Merry Christmas!

It's Christmas Eve! Last night we had carols by candlelight at the warehouse on the dock, and we managed to get all of our patients (who are here for the holidays) down the gangway to enjoy it with the crew! It was truly a beautiful time to spend with them. Rudolph the Red-Nosed Reindeer and Australian Jingle Bells were crowd favorites! But if I'm honest, I have to admit that I teared up a little bit as we sang the words to Have Yourself a Merry Little Christmas. It's not always easy during the holiday season to be away from friends and family. At the very moment I had that thought though, I turned to my side and saw little Hermina and her mama sitting right next to me, miles away from their loved ones, spending the holiday with their nurses and doctors instead of with their siblings/children and father/spouse. Although it's hard for them to be away from family, it's important for them to receive the appropriate care that they need in order to heal... and it's important for us to be here to help them in that! So today I just wanted to share some photos of life and of a few wonderful patients that we've been working with here to spread the holiday cheer!

Romino

Sandrin

Hermina

Here are some photos from the candlelight carol session last night:

 You may remember Vololonirina, who I posted about several weeks ago. Here she is at her follow up appointment! And below is the letter that she wrote for us, translated into English!

You are all in my thoughts and prayers, and in my heart, during this holiday season - no matter the distance between us!

 Merry Christmas!!!!!!

Local Healthcare Education

In addition to performing surgeries on the Africa Mercy that offer instant change for the people here in Madagascar, Mercy Ships believes in creating sustainable changes and providing education that will encourage positive changes in healthcare even after we leave. Surgical courses have been happening on the ship and in the capital city, and I have been incredibly honored to be a part of the local nurse education program at Hôpital Be over the last four weeks!

I have been waiting to write about this topic, because I wasn't really sure what to say about the current state of the healthcare system here. The best way to describe it is to begin by saying that there is a great deal of injustice here in Tamatave. Ever since the coup in 2009, funding for the healthcare system has been cut drastically. There are very few resources available in hospital. In fact, there is no oxygen running through the surgical wards, no ambu bags in case they need to provide CPR. Chemotherapy and radiation do not exist in Tamatave - they are only offered in the capital city of Tana (a 9 hour drive away) and are incredibly expensive.... so a cancer diagnosis here is basically treated by palliative care. They have basic sterilization for tools to use for wound care, but no supply room with shelves filled with dressings in every material, NG tubes, plugs, IV catheters in every needle gauge, a PYXIS machine. In fact, there is so little money for the hospitals here that patients are expected to provide everything needed for their care. And when I say everything, I mean EVERYTHING. Every single medication, IV needles, tubing, syringes, gauze and tape for dressing changes, gloves and alcohol for the staff to use are bought at the local pharmacy. Sheets for the bed and food for the patient must be provided by the family. A wonderful, entrepreneurial woman has taken it upon herself to clean the restroom (so at least it's useable), and then charges for her services there. Family and caregivers are charged to use the restroom, 100 Ariary for pee and 100 Ariary for poop. And the nurses? Imagine being a single nurse caring for, on average, FIFTY (50!) patients over a 24-hour shift. That is the normal schedule here. In fact, only four nurses are employed by the surgical ward and they rotate days. How is it possible to spend time with each of your patients and their families when you have thirty dressing changes to attend to?

As for the patients? A woman in the middle of an asthma attack must have a prescription for an inhaler written by the nurse or doctor at the bedside, the family then runs it (literally) to the pharmacy to buy it while she struggles for breath. And what happens if you cannot pay? Then you cannot receive care. And it's not because the staff does not WANT to provide care, but rather it's because they lack the resources to do so. The operating room has basic sterilized instruments, but everything else required for surgery must be provided by the patient. So if you come into the hospital needing surgery but cannot afford the supplies, they cannot help you. There is a financial aid office that they can apply to, but it is open only regular office hours. So when a woman came in on a weekend needing an emergency C-section because she was in obstructed labor, but was unable to pay, they had to turn her away. Where is there left for her to go? When an eight year old boy came in with an open fracture (bone sticking out), his mom just took him home because she could not afford the repair. A cancer patient with severe anemia stays there laying in bed because her family cannot afford to buy blood from the blood bank across the street and they are not matches. I see both the doctors and nurses being incredibly frustrated by their patients having to be turned away or choosing to leave without receiving care because it is simply too expensive. A total prescription bill for a patient this week was 24,000 Ar... that's about the equivalent of $9. However, the patient was unable to afford everything recommended for treatment so the nurse had to help them pick and choose which items were the most important for their care. It breaks my heart. It is difficult to see people who could be treated so easily at home, suffer because they simply don't have the necessary medications or equipment to treat them as we would. Although the American medical system is deeply flawed, at least those in need of emergent care are not required to pay in cash before they can receive it. 

However, the patients themselves are incredibly generous towards one another, offering to share their tape and gauze when the patient in the bed next to them cannot afford it. There are many car accidents here, and several times I have seen other people offering to pay for the patient's care. In fact, a young boy had his foot broken by the wheel of a car rolling over it, and the driver came to the hospital every day to check in with the nurses and see what supplies they needed in order to care for the boy. A man was hit in the street and a passer-by drove him to the hospital and paid for his initial treatments. Even in a place where people may not have very much according to American standards, they are incredibly generous with the resources they do have.

The hospital itself looks like an abandoned building. Our nurses will actually be going in to clean up and paint the surgical ward, but Mercy Ships is currently in the process of updating and renovating the original medical ward. Just so you can get an idea, here are some of the before pictures:

Amidst all this, I have still been greatly encouraged by our partnership with the local nurses on the surgical ward. They are amazing. They are incredibly knowledgable, and excited to work with us. They work impossible hours at the local hospital and are still enthusiastic when they come to the ship or back to the hospital for education on their days off. I call it a partnership, because I feel like I have learned just as much, if not more, from them than they have learned from us. I have spent two days a week by their side at Hôpital Be, and they come to the ship to work on the wards with us for two days a week and receive education. Although they don't have the same resources as us, they are incredibly innovative. I have seen them make a negative pressure drain system out of a syringe, some tubing, and an extra plunger. They are the MacGyvers of the nursing world. We have started to see some positive changes in their practice as well since we have been here. After explaining on the Africa Mercy why we swab injection ports on IV lines with alcohol before injecting anything, I noticed the nurses gathering cotton and alcohol from their patients so that they could do the same. They are talking amongst themselves about the topics that we spend time developing teaching sessions on. Every day there a little victories and we are able to offer them some much needed encouragement and support! The program will now offer those same things to the pediatric and labor & delivery wards in the hospital as the year goes on. Then, in April/May, Mercy Ships nurses will be returning to the surgical ward for another four week period. Although my official mentoring time has come to an end (for now), I am excited to continue building relationships with these nurses. They are really the most wonderful and inspiring people! Plus, they have the best senses of humor! I am not exaggerating when I say it has truly been an honor to work with, and get to know, each of them. Here is a photo of our lead educator, Amy, with some of the local nurses and translators that we work with, my friends:

This Christmas season, I am reminded of how incredibly blessed I am to be working on a hospital ship with so many resources and supplies... everything I need to take care of my patients is right at my fingertips! Please continue to pray for the work we are doing here in Tamatave, and for all the local healthcare workers as they continue to provide care in such challenging circumstances.

Happy Thanksgiving from the Africa Mercy

Nursing

It is a long weekend here on the Africa Mercy, which means that only the people who need to continue working to maintain the ship and the safety of the patients are still on board. The ships designates a 3-day weekend about once a month in order to give the crew members a rest and time to explore Madagascar. As for myself, I have the pleasure of spending the weekend working with our wonderful patients. So many people work on the ship in different functions to allow us to do the work we do as nurses and medical professionals (only about 50% of the crew actually works directly with the patients). Nursing here is truly a unique experience and it's a gift to work with these patients.... and live right down the hall from them! As we are not allowed to take photographs on the wards since patients have to sign a consent form, here are a couple pictures that our communications team has taken for us over the last several weeks since the hospital opened.

Vololona. Well, that's her nickname.  Since this photo was taken she has had her maxillofacial surgery and is becoming a familiar face on the wards! I cared for her for the first time this week, and was so touched by her sweet spirit and genuine smile. I ended my shift on Thanksgiving walking side by side with her down the hallway, and I couldn't have asked for a sweeter friend on that day.

Playing cards on the ward. Mariette had a birthday while she was staying on the wards with us, and we had a surprise party for her up on deck 7 with cake, balloons, and singing!

Sandrins' foot was turned from receiving a quinine injection that damaged her nerves. I was never her nurse.... but I was her playmate in the little play house on deck 7 where we take our patients to get some fresh air every day!

Happy Thanksgiving!

We had a wonderful Thanksgiving celebration here on the Africa Mercy this week! There were several options for dinner, but my American cabin mates and I chose to attend the traditional Thanksgiving dinner. The pictures may be blurry since I am borrowing them from Facebook.... but here we go!

Our Thanksgiving table! Our chef did an amazing job feeding the 400 crew members for dinner! Roast turkey, mashed potatoes, sweet potatoes, cheesy grean bean casserole, stuffing, and 4 different desserts! We shared our Thanksgiving tradition with our crew mates from around the world, and many of our friends had their first Thanksgiving ever here on the ship. Our table alone was made up of American, Swiss, and Dutch crew members. Everyone had a wonderful time and was stuffed by the end of dinner... as it should be! As a special gift, Carol (our director's wife), bought each attendee a hat from the local market and as we received it, we shared what we were thankful for with the rest of the crew. 

Our new hats! 

Although it's about 90 degrees outside with sunny skies and palm trees blowing in the breeze, we did our best to get in the Thanksgiving spirit by decorating our cabin door:

Each leaf on the fall mobile says one thing that we are thankful for. Each person in our cabin also drew and decorated a hand turkey.... which means that along with the classic American turkeys, we had an abstract Swiss turkey and a turkey with a giant British flag covering it's body. I loved that our international cabin mates were willing to celebrate with us! Cabin 3437 has quickly become my little family on this ship, and a comfort during this holiday season. It is not always easy to be away from home on a day that usually means celebration with family and friends, and all of you are in my heart no matter the distance. I am so thankful for all of your continued emotional and financial support, as it allows me to live and work in this truly incredible place! 

"And whatever you do, whether in word or deed, do it all in the name of the Lord Jesus, giving thanks to God the Father through him" -Colossians 3:17

Screening

We have officially begun screening! After weeks of preparing, we were finally able to meet our future patients when we went to the screening center early Monday morning. In the past, Mercy Ships has done one large screening day for patient selection. However, in an effort to give our patients more time to get to us, allow more time for in depth patient assessment, and to limit crowds and the spread of communicable diseases, screening will be done continuously Mon-Fri over the next four weeks. The current goal is to see between 150-300 patients per day.... and over 2,000 patients & caregivers lined up the first morning! Although we couldn't see them all the first day, people have been coming back all week to be screened, starting to line up around 1:00 am. It's just a small taste of how many people are hoping for healing and physical help in this place. After we finish up screening in Tamatave, the screening team will also open up sites in various villages around the country in an attempt to reach even more of the population.

     The line outside the "hopital".

Most of us worked simply as "crowd control" to keep the people happy and entertained while they were in line. This gave me an opportunity to practice a little Malagasy and French as I walked up and down the line meeting people. Although the langauge is definitely a barrier, I was able to begin building relationships with the people... I cannot express how much can truly be communicated through a smile, a laugh. When you spot someone in the crowd, staring at their shoes, and then see their eyes light up as you offer a simple "bonjour" and a smile straight at them. At Mercy Ships, they call that the "I see you" moment. Love is universal. I took pictures with people in the crowd, asked them Malagasy terms, and.... blew bubbles with the kids! I never knew how magical it can be to let a child blow some bubbles! It kept everyone entertained and laughing... especially when I let the grandmothers give it a try.

Kids practicing blowing bubbles.

As many people as we can help, unfortunately there are still some that we can't. It broke my heart to see small children with severe hydrocephaly - a condition that would be managed in the States, but is out of our scope here... especially as we cannot provide continual care over the years. To see children running around on club feet, bow legs... things that would have been prevented through diet or treated at birth. Yet some simple bubbles bring a huge smile to their faces. The injustice of it is staggering. I have been thinking of a song called Hosanna over the last week, "Heal my heart and make it clean, open up my eyes to things unseen, show me how to love like You have loved me. Break my heart for what breaks Yours..." And while my heart does break for the people that we are unable to help physically, for the suffering our patients have already gone through, I still have hope and a great sense of joy! Because  these kids are starting to wander the halls of our hospital on the ship in preparation for their surgeries:

He has the sweetest smile.

This little girl LOVED the bubbles! LOVED them I say.

She's so cute!

Starting next Monday we will begin officially admitting our patients to begin our surgery season. We have started training with our local "day crew" who we'll be working with, side by side, on the wards. Last night, our orthopedic surgeon gave a lecture on surgeries for osteogenesis imperfecta, genus varus & vagus, quadriceps contractures, and club feet. It is truly incredible because they are doing surgeries here that don't exist in a text book anywhere in the world. Our surgeon actually had to make models out of play-dough himself to demonstrate step by step what they do. Issues that we don't see in first world countries still remain prevalent here, and the Mercy Ships physicians have done an incredible job at creating innovative solutions in order to provide the best patient outcomes. The surgeon closed by saying "We operate on their legs, but you operate on their hearts". It may sound cheesy, but I often think of that role as being one of the key components of nursing, and I'm so excited to get started with our patients here in Tamatave!

Salama Tompoko!

Salama Tompoko (hello), and welcome to Madagascar! The past few days have been exciting ones, as Saturday morning we completed our sail and docked in Tamatave right on schedule. The leaders of the country are very happy to have us and showed it extravagantly, welcoming us with water cannons and hosting a formal celebration on the dock. The President and Prime Minister of Madagascar both attended the celebration, gave formal speeches, and then toured the ship. During the tour, the President's wife was so impressed that we offer all these services for free. She essentially asked our director four times in a row "For FREE? So, this is all free? Surgeries are free?". There is a lot of mistrust of outsiders here, and I think the fact that we have come solely to provide a service and not take anything from the Malagasy is a new experience. The Malagasy people have a complicated history with everyone trying to get a piece of their country, the English, French, and even pirates! Our reputation as an international service, and not an aid group that is associated with one specific country, is a true benefit to us in this way. While giving his speech, the President mentioned that even there are already people from all over the country staying in relatives' homes in Tamatave, waiting for screening and surgery... waiting for healing. It is truly humbling to think that our patients are already here, waiting for us to arrive. We have a lot of work to do!

Here are some pictures from the arrival celebration, courtesy of our communications team!

Leading us into port with water cannons.

The President and his wife waving to us on the upper deck as they entered the celebration.

Dancers and drummers for the welcome celebration!

Hopefully I will have more pictures of the country to share soon, and write a more detailed post about the culture and lifestyle here. A little bit to start though... Madagscar is a beautiful country, with beautiful people. We arrived to palm trees and white sand beaches. The people are friendly and very kind. The island has influences from West Africa as well as Arabic and Polynesian countries. The Polynesian influence is especially notable in the language, music, and dancing.  After our fantastic day of celebration, we ventured out into the town to explore. While out to lunch, we met Miss Vivian who cooked us up some delicious Malagasy food and gave us some cultural lessons. We saw motoped races in the street. People sitting on the beach, sipping out of straws in coconuts. It's truly amazing. But there's also a dark side here, which comes out as soon as the sun goes down. Miss Vivian warned us all to get home as soon as it gets dark, as we would not be safe in town. I've learned that sexual tourism is huge in all of Madagascar, especially in this city. 1 out of every 7 women in the country works as a prostitute. There are restaurants that are known as places to pick someone up, and they are often filled with European men who come here specifically for that reason. It breaks my heart to see young girls on the street, and know that their parents are serving them out to help support the family, or to support other habits. I am often reminded of a verse from Psalm 147:3 "He heals the brokenhearted and binds their wounds". I think all of us would love to represent a safe place, where we address not only the physical issues these people have, but also the emotional brokenness by showing kindness and love to every single one of our patients. It's a small thing to do, but hopefully it will make a big difference for the local day crew who work with us, and for our patients.

For the next two weeks, we will be setting up the hospital and getting ready to start screening patients! This morning has been filled with scrubbing floors, mattresses, and bed frames. As we opened up the closed cabinets toys for our patients spilled out, shuffled around during the sail. There are sheets to wash, items to sanitize. It is so exciting to see everything start coming together and to finally prepare for our patients! All of the nurses are very eager to get to work, as we spent most of the sail in lecture and orientation while the rest of the crew worked diligently to keep us safe and get us to our destination. Now it's our turn! More updates to come soon!

... Still at Sea

We are officially half way through our journey to Tamatave, Madagascar. There are not really words to describe what sailing on rough waters is really like... but unfortunately my video is too large to upload here. So words will have to do. Imagine sitting in a large conference room with 300 of your crew mates, only to all tip out of your chairs and onto the floor when you hit a large swell.  Imagine riding one, of the only two, stationary bicycles against the pressure of gravity as the boat rises and then you are suddenly lightened when it lifts.  Imagine sitting in the cafe, sipping some coffee, when your chair slides across the room and only stops once it hits your neighbor's table. Imagine watching the person in front of you walk with their entire body at a 20 degree tilt to stay on their feet... and realizing that you are doing the same thing. Imagine laying in bed being lulled to sleep by the sea, and then being rudely awakened by your body sliding nearly to the headboard and back to the end of your bunk, while the metal walls of your cabin vibrate from the shock of the waves.

We have moments of incredible peace at sea, and then times when you are just trying your best to stay on two feet, or stay in your chair, or keep your silverware from falling to the floor.  Today we managed to take a tour of the bridge, and it was nice to see our journey from the Captain's point of view: charts, GPS, engine throttle, glass walls, stillness from above while looking out on stormy seas. They even have a piece of glass bottomed floor so you can look down on the ocean below! It was wild to see the ocean speeding beneath my feet!

They are doing a great job at planning activities to keep us all occupied.  We continue to have nursing orientation each morning, this week we talked about tropical diseases (FYI, do your best to avoid getting any of these when traveling), local nurse education programs, palliative care, etc. It's been great to spend this time with my fellow nurses.  The activities coordinator is also keeping us busy in the evenings! Tonight we have a documentary about Madagascar, then "speed friending" for the old and new crew to meet. Tomorrow is the Academy's science fair (we have about 45 kids in school on the boat), a seminar on social media, AND Trivia Night. There's always something to do! Continue to keep us in your thoughts as we progress onward - the seas are supposed to get rough before they get better. We're also still on a time crunch to make it by Saturday morning since we're expecting to host some  local politicians and take part in some ceremonies later that day. Will be in touch soon!

Table Mountain, Robben Island, Penguins... and Sailing!

After 30 hours of traveling, I arrived in Cape Town and saw the Africa Mercy first hand for the first time in my life. It was surreal to finally put foot on the ship that will be my home for the next 8 months, and to see a dream that I've held to for so long finally coming true. Working, sleeping, and eating with the crew creates an intense bonding experience, and I've already become fast friends with my five cabin mates (more to come on ship life soon).

Once we get to Madagascar we will be busy with the field service, so we took every opportunity to travel and eat dinner off the ship. Cape Town is beautiful, international, and very tourist friendly. Our first group stop was a hike up to the top of Table Mountain. It didn't seem so strenuous at the time, but it's been four days and my legs are still giving me trouble going up and down the decks on the ship. It was worth it for the sunset view though! Here I am at the top!

We also managed to take the ferry out to Robben Island which housed many political prisoners, including Nelson Mandela for eighteen years. It was a very moving and impactful experience to hear the stories of former prisoners and how they fought to create change in their country. An "ex-political prisoner" even gave us a tour of the facilities. I cannot begin to imagine how difficult it must have been for him to come back to the place he was imprisoned for over four years, but his story was incredible and will continue to inspire visitors from across the world. 

Our final adventure was a trip to Boulders Beach, AKA home of the penguins! I never thought I would spend an afternoon watching penguins playing on a white sand beach, but it brought all of us a lot of joy and laughter. 

Although we all enjoyed Cape Town, we are also anxious to make it Madagascar and get to work! All of us are eager to serve and get settled into our home country in the next few weeks. We were scheduled to leave last night, but after a series of engine repairs and strong wind that prevented ANY ships from leaving the harbor, our departure was delayed until this morning. But we are now on our way! We've just passed the Cape of Good Hope about an hour ago, and are headed into very rough waters. Already the waves are crashing outside the window where I am sitting on deck 6. I am holding up well though, as our crew medical staff have been passing out seasickness medications at every opportunity. Early in the journey we were able to step out onto the bow and saw some amazing marine life - seals, whales, dolphins. Besides seasickness, the biggest concern seems to be cabin fever. We have movie nights scheduled, and nursing orientation every day to keep us busy while we are all cooped up on ship. We have ten days at sea, although we are hoping to make it more quickly as we are scheduled to be a part of Madagascar's celebration of the Year of the Volunteer. We are to be a part of the kickoff ceremony, and have some time to make up due to delays. Please continue to pray for a safe and speedy journey for all 315 crew on board. Our technical crew and deck hands have been working around the clock to get us ready, and many others are feeling sea sick. I will keep you updated on our progress! Here's a photo of Cape Town in the distance as we head out to sea.

Welcome!

Welcome to "The Thing with Feathers"!  The intention is for this blog to be a space I can communicate with those back home, and friends around the world, about the happenings on the Africa Mercy over the next eight months.  I have been truly overwhelmed by the support and encouragement I have received from fellow nurses, family members, and friends as I have been preparing for this adventure.  Although there have been some setbacks and long waiting periods along the way, I have felt a true sense of peace about my future service with Mercy Ships.  As an update, I will leave October 10 to fly to Cape Town, South Africa where I will join up with the Africa Mercy. From there we will head out to.... Madagascar!!!!! A little info on our destination:

Location: Where IS Madagascar?
Madagascar is the 4th largest island in the world and is located off the lower east coast of Africa.  We will be docked in Tamatave on the east coast of the island. 



Ecology: Madagascar is renowned for its unique ecological system & biodiversity.  Despite deforestation, Madagascar remains home to many species of plants and animals that do not exist anywhere else in the world, including over 60 types of lemurs (species, sub-species).

Languages: French and Malagasy

People:
-Population: 23,201,926
-80% employed in agriculture
-Live on average $2/day
-Religions practiced: traditional beliefs, Christianity, Islam

Healthcare:
- 0.16 physicians/1,000 people
-0.2 hospital beds/1,000 people (1 bed/5,000 people)
-Maternal mortality rate (MMR) = 240 deaths per 100,000 births (For comparison the US, MMR = 21)

For more details, check out the CIA World Factbook:  https://www.cia.gov/library/publications/the-world-factbook/geos/ma.html

I am very excited and proud to be a part of an organization that will bring not only physical healing and healthcare education to the people of Madagascar, but also a greater sense of hope to people who have been outcast or forgotten by society. And when I come home, I will teach you all how to "move it, move it"!

As many of you know, we were originally scheduled to travel to Guinea, and then Benin, as ebola swept across West Africa.  Since Mercy Ships is not equipped to handle this type of infectious disease, these plans were appropriately changed. While I am very excited to travel to Madagascar and serve the people there, I am also heartsick that those individuals hoping and planning for a visit from Mercy Ships in West Africa will be disappointed. Thankfully there are many aid organizations present in the area and serving those in need.  Please keep the people of West Africa in your continued thoughts and prayers, and consider helping practically by donating to one of the organizations on the ground featured  in this great CNN article:
http://www.cnn.com/2014/09/19/world/iyw-ebola-outbreak-how-to-help/