Wednesday, March 26, 2014

Africa Mercy - A Small Piece of Plastic: One Nurse's Journey

Hi. Another post from Marilyn in Africa, my dear friend on board the Africa Mercy. Some of the blood pressure readings and sugar counts for diabetes are "pretty generous," she writes. In the United States they would be disqualifiers for all the surgeries the doctors do, but apparently, the medical staff has little choice. It's hard to fathom. As typical, Marilyn is positive and optimistic through it all.

I was also reading in the newspaper this morning about an Ebola outbreak in Guinea, where the ship sails next. The article said that the outbreak may be headed for Pointe Noire (Congo), where they are at present. Marilyn writes about the Aids epidemic and some of the tumors that result they are dealing with, but I worry about the Ebola virus headed their way. Those of you who pray, please remember Marilyn and the Mercy staff in your prayers!

(This is a running email post written by a volunteer nurse serving on the
Africa Mercy, a hospital ship that travels the African coast).

(Pointe Noire, Congo)
 21 March 2014

It has been a long time since I've written. Time seems to melt like
Marilyn in front
butter around here! We have only 3 1/2 weeks of cataract surgeries remaining because our surgeries need to stop well before the ship leaves to allow time for proper followup. The ship leaves Congo the
end of May, so our eye surgeries end mid-April. For myself, since the surgeries are done mid-April, I plan to leave for home shortly after that, and then return to the ship in early August, in plenty of time to sail for Guinea, our next port of call.

So, what have I been doing, week in and week out? In one sense, every week is about the same--preparing patients for surgery starting at 0645, sending the last one home around 4:30 or 5:00, on Monday through Thursday. Then, I am working with the field team and having meetings on Friday. On weekends, I do whatever personal chores need to be done, but mostly I rest.

But...that description is deceptive. It sounds regular, steady, predictable...but in reality, it certainly doesn't feel that way. It seems that every day brings unexpected twists and turns. Perhaps it will rain, destroying any "timetable" we think we have. Perhaps six patients will not come and we need to find substitutes...or two extra patients will show up on the wrong date and expect surgery. Perhaps the surgeon will go fast and have no complications, and we struggle to keep up. Or perhaps he's training another surgeon, and they go really, really slow. Or they suddenly start running two surgical tables simultaneously without telling us, and we can't get enough patients ready in time to keep them busy. We think they'll be done by noon! Oh, wait, complications pile up, and in fact they are not done until 6:00 PM. (Yes, we did have such a day...)

Our patients range from 14 to 98. Many younger children also have cataracts, but they require general anesthesia instead of a local nerve block, and this year, we do not have that capacity. In addition to having a surgeon skilled in working with children's cataracts, we would also need an anesthesiologist who works with children. The ones that we have are fully booked for other types of surgery this year. Perhaps, next time we come to Congo, we can help the children, too. I hope so.

We've tightened our policy concerning blood pressures and blood sugars. Our blood pressure limit is generous--200/110--but now we have to send patients home if their pressure is higher than that, instead of just giving them medication to lower the blood pressure temporarily for surgery. We tell them at screening to see their doctor and get it under control, and then we call them (if their phones work...) and remind them, and still, some days we have four or more people arriving with blood pressure over the limits. Sometimes, if we let them sit on the dock and wait a couple of hours, the pressure will come down. If it does, I sure don't take it again! If it doesn't, I eventually send them home to get better medication and return to the clinic for a recheck before we reschedule them for surgery. The procedure is the same for blood sugars. Our limit is 200, pretty tight control for a diabetic.

Uncontrolled diabetes really wrecks eyes, though, so maybe in the long run we do them a favor by demanding that they figure out how to get good control before we do surgery.

Actually, I've been amazed at how many blood pressures do drop to just barely within the limits, allowing surgery. We pray, of course, and it certainly looks like answers to prayer when their numbers drop from 254/125 to something like 198/110 or 200/106. Just barely under the wire feels like God puts his thumb on the number and pushes gently down.

If it happened once in a while, I'd think coincidence, but it happens so often that it feels deliberate. In my life, anyway, I find that God often does "just in time" and "just barely enough", almost like a fingerprint, so that I do see his hand at work in the situation. It's not the big, splashy's the still small voice.

Normally, we do two types of surgeries--cataracts and pterygiums. Pterygiums are growths of tissue caused by irritants like dust and sunlight. They grow gradually from the edge toward the center of the eye, and eventually obscure vision if not removed. Lately, however, we've done several patients who have a cancerous tumor that looks a lot like a pterygium, but isn't. This particular type of tumor is strongly associated with HIV infection, so we offer these patients a blood test if they want to know their status. It's a delicate situation because a diagnosis of HIV/AIDS can be socially devastating, and yet, anti-retroviral treatment is available for free in this country, so not telling them of our suspicions could deny them the chance to get early intervention and longer life.

Two of these patients are heavy on my heart tonight. One was a young pregnant woman we had last week. Her test came back positive. I wonder what her husband will say, and I wonder if the baby will be all right. We did get the tumor off her eye...but that pales in the light of her greater problems.

This week we had another young woman with an even larger tumor. It was so large, in fact, that the surgeon felt he couldn't remove it under local anesthesia. It took quite a bit of negotiation, but our team leader got her scheduled for general anesthesia next Tuesday. Alas, her blood test also came back positive, and her counts revealed that she has full-blown AIDS. Her counts are so low that I'm not sure they can proceed with the surgery--but again, that's the least of her problems.

I can only imagine what it must be like to think that someone is going to remove a small growth on your eye...well, no, it's too large... and it's not just a growth, it's's not just cancer, it's associated with HIV...oops, you are not only HIV positive, you have AIDS and are too sick for surgery. Her world has crumbled step by step over the last week or so as we deliver one piece of bad news after another.

Meanwhile, many people are receiving their sight. If I have a stressful day, or if I focus too long on those we can't help, it is good to come back to that bottom line. Many people have their lives transformed by something as simple as a small piece of plastic cleverly lodged in their eye. Every once in a while, I try to walk down the hall with my eyes closed just to remember and appreciate the incredible blessing of being able to see. Hundreds of people in Pointe Noire are receiving this blessing, and I get to be a small part of making it happen. Now that's job satisfaction!


[Click here to learn more about the nurses and doctors on board the Africa Mercy]


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