And as quickly as it began ...

It was just days ago that Lori drove me to the airport in the middle of a cold Saskatchewan winter's night. The Mercy Ships shirts at the boarding gate in Brussels 2 weeks ago, now all have names and stories of their journey to Conakry. And there are those with whom I have been reacquainted - Gerry from Thunder Bay; Michelle from England; Mark from Boston; Melissa from Netherlands; Michel from Germany now married to Melanie from New Zealand among many of the long term crew that remain.

And today I will leave Africa for home. The Hospitality workers have inspected my cabin; my crew bank account is closed; departure arrangements are finalized with the Purser's Office; and all of my scrubs have been returned to the laundry. I will meet with 10 others that are leaving tonight and we will leave for the airport more than 4 hours before our departure time. Our plane will be bringing fresh replacements from Europe aboard  Brussels Airlines flight 217 as we take their seats on our way home.

There will be goodbyes on the gangway, promises to return on future projects and a little sadness as we walk away from this remarkable work of God.

What do we really accomplish is so short a visit? These weren't the dates nor the duration that I would have chosen, but this very much was His time for me to be here. We may never fully know what He does through us for West Africa, but He has used this place to speak into my heart and grant me some perspective and insight as I return home to where He has placed me in Saskatoon.

Gary

Hope fulfilled

My day yesterday highlighted much of what Mercy Ships brings to West Africa.

A young mother has noticed a tumor growing from her jaw. She found the resources to consult with a local doctor only to be told that there was nothing he could do or offer for her. What the future look like for her and for her infant, now 4 months old? She has likely seen the rejection of those disfigured by similar afflications. What of her baby? Will they be banished from their community to find their way? As with most women here, she has never been to school, cannot read, and has limited marketable skills.

A father brings his 15 year old daughter with a large, disfiguring cleft lip. Taunting form others at school has never happened, as she too has never had the opportunity to learn to read or attend school. What will her future look like? Will she find the security and love from finding a partner in marriage? Will she ever experience the joy of becoming a mother? Her appearance quickly separates her from the other young women in her community.

Somehow, they each received word that surgery may be possible. They have journeyed to the port in Conakry, one with a small infant; another with an anxious father that just wants his daughter normal. But today, Dr. Parker is ill. Should we cancel them and reschedule? Will there be tme next week?

The surgical assignments are rearranged and 2 of our short term surgeons agree to proceed. The baby shadows the charge nurse while waiting for the return of his mother. Often bundled on the back of the charge nurse traveling D Ward. At other times realxed, his feet up on the desk, helping her enter statistics in the computer. Always his big, black, bright eyes eager to snuggle with whichever nurse if available.

The father sits and waits. Can his daughter really be restored? Normal?

Today on rounds both are recovering. Their future today looks very different than it did only last week. Yes, it just 2 of many. But for those 2 .....

But for the the Grace of God

Last week was such a stretch to our resources and skills. As we look ahead to our next challenge there is an anxiety, some doubt as to the extent of our preparations, questions about our abiliites. Today our case was so different. We were always able to maintain control, the surgeons worked in concert with skill and precision and today our patient have an uneventful morning, out of OR by early afternoon and settled comfortably on the ward before dinner.

Many of those that had committed to donate blood were not called upon. This time. But they were willing to put themselves out there. to work with the tiredness and fatigue that comes with anemia. I thought they might start passing our iron tablets at meals for all the crew that were a few pints of blood short.

So close to being sent away. Another dream was realized today. There is a real sense of grace at work post-op on D ward tonight.

Love with abandon

It has truly been a remarkable journey for me with Mercy Ships in Guinea. I have worked in mission healthcare in Canada, Kenya, Ecuador,Jamaica, Togo, Benin and now Guinea. Not that life on board the Africa Mercy is ideal, but the unconditional, effervescent, sacrifical love lived out by the volunteer crew of those servicing on this hospital ship takes your breath away some days.

Many of the patients that present for surgery here have been rejected and ostricized by their communties and even their families. Those with enormous, disfiguring facial tumors hide behind scarves and head wraps; the fistula women suffer as their wetness and odor have separated them from any hope of a normal life; and children with deformed legs struggle to limp or crawl while they dream of a normal childhood. Rejected and broken they are not worthy in a culture where different is often equated with cursed.

As they are admitted to the ship without exception they are loved with abandon. Looking into their eyes they are welcomed, encouraged, loved, hugged, kissed, laughed with, cried with, valued, validated, and blessed. The children spend more time in the arms of the nurses than of their parents. These unusual people with a different skin and language embrace them in a way most have never known. though we speak of it in our hospitals, this staff has truly been "released to care".

Last week we had 2 patients both with B+ blood type come for major surgery. This is not a common type among the white population but reasonably common among the West African black peoples. 17 units of  blood were administered to these 2 patients. All donated from among the crew of the Africa Mercy. This week another man presents with an enormous parotid tumor, also expected to experience great blood loss. His surgery will be challenging and this is one of hte few weeks with 2 surgeons on board with the specialzed skills to manage the surgery. Without blood we would need to send him home. We were sure that all of our B+ donors had already given all that they could. We asked the crew to pray. God worked as we saw many of those that have recently joined the ship come to be tested and mnay of them found to be B+. Surgery is scheduled tomorrow and booked for 7 hours - with sufficient blood to safely proceed.

It is most certainly true that you couldn't pay people enough to work and give like this. But they are not working for a wage or for Mercy Ships but have chosen to bind together to be God's hands and feet and heart and very lifeblood to bless those abandoned by their world.

I have been truly blessed to be a part. Thanks for your prayers.

A Parent's Sacrifice

I have been doing cases in the eye room these past few days. We will do over 20 children with cataracts over the first few weeks of this year. One family had a son with congential cataracts, unable to see much more than light and dark. They lost everything seeking help. Several surgeries later his left eye was hopelessly damaged and sightless, his right eye had developed a dense secondary cataract blocking sight in his other eye. They had sacrificed everything to gain sight for their son - and they were now no further ahead.

We were able to remove much of the obstruction from his functional eye and should resotre reaosonable vision if only in one of his eyes.

Only a parent can really understand the sacrifice one would make for a child, and only a parent could understand the hopelessness and frustration of sacrificing all for a child and yet without effect. I am reminded of the incredible sacrifice that God made and how much He must long for us to walk with Him.  

Trust

I had the privilege of working with Dr. Gary Parker today. There is a gentleness and confidence that envelops his OR. There is time to speak personally with each member of the team. There is tme to teach the medical student, to illustrate principles to the national physicians, prayer is offered for each patient just before scalpel meets tissue. We are all richer for working in Theatre 4 today.

A young mother travelled 8 hours from "up-country" to bring her 1 year old child to this intimidating white structure in the Conakry port. Born with a bialteral cleft lip and palate his upper face and the roof of his mouth were splayed open. He was never able to breast feed, and the powdered formula that she had been feeding him with forever leaked out the front of his face and through his nose every time he eats. What will their future look like? Can they really trust this ship full of white prople to actually "fix" her broken child - for free?

3 hours later a happy mother held her contented baby, his face intact. There is still more surgery to come, but not for a few years. The deficiency of tissues on the inside of his mouth will make it difficult for him to peak normally. Once he grows he will need another procedure, but today he looks "normal".

A middle aged man has a long standing sore on his face that proves to be cancer. He had had many treatements over years, with no effect. To cure him from this cancer will not be straightforward. It is simply too large. He will lose a portion of his nose, the right half of his upper lip and a large portion of his right cheek. Yes, we all agree the cancer needs to be removed but how do we cover  the large portion of bone now exposed on his right face? Like the baby, we cannot complete his "healing" today. Unlike the baby, he looks far worse after the procedure than before we started. We took a large portion of his lower lip and sewed it into position to cover much of the exposed bone. When we finished he had two holes as mouths. His face was disfigured. But there is hope. In three weeks we will release the flap and as we sew it into its new position he should be restored. Normal, other than a slightly smaller right nostril.

Both of these have chosen to trust us. The young mom now has her son restored. The man will have to continue to trust us that this disfigured condition that we have left him with is only temporary. The reality that he sees tonight in the mirror is not the final result. It has been a vivid reminder for me to look beyond what I can see today, and believe in what I know to be true.

A Weekend to Reflect

I was on call Saturday. In my pocket were the keys for hte OR and a pager attached to my belt in case there should be a need to return to surgery with one of our post op patients. The only restriction was that I needed to remain aboard ship. Many of the others chartered a small boat to one of the surrounding islands and in a 40 minute trip with only a little bailing of water, they arrived safely. Shortly after their arrival they had some locals take orders of fish for lunch. It would seem that they then went to catch the fish that had been ordered. It took several hours before their lunch arrived but all were able to finish before the small boat left for the port.

I spent a few hours on Deck 8 in the African sun. A little reading, a short nap, some visiting with some surgical colleagues, and some realxing at Starbuck's in the evening.

Today, I spent some time reflecting on my time here and tried to write some suggestions to consider for enhancing the surgical progam aboard the ship as well as some ideas for their next initiative where Mercy Ships will be mentoring local physicians and training health care providers with additional skills to use in their local hospitals.

A few hours this afternoon were spent at the Riviera Hotel. They allow Mercy Ships staff to enjoy their pool and facilities as long as we buy some food or soft drinks at the restaurant. One of our shipmates felt as though we were in the midst of a spy novel. there was an interesting mix of African, Libyan, Mediterranean, Chinese, and English sitting in an open restaurant with Middle Eastern music playing, "hooka" pipes and cigarette smoke wafting across the cement floor while a few others lounged in the pool. Felt like an Indiana Jones movie.

A remarkable change saw our lady form Tuesday and Wednesday vastly improved today. She ventured to Deck 6 to sit with other ward patients in the sunshine soaking up the warmth of an African afternoon. Amazing!

The slates are set for tomorrow and several staff have returned home and a few more are to be welcomed at the staff meeting after breakfast. A new week ahead, a ward full of expectant patients looking forward to the possibility for surgery.

It takes a village...

There are many of us that come to the Africa Mercy as short term staff bringing an eclectic package of skills and abilities. This week there were staff representing 30 countries on board. We offer what we can and work alongside some of the most gifted missionary surgeons on the globe. This week I have had the opportunity to spend time with Steve Arrowsmith as we shared stories int othe early hours of the morning at the bedside of one of his patients that had dramtically deteriorated after a very simple procedure. While waiting for lab and xray results he shared some of his stories as a missionary surgeon with his young family in Nigeria and Ethiopia. It has not been an "easy" assignment. While on assignment they have survived a Lassa Fever epidemic; have been held hostage; suffered malaria infections; and significant HIV exposure. And yet, he is convinced that he has the "Best Job in the World".

Mothers Day the NY Times ran an article on their work. I tried to paste the article but it is probably better to just send the link and you can read it properly formatted. http://worldwidefistulafund.org/in-the-news/ 

To understand the scope of this condition, PBS presented a remarkable video highlighting several Ethiopian women with VVF and its imapct on their lives. Below are links to the video at both PBS and YouTube. 

http://video.pbs.org/video/980049841/

http://www.youtube.com/watch?v=3w-fOmovijc

This week each surgical team is led by surgeons, remarkable not only for their surgical skills but for their passion and love for patients cast aside by their communities. I feel very humbled to work as a part of their teams, privileged to step into the story of what God is doing in West Africa. 

A Bright New World

The past 48 hours has been spent working alongside Glenn Strauss. An opthalmologist from Texas, Glenn has spent years aboard Mery Ships and has developed a unique approach to cataract surgery in Africa. He has pioneered an approach as effective as the traditional North American approach but at a cost less than 10% of that in North America.

We operated on 4 children this week ages 4,6,6 and 10, each with very dense cataracts that have been present since early childhood. At best they could see only shadows. They knew the voice of their parents and siblings well, but had not seen a smile of approval; witnessed a spectacular sunset; experienced the vibrant colors of God's creation; or had the opportunity to learn to read. Wearing thier new "fashion" sunglasses to protect thier eyes from brilliant sunshine, it was great to play a small part as they walked down the gangway into a new future. 

The joy in the face of a parent whose child can now see.... Priceless.

Walking at the edge

This week we walked right to the edge with a woman that had presented with a massive parotid tumor that had grown to a size almost as large as her head. I was not scheduled for this case. Our Norwegian colleague was ill this morning so I joined on of the long term anesthesiologist to help a visiting ENT surgeon remove this tumor. This frail 40 kg West African woman had such a large mass that we needed to secure her airway awake. It was difficult but between 2 anesthesiologists and a surgeon her airway was secured and the procedure started.

Within minutes torrential hemorrhage ensued. Bleeding from everywhere, the surgeons struggled to gain control. Blood pressure was soon I recordable, the pulse oximetry quit working as her bleeding continued unabated. Her kidneys shut down, we used all of the B+ blood on the ship and searched for  any other crew that might be B+ and willing to donate. We finished the procedure but as the bandages were applied her wound swelled dramatically and we needed to re-open to try to control bleeding out of control.

Her clotting factors and platelets were exhausted. Blood oozed from everywhere. Her blood pressure had not been recordable for hours. As a last result 6 large surgical packs were sutured in place and the patient taken to the small ICU. The ship was praying but would she survive the night? If she did, had she stroked because of her severely depressed BP? Would she die a slow death from renal failure as her kidneys quit working?

Stable overnight, we returned to the OR in the morning to remove the packs and ensure there were no further bleeding sites. Back to ICU at noon, her kidneys started to work, she woke up, and by the afternoon was off all BP medications and was able to be separated from the ventilator. By evening, like so many of our facial tumor patients, she was asking for a mirror to examine our handiwork, ecstatic to be rid of this enormous tumor that had consumed her life.

It was truly remarkable to work with this team pieced together with members from many countries, working together for the first time on this case. Members of the crew lined up to donate blood for a frail African woman much closer to eternity than to the OR of a hospital ship anchored in the Conakry harbour. We offered all that we had and God did the rest.

Many remarkable stories play out each week aboard the Africa Mercy, but this week even the most seasoned of the medical staff were in awe as one poor, forgotten African walked to the edge of eternity for a chance at a new life.





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Moving into the Neighborhood

This is my first full day aboard ship and have completed the Orientation tour, set up my email; established phone contact with home (even though everyone is away somewhere, I managed to leave some presonal reflections on the answering machine); checked out the latest AFM Starbucks pricing (yes, everything still less than $1) ; sequestered a few scrubs for work tomorrow; found my OR assignment lists; and changed a few US dollars into a great stack of Guinea Francs. I read a recent posting from Susan Parker and it really challenged me as to the impact that this ministry has in West Africa.

Gary

 Dr. Gary and Susan joined Mercy Ships in 1987. Gary is the Africa Mercy's chief medical officer and maxillofacial surgeon and Susan is an executive assistant to Donovan Palmer.


Moving into the neighborhood.

“The Word became flesh and blood, and moved into the neighborhood...” John 1:14 The Message

I (Susan) am taking beginning French for something like the sixth time. My Guinean tutor, Prof. Mohammed Kaba(i), first endeavored to impress upon me the importance of learning to conjugate four French pillar verbs (pouvoir, vouloir, devoir, and aller[ii]) back in ’98 when the Anastasis was last in Guinea. I still don’t quite have them, but with five more months in Conakry, this just may be the year...


Gary and I met up again with Professor Kaba shortly after the Africa Mercy docked in Conakry. We didn't remember this--but the Professor fondly recalled how fourteen years ago, as the Anastasis prepared to depart Guinea, Gary had thanked him by name during his televised “farewell to the nation” address. Prof. Kaba wanted us to know how honored he was to have been acknowledged publicly for his contribution to Mercy Ships’ Staff Development.

The Professor, a devout Muslim, prays five times each day, attends mosque on Fridays, and spends a great deal of time both studying and teaching the Q’uran. Finances permitting, he’s hoping to make the Hajj[iii] next year – so, It would probably be safe to assume that he’s not looking for a new belief system. Yet, the Professor mentions repeatedly that when he’s on board the Africa Mercy, he has this strange feeling inside--like he never wants to leave. Now, before you’re tempted to dismiss this as nothing more significant than the air conditioning, or perhaps the atmosphere at the Starbucks Café where we often share a café au lait, you should know that the Professor also teaches at the American and Saudi Embassies--and we’re pretty sure they have a/c.

Besides drinking coffee and discussing the basics of French grammar, we talk a lot about what’s going on in Guinea. Last month, the papers were full of this story:

CONAKRY, Guinea November 10, 2012, (AP) — The head of Guinea's treasury was gunned down as she was driving home in what her colleagues describe as a brazen assassination aimed at silencing [Mrs. Boiro} an official who had launched an investigation into the disappearance of millions in state funds... Guinea has a long history of allowing officials to pillage its treasury. During the last years of ex-President Lansana Conte's rule, employees of the treasury said they would routinely see the president's convoy drive up to their building and leave with bags of cash. Mrs. Boiro had zero-tolerance for corruption and was intent on putting an end to the mismanagement of state funds, say two of her colleagues. She had launched an investigation into the loss of 13 million francs ($1.8 million) which [recently] went missing from the state coffers...”

The Professor confided that following Mrs. Boiro’s murder, it seems to him that Conakry is becoming more and more lawless. He, who was an enthusiastic supporter of the highly educated and human-rights conscious, President Alpha Conde, now wonders aloud if Guinea might not be better off with a strongman--someone who is able to keep order with an iron fist.

On board the Africa Mercy, we’re observing Advent--the coming of God’s anointed One--that pin-point in time 2,000 years ago when “the Word became flesh and blood, and moved into the neighborhood.” Jesus “moved into” a Bethlehem neighborhood, just five miles south of Herod the Great’s Jerusalem Palace in Roman controlled Judea. If ever there was a strongman who ruled with an iron fist, it was Herod the Great, appointed King of the Jews by the Roman Senate. The Roman Empire established and maintained their rule over the land of the Jews through forcible external means. While this period known as Pax Romana, brought peace and prosperity to the citizens of Rome, it was neither of these for the working class Jew. Yet, this was the time and place where the God revealed in Jesus chose to step into our world. It wasn’t when Israel was on top of her game that He came. It was not particularly comfortable, nor was it safe. It was a time of injustice, of suffering and of great fear. And Jesus moved into that neighborhood.

German medieval mystic, Meister Eckhart, made this provocative observation:

“What good is it to me, if Jesus was born to Mary 1400 years ago, but is not born in my person and in my culture and in my time?”

Maybe the Professor was on to something significant when he said that he has this feeling on board the Africa Mercy that he never wants to leave. Could it be that the presence of Jesus is in the neighborhood? Gary and I are convinced that each and every one -- whether you work on board the ship, at one of the National Offices, or at the IOC—together we are establishing the presence of Jesus in this Conakry neighborhood, at this particular time.

And guess what? The neighbors are beginning to notice!

And so this Advent season, as we sing, “O come, O come, Emmanuel, as we bend to light the candles of hope, of joy, of peace, and of love, and as we ponder the mystery and wonder of the incarnation—may we not also remember to breathe a prayer, sing a song, or read a scripture over Guinea?

And to each and every neighborhood where we find ourselves, may we continue to collectively declare with our words and with our lives:

Peace on earth and goodwill to all humankind.

Grace and Peace,

Susan and Gary

Guinea

It is all too familiar. Sitting at the gate waiting to board in Saskatoon after a long discussion at the check-in counter where they struggle letting me board a flight to a West African country without a visa in my passport. Long security line ups, other flights delayed due to mechanical problems, dogs in little baskets, tired unhappy kids awoken much too early.

I fee unsettled, ill-prepared, and restless. Our renovations are a long way from complete, and the pressures of living in the midst of construction are taking their toll. And yet with all this opposition from the enemy, maybe God has something very special ahead....

I will keep you posted as best I can.