Interior Screening: N'Zerekore to Kankan to Mamou

There's a space of time before dawn when the world seems to stop - just to take a moment and breathe - before jumping into a new day.  In sandals and scrubs in the twilight before the morning, I turned off my night-vision headlamp, ignored the chatter from my radio earpiece, and prayed for wisdom.  The whole purpose of this trip is to find surgical patients, but we came with limited surgical slots, a few handfuls of hope to share among hundreds.

Because these hours of dirt roads in between town, a minor inconvenience or adventure for me, are the difference in medical access for thousands.

And they came, as the sun began to rise.  Young and old, wearing their shame under a carefully wrapped lappa or nursing it along on crutches or hidden under a keffiyeh.  There were the cleft palates and noma patients I rejoiced to find, a boldly written MAXFAX across the top of the pink screening sheet.  An alcohol-cleaned finger held out in a prayer that the HIV test would be negative and the immune system strong enough for surgery.  A tentative smile that danced in brown eyes with a carefully held patient card - the golden ticket for a screening slot on ship and a chance at surgery.

And there were the moments that ripped my heart in half again and again and again.  A double line on an HIV test, a plastic surgery desperately needed but no spaces in the surgery schedule and a waiting list already too long, a medical illness with no medical doctors or medication available to help, a brand-new baby in my arms and no orthopedic slots to straighten tiny deformed legs.

 From town to town the schedule steadily filled with the carefully reserved spots I had counted out for each location.  From town to town they came, and the need was great.  My own wisdom could not possibly have been enough to make the choices on which so many lives depended, and I was left in freefall - trusting in the wisdom and guidance that could only come from the One with the power to see and touch every life, the only One who can truly heal.

When Jesus heard what had happened, he withdrew by boat privately to a solitary place. Hearing of this, the crowds followed him on foot from the towns. When Jesus landed and saw a large crowd, he had compassion on them and healed their sick...And when the men of that place recognized Jesus, they sent word to all the surrounding country. People brought all their sick to him and begged him to let the sick just touch the edge of his cloak, and all who touched him were healed. ~ Matthew 14:13-14, 35-36

Interior Screening: Conakry to N'Zerekore

It was almost midmorning on day 2 of the interior screening trip when I found myself belly down over the spare tire on top of the Land Rover, hooking ratchet straps into the frame and rearranging our waterproof backpacks under the tarp.  I could feel the sun starting to bake through my tee-shirt and kilted skirt, warm on my bare feet.  Swatches of grass line the road back over the hill to warn approaching trucks of our presence: a creative African version of the reflective orange warning triangle.

Our first day had gone very smoothly: 12 or so hours in the car from Conakry to Faranah, with around 25 potential patients to screen when we got there.  We spent the night at a guesthouse, after a late evening of unpacking and talking in the wide open field out back, while fireflies danced with the blanket of stars.

We hadn't even hit unpaved road yet the next morning when a loud CLUNK from the front Landie (Land Rover) had us pulled over in the tall razor grass on the side of the road.  A verdict of broken rear differential had us splitting our team - two to stay behind with the vehicle waiting for a tow, and the rest to continue on.  We had two stops for screening that day before driving on and through mudholes and more holes all the way around the northern border of Sierra Leone, out of the sunset and almost to the Liberian-Cote d'Ivoire border.

The first two days (Part 1) in light purple.  Guinea is a big country, and an incredibly gorgeous one!

The morning of day 3 we met a few patients at the beautiful little clinic in N'Zao and met with the hospital director and officials to prepare for the "big" advertised screening planned for the government hospital in town the next day.  Only 3 days, and already we had several patients scheduled at 4 stops, with a month's worth of dirt road in between.  My back was a bit sore from being airborne between holes so much of the trip, already I had earned a designation as "trunk monkey" from swinging off the handles above the Landie doors so I wouldn't land in other people's laps quite so often.  Already my heart rejoiced in the mountain greenery and endless rice fields that filled the drive.  I went to sleep that night tucked into the mosquito net, with my headlamp by my bed and bag already packed, scrubs laid out ready for the early morning screening the next day in N'Zerekore.

The medical team prepares patient cards in N'Zao.  Sorry, no patient closeups for privacy reasons!

Adventure to the interior: A beginning

Well the land rovers are packed and our team is ready to head out early tomorrow morning at 0430.  Two weeks of guesthouses and camping, muddy dirt roads and plenty of coffee, large crowds and lots of potential patients...

In short, two weeks of incredible crazy adventure.

The meetings and planning of the last two months fed neatly into the increased pace of the last week...spreadsheets and plans and meetings, the glaring orange of the medical bags in my camp chair under the window and the boxes of pregnancy tests and yellow patient cards sitting on my desk under a small pile of very conservative clothes.

It started when I offered to help, two months ago.  Just mentioned that I would be willing to work with the screening team again if needed.  And here we are, headed out with a team of nine crew (including three nurses), hitting up cities throughout Guinea to screen for patients.

There could be thousands waiting for us - some already with surgery dates and so many others hopeful.    It is impossible to go in my own strength, my own wisdom: sure recipe for disaster.

So I kneel in my weakness at the foot of the cross and rise in thankfulness that He has already gone ahead of us.

I pray that I would see through His eyes, to see him there in N'Zerekore and Kankan and Mamou and everywhere in between.  Would you pray with me?

Yu sabi?



Ortho kids from Sierra Leone with Melinda and Michelle

Christiana stood at my elbow, stethoscope around her neck, watching intently as I entered the assignments for the night nurses into the computer and started printing them off.  I had already warned a few kids away from the computer with my newest Krio phrase, Lef am, dis no fo pikin (Leave it alone, that's not for children).  After a few deleted censuses and an amazing thankfulness for automatic retrieval, I've learned never to walk away from the computer without locking the keyboard.

Two of our peds patients play "mama" with balloons tied on their backs



B ward is lively and full of fun and kids, 20 patients aged 15 and under, most of them in bed with blue and white and purple casts sticking straight up off the pillows with small brown toes wiggling at the ends.  Most of them I know already from ortho in Sierra Leone, some I've met here.

Laura, we de go na waka-waka? Ar wan go waka-waka wit yu! Can we go on a walk now?  I want to walk with you!  Christiana radiated excitement, and I decided some of the kids could use a little excursion.  Yesterday Christiana and I had gone on a "waka-waka small" through the hospital, visiting her friends on other wards and discovering the delights of an automatic ice machine. She and her miniature walker are unstoppable, roaming through the corridors with an escort or stubbornly taking the stairs one step at a time, four flights up to sunshine.

Usai yu wan go? I asked.  Where do you want to go?  Na office.  Her favorite place, the staff office has plenty of people working there during business hours, and all sorts of fun things to interest curious kids.    So I set off with a small flock of casted ducklings to retrieve my nursing assignments from the printer in the office - around the corner and 50 feet away.  I paused to help Sheku manage his crutches and heard a small voice behind me, Adam, Adam, usai yu de go? Adam, where did you go?  5-year-old Bindu was trying determinedly to catch up, using a small stool as a modified walker for support.  My followers all chorused na office, na office...yu sabi office?
Sabi means to know, to understand...and in this case, perhaps know how to get there.  4-year-old Adam persisted that he sabi office, and after trying the stairs, the laundry, and the kitchen, finally found his way there.  He stood in the doorway in awe looking at the computers and repeatedly washing his hands with the hand sanitizer from the automatic dispenser by the door.  Every one of those 5 kids slowly worked their way to the door of the office, tested the ice machine and squealed when it dumped a bit of water on them, then thoroughly washed their hands with sanitizer.  Adam proudly carried my assignments back from the printer to scatter them across the desk and nearby floor before announcing again with conviction, a sabi office.

It's easy to claim knowledge of something without ever having experienced it.  In Adam's case, he was convinced he "sabi office" even though he had not been there, had not experienced it, and had no idea where it was.

Later that evening one of our day workers asked me if I sabi Krio. 

I sabi Krio small, but I want to learn more.  How many other things in my life is that true of?

In color

It would be easy to turn and walk away.  Escaping reality with the TV turned up just a little louder, telling stories of the good old days and ignoring the hurt in front of us. To walk through a day without ever seeing, and to give care without ever loving.  Because without love there can't be loss - or at least that's what we tell ourselves.

Too easy.  Too safe.

So many choose the path of less resistance, not realizing with hurt and heartache there can also be joy; unwittingly imprisoning themselves in a world of gray.  Never knowing the richness they have carelessly traded away.

I want to live in colors brilliantly painted with a bold hand on a canvas of my own life.

My hands, cupped in prayer, catch raindrops together with blessings, trickled down between my fingers and onto my palms to mingle with the warm salt of my own tears.  Above my head, all I can see are storm clouds dark with promise.  But out across the ocean, in the midst of the rain and storm, the bright pinks and blues of a beautiful sunset still shine persistently through.

I want to go into the world of distractions and toys, of ignoring problems and hoping they'll go away, the world of make believe and masks.  I want to tell people there is more to life than the safety of grey.  It's worth taking a risk to live life in color.  They may miss amazing sunsets if they're too scared to stay out in the rain.

Full of life again

Nestled in my lap between crossed legs, Lamaran focused on my finger and thumb, gripped them tight and drooled ferociously through a half-healed lip.  He is precious, this tiny little boy, with a constant beautiful grin below the steristrip whiskers soggy with drool and milk that leaks through the hole in his palate and out his nose.  He's not yet big enough for the surgery to close his palate, but in a day or two we'll send him home with a healing lip to work on getting fat.  For now he's content just to lay and drool down my leg and smile at me while his grandma sleeps.  I've taken opportunity of the quiet moment to sit down and chart on my few patients and work out nursing assignments for the next shift.  On the stool next to me, Hawi and Lama sit drawing circles and chattering to each other in languages the other cannot understand, fast friends despite the language barrier.  Already they've assisted me today in wiping down the laminated meal order form, cleaning random ward items with copious amounts of hand sanitizer, and stickering each other, the nurses, and everything else in sight.  In a few minutes, when I finish printing assignments, we'll take a waka-waka small (short walk) down the hall to retrieve things from the printer and sticker them too. 

We went up on deck later to enjoy the sunshine and boats going past amid rollicking worship music with the hospital chaplaincy team and a rather wild tricycle and wagon gang from B ward.  B ward is almost full now with a poda-poda load of kids from Sierra Leone here for follow up surgery.  They arrived at night early last week, 14 kids tumbling out of the poda-poda with parents and a few extra patients that hitched a ride along from Sierra Leone.  I snuck into B ward the morning after they arrived and was instantly mobbed.  Padi, padi, padi (Friend, friend, friend) Fatima hollered as she attempted to climb my leg.  Sheku and Osan were right behind here, and a crowd of faces I recognized behind them.  Over the next few days I contrived to spend as much time in B as I could - covering lunch breaks and helping organize the mob of "hotel patients" needing Xrays, charts, and labs.  The enthusiasm is incredible and a bit exhausting!  Every kid wants to interact, to sit on laps, to be involved in everything that is happening with every other kid.  I had to laugh when I returned Osan to the ward (screaming and upset after a blood draw) only to have Sheku climb up my leg and ask earnestly, "na me?  na me? (Me too, me too?)"My 6-year old fiance from the C ward chaos of early last year is still toothless, still grinning, but proposing much less often than last year.  In fact, almost all of my kids from those few days in C ward are back again, including the ones we visited at their homes upcountry in Bo.  It's good to see familiar faces, to welcome new ones, and to once more be a part of the miracles we are here for.

In short, the hospital is open again, busy and full of life, and I am excited for a new season of surgeries in Guinea!

Ten thousand hopes

He looked through me far into the past, wrinkled hands tightly holding mine as I squatted beside him in the drizzling rain and mud at the edge of the road.  "I will tell you the story of my eyes," he said.  "Seven years this one cannot see, and five years this one can only see small.  We are come from Sierra Leone with my family during the war."  The light from my headlamp reflected off the cataracts clouding his pupils; a huge smile lit up his face when I welcomed him and told him to wait to see the eye team in the morning, that we had surgeons who will see if they can help him with this problem.   He quoted from the gospel of Mark and prayed fervent blessings on the screening team and all the patients we would see in the coming day.  His wife and son shook my hand, and the small family began singing praise songs in Krio as my translator and I moved away.  I started to sing quietly with them...Yu are da pilla that holds my life...

Beside him a man looked at me, pleading.  I had already spoken with him, seen the displaced femur fracture clearly on the x-ray against the light of my small flashlight, and the surgical rods in his radius now exposed at his left wrist.  It was clear he needed multiple surgeries to move back towards some semblance of normalcy, just as clear that we could not do his surgeries.  I could not tell him yes.  How could I tell him no?  No, we cannot do your surgery, even though you have walked on a badly broken leg for over a year; no, we cannot help.  There was nothing left to say, and so the translator and I stood beside him and prayed for healing.  "Allah has spared me from my car accident for a purpose," he told me, "I am praying to find what that reason is."

My shift started at 1800 the night before screening.  After setting up the building for patients the next day, my fellow nurse Greta and I began screening potential patients in the line outside the gate.  As with other screenings, not all the potential patients there were surgical candidates.  We discussed headaches and acid reflux, basic wound care and how to determine when antibiotics were needed, and I spent at least 15 minutes trying to explain to an elderly man in a car why his swollen legs really meant he needed medical management and oral medication instead of surgery.  It was an early morning of heartache, and there are some that I told no whose faces will stay with me forever.

We are not called to fix all the medical problems of Guinea.  Without a surgical screening it would be impossible to choose the ones we can best help.  There is no denying that many we saw needed medical care we could not give, and to leave so many suffering makes me angry at the injustice - the disparity between those who have access to healthcare for the smallest problems and those who cannot afford care even in emergencies.

As painful as it is to say no, it is just as joyful to say yes to the man who has been waiting for the last few hours and the last ten years to hear "yes, we can take this tumor off of your face."  To see the children with leg deformities who will be able to walk again, the bent and twisted that will become straight, and the blind who soon will see.  We are a surgical specialty hospital, and tomorrow morning the healing surgeries will start.  My prayer is that even Sunday, even with those we could not physically help, that the healing has already started.

As my LandRover drove away at 0615 there were crowds coming to join the screening line, running along the side of the road as though they were afraid to miss their last opportunity at healing.  They came with their hopes tied to their backs in lappas and wrapped in strips of bright african cloth; an overwhelming press of need, an echoing chorus of hope.  And they continued to come in crowds, until the end of the line was out of site and still stretched on.  All through the day as I stayed on ship to be the on-call emergency responder, my pager went off with requests of more wheelchairs or paperwork for the screening site, more gloves, more supplies.  

Initial numbers report at least 3,500 patients were screened in the stadium that day, welcomed together with family members.  Those numbers don't include all the hopeful patients Greta and I had to turn away overnight, the bystanders and Minister of Health and translators watching and praying for a better world, or the family and friends expectantly waiting at home to hear the news.  

It was a day of dreams finally becoming reality.

A day of ten thousand hopes.