Max-fax patients

A couple of weeks ago I got to spend a few hours in the operating rooms, observing various surgeries. I went back and forth between the max-fax, ENT, and plastics rooms, but spent the majority of my time in the max-fax room. I watched Dr. Gary remove a massive bony tumor that I think was caused by fibrous dysplasia. During the next several days, I had the priviledge of being the nurse assigned to the spunky eleven-year-old girl, Comfort, whose surgery I watched. Comfort usually had a smile on her face, especially after I took out her feeding tube and let her start eating real food again. She liked to hold and play with the babies on the ward, sing and clap with us during ward worship, and take pictures whenever the photographer came through.
Comfort and her sister are staying at the Hope Center now, and will be going home to Liberia (I think - maybe it's Nigeria, I'm not sure) in a few days. Pray that the tumor doesn't come back, and that Comfort regains normal muscle control as the swelling goes down.

We've been enjoying all the babies we've had on the ward lately:

Another day on the ward

A missionary named Jon Erickson recently brought a group of his patients from the Hope Clinic in Guinea to the ship to have various operations. Jon is from America originally, but has lived in Africa for many years. He's really amazing with his patients - he's pretty much been living in the hospital with them while they're here, sleeping on the pallets under their beds, eating the African meals with them instead of going upstairs to the dining room, and translating for all of us on the ward who don't speak French. We've all had fun getting to know the Guinea patients - they're a wonderful group of people, and we'll be sad to say goodbye this Sunday when they go home. It's amazing how attached you can get to people that you can't even talk to. You can say a lot through facial expression and make-shift sign language. :)

Small victories from work today:

I had to take staples and sutures out of a little 7-year-old boy's scalp and face. Even after pre-medicating him with paracetamol and codeine, I expected him to cry at least a little bit. It's not fun for anyone to have staples and sutures removed, let alone a little boy who doesn't understand what's going on. But he was so brave! He didn't cry at all and held perfectly still while I carefully removed each one. I was praying that God would help me be gentle, and He did.

A little girl I was looking after today had to have her head bandage changed. Her incision had oozed a little bit, and there was some gauze stuck to her chin. When I tried to pull it off she immediately started whimpering. So I put a little saline on the old dressing, and sang her a song while I slowly soaked it off. In the end I got all of the old dressing off, the incision cleaned, and a new dressing neatly wrapped around her head.

The same little girl had to have her last dose of IV antibiotics today. She did NOT like her IV to be touched even though it was still working well, and she started crying and wiggling as soon as I came near her. Then I thought to give her my penlight to play with, and let her examine the inside of my mouth, nose and ear with it. That distracted her enough that she didn't notice me injecting the medicine in her IV.

I know those are just little things, but it's the the little things that matter the most sometimes. The best part was that both of those patients still had smiles and hugs to offer me at the end of the day. :)

This week's highlights

As you can see from the picture I posted Wednesday, our noma patient has had his second surgery, and now has a new nose and roof of his mouth. The surgery involved cutting the pedicle flap away from the nose and unrolling it back onto his scalp, and releasing his tongue from the roof of his mouth. One of my coworkers had the opportunity to observe the surgery, and she said that the surgeon, Dr. Parker, was impressed by how clean everything was. He said "there's obviously been some excellent nursing care going on in the ward." We all gave ourselves a little pat on the back for that. ;-) The patient is just as much to be praised for how well he's doing. What he's gone through the past 3 weeks would be difficult for anyone, with tube feedings, living off of soft foods and ensure supplements, having his nose suctioned every 4 hours, and multiple dressing changes and mouth washes. But he's endured it all with a smile on his face and a cheerful wave every morning for the nurses, never complaining, and being more than compliant with every treatment. I wasn't on shift when he returned from his second surgery, but everyone said that he came back wearing the biggest grin yet, and asking for a mirror.

Monday a group of about 30 new people arrived on the ship, so there have been lots of new faces to get used to. This happens every couple of months, and it's always a little disorienting at first. The ship feels like a different place for awhile, but soon everybody gets used to each other again and routines continue. I'm a preceptor on the ward now, so I've been helping to orient some of the new nurses. It's reminding me of how out of place I felt when I first arrived, and how strange everything first seemed. Now the way we do things in the hospital has come to feel more normal, and those thoughts of "we would never do it this way at home" don't cross my mind nearly so often.

About a month ago I joined a women's Bible study here on the ship, and we've been going through Beth Moore's Esther study. Watching the lesson every Monday night with the other ladies has been a highlight of every week, and the daily "homework" has helped me stay in the Word more consistently. I was really excited to be in a Bible study like this, because the past few years I haven't had the ability to, due to moving around so much and working crazy nursing schedules. Since most of the women in the study work shifts, they show the lesson Monday mornings as well as evenings so that everybody has the chance to come.

In my time off I've been trying to sign up for more of the "Mercy Ministries," like the women's prison and Missionaries of Charity. Yesterday I joined a group going to visit an orphanage outside the city, called Fatima Home. The orphanage is run by a local couple who started it for war orphans about 10 years ago. Some of those original children are still there, and more have joined them since. Living on a piece of land outside of Freetown, the children are provided meals, clothes, beds, and an education. Exams are expensive in Sierra Leone, and the Mercy Ships crew recently collected a donation large enough to pay each child's school fees for a year! When we pulled up to the home in our land rovers yesterday, it was raining but the kids were all standing outside anyway, jumping up and down eagerly and waving, big smiles on their faces. We all crowded into the living room inside the couple's house, to get out of the rain. While we took seats in the chairs and couches around the perimeter of the room, all the kids settled on the floor. Denise, the lady leading our team, said "don't be shy kids, you can sit in our laps!" The kids stayed where they were on the floor and just looked at her, obviously confused. Then the man who runs the orphanage translated what Denise said and within seconds the floor was cleared and every lap was filled. :-) We all had fun cuddling the munchkins while Denise taught a lesson on the fruits of the spirit, with the translator's help. Then we sang some songs and gave the kids coloring pages and crayons. The time passed all too quickly, and soon it was time to load up and make the bumpy hour-long drive back to the ship. Hopefully I'll be able to go back again in a couple of weeks.

The rest of my free time this week has been filled with walks on the dock, admiring the sunsets after dinner, reading books, movie nights with friends, and calling home to make sure my family's safe amid all the Texas wildfires. It's strange to think that my time here is more than half-way over; sometimes the next 3 months seem like forever, and other times I feel like they're going to just fly by. I've been battling a little more homesickness and burnt-out feelings than usual this week, so I'd appreciate your prayers that I would make the most of the time I have left. I want to relish every opportunity I have here in Sierra Leone, but I know that come December, I'll be more than ready to see Texas again.

a new nose!

Hospital Updates

Max-fax has been slow the past few days, so D ward has been pretty quiet. They haven't been doing as many surgeries, but it should pick back up again shortly - I think we're waiting to get the anesthetists we need to do pediatric surgeries.

One of our general surgery patients, a lady who had a thyroidectomy, developed some complications and is now in the ICU. She came down with severe malaria, typhoid fever, and congestive heart failure-like symptoms. I cared for her the past 3 nights, and she stayed about the same over the weekend. Not doing any worse, but not really much better either after receiving antibiotics, diuretics, ACE-inhibitors and a blood transfusion. Please keep her in your prayers, that she will respond to the treatment and take a turn for the better soon. Also, typhoid is contagious and not all the nurses have received the vaccine. I have, thankfully, but please pray for the health of our nurses and everyone on the ship.

The man with the noma nose and palate reconstruction is going back for his second surgery tomorrow! He's been doing well, although losing weight. I'd lose weight too if my tongue was sutured to the roof of my mouth! We started him on nutritional supplements a couple of days ago, so hopefully he'll gain the weight back and his wounds will heal faster. Everyone's looking forward to his second surgery tomorrow, to release his tongue and replace the pedicle flap back on his scalp.

The plastic surgeon who was here at the beginning of the outreach returned this week for another round of plastics. The plastics patients take months to heal, and we finally sent the last ones home last week. Now we're about to fill up A ward again with a new set.

That's all for now. I just worked night shift the past 4 nights, and I'm tired!

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...

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.

B, C, D, and Hope Center

This week was so packed and busy, it seemed to go by really fast! I worked day shift (7am-3pm) Monday-Thursday, and evening shift (2-10pm) Friday. I was a ping-pong ball this week, bouncing around from ward to ward. Monday I got pulled to B ward for the first time, which is where the general surgery patients are - mostly hernias. Tuesday I worked in D ward (where I'm usually assigned, max-fax), but it was so slow I went back to B half-way through my shift to help them out. Wednesday I was in B again, and Thursday I worked in C. Up til about a week ago, C ward has been left empty. Now we have overflow, low-acuity max-fax patients in there. That day consisted mostly of wound care and dressing changes for me, then playing with balloons and bubbles with the kids once my work was done. Friday I was back in B. It was a good week, but I did feel a little displaced. D ward has come to feel like my home, and I missed it a little. After work we had various meetings and worship services, so I didn't have a whole lot of down time this week. Here are some more pictures from the wards this week:

worship time on D ward

Ursina with some of the kids

Natalie (the max-fax team leader) playing with Lamin

2 of our little ones making friends

Juanita, me, Hannah, and Beth

crazy B ward nurses, with 2 of our translators and one of our patients

Despite the business of the week, I did have time one day to go visit the patients at the Hope Center. That's our outpatient facility down the road from the docks. When patients live too far away to go home, they go stay at the Hope Center to wait for their surgery or follow-up appointments. Going there definitely lifts my spirits - as soon as I walked through the gate I was surrounded by kids who wanted to talk and play and arm wrestle and hold my hands and sit in my lap.

alive, but not so well

Hello friends. I've been getting questions along the lines of "are you still alive?" lately. Yes, I'm still alive. Just not quite myself. Monday I got hit hard with some kind of nasty bug that resulted in 5 days of fever, chills, general achiness, headache, and sore throat. I've been to the doctor, started antibiotics, and have been drinking lots of water and getting lots of rest. A crazy amount of rest, actually. I'm really not used to this. I'm hardly ever sick, but after spending the better part of a week lying in bed, I'm still exhausted. The fever's gone down a little, but my throat still looks like raw hamburger meat. Hopefully I'll be back on my feet again soon, and can go back to the ward. I feel guilty for missing work, but am very thankful for the friends I've made who force me back into bed time and time again when I've deluded myself into thinking I'm well enough to get up.

But enough about that. Here are some pictures I found on the hospital transfer drive. We aren't allowed to take pictures in the hospital, but we can pull the ones that the official photographers take and share them on our blogs.

This first one is from the 4th of July barbecue we had out on the dock:

This is what happens when we take our patients to surgery. We sit them down on a bench outside the OR, and when the OR nurse and a translator come to fetch them, we all lay our hands on them and pray for the surgery. I love this.

These are 2 of my lovely coworkers, Ruth and Ursina, in D ward where I work.

Please pray for my continued healing, so I can get back to work. I miss the patients.

a taste of perspective

Working on the max-fax ward involves giving a lot of tube feedings. Many of our patients are unable to eat for a week after their surgery, since they've had their jaws and faces operated on, and they come back from the operating room with an NG (nasogastric) tube in place and require feedings every 3 hours. We usually use Ensure for our tube feedings - that's a milkshake-like nutrition drink that comes in cans. About a week after I started working in the ward, we ran out of liquid Ensure and had to start using powder instead. That meant that for every tube feeding, instead of just calculating the total amount based on the patient's weight, we first had to calculate how much water and how much powder to use, then mix it up really well to get all the lumps out so it wouldn't clog the tubes. Kind of annoying, right? At least, it seemed annoying until we ran out of Ensure powder too. I was working night shift, and we were down to one can - enough for our 2100 feedings, but there wouldn't be any left for the next day. We hunted in all the other wards and the pharmacy, but to no avail - there was no Ensure left in the hospital. So we paged the dietician, and she got to spend her Saturday night inventing a substitute. A couple hours later she showed up in the ward with a recipe that included milk, peanut butter, sugar, liquid multivitamin, and fiber powder. Yummy! We're glad our patients won't starve, but this new concoction is kind of tricky. The fiber powder doesn't exactly dissolve, and it tends to settle to the bottom of the feeding bags and get clogged in the tubes. That means that while the feedings are going, they need to be checked very often. We asked our ward supervisor how long it would be before we'd get more Ensure. She replied that apparently, there's some in a shipment container sitting on the ship that's docked in front of us. So near, and yet so far away.

All this makes me very thankful for creativity, God's provision, and coworkers who make the best of difficult situations instead of complaining about inconveniences.

farewell to a faithful friend

i'd like to have a moment of silence for my faithful stethoscope, whose auscultating days have come to an end. this was my first stethoscope, the one i received from my nursing instructors in school. it's helped me listen to countless crackles, wheezes, S1's, S2's, murmurs, bowel sounds, and bruits. it even helped get me out of a speeding ticket once. about a month ago i felt a scratch on my neck where my stethoscope was hanging. to my dismay, i discovered that it was cracked. my response? medical tape!

but to no avail. tape was just a temporary fix. it's time to face the truth.

so sad!

so i finally bit the bullet and bought a new one. which is...exactly the same as the old one.

i shall now re-tape my old broken-down friend and station it in my car, to enjoy it's retirement as "decoration." ;)

i love my patients

in the midst of all the busyness and stress of my job, there's always room for a little humor...

yesterday, i was called into a room to help a doctor out with his assessment on one of my patients. basically, the patient had a problem, and the doctor wanted me to deal with it so he could get on with his day. no problem, that's what i'm there for. so, i went in and was taking care of my patient, an adorably feisty little old lady who talks everybody's ear off. the doctor was just about to leave when his cell phone rang. his ring tone was a pretty, yet somewhat mournful rendition of Amazing Grace on the bagpipes. he silenced it, then turned to the patient to say goodbye.

"What was THAT?" she demanded.

"What do you mean, what was that?" the doctor said with a smile. "That was bagpipes."

"Well, I'm not dead YET, honey."