Out of control

It was a warm spring day in Binghamton when I joined the other carefully picked students for a "meet and greet" and tour of the campus for prospective freshmen and their families.  One of the parents struck up a conversation, asking how I liked the school, what my major was, and if I had plans for after college.  He was enthusiastic about the fact that I was majoring in nursing ("good job security there") but not so much about my future plans.

"Don't you know those people get killed?" he asked, obviously concerned.  "It's not safe to go overseas.  There are cannibals.  You can't do that, especially not on your own.  It's not safe," he repeated, with a concerned glance at his daughter as if she might catch some sort of contagious illness from me.  I wanted to laugh, not really sure what to say.

I never told him that I grew up overseas, not always knowing from day to day whether it was safe to go to school, or if we would show up to church only to find it burning to the ground.  We rode motorcycles and climbed exploding volcanoes, hid behind cars during riots, kept our bags packed for months at a time in case of emergent evacuation, and walked by the training schools that sent Jihad warriors overseas to fight the Americans.  As childhoods go, it wasn't really a safe one.  My future plans were only in keeping with the same radical existence...a realization that safety isn't everything.

It is dangerous to work in emergency nursing, never knowing what contagious diseases you may be exposed to or which patients will become suddenly violent.  It isn't safe to sail to one of the poorest countries in the world, a country still recovering from 11 years of civil war and teeming with refugees and demobilized child soldiers, in hopes of reaching out to touch the hurting.  But I don't choose this life because of my background or a blatant disregard for my own safety.  It is in a realization that to live life one must encounter danger on some level.  Danger is not only in a life of wild adventure, it is also in driving a car, in trying new foods, in living, in loving.  Can we neglect our responsibility to reach out and touch lives because of a fear of failure?

We were never promised a comfortable long life as Christians - rather persecution and hardship.  We were not promised riches, but instructed to store up treasure in heaven.  It is an uncomfortable life and an uncomfortable gospel.  Our God is not a "safe" God...

"Then he isn't safe?" said Lucy.

"Safe?" said Mr. Beaver. "Don't you hear what Mrs. Beaver tells you? Who said anything about safe? 'Course he isn't safe. But he's good. He's the King, I tell you."                                             ~C.S. Lewis

"Hidup mulia atau mati syahid"...live gloriously or die a martyr.  My neighbors in Indonesia understood radical faith...how is it that my neighbors in America have missed the boat?  What is the point of hiding in a hole?  To  live a timid existence with minimum risk, only to die in a car crash or fade away with cancer?  You may pass through life with no ripples in the pond, never having lived at all.  Who is to know when your days are through and God will call you home?  You are not in control of your future.  It is God who is in control; God who holds you in the palm of his hand.  As my Dad so often liked to say, "The safest place for us is in the center of God's will."  A life of wild adventure in following Christ may not be overtly safe, but it is GOOD, and God is ultimately in control of what happens.

To others it may look like the terrifying adventures of someone with a blatant disregard for their own life.  Trust me, I don't have a death wish.  For me the safest place for me to be next month is aboard a converted ferry ship in the wide ocean, watching out for pirates, sailing towards a life of love amidst poverty, refugees, and ex-child soldiers.  If I die a martyr...so be it.  I will have lived gloriously in obedience to my King.

...I am out of control.

Prayer Letter

It’s a shock to realize that what you once dreamed is no longer the dream of your heart.  That where your heart once was is no longer your home.

It hits me hard when I look out on the beauty of small-town New England in the autumn and realize that, gorgeous as it is, there is so much more to life.  My past goals of living here, raising a family, saving lives at a local hospital – it’s a transient reality, lived for a moment and then ready to go on the back burner to simmer again. 

I thought that when I came home from Togo I could go back to normal, that the heartache would heal in time.  Instead I find myself still there, in the stark, bare reality of a life without resources and a soul joyfully reflecting the glory of God, regardless of the cost.  My skin may be white, but my heart still beats with the rhythm of the djembe.  My naiveté has been lost and instead I sing with Brooke Fraser, “Now that I have seen, I am responsible; faith without deeds is dead.  Now that I have held you in my own arms, I will not let go…”

I found myself debating the point with a doctor from work at 4 am this week.  Night shift can sometimes be good for substantial debate.  Dr. Duke is wrong…a life of service cannot and should not be separated from faith.  In reality, a life of service can only be lived by faith, a reflection of Christ at work in a soul…a heart surrendered in worship.    Otherwise it becomes dry and meaningless.

And so, friends, I am headed back to West Africa.  To be a part of the miracle of a child living only by the grace of a good God and the fervent prayers of a mama.  To love the outcast and touch the hurting.  I will be a pediatric nurse again with Mercy Ships, this time in Sierra Leone – a country already torn apart from years of war.  My commitment is from January - May, 2011, and I am very excited!

I plan to meet the Africa Mercy in South Africa for the sail to Freetown, Sierra Leone. Along with my responsibilities as a pediatric nurse I expect to participate again in surgical screenings, respond to the need for Pediatric ICU (PICU) and ICU nurses, and most likely joining the emergency team again as well. 

I covet your prayers and welcome your support.  Because all of our surgeries on Mercy Ships are provided free of charge, I will need to raise just over $5000 for my 4 months of crew fees and the plane tickets.  Regardless of whether or not God leads you to contribute financially or join me overseas, please pray for my co-workers, patients, and myself.  Please pray for volunteer medical staff to be raised up, for God to prepare our way in the hearts and lives of the West Africans, for safety and for opportunities to witness.  I have continued keeping up with my blog here at this address, and plan to continue to do so throughout my trip.

To learn more about Mercy Ships or make a donation, you can visit my page at https://connect.mercyships.org/page/outreach/view/crewmates/colesl.  Donations can also be mailed directly to Mercy Ships, P.O. Box 2020, Garden Valley, TX 75771, with a note attached that they are for Acct # 2699.

Aiming to reflect His love,

Laura

Reflection of Glory

Autumn in New England is a glorious thing; autumn in the Berkshires is no less beautiful.  Stretches on vast stretches of rolling green-and-gold hills.  A mountain view on the walk into work that makes me just stop, and stare, and sigh.  My heart sings with the brooks and creeks as they wander along the path God guides them in.

I stop for a moment and stare, lost in the reflection of fall colors so perfect it's hard to know which is reality and which is only the reflection in the smooth water.  A few hundred feet down the current swirls, speeds around rocks, and the perfect image is broken.

We were created to reflect the glory of God.  It's hard to remember that sometimes, living in a world that frowns on vulnerability, encourages us to trust in our own strength.  In a job where I need to present confidence and competence in the first few minutes of meeting a patient, twenty, fifty or a hundred times a day.  Where co-workers tell me that service overseas is a farce of proselytizing and coercion rather than a God-given calling and ministry.  Where genuine joy is the oddity and not the typical.

I love the Emergency Department.  It's not the adrenaline rush, not anymore.  It's reality.  Where facades are stripped away and people show who they truly are.  I miss the innocence of before, but now that I know the reality I can't stay away.  It's not just in Africa where there are the poor, the forgotten, the outcast and the needy.  They are here too, our neighbors and friends, the town drunk, the lady camped out under the bridge, the girl who intentionally overdosed, the young father with a new diagnosis of cancer.  It's just that here in America we try to hide our brokenness.  It may not be physical, not always.  We have to look a little harder to see beyond the mask.

Lord, to these the hurting let me be a reflection of Your glory, albeit still a little broken sometimes.

The limitations of Wong-Baker

I was getting patient report during an early orientation shift at an ED nursing travel job in New England. The nurse reporting off added as an afterthought..."oh, and you may have trouble communicating with "John". If a family member's not there you may need to call the translator."

I went and assessed my patients, had a nice conversation with "John", and came back out to touch base with my preceptor for the day. "Oh, and "John" is doing well, no nausea, vitals are great, and he needs a little more pain medicine."

"So, family was still there?" she asked.

"No, he stepped out, but he'll be back in a few minutes." And no, I don't know "John''s language. Within a few minutes I found myself explaining to a new staff how I came to be semi-fluent in medical pantomime.

It was difficult for them to wrap their American medical minds around a place where ATT translators are not readily available. Where we hire aides for their language skills rather than medical knowledge and background. Where conversations may go through multiple nurses, translators, and other patients or family members. Where a little girl and her uncle could spend a month on a ward with no one who spoke their language, and our one translator for them came

down a few times a day; where complex sterile dressing changes, NG feeds and assessments could take place with little or no verbal communication if necessary.

And so in an effort to convey the challenge and the reward of care in this environment, I found myself telling them about Sayeed.

Sayeed was born nine years ago into a society and culture where any physical disability could be fatal. Babies with any deformity could be thrown out on the belief that they were cursed; even if the family kept a child he became a liability because the family had to care for his needs. Until May, Sayeed lived life on his hands and knees.

I first took care of Sayeed just as he was coming out of the recovery room. His beautiful innocent grin lit up his face, a response to my welcoming smile as he rolled in the doors of B ward. One of the translators was next to me for this first crucial moment - an initial set of vitals and assessment, explanation of postop procedures, circulation checks and pain medicine. Reassurance that he would have his own legs back and they were indeed still there under the strange hard whiteness of the casts. He wiggled his toes, giggled and gave me a thumbs up when I pinched them, and pointed to the smiley face (0) on the Wong-Baker pediatric pain scale, then settled in happily coloring.

I opened his chart to look over the postop orders and stopped, half-stunned, at the medical history: cerebral palsy. Only the strong love of a mother and the grace of God could have brought him this far in the villages of West Africa. I glanced over at his bed and he gave me a brilliant smile and thumbs up, then went back to coloring.

He breezed through the first few hours after surgery with no complaints, no problems, no need for pain meds. Around dinnertime I went to check on him again, a routine becoming familiar to him by now. He turned on the pulse ox and put it on his finger, put the thermometer under his armpit and held it there until the beep. Vitals...WNL. I pinched his toes and wiggled my fingers. He grinned and wiggled his toes, gave me a thumbs up. CMS checks...good.

Finally I pulled the laminated Wong-Baker faces scale off the wall and ran my finger along it. Are you having pain, Sayeed? He pointed to 4, a slightly sad face, and gave me a happy smile. I pointed to the 4, shrugged and looked confused, and ran my finger along the scale again. Are you sure you are having 4/10 pain? Again the nod, beautiful smile, finger on the 4. Then he went back to coloring with his mother.

Confused, I called over one of the translators. "Yaovi, can you ask Sayeed if he is having pain?" I asked. He came back with the same answer, "A 4, Afua."

"But Yaovi, he looks very cheerful. Can you ask him again if his legs are paining him and if he would like some paracetamol?" He did. "Afua, he says his legs do not hurt, and he does not need medicine."

Now I was really confused. "Then why did he tell me it was a 4? Can you ask him what he thinks the faces mean? Yaovi did, and came back laughing uproariously. "I think he does not understand the faces, Afua. I have taught him again what it means."

I found out later that the faces meant something a little different to Sayeed than what Wong and Baker initially had in mind. The zero- I am having a lot of fun; a two - I am having fun. A four...I'm a little bit bored.  I love the pure, uncomplicated mind of this little boy who was completely unconcerned that he would be the object of horrified pity in my country, a symbol of family shame in his.  He didn't know that he had just had surgery and by any stroke of logic he should be thinking about his legs, crying, fighting the nurses....instead, in total innocent oblivion he trusted that we would fix his legs.  And in the meantime, he just wanted to play!

Sayeed hanging out with a few of his friends at the Hospitality Center, including Bo, Komla and Abe. Photos by the ever-talented Liz Cantu.

Mental preparation

As my next trip to West Africa with Mercy Ships is coming up soon (YAAAYYY!!) I've been planning ways to get back into the groove. After all, living on a ship and working in this unique hospital does take some creativity and adjustment. If you have been thinking about living or working on board a hospital ship in West Africa, feel free to try a few of these out and see how well you adjust. And of course, post and let me know how it works out for you!

*Disclaimer…”hospital life” suggestions are not meant to be tried in actual American hospitals, as some of these are by design not intended for western healthcare facilities.

Ship Life:

Invite five of your friends to stay with you for the next three months. You should all live in a partitioned one-room apartment, and take turns sleeping in the closet. Remove all the doors and hang curtains instead. All wall decorations should be magnetic.

Most of these new roommates will be medical professionals. At any given time, two should be working days, evenings, and nights respectively. Rotate shifts to keep things interesting.

At least half of your new roommates should speak another language. Learn medical terms in that language and try them out at work.

Set aside a small room for privacy and prayer, and spend time there regularly. Donate books in 10 different languages to the local library. Check them out in the middle of the night.

Line up for mealtimes at 0730, 1200 and 1700 each day. Eat together with 400 of your closest friends. Have fried plantains at least once a week.

When you go out into town, don’t wear shorts no matter how hot it is. Go with at least 5 other people for safety. At least 8-12 people should fit into each taxi...15-20 per van. Never pay the initial asking price. Sit on top of each other. Bring goats.

Move somewhere very sunny, and then take Doxycycline. Keep your apartment temperature above 90 degrees. Drink at least 4 liters of water daily. Eat the goats.

Fill plastic bags with water. Refuse to drink any water that comes out of the tap. Instead, drink out of the bags...or your nalgene.

Leave a lawnmower running in the living room for proper noise levels. Occasionally bang on pots. Turn on the vacuum every time you flush the toilet. Color water green and put it in the bathroom. Once a week measure some out and flush it down the toilet.

When you take showers, make sure you turn off the water while soaping down. Limit yourself to two total minutes of shower water per day and one load of laundry per week.

Have a birthday party at least once or twice a week. Invite 50 friends. Play baseball with an empty Pringles can as a bat. Cook plenty of sweets, using at least 5 mangoes. If you bake a cake, GoogleTranslate the instructions into Dutch, then ask your roommates to help you figure them out.

Stop wearing heels. Climb 50 flights of stairs per day. Watch the sunset over the ocean.

Ask famous national leaders to visit. Invite them to make a speech, or share their testimonies. Then give them a tour of your workplace. Introduce them to patients. Throw them a party.

Bring maracas and drums to church. Dance excitedly during worship. Encourage friends to dance with you. Sing in several different languages. Provide two translators for the pastor. Have a 100 person church service in your living room with all the patients from the hospital.

Announce emergency drills every other Thursday afternoon. Gather with a group of your friends in the dining room. Pretend to do CPR. Every few months change the drills to 3 times a week with life jackets. Take roll call.

Set up a rotating schedule to watch for pirates. Dress up like pirates. Watch Pirates of the Caribbean on a laptop. Then watch Titanic and the Guardian. Then hide for an hour in an undisclosed location.

Get up excited for work, knowing that God is in control and making a difference in hearts and lives!

Hospital Life:

Make individualized balloon animals for each patient. Hang them above their beds. Play volleyball with the balloons.

If family members want to stay, provide mattresses for them under the bed. Encourage family to stay for a few days...the more, the merrier!

Put all the patient beds two feet apart. Encourage your patients to get to know each other.

Pantomime all instructions and questions to patients. Insist on teaching each new admission how to use a toilet. Put up signs depicting improper toilet use.

Go to work in flip-flops. Bring your Ipod. Play music with a catchy beat to entertain the patients.

If the patient needing a transfusion is your blood type, offer to be the donor. Have your friend collect the unit while your bed is moving. Then start the IV and transfuse your own blood...by drip.

Refuse to use prefilled saline flushes. Draw up all of your own flushes instead. Wash the medicine cups and basins, and the Toomey syringes.

Start IVs with an emesis basin at the bedside. Don’t retract your needles; instead, put them in the basin. All IVs should be 18ga or larger.

Carry your pediatric patients up several flights of stairs, then take them outside in the sunshine and let them play on tricycles. Draw pictures on their casts with sharpie markers.

Refuse to use regular IV pumps. Instead use burettes, or syringe pumps, or calculate drip rates.

When the pain meds aren't working...blow bubbles, color, and put on fake tattoos!!

Dress your patients in surgical gowns and caps. Have tricycle races at 5 in the morning. Then wrap their IV sites in trash bags and encourage them all to shower.

Chart all of your temperatures in Celsius and weights in kilograms. If a temperature is above 37.5 consider malaria.

Hang privacy curtains from hooks in the ceiling. Move them around according to need.

CPAP? Take apart the crash cart and put together equipment that fits. Use Coban instead of elastic face straps.

Regularly have dance parties at work. Play the drums. Encourage your patients to play the drums. Provide crochet hooks in place of drumsticks.

Pray during shift change and ask your patients to join you. Wear matching scrubs with all your co-workers.

Play Jenga with your patients.

Scrub the wards on your hands and knees…on camera. Then watch when Discovery Channel airs the episode.

Pray during emergency codes. Ask for the resuscitation trolley. Who needs a crash cart??

Make sure to specify if a regular diet includes snake or not. This may be important.

Announce an emergency blood drive overhead. Draw blood from all your friends that are A+ or B+.

Need to do a stress test? Have your patient run up and down several flights of stairs, and then do an EKG.

Import medications from Europe. Ask other nurses to translate instructions for you. Refer to acetaminophen products as “paracetamol” and Versed as “midaz.” Double check with pharmacy before giving your IV medications orally, and optical preparations aurally.

Let your patients check their NG tube placement when you do, and ask if they would like to watch dressing changes with a mirror.

Crying baby? Tie them to your back with a sheet and keep doing your nursing work. They'll happily fall asleep soon.

Look at the drool spots on your scrubs...and smile fondly at the adorable brown baby who fell asleep while you were charting. Thank God that you get to be here.

Sierra Leone 2011!

I'm going back...and I can't wait!

Since I got back to the States in May things have been different. It's a good different, a challenging one. I love what I do here, but I found that I've left pieces of my American-Indonesian heart with the innocent little brown hearts I met aboard an ex-Dutch ferry boat. It's no longer a constant ache. I don't feel as guilty about showers longer than two minutes, I don't accidentally use Ewe or French in my sentences any more. But it hasn't totally gone.

There are reasons I'm in the US right now. But that doesn't stop my heart from asking when I can go back. There are so many triggers - the lyrics of a song, a call from a friend, an innocent co-worker's question about where I've traveled as a nurse....

All this brought me to my knees one afternoon at the lake, asking God for the privilege of being his hands once again aboard the white mercy box, for the opportunity to love on the unloved, that he would give me His heart and break it once again.

Questions like that should only be asked if you mean it. Because it's not a question of whether we are called to missions, but where. It's not if we are called to love, but how and who.

Isaiah 58 is a chapter that's spoken to me in the past, a set of Bible verses God has used to direct my choices of who and how to love. There is nowhere more than aboard Mercy Ships that I was truly able to say that verses 6-10 were truly being fulfilled in my life. But I hadn't really paid attention to verse 11 before: "The Lord will guide you always; he will satisfy your needs in a sun-scorched land and will strengthen your frame. You will be like a well-watered garden, like a spring whose waters never fail."

I think I can honestly say that God has a sense of humor. With this verse that afternoon I felt his clear call back to a sun-scorched West Africa, and with it direction and peace on a number of other questions I had been wrestling with. Friends, I can tell you with certainty that unless something drastically changes, I'll be headed back to Africa with Mercy Ships from January-May 2011!! I'll be a Pediatric Ward Nurse again, knowing that this will not be my only job. There will be ICU and PICU shifts again with my heart in my throat and a constant prayer on my lips, the difficult IV starts and lab draws saved for an ER-trained nurse, riding a stretcher down the narrow metal corridor doing compressions as a part of the Emergency team, the challenge of caring for a friend, crowded screenings in the hot sun and surrendering my own need for control when He chooses to take a child home forever.

My heart, still healing from my last trip there, is going to be irrevocably broken, again and again and again. While I'm not sure my heart can stand another medical missions trip to West Africa...I'm sure without a doubt that I can't afford not to go. Africa needs me, sure. But I need Africa more. The fog is gone, and I can see clearly again.

Isaiah 58: 5-11

⁵ Is this the kind of fast I have chosen,
only a day for a man to humble himself?
Is it only for bowing one's head like a reed
and for lying on sackcloth and ashes?
Is that what you call a fast,
a day acceptable to the LORD ?

⁶ "Is not this the kind of fasting I have chosen:
to loose the chains of injustice
and untie the cords of the yoke,
to set the oppressed free
and break every yoke?

⁷ Is it not to share your food with the hungry
and to provide the poor wanderer with shelter—
when you see the naked, to clothe him,
and not to turn away from your own flesh and blood?

⁸ Then your light will break forth like the dawn,
and your healing will quickly appear;
then your righteousness will go before you,
and the glory of the LORD will be your rear guard.

⁹ Then you will call, and the LORD will answer;
you will cry for help, and he will say: Here am I.
"If you do away with the yoke of oppression,
with the pointing finger and malicious talk,

¹⁰ and if you spend yourselves in behalf of the hungry
and satisfy the needs of the oppressed,
then your light will rise in the darkness,
and your night will become like the noonday.

¹¹ The LORD will guide you always;
he will satisfy your needs in a sun-scorched land
and will strengthen your frame.
You will be like a well-watered garden,
like a spring whose waters never fail.

moving on

The leaves are just starting to turn, green and red rustling softly together in the breeze. Blue skies and the mountains behind visible just outside my apartment window, it promises to be a beautiful autumn.

After a busy summer in NH, a relaxing week with family in Virginia and one with friends in Binghamton, I stopped off briefly in Potsdam and Saranac before hightailing it off on another adventure. I also got to go hiking in the Adirondacks with a Mercy Ships friend, enjoying the gorgeous view of mountains and lakes all around at sunset from the fire tower, topped off with a long and bumpy ride along narrow unpaved roads.

Travel nursing really can be described as nothing less than a crazy adventure into the unknown. 3 weeks on ice - with not-quite job offers from 3 hospitals in the Dallas area, I started wondering if there was a hiring freeze, or if perhaps Texas was plotting to secede from the union. Then after a brief and cheerful phone interview I found myself rather dazedly accepting an offer that seemed almost ideal in a state I was already licensed in...and an ASAP start date.

I've been here just over a week. After a brief and intensive orientation I found myself on my own, ED nurse once again. It came back to me quicker than I could have hoped...the first large bore IV slid in easily, the impersonal beep of the cardiac monitor registering "NSR, we're good" in my mind, a slightly quickening pulse as the sirens get closer, a calm smile for the anxious mother, a high-five from the 6-year old who "wants to be a doctor when I grow up". It's not the glamour and adrenaline rush of another life saved...not always. It's not the desperate creativity of a nursing staff without first-world resources. We don't dance at shift change or pray as a staff for the little ones that have filled our hearts. No, it's not quite the same.

But it's still a mission field...MY mission field for the next few months until I follow my heart back to the rolling blue waves that rock me to sleep and deep brown eyes that dare to hope despite the pain they have known. I still pray for eyes to see the wounded soul behind a cursing demand for narcotic pain relief, the drunken stupor, the anxious questions, the intentional drug overdose, the look of fear at the sound of a baby's wheeze. These are hurting and in need as well, just here it comes across a little differently. America has the needy too - people in need of hope, of reassurance and love, of a sense of purpose and an understanding that material wealth and drugs cannot solve all of their problems either. Lord, give me patience and love for these ones too...

Finally Home

I found out just a few days ago, chatting with one of my Mercy Ships friends over the telephone. We were rejoicing over Abe's recent reunion with his family after months of surgery and physical therapy, overjoyed that he finally made it home. He is walking and running again, with chicken legs now straight like any little boy's legs should be. I can see him beaming at me from bed 5 in B ward, drumming away happily on the djembe with two crochet hooks for drumsticks, patiently waiting for the day that he would be able to play football with other boys again. He's there, he's home...excitedly showing off his new straight legs to the village, a living testament of God's healing power.

And then she said it. "I don't know if you heard, Laura, but Mariam died at home a few weeks ago. Her husband called the ship to let them know." No, I hadn't heard. Mariam was the little mother we had given a pint of my blood just a few months ago in April, a fixture in our ICU for weeks as the doctors struggled for a diagnosis. Her husband read his bible over her and prayed as the nurses flowed around him in the choreographed dance of IVs and fluids, monitors and medications. We sent her home with a tracheotomy - still not knowing why she couldn't breathe when we took out the tube.

I flashed back for a quick second to the night I met her - the concerned voice of the charge nurse asking for an ER nurse to start an IV as I untied my lappa and gave away the baby on my back, the pale resigned face in the bed, the one small vein I carefully slid the IV catheter into, the smell of benzoin and alcohol, the voice of our translator/pastor Yaovi telling me "I don't need to explain to her what you will do, Afua, the other nurses have tried this already. But I told her God gave you magic eyes to see the veins that no one else can."

I can see her smile around the endotracheal tube that allowed her to breathe those first few days, hear her husband greet me by name as I come back to start another IV, and another, and another over the weeks that followed, feel the tears on her cheeks and mine as she hugged us good bye and mouthed "akbe, akbekaka" as she walked home - breathing from a hole in her throat, but definitely breathing on her own.

I'm happy for her to finally dance free, to sing again in praise, to breathe without anything to hold her back. I grieve for her husband and little boy. Please pray for them as they face a life without her...with her gone home ahead of them.

Pray also for the Mercy Ships crew - finishing up the outreach and headed home all over the world. Pray for strength, for patience, for love and for a sense of wonder at home as well as in Africa. It is so easy to wonder at the clear evidence of God at work there in the bright sunshine, to dance in praise to the beat of the djembe, to love on the little ones that have lost so much and yet still smile and hope. Sometimes things are not so clear here; sometimes it is hard to see through the fog.

Life after Africa

Friends, this post is long overdue and I apologize for the delay. Life since I got back from Togo has not slowed down. If anything, it's speeded up into double overdrive and some days I am hanging on for dear life watching the scenery race by.

God has blessed me beyond what I could have imagined. In between snippets of time with friends and family and co-workers, I've also been working and started back up at school. Most of May was with InterVarsity at a camp in the Adirondacks - working on-call and leading small groups and work crew. It was an incredibly busy time but also truly blessed. Spending a life truly focused on God and His glory, and worshipping with hundreds of other believers with that heart really was incredible. And as I pushed myself to the limit I realized exactly where that limit lies, and how important it is to rely on God for everything. It is in my own weakness that I am truly strong.

Come mid-June I headed over to New Hampshire, where I'm the full-time camp nurse at a lakeside Christian camp. I still get to take care of kids, but it's a little different here. They all speak the same language as me. We don't have spontaneous dance parties. Most of them are the same color. I don't get peed on as much. Most of them grew up knowing that they are loved.

They're still kids who need care and love, but are already privileged beyond what they will ever know. There is clean water, and food, and vaccines, and medical care. And while there is still the sadness of broken homes and unloved children and sickness sometimes, there is not the constant tragedy of the poor, the broken and deformed, the outcast, the discarded child. And while my heart still breaks, it's not the constant and overwhelming crush of pain.

I'm still asking God every day why I'm not in Africa. When I will get to go back and pour out into a people that still need to know they are not forgotten. Whether I will be back on the big white Mercy box as a constant and living expression of His love for the lost.

But for while I'm here, let me live that love for these kids. This staff. These co-workers. This family.

The day I was a vampire

There is nothing like living on a mobile blood bank...nothing.

Rewind back with me to just over three weeks ago. I, again, should have been sleeping. Instead I was up praying for Brian and his mama, as I had just heard that Brian had been transferred back to the ICU that morning, and I was sure I would be taking care of him again that night, if he made it that long.

Unable to sleep, I read and prayed for a while, then made my way up to deck 8 to relax in the sunshine, enjoy the breeze, and watch the sun slowly sink into the ocean. I had been up there a few hours and was almost asleep when we heard the announcement, "All crew with type A+ or B+ blood please report immediately to the laboratory. If we do not find enough donors then surgeries may have to be cancelled." I packed up my things and headed down, knowing they wouldn't let me donate again after just 3 weeks, figuring I could help draw samples or units for donation. Less than a minute later I found myself unable to get down to the lab via normal routes; the stairs were already packed with potential donors, and nurses there to volunteer. As I rapidly set up a makeshift phlebotomy station with tourniquet, tubes and alcohol, I heard the next overhead page. "All nurses not currently working, please report to the laboratory immediately." And the floodgates opened.

Most of our patients have type A+ or B+ blood. We have no way of separating blood parts, or even properly storing units, which means donors must be an exact match, and donate immediately before transfusion. Since A+ and B+ are less common among Caucasians, those of us with this type blood and no debilitating illness end up donating often, though even this is not always enough.

An hour later I found myself marveling along with the lab techs at our small miracle. Down from 1 B+ donor left on the grid, we now had several. Enough A+ blood for the next few weeks, Lord willing. Deckhands, ship officers, doctors, galley crew...and the nurses! There were nurses everywhere, donating blood, collecting, and generally helping organize everything. It's amazing to live and work in an environment with such a heart for others. Thank God for my amazing crew mates! And God bless them as they continue their work and service...with just a little less blood now that it's been given away.

Peace and rest

Last friday...

I should be sleeping, or packing, or spending a last few precious minutes with friends. But instead I can only grieve.

I got the call this afternoon, just as I settled down for a little packing and then a post night-shift nap. "Hey Laura...Brian just died. I know you took care of him a lot so we wanted to let you know, you're welcome to come down to the ward." He was 5 months old, and weighed 7 pounds. A whole month of his short life he spent aboard the big white Mercy box with tubes and oxygen and monitors so he could eat and breathe. Was it only a month ago God had reached out his mighty hand and allowed him to breathe again before we put down a tube and began to breathe for him?

Last night he was my baby again, swallowed up in the big ICU bed as he fought for each breath-80, 90, 100 times a minute. Bits and pieces of shift report from the charge nurse floated through my mind, "his heart is enlarged because it's so hard for him to breathe...can't tolerate CPAP again...we talked to his mama already...no heroic measures...he would never come back off the vent...only a matter of time now." I lived the long shift in moments and in breaths. It was a constant prayer: to get back in the IV catheter he had pulled out in his struggles, for healing again, to stop his vomiting and bring down the fever, and with each rapid breath that he would take another one. By midnight I had stopped praying for miraculous healing, and in a desperate "your will be done," I prayed for peace and rest for my little boy...whatever it takes.

He settled only in the safety and security of my arms, so I sat and we cuddled. Sharon and Clare peeked in on my other sleeping patients, brought me food and water, while I whispered to Brian of his mama's love and sang him a promise...

You will be safe in His arms

You will be safe in His arms

'Cause the hands that hold the world are holding your heart

This is the promise He made

He will be with You always

When everything is falling apart

You will be safe in His arms

And we had a small miracle. He rested and slept. The hot little body stayed snuggled in my arms, the oxygen blowing reassuringly in his face and hand curled in trust around my index finger, and he slept.

While in my head I know that baby Brian is better off snuggled happily in the arms of God, eating and drinking on his own and breathing effortlessly, my heart cries for the little mama going home with empty arms and the baby that never had a chance to live. We helped his mama bathe the tiny gray body, dressed him in a white fleece jumper and warm hat, and mingled our tears with hers. She called for each of her nurses by name, those of us who weren't there already, and we filled the room to sing and pray and show her in a language without words that they were dearly loved.

It may not be the miracle that I would have asked for. We had one healing, and like a greedy child I demand why we didn't have another. And while I don't understand it, I pray that it is enough. The extra time Brian's mama had with us, to open her heart to Jesus. An extra month of love with a broken little boy. The terrible, amazing thing is that my desperate constant prayer of that night has been answered in full. Brian has been healed, fully and forever, and he is finally at peace.

Welcome home?

I wanted to tell them it was a mistake. That we needed to turn the plane around so I could go back where I was supposed to be. I may be in the country I call home, but while it is good to see friends and family again I feel like this is the dream, and there is the reality. So as I do the jobs I've committed to do here, knowing that this is where God wants me NOW, I'll be praying and see if maybe I am supposed to go back next year to where I've left little pieces of my heart scattered all over the red clay and wide brown eyes of Africa.

So much happened in the last four months; it's impossible to sum up in a dry and sporadically written blog with a few pictures. I've left out so many pieces of my life because there simply wasn't time to write. Even within my last week aboard, so much happened that I could only be and be a part of...and store up everything to process later. So if you don't object I plan to continue sharing bits and pieces of Africa and my life with Mercy Ships, interspersed with the ministry and life to which God has called me for the rest of this year.

Why me...why Africa?

I was thinking about that question this week, as I prepare to leave and head back to the States. It's easy enough to spout platitudes about helping the poor, to say that I'm a nurse and help heal the hurting. Truly, none of us can take credit for any of this. The more I work in the medical field the more I realize that no matter how good of a job I do as a nurse, it will never be enough. I just do the best job I can, pray, and have to let God do the rest.

So why am I here? It didn't make sense to me at first. An ER nurse going to work on a surgical ship as a pediatric postop nurse; a girl fluent in Indonesian and English going somewhere where they speak French and Ewe. Wouldn't it make sense to go somewhere else, to be involved in something other than surgery? In short, why did God tell me to come to the Africa Mercy?

It was for you my prayer partners to be a part of something bigger that challenges all you might take for granted. It was for the patients and families to see an expression of Christ's love for THEM. And it was for me. I've been strengthened, challenged, stretched, and had my faith deepen in a way I've never known before. I have had my heart broken for the things that break Christ's, and my eyes are wide open.

Life is not all about making sense. That's the wild and crazy thing. It is in our weakness that God can show His strength. Being here, in part, is for me. When I realize my own limitations it is so easy to step back and let God take over. Things that I've never seen happen in the US, things that go against all my emergency training, somehow work. Prayer works, in desperate situations where nothing else does. The prayer, the life, the love and the service is direct contradiction to everything my culture holds up as an ideal, a healthy challenge to a worldly standard. He truly is showing his power in the lives of these patients, my coworkers, and my life. And without a doubt, worship will never be the same after the wild ward church dancing!

Would it have happened without me? Absolutely. Will it go on when I leave? You bet. Can God work in and through my life and talent? That is why he gave them to me. I was here for a purpose. I was here to strip and wax floors and bleach the hospital inside out, to give Mariam my blood when she didn't have enough of her own, to put IV after IV into her and other patients with dehydration and difficult veins. To get a struggling little girl through her first postop night in the ICU, to hold pressure on a bleeding artery, to be CPAP for baby Brian and to soothe and cuddle him as he fought for each breath, to grieve with his mama at her devastating loss. I was here to have long talks with roommates and friends, to give back massages, to carry a love-starved child on my back until she fell asleep. To sing on deck in the sunrise of an Easter morning, to dance with cast footed kids to the beat of the drums, to bring my last gatorade packet to a sick friend or nurse them through an illness...

But if it was only one of these small things that I was here to do, it would be enough...just one.

Angels amongst the Sons of Men...

I wanted to share a poem with you, written by a patient aboard the Africa Mercy last year...a tribute to my co-workers. It's also a challenge to you and to myself, to stop and think about how others see you in your life and work. Are YOU the light of Christ, am I the hands of Christ to a hurt and dying world? And if not, what needs to change?


Angels Amongst the Sons of Men

The day the Big White Whale landed on the black shores of Africa
was a blessed day to the Sons of Men.
It came with Angels to walk amongst the Sons of Men.

Why do I call them Angels?
Let me tell you of my time with them.

I came on board the White Whale
with rooms filled with the lame
the maimed
the formed
the deformed
the wrong
and the rough.

And deep into the darkest part of the night,
I saw men and brethren,
maidens and ladies,
though flesh as us,
yet with hearts as Angels.

Sleeplessly and tirelessly they toiled through the night,
through the pains and aches of men;
they with hands to heal and mend,
bringing from above the Father's love to the Sons of Men.

Some they cut.
Some they tie.
Some they seal,
and yet others they fix with tools untold.

Like messengers of the Most High they came.
Not thinking of their own,
they risked their lives
and sailed the seas to lands beyond the endless world,
to shores of Men afflicted and in pain.
Their hearts and lives they came to share,]
as Angels walking amongst the Sons of Men.

Some in this life are born to pass,
and some are born in life to live,
yet these Angels are born to preserve humanity.

Though some may see lives as waste,
yet with speed they move to save.
With words of love and touch of peace,
they endlessly toil to make right the wrong.

You were born as Men to your lands,
and yet as Angels you served the earth.

Gold is digged from earth beneath.
Treasures are hunted on high seas.
But love so pure and true
can only in hearts like yours be found.
Your labor in the Lord shall not be in vain.
For every life you touch and every soul you save,
For every bone you mend and every face you straight,
The Lord of Life and Light will light your path
and guide your life.

For you are truly Angels amongst the Sons of Men.

noma

No, not Rob Bell's video productions. Noma is a disease that most of us in the western world have not even imagined, much less seen. Photos, inservices, and teaching times aside...up close and personal, noma is a pretty wacky illness. I had my first noma repair patient for the last few days, a full challenge and a half!

"an acute, necrotizing ulcerative process involving mucous membranes of the mouth. The condition is most commonly seen in severely malnourished, debilitated persons, especially children with poor nutrition and hygiene. There is rapid spreading and painless destruction of bone and soft tissue accompanied by a putrid odor...Treatment involves high-dose penicillin, debridement, and improved nutrition. Healing eventually occurs, but often with disfiguring defects."

That's cut-and-dried for, "sorry kid, you don't have a face any more." At 7 years old, that can be totally devastating.

Aimee arrived on the ward a few days ago. She is one of the survivors, the 10% that make it through acute noma to live an ostracized life, hiding the hole in her face with a rag, struggling to chew soft foods when they fall out as she chews...without even daring to hope for normalcy. Graft after graft have failed, leaving a scarred cheek and a scarred heart. One of the blessed ones - her infection was caught early, before it took an eye or nose. She's chunky now, her exhausted body on my back and soft cheek relaxed, tired from the last love-starved tantrum that we ignore, basking happily in the aftermath of love. We talk in pantomime, waiting for the one staffmember that speaks a little of her tribal language to come down so we can explain surgeries and dressings and drains and tubes. Our plastic surgeon had been held up in Europe, airplane grounded by a volcano a million miles away.

As of yesterday, Aimee has a face again. The physicians assistant that brought her from Cameroon came down to excitedly show photos of surgery - of sutures and skin where there was no skin. My night was filled with IVs and antibiotics, NG tube feeds and codeine and JP drains...and mainly just praying hard that our irrepressible little girl with discipline issues wouldn't pull any tubes out or sensitive plastic surgery dressings off. Her bandages won't come off for a few days yet (we hope!), but we know that underneath there's a new face just waiting to smile!

I am not forgotten

Chantalle's face lit up as she danced her whole heart out in praise to the Lord. Arms lifted high in praise, her feet pounded out the rhythm along with other mama and patients, a worship service like no other. Because this congregation is still bandaged, still bleeding, still casted, still disfigured. Nurses mixed in with the patients - a fussing child tied on a yovo back here and there to give a mama some relief.

Jasmine sat on my lap, still drooling a bit after her palate surgery almost a week ago. I remember just the day after I had taken care of her in the ICU mama called me over on deck to rejoice with her that the nasal airway was taken out and she was breathing well on her own. The little nose is clear now of airways and feeding tubes, the small fingers twined around mine as we sing, "I can't do without you in my life, oh Lord..."

Baby Brian lay in mama's arms in a corner bed, body bouncing a bit as she clapped in time. He is still on a bit of oxygen, our miracle baby is still a sick little boy, still has his moments where he struggles to breathe and then stops, to start again.

Like everything else in our floating world, the songs and sermons and sharing are a mix of English translated to French to Ewe and Fon, or vice versa. The maracas and small drums played by patients and staff, a whiskered cleft lip baby dancing on his mother's lap. A little girl with her face melted away by Noma banging legos together and singing in a language no one else understands.

It puts my heart to shame, witnessing this unabandoned joy in worship. How often do we refuse to rejoice, refuse to be thankful, thinking of all that we could have. And these who have nothing, worshipping with everything they have. Those who have been cast out and forgotten, the broken and hurting, with maybe just enough to survive.

I haven't told you about Chantalle. She came early with her little boy Mark, a skeletal 4-month-old with a smile for everyone. Bit by bit he gained weight, tucked away in a corner of the ward or at the hospitality center until his lip and palate could be fixed. I didn't recognize him when I saw him again, with dimples in his knees and a chubby fist tucked in around the cleft.

Like so many of our babies with holes in their mouths, he inhaled his milk one day and surgery had to be postponed until the pneumonia was treated. Finally the surgery day arrived, only to have his throat close down in reaction to the anesthetic gas. Emergently intubated, then trached, Mark is still in the ICU with a hole in his throat allowing him to breathe, connected to oxygen and tube feeds and central IV lines. "What about this one," I asked God. "Ana you took home, Brian you kept here. Have you forgotten this one?" And yet in all of this Chantalle continues to praise her Lord with her whole heart, with total abandon.

What makes us think that we can demand things of God, that we are entitled to privelege, health, and wholeness? When is it that we will finally be able to say with Job, "The Lord gave, and the Lord has taken away; may the name of the Lord be praised!" When will we be able to rejoice in the presence of God, knowing with certainty that they, and we, are NOT forgotten.