what one human being or one set of beliefs can lead people to do to one another. God’s good design for sex and pleasure destroyed for these women. The difficulties of child birth and likelyhood of fistula’s increased due to all the scarring. Meanwhile the men stray at their leisure often bringing home the HIV infecting their wives. For this lady hopefully there will be some joy. An elderly church man brought her over a 100 miles to the screening. They arrived with barely enough money between them for the long taxi ride back. The eye team did a run around to scrounge together some money for food etc for them. The fistula surgeon is not here yet but this young women will God willing come to see him and I pray her bladder will be repairable so she can enjoy some normality of life and community instead of living as an outcast from her smell. Words probably can’t sum up your response or mine to this appropriately so I will say no more.

No need for seatbelts when your packed in like sardines- 12 0r 13 ppl in total

Every outreach before the OR’s are sterilised the hospital has a fun open night for all the non hospital crew to come and enjoy the hospital and get to feel a bit at home in it. Many of them serve us amazingly with food, cleaning, deck and trade skills to mention a few and they rarely get to see the hospital. Each dept designs activities for the crew and kids to do. Taking blood pressure, cannulating sort toys, suturing pieces of form, watching cataract surgery DVD’s and looking at the glass eyes. The lab hosted “A day in the life of a mad scientist”. The crew could pierce their fingers and test their own blood group. They looked at anti biotic plates, malaria, blood cells etc. I ventured into the OR and was smartly ushered into the stirrups- how graceful. Legs strung up a mile high and just as far apart -all to demonstrate what a fistula was and how the surgery was done. The kids then proceeded to throw a ball through my legs into a hole in a plastic sheet. The nurses had the pleasure of playing the troublesome patient whilst crew had to take temps, blood pressures and empty bed pans full or cordial and toilet paper. I am not sure all tactics used by the crew would pass normal standards- one crew member whilst bandaging a head held his patient down with a knee in her chest (he’s from the deck crew- perhaps that explains the man handling). All in all it was a fun night.


In stirups..... :S
Crew in the lab been mad scientists

What to do when the Togolese day volunteers are all on board for orientations and there is no room in the dining room for dinner- well a BBQ of course- on the dock. We had many local spectators probably wondering what those crazy Yovo’s (white people) were up too all piling off a perfectly air-conditioned, clean boat in their hundreds for dinner on the filthy port in the heat. Fun times.

Surgery started this week. The first 6 wks will be paediatric orthopaedics and maxillofacial surgery along with about 30 plus cataract surgeries a day. The wards were filling up with kiddies with bowed legs and club feet- now they are full of kids in casts that are going anywhere. The ship is also using a casting technique on small children to correct club feet which will mean only minimal surgery. They are teaching the local hospitals how to do it because plaster of paris and a small nick in the archilles tendon are about all that is required for the milder younger cases. The rush is on to get the casts on and off before the wet season in March/April- mushie muddie casts won’t be pleasant. The things we don’t even consider at home. The objects the kids put down their casts is interesting- nails, money the occasional grub crawls in.....mmm nice.

One of the first surgeries was a young boy with a large facial tumour. He had his maxiallar (top jaw bone) with teeth removed from his face and a muscle from his head moved across his face to hold his cheek up. These cases are not uncommon here and often a metal plate is screwed in place of the removed facial bones. I watched a DVD on this type of facial surgery where one of our surgeons operated- Dr Gary has been with the ship for nearly 30 years fulltime, brought a family up here and does some amazing work. When you see the face peeled back and the bones exposed and then removed you wonder how the patient will ever look human again- but with some clever manipulation of muscles and stitches hidden under the chin an almost normal looking face reappears- with swelling of course and excess skin that needs to shrink in time.
The Blood donor drive team- sucess with about 90 donors

Church is an adventure. I have attended two local churches in Togo. The first was in the North of Lome in a slightly rural area. We travelled along the road lined with homes built from women palm fronds and bamboo. Arriving at a large part finished church. As we arrive slightly late- which is normal and quite accepted here we are assured to the front stage facing the crowd in church. We take our seats as guests of honor. The sermon is mostly in French and translated also to a local dialect. The people though poor are all well dressed in their best. Some of the children where what look like grandpas slippers on their feet- many sizes too big. The church usher wanders around during the 3hr service with a switch which she uses to keep the kids in line and the dozing adults awake.

Last week I went to church in a fishing village. First we called to the tin shed where the men spend most of their days if they are working at the port and living here far from home. We stop and greet the dozing men- they look old and leathery but buff from their hard labor. This shed was where the church started- we stop briefly so the African pastor can have a chat and build relationship with the men. Driving a short way further into the village we come to an open sandy patch surrounded by cactis. In the middle is the church- a tin structure supported by small tree branches. Around the outskirts some foundations exist- the beginnings of what may one day be a brick church. In this very poor part of town it may be a lifetime until the bricks resume the shape of a church- particularly as the men of the village are fisherman and spend most of the year away from home. As such the church is full mostly of women and children and some older men. Some pictures of the two churches are below.
Church at the fishing village

Well I think I have come up with a good analogy for ship life to give you a fair picture. It is kind of like living life in a busy 8 storey Westfield shopping centre. Everywhere is public access and shared. Noise is constant and so is the flow of people all rushing around with one purpose or another. A few sit in the cafe and watch the bussle go by. A hive of activity..... Yesterday on my way to the laundry I past some children playing in the hall- I briefly enquired of their activitity, was invited to play ponies. It wasnt long before I was invited in by their parents- also people I hadn't met before. An enjoyable meal together followed and I had made some new friends and playmates I am sure. Maybe that bit isn't like the shopping centre- but it is unique and nice.

Lunch beckons and the computer battery is low so "so long"

Screening days- The joy and the pain

Where to start???

It has been some time since I last wrote and life has been insanely busy, interesting and at times overwhelming.

Last weekend the ship was blacked out so we went into town to the markets. The roads are as crazy as in Benin – potholes, zimee johns, rust bucket taxi’s and people people people- balancing all manner of things on their heads.The market is full of handy crafts and everyone is offering you a “Good Price, Good Price”. Which is code for they are trying to rip you off- but who’d blame them when you see their homes etc.

The military are everywhere with the upcoming election. They have a very public display of artilliery just in case you think of getting out of line. We have been caught in more than one election campaign. They are loud events where many trucks drive through the market with horns blahing, people yelling on megaphones and drums beating. The election has been postponed until the 4th of March- Please pray for a peaceful outcome- some people are suspecting otherwise (to the point that they are leaving the country)but so far so good.

Screening has commenced for the surgery list. I went on Tuesday. We were anticipating large crowds (which have been forbidden due to the upcoming election) however much to our surprise when we arrived less than 100 people were lined up. The line was orderly (thanks to our security). We were at a handball stadium right next to one of the major political buildings so we are unsure whether that scared people from coming- additionally it is hard to tell if the media is giving good advertisements as the election is taking precedence. We set up a maxilla facial table, an orthopaedics table and a data entry table for all patients with other ailments.

Initially I was on the line escorting people we were unable to help to either the prayer area if they chose or to the exit. It was a sad line to be on but at the time you have a job to do and do it compassionately. It is only afterwards that you take it all in and realise that for some you were their last hope, a life line. The people take no so graciously- even though they may have waited many years in hope that we could help them. Not everyone we had to turn away had a life threatening issue (well not yet). There were many thyroid goitres and hernias, which whilst back home were huge, here in West Africa they were relatively small. If they weren’t yet life threatening we had no choice but to send people away. With so few surgery slots only those who struggle to breath or have toxic thyroids will receive surgery. Maybe those with small goitres will be alive next time the ship comes- or maybe their goitres will have prevented them from breathing- a sad reality.

I was rotated from the turn away line to the pre screening line where those patients who the pre screen team thought we may be able to help came. Translators took brief medical histories and I tried my best French to greet and direct potential patients to one of our 3 nurses who then decided if the patient was suitable to see the doctor or whether there was nothing we could do. Some adults came through with leg deformaties/injuries- but there is only time to do paediatric orthopaedics so regrettably the adults will go home. Some twins came through- so cute and yovo phobic (scared of white man). The boy twin was bilateral club feet and is scheduled for surgery this week from memory. Another child with bowed legs hidden under baggy pants is also scheduled. We saw a child and adult with large keloid masses behind their ears who will be scheduled. The last patient of the day was a 16yo boy who had a large maxillary tumor on his face. He was so ashamed he dropped out of school. It will be great to see him in the hospital for the first surgery of the year.

A baby with an encehpocele (hole in the skull through which the brain protrudes) came. His mumma was so happy that he could be scheduled- even though the risk is high as the skull is opened and the brain brought back inside and the hole sealed. Without surgery though he could not live to adulthood.

A lady with a fistula tried her best French to explain her condition to me- thankfully someone had written the word “gynaecological”in English on a piece of paper she brought with her. Fistula surgeons are coming later in the year so she will come to another screening where a surgeon can examine whether she will be repairable by surgery.

Over the morning the line of people grew slowly. The military came by at one point and the fear in the crowd was obvious. How blessed we are to live in a country where police and law enforcers are not to be feared. Many of the patients were cataracts and dental so they were referred to our eye and dental teams. There are many more eye spots available as the cataract surgery can be done in 7 minutes here. It is crazy to think something so debilitating can be fixed in 7 mins (though with a lot of skill too).

There are many more patient stories I could tell but i'm sure they will come over the coming months....

General surgical screenings will go on 3 times a week for the next 10 wks. Eye and dental screenings go on with similar regularity until about June. Time is not a concept the Africans are familiar with so we can’t give the patients notice of their surgery more than about 4-6wks prior to surgery or they loose track of time and fail to turn up or turn up too early.

Unlike Benin where French, and 2 dialects were spoken I am told up to 23 dialects are spoken here so confusion is common. Will I ever be able to communicate- mmmm not looking likely.
Please be praying for surgery which starts on the 25th and for wisdom for the staff who continue to select patients we can help.

My cabin is filling quickly and I ebb and flow with bouts of missing home. It is a very unique environment to live in- 6 people in my bed room, 400 people in my house with any number of those in the lounge room, kitchen, dining room and laundry at a given time. Add that to a street address that reads something like the craziest busy port in hot humid West Africa with men who eye you all the time and a never ending bombardment of noise, smells and sights.......sensory overload big time. Prayer for my sanity at this stage would be great :)

There is so much more I could write about the events of the last two weeks- but you have more to do than read a long long blog –so until next time......
Au revoir

Thoughtless Thursday- Pictures from the Sail

With my room mate Keisha
Yens- our resident comedian (carpenter by trade)from Holland

Counting and Packing pills for the Pharmacy with Shaun providing the inspiration (Music) and the ship to provide enough movement that sometimes all your nicely counted pills slide off the table in one wave :)

Worship on the Bow

Cabin fever has set in bad- the newly formed powerwalking team- anything for amusement by this stage- sock golf was another sport introduced.

Maggies scavenger hunt birthday party team

Our Scavenger Hunt team (note for sensible reasons they only let us be responsible for one child in case we lead her astray or got lost on the ship... :))

Sunset from the Bow

Bienvenu to Togo

Bienvenu to Togo- Welcome to Togo.
We have arrived- Praise God for safe travels.
Just after 10am this morning we picked up our Pilot and pulled into the port of Lome, Togo. On route we passed numerous fishing boats reminding me of Benin- true to it they were bailing water out of the boats before having left the port.
We were up early anticipating the sight of land but the horizon was hazy. Around 9:30 we could just make out the beaches in the distance and a constant flow of exiting cargo ships indicated we were close to the port.
Pulling around the break wall we could hear a band. In front of us were several dirty big cargo ships. Spotting a crowd of people on the wharf we soon gathered which berth was to be our home for the next 6 months God willing. I say God willing because the Togo election campaign starts this weekend with the election scheduled for the 28th Feb. Whilst little unrest is hoped for the police presence is high and check points are common. The 2005 elections saw much unrest but 2008 was relatively peaceful. That is a prayer point for sure.
Many people colourfully dressed and waving excitedly gathered on the dock. The bands of brass instruments and drums beat out the turn “Our God is the most High God”. We could sing along with the people as we had become familiar with the song in Benin last year.
Due to the elections the gathering on a large crowd is strictly prohibited so only those approved by the Port officials and government would be there to welcome us.
Almost in slow motion we safely touched the dock and were tied- down came the gangway and the official welcomes began. In usually African style the official party of government was unable to make it due to the upcoming elections- I stood and listened as the welcome was translated to English- I am still unsure who made the welcome speech.
This is the fourth time that Mercy Ships has been to Togo- but this time is the first time with the new ship so the people are eagerly waiting.
Due to the elections we are unable to have a mass screening for patients so instead teams will into designated towns and clinics to do multiple smaller screens. Already a baby boy was scheduled to join our infant feeding program immediately- that is his mother was to meet us on the dock for his feed to start- however they are yet to turn up- maybe tonight or tomorrow- the concept of time is a mystery here.
As I sit looking out at the port a large cargo ship is been loaded with bags of grain. Rats and cockroaches are common residents here- as with any site associated with grain. Lorry’s are moving everywhere, large cranes move back and forth , shipping containers balance precariously on fork lifts and grain hoppers line the horizon. This is a busy working port....we will have no shortage of entertainment to watch over breakfast.

Today we all dressed up for the occasion and celebration as dignatories came on board. Behind me is the Togolese Navy - two ships in total.

Praise God for our safe arrival. I look forward to filling you in on the adventures in Togo.
Au revior.