To my friends..

As I’m getting ready to leave on another adventure across the world this next week, I want to tell you thank you. To my friends and my community and my family, you are so important to me and have been more than I could have asked for these past few months being home. 

It has been such a beautiful and restful and fun and happy time. Thank you for welcoming me back at work and helping me grow as a PICU nurse and learn quite a lot of new things in the space of 18 weeks. Thank you for making it feel like I never left my small group at church because we picked up right where we left off a year ago. Thank you for inviting me to your houses for dinner or coffee or a glass of wine and listening to me, really listening to me. Thank you for being real with me and creating safe places for me to talk or cry or laugh. Thank you for reminding me of things that you are thankful for about ME and encouraging me through a myriad of little ways. Thank you for all of your support in so many different ways in making it possible for my to go back to the ship. Thank you for letting me snuggle your babies and play with your puppies. Thank you for the happy hours and patio chats. Thank you for the craziness and the silence and the example that you are to me. 

I hope you remember how much you have blessed me. I love you all and I’ll see you again before too long! 

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Those babies

One of my favorite parts of being on D ward is watching little malnourished babies with cleft lips or palates getting chubbier until they weigh enough to be able to have their surgeries. Syringe feeding those tiny mouths once an hour on night shift to prevent them from having refeeding syndrome. Seeing the helpless and scared faces of those mamas turn into determination and slowly, joy as those babies start making progress. Being there for that baby’s first smile or giggle because he is catching up developmentally with the proper nutrition he is receiving. Hearing that same mama tell us that she is “Faly faly be!” (Very happy!) after her baby’s successful operation. 
Last week the surgeons on board the Africa Mercy repaired the 200th palate for this field service, which is more than we have ever been able to repair before. 

Even one

You were singing in the dark, 
Whispering Your promise 
Even when I could not hear 
I was held in Your arms 
Carried for a thousand miles to show 
Not for a moment did You forsake me 

Lots of little moments happen here every day that are unexpected and beautiful. Like that little cleft lip baby who has cried every time anyone comes to the bedside besides her mama, who smiles and holds her arms out to you one day to hold her. Like that girl you’re doing a routine dressing change on, when tears start trickling down her cheeks and she tells you she can tell from your face and gentleness with her that you really care about her. Like that sweaty kiss and hug and handshake from patients at the HOPE center, some of whom you don’t even remember taking care of. Like friends who sit on the floor crying with you for hours when your heart is breaking a little bit. 

But even though we sometimes don’t want to think about it, we cannot help everyone. There are so many people that our screening team has had to look into their eyes and tell them they are sorry, we don’t do that type of surgery. Or it is too risky of an operation or the condition too advanced to operate on. Or no, we cannot give you Paracetamol for your blinding headache. 

And sometimes patients that we thought we would be able to help die unexpectedly. You play with her, squeeze those pre medications into that little scrunched up mouth, and watch the OR team take her to surgery and go back to work without another thought. 

I didn’t know that it was the last time I would see her smile. I didn’t know that I would hold her little hand as her heart stopped beating 2 days later. 

I know that I was just a tiny part of this one story, but still some days my heart just hurts. I can’t explain why some are not healed and mama’s are left daughterless and heartbroken. But I also know that what I can see is sometimes small and I trust in a Savior who can explain it and who is still good and loving and kind. 

So is it worth it? Yes, yes it is. Even on the hard days and with the ones that break our hearts. Some days I have to remind myself about those other beautiful moments that happen too. Each individual that we did help and who will be able to have a full and healthy life now. Each person who left this ship feeling that they truly experienced love while they were here. Whether you are in Jesus’s arms right now, or happy and healthy and healed, you were worth it. 

More pictures

Some of the patients I’ve gotten to take care of over the past few months. Each of these patients has a story and a special place in my heart. 

   
    
    
    
 
Games and deck 7 time are always big hits

   
   
I know I’m not supposed to have favorites but this baby…

  
These friends have become my family here on the ship. They are kind, humble, patient, inspiring, and brave and I sure love them. Thanks for reminding me why I’m here and making the hard days not so bad. 

   
 

A letter

I wrote this letter to one of our long term patients, Tahina, a few weeks ago. I thought about asking one of our translators to help me write it in Malagasy for her but I ended up just keeping it for myself because I didn’t know if she would understand. I did tell her some of these things in person, but sometimes all she wanted was a friend to hold onto or a smile that didn’t need translating. 

Dear Tahina,

I know that I have never had a long conversation with you. It’s hard when we don’t speak the same language. I think you already know, but I want to tell you that I love you. I’ve never actually been your nurse, just your cheerleader and friend, but I feel like I know you. You might not remember me but I was on D ward the day you were first admitted as a patient. None of us knew just how long you would stay with us or what your journey would look like. I brushed past you, busy taking care of other patients and touched your shoulder to let you know that I was passing you. I remember vividly the way you cringed and shrank away from my touch and scurried back to your bed to hide under your blankets where no one could look at you. Or touch you. I thought about you many times that first day and my heart ached a little bit. 

I don’t know what your life has been like really. I can imagine things but all I really know are the facts in your chart about how you were so young when Noma ate away part of your face and changed forever what the course of your life would look like. I think about the stares and cringes and ridicule and loneliness and pain that has been part of every day for you. I only know you from here, D ward on the Africa Mercy, and your journey through these past 3 large operations you have been through. You have had to trust us with your life and your future every time you go back to that OR. I know you are tired some days, or frustrated with us for making you drink another can of formula, or just simply in a lot of pain because of your multiple incision sites. I know some days you just want to get back under those blankets just like you did that first day. 

But please keep fighting. Please be brave and strong. You are ALREADY beautiful. I know it matters a lot to you what your face looks like on the outside right now, and right now you are still disappointed. Your face won’t be perfect but honestly, when I look at you, I see your eyes when they crinkle up in a smile, your cute little chin, and your big cuddly hugs, even when you surprise attack me with them. I love that you don’t wear a scarf over your face anymore and even have dance parties with me in the hallway if I’ll play some Taylor Swift for you. 

I wish I could convince you of how precious you are. Like so you actually believed it. You are worth something that is much greater than you can imagine, not because of how your face looks or where you live or anything you have done, but because you are made in God’s image and you have a beautiful soul that will live forever. 

I’m so glad we are friends, Tahina. You may not know it, but you have changed me too. If you were the only patient I had met or taken care of here in Madagascar I would have happily come because you are so worth it. You are loved, Tahina. Not only by me but by so many others here on this ship. I hope you know and feel and believe that now and for the rest of your life. Keep being brave and beautiful, dear. I love you! 

Laura

  
  
 (Photos by the Mercy Ships Comms team)

Love is…

“To love at all is to be vulnerable. Love anything and your heart will be wrung and possibly broken. If you want to make sure of keeping it intact you must give it to no one, not even an animal. Wrap it carefully round with hobbies and little luxuries, avoid all entanglements. Lock it up safe in the casket or coffin of your selfishness. But in that casket, safe, dark, motionless, airless, it will change. It will not be broken; it will become unbreakable, impenetrable, irredeemable. To love is to be vulnerable.”    -C.S Lewis

I have witnessed some pretty incredible examples of love during the past couple months. Parents selling everything that they have besides the clothes that they are wearing to perhaps give their child a chance to have surgery that will save or drastically improve their life. A doctor taking time to sit and look a mother in the eye to explain to her that is’s not her fault that her baby’s lip and palate have clefts in them, that she is a good mother, and that many children don’t even survive these anomalies because of severe malnutrition. A day crew member sitting up for hours at night when everyone else is sleeping to comfort a mother who is worried about her child’s operation the next day. People who have left their homes for five or ten or twenty-six years to love people on this ship without any monetary gain. 

Most weeks I vacillate between thinking I’m doing pretty alright in the loving people well department, and feeling sadly inadequate when I recognize my frequently selfish thought patterns. Sometimes I can dwell on feelings of guilt and come up with plans to change my attitude and be a better, more loving person. But I know that love is not just feeling differently towards a person but displaying it in how I live and act, even if I don’t say anything or even speak your language. 

I’m thankful for my Savior, who has allowed me to first begin to understand and experience real love that never changes. I’m so thankful for the people in my life who have loved and do love me well and allow me to tangibly experience and grow myself through their encounters. I know that I am where I am supposed to be right now. I know that the work that has been started in me will continue. And I know that God has good things worked out for me on this journey. 

Natolotra

Last week little Natolt (his family’s nickname for him) finally got to leave the ship. I never met the little guy before his surgery but I heard stories about the tumor pressing into his neck and occluding his airway more and more each day. The nights leading up to the day of his operation were nerve racking for some of his nurses as his oxygen levels would desaturate to as low as 40%, and his breathing sounded like a train passing through the room. His dad never left his side and sacrificed hours of sleep to keep his son breathing and comfortable. 
I was introduced to my little friend for the first time in the ICU after returning from surgery. Over the next few days we tried a couple times to take the breathing tube out and let him breathe on his own but the swelling and extra tissue that are common after such a major surgery made each breath a struggle. Each time the team had to re-intubate after only about an hour. After the second failed extubation, the decision was made to take him back to the OR for a tracheotomy, which can stay in as an airway more comfortably for a longer period of time. His auntie had been staying with him during this time as his caregiver because his mother was just about to have a baby. She had been really brave but got scared when she heard about the trach. Right before the OR staff came she broke down and started crying for him. She told me she was so thankful that we were here and that I was taking care of Natolotra and that she trusted me and the doctors here to do the best thing for Natolotra but that she was still afraid. It was a moment where I realized that I really cared about her and her little nephew and was so thankful to be there with her right then as well. His trach placement went as planned and we were able to take little Natolotra off the ventilator and move him back to the ward from the ICU after the surgery. His recovery was much slower than anticipated but he definitely surprised us more than once with his feisty little spirit. One evening after the trach placement we were discussing how listless he had been, unable to stand and uninterested in anything. Not long after, we learned that his legs worked just fine when his dad left the bedside to go to the bathroom and Natolotra tried to jump off the bed and run after him. You sure had us fooled for a couple days, little guy… 

We eventually took the trach out and our next challenges centered around the trach site healing and Natolotra being able to eat and drink without coughing or aspirating. Again, we took baby steps every day and the small hole in his neck healed even better than I could have imagined with only a tiny scar showing. A couple days before he went to the Hope Centre, I went into his room to do an assessment and vital signs. He still usually fussed a bit during this part of the day, but that day he was such a good boy and let me take his temperature and pulse and listen to his lungs with a smile on his face. As I was leaving I heard a little “bye bye!” and turned around to see a tiny wave and smile. It kind of melted my heart a little bit. The next time I worked I learned that he had been discharged but that he would be coming back to the ship for an outpatient appointment the next day. As I walked down the gangway to look for them to say hi, Natolotra’s father saw me first and gave me a big hug. Natolotra was riding around in a little tractor and came over with a big smile and gave me a hug. He looked so good and was so happy and it made me so happy too. 
Each week on the wards we have thankful Thursday. This week I am thankful for the people here who help me to see Jesus a little more clearly. I’m thankful to be able to see stories like Natolotra’s from start to finish. Whether it is Natolotra’s father and his constant vigilance in making sure all of his son’s needs are met, or the kindness and humility that I see displayed every day in the fellow doctors and nurses that I am serving with, I know I’m not going to be the same after my time here on the Africa Mercy. 

Just pictures…

A few pictures from the last few weeks on the Africa Mercy!

  
D Ward! This is where I spend a lot of time. There is usually a game of jenga or dominoes going on along with those NG feeds hanging from the ceiling. 🙂 I like that you can still play games and laugh together even when you don’t speak the same language. 

  
Rachel is our team leader on D Ward. I want to be like her. She is patient, kind, humble, and just awesome. 

  
One of my peds patients in the ICU a couple weeks ago. He is still in the ward and doing much better now! We have 2 beds in the ICU and it is attached to D Ward. 

  
Deck 7 time means play time!! No nursing stuff allowed. 

   
   
We have the cutest patients!

A day on the ward…

My room is pitch dark when i wake up a little after 6 in the morning to get ready for my day shift at work. I live in a 6 berth cabin on the third deck in the middle so there are no outside windows. I remember the first night I saw my cabin incredulously thinking, “This is ALL the personal space I have?? How am I supposed to fit all my stuff on 2 tiny shelves and half of a little closet?” Now, a month later, it doesn’t seem like an issue anymore and my stuff actually fits just fine with some expert maneuvering. 
I eat breakfast quickly with other day shift nurse friends and we walk down a couple flights of stairs back to the third deck which is also home to the operating theaters and all the wards. I work on D ward which is home to the post op maxillofacial patients. The surgeries that they have had include things like cleft lip/palate repairs, facial tumor removals, maxillectomy and mandilectomies, etc. Most of us on this ward are either pediatric or adult ICU nurses because of the higher potential for there to be complications involving the airway after these specific surgeries. 
At the beginning of each shift the oncoming and offgoing shifts (both nurses and Malagasy day workers, and sometimes some curious patients!) meet together for any updates and a brief time of prayer for the day and upcoming admissions or surgeries. Then our day starts. The ward feels so different than what I am used to at home with all the patient beds right next to each other in one room, caregivers and younger siblings sleeping on mattresses under the patient beds and generally people all over the place and lots of activity going on all the time! At first it felt kind of chaotic and stressful for me but I’m getting used to running into people and hearing constant chatter from babies playing and parents conversing with each other or with the day crew. 
Yesterday was the first day that I had a little extra time during my shift to be able to play with my patients between nursing tasks. One of my patients, a twelve year old girl who had gotten a cleft palate repair, wanted me to paint her nails. Ten nail polish colors later (each finger was a different color!) she was finally satisfied with her results. We also had a little hair washing/head massage session after taking out her NG tube since she had not had her hair washed or brushed since her surgery 5 days previously. The rest of the day she proceeded to be my new best friend and follow me around the unit with her arm around my waist and communicating through random grunts and hand gestures. (Surprisingly effective when you don’t speak each other’s languages!) 
Every afternoon between day and evening shifts we take all the patients who are able to get out of bed up to Deck 7 outside. There is lots of room for children to ride tricycles around, a basketball hoop, tables to play jenga and board games and lots of times an impromptu concert with guitars and drums. There is a beautiful view of the ocean off the deck and a salty tasting breeze and it feels refreshing to be able to focus on playing and relationships without having nursing responsibilities for that one hour every afternoon. Today one of the second officers on the ship even took a couple of the nurses and patients on a tour of the ship bridge where all the control panels are. My new little friend had quite a blast and there were lots of giggles. 
As I was leaving the ward, I told her I would stop by the next morning to say goodbye before she gets discharged to the HOPE (Hospital outpatient extension) center tomorrow. Patients get to stay there between being discharged from the hospital and follow up outpatient appointments since many of them live more than a couple days drive away. I got one more big hug and squinty eyed smile as I walked out the door. 
  
D ward nurses! 

  
Exploring a local town. 

  
Yes, we do have a Starbucks on the ship. Coffee and tea breaks are taken very seriously. 

Madagascar week 1

It is hard for me to condense and put into words an accurate picture of everything that has been happening and all the changes since arriving here but I will try to give a glimpse. 

It has been, and will probably continue to be an adjustment living on a ship with 400 other crew members. It’s hard for me especially to have much less personal space than I’m accustomed to at home. But at the same time it is such a unique opportunity to be able to live in community with (for the most part) like minded people. I have already been blessed several times by someone’s encouraging words or thoughtfulness. 

Another thing about living in community though is that is tends to show me exactly how much more selfish I am used to being. I’ve caught myself thinking “How can I be most comfortable in this situation?” or “How can I feel better about myself in this situation?” I hope that through the coming months I learn to think about others needs as easily and naturally as I think about my own. 

This last week has been full of orientation and cleaning and setting up the hospital wards. The whole hospital is packed up and stored during dry dock season so it is a process to get everything ready for surgeries to start again. During the week we also got to spend some time meeting and getting to know the Malagasy day crew workers. Mercy Ships hires many local people from the country they are serving in to help with many jobs on the ship as well as being our primary translators and kind of cultural bridge in the hospital. At first I thought that we (Mercy Ships) were helping these people by giving them jobs, but I quickly realized that we would be pretty ineffective without all the help and cultural knowledge and translation that these day workers provide for us. I’m looking forward to working closely with these people and getting to know them even better. 

Patients screenings for surgeries have been going on for months, we began admitting patients to the hospital yesterday, and surgeries have just begun in the last couple hours. I will be primarily working on D ward which will be both pediatric and adult Maxillofacial surgical patients. D ward is also connected to the ICU so I will take care of higher acuity patients if needed as well. 

This next week will consist of more ICU orientation, a 2 day cultural training course, and maybe whale watching this weekend! I’m looking forward to my first shift on the ward next week and using my nursing skills again too. 

A few pictures… 

  
Lemur. Obviously. 🙂 

  
International church service in Antananarivo last Sunday. 

  
Setting up the ICU. 

  
Group medical crew photo. (Photo credit: Katie Keegan)