Saturday morning, I woke up before my alarm. Unlike most days, I didn't need to lay around for 20 minutes willing myself to get out of bed and embrace the day. Before 10:00 I had already gone to the gym, showered, eaten breakfast, spent a few last precious moments on the dock, watched the crane lift the remaining items onto the ship, mulled with the rest of the crew about when we might actually leave, and secured every mobile object in our cabin to the floor.
Saturday was sailing day.
Now, for all the time I have spent on this ship, I have never accompanied it onto the open water. I have known this ship in three different countries, through various stages of my life, but I have only ever known it to be stationary.
Which was why I was so excited on Saturday morning. Excitement - a sentiment I seemed to share with the other 275ish crew that are currently sailing somewhere off the coast of West Africa - was the overall vibe of the morning. It really felt like we were a family, all getting ready to set out on some big adventure together.
And, it seems that all of the anticipation was well-deserved.
This whole sailing thing has been incredible for me thus far. Highlights are as follows:
- We saw dolphins yesterday. Hundreds of them. Apparently there is something about swimming alongside the ship that makes life easier for them so they seem to hang around us a lot. Which is fine by me.
- It really IS like we are a tight-knit family on a vacation together. Sure, people are working and getting the essentials done, but everything just feels a little bit more laid back. That, combined with the uniqueness of a smaller crew on-board, with no one coming or going, makes for a very cozy-like atmosphere.
- The air is AMAZING! I tried to think of the last time I breathed air so clean and pure, and my conclusion was clearly.....never!
- Sunsets and full orange moons and stars. How anyone can experience such things and not be blown away by the magnificence of creation is beyond me!
I am sure there are more. However sailing does have it's downfalls and sitting in front of a computer screen for too long and causing seasickness is one of them, so this session of counting my blessings shall conclude for now. But, I am left feeling overwhelmingly blessed and romanced by a very powerful God.
It’s a fairly common debate around here: Are we a ship that happens to have a hospital on it? Or are we a hospital that happens to be located on a ship?
The majority of the time, my answer would be “B”. It generally feels like a hospital to me. Despite the added bonuses of fire drills, overhead announcements about fuel bunkering, the constant white noise of generators, the lack of candles, and the pleasure of trying to explain to people that “yes, in fact, I do live on a boat”, my life here typically revolves around the fact that I am a nurse...in a hospital...doing typical nurse activities. Therefore, I have grown a strong affinity for the hospital-located-on-a-ship philosophy.
Every so often – this week being one of those times - I get swayed to the other side. Surgeries are over, all the patients (and a large proportion of the nurses) have gone home, and now all that is left to do is bleach and pack up every supply and piece of equipment that is required for a hospital to function and get the place ready for the sail. Sounds simple enough
Now, I have never sailed on the Africa Mercy, but, thanks to Discovery Channel Canada, I have seen a computer animation of what happens to our vessel when out on the open sea. It rocks. That being said, everything we store away in the hospital also has to be packed tightly and well secured to some sort of stable structure in order to prevent damage when we head out into the ocean.
These are the times when I am starkly aware of our shipness.
Late Tuesday afternoon, I was standing in the middle of B ward with a fellow nurse. A nurse who is incredibly competent at reading a cardiac rhythm, giving IV antibiotics, drawing venous bloodwork, doing an assessment or suctioning an intubated patient. Those skills proved to be highly useless to us when faced with a ward full of benches that needed to be secured to the ground with some strappy-clippy-tie-things that we couldn’t even begin to figure out how to use. We threw the straps around the ward for a couple minutes, with no particular aim, but hoping that upon manipulation of said ties, we might be inspired as to how the integrity of the benches might be preserved by them.
The answer never came.
We really are a ship, and such tasks are best left undone by folk such as us. Thank goodness for Maike, the one member of our nursing team who knows what she is doing and had the place whipped into shape in about a quarter of the time it would have taken us to pretend to do it.
I guess we all have our strengths. The rest of us spent the week scrubbing and waxing floors. Again, a trade not particularly within in our scope of nursing practice, but one that is at least straight forward enough for us to master within a try or two.
This week, we are definitely a ship.
It’s almost done.
The last lips were repaired last Thursday. Tuesday morning at 5:30am, six of the last pikins (“children” in krio) and their respective caregivers and siblings got on a bus that will start their journeys back to villages all over West Africa. We repeated that potential gong show nearly glitch-free again yesterday morning. By 11:00 this morning, the wards will be empty.
For the first time in over nine months, the wards will be completely still and silent. All the joy and pain and tears and laughter that have flooded those wards will be scattered throughout this country that we have been so blessed to serve this year.
And, I got to catch a glimpse of it.
I walked into this outreach as it was already on its last legs. When the crew of the Africa Mercy had already been stretched and tried. I walked in and got to be a part of it. And, I walked in and got to experience something that I have never been a part of here...the end.
The other night, we rounded the wards, sorting out medications, dressing supplies, transport money, personal possessions, border letters, nutritional supplements, and photos for the remaining fourteen patients. It was obvious: This was all coming to a close. I couldn’t help but notice that last night of camp feeling in my heart.
I started thinking about endings. I’ve experienced a couple of beginnings here. They are exciting and everyone has boundless energy. But, this is my first conclusion. And, I think I might like it even more.
Yesterday morning, as I did my last charge shift of the outreach, we had an amazing time of worship on the ward. Everyone was cognizant that this would be our last one, and as a result, it was no “check it off the list” worship session. We sang and danced and beat on drums and I am pretty sure the phone rang a couple of times but no one could have heard it even if they wanted to. I looked over at Grandma Groundnut at one point and saw tears streaming down her face. She knows she will leave the ward that has been her home for the last number of months and she is sad “to see her family go to another country while she stays here” (in her words). Grandma Groundnut and I spent the rest of yesterday’s worship time with our arms wrapped around eachother - singing, praying, crying a little. Aware that this was goodbye. But, for me at least, aware that saying goodbye means that a good work is complete. That finality only has its bittersweet sting because of the highs and lows that were encountered along the way.
Coming in for the last leg of the race has been a blessing to me. We care when something ends because of the significance it had throughout its course. And, as it turns out, experiencing the end of something significant can be just as moving as being part of its beginning.
It seems that every outreach, one individual child steals my heart. This time, Aminata has, hands down, taken the cake.
Oh, there have been other children, of course.
Like Bed 11 from last week: the 4-month old whose name I can’t even remember because his mother referred to him exclusively as Duck. Duck had an incomplete cleft lip, on the left side that Dr. Gary repaired. Conveniently, this is the same diagnosis and location of my own infantile malformation – which, to Duck’s mama, clearly meant that we were to be married. And thus, Duck & I are in love.
And then there is Kadia, who you have to tickle fight to the bed, in order to get her situated and stationary enough to start her NG feed. At which point she screams at you for a couple of minutes. Then chatters on about what I can only assume is a consideration of how many stickers she currently has plastered to her forehead and what strategy she should adopt to get more out of us.
And, of course there is Sia – our “almost too late in the outreach, but God seems to always provide the way” Burkitt’s Lymphoma kid who is literally a walking wonder. She and I were on a little walk the other day, hand-in-hand, her chatting away, again in some unknown language about who knows what, and I was struck by how blessed I am to get to participate in something that, in any other context, would be a once in a lifetime kind of miracle. And it happens here every day.
But, when all is said and done, it’s Aminata who I hold most near and dear to my heart. When we get up to deck 7 at the end of day shift to allow the patients some “fresh” air time, it’s Ami that I look for. It’s Ami that I will do any amount of running up and down the deck in Sub-Saharan African heat to make giggle. It’s Ami who brings me exceeding joy, watching her take little baby steps when she used to be barely able to sit up. It’s Ami who reminds me of God’s work in all of our lives when I watch her play with toys, not just stare at them, and know that her brain is now nourished enough to allow for close to developmentally appropriate mental processing.
The story for Aminata is far from over. She has a long way to go. More surgery needed. Money needing to be raised to get her to wherever that surgery will need to happen. Her body needs to clear itself of the infection that seems to stick around regardless of the assorted cocktails of antibiotics we have pumped into her. Her mama needs to learn how to treat whatever related mild ailments may surface, as they seem to be having the habit of doing. She actually has a lot to figure out in the next week, before the hospital gets packed up and the ship sails away.
She is by no means home free. But now she has a host of people praying and wholeheartedly invested in her ultimate well-being. That should serve her as well as anything else could.
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 1st as the beginning of permissible Christmas celebration time. Always just a little bit more extreme and unreasonable – I prefer to use October 1st.
And this is the story of how on October 5th 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.
I started my nursing career six years ago as a neonatal nurse. Most seasoned nurses would probably advise a new grad to start out as a nurse in a much more general field and then move on to something specialized like the NICU. I guess I just knew that it was the place for me. “My unit” has become a second home for me – my coworkers, like a family to me. It’s where I learned to be a nurse. It’s where I struggled through feeling incompetent and learning to thrive. In this past year, it has become the one of the places where I feel most comfortable. In the times when I don’t find myself in West Africa, I know it is where I belong. All that to say, I am a neonatal nurse – through and through. Give me a 600gram baby and I know what to do.
This week, in the Africa Mercy ICU, I have been taking care of Aminata who weighs a whopping 9 kg - which, incidentally, is double what she weighed when she stepped into the world of Mercy Ships about three months ago. Aminata is two years old. As far as taking care of ventilated ICU patients go, two is my maximum, so she made the cut. Her diagnosis, on the hand – cystic hygroma – made me slightly more uneasy. The only patient I have ever taken care of with a cystic hygroma was Baby Greg from Liberia. He was the first African baby to steal my heart and take it to heaven with him. I knew that Aminata’s diagnosis was by no means a life threatening condition, but it’s funny the effect that one significant experience can have on a person.
Aminata spent about a week after her surgery intubated and ventilated. As children tend to do, she lost her ET tube on Monday and bought herself a trach, which will serve as a temporary solution to her lack of airway due to excessive swelling dilemma. By Tuesday, it seemed that keeping her ventilated was causing her more distress than it was worth, so, the decision was made that it was time to wake her up (as it is referred to in the ICU) and give her a shot at breathing on her own.
At this point, it is important to keep in mind that my ideal patient size = 1/10th of Aminata’s.
Tuesday morning, we stopped the Ketamine and Midazolam infusions. We cut the Fentanyl by half. And we waited for it to happen.
And that is when the term “wrestling with an alligator” bounced around in my head for quite a few hours. Aminata went a little bit squirrelly. We tried different combinations and doses of drugs. We watched her closely. We sang, and held her head and rubbed her back and turned the lights down. We wrapped our arms around her and told her that she was safe. And she squirmed all over the bed. We finally won, but she didn’t go down without a fight. (I am fully aware that any nurse who has any experience with larger children, let alone adults will consider my sentiments to be somewhat exaggerated, perhaps even humorous…but keep in mind that I am usually able to contain my patients with one hand and use the other one to chart)
By yesterday evening, in just the way that makes me ever so happy to be part of this whole thing – she had come around. When her night nurse came to get report, Aminata was sitting up on the lap of one of our day volunteers, breathing room air, and maybe, possibly, even trying to force a smile through her impossibly swollen neck, tongue, and lips. When I leaned over to tell her goodnight, she reached both of her arms up at me in a purposeful motion and grabbed at my neck. She didn’t seem so much like an alligator anymore. She seemed a lot closer to a healthy, on-her-way-to-happy two-year-old; whose life I was blessed to be a part of for a short season.
Still, I hope that a 9kg alligator is the largest I ever have to face.
Yesterday, we climbed Sugarloaf Mountain – the 17th highest mountain in Sierra Leone.
Well, to be correct, we set out to climb Sugarloaf Mountain. But first we accidentally climbed the mountain a little bit to the right of Sugarloaf. Upon arriving at its peak, we realized that our intended destination was over to the left, which meant that we would have to climb halfway down Mountain Peak #1 and proceed the rest of the way up correct mountain.
No problem.
Despite it bordering on “sports” – it turns out that I actually really enjoy hiking. Especially this type of hiking. No real trail. Continuously assessing various options for routes to see which is more manageable. Hanging off vines. Climbing up and then sliding down granite rock faces. I find it sort of exciting.
Whilst climbing a mountain (which I should clarify, is an activity that I have experienced exclusively in West Africa), I waiver back and forth between images of Maria and the Von trapp children in the last scene of "The Sound of Music" and singing “The Climb” in my head. Yesterday, we threw some Pocahontas "Colours of the Wind" in there, just for variety’s sake. Needless to say, I was really enjoying myself.
For the first two and a half hours.
Then the climb got a little bit ridiculous. By this point, we were well off the so-called trail. We had been drenched from the rain for about three hours now. It was dark, and the path seemed to be less and less present. My legs were starting to hurt, and everyone’s breathing was getting faster and heavier. It seemed like a really good time for the relief of reaching the summit.
That’s when we arrived at the top of Mountain #2. Which unfortunately, turned out again, to not be the peak of Sugarloaf. It was at this point that I was wholeheartedly ready to bail on our adventure. We had reached the top of two mountains – neither of which had a particularly impressive view - and I was done.
Thank goodness for the rest of the group who remained committed to the goal. If I had been the decision maker for the group, we would have turned around at this point. I knew that however far we had gone up, we still had to climb down, and I just didn’t think I had it in me to keep going. But they didn’t waiver. They wanted to reach our destination, and there was no doubt in their minds that we were going to persevere until we found it.
I think that’s the only reason we ever did make it. It wasn’t physical endurance, because I definitely was feeling it in every muscle and wanted to quit. It wasn’t our navigational skills; because they failed us multiple times. The only thing that really got us there was the perseverance of my friends.
So, we made it to the top of Mountain #3. And it really was amazing. We spent 45 of the best minutes overlooking Sierra Leone, eating packed lunches, and listening to birds and the wind.
And, if it had been left to me – I would have never made it.
Thus, I am left concluding yet again, that life is all about the lessons we learn through it. Yesterday reminded me why it is so important that we live life together, and not alone. Why we need to function in teams. Why two heads are better than one.
Because if not for my “others”, I would still be sitting at the top of Mountain #2, wondering what I ever was thinking!
Once again, I find myself here.
Everything is exactly as it used to be, and completely new, all at the same time. Familiar and comfortable yet foreign and challenging – if that is even possible.
A new city in a new country. New friends and coworkers. New ways of doing things.
For starters, there is this ship – a 500ft vessel which has set the stage for some of my life’s most significant moments. I walked on board early last Thursday morning and breathed an immediate sigh of peace. Joy filled my heart. I was greeted by loving, familiar faces and had that wonderful sense of coming home to a place where you “fit”. I know where I belong for this time. I know what to do and how to go about things.
And then there is the city. I spent Friday exploring Freetown. I had been warned that excursions into town were fairly dramatic. “Freetown” and “traffic” are essentially synonymous terms here on the ship. I should have been prepared – I guess I thought I was. But, calling Freetown busy is the understatement of the century. It’s hard to truly describe the chaos of the heart of town. Between the open sewers and the vendors and the trucks and the “it’s here then its gone” excuse for a sidewalk, even getting from point A to point B on foot is a challenge. It sort of feels like you are in a videogame but there is more pressure because, if you fall in the gutter or get run over by a truck, you don’t get another life. Maybe I just don’t deal well with being over stimulated in every way simultaneously, from every direction. Either way, I found Friday overwhelming.
But then I did it again today. I went into Freetown - just myself and one friend, with a specific purpose. And, all of a sudden, it didn’t seem near as overwhelming. I would go so far as to say it was enjoyable. Relaxed even. I guess it doesn’t really matter how many times you come to Africa – every time you come back again, it takes a while to sink in. It’s just starting to sink for me. My being is ready, but I guess it takes time. 
By Saturday, I was doing my first shift on the ward. D Ward. Where last year, we set up the summer camp craft corner for Tani and Gafar. Where O’Brien was healed. Where O’Brien died. Where there are now new faces: some repaired and ready to face the world and some still waiting. Two o’clock Saturday afternoon, I jumped in. As a result of our Gambian detour, our group left the wards a little short staffed. So, instead of having orientation shifts, I just went for it. I took care of patients in a world that I know incredibly well, and yet felt so unaccustomed to at first. Where do we keep this now? Do we still do it this way? How does this work now?
And again, just like riding a bike, as my friend Deb reminded me before my first shift, it has come back. It all feels as normal and natural as it possibly could. Half the time, I still don’t have the answers to the questions that arise in my own head or from others’ – but, I do know that I am doing it. Adapting. Coping. Caring for those that I have been sent to serve. Maybe not perfectly. Probably still with a lot of assistance for the time being. But, doing it.
We probably don’t ever figure it all out. Perhaps we don’t ever need to. If we ever think we have all the answers, we probably need to start again at the beginning and figure out what it was we missed. No matter how much experience we have, I doubt we ever have the ability to adapt to every situation seamlessly. I am thinking that I would never want to. Because these places that I find myself in are the ones where I learn the truths that I didn’t know I was missing.
I was excited about my birthday this year. Something about being so close to 30 makes me feel like I have almost, maybe, come to verge of “arriving”. Arriving to true adulthood or maturity or something. When you are 23 and you present your wild and crazy ideas to the world, people smile sympathetically, pat you on your head, and tell you that it is simply your naivety that makes you think the way you do. But when you tell someone you are 30, they are suddenly a little less justified in assuming that “life” will eventually jade your rose coloured glasses. I am not for a second suggesting that I know all there is to know or have seen even a fraction of all there is to see in my 29 years on this earth – but it is nice to be given a little bit of the credit that living life grants you.
Back to the point – I was ready to turn 29.
And thanks to a small rock on a particularly long runway at Banjul International Airport, I rang in the beginning of my 30th year of life with an experience that I can now add to my list of ways I have lived.
So, it all started with a bird. Or what we thought was a bird and turned out to be a rock. We had stopped in Banjul – capital city of the Gambia – to drop off about half of our flightmates and would have been carrying on and arriving in Freetown, Sierra Leone, approximately an hour later.
Except that we never took off. The plane sped down the runway and just as we would have been about to take off …
“THUNK” ….. followed by a smooth deceleration….. followed by a screeching stop (when the runway, which ironically and thankfully is significantly longer than the average runway, ended).
The captain came on the overhead to announce that a bird had flown into the engine and we would have to taxi back to the airport to check the plane and make sure it was safe to fly.
At which point, I decided that I wasn’t going to see the Africa Mercy any time soon. Because you see folks, this was not my first time in West Africa. Within a few minutes, a crowd of people had gathered around the plane – some of whom appeared official with uniforms or fluorescent vests; others of whom seemed to just have shown up because there seemed to be some commotion. Some people started crawling inside the engine. One dude shone his pen light into the cavity in an apparent effort to help identify the problem. Cameras were out and everyone seemed to have an opinion about what was wrong and how to fix it. Our stewardess even ended up out there having a look. Just didn’t seem like an effective recipe for “airplane repair following bird damage”.
To no surprise, three hours later, after having checked in to a lovely Gambian hotel courtesy of Brussels Airlines, I was sitting down to my first African dinner in over a year with all 150 of my flight 0225 mates, under a blanket of palm trees, minilights, and stars.
And two days later, I turned 29 and found myself still stranded in the Gambia – which turned out to be about the loveliest place on earth to be stranded on one’s birthday. Between pina colodas, a trip to a treetop café, a cherrycheesecake – esque dessert that the hotel chef made for me (which ironically tasted terribly, considering how beautiful it was) , and pretty much lying by the pool for the entire day…..I really couldn’t have asked for anything more.
That, plus the fact that after traveling the entire next night, I finally did arrive, safely and soundly on the ship, made me a fairly happy, legitimate almost 30-year-old.
It's happening again.
Last weekend, it all sort of clicked in my head. It's time to start getting excited again. It's time to start feeling the things again that only Africa can stir up in me. It's time to start thinking about the things that, despite having experienced before, I know I can't truly prepare for.
It's happening in my head and the excitement is quickly working it's way towards my heart. As desperately as I try to avoid romanticizing the whole thing, I can't help but find life a little bit sweeter, just knowing I get to spend the next 4 months on a floating white hospital.
I don't have my plane ticket. My apartment looks like it has been attacked by a group of college kids. I still don't know what to do with my car when I go. I work about 452hrs/week up until the day I leave. Never in my life have I felt so strikingly aware of my personal flaws & weaknesses. My to-do list is rubbish.
And yet, I have never been more ready. Because I think I finally get that we are never really "prepared" for these things, the way we think we should be. I might find the time to clean and organize my room. I might make and cross off every item on a highly structured list. I might finally take the time to figure out how to overcome the things in my life that hold me back. I might even figure out a sleep routine amidst flipping back and forth between day & night shifts and actually land on the other side of the world not already jet-lagged. The funny thing is that these things always come together.
Despite it all, I feel prepared. I think that preparation really has very little to do with lists and finances and plans. The reality is, I am ready to be used for the purpose my maker designed me for. Ready, once again, to learn and to teach, to laugh and to cry, to be challenged and broken and to fail and succeed - in a place where I know my heart beats a little bit stronger.
The other day a friend, who had recently left our floating home sent me an instant message asking how ship life was going for me. The tricky thing about instant messaging is that it forces you to summarize oceans of emotions together into brief, cohesive sentences. I had no problem.
“You know…..the same….amazingly wonderful and horribly challenging all at the same time”
It’s just how it is. The wonderful side tips the scales, obviously. I can think of nothing that I would rather be doing than living this life, doing what I am doing. It is overwhelmingly rewarding and downright incredible to spend the better part of all of my wakeful hours contributing to something in which I believe so strongly.
But, the challenge part of it all is just as existent, and I am beginning to think, just as important as the rest of it.
We are taught from such a young age that through trial, strength is developed. The preacher at church last Sunday morning reminded us that “…when troubles come your way, consider it an opportunity for great joy. For you know that when your faith is tested, your endurance has a chance to grow. So let it grow, for when your endurance is fully developed, you will be perfect and complete, needing nothing” (James 1:2-3). His words came as an insightful conclusion to a challenging, yet entertaining morning. Rainy season has arrived in Togo. When we woke up and saw the massive amounts of water streaming from the sky with intense determination, we briefly considered bailing on our plans to go to church. But that would have meant we missed the important part – the part where our group, plus about 25 of the members of the congregation bailed a foot of water out of the church, so that church could happen. As I looked around at the group, in probably what is their only set of church clothes, soaked head to toe, using buckets and serving bowls and towels to defend their church home from water damage, I couldn’t help but be touched by the devotion and determination displayed.
When you care about something, you work for it….sacrifice for it….put your heart into it. And if you have to work, sacrifice, and put your heart into something, you can’t help but end up caring deeply about it.
Our approach to adversity is peculiar really: despite the fact that it is entirely inevitable and most often, completely out of our control, we dread its presence. And because we are in the habit of convincing ourselves to believe in a standard of utopia, we feel slighted when it shows its unfortunate face. The thing is - there is not a single one among us who has been promised a life free of trouble. The Bible doesn’t say if you face troubles, but when.
As I reflect on these last couple of months, I wonder what has changed me the most…where I learned the most….what will stick with me and define who I become. O’brien, Aissa, Tani, Abel, O’brien’s mama, fat baby Marius, bartering for hours with vendors in markets, being squished in taxis with seven others, working in areas that aren’t my comfort zone, having to make “bunk beds” in the wards to fit all the patients in, eating foods that I didn’t think I would like, trying and failing at walking across Togo, failing miserably at communicating in French – small trials that forced me to grow and learning from people who have encountered much greater trials than I have yet to face.
As much as the anticipation of adversity can be overwhelming, I would argue that we are completely dependant on it. A life of perfection on this earth is, at best, a falsehood. Trials will come. They will hurt. They might leave scars. But they will make us people of substance who are intensely purpose-driven in their passions.
Two years ago, Africa changed me. It changed the way I thought about what it means to be human. Perhaps at the time, I thought the change was like a one-time graduation from naivety to enlightenment. It seems however, that as so many before me have cautioned, learning really is a never-ending journey.
These last couple of weeks, one of our patients - an absolutely delightful little girl named Tani - has completely changed the way I think about beauty.
Physical beauty is one of those forces whose power over us we hate to admit. When you stop and think about it, basing our opinions of one another on a somewhat arbitrary criterion such as beauty seems not only superficial, but also simplistic and downright cruel. However, the unfortunate reality is that it does have a very significant impact on our interpersonal relations. We are innately attracted to beauty. It’s one of the reasons we do what we do here on the Africa Mercy….Because eliminating a feature that is grossly deforming means that a person can go from living a life of disgrace to living a life of acceptance.
Tani came to stay with us around the same time as Aissa was on the ward. I distinctly remember my first day with her. I came on for my charge shift and one of the first things Ali said to me was “Check out bed 8. She’s beautiful. You’re gonna love her!”
I turned my attention to the new little girl in bed 8. Tani didn’t look beautiful to me. Having been in West Africa for a little while now, and seeing what I hope are some of the most disfiguring cases out there, I credit myself with having some degree of tolerance for the worst of it. I would like to think it takes a lot to shock me at this point. But, Tani did.
Though nobody really knows the story of when or how, at some point in her 9-years of life, Tani’s face was burned off. She was left with bits of a mouth, and one eye. Though most of her little body was spared, one of her hands, which she probably used to catch herself when she fell into the fire, was left mangled. To be completely brutal, at first glance, Tani was hard to look at.Until my experiences with this little one, I don’t know if I ever truly believed that beauty comes from within. It always sounded nice, and makes us all feel better about our imperfections, but then again, we make stuff up all the time to make ourselves feel better. But, Tani made it real for me, because my friend was right. Within 5 minutes of encountering Tani, I absolutely loved her. I like kids, as a rule, but Tani has a special quality within her that is unmatched. She makes it absolutely impossible to see anything but her inner beauty. Every day I spend with Tani, she grows more and more radiant. Her loving, joyful spirit can almost not be contained within her tiny little body.
Looking at her, you would expect that she would repulse others, but Tani cannot help but do exactly the opposite. Her presence is actually magnetic on the ship. Our head chef came up from the ward last night and announced:
“I just spent 10 minutes playing with Tani. It changed my life.”
It probably did. And it defies everything I used to think about beauty. Because Tani has a beauty that is legitimate, undeniable, and worth so much more than I could have ever realized without her.
In order for a weekend trip away from the ship to truly qualify as typical, there are several criteria that must be met. They are as follows*:
- Just minutes after your departure, the driver will need to stop at the station, where you will have to...
a) Renegotiate the fare (which will have inevitably gone up from what you originally agreed upon)
b) Pick up a wingman
c) Sit around in the vehicle with all the doors open while the driver and the wingman exchange pleasantries with everyone else at the station.
d) Get gas – which, as a side note, cannot be done in combination with any of the above tasks.
- You will begin the trip in a mildly uncomfortable seat, sitting relatively close to one of your friends, with some degree of leg / breathing room. You will conclude the road trip sitting on someone’s lap (in the most ideal scenario, this someone is a wet stranger that you picked up along the road), unable to feel your legs, and with your arms either directly out in front of you, straight up in the air, or wrapped around one of your other twenty travel-mates.
- Numerous times along the way, the driver will pull over to the side of the road. The wingman will hop out of his seat (which is always conveniently located next to the one sliding door) and disappear under the vehicle for about 20 seconds with a bottle of discoloured water. Immediately after he resurfaces, the vehicle starts in motion and he hops back in. Nobody has ever been able to come up with an explanation for this one.
- When you arrive at the hotel, the first staff member you encounter at the desk will respond to your attempts to explain who you are with complete bewilderment. After a couple of confused minutes, someone else (usually of higher power) emerges and provides you with some reassurance that you did, in fact, make reservations. These reservations will most likely not resemble what you intended them to, but they do usually exist.
- You will then carry on to have a fantastically entertaining, re-energizing weekend with your friends in a setting that makes you consider throwing it all away and living in the jungle, under a waterfall for the rest of your life.
Thankfully for us this weekend, every single one of these criteria was met. Although it is always nice when things play by the rules, it was of particular importance this weekend, since Ali’s parents are on the ship right now, and she was committed to giving them a truly African experience. We had an incredible weekend marketing, swimming, eating, hiking, and playing in the waterfall. And, it truly did represent all of the things we love about
*this list is not exhaustive.
Saturday morning, I woke up before my alarm. Unlike most days, I didn't need to lay around for 20 minutes willing myself to get out of bed and embrace the day. Before 10:00 I had already gone to the gym, showered, eaten breakfast, spent a few last precious moments on the dock, watched the crane lift the remaining items onto the ship, mulled with the rest of the crew about when we might actually leave, and secured every mobile object in our cabin to the floor.
Saturday was sailing day.
Now, for all the time I have spent on this ship, I have never accompanied it onto the open water. I have known this ship in three different countries, through various stages of my life, but I have only ever known it to be stationary.
Which was why I was so excited on Saturday morning. Excitement - a sentiment I seemed to share with the other 275ish crew that are currently sailing somewhere off the coast of West Africa - was the overall vibe of the morning. It really felt like we were a family, all getting ready to set out on some big adventure together.
And, it seems that all of the anticipation was well-deserved.
This whole sailing thing has been incredible for me thus far. Highlights are as follows:
- We saw dolphins yesterday. Hundreds of them. Apparently there is something about swimming alongside the ship that makes life easier for them so they seem to hang around us a lot. Which is fine by me.
- It really IS like we are a tight-knit family on a vacation together. Sure, people are working and getting the essentials done, but everything just feels a little bit more laid back. That, combined with the uniqueness of a smaller crew on-board, with no one coming or going, makes for a very cozy-like atmosphere.
- The air is AMAZING! I tried to think of the last time I breathed air so clean and pure, and my conclusion was clearly.....never!
- Sunsets and full orange moons and stars. How anyone can experience such things and not be blown away by the magnificence of creation is beyond me!
I am sure there are more. However sailing does have it's downfalls and sitting in front of a computer screen for too long and causing seasickness is one of them, so this session of counting my blessings shall conclude for now. But, I am left feeling overwhelmingly blessed and romanced by a very powerful God.
It’s a fairly common debate around here: Are we a ship that happens to have a hospital on it? Or are we a hospital that happens to be located on a ship?
The majority of the time, my answer would be “B”. It generally feels like a hospital to me. Despite the added bonuses of fire drills, overhead announcements about fuel bunkering, the constant white noise of generators, the lack of candles, and the pleasure of trying to explain to people that “yes, in fact, I do live on a boat”, my life here typically revolves around the fact that I am a nurse...in a hospital...doing typical nurse activities. Therefore, I have grown a strong affinity for the hospital-located-on-a-ship philosophy.
Every so often – this week being one of those times - I get swayed to the other side. Surgeries are over, all the patients (and a large proportion of the nurses) have gone home, and now all that is left to do is bleach and pack up every supply and piece of equipment that is required for a hospital to function and get the place ready for the sail. Sounds simple enough
Now, I have never sailed on the Africa Mercy, but, thanks to Discovery Channel Canada, I have seen a computer animation of what happens to our vessel when out on the open sea. It rocks. That being said, everything we store away in the hospital also has to be packed tightly and well secured to some sort of stable structure in order to prevent damage when we head out into the ocean.
These are the times when I am starkly aware of our shipness.
Late Tuesday afternoon, I was standing in the middle of B ward with a fellow nurse. A nurse who is incredibly competent at reading a cardiac rhythm, giving IV antibiotics, drawing venous bloodwork, doing an assessment or suctioning an intubated patient. Those skills proved to be highly useless to us when faced with a ward full of benches that needed to be secured to the ground with some strappy-clippy-tie-things that we couldn’t even begin to figure out how to use. We threw the straps around the ward for a couple minutes, with no particular aim, but hoping that upon manipulation of said ties, we might be inspired as to how the integrity of the benches might be preserved by them.
The answer never came.
We really are a ship, and such tasks are best left undone by folk such as us. Thank goodness for Maike, the one member of our nursing team who knows what she is doing and had the place whipped into shape in about a quarter of the time it would have taken us to pretend to do it.
I guess we all have our strengths. The rest of us spent the week scrubbing and waxing floors. Again, a trade not particularly within in our scope of nursing practice, but one that is at least straight forward enough for us to master within a try or two.
This week, we are definitely a ship.
It’s almost done.
The last lips were repaired last Thursday. Tuesday morning at 5:30am, six of the last pikins (“children” in krio) and their respective caregivers and siblings got on a bus that will start their journeys back to villages all over West Africa. We repeated that potential gong show nearly glitch-free again yesterday morning. By 11:00 this morning, the wards will be empty.
For the first time in over nine months, the wards will be completely still and silent. All the joy and pain and tears and laughter that have flooded those wards will be scattered throughout this country that we have been so blessed to serve this year.
And, I got to catch a glimpse of it.
I walked into this outreach as it was already on its last legs. When the crew of the Africa Mercy had already been stretched and tried. I walked in and got to be a part of it. And, I walked in and got to experience something that I have never been a part of here...the end.
The other night, we rounded the wards, sorting out medications, dressing supplies, transport money, personal possessions, border letters, nutritional supplements, and photos for the remaining fourteen patients. It was obvious: This was all coming to a close. I couldn’t help but notice that last night of camp feeling in my heart.
I started thinking about endings. I’ve experienced a couple of beginnings here. They are exciting and everyone has boundless energy. But, this is my first conclusion. And, I think I might like it even more.
Yesterday morning, as I did my last charge shift of the outreach, we had an amazing time of worship on the ward. Everyone was cognizant that this would be our last one, and as a result, it was no “check it off the list” worship session. We sang and danced and beat on drums and I am pretty sure the phone rang a couple of times but no one could have heard it even if they wanted to. I looked over at Grandma Groundnut at one point and saw tears streaming down her face. She knows she will leave the ward that has been her home for the last number of months and she is sad “to see her family go to another country while she stays here” (in her words). Grandma Groundnut and I spent the rest of yesterday’s worship time with our arms wrapped around eachother - singing, praying, crying a little. Aware that this was goodbye. But, for me at least, aware that saying goodbye means that a good work is complete. That finality only has its bittersweet sting because of the highs and lows that were encountered along the way.
Coming in for the last leg of the race has been a blessing to me. We care when something ends because of the significance it had throughout its course. And, as it turns out, experiencing the end of something significant can be just as moving as being part of its beginning.
It seems that every outreach, one individual child steals my heart. This time, Aminata has, hands down, taken the cake.
Oh, there have been other children, of course.
Like Bed 11 from last week: the 4-month old whose name I can’t even remember because his mother referred to him exclusively as Duck. Duck had an incomplete cleft lip, on the left side that Dr. Gary repaired. Conveniently, this is the same diagnosis and location of my own infantile malformation – which, to Duck’s mama, clearly meant that we were to be married. And thus, Duck & I are in love.
And then there is Kadia, who you have to tickle fight to the bed, in order to get her situated and stationary enough to start her NG feed. At which point she screams at you for a couple of minutes. Then chatters on about what I can only assume is a consideration of how many stickers she currently has plastered to her forehead and what strategy she should adopt to get more out of us.
And, of course there is Sia – our “almost too late in the outreach, but God seems to always provide the way” Burkitt’s Lymphoma kid who is literally a walking wonder. She and I were on a little walk the other day, hand-in-hand, her chatting away, again in some unknown language about who knows what, and I was struck by how blessed I am to get to participate in something that, in any other context, would be a once in a lifetime kind of miracle. And it happens here every day.
But, when all is said and done, it’s Aminata who I hold most near and dear to my heart. When we get up to deck 7 at the end of day shift to allow the patients some “fresh” air time, it’s Ami that I look for. It’s Ami that I will do any amount of running up and down the deck in Sub-Saharan African heat to make giggle. It’s Ami who brings me exceeding joy, watching her take little baby steps when she used to be barely able to sit up. It’s Ami who reminds me of God’s work in all of our lives when I watch her play with toys, not just stare at them, and know that her brain is now nourished enough to allow for close to developmentally appropriate mental processing.
The story for Aminata is far from over. She has a long way to go. More surgery needed. Money needing to be raised to get her to wherever that surgery will need to happen. Her body needs to clear itself of the infection that seems to stick around regardless of the assorted cocktails of antibiotics we have pumped into her. Her mama needs to learn how to treat whatever related mild ailments may surface, as they seem to be having the habit of doing. She actually has a lot to figure out in the next week, before the hospital gets packed up and the ship sails away.
She is by no means home free. But now she has a host of people praying and wholeheartedly invested in her ultimate well-being. That should serve her as well as anything else could.
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 1st as the beginning of permissible Christmas celebration time. Always just a little bit more extreme and unreasonable – I prefer to use October 1st.
And this is the story of how on October 5th 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.
I started my nursing career six years ago as a neonatal nurse. Most seasoned nurses would probably advise a new grad to start out as a nurse in a much more general field and then move on to something specialized like the NICU. I guess I just knew that it was the place for me. “My unit” has become a second home for me – my coworkers, like a family to me. It’s where I learned to be a nurse. It’s where I struggled through feeling incompetent and learning to thrive. In this past year, it has become the one of the places where I feel most comfortable. In the times when I don’t find myself in West Africa, I know it is where I belong. All that to say, I am a neonatal nurse – through and through. Give me a 600gram baby and I know what to do.
This week, in the Africa Mercy ICU, I have been taking care of Aminata who weighs a whopping 9 kg - which, incidentally, is double what she weighed when she stepped into the world of Mercy Ships about three months ago. Aminata is two years old. As far as taking care of ventilated ICU patients go, two is my maximum, so she made the cut. Her diagnosis, on the hand – cystic hygroma – made me slightly more uneasy. The only patient I have ever taken care of with a cystic hygroma was Baby Greg from Liberia. He was the first African baby to steal my heart and take it to heaven with him. I knew that Aminata’s diagnosis was by no means a life threatening condition, but it’s funny the effect that one significant experience can have on a person.
Aminata spent about a week after her surgery intubated and ventilated. As children tend to do, she lost her ET tube on Monday and bought herself a trach, which will serve as a temporary solution to her lack of airway due to excessive swelling dilemma. By Tuesday, it seemed that keeping her ventilated was causing her more distress than it was worth, so, the decision was made that it was time to wake her up (as it is referred to in the ICU) and give her a shot at breathing on her own.
At this point, it is important to keep in mind that my ideal patient size = 1/10th of Aminata’s.
Tuesday morning, we stopped the Ketamine and Midazolam infusions. We cut the Fentanyl by half. And we waited for it to happen.
And that is when the term “wrestling with an alligator” bounced around in my head for quite a few hours. Aminata went a little bit squirrelly. We tried different combinations and doses of drugs. We watched her closely. We sang, and held her head and rubbed her back and turned the lights down. We wrapped our arms around her and told her that she was safe. And she squirmed all over the bed. We finally won, but she didn’t go down without a fight. (I am fully aware that any nurse who has any experience with larger children, let alone adults will consider my sentiments to be somewhat exaggerated, perhaps even humorous…but keep in mind that I am usually able to contain my patients with one hand and use the other one to chart)
By yesterday evening, in just the way that makes me ever so happy to be part of this whole thing – she had come around. When her night nurse came to get report, Aminata was sitting up on the lap of one of our day volunteers, breathing room air, and maybe, possibly, even trying to force a smile through her impossibly swollen neck, tongue, and lips. When I leaned over to tell her goodnight, she reached both of her arms up at me in a purposeful motion and grabbed at my neck. She didn’t seem so much like an alligator anymore. She seemed a lot closer to a healthy, on-her-way-to-happy two-year-old; whose life I was blessed to be a part of for a short season.
Still, I hope that a 9kg alligator is the largest I ever have to face.
Yesterday, we climbed Sugarloaf Mountain – the 17th highest mountain in Sierra Leone.
Well, to be correct, we set out to climb Sugarloaf Mountain. But first we accidentally climbed the mountain a little bit to the right of Sugarloaf. Upon arriving at its peak, we realized that our intended destination was over to the left, which meant that we would have to climb halfway down Mountain Peak #1 and proceed the rest of the way up correct mountain.
No problem.
Despite it bordering on “sports” – it turns out that I actually really enjoy hiking. Especially this type of hiking. No real trail. Continuously assessing various options for routes to see which is more manageable. Hanging off vines. Climbing up and then sliding down granite rock faces. I find it sort of exciting.
Whilst climbing a mountain (which I should clarify, is an activity that I have experienced exclusively in West Africa), I waiver back and forth between images of Maria and the Von trapp children in the last scene of "The Sound of Music" and singing “The Climb” in my head. Yesterday, we threw some Pocahontas "Colours of the Wind" in there, just for variety’s sake. Needless to say, I was really enjoying myself.
For the first two and a half hours.
Then the climb got a little bit ridiculous. By this point, we were well off the so-called trail. We had been drenched from the rain for about three hours now. It was dark, and the path seemed to be less and less present. My legs were starting to hurt, and everyone’s breathing was getting faster and heavier. It seemed like a really good time for the relief of reaching the summit.
That’s when we arrived at the top of Mountain #2. Which unfortunately, turned out again, to not be the peak of Sugarloaf. It was at this point that I was wholeheartedly ready to bail on our adventure. We had reached the top of two mountains – neither of which had a particularly impressive view - and I was done.
Thank goodness for the rest of the group who remained committed to the goal. If I had been the decision maker for the group, we would have turned around at this point. I knew that however far we had gone up, we still had to climb down, and I just didn’t think I had it in me to keep going. But they didn’t waiver. They wanted to reach our destination, and there was no doubt in their minds that we were going to persevere until we found it.
I think that’s the only reason we ever did make it. It wasn’t physical endurance, because I definitely was feeling it in every muscle and wanted to quit. It wasn’t our navigational skills; because they failed us multiple times. The only thing that really got us there was the perseverance of my friends.
So, we made it to the top of Mountain #3. And it really was amazing. We spent 45 of the best minutes overlooking Sierra Leone, eating packed lunches, and listening to birds and the wind.
And, if it had been left to me – I would have never made it.
Thus, I am left concluding yet again, that life is all about the lessons we learn through it. Yesterday reminded me why it is so important that we live life together, and not alone. Why we need to function in teams. Why two heads are better than one.
Because if not for my “others”, I would still be sitting at the top of Mountain #2, wondering what I ever was thinking!
Once again, I find myself here.
Everything is exactly as it used to be, and completely new, all at the same time. Familiar and comfortable yet foreign and challenging – if that is even possible.
A new city in a new country. New friends and coworkers. New ways of doing things.
For starters, there is this ship – a 500ft vessel which has set the stage for some of my life’s most significant moments. I walked on board early last Thursday morning and breathed an immediate sigh of peace. Joy filled my heart. I was greeted by loving, familiar faces and had that wonderful sense of coming home to a place where you “fit”. I know where I belong for this time. I know what to do and how to go about things.
And then there is the city. I spent Friday exploring Freetown. I had been warned that excursions into town were fairly dramatic. “Freetown” and “traffic” are essentially synonymous terms here on the ship. I should have been prepared – I guess I thought I was. But, calling Freetown busy is the understatement of the century. It’s hard to truly describe the chaos of the heart of town. Between the open sewers and the vendors and the trucks and the “it’s here then its gone” excuse for a sidewalk, even getting from point A to point B on foot is a challenge. It sort of feels like you are in a videogame but there is more pressure because, if you fall in the gutter or get run over by a truck, you don’t get another life. Maybe I just don’t deal well with being over stimulated in every way simultaneously, from every direction. Either way, I found Friday overwhelming.
But then I did it again today. I went into Freetown - just myself and one friend, with a specific purpose. And, all of a sudden, it didn’t seem near as overwhelming. I would go so far as to say it was enjoyable. Relaxed even. I guess it doesn’t really matter how many times you come to Africa – every time you come back again, it takes a while to sink in. It’s just starting to sink for me. My being is ready, but I guess it takes time.
By Saturday, I was doing my first shift on the ward. D Ward. Where last year, we set up the summer camp craft corner for Tani and Gafar. Where O’Brien was healed. Where O’Brien died. Where there are now new faces: some repaired and ready to face the world and some still waiting. Two o’clock Saturday afternoon, I jumped in. As a result of our Gambian detour, our group left the wards a little short staffed. So, instead of having orientation shifts, I just went for it. I took care of patients in a world that I know incredibly well, and yet felt so unaccustomed to at first. Where do we keep this now? Do we still do it this way? How does this work now?
And again, just like riding a bike, as my friend Deb reminded me before my first shift, it has come back. It all feels as normal and natural as it possibly could. Half the time, I still don’t have the answers to the questions that arise in my own head or from others’ – but, I do know that I am doing it. Adapting. Coping. Caring for those that I have been sent to serve. Maybe not perfectly. Probably still with a lot of assistance for the time being. But, doing it.
We probably don’t ever figure it all out. Perhaps we don’t ever need to. If we ever think we have all the answers, we probably need to start again at the beginning and figure out what it was we missed. No matter how much experience we have, I doubt we ever have the ability to adapt to every situation seamlessly. I am thinking that I would never want to. Because these places that I find myself in are the ones where I learn the truths that I didn’t know I was missing.
I was excited about my birthday this year. Something about being so close to 30 makes me feel like I have almost, maybe, come to verge of “arriving”. Arriving to true adulthood or maturity or something. When you are 23 and you present your wild and crazy ideas to the world, people smile sympathetically, pat you on your head, and tell you that it is simply your naivety that makes you think the way you do. But when you tell someone you are 30, they are suddenly a little less justified in assuming that “life” will eventually jade your rose coloured glasses. I am not for a second suggesting that I know all there is to know or have seen even a fraction of all there is to see in my 29 years on this earth – but it is nice to be given a little bit of the credit that living life grants you.
Back to the point – I was ready to turn 29.
And thanks to a small rock on a particularly long runway at Banjul International Airport, I rang in the beginning of my 30th year of life with an experience that I can now add to my list of ways I have lived.
So, it all started with a bird. Or what we thought was a bird and turned out to be a rock. We had stopped in Banjul – capital city of the Gambia – to drop off about half of our flightmates and would have been carrying on and arriving in Freetown, Sierra Leone, approximately an hour later.
Except that we never took off. The plane sped down the runway and just as we would have been about to take off …
“THUNK” ….. followed by a smooth deceleration….. followed by a screeching stop (when the runway, which ironically and thankfully is significantly longer than the average runway, ended).
The captain came on the overhead to announce that a bird had flown into the engine and we would have to taxi back to the airport to check the plane and make sure it was safe to fly.
At which point, I decided that I wasn’t going to see the Africa Mercy any time soon. Because you see folks, this was not my first time in West Africa. Within a few minutes, a crowd of people had gathered around the plane – some of whom appeared official with uniforms or fluorescent vests; others of whom seemed to just have shown up because there seemed to be some commotion. Some people started crawling inside the engine. One dude shone his pen light into the cavity in an apparent effort to help identify the problem. Cameras were out and everyone seemed to have an opinion about what was wrong and how to fix it. Our stewardess even ended up out there having a look. Just didn’t seem like an effective recipe for “airplane repair following bird damage”.
To no surprise, three hours later, after having checked in to a lovely Gambian hotel courtesy of Brussels Airlines, I was sitting down to my first African dinner in over a year with all 150 of my flight 0225 mates, under a blanket of palm trees, minilights, and stars.
And two days later, I turned 29 and found myself still stranded in the Gambia – which turned out to be about the loveliest place on earth to be stranded on one’s birthday. Between pina colodas, a trip to a treetop café, a cherrycheesecake – esque dessert that the hotel chef made for me (which ironically tasted terribly, considering how beautiful it was) , and pretty much lying by the pool for the entire day…..I really couldn’t have asked for anything more.
That, plus the fact that after traveling the entire next night, I finally did arrive, safely and soundly on the ship, made me a fairly happy, legitimate almost 30-year-old.
It's happening again.
Last weekend, it all sort of clicked in my head. It's time to start getting excited again. It's time to start feeling the things again that only Africa can stir up in me. It's time to start thinking about the things that, despite having experienced before, I know I can't truly prepare for.
It's happening in my head and the excitement is quickly working it's way towards my heart. As desperately as I try to avoid romanticizing the whole thing, I can't help but find life a little bit sweeter, just knowing I get to spend the next 4 months on a floating white hospital.
I don't have my plane ticket. My apartment looks like it has been attacked by a group of college kids. I still don't know what to do with my car when I go. I work about 452hrs/week up until the day I leave. Never in my life have I felt so strikingly aware of my personal flaws & weaknesses. My to-do list is rubbish.
And yet, I have never been more ready. Because I think I finally get that we are never really "prepared" for these things, the way we think we should be. I might find the time to clean and organize my room. I might make and cross off every item on a highly structured list. I might finally take the time to figure out how to overcome the things in my life that hold me back. I might even figure out a sleep routine amidst flipping back and forth between day & night shifts and actually land on the other side of the world not already jet-lagged. The funny thing is that these things always come together.
Despite it all, I feel prepared. I think that preparation really has very little to do with lists and finances and plans. The reality is, I am ready to be used for the purpose my maker designed me for. Ready, once again, to learn and to teach, to laugh and to cry, to be challenged and broken and to fail and succeed - in a place where I know my heart beats a little bit stronger.
The other day a friend, who had recently left our floating home sent me an instant message asking how ship life was going for me. The tricky thing about instant messaging is that it forces you to summarize oceans of emotions together into brief, cohesive sentences. I had no problem.
“You know…..the same….amazingly wonderful and horribly challenging all at the same time”
It’s just how it is. The wonderful side tips the scales, obviously. I can think of nothing that I would rather be doing than living this life, doing what I am doing. It is overwhelmingly rewarding and downright incredible to spend the better part of all of my wakeful hours contributing to something in which I believe so strongly.
But, the challenge part of it all is just as existent, and I am beginning to think, just as important as the rest of it.
We are taught from such a young age that through trial, strength is developed. The preacher at church last Sunday morning reminded us that “…when troubles come your way, consider it an opportunity for great joy. For you know that when your faith is tested, your endurance has a chance to grow. So let it grow, for when your endurance is fully developed, you will be perfect and complete, needing nothing” (James 1:2-3). His words came as an insightful conclusion to a challenging, yet entertaining morning. Rainy season has arrived in Togo. When we woke up and saw the massive amounts of water streaming from the sky with intense determination, we briefly considered bailing on our plans to go to church. But that would have meant we missed the important part – the part where our group, plus about 25 of the members of the congregation bailed a foot of water out of the church, so that church could happen. As I looked around at the group, in probably what is their only set of church clothes, soaked head to toe, using buckets and serving bowls and towels to defend their church home from water damage, I couldn’t help but be touched by the devotion and determination displayed.
When you care about something, you work for it….sacrifice for it….put your heart into it. And if you have to work, sacrifice, and put your heart into something, you can’t help but end up caring deeply about it.
Our approach to adversity is peculiar really: despite the fact that it is entirely inevitable and most often, completely out of our control, we dread its presence. And because we are in the habit of convincing ourselves to believe in a standard of utopia, we feel slighted when it shows its unfortunate face. The thing is - there is not a single one among us who has been promised a life free of trouble. The Bible doesn’t say if you face troubles, but when.
As I reflect on these last couple of months, I wonder what has changed me the most…where I learned the most….what will stick with me and define who I become. O’brien, Aissa, Tani, Abel, O’brien’s mama, fat baby Marius, bartering for hours with vendors in markets, being squished in taxis with seven others, working in areas that aren’t my comfort zone, having to make “bunk beds” in the wards to fit all the patients in, eating foods that I didn’t think I would like, trying and failing at walking across Togo, failing miserably at communicating in French – small trials that forced me to grow and learning from people who have encountered much greater trials than I have yet to face.
As much as the anticipation of adversity can be overwhelming, I would argue that we are completely dependant on it. A life of perfection on this earth is, at best, a falsehood. Trials will come. They will hurt. They might leave scars. But they will make us people of substance who are intensely purpose-driven in their passions.
Two years ago, Africa changed me. It changed the way I thought about what it means to be human. Perhaps at the time, I thought the change was like a one-time graduation from naivety to enlightenment. It seems however, that as so many before me have cautioned, learning really is a never-ending journey.
These last couple of weeks, one of our patients - an absolutely delightful little girl named Tani - has completely changed the way I think about beauty.
Physical beauty is one of those forces whose power over us we hate to admit. When you stop and think about it, basing our opinions of one another on a somewhat arbitrary criterion such as beauty seems not only superficial, but also simplistic and downright cruel. However, the unfortunate reality is that it does have a very significant impact on our interpersonal relations. We are innately attracted to beauty. It’s one of the reasons we do what we do here on the Africa Mercy….Because eliminating a feature that is grossly deforming means that a person can go from living a life of disgrace to living a life of acceptance.
Tani came to stay with us around the same time as Aissa was on the ward. I distinctly remember my first day with her. I came on for my charge shift and one of the first things Ali said to me was “Check out bed 8. She’s beautiful. You’re gonna love her!”
I turned my attention to the new little girl in bed 8. Tani didn’t look beautiful to me. Having been in West Africa for a little while now, and seeing what I hope are some of the most disfiguring cases out there, I credit myself with having some degree of tolerance for the worst of it. I would like to think it takes a lot to shock me at this point. But, Tani did.
Though nobody really knows the story of when or how, at some point in her 9-years of life, Tani’s face was burned off. She was left with bits of a mouth, and one eye. Though most of her little body was spared, one of her hands, which she probably used to catch herself when she fell into the fire, was left mangled. To be completely brutal, at first glance, Tani was hard to look at.Until my experiences with this little one, I don’t know if I ever truly believed that beauty comes from within. It always sounded nice, and makes us all feel better about our imperfections, but then again, we make stuff up all the time to make ourselves feel better. But, Tani made it real for me, because my friend was right. Within 5 minutes of encountering Tani, I absolutely loved her. I like kids, as a rule, but Tani has a special quality within her that is unmatched. She makes it absolutely impossible to see anything but her inner beauty. Every day I spend with Tani, she grows more and more radiant. Her loving, joyful spirit can almost not be contained within her tiny little body.
Looking at her, you would expect that she would repulse others, but Tani cannot help but do exactly the opposite. Her presence is actually magnetic on the ship. Our head chef came up from the ward last night and announced:
“I just spent 10 minutes playing with Tani. It changed my life.”
It probably did. And it defies everything I used to think about beauty. Because Tani has a beauty that is legitimate, undeniable, and worth so much more than I could have ever realized without her.
In order for a weekend trip away from the ship to truly qualify as typical, there are several criteria that must be met. They are as follows*:
- Just minutes after your departure, the driver will need to stop at the station, where you will have to...
a) Renegotiate the fare (which will have inevitably gone up from what you originally agreed upon)
b) Pick up a wingman
c) Sit around in the vehicle with all the doors open while the driver and the wingman exchange pleasantries with everyone else at the station.
d) Get gas – which, as a side note, cannot be done in combination with any of the above tasks.
- You will begin the trip in a mildly uncomfortable seat, sitting relatively close to one of your friends, with some degree of leg / breathing room. You will conclude the road trip sitting on someone’s lap (in the most ideal scenario, this someone is a wet stranger that you picked up along the road), unable to feel your legs, and with your arms either directly out in front of you, straight up in the air, or wrapped around one of your other twenty travel-mates.
- Numerous times along the way, the driver will pull over to the side of the road. The wingman will hop out of his seat (which is always conveniently located next to the one sliding door) and disappear under the vehicle for about 20 seconds with a bottle of discoloured water. Immediately after he resurfaces, the vehicle starts in motion and he hops back in. Nobody has ever been able to come up with an explanation for this one.
- When you arrive at the hotel, the first staff member you encounter at the desk will respond to your attempts to explain who you are with complete bewilderment. After a couple of confused minutes, someone else (usually of higher power) emerges and provides you with some reassurance that you did, in fact, make reservations. These reservations will most likely not resemble what you intended them to, but they do usually exist.
- You will then carry on to have a fantastically entertaining, re-energizing weekend with your friends in a setting that makes you consider throwing it all away and living in the jungle, under a waterfall for the rest of your life.
Thankfully for us this weekend, every single one of these criteria was met. Although it is always nice when things play by the rules, it was of particular importance this weekend, since Ali’s parents are on the ship right now, and she was committed to giving them a truly African experience. We had an incredible weekend marketing, swimming, eating, hiking, and playing in the waterfall. And, it truly did represent all of the things we love about
*this list is not exhaustive.