I don’t know that the why I love Africa post will ever grow old for me.

Last weekend, we had the opportunity to spend the night as part of an Eco-Tourist Community at John Obey beach, which is located about 80km outside of Freetown, where the ship is located. (http://sierraleone.tribewanted.com/). While we didn’t take part in the whole Tribewanted week-long experience as community members, it was an interesting concept to catch a glimpse of, and it provided us with a lovely way to spend the Saturday night of our long weekend. A small group of friends and I ate 3 tasty meals of African food, had a campfire, spent the night in tents, woke up to the sound of crashing waves, played beach volleyball, swam in the ocean, lazed around in hammocks, and enjoyed the serenity of not being on the ship for 24 hours. However none of these things provided my true why I love Africa moment.

It didn’t happen until we were on our way home. Six of us were packed into our second taxi of the trip (which, to be fair, is actually a comparatively decent occupancy). The rains started to come down. It seems to still be rainy season here, which I had always assumed would finish itself up somewhere in the middle of September. Apparently basing all of your big life decisions on what Wikipedia tells you can be misleading. But anyways, back to the point…

We’re in the taxi. The rain starts, and naturally starts coming in the windows. The driver hands us a screwdriver.

There is no explanation provided. Not a person in the vehicle bats an eyelash. Jeff, who had the honour of the “aisleseat”, so-to-speak, just went about the business of jamming the screwdriver into the hunk of metal on the door where the window crank must have lived at some point in the taxi’s life, and starting the process of doing up the window.

Perhaps the thing that truly made this moment for me was the fact that the taxi driver felt no need to tell us what to do with the screwdriver. That he didn't think to apologize for the fact that a screwdriver would be necessary to keep the rain from pouring in the window. That the whole thing happened just so seamlessly and naturally.

We looked around at one another. Smiled. Loved it. Knew without saying any words that it is moments like this one that keep life interesting and keep us coming back for more.

Dr. Gary said something to me a couple of weeks ago that I have had a hard time erasing from my mind.

He came into D ward on my evening charge shift and we started talking about how appropriate it is for me to be taking care of all these people having cleft lip repairs because, in his words, I have “lived it”.

I guess I feel like I havn’t earned the right to say I have lived it though. From what my long-term-memory-challenged mother tells me, I never really had any issues. I had my cleft-lip repaired when I was 12 weeks old and carried on to live a relatively lovely life. I ate, spoke, and for the most part looked like anyone else. Never once did a teacher tell me I wasn’t the same as the other kids. Never once was I cut from a team because of the way I looked. Never once was I denied a job because someone thought that having a congenital deformity would affect my work performance.

I had the opportunity to be who I was created to be --- that’s how Dr. Gary worded it anyways.

The unique qualities that I was designed to share with the world didn’t have to be suppressed as a result of a society that told me I was undeserving. We see people here every day who don’t have that same luxury.

Lack of access to healthcare means that people go their entire lives without a surgery that takes little more than an hour. Lack of awareness about the physiological basis of congenital disorders, and sometimes just disease in general, means that people are ostracized from sources of income and socialization. Something so minute can literally have the ability to take a person’s life away on so many levels. Something that is also a part of me but never had the chance to define or dominate me.

This morning, I was going through my 10-yr-old patient’s chart, making sure she was ready for surgery. I quickly scanned the admission assessment, looking for anything pertinent. I found something that was more significant to me that I would have been hoping for. Under “occupation” was the following response

“Quit school three years ago due to teasing”

Her whole life, education, and future, defined by the split tissue on one side of her upper lip. An entire nightmare that she has been living that I never had to experience. A soul that has been denied the opportunity to be shared with the world, because of a socially constructed hierarchy of value. To say “it doesn’t seem fair” is an understatement.

Dr. Gary told me that he loves when – within weeks after a person’s repair – you start to see them coming through. The parts of them that were always there, but that they felt ashamed or unable to show.

It gives me hope, for the ones who are here, having surgery - being given the opportunity to look more like the world expects them to look. But it leaves me asking that age-old question, yet again, of how is it fair that where you are born determines so much about whether you live or die.

I remember reading the well-known story of one man's humble attempt to rescue thousands of beached starfish back into the ocean, one by one. Mama Sue had it posted on our fridge for years. I remember not really grasping the significance of the punch line.

“It matters to this one”

At the time, it didn’t even occur to me that some would have considered the man’s efforts futile. I wholeheartedly sided with the labourer, not the skeptic.

I guess then I grew up a little. Went to University. Took “Statistics for Nurses” (aka, we’re only going to teach you what you absolutely need to get by, cause it’s just that hard and we don’t believe you have it in you to pass an actual stats course). Learned about upstream healthcare interventions. Started thinking about the world of limited resources that we live in. Adopted a “greatest good for the most amount of people” line of thinking. Came to Africa for the first time and stood face to face with thousands of people needing help.

Somewhere along the line, I started thinking about numbers.

It’s easy to focus on the numbers. Numbers indicate the significance of an issue. Numbers can prove that an intervention is effective and valuable. Numbers provide evidence. We hear that 22,500,000 people in Sub Saharan Africa are HIV positive and we are shocked by the magnitude of the statistic. But, unless we choose to go beyond the initial shock value of the number, then for me at least, the effect of the number ends there.

Maybe it is because I am, and forever will be a frontline person. I am invigorated when I am connecting or caring for another person. I relate to others – I find it natural to feel someone else’s pain. So a couple of weeks ago, when we were handed the lab slip for one of our patients, indicating in permanent ink that she is HIV positive, it didn’t matter to me at all that she now joins the 2% of people in her country with the same diagnosis. I know the numbers. I give socially responsible gifts for Christmas. I’ve got the GAP t-shirt. But I havn’t spent so much time thinking and reading about HIV in my life as I have these past few weeks. For me, it takes knowing the one.

She has, what will most likely prove to be for her, a terminal diagnosis. And, that news will shatter her world in the same way that it would shatter mine. She isn’t a number. It’s not easier for her to have HIV because so many others around her do too. She will experience it fully. The fact that she is one of millions doesn’t make her any less significant

It absolutely matters to her.

The day was already going well. As opposed to doing charge, which is how I spend a good seventy percent of my shifts, I got to be a real nurse yesterday. Don’t get me wrong, the opportunity to put my borderline OCD organizational skills to use in coordinating patients, caregivers, and a constantly fluctuating surgical schedule is one that I am grateful for; However, it also turns out that as a charge nurse, you can accidentally go an entire shift without ever cuddling a baby, if you don’t go out of your way to do so.

So, there I was, being a nurse. Doing my thing. Waiting for Aminata to come back from the OR, where she was having her trach tube removed.

And Natalie, our team leader, asks us what music we wanted to listen to / subject our patients to. She rhymed off the options. Came to the end of her ipod genres and offered “Christmas Music?” with a laugh.

We didn’t miss a beat. Christmas was the obvious choice. Regular Christmas fanatics use November 1^st as the beginning of permissible Christmas celebration time. Always just a little bit more extreme and unreasonable – I prefer to use October 1^st.

And this is the story of how on October 5^th at one o’clock in the afternoon, on the max-fax ward of the Africa Mercy, docked off the coast of Freetown, Sierra Leone; four questionably stable nurses belted out “Baby it’s Cold Outside” as our patients looked on in wonder.

I have always wondered what people with very opposite lifestyles & traditions would make of our highly culturally-specific representation of the birth of Christ. I have multiple distinct memories of my brother Dave, belting out with Bono, wondering “Do the Africans even know it’s Christmas?????” (in the overdramatized, sarcastic way that only Dave can achieve). I have known since that first year my brother serenaded me with Band-aid’s hit that there would never be snow in Africa at Christmas.

Turns out there are a few other things that don’t translate either. I guess I can only be left with the thankfulness that acknowledging the arrival of my King to earth has next to nothing to do with the weather or pageants or songs about eggnog. I will probably continue to wholeheartedly embrace these endearing symbols, simply because of the memories they hold in my heart – but if it so happens that this Christmas, I find myself in Africa, without any snow, things will be alright.