Monday, April 22, 2013

A Glimpse from my Hammock





36 hours free from work calls for a quick trip out to the island to kick it in a Hammock watching the world slide by.


Not far from the Port where our Ship is docked is the local Fish Market, it is here where locals can go to buy fish, and catch local taxis to the surrounding islands that are scattered just of the coast. We arrived to the local boat taxi in the early afternoon only to find that all the local taxis had left and we were left with only one option, an overpriced Privet Boat taxi! So we payed the "Forte" (white person) price of 65 000 GF each for a return trip to Kassa island. Here in the photos you can see the hand made wooden boat, it is always a good feeling when the driver is bailing out the boat while we cruise.

 


Here is Nadine and I and Kiley and Kristie sporting our fancy child sized, saturated in stale water life jackets.


We arrived on the island around from the main docks and made our way along the shoreline over the rocks and lava rocks that make up the coastline of Kassa Island. We had a vague idea of where we were heading and our requirements for a perfect spot was a short lists of must haves! We found a beach with no dog tracks, no signs of people, no roads, and a circle of trees where we could hang our four hammocks. In the distance we could see a building about 30 min or so along the coast. Once did we hear a car in the distance. There was an old shoe in a tree, stones built up from an old cooking fire, a doll pulled apart in the woods, and only two needles in the sand... TIA (this is Africa).


The islands in the area are crescent in shape with the odd small blob of an island in the center, the remains of old volcanoes.



After swimming in the Atlantic Ocean we enjoyed playing "Crazy American" a card game we have learned from the patients here on the ward, it is a little like Crazy 8 but with just a tab better!


We bought bread and avocados on the way to the island for make shift sandwiches as our evening feast.



As we sat on the beach, boats passed by coming and going from a day of fishing as the sun was setting over the ocean and islands that surrounded our little paradise. We listened to music and sat on the beach under the moon light before retiring to our hammocks.


Waking to the sound of waves lapping on the shoreline, and birds overhead was surreal. Watching fishermen passing by on their way out to Sea was a beautiful. I want to wake up to more mornings like this. I loved the time this night away from the boat gave me to think and pray and reflect on all that is happening here in Guinea in my life and in the lives of those around me. Its a blessing to be able to have moments of reflection. I am fearful of returning home and falling into the speed of life, and loosing grip on moments like these.


We rolled our mosquito nets and hammocks back up and packed our backpacks and headed back to our meeting spot with our boat driver to head back to the Port and back to what is my reality right now, on board the African Mercy in Guinea West Africa. This is life.

Saturday, April 20, 2013

Kindia Once again....


Last weekend (April 12th-4th) 18 of us embarked on another adventure upcountry to Kindia! Through a series of Facebook messages, phone calls in broken English, and lists, we coordinated our travel up to Kindia in 4 different groups. I was in the first group with Nina and Jillian. We were lucky enough to have the day off fro work and got an early 10am start! We took the bus to Madina Market and found a public Taxi, I climbed in the back as I am not bothered to sit in back crammed seat with minimal air flow! Nina and Jillian stood outside and watched as they rolled the car around in the market and sold the remaining seats. Of course there were arguments and men yelling at us, and people pinching my arm. It is always a chaotic mess at Madina Market!

Once on the road we made our way upcountry towards Kindia. We arrived at the truck stop and walked 10 min up the road to Hotel Masobi. It was a lovely hotel with a whitewashed exterior and a wonderful garden area with tables and a dinning room. We were entertained by a shady character of a man talking about his smuggling history and time in Jail while we waited for our room keys.
 

Dinner at Sunset
Lovely courtyard
 The rooms were clean. water was running, and there was AC wall units in every room, what more can a girl ask for! Only a couple of the rooms had a mouse or fire ants, but they didn't cause much harm. The three of us made our way out to dinner and enjoyed the sunset. Once we made our way back to the Hotel the 2nd group of 4 girls arrived. After playing games and enjoying the evening in the garden the 3rd car of 7 arrived at the hotel after their long journey. Everyone was happy to find their rooms and settle into the evening sitting in the garden. As the night went on people turned in. Four of us stayed up waiting for the 4th and final group of people to arrive, Amy, Michael, Prithvi and Jeremiah had left the boat at 5:30pm. At midnight we begain to worry and by 1:45am when they arrived we were so relieved that they were safe and had found the Hotel in the dark of night after their long 8 hour Trip. (Africa traffic is insane, a drive that takes 4 or 5 or 8 hour is not a surprise!)

Taking a break on a rock over
looking the valley

   After a restfull night we ate a lovely breakfast and split up into smaller, more manageable groups for the day. Six of us headed out for Mount Gangan to the illusive Banana Village. We got dropped off at the base and made our way along the well worn paths. A man came and offered to be our guide. We refused, saying that we would find our own way, however he continued to lead us. We made our way quickly up to the Platue where we had turned around three weeks prior. We continued climbing up the mountain towards the backside and found a rock that jetted out from the cliff to have a nice break. From there we saw some children collecting fruit from the trees, they shared some with us, it was a hard shell that cracked open, a liquid spilled out and you were left with a seed with flesh around the outside that you sucked off.
 

Mystery Fruit

Lamb

Lindsay with local kids

Lunch!

  We made our way into the village. The man brought us to his Mothers hut and introduced us. We greeted her and sat down. Now a quick back story, through the course of the day we had bought bread and Laughing Cow Cheese to make sandwiches, we had searched for Avocados with no luck. After greeting us the mother went into her hut and emerged with 3 glorious Avocados. Trudi was thrilled! after the mother saw our faces she went to find more avocados for us! We spread out a skirt I was carrying in my bag and put together lunch. Prithvi played a quick game of soccer with the kids and after Lunch Kari and Lindsay watched the kids dance and sing different songs. After lunch our guy lead us on to the next village where the elusive Bananas grew! We were presented with bunches of Bananas, with the first bite we knew we had found what we had been searching for! The magical taste of fruit, we all know Bananas are a fruit, but these tasted like fleshy ripe, rich Bananas! The walk had been worth it! We packed a few bunches into my backpack and made our way back down the other side of the mountain, towards Kindia.


That evening we all made our way back to the hotel, washed up and headed out for dinner. Saturday evening we enjoyed in the garden under the tree and umbrella of stars in the sky listening to music and enjoying the wonderful company of 17 friends. 
     

     
Kelssi Waterfalls
  Sunday found us spliting up once again. 6 of us made our way into Kindia via motorcycle taxis to buy fabric and hire a minibus for the drive back down to Conakry. After what felt like an hour we hired the same minibus that had brought the 3 guys and Amy up Friday night on the 8 hour trip! Prithvi was excited to end the journey in the same fashion as starting it. The 6 of us loaded in the bus while two men pushed it down the narrow street as the driver tried to turn over the motor again and again. We  stopped at the hotel to pick up the other 6 left behind and then made our way to The Kelssi Waterfalls. It was there where we ate lunch and had a lovely swim in the waterfalls. As we were leaving the we posed for a group shot infront of the bus, but as we were about to snap the picture the bus started rolling away, again trying to get a rolling start to be able to turn over the motor. From my seat I was next to a foiled window covering with a tiny hole for a veiw of the road and world passing by. The drive down to Conakry was entertaining and this time we had space! 12 of us in a mini bus that would regularly seat 20!
  
Sad about our flat tire

 

The Boys helping out!
     One flat tire and after karaoke to Spice Girls, Lion King, and other fan favorites we all placed bets on our arrival time to the gate of our port, the stakes were high, 20 000 GF! I missed the bet by 1 min. We had called the ship ahead and had our dinner set aside, the 12 of us recapped our exciting weekend over a meal finally back home on board!

   

 


Monday, April 15, 2013

1:700




A Mama and her baby
  Clefts affect 1:700 births world wide. Is is a common birth defect that in the western world is addressed at an early age. A cleft lip can result in malnourishment due to the lack of ability to breast feed or drink from a bottle. Another type of Cleft is of the hard pallet (oro-facial cleft) these are 1:1000 births resulting in communication between the nasal cavity and mouth. The oro-facial cleft often results in a very malnourished baby and often will not survive. These sweet babies who have clefts are not spared from social judgment. Some are considered cursed and even abandoned as infants for this congenital condition.

Often these surgeries are done by our Maxillo-Facial surgeon Dr.Parker throughout the entire course of our field service (for the last 26 years). Over the past month however the past month the Plastics Surgeon on board has preformed a couple cleft lip repairs. It is a surgery that takes 2-3 hours and repairs the gap in the lip and bone to create a seamless lip. The children who we have had on our unit have been 5-9 years old. As the patients arrive to the ship they are shy, and cautious of everything new that they are experience. How strange it must be to walk onto a giant metal ship, down into a windowless hospital, with nurses and doctors speaking a foreign language. Using our translators is essential to be able to describe all the details of what to expect during their stay. I have cared for two of our Cleft lip patients over the past month.They only stay for 2-5 days.


.
 
The first little boy was 9 but looked more like a 7 year old in his tiny malnourished frame. He was a shy little one, who disliked the liquid Tylenol and took a lot of coaching and encouragement when doing his exercises. After the surgery the patient practices smiling, saying ooooo, eeeeee, and making fishy lips, this stretches the new tissue so the healing scar tissue does not become taught. After a couple days of being his nurse i finally got a genuine smile from him. When passing by the unit on time off i would make fishy lips at him through the window. He was so adorable and i pray that he is able to gain weight, return to school and grow into a fine young man in the future.

The Cleft Palate patients are done by Dr Parker and go through Ward D (our high acuity and ICU ward). These surgeries are more extensive, the cleft goes through the soft pallet and sometimes even into the hard pallet resulting in feeding, speech and hearing problems. The surgery takes a flap graft covering the cleft area. This graft comes from the pharyngeal wall or cheek to close the cleft. The patients can experience respiratory distress due to the newly corrected airway. These patients have nasal trumpets through a nostril to maintain their airway, and a nasal-gastric (NG) tube to provide nourishment while the repair starts to heal. 

This Little Girl had a Cleft Lip and Pallet
The tube is an NG tube for the first
few days after her operation.
 (Side story about the NG feeds here, we have been using ensure and peidasure for the tube feeds however as the field service winds down and containers are delayed at times our supply of Ensure and Peidasure has run out a couple times. For the weeks when we do not have any canned NG feed the wonderful nutritionist here on board has put together a recipe for self made tube feed! As nurses we blend together 60 ml Peanut butter, 1 L whole milk, sugar, 10 ml Multivitamin liquid, and 6 tsp of fiber. After becoming smooth we store it in the fridge and give it as we would Ensure! To those nurses out there, can you see yourself fitting in a blending session into your busy day just prior to one of your 6 tube feeds of the day?! On my unit we have only had 3 patients requiring an NG and as a result this wonderful need to make our own feeds. However, on Ward D where the majority of complex cases and Max facial cases recover they are tirelessly making NG feeds throughout the day. But hey this is Africa and its a wonderful solution that works!)




My friend Jessica with one of
her Cleft Lip patients.
 Cleft Lip and Pallet is a surgery performed by aid organizations around the world and is a life saving surgery to so many rescuing them from a life of malnourishment and even death. It is a great part of my job to go up to a little one to tickle them make them laugh and make fishy faces as part of their lip exercises! I love my Job. I enjoy working with the children and seeing the quick change of a cleft lip repair. Last month i saw a little baby headed into surgery and just thought of how blessed that they were born here in Guinea while the Africa Mercy was here and was able to receive the care they needed. Timing in that little ones life that we were in the right place at the right time. 
My roomate Jillian with a little one she was caring for on Ward D







How a Human Makes a Nose out of Nothing!





In Greek "nomein" is to devour. This is where Noma (Cancrum Oris) get its name from. It is a gangrene of the oral/nasal cavity due to a tissue infection in this area. It affects children under 5 who are malnourished or have recently had a systemic illness like measles. West Africa is the poorest area in the world and the population is not vaccinated, which contributes to this horrific disfiguring disease to exist. One of the patients asked a fellow nurse what the people in America do who have Noma, she had no answer because it doesn't exist in the developed world. It seems to be only in the poorest of populations where an infection can take a beautiful little girl and consume her nose, mouth and cheek, leaving her teeth exposed and holes in her face in place of a nose.
 
Here is Mama and her Uncle
After her first surgery

The disease begins as a sore inside the child's mouth or nose, the sore grows and consumes the soft tissue and occasionally bone and oral cavity. Infection or starvation will kill up to 90% of those infected. And those who do survive are social outcast due to the visible proof of evil that has cursed them the locals believe.

So how does the surgeon rebuild a face, and create a nose, cheek, and lips? Through grafts, and flaps!          

A skin flap is moving a section of skin and subcutaneous tissue from one part of the body to another. For example a little Girl we had, we will call here Mama, she had Noma when she was a couple months old, she was left with an open hole where her nose once was. The plastic surgeon in her first surgery took a 3 cm x 5 cm section from her forehead, kept it attached at one end (so it would still receive blood supply from the forehead) rotated the flap down over the area that will be the nose, and attached the opposite end to the face in hopes that the flap would take and become vascullarized from the new end that is attached. The hole in her forehead was closed. She was kept on the unit as the flap began to take, after 3 weeks she was able to return to the OR for the final stage. The flap was detached from her forehead and formed into a nose! It was covered with steristrips and we were all so excited to see what it would look like when reviled! In the end she has a round button nose! ?It is not a perfect nose, and when the Africa Mercy returns in the future she should return for follow up surgery to sculpt the nose into a more appealing shape. However, she has a nose!
 
This is Mama a few days before her Final
Surgery. You can see the scar on her
forehead where the flap
that is now her nose is connected

Mama was a very active child on our unit. She spoke a tribal language that none of the translators spoke, but her  uncle (who spoke french) was her caregiver. Although we couldn't speak her language we all got to know her and enjoyed playing memory, colouring, and cuddling with her. The day of her second surgery I had finished my morning rounds with my patients and as Mama's pre-medication Medazilone started to work she became a giggling ball of excitement laughing and screaming and throwing her self around, with the flap sitting on her face exposed if she were to fall it would be ruined and with her unable to be calm or still due to the medication there was only one solution! On my back she went, even though she was a tiny 5 year old, usually too big to be in a bumba (Mothers place the babies on their backs and wrap a piece of fabric to secure them in place). She was much calmer sitting on my back wrapped up. We bounced around and she played with my hair and let out giggles and a few yelps. For an hour until her surgery she remained tied to my back as i finished handing out patient morning meds. It has been a week and she has been discharged to the HOPE center (to stay until all fallow up appointments are finished, they are originally from Sinagel). Walking on the unit without Mama is an adjustment. No one is there to steel my pens, and wipe their face on my scrub top! I do hope to visit the hope center and see her before she heads home.
 
Today (April 16th) i did make it over to the Hope Center before lunch and here is the final picture of her new nose! It was so great to see her and play with her once again!


Thursday, March 28, 2013

A new thumb and a new future!



This is the story of a young man who I had the privilege caring for these past few night shifts, it is written by the writers here on Mercy ships. Mamadou has now received his second surgery for relocating his index finger as a thumb! I look forward to seeing him through his recovery and writing a celebratory blog post once he is discharged with a new left arm and a public image that allows him to accomplish what he knows he already can! Enjoy!




Mamadou prayed silently to himself, asking God for just one more ounce of courage as he waited alone at the Mercy Ships patient screening in Conakry, Guinea. Mamadou tried to blend in with the other adults, silently shifting from chair to chair as the line-up of patients advanced.As he waited, Mamadou held his arms, bent inward at the wrists and elbows, close to his chest. He felt awkward and uncomfortable. So many times in his life people had insulted him and chased him away as they yelled, “That boy is cursed! His arms are devil arms!”


Mamadou had not told his family – including his Aunt Hadja, with whom he lived – that he had come to the Mercy Ships screening. He did not want to disappoint anyone if he could not have surgery. Mamadou lived with his aunt in Conakry so he could beg on the traffic-choked streets. His mother and father, in the city of Mamou, had tried to find an apprenticeship for him so he could have an occupation, but his arms were not strong enough to carry wood or hammer nails. So, because the family was desperately poor, they relied on their eldest son to use his deformity to earn money for the family by begging.

But Mamadou wanted something much different for himself, and all he needed was arms that looked normal. If he had no deformity, he would not be expected to beg. He wanted to use his sharp intellect to learn English, as this language came easy to him. And if he looked normal, it would not be strange at all if he supported his family through his own business.Mamadou knew he could do those things now, even with bent arms, but he was the only one who could see past his deformity. As Mamadou confided to the Mercy Ships nurse who examined him, “I can do much more than people think.” He added proudly, “I make good use of my arms to take care of myself and help support my family. I do not want to beg for the rest of my life, but I have learned to do it very well. With the money I earned from begging, I bought sheep. Now, the lambs from those sheep feed my family.”
Mercy Ships was Mamadou’s only hope, and he was grateful to be accepted for treatment. He now felt comfortable sharing the good news with his parents. Mamadou explains, “My condition was a huge burden on my parents. There was so much disappointment and shame that I had to beg for the family to survive. I wanted to be certain that Mercy Ships would do my surgery before I said anything to them.”

His mother and his one-year old sister came to stay with him. His father assured him that the family would get by during the many months that Mamadou would be in the hospital and recovering. Relatives would be called upon to help, and Thierno would find extra work in Mamou. They wanted to support Mamadou’s dream of having his own business and living like any normal young man. Onboard the Africa Mercy hospital ship, volunteer plastics surgeon, Dr. Tertius Venter, explained Mamadou’s rarely seen condition. “Mamadou was born with radial club hands and only four fingers on each hand. The front sides of his hands are underdeveloped and bend downward on an angle. His elbow joints have also been affected. On his left arm, the joint is working fairly well – but, on the right side, the joint is stiff and cannot bend all of the way.”
 
Since Mamadou’s left elbow was functional, Dr. Tertius proceeded with a two-stage rehabilitation of the left arm.In the first surgery, Dr. Tertius aligned Mamadou’s left hand with his forearm. In six months, when Dr. Tertius returns to Mercy Ships, he will take Mamadou’s index finger and reposition it to create a thumb. Mamadou’s left arm will look and function almost completely normally. Sadly, Dr. Tertius determined that no surgery could improve the functioning of Mamadou’s right arm. He explained to Mamadou, “With your right elbow joint in its bent position, like it is now, your right hand is close enough to your body and other hand to be of help. But that right elbow joint can never be made to move and flex. All I can do is set the elbow joint so that your arm is straight. But then, your hand would be out of reach of your other hand and your body and be far less useful to you. The best thing I can do for you is to leave your right arm completely as is.”
For Mamadou, the prospect of one normal arm and one still misshapen arm did not dampen his determination to learn languages and have his own business. He had already proven himself quite capable by becoming a successful sheep owner and lamb producer – even with two bent arms. Just think of what he could accomplish with one fully functioning arm and a hand that could continue to help!

Mamadou looked forward to the months of recovery time before his second surgery. He spoke excitedly to his mother, “I want Uncle Alpha to teach me all about his clothing business in the big market. But most of all, I want to learn how to say something I have in my heart in English: ‘Thank you, Mercy Ships, for giving me the hope and courage to show the world that I, like any normal eldest son, can support his family with the many abilities God did give me.’”   

Mamadou came to the Mercy Ships patient screening day on his own, not wanting to disappoint his family if he could not have surgery. When he was given a surgery date, he joyfully informed his mother and little sister, who came to stay with him during his two surgeries and recovery.  
Mamadou has been a diligent patient, faithfully completing his required exercises. Volunteer doctor Lydia Marx shows Mamadou his latest x-rays that confirm that his healing is on track.
 
Mamadou’s follow-up surgery, planned by Dr. Tertius, will take Mamadou’s index finger and reposition it to create a thumb so that Mamadou’s left arm will look and function almost normally. Dr. Tertius decided to leave Mamadou’s right arm as is. The only other alternative in Mamadou’s situation was a straight arm without the ability to bend, which would have kept his right hand out of reach to be helpful.

Story by Joanne Thibault
Edited by Nancy Predaina
Photos by Debra Bell, Michelle Murrey, Bright Efflowe