Kick Off

Welcome back, my friends & family! It's been quite a long hiatus on this blog as I've been traveling around the globe and back again. The time away from the ship was refreshing - seeing my friends and family at home was such a balm to my heart after being away for so long. I also had the opportunity to travel, with friends and family, around France, Ireland, Botswana, and Namibia. Add to that a final stay in Durban, South Africa as the ship was still in dry dock, and I think I've met my traveling quota for the year! That special time with loved ones has given me the energy and passion to come back to the Africa Mercy for "Mada 2" and get to work! There is still much to be done here, and I'm excited to be a part of it for the next few months.

After a delayed start from Durban, we made quick time sailing back to Tamatave, Madagascar. It was a beautiful sail, much easier than last year. There was a seemingly endless supply of wildlife to watch, calm seas, and lots of sunshine. At one point we were able to set up our hammocks on the deck and enjoy the view. Here are a couple of photos from our sail and arrival in Tamatave. The advance team and other crew members who came ahead were anxiously waiting for us on the dock.

We arrived here in Tamatave only a little over a week ago... and things are already in full swing. The Land Rovers are all prepped for service. Over 100 new crew have boarded. New nurses and hospital day crew are being oriented. The ORs officially opened with a prayer to start surgery for the service. It is all starting to come together! My role looks a little different this year, as a "returner". This means I get to help more with set up, patient selection, and training the 60-some new nurses that arrived on the ship last week. In the past few days we have been reviewing previous surgical cases from last service and screening our new patients for admission. It is so wonderful to see so many familiar faces; patients and their families who have touched my heart. So many of our plastics patients returned (Lixia, Dyllan, Rosa, Hosni, Landrino), and we had a sweet time visting with one another. At the same time, there is a lot of excitement to meet our new patients and begin forming relationships with the people we will treat this service! Patients have started walking up the gangway to begin their journey here on the Africa Mercy, and today will be my first day back on the ward! I'm thrilled to get to work with the patients once again, hear their stories, and start building new friendships as they heal.

Here's our entire hospital team! Ready to kick off the surgical season for Mada 2!

I also want to mention some very special people who do not get nearly as much recognition as they deserve: our advance team. They are the ones who set everything up and make it possible for us all to be here and do the work we do.  This summer, while the ship was in Durban for dry dock, they remained behind in Madagascar working on new buildings, signing contracts with the government, arranging for crew to arrive and be transported to the ship, dealing with visas, visiting patients, and maintaining important contacts for our service. Last week they gave us an update on how the advance went and what they were able to accomplish. One of the team members was in charge of renovating buildings for our new fistula clinic and for educational purposes. I wish I had a photo to show you of the buildings before and after renovations. A dilapidated building from 1904 was completely transformed! Now, maybe it's just because I'm a girl who grew up in a construction family and can appreciate a good renovation, but the visuals of these buildings brought a tear to my eye. Here is something that will last, something that will be left behind to benefit the people of Madagascar. It is such a tangible gift. Our patients come to this ship and leave looking, and hopefully feeling, different. We hope that they are better able to perform daily activities, that they find acceptance that they did not have before. We hope that they are healed and know that they are valued; and that this makes a permanent change in their lives and how they contribute to community. These buildings, similarly transformed by the loving hands of many people, will hopefully do the same thing for the people of Madagascar. They will continue to provide a safe place for the treatment of patients and the education of healthcare professionals. They will remain, even when the ship is gone. They will help to make a difference in the lives of so many Malagasy, here in Tamatave, and beyond. Simply put, they are a beautiful example of what Mercy Ships is all about. When the pictures from communications are loaded up, I will post some for you.

Don't worry - I won't leave you waiting so long next time for another post! I'll be sure to write again in the next couple weeks as we settle into the surgical service!

We're All in the Same Boat

Last Friday was the final day of surgery, for this field service, on the Africa Mercy (AFM). Quickly the patient beds have emptied, those who have been in rehab for months are heading home, and the wards are getting prepared for "pack up". My friends and crew members have started trickling out the doors, leaving empty pockets around the ship that was so bustling and crowded just a few short weeks ago. And in just two days' time, I will be one of those walking down the gangway to start my journey home. There are so many things I can't wait for: seeing my family, taking a shower that lasts more than two minutes, eating at any time of the day I want & whatever I want, driving! At the same time, there are many things here that I'm sad to leave. Since I am returning for the beginning of the next field service, there are not quite so many losses for me this time around. I will still be coming back to this incredible community, still working with our Malagasy patients, and seeing many of our same day crew. At the same time, I am saying goodbye to many patients and friends who have touched my heart.

Being on the Africa Mercy is a unique experience that's difficult to describe. In fact, it seems almost daunting, but I'll do my best. Instead of being asked "Why would you want to go live on a ship in Africa?", you are surrounded by people who want the very same thing, who are here with the same desire to serve. And we live with, eat with, work with, and travel with these same 400 crew members day in and day out.  While we deal with the typical problems that happen when you live in such a tight community (gossip, finding anywhere to be alone for five minutes, following strict rules, "laundry rage"), there is also a lot of grace and understanding that I think would be difficult to find anywhere else. We have lived through this experience together, faced and overcome the same challenges... we are *lit'rally* in the same boat. Although the people who actually keep this boat running would like to ensure that I let you know it is actually a ship, not a boat.

Crew having a special dinner on the dock.

We had our final, in port, fire drill last week, with a simulated mass casualty situation. All the nurses were called back onto the ship to help triage and care for the "patients", while the fire crew, reception, and other crew members carried out their functions. In the midst of all of this, I was impressed by the teamwork that I saw. Everyone was working to ensure the safety of the crew and hospital, even in a drill situation. A popular phrase on the ship goes, "You come as a _______ (fill in the blank: nurse), and leave as a crew member". No statement could be more true. Everyone works to fill in the gaps to make this work. Nurses clean floors & count inventory in containers, chaplaincy members work extra hours in the cafe, deckhands works as volunteer firefighters, and our communications team travels days to return patients home. And when we have a patient who needs a miracle, the whole crew steps in... to provide blood for transfusions, to physically take care of them, to clean up after them, to visit on the wards and keep patients entertained, to cook meals for them day in and day out, to pray for the patients & the staff looking after them. It takes a village to do this work, and I have been so very blessed & grateful to be a part of the crew this field service.

In the spirit of wrapping things up for the field service, I'd like to give you a couple little updates on some patients who have been a special part of this service:

Sambany is home! After several months with Mercy Ships, our comms team made the several day journey with him to his village.... even running into his wife along the road! They shared the whole story with us tonight at our community meeting, and I cannot wait for them to put it all together so that you can view some of the footage after following his journey all this time. Seeing him climb those mountains on the way home, it's difficult to believe that he had to be carried over them by six people on his way to the ship. What an incredible transformation!

This beautiful girl is Lixia! After five months on the ship she, along with her lovely older sister who cared for her, left today with about twenty nurses standing on the dock crying and waving them off. She was one of our burn patients with an arm contracture, who had a difficult time healing. At one time, the surgeons weren't even sure that her graft would heal... we had her on a wound vac, yet were not seeing progress. Now, against all odds, she is almost completely healed, and able to head back home to where she lives with her aunt & uncle. During her time here, Lixia practiced her writing, we listened to a lot of "Call Me Maybe", she learned more English than I thought was possible while also teaching us Malagasy, and we celebrated her birthday. She was one who definitely captured our hearts, and will be missed.

The little girl sitting on the bed next to my friend Heather, and in the midst of all that confetti, is Mioty. She lost her nose after an animal bit her when she was just a baby, and so Dr. Gary has made her a new one. The nursing staff on D ward did incredible work with this little one. When she first came she wouldn't let any "vazas" near her, screamed during every treatment, and was generally distrustful of everyone. But over time, with care & lots of love, she has opened up. So much so, that while I was working a shift as charge on the ward this week she came and sat on the stool next to me and pulled out a sticker book. As she looked at me very intently, she began to sing her favorite song ("bless the Lord oh my soul, ohhhhh my soul") in her girlish voice before picking a sticker, kissing it, and placing it on my forehead. It is a moment that has been ingrained in my heart.  

This service has been full of little moments like that, that have been such a blessing to me! Thank you everyone for the support, encouragement, and donations that have made this field service possible. See you all soon!

A Crown of Beauty

My original intent for this blog was to write about "ship life" (don't worry, that's still coming), but it has been heavy on my heart these past weeks to share about our VVF/women's health program and the incredible women who have been marching up and down the halls in the hospital this month.

VVF is an abbreiation for vesiculovaginal fistula.... essentially an opening between body parts that means the woman leaks urine continually. Besides the physical consequences of the condition, these women suffer social repercussions as they are ostracized and are cast out from their homes and families for being "unclean". Madagascar has a huge population of women suffering from this condition, with over 50,000 known women on a wait list for surgery and repair.

You may wonder, how do so many women in Madagascar suffer from this condition and we rarely, if ever, see it in the States? Actually, VVF used to be common in the US as well, until C-sections became common practice that is. This allowed for quick rescue of both baby and mother from the dangers of obstructed labor. Typically what happens is that a woman is in obstructed labor for a prolonged period of time (sometimes DAYS), and the pressure against her bladder/vaginal tissue causes it to lose blood supply and creates a hole. Many Malagasy women are very small in stature and have difficulties with child birth. Without an emergency C-section, the woman usually loses her baby and is then left with a fistula that means she leaks urine continually. At times the emotional struggles of this complication can be much harsher than the physical. They come from all around the country, some of them having suffered for years of their lives, looking for hope and healing... however unreachable it may seem.

A couple of weeks ago I attended our first dress ceremony for five women who were "graduating" from the program. It is a special time of celebration for women who are now considered "dry" after successful VVF repair, and are ready to begin their journeys home. Each lady is gifted a new dress and hat, and is pampered by having her hair and makeup done (all of this comes with the approval of the local Malagasy chaplains that we team with in the hospital to make sure it is culturally appropriate). Then we all gather together, share in some music and worship, and then host a "graduation" ceremony. Each woman is invited to the front to collect their graduation gift (typically practical supplies that they can use, but that also have a symbolic meaning) and share a few words with the other patients and crew members.

These stories touched my heart deeply and reflect the individuality of each woman's journey. One woman had her fistula for only months, but was so withdrawn you could see how alone she felt in her suffering. Although she had heard rumors that maybe the ship would kidnap her and take her away, she felt the risk was worth it for the chance that she might be healed. I can't imagine how desperate you must feel to voluntarily travel across the country by yourself, to a big white ship that may either offer you hope and renewal, or may take you away from your loved ones forever. Despite that initial fear, she laughed when she told us her story.  Another beautiful woman shared that she had been leaking for over 30 YEARS, had been abandoned by her family and husband, and had been completely alone in her suffering for that time. That is just a little longer than I have been alive on this earth.  Finally, she is dry and can return home to her loved ones. It was a joyful celebration!

In the midst of these individual stories, is a feeling of sisterhood among the ladies. For the first time, they are together with other women like them. They realize that they are not alone in this situation. Although they are generally quiet when they first arrive on the ship, we soon see them gathered together in the wards, giggling over something our day crew has said or holding knitting circles. We see them walking down the halls, singing at the top of their lungs. We see them laughing at the "vazas" (us, foreigners) who do silly things just to make them smile. And while at 5'4" I tower over these petite ladies, their presence fills the hospital. While there are many emotional struggles to work through, and while surgery is not always successful after the large amounts of damage their bodies have suffered, there is so much more work being done in these women. Here, they come back to themselves, discover hope, and build community. Although challenging at times, it has been such a blessing to work with these women... here are some of their beautiful faces.

Walking out of the dress ceremony in a dance line! 

Group photo.

Hanging out with the ladies on B ward.

Me, Joceline (recovering after surgery) and Deborah.

Joceline, at her dress ceremony! So beautiful!

Our VVF team leader Steph, shared Isaiah 61 as her hope for these women, and I'd like to share a piece of it here with you: 

He has sent me to bind up the brokenhearted,

to proclaim freedom for the captives

and release from darkness for the prisoners...

to comfort all who mourn,

and provide for those who grieve in Zion-

to bestow on them a crown of beauty instead of ashes,

the oil of joy instead of mourning,

and a garment of praise instead of a spirit of despair. 

They will be called oaks of righteousness,

a planting of the Lord for the display of his splendor.

If you are interested in learning more about VVF, I recommend watching "A Walk to Beautiful". It's a short, touching documentary about the lives of these special ladies.

I'll be posting again, hopefully next week, to give you some updates on our long term patients... and lots of photos!

Everyday Miracles

A few weeks ago I was assigned to help the screening team on the dock. It's one of my favorite nursing assignments, despite the fact that it means spending hours in the warehouse in 90 degree, 85% humidity, weather. With my scrubs rolled up to my knees and my burlap TOMS on, I headed down to the dock, wondering what the day might bring. Working with screening at this stage means you get to be part of the team that introduces the patients to our ship, to the surgeons, and the incredible crew on board. You help draw blood work, do patient interviews, escort patients for CT scans and XRAYs, and entertain restless kids with a seemingly endless supply of bubbles. And while screening is not always a "happy" job since there are those we simply cannot help, it is certainly a meaningful one. After all is said and done, the patients who have been selected for surgery receive an appointment card with their admission date and instructions on when to return to the ship. Some patients will even be admitted to the hospital right then and there, to have surgery the next morning. On this day we were wrapping things up when I sat down with a man to give him his yellow patient card and admit him directly to the hospital for surgery the next day. He had a baseball sized growth on his neck that had been there for over ten years. Since he spoke a little English he had learned years ago in school, we had developed a rapport throughout the day. After I told him that he was scheduled to have surgery the next day, he broke into a smile and thanked me. As I wrote down his admission information, he said to me in his broken English, "Ten years I have had this, I have suffered. Now, tomorrow, new face, new day."

I will never forget those words. We are at the point where there are only three months left in the field service. We have gotten into a routine. Monday, screening and new admits. Surgery through Friday. Discharge patients home or to the HOPE center. Empty drains. Do patient exercises. Deck 7 time from 2:30-3:30. Neuro checks at 8 and 12 o'clock. Crafts with the kids. Check your charting. It is easy to get caught up in the activities and nursing tasks, it's easy for this unique hospital to become normal. And then I remember my friend's words... "tomorrow, new face, new day". Nothing we do here is normal. In the space of one day, we are able to offer hope that people have lived without for so long. And while recovery may take longer than that, the healing process begins in that space of time. During this time we have the opportunity to not only offer physical healing, but support our patients emotionally and spiritually as well as they recover from, potentially, years of suffering from pain, difficulty breathing, frustration, and social ostracism. I live and work in a place where miracles happen every day, where they become ordinary, and it is easy to take them for granted here... they've become everyday miracles. Each patient here is special in their own way, teaching us important lessons, and leaving imprints on our hearts. But today I want to share just a few more patient stories with you all, to represent these incredible, everyday miracles.  Some of these have been patients that I've taken care of directly, while others have been stories shared ship wide.

"Doctor" Daniella
This little girl captured my heart. During her time on the ward, she helped me check the crash cart, learned how to use my stethoscope (and how to clean it with alcohol swabs), how to find my pulse, and even how to take her own vital signs. When I brought music to the ward, she would always ask for "Boom,Clap", shouting at the top of her lungs in a straight monotone voice, "Boom, clap, the sound of my heart, the beat goes on, onononononon." I will forever hear that little voice in my head when that song comes on. She loved dance parties, and providing manicures to the nurses and other little girls on the ward. After having surgery on her foot, she progressed from hobbling around the ward with a crutch, to running up and down the halls with me chasing her shouting "mora, mora!" (slow down!).

Olivier
They do patient interviews prior to surgery, and when asked why he wanted his syndactyly on his hands fixed, you will never guess at his response. So he could count to 10 without the other kids making fun of him, and so that he could wear a wedding ring! This little one always made us laugh, he was quick to smile, and it was a joy to have him on the ward! It's easy to see why in this photo.

Mariette
We've recently started doing our goiter surgical service, and we are loving it! Although men are also affected, we've met so many amazing women during this time. We love our goiter ladies! Mariette had a large goiter that made it difficult for her to breathe. She was such a sweet, quiet, presence on the ward during her time with us.

Sambany
Sambany has become the face of the Africa Mercy this year, and many have been following his story on the Mercy Ships Facebook page. For those of you who haven't... here's a quick synopsis. After a four hour car ride and then three days of walking an incredible distance with his grandson, with just the hope that Mercy Ships could help him, he arrived at our doors. Due to the size and nature of his tumor, the surgery planned was very risky. When asked if he would still like to proceed, Sambany told the team, "I know without surgery I will die. I know I might die in surgery, but I already feel dead inside from the way I'm treated. I choose to have surgery." After 12 hours of surgery, and multiple blood donations from crew members, he was free of the 16.45 pound tumor that had weighed him down! For the first time in memory, he is able to choose which side to sleep on instead of using his tumor as a pillow. He was a patient on our D ward, where my wonderful nursing friends took amazing care of him, and the entire ship prayed for and supported him. During an interview with our communications team after surgery, he told them "...I am very happy, because I am saved. God helped me to become like this. God saved me." Amen.  

Seeing himself for the first time after surgery with my friend Marta holding the mirror!

Here he's on the left playing cards with new friends.

Although I am missing home and my loved ones, it is such an incredible honor and joy to be a part of these people's lives, if only for a moment. We have little time left in this field service, and so much left to do, so many people to reach and to learn from. Please keep our crew and patients in your thoughts as we enter our next surgical service with our VVF (vesicovaginal fistula) patients this next week. I'm sure I'll have many more stories to share! 

 

Scars

Scars. Marks left upon the skin (or heart, or mind) from a healed injury. In the States, we do everything we can to avoid getting a scar. Special creams, medical ointments. And if a scar does remain, after every effort to erase it, it is usually a minuscule mark that we brag to our friends about, or conceal with makeup... turning our injury from a sports match or our own tripping clumsiness into a measure of how brave we are. These minor scars do not make us targets for ridicule or for ostracism.

Scars here have taken on a new meaning for me during my time here in Madagascar,partly because of how they originate. It may be simply that I've never worked in trauma or in a burn center before, but the scars I've seen here have had a great impact on me and have changed my perspective regarding their significance. I've seen a man in the local hospital who was attacked with a machete for the fruit he was harvesting, who will bear the scars of those slashes for the rest of his life. Children who rolled into the fire pit in the floor of the one room hut they live in with their families. Adults scarred from childhood diseases that don't even exist anymore in the developed world. Scars are a measure of survival. They are a measure of strength, of endurance. And while the people here hide these debilitating scars and contractures on their bodies with scarves and giant floppy hats, while parents bring their scarred children to us hoping that we will have the ability to erase those scars - to us they indicate a courage and will to survive that very few posses. We are just starting the plastics portion of the field service, working with patients with physical deformities, tumors, or severe burn contractures. These patients come in to the hospital downcast, hiding their faces or different parts of their bodies, hiding their scars. As they spend more time with us though, it is a gift to see them begin to open up, laugh, and build relationships with us and the other patients on the ward.

When we first started our nursing orientation, one of the nurses shared a quote from Chris Cleave's book,Little Bee, with us. Although I read this book myself several years ago, this quote has taken on a much more significant meaning for me during the last few weeks of plastics:

"On the girl's brown legs there were many small white scars. I was thinking, Do those scars cover the whole of you, like the stars and the moons on your dress? I thought that would be pretty too, and I ask you right here please to agree with me that a scar is never ugly. That is what the scar makers want us to think. But you and I, we must make an agreement to defy them. We must see all scars as beauty. Okay? This will be our secret. Because take it from me, a scar does not form on the dying. A scar means, I survived.”

I'd like to introduce you to just a couple of the patients that we are currently working with, who bear these scars of survival. 

Windy! He suffered from these burns when there was an explosion in his home a few years ago. The burns radiate down the side of his body, limiting his ability to turn his head or straighten his arm. He's also one of the cheekiest, and smartest, kids I've ever met! The first night I met him before his surgery, I started to count to ten in Malagasy, proud that I could say all the numbers. "Iray, roa, telo..." He quickly cut me off and counted, in English, "One, two, three, four, five, six, seven, eight, nine, ten!" Then he started giggling at me. In the middle of a game of Jenga, when I asked another nurse to please bring me something, he looked up at me and clearly stated, "Please. Clean the blackboard, please." Someone's been getting in trouble with his English teacher! And despite everything he's been through, he is always quick to smile.

Mamisy! This is a truly incredible teenager. As a child, he suffered from a disease called NOMA. NOMA is a disease that affects mostly children in third world countries, eating away at the flesh. It has a mortality rate of 90%, meaning that survivors are very rare. It thrives in areas of poverty. The last time this disease was seen in the Western world was in the Nazi concentration camps (Auschwitz). Mamisy is a survivor! And Dr. Gary is in the process of building him a nose and upper lip. It's a total of three surgeries, so it's quite a road to travel down.
Here is his before picture:

And here is his latest picture. He has one more surgery to do on his lip before it will be complete.

And just for fun, here are a couple pictures of some other wonderful patients who have captured my heart in plastics:

Narcisse. He is great at entertaining the little ones on the ward. He just left to return home, and although we are so happy he has healed so quickly, we are all missing him on the ward!

Ezra. If you ever want to play a challenging game of "Memory: Spongebob Squarepants Edition"... find this kid. I beat him by one pair this week, and it was a major accomplishment for me.

Fandresena... although he likes to be called Clemmens. He has become one of the poster children for plastics... how could he not with that infectious laugh and giant smile??

I never imagined that I would get to be a part of something like this. The patients are truly incredible, and I am so blessed to be able to spend so much time with them on the wards. Even on my days off, I find myself wandering through to say hello and check in with them. I've truly seen miracles here! Healing that shouldn't happen. A nose being built from a piece of scalp. The nurses and medical team I work with encourage and challenge me to grow in my faith and become a better nurse every day. I can't wait to see what the rest of this plastics service holds for us!

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.