Differences

Working as a nurse on board the Africa Mercy has its own set of challenges and triumphs. After 12 weeks, many things have come to feel normal that are much different than working in a hospital back home. Here are some of the differences that are part of a "normal" work day:

Small spaces. The "nurses' station" consists of a desk with a computer for the charge nurse, and one counter beneath the medication cupboard. The nurses are always running into each other as we attempt to get our meds together, sign off charts, or just walk from one side of the ward to the other.

IV bags swaying as the ship rocks back and forth.

Praying with patients before surgery, praise and worship time every day, ward services on Sundays.

Lack of privacy. Men, women, children, and babies all together in the wards. All the patients and their family members in each other's business, listening to each other's conversations, helping take care of each other's babies. It really shows the cultural differences. Back home, my patients get grumpy if they have to be in a semi-private room, shared by two patients. Here, the few patients that get their own rooms for isolation precautions, don't like it at all. They usually prefer to be out in the ward with everybody else.

Language barriers. We have translators, but sometimes we need more than one. The other day I had to hunt down someone who spoke Mende, and it turned out to be another patient's family member. As I was doing some teaching with my patient, I spoke in English to the day volunteer, who spoke in Krio to the other patient's caregiver, who spoke in Mende to my patient. I'm never quite sure how much gets lost in translation.

Patients' family members sleeping on pallets underneath the patients' beds.

Creativity and flexibility. For example, making peanut butter and milk concoctions for NG feedings when we run out of ensure.

Living, eating, worshiping, and hanging out with my coworkers every single day, not just during our shifts.

Living in a cabin just a few steps down the hall from the ward where I work.

Getting a lunch break EVERY day....and coffee/tea breaks on slow days. :-)

Mixing up my own IV meds, instead of a pharmacist doing it.

Hanging curtains from magnetic hooks that stick to the ceiling.

Calculating drip rates, and constantly fiddling with IV drips that are running by gravity instead of through a pump.

Chatting with my patients and their family members until the wee hours of the morning when they don't feel like going to sleep.

Taking care of pediatric patients. This is a BIG difference for me, since I haven't done that since nursing school!

Always finding different brands and types of supplies for IV's, meds, dressings, etc. One week we had the IV catheters with retractable safety needles - that was exciting. Another time our betadine ointment was from Norway or someplace and I couldn't read the label - I had to open it and look at the medicine to be sure what it was.

Different terminology: calling tylenol "paracetamol" and the OR the "operating theatre"

Dancing around the ward with the kids singing "I like to move it, move it" or "Shake your body for Jesus, clap your hands for Jesus..."

Blowing bubbles and playing with balloons to keep the kids entertained

Making sure our patients understand how to use the toilet...some of them have never experienced indoor plumbing. One bathroom shared between 15 patients and their family members. Also, the plumbing runs on a vacuum system, which doesn't ALWAYS work...

Going on treasure hunts in the pharmacy late at night when we run out of meds and don't want to wake the pharmacist up.

Wearing many different "hats," not just that of a nurse, and especially on night shift. In one day I might be the nurse, nurse's assistant, respiratory therapist, lactation consultant, speech therapist, baby sitter...

Missionaries of Charity

Today I signed up to go with a group to Missionaries of Charity, an organization founded by Mother Teresa which has missions all over the world. The one here in Sierra Leone is just a short drive down the road from the ship, so it didn't take long to get there. The mission is run by 4 sisters, who have taken a vow of poverty and care for the most destitute of the poor and sick. It isn't exactly a hospital, but one of the sisters is a nurse, and a doctor comes in weekly to prescribe medications. They have it set up into 3 wards: one for men, one for women, and one for mothers and babies. The people who live there have illnesses like malaria, HIV, TB, some are malnourished, some are developmentally delayed...

We were there for a couple of hours, which went by really quickly, but we had time to meet and visit with the men and women, cuddle a few babies, sing some songs, and do a craft with everyone. I received lots of smiles, hugs, and handshakes...and had a few good-natured laughs with the ladies when I attempted and failed to understand what they were saying. Ah, the ever-present challenges of a language barrier. ;-)

Life Goes On

Life onboard the Africa Mercy continues to be busy. In addition to working shifts in the hospital every day, I've been spending time with friends, saying goodbye to many of them as they return home, and taking trips into Freetown. Here are some pictures from the past few weeks:

"Tea at ten" has become a tradition every night in the dining room

Goodbye party at The Country Lodge restaurant

Saying goodbye to sweet friends

Everyone gathers on the dock to wave goodbye

Spending time with patients at the Hope Center

Views of Freetown

Monday, Monday

After enjoying a weekend off, I'm well-rested and back in the swing of things at work. Here's a glimpse into my day today on D Ward:

0625 - Tried not to fall or wake my bunkmate up as I got down from the top bunk, waited my turn for the bathroom, and stumbled my way through brushing my teeth and getting ready for work.
0640 - Ate breakfast upstairs in the dining room with the rest of the day crew, none of us feeling very social as we gulped down our coffee in half-asleep silence. DONUTS were a nice surprise this morning, instead of just the usual cereal and toast :)
0655 - Made the long commute ;-) to work down 2 flights of stairs to the hospital. Prayed with the night shift team, received handover report, checked all my charts, and made a list of things to do for each patient.
0730-0900 - Gave morning medications, tube feedings for my 2 patients with nasogastric tubes, mixed up infant formula for the little babies after their mothers breastfed them all they could, chlorhexidine mouthwashes for everyone after breakfast, and saline nebulizer for my man with a nasal trumpet.
0930 - Ward devotions / prayer and praise with the patients. Then had African praise songs stuck in my head for the rest of the day "Tell him tenki, tell him, tell Papa God tenki..."
1000-1200 - More scheduled meds, tube feedings, and mouth exercises. Wound care and dressing changes for 2 of my patients. One of them only took about 10 minutes, but the other dressing change lasted close to an hour. It was for the noma patient I wrote about the other day. He's doing great! I took out his nasal bolsters and NG tube today. I was mistaken, he doesn't have to be on tube feedings for 3 weeks. But his tongue is still sutured to the roof of his mouth, so he'll probably be drinking lots of ensure.
1200 - Lunch break! After lunch, said goodbye to 2 good friends who were about to head home to America.
1230-1400 - Discharged my 2 little cleft lip babies who were ready to go home. Through the help of the translators (and another patient's family member, who assisted us with a 3-way translation) I taught their mamas how to do the chlorhexidine mouthwashes, made sure they knew when their follow-up appointments were, and then sent one of the translators/day volunteers to take them down the gangway and out onto the dock. Then wrapped up all my "loose ends," checked some vital signs, and finished charting. Also made sure my pre-op patient was doing ok, still waiting for his surgery.
1400 - Prayed with the oncoming evening shift and gave handover report to the nurses taking over.
1430-1530 - Took the patients who were able up the stairs and outside onto Deck 7 to get some much-needed fresh air.

Back at it again in the morning!

Noma

This week I've been learning more about noma, a horrible disease that is almost never seen back home. It's a gangrenous infection that begins with sores in the mouth and proceeds to eat through tissue in the face, reaching the bone and often killing its victims. It usually affects children and is related to lowered immune systems, malnutrition, poor hygiene, unsafe drinking water, and having recently had other illnesses like malaria, scarlet fever, and chicken pox. Some children survive the disease, and without reconstructive surgery, go through life with severely deformed faces, often becoming social outcasts.

Right now we have 2 noma patients on D Ward, a man and a woman both in their 40's I think. When the woman came to us she kept her face hidden behind a veil at all times. Now she's recovering well from her surgery, is regaining feeling and movements in parts of her face that she hasn't been able to use in decades, and she smiles and waves at everyone who comes in the ward. This week I got to care for her when she had her NG tube taken out and started eating soft food, removed all the sutures and staples from her incisions, and began her facial nerve exercises. Her wound care yesterday was a long, tedious task, but definitely worth it when her eyes lit up and she gave me a big thumbs-up afterward. I'm excited she'll get to go home in a few days, but everyone will miss her on the ward.

Today I also was assigned the other noma patient, who had a much more complicated surgery. The disease had destroyed his nose and the roof of his mouth, and what Dr. Gary did to reconstruct his face really amazes me. I had a general idea earlier this week of what the surgery entailed, but when I helped change his dressing today I understood it a lot better. They basically took a flap of tissue from the man's scalp to form a whole new nose, and grafted it in place on his face. Back home they probably would have done a free flap, which is where you completely remove the tissue from the original site. They don't do free flaps here, because the patients' nutritional definciencies and the difficulty in maintaining a sterile environment during recovery here in Africa lower the chances of the graft surviving. Instead, they did a pedicle flap. That's where they cut a flap out of the scalp, but left it attached so that it keeps its original blood source. The end of the flap was used to form the nose, but the rest of the tissue is just rolled up and kept moist in a sterile dressing, connecting the new nose to its original blood source on the top of the head. After 3 weeks, the flap will be cut away from the new nose, unrolled, and placed back down where it originally was on the scalp. The section of the scalp where the tissue for the new nose was taken from won't have its original tissue replaced, so they took a skin graft from the man's thigh to cover that portion. Sounds complicated, right? It gets better. To make a new soft palate, the surgeon stitched the patient's tongue to the roof of his mouth. It'll stay like that for 3 weeks, at which point a new layer of tissue will have grown over the roof of the mouth and the tongue can be released back down. Is that not AMAZING? Who came up with the ideas for these kinds of surgeries? Even more amazing is the patient's reaction to all this. Yes, he's lived with a horrible disfigurement most of his life, but the 3 weeks of recovery he has to go through is awful. His face looks worse at the moment than it did before, there are only a few layers of gauze between his skull and the environment, he can hardly communicate, and he has to eat through a tube for 3 weeks. And yet he's incredibly calm and relaxed about the whole thing, not even complaining of pain! Please keep this man in your prayers over the next few weeks, that he would continue to be at peace, that the nose graft will take and everything will remain free from infection.

August on D Ward

So, I've been meaning to blog for awhile now. I know I'm really behind, and I'm sorry. I just don't know what's happening to August! I keep having to look at my calendar, because I can't believe it's already the 18th! Time seemed to go by really slowly in June and July, but not this month! Maybe because I was sick in bed so much the first few weeks I was here. Also, many of the good friends I've made here on the ship are leaving this month, and we've been frantically trying to pack in all the good times we can before we have to say goodbye.


Work has been a lot of fun lately. For a couple of weeks, our max-fax surgeries slowed way down, and D ward was very quiet. During that time I worked a lot of shifts in the other wards, which was fun but I missed max-fax. Dr. Gary Parker, who does the more complicated max-fax surgeries, got back from vacation a week or 2 ago, so now D ward is up and running again. We've had a lot of cleft lips and palates lately, which means lots of cute kids to cuddle and play with. When there are babies wandering around everywhere on the ward, I get used to just picking them up whenever, patting their heads when they walk by, squeezing their chubby little thighs...I get so used to it, that today when one of the missionary kids walked by me in the dining room I almost reached out and ruffled his hair. I stopped myself in time though. ;-)


I've been overwhelmed whenever I think about blogging, because there are so many stories I'd like to share, and I just haven't had time to write them down. So for now, I'll just stick with pictures.

if cleft palates were purely genetic, wouldn't they both have been born with one? but only one of these twins had to have surgery. interesting...

everyone loves bubbles

when i have babies, i'm going to carry them around like this

baLOON!

out on deck 7

I'll do my best to update again soon. If y'all could continue praying for my neck, I'd appreciate it. Whiplash seems to take a very long time to get over, and I'm still not sleeping well because of it.

prison ministry

Saturday I went with a group of 16 or 17 women from the ship to visit the women's prison in Freetown. The prison ministry alternates every other week between the women's and men's prisons. I really didn't know what to expect, but we all had a good time! We did a Bible lesson, sang some praise songs with the inmates, and then worked on crafts/activity pages and just spent time with them for a couple of hours. It was fun getting to know the inmates, even though we couldn't understand each other very well. The women I sat with enjoyed making fun of my miserable attempts at speaking Krio. ;-) I'm not sure exactly what the inmates were in prison for, but we were told that it's often for debt or financial issues. One of the ladies was trying to explain to my friend Rachael why she was there, but because of the language barrier she couldn't find the right words. Rachael told her "It doesn't matter, I'll be your friend anyway" and the lady almost started crying.

Traffic was terrible on the way back to the ship on Saturday - we drove down lots of little streets full of pot-holes for about an hour and a half. I think that during all the bouncing up and down I injured my neck, because for the past 3 days my neck has been hurting more and more and getting really stiff. Right now I can barely turn my head, and I've had a throbbing headache all day. Please, please pray for it to get better soon! My shift on the ward was hard to handle today, with energetic kids climbing up my legs and squealing in my ears - I just kept getting tenser and tenser until I took a break, ran down the hall to my cabin and cried for about 10 minutes. Then I had a cup of tea and was able to get through the rest of my shift. But I've called in sick for tomorrow, and will probably go to the crew clinic in the morning. I'd really appreciate your prayers right now.