Looking for you

Halima is a petite little grandma...not much left but skin and bones and tumor.  I can feel each of her ribs through her dress as we embrace - the same bright dress she was wearing when we met in the market between here and Mamou. I have been looking for you, she tells me, for a month I have been looking for you.  She takes my hand and places it on her tumor and it throbs warm and alive beneath my bare fingers.  This pains me and chuks (pricks) and suffocates me at night...I just want it to be gone.  Will you take it away?

Halima, I have been looking for you too.

Every day for the last month I have thought of the morning we met in the market, when we came in the land rovers and asked them to find you, when you rode up on the back of a motorcycle and unveiled your face for your neighbors to see your shame.  Every day I think of the first moment I saw you and realized the lump on your face you had covered so carefully was almost as big as your face itself, and I looked past into eyes so full of life and impossibly joyful.  When I lie in my bed at night I remember you told me you had trouble breathing when you sleep, and I looked in your throat then and could not see an airway, only tumor and palate, and I wondered how you were breathing still.

My heart remembers you. 

I have often thought of the morning I unfolded a square of gauze on the rubber mat of the land rover floor, between the backpacks and baskets of food and guitars, and laid out the laboratory equipment in my island of clean white, when I pressed a lancet to your wrinkled finger and read your blood test in the main street as your whole village watched.

I saw them rejoice with you when we gave you the golden ticket: a patient card with your name and a screening date in four days.  I met your husband and your granddaughter and that man who translated for us from French to Pular.  I cannot remember his name...do you?  What do you remember of that sunny morning when we met?  What captures your heart in the darkness as you struggle to breathe?

When your screening date on ship came and went and you were not here, I asked what had happened to you and no one knew.  Did you forget to come?  When your surgery date arrived and you still had not, I wondered if a night had passed when you finally fell asleep and did not wake back up.  Were you lost and alone?  I looked for you but I did not see you.  I prayed for you...God sees you.

Now you are here and your voice has changed and you still struggle to breathe every night.  You tell me the Hope Center is a good place with plenty of milk to make you fat, and you pinch your arm proudly in display.  You look at me with a spark still in your weary eyes and ask me to take away the monster that pains and steals your breath.

I send you away with pillows to prop your head at night and paracetamol and a promise of hope.  Just a few more days, Halima, and the operating rooms will open again.  A few weeks only, and Insha'Allah you will no longer cover your face in shame.  After looking for the last month you have finally found us, and I welcome you with open arms.  

Interior screening: Lemon tree thorns

It crept up on me slowly, barefoot on the cool tile floor
Tiptoeing in the near-dark to where I stood
Lighting the gas stove with a match
To boil filtered water for coffee.

It whispered warm across my face
A breeze that bent the rice stalks
And blew fingers of fog through the vines
Hanging looped in the forest,
Waiting for Tarzan to swing through.



And then it hit
With a flip-flop smack that killed the bathroom spider,
Cold water splashes of dipper baths under the stars,
Splatters of mud from under a motorcycle tire.

I was comfortable.

Comfortable in an environment most would find a hardship
Rejoicing in a lifestyle mistakenly called primitive.

I can transport live chickens and run barefoot through the mud
Tie my backpack to the top of a land rover
and pee in the prickers without getting hurt.
I can chew the rocks out of street rice
Or perform a blood test in the middle of a busy market street.

I cherish my nights without electricity as a gift
A chance to see so many more stars
To meditate without the distractions of modern convenience.

The eclectic collections of skills I have so carefully collected
Filed away like scrapbooks on a living room shelf
Start to fit together
In a complex puzzle of belonging.

The idea niggles in the back of my mind
A lemon tree thorn caught and driven deep
Until I turn on the headlamp to dig and find
An epiphany hiding underneath.

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.

recklessly abandoned

During my few weeks of summer at home we drove hours up and down the roads through mountains and fields and forests and endless miles of construction zones, to visit friends and family and go to work and drop others off at the airport.  Chipper K-Love radio music followed us up and up until it finally faded to North Country Public Radio and French talk shows, then found the car as we headed south again back down to the airport a few days later. 

It was on one of these road trips that I first heard the song, playing softly under the chatter of catching up on life after a year away, in the background of discussions on plans and hopes and dreams.

“Recklessly abandoned, never holding back.” 

The lyrics wormed into my thoughts and refused to leave.  Reckless abandonment, with its negative connotations of gambling and bad parenting, could also be a desirable goal.  Wait...what?

I began to question what it would look like to live like that.  I had the sudden image of hang gliding off of a tall ocean cliff - there is no safety in faltering during the launch.  Reckless abandonment is the rush of the free-fall after a jump before the harness jerks you back to reality.   It’s the sure pursuit of a dream despite failure, the swift cut of a surgeon’s knife, and speeding up to lean into a sharp turn on a motorcycle.  It’s giving away water to the thirsty until I don’t have any left for myself.

It’s living my life as if it wasn’t mine, making the most of every moment without a thought for potential failure.  There is freedom in this.

We're halfway through another sail back to Africa, with the gentle rise and fall of endless blue outside my window and the sun swallowed up in haze every night.  Life moves more slowly - not because there is less to do, but because no matter what I do we aren't getting to land any sooner.  My world has temporarily shrunk to 499 feet and 8 decks of steel.

Like a New Year's resolution, it's a moment to stop and think what the last year has been, and what the next year will be.  It will be amazing and challenging and hard and wonderful, but the point is not what I will see or how it makes me feel.

What matters is how I respond.

I wanna live like that


And give it all I have


So that everything

I say and do


Points to You


If love is who I am


Then this is where I’ll stand


Recklessly abandoned


Never holding back


I wanna live like that    ~ Sidewalk Prophets

This idea has challenged me, gripping my heart until I’ve joyfully agreed.  This is where I stand.  My goals for Guinea start with reckless abandonment, until everything I say and do points to Christ…

I wanna live like that.

Drink deep

All of us are wounded, bruised and bleeding
Some put on an elaborate mask and pretend they are whole, carefully avoiding eye contact so they don't give away a secret that everyone already knows.
I don't display my injuries openly, neither are they hidden as if I am ashamed...they are a part of me.
I clean my lacerations and wrap them neatly in gauze and colorful cobaan,
Steristrips and benzoin to hold together wounds deeper than skin
And an old fracture, perhaps splinted too late,
Knowing if I cover my pain it won't disappear, no matter how many happy-face stickers I wear.

Sometimes loss seems almost too much to bear:
Young mothers suffering, slipped away before their time,
Bony brown babies struggling for breath in my arms
The unloved orphans living on the street, with stick-thin arms and worm-filled taut bellies and eyes unshuttered to wounded souls.
Abused, outcast, unwanted and homeless, does anyone remember their names?

They tell us in school to guard against your patients' pain
As if only the weak nurses recognize and share in loss.
But I leave myself unguarded with arms open to embrace.
I can't risk the callouses on my soul.

So I take my 5-gallon plastic jug with it's motorcycle-tire rope
Drop it deep into the community well to fill it full with sorrow
Drinking until it spills out the holes and the top and soaks my grimy shirt
Sharing with the mamas and papas and toothless grandmas
The baby with the broken face tied in a lappa and drooling down my back
And the children that clamor to hold my hand and call me Auntie.
Can I do any less?

Drinking until I am saturated, until all I know is that
Jesus is the pillar that holds my life.
Until all I know is that God is sovereign, and he will keep holding me when no one else can.

And I soak in the little things
Wrapped in strong arms and a blanket of sunshine and brilliant stars,
Rocking in gale-force winds that whisper comfort and strength
While dolphins play in the spray outside my porthole.
I breathe deep the scent of manure that lingers in the air and the back of my throat as I bike past silos and green fields
Wave to the bold raspberries peeking invitingly around the "No Trespassing" signs
Drain out the warm dishwater while wildflowers watch from their canning jar in the windowsill.

I steri-strip a cut finger and firmly wrap a bruised ankle and offer a reassuring smile as I think of my own wounds bandaged tight.
Offer a cool and gentle hand to smooth a hot forehead
or slip in IV after IV with a promise of fluids and morphine to come
And I grab scarred brown hands and spin around and around to the beat of the djembe,
A shouted and joyous prayer echoed in my heart
In celebration of hope and a new chance at life.
My cup overflows, again and again and again.

I can feel the wood grain beneath me and a warm breeze lifting my hair as I watch the sun drown
Brilliant colors perfectly reflected in the glassy lake.
And I peel off my bandages, layer after layer of bloody gauze
There should have been scars, twisted and deep and red with fresh memory
Instead I find only skin, smooth and whole, turned dark in the African sun.
I am ready again to share in the sorrow and intense joy, to love until it cuts deep again and burns like fire and I pull up another bucket hand over hand to drink...
Because my Jesus has come to the well, barefoot and bleeding and asking to share our water
It is here I've caught a glimpse of his heart.

Breathe

A cryptic trail marker

There was space to breathe there in La Orotava Valley – fresh and unrecycled air - between the steep pine-forested mountains that dropped off into sheer rock or reached up above the cloudy haze.  There was room to walk, in the sandals that clung to my feet and pulled at my toes, through marked and unmarked and cryptically marked trails, streets and patches of fern that clearly hadn’t seen a machete in a while.  Past ancient stone buildings and aqueducts and over bridges and through black raspberry bushes and pines draped with trailing green streamers of Spanish moss.  It was good to be on land again.  Away from the concrete and Terexes of the Tenerife port, without crowds of tourists to distract.

The Finger Lakes welcoming me home

 Two days later I was picking black raspberries in my own hometown, watching the squirrels chase each other, reveling in the freedom of being barefoot, enjoying the sunshine dappling in the edges of the river, and drinking real milk to my heart's content.  After 36 hours of incredulous amazement at the footwear and outfits people choose to travel in, I am able to sit back and just enjoy America again.  As we flew in low over the countryside, the Susquehanna and Finger Lakes greeted me, familiar and friendly in their twinkle against the setting sun.  I marveled at the lush green of the mountains, the open lakes and blue rivers, and looked forward to hiking and kayaking the places I call mine.  This time with my family is a gift; here there is time just to breathe.

Even the wind and waves obey...

We've been sailing for days now, and there is only water.  There are mini-rainbows in the sea-spray coming up from along the bow, the dolphins dance for us, and the fish have wings.  It's an exercise in patience in a world that usually demands instant gratification.  The distance that could be covered with just a few hours in an airplane takes 10 days of steady sailing.  There is nowhere else to go.  My world is 499 ft long, there is salt in the air, and my eyes can see nothing but blue on blue on blue endlessly stretching out into forever.
It's an instant relief from the stacks of containers on concrete of the Lome harbor, the ever-present trash of Freetown and the faint odor of raw sewage.  There is time to meditate and be still.  To feel the sun on my face and the wind teasing my hair and to just...be.  The night skies are a stretch of dark velvet lavishly scattered with glitter and the faint swirl of the Milky Way, marred only by our masthead running light.

By the word of the Lord were the heavens made, their starry host by the breath of his mouth.  He gathers the waters of the sea into jars; he puts the deep into storehouses.  Let all the earth fear the Lord; let all the people of the world revere him.  For he spoke, and it came to be; he commanded, and it stood firm. The Lord foils the plans of the nations; he thwarts the purposes of the peoples.  But the plans of the Lord stand firm forever, the purposes of his heart through all generations. ~ Psalm 33:6-11

Who is this Lord that I serve?  He breathed a blanket of stars...he has jars big enough for this endless ocean and the might to store it inside.

As the wind whipped along the peaks of the waves at over 40 knots yesterday, I stood on the bridge and watched our bow crash into wave after wave and spray seawater all across my favorite dolphin-watching spot.  In a fishing boat it would have been a wild ride for sure.  Was it an afternoon like this where Jesus slept while his disciples got soaked and scared?  From gale-force winds to total calm at a word?

The wind and the waves not only obey him, they exist only for His glory.

So do I.

Photos by the amazing Deb Louden - Thanks Deb!

Africa on the right, and straight on 'till morning

It’s a magic moment, hovering between light and darkness, as the sun sinks behind thick clouds, and the sea slowly fades into progressively subtle shades of grey and deep blue.  I can watch from my window, looking out on the hard white caps and the shallow swells on the haze through the glass.  It’s endless, the blue and the grey, stretching out for miles and miles to Africa somewhere to starboard.  In the morning I wake to sunlight reflected off the sea and shining in the window across my quilt.  The welcoming sun belies the cold air conditioning, and I'm looking forward to some time in the warmth out on deck.

By last night we’d been sailing for over 60 hours, with the hospital and all our cabins tied down tight.  Large piles of bedframes and chairs and trashcans in each ward saran-wrapped together and racheted to bolts in the floor.  My first few hospitals would never have dismantled so neatly.  

The staff is scattered through other departments, with just a few left in the hospital.  My first few sails I also had been loaned out - to housekeeping and hospitality, with a few-week stint as the ship seamstress and a sewing machine tied down to the table.  This time I've stayed in the hospital department, and in between writing final reports and preparing for Guinea my main job is compiling an appropriate sailing playlist of songs such as "For the moments i feel faint," "Stranded," "Rescue Me,"and "Let the waters rise."  My initial assignment was unstrapping the land rovers on deck and seeing how long they take to go overboard, but in the interest of not being thrown overboard myself I've decided to postpone that for after we dock.  Others of my co-workers have decided to try a wide variety of balancing skills such as yoga and juggling,  some are on flying fish and dolphin watch, and windsurfing along the deck with hammocks also looks quite fun. :-D Just kidding, Mom, of COURSE I would never try something like that.

I took the first afternoon to get used to the rocking, my head attached on a string and bouncing around in a fog somewhere above me.  Guardrails on my bed let me sleep soundly without fear of falling out, and after a few hours I could walk without looking completely drunk.  It's sunny now, out on the bow, and I'm looking forward to a good week of catching up with paperwork and reports, and taking time just to relax and enjoy spending time with God and enjoying the beauty of His creation and the vastness of His love.  I am blessed beyond anything I could ask or imagine!

pink sheets

Scorn has broken my heart and has left me helpless; I looked for sympathy, but there was none, for comforters, but I found none.  ~Psalm 69:20                              

20M - jaw osteomyelitis, non-surgical, referred to dental.  21F - breast cancer - nonsurgical.  56M - hypertension and inguinal hernia; referred to local doctor for hypertension, wait listed for hernia repair.  2M - inguinal hernia; wait list.  Lipomas, cancers, goiters and physical assaults, urinary incontinence and tumors and hernias and more hernias.

Names cut off the top of the pink pre-hospital paperwork, each page gives an age, a problem, a reason we couldn't help.  The opening few notes of a requiem, ended before the story is ever told.  There are hundreds of pages, each one a life.

These are the people that made it past the pre-screeners and into the stadium on screening day.  The ones who maybe came onto the ship for an Xray or scan, or who saw one of our surgeons for evaluation.  The ages and problems are varied but the conclusions are the same - we could not do surgery for them during this outreach.  The space on the surgery schedule is limited, and not everything can be cured simply by cutting it out.  

We come testifying hope in Jesus' name, regardless of physical appearance or medical diagnosis or community position.  Often our patients understand that hope as they begin to see something tangible change in themselves, as they see people willing to reach out to them despite their appearance, and as they realize that after surgery they can re-enter their village and community with dignity.

For this pile of life, the spark of hope they had for a possible change in their condition with surgery was not realized.  We in our limitations can only touch the few, and must trust God with the rest.

Please pray for healing for each of these patients represented by a pink screening sheet.  We claim  hope for them from a God who has promised to hear and save his people.

The poor will see and be glad - you who seek God, may your hearts live!  The Lord hears the needy and does not despise his captive people.  ~ Psalm 69: 32-33

when the whiskers come off...

Monday afternoon I set a stool next to the charge nurse desk and gathered some supplies - gauze, saline, a basin, gloves, and several pairs of small sterile scissors.  We were fresh out of mirrors on D ward, so I walked down to B to get the most important item for my small salon: a handheld mirror.

Bla before surgery

And I chose my first victim carefully.  I looked up from my preparations to find 8-year-old Bla watching me intently.  He grinned and came over for a hug.  Bla was one of my broken-lipped kids, with a smile so genuine and brilliant you would never realize he had a hole in his lip, and an enthusiastic snuggle-hug every time he catches a nurse with an arm free.  Bla and his mama are from way up north, so far that no one else on the ward speaks their language.  When our one translator fluent in Moba goes home for the day, we pantomime.


The "serious face" - shortly after the
visit to the cleft lip salon.

So I made faces at Bla, sat him on the stool, pretended to clean my lip with the gauze, and gave him the purple mirror to watch.  He nodded, and smiled, and then looked very serious.

As I cleaned Bla's lip with the saline and gauze, we gathered a small crowd of whisker-lipped kids all intently watching and commenting on the process, reaching half-way up to their own repaired lips before remembering not to touch.  I kept up a running commentary of who would be next and how beautiful their lips would be, while the two-year-old with his hand on my knee patted me and giggled along with the rest.  Bla stayed very still, intently watching my hand in the mirror as I snipped the extra spiky suture ends along the upper lip and up just into his nose.  When I finished I told him how handsome he looked, and he inspected himself in the mirror before breaking into an excited smile.

The reward was stickers, and he decorated himself enthusiastically while I cleaned up.  Then I took him by the hand and led him over to my next victim, 4-year-old Abla.

See how handsome Bla's lip is?  I would like to take your stickers off your lip and make it look pretty.  Abla hid shyly behind the translator, but she didn't particularly object, so I soaked off her steri strips and started snipping.  Abla's mama came over to inspect the repair job.  I didn't understand much of the words, but the big grin and thumbs-up are relatively universal.  Little sister watched, interested, from her place on mom's back.  Once I had finished four little lips, we gathered all the mamas and the kids for a group teaching session on wound care and lip exercises -  in four different languages.
This field service our surgeons have repaired 34 cleft lips and palates.  We had 8 on the ward that day in various stages of healing; some still with nasal bolsters and fresh steri-strips, and others already "discharged" and just waiting for a final would check before the long trip back north and home.  The next morning 5 newly-healed little lips were ready for a final photo and a discharge once all the transportation and follow-up details finished.  They're in varying degrees of acceptance still: Bla is quite proud of his new lip, flaunting a "see how handsome I look" at every one of his favorite nurses and visitors that walk in the door, while 6-year-old Assoum isn't used to the attention and mostly just hides his face in his chair and 5-year-old Yaovwi hasn't quite forgiven me for taking off his steri-strips.  They'll forget to be shy eventually and forget that maybe once they were called ugly and outcast.

Instead I hope they remember that first look in the mirror once the tape and crusts and dried blood have all come off, that first glimpse of a chance at normal life, and a voice telling them they are handsome or beautiful...

I pray they know they are wanted and loved, and that beyond just physical repair they find wholeness and new life in a God who loves them regardless of the brokenness on the inside or outside, and no matter where they once had holes or whiskers still waiting to come off.

An ode(r) to toilet juice

Oh M3 blackwater treatment, how I love thee
50 mL of enzyme twice a week.
Your faithful and constant breakdown of waste
Keeps the pipes from clogging with reek.

Quiet and modest, your presence is ignored
Gone once vacuumed down the pipe.
If it's yellow let it mellow, if it's brown flush it down
Why is our bathroom odor now so ripe?

For three days the smell is increasingly rank
Deck 4 starboard main vacuum line closed.
A row of cabins with toilets out of order
Even Febreze just disguises the waste decomposed.

Oh toilet juice, let me not forget you,
Keep our toilet pipes unclogged and free;
And our cabin will be sweetly scented,
No longer graced with the odor of pee.

Biggest man on D ward

Maurice - watching life.

Just back from the operating room and a lumbar puncture, Maurice lay snuggled in a brightly-colored nest of African fabric after ravenously drinking his fill from Mama.   His young mama came back out of the bathroom and announced she was going to ward church (down the hall) with an unspoken question in her eyes...watch him while I'm gone?  I nodded and smiled, and picked him up to cuddle, nest and all, as soon as she walked into the hallway.  Fuzzy head cupped in one of my hands, he gummed a grin up at me and stuck two miniature fingers into his mouth to suck on furiously.   Both knees curled up to his belly, as if he were still in the womb, and he kicked one bare foot into my elbow.  Even the steri-strips are gone now, and the row of stitches around his eye lay flat, with no other signs of where there was once a bulge of fluid.    He's not a fan of frequent vital signs after his sedation, but with lots of sweet talk and cuddling he finally gave me a toothless half-grin around the fingers.  Every four hours I shine a flashlight in the fascinated eyes, check for any signs of neurological problems as he kicks off the oxygen sat probe, and I am thankful there are no signs of clear fluid leaking from the suture line or his eye today.
At 3.83 kilos of tiny perfection,  Maurice is one of the smallest babies in the hospital right now.  But we don't tell him that.  Instead, Rudy's mama cooed down at him that he was "the biggest man on D ward."  With a startled laugh, one of the other nurses and I realized that it was true...Maurice was the biggest (and only) male patient on D ward at the time!

Rudy on deck with one of his "aunties"

It was good to be a ward nurse again for a weekend and let someone else be in charge.  To change a bandage as the patient watches in the mirror, grin just barely starting to peek out through suppressed hope.  To tie a baby on my back while his mama recovers from malaria - checking NG placement and giving medications as he supervises solemnly from behind, drooling down my back with one small hand exploring the pager on my hip.  To catch Rudy escaping from B ward down the hallway on a scooter and scoop him up for a hug; to see Rudy and Shara both back in the ward from ICU - in need of prayer for total healing, but doing well enough  to join the rest of the small and broken village.  To lay a naked and fussy Maurice on the scales and see that he weighs just a bit more than he did yesterday....right before he gleefully pees everywhere.

There is a rhythm and meaning to the day that maybe wasn't there yesterday.  It's not the rhythm of the djembe this time but something softer, quicker...the rhythm of a mama's heart filled with hope; the rhythm of a patient's heart, wrapped carefully and lovingly in mine.

I found a man who has stolen  my heart...and he's the biggest man on D ward.

Life lessons from the PICU

Only four hours into my shift, and already I was tired.  I only had three patients - one had been discharged by a thoughtful co-worker, one was sleeping soundly, and the third...well, this is his story.

The nurse giving me report started with "I'm so glad you're here!"  The first hour went well enough.  He was settled peacefully in the big ICU bed, mama at his side.  I introduced myself, and we peeled open one swollen eye long enough for Rudy* to see his new "auntie" and give me a high five.  With both eyes swollen shut there's little for a preschooler to do for entertainment, so I set up my Ipod and speakers with some wild African music, turned down the midazolam drip a bit, and we settled in for the evening.

For about 20 minutes.  Then the crying started, and the kicking, and the flailing.  Sometimes it was tea he wanted and sometimes bread, and sometimes to get out of bed, and sometimes because he didn't like the diaper, and sometimes just pure temper.  But mostly he just wanted to see.  Hands reached up again and again to pull open an eye just a crack, trying to claw through gauze mittens at steristrips and the row of sutures that marched from under the bandages down his forehead and nose. The next several hours Gina* (Rudy's patient mama) and I walked the fine line of discipline and rewards and strategic ignoring of outbursts when possible, with one eye on the IV lines and surgical site to make sure everything stayed intact.  The delicate balance of trying to decrease his sedatives while keeping him safe, because while I don't mind so much getting hit in the eye with a gauze-covered armboard, too much screaming isn't exactly ideal only two days after major craniofacial surgery.  

Over dinner I prayed for strength instead of just for the food, while the other ICU nurse watched Rudy and a still-ventilated baby just back from extensive surgery, and then it was my turn with baby girl and the ventilator, with one eye still on Rudy.  Gina and I discussed the fears and challenges of young children in hospitals, loving discipline, and the importance of choices.  It's a scary thing to have every choice taken away from you, to wake up and not be able to see, to have surgery after surgery almost every year of your life, especially when you can't understand why, and tomorrow seems like a million miles away.  Granted, it wasn't always much of a choice we could offer (oral versus rectal Tylenol, for example) but hey, we did what we could.  And he dropped into a peaceful sleep long enough for Mama to head back to her bed and get some much-needed rest.

I sat down to catch up on charting, and heard a sleepily murmured Auntie from the bundle of sheets, as a bandaged head popped up and Rudy stood up on the bed in only his diaper.  Auntie, I need a hug.   I pulled over a chair, untangled the IV lines, and settled him on my lap for a good half-hour of cuddling.  I lifted one of his eyelids so he could wave at "Auntie Lindsey" and give her a high-five, and we whispered so we wouldn't wake up the now-extubated baby.

The next day, apart from a few cranky moments, Rudy was an angel.  One eye had opened on its own, just a crack, and he turned his head to peer at me with a half-smile on his crooked little lip.  We set up the music again, and as I suctioned nasal trumpets (here it's known as hoovering) and re-wrapped mittens and re-started IV's for baby Shara*, Gina laughingly commented "yesterday you were busy with Rudy, but now Shara is keeping you busy!"

Yesterday I stopped by the ICU, and found all the beds empty!  Shara is sleeping comfortably next to the nurses's station in D ward; helmet of perpetually damp bandages now almost gone, and swollen eyelids looking more like prunes than balloons blown up to the limit.  And Rudy waved at me from his bed across the ward, gave me a high-five as I hugged his mama, and he proudly showed me how far he could open his eyes on his own.  When the nurses took the patients up to deck 7 he came too, and as the djembe players and dancers went wild, we danced too - first with Rudy in my arms, then as he got tired, tied securely to my back in Gina's lappa.

And as we danced I marveled at how far he's come in just a few short days - from fighting, terrified and blind, to dancing wrapped securely in my arms, knowing he is loved.

Why am I so surprised...how often have I done the same?

*As with many of my blog posts, names have been changed for privacy.

Another donation

I’ve written before about blood donation, how we match up patients on ship who might need blood transfusions to crewmembers with the same blood type.  I’ve written before about donation, the personal element present here that is often lacking when I donate in the West, the intimate knowledge that the intravenous cannula I put in one night would transfuse my own life for Mariam with the sunrise, the surreal moments of watching my own blood drip through the chamber whole and warm.  And there is nothing like spontaneous hugs from an energetic little boy, knowing that the bits of myself I gave away two months ago have made a difference.

Yesterday was the sixth day I’ve been crossmatched to a patient in just over a week…after waiting exactly the minimum time since my last donation of two pediatric units for Eddie.  B+ blood is a hot commodity here in West Africa, and not common among the rest of the crew.  And because our blood storage capability is limited, we prefer to store it uncollected, inside a crewmember.  The week progressed into a laughable pattern – crossmatch notice in the evening, solid meals with several liters of water each day – and by Friday morning my bladder was starting to object.  On Friday afternoon I came home to my room and just started to giggle…not only did I have another crossmatch notice, but above the line where my name was written in as the donor, I had “faithful, old” written in as well.

Apparently #6 was the winner, because I got paged to finally donate – the third of four units of blood for a patient (quite a lot of our current B-group blood!).  But this time after Claudia pulled out the needle I downed an extra pint of water and asked if this time, maybe I could take my own blood to the patient.

So I waited, chugging orange juice, while she cross-checked the blood type to be extra sure, then I signed the transfusion form in the “staff delivering blood” spot, and carried it carefully down the hallway. 

A scrub cap and set of booties later, I found myself offering a double handful of my own blood to the anaesthetist in OR#3, the cobaan elastic wrap around my elbow still smooth and white over the vein we finished taking blood from less than ten minutes ago.  Lina was stretched under a sterile blue sheet, breathing easily with the ventilator, a name and type and blood bank number on a page as we checked and crosschecked the details. 

I only gave 450 mL...an amount my body can easily spare and quickly replace.  I might be a little lightheaded, or more tired the next few days, but I probably won't miss it much.  But if we needed to give all of mine, to save these lives at the cost of my own...would I be willing?  Would I give my life?

Jesus willingly gave all His blood: as a covenant and payment, for freedom and holiness.  He watched it drip, whole and warm, knowing it would give life in abundance.  But at what cost?

In giving everything, He has given us everything.  What an incredible gift.

Whoever wants to become great among you must be your servant, and whoever wants to be first must be slave of all.  For even the Son of Man did not come to be served, but to serve, and to give His life as a ransom for many. ~ Mark 10: 43b-45

Komlan RN...age 8?

We had just started our shift-change report when 8-year-old Komlan walked up to me and grabbed my left arm.  With a few well-timed swishing noises he pretended to wrap something around my bicep, and then started slapping the inside of my elbow hard.   He poked around thoughtfully for a moment with his index finger, then stuck a fingernail into the bulging antecubital vein, tapped my arm, and declared evo (It’s finished).

I, being a good pediatric nurse, egged him on after a good laugh, and he pantomimed several more IVs on our nursing staff before tiring of his new game.  Ironically enough, this started just a day or two before I was called down to B ward to start an IV on Komlan – restarting on IV antibiotics for a swollen ankle and leg after his skin graft surgery.   I showed him how to tie the tourniquet, and he put it back on me, happily poking through the equipment until he understood that I was actually going to put one in HIM.  He wouldn’t look me in the eyes then, and dropped silent tears onto his gown until we carried him to the next room.  The minute the tourniquet went back on he started to scream, and didn’t stop until I finished filling the syringe of blood for labwork, popped off the tourniquet to flush the IV, and declared evo, dodgi…bravo (It’s over now, brave boy…well done).

I tried bribery with stickers and a tourniquet of his own afterwards, but I wasn’t forgiven.  He was set to sulk, and sulk he did…through the next few doses of IV antibiotics, peeking over the bedrail at me when I came to visit.

Shortly after that I brought over a kidney dish, filled with all the usual IV start supplies, and a cannula minus the needle, to announce that it was his turn to put an IV in ME.  He happily tightened the tourniquet, nodded in understanding when I complained that it was too tight, and put a finger over his lips with a whispered shhhh.  He slapped until it looked like my inner elbow had developed some sort of a rash, rubbed thoroughly with alcohol, and chose a promising-looking freckle.    Out came the plastic cannula, and he jammed it into the freckle, then the vein I pointed out, with enough force to buckle the cannula into quarters.  After a few pokes he declared evo and taped on a bit of gauze before taking the tourniquet back off.

Komlan frequently starts IVs on his nurses now, complete with occasionally taking a fingertip off of his glove to feel for a vein. The last time I drew his blood for labwork, instead of screaming, he pointed out all of his veins and freckles and scars for me to choose from.  He nodded in understanding when I indicated my choice, and watched interestedly as the blood spurted into the tubes, pointing and commenting in wonder cesi est sang moi (this is my blood!).

Others of our pediatric patients frequently join in using medical equipment for a variety of things – from practicing with their designed function to other, more creative uses.  In the long run, we hope it makes their time on our big white ship much less of a scary experience and more of an interesting learning experience.  In Komlan’s case, he should be ready to join the IV team well before he starts high school…or maybe once we actually let him use needles.

If it beeps in the armpit, time to take it out and make an important call...

Our young patients-turned-nurses try out the sound quality of the stethoscopes.  Yes, they do make great microphones!