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!
---Sharon

(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 answer...it'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 cancer...it'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!

Marilyn


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

Africa Mercy - Square Wheels: One Nurse's Journey

Hi....another email post from Marilyn in the Congo on the Africa Mercy! The challenges continue, this time with a large turn-over of personnel and translator problems, but the beauty of Mercy's mission to aid those who otherwise lack access to health care has not changed and God continues to provide.

Marilyn is now on Facebook and I urge all of you interested in her  journey to connect with her there. She has posted some new photos. You might want to mention you discovered her at my blog, so she doesn't think you are some spammer. For now, I will continue to post her letters.

(This is a running email post written by a volunteer nurse serving on the Africa Mercy, a hospital ship that travels the African coast. In your charitable donations please remember this worthy organization).


January 19, 2014
Square Wheels

 In honor of the new year, I've started something new--facebook! Not that I know what I'm doing... Anyway, if you want to "friend" me and I haven't found you to ask you yet, maybe you could let me know how to find you on facebook, if you are there. Hopefully, the more savvy folks around me will help me to figure out privacy settings, messages vs. timelines, and so forth. And maybe facebook will help me to know what's going on in your worlds, if I can figure out how to navigate it without spending all my waking hours poking around.

We've had three weeks of surgery since the Christmas break. They have been difficult weeks, in a way. There's a large turnover in personnel at the end of the year, a problem that seems to have affected the OR particularly hard. Not only did we have a new surgeon, we had a new team leader in the eye OR, new nurses to assist and to scrub, and new translators. They had to reinvent the wheel back there, it seems, and that slows things down. Then, they were having a lot of difficulty with the new translators not showing up for work on time and taking unseemly long breaks when they did show up. Our eye patients only get a local anesthetic, and they need to be able to cooperate with instructions during surgery. The whole system breaks down if we can't communicate.

The OR solved that problem by borrowing one of our translators from the peri-op room. Ordinarily, that would have been a hardship for us, but the OR was working so slowly that we didn't have any trouble keeping up with them.

Because of the difficulties in OR, our work in the peri-op room was tedious, with long hours of boredom waiting for patients. We start more than an hour before the OR does, preparing the patients, and we stay half an hour after they do to discharge patients, so we were "working" eleven hour days, but accomplishing little, with only ten patients per day. After a couple of weeks of this, our day crew got restive. The harmony of our little team started breaking down. When we keep them until after 4:00 or 5:00 PM, it becomes difficult and expensive for them to get home; they started demanding changes. We are looking at some options, but haven't solved the problems yet. It has been a bit disheartening to see the camaraderie of our team fraying at the edges.

One obvious solution is to do fewer surgeries until the OR team gets up to speed. That is not a good solution for a couple of reasons: 1. fewer patients receive their sight (this is the reason that resonates with me...), and 2. we are under a tremendous amount of pressure to reach our target numbers to keep both the donors and the Congolese government happy. (sorry, my gut reaction to that isn't very nice.

Maybe it's a good thing I'm not the manager who has to deal with these realities.) Compounding the problem, one surgeon scheduled for two weeks in February just canceled, and last-minute efforts to fill the gap were unsuccessful. So, that's another 100-120 surgeries not able to be done. Our team leader is trying to make up some of the difference by pushing the surgeons she does have lined up to do more surgeries each day than originally planned. In the peri-op room, it feels like we're between a rock and a hard place...

Have you ever contemplated the mystery of life? For an organism to survive, every single function of the body must be in working condition at all times. If the heart misses 6 beats, you're toast. If the liver, if the kidney, if the brain... Have you noticed that even when you have something as minor as an infected toe, it affects the whole body? So it is with organizations trying to perform complicated tasks. If you haven't got a translator, if someone in the home office fails to order supplies, if a surgeon's family member gets sick, if, if, if... you have to have it all, or you have nothing. 

While not as complicated as what even a single cell must do to stay alive, still I find it a marvel that Mercy Ships can keep on functioning despite the obstacles that arise. When everything is functioning smoothly, we're traveling on nice round wheels. These last few weeks have felt like square wheels most of the time, and one day, I declared we even had triangular wheels. Not a smooth ride! And yet, still I see the Lord's hand of provision. Patients continue to receive sight. We do still function as a team despite the challenges. The mission of Mercy Ships goes forward, pretty much on course. 

Blessings,
Marilyn


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

Africa Mercy - Heartwarming Stories: One Nurse's Journey

Just in time for Christmas, here are two heartwarming stories from Marilyn in the Congo. Learn more about the African people this amazing ship serves, and how faith in God is behind it all. ---Sharon


(This is a running email post written by a volunteer nurse serving on the Africa Mercy, a hospital ship that travels the African coast. In your charitable donations please remember this worthy organization).

December 20, 2013

Greetings, my friends,

I like to share two stories with you, stories that make me smile, stories that make me grateful to God not only for my own blessings and good health, but also for the privilege of being here to help extend God's compassion to the people of Congo.

Earlier this week, our field team conducted a routine eye screening at a small out-of-the-way church in one of the residential neighborhoods of Pointe Noire. What wasn't routine, however, was the appearance of one of the first people in line. A twelve year old boy stood there with his father, his face disfigured by a large, weeping tumor covered in bandages. Nothing wrong with his eyes? Good, go home!  Next!...No, that's not how it played out.

He wasn't a candidate for cataract surgery, but he sure would have been a candidate for maxiofacial surgery, had we been screening for that. So, stop the presses. What can we do? Ask more questions.

It turns out that the boy lives far away, and they only heard about    Mercy Ships last week.  Filled with hope, father and son traveled for ten hours to reach the ship.  They couldn't find a screening for tumor surgery (that was done last September...), but undeterred, they sought us out anyway by coming to the eye screening site. How they found us at that little church, I'll never know.

It took a few phone calls, but we got clearance to bring the boy to the ship for further work-up on that very day.  He and his father rode to the ship in the eye team vehicle after the screening was done. That boy was radiant with joy, and full of hope. By the end of the day, he'd had a CAT scan and lab work done; he'll most likely have surgery sometime in January.  What a different life he'll have without that tumor on his face. What initiative and perseverence his father showed to give him that chance.

My second story concerns a young man, age 19, who has been completely blind for many years with dense cataracts.  His mother was afraid for him and refused to allow surgery by the local surgeons. (From what I have seen, she was probably wise in that decision...) Sadly, his mother died a year ago, so now he lives with his aunt. Mercy Ships came to town, and together, they decided to risk surgery. He had his first cataract surgery a week ago. He was brave, but during surgery, he called out to mama...her dreams for his future, grief, and hope all intermingled in that one word.  Well, her dreams and his hope were rewarded--he had nearly perfect vision in that eye even on the day after surgery.

A week later, we operated on his other eye. Oh, oh. According to the measurements, he needed a very different lens in that eye--four diopters different, which is huge. That's not usually the case--people's eyes tend to come in a matched set. What to do? Were the measurements wrong? Dr. Wodome, a very competent and confident surgeon, was in a dilemma over which lens to implant, one that matched the measurements, or one that matched the other eye, since that one had worked so well? The team stopped for prayer, and the surgeon chose to match the lens to the measurements. Results? Nearly perfect vision in the second eye also. His two eyeballs really were different lengths. It's good to work with a surgeon who seeks God's guidance in making decisions.

A new year is soon here, and what blessings will we find awaiting us? I feel like I'm living in a wonderful pagaent of God's grace. It reminds me of the Exodus miracles--not so dramatic, of course, but clear evidence all around me of His compassion and His active involvement in the affairs of men. I am blessed every day just by being here, in my ringside seat.

Marilyn 



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

Africa Mercy - Surgeries, Excursion, & Slaves: One Nurse's Journey

Sorry to be so behind on my blogging schedule. Not sure I have a schedule, but I have aimed for more than one blog post a week! Here is another email from my friend in the Congo. She is learning so much! ......Sharon




(This is a running post about a friend's journey as a nurse on the Africa Mercy)

2 nov 13, Surgeries, Excursion, & Slaves

Greetings:

First, an update on surgeries:  In general, our surgeons come for 2 to 3 weeks, tucking their time with us into their vacation time from their regular practices.  Dr. Guy was with us for two weeks, and he performed over a hundred cataract surgeries while he was here.  The results have been very, very good.  Many patients could see well from the moment the eye patch came on the day after surgery; others had some edema which cleared by their two week checkup, and their vision improved correspondingly.  That's actually the more normal scenario for cataract surgery.  I've attached a picture of the man I described last email, rejoicing over his restored sight.

 Halleluah! Man praising. Marilyn on right in blue.

 We now have a gap in the surgery schedule--no surgeon for three weeks. Normally, I'd say that this is very sad--all those potential surgeries not being done--but perhaps it's a blessing after all.  We are having trouble lining up enough patients to fill the surgery schedule as it is.

 We're not sure why--I would suppose there are several factors.  This is our first time in Congo, so we don't have the reputation here that we have in West Africa. I imagine that there are many who have adopted a wait-and-see attitude.Also, Pointe Noire is a much smaller city than other places we have been, and the extended follow up required for cataract surgery makes it hard for out-of-town patients to come.  Then, too, Congo seems to have more health care available for those who can afford it than does West Africa.  There are surgeons here who do cataract surgery.  That seems to be a mixed blessing.  We see quite a few people who have had cataract surgery, but they can't see.  Most surgeons here--maybe all--don't put a new lens in place, they just remove the cataract lens.  That gives people more light and color, but no focused image.  Of course, we probably aren't seeing patients whose previous cataract surgery has gone well because they don't need us--and who knows how many of those there are?  Whatever the reason(s), we are not getting the expected numbers of people at our screenings, and therefore we are not getting the number of patients scheduled for surgery as we expected, and need, if we are to keep our surgeons busy when they come.

The Gorge - near Pointe Noire, Africa



On another note, let me tell you about our excursion yesterday.  Pam and I took our day crew plus several others out for a day of exploration and fun.  We went to The Gorge, a beautiful area about 15 miles outside of Pointe Noire.  Our three day crew have lived their lives in Pointe Noire, but none of them had ever been to the The Gorge before.  Fifteen miles sounds close--but it's a long walk if you don't have a car.

Anyway, the Gorge consists of red cliffs in the midst of jungle leading down to the ocean.We hiked for a couple of hours along a trail leading from the top of the Gorge all the way to the ocean.  (They didn't think I could do it!  And they did have to help me in spots...)  At the end of the trail is a beautiful sandy beach, and it is even free of debris and garbage.  There is some very lovely scenery here in Congo.

On the way to the Gorge, we stopped to visit a very beautiful, very sad place.  Apparently, Pointe Noire was a major port for slave traders.  We visited the bay where two million people were shackled, counted, labeled, and shipped to serve as slaves in Europe and America during the heyday.  You read about it, you see movies about it, but being at the actual site brings great sadness as you ponder the reality of man's inhumanity to man--and not just historically.  It's not happening at this location at this time, but elsewhere, people still suffer.  Being there also sparked a bit of introspection--am I free from the all-too-human tendency to use other people for my own ends? Perhaps I am not a slave trader because I was born in a different place and and different time, not because I am essentially superior. I grieved for the slaves, but also for the slave traders, caught up in an evil they didn't even see.

Well, enough philosophical musing.  Next week, since we don't have surgeries, I will be involved in some special screening days.  We have given tickets to all the Congolese day crew so that they can bring people they know who have cataracts to see if we can do surgery for them.  I hope that many people do come, because I know that there are many people here too poor to afford cataract surgery from the local surgeons, no matter how excellent their surgical technique is, or isn't.

We can do a lot of good for many people, if only we can find them and get them scheduled.  Maybe our day crew will find them for us.

Blessings,

Marilyn

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

Africa Mercy - Reaching the Summit: One Nurse's Journey

Hi......Cataract surgery is something we take for granted here in the United States. All of us can probably think of at least one person who has benefited from this life-changing surgery, and there are few if any complications. Imagine the joy of being able to see again, after waiting for months (maybe longer) for the Africa Mercy to arrive. Marilyn shares the excitement of one such day in the following post. How I wish I could have been there!     Sharon

 (This is a running post about my friend's journey as a nurse on the Africa Mercy, a hospital ship that travels up the coast of Africa)

15 Oct 2013

Today was a mountaintop day.

We finally started cataract surgery yesterday, after two months of training and preparation.  We've done many screenings to select patients, and we've seen quite a few people in the clinic for a more thorough eye exam.  Those patients who qualified for surgery have been waiting for their big day...and for some of them, that day was yesterday.

Actually, their big day was today.  After surgery, the patients have an eye patch for 24 hours.  So yesterday's surgery patients came today to have their patches removed.  It was the moment of truth--and what a moment it was!

The patients arrived around noon and were seated on benches facing each other. It had been raining, but now the sun was out, and it was hot even in the shade of the canopy. But the atmosphere was charged, expectant, suspenseful.  One of the day crew started taking off the eye patch from the first man in line. The crowd held their collective breath.  As the patch came off, the man jumped up and started shouting "Hallelujah."  Someone held up some fingers for him to count...and he could.  With every finger count he got correct, the crowd went wild.

Soon they were all singing and clapping and even dancing.  One by one the patches came off, and the people rejoiced.  We had quite a crowd--patients, caregivers, workers, kids--so it got to be a very spirited party right there on the dock. Several of our day crew were openly weeping, overcome with emotion to see the first fruits of all their labors.

 Our very first patient to have cataract surgery yesterday was a little grandma with a lot of spunk.  Once she could see again, there was no holding her back.  She was practically running to get onto the ship for the doctor's post-surgical exam.  Suddenly, she stopped dead in her tracks and her eyes got big.  "The boat is so large!  I had no idea it was so large.  I couldn't see it yesterday when I was here."

We brought all twelve of yesterday's patients into the ship for their follow-up exam.  They were all lined up in their chairs...until the singing and dancing broke out again.  We did eventually get them all examined, and they went on their way rejoicing.  I tell you, it was an afternoon to remember!

These people received their healing as a gift from God, and rightly so. God planted the vision of Mercy Ships, and he has brought the vision to fruition.  This is such a complex project, with so many obstacles to overcome, it just wouldn't be possible if He didn't facilitate it.  And to think that it is done by a bunch of volunteers, just ordinary people that God has called to come play with him.  I count it such a privilege that there is a place for me here, a ringside seat to watch him work, an invitation to join him in the fun.

Blessings to you all,

Marilyn


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

Africa Mercy - Moving Along Gently: One Nurse's Journey

Hi. Another interesting post from Marilyn in the Congo, my longtime friend serving as a nurse on the Africa Mercy. Her posts are a treasure trove for those considering a similar journey, and a window in for those who never will. I love her story of the little boy at the end, how one small life can make such a difference. It gives hope for those in the future....Sharon

(This is a running post about a nurse's journey on the Africa Mercy, a hospital ship that travels up and down the coast of Africa)

9/26/13

Moving along gently

 Pam, one of my teammates, was gone for two weeks to attend her daughter's wedding. It didn't seem to me that she'd missed much...but she thought so, and it's the same two weeks since I last wrote.  So, what did she miss?

Perhaps the main change has been the establishment of a routine, albeit a continually changing and interrupted one. Tuesdays and Wednesdays, we go to one of several sites around town to screen for potential patients. Mondays and Thursdays we are at the eye clinic giving a more complete eye exam to people who passed the first cut at screening. Fridays have been a potpourri, but will become clinic days starting this week.  Our first eye surgeon arrives in two weeks. Until then, we do preparation and training, shifting people around so that as many people as possible can learn to do the different jobs.

What all happens in the clinic exam?  First, we collect personal information, including phone numbers and languages spoken.  It still amazes me how widespread cell phones are, even among people living in shacks with deficient diets. It is a way of life here, an essential tool that people really depend on.  Well, we depend on them, too, in case our surgery schedule changes for any reason.

But getting an accurate phone number seems to be a challenge.      Either they don't know it, or it gets transcribed wrong, or our     western way of reading the numbers the translators write is      sketchy, or some combination of factors.

 To begin the eye exam itself, we use a Snellen chart to test visual    acuity.  If the person sees too well, we don't do cataract surgery,    saving our limited surgery spots for people who are too blind to    function without a caregiver.  For those with somewhat better vision, we see if perhaps glasses would help, and we use a tonopen to check for glaucoma. Glaucoma is a major cause of blindness here, but if we catch it soon enough and send them for proper treatment, their vision can be saved. 

Is their vision poor enough to qualify for surgery? The next step      is to dilate their eyes.  Then we use an auto-refractor to measure      the curvature of the cornea, one of the measurements they need to choose the proper lens to implant in surgery.  From there, they   move to the slit lamp, where an ophthalmic provider or technician examines their eyes for a variety of diseases and conditions that would prevent a successful cataract surgery, including corneal scarring and retinal damage.  We also test these patients for glaucoma, since cataracts and glaucoma are not mutually exclusive.

Is the patient still a good surgical candidate? Next comes the A-scan, an ultrasound device that measures the depth of the eyeball, another number needed for choosing the proper lens. Then we take a short medical history and take their blood pressure. Africans tend to run high blood pressures, but if it is above 200/120, the retina can bleed during surgery--not good.  So, we send them to see a doctor and get their blood pressure under better control, and then we bring them back in a month for another try at qualifying for surgery.

 Finally, about half the people who come for the eye exam are found to be qualified for surgery.  We then enter their information into the computer, schedule the surgery, and fill out the necessary paperwork.  Last stop--teaching.  We need to explain the surgery and the risks and get a consent signed.  We need to tell them when  and where to go, what to bring, and how to prepare for the day of surgery.

It takes an hour or more to get each patient through the whole       process, and we're seeing around 60 patients a day on clinic days. It becomes quite the assembly line, but each of the tasks require some skill and some practice to do them well.  Of course, we also require translation for every step of the way-- communication is always the biggest challenge.  Many of the machines and tasks can be done by our Congolese day crew once they have been trained, and indeed, we couldn't function without them filling many of the roles on the team.  But, perhaps now you can understand why it takes so long to get each one properly trained in a variety of tasks and to get the whole operation running smoothly.

 Today brought an unexpected treasure.  It is our practice as a team to circle up to pray before we start our work day.  This morning, however, the patients and caregivers who were lined up waiting for their appointments wanted to join our prayer circle!  Some of them prayed in Kituba (I think it was Kituba, anyway), some in French, and some of us in English.  Congo is 90% professing Christian, and they are passionate about it.  When they pray, it is loud, long, and fervent.  When they have a church service, it lasts two or three hours and includes much loud, passionate singing and loud, passionate preaching.  So, our morning prayer time was energetic today!

It seems that Wednesday is market day in Pointe Noir.  We were      trying to reach a screening site fairly far across town yesterday,      and the traffic was so dense it took an hour to get there.      Thankfully, I did not have to drive!  Do you ever find yourself      squeezing your  elbows to your sides when your vehicle is trying to  navigate a narrow spot?  Or squinching your eyes?  Wednesday gave me plenty of opportunity to observe those reactions in myself!  But we got there, and we got home again in due time.

 Market day was interesting to observe from our slow-moving car.  Hundreds of people swarming everywhere (mostly not watching for cars, either).  Traders were sitting by their little patches of      wares laid on a cloth on the ground, hoping for customers. I would  have been bored out of my gourd to have to sit there all day in the   sun hoping for an occasional sale, but these folks seemed content.  They'd visit with the trader sitting next to them, or just sit      doing nothing visible, but their faces were peaceful and their      movements were placid.  Little children flitted all around--who      knows who they belonged to?  They have a freedom of movement that our kids have lost.  I would have been gripping mine tightly in the midst of such a crowd, I know, but these kids seemed to be able to play freely.

 Speaking of screening day and of little kids, let me end by mentioning a special little boy. He was probably about seven or eight, and he came alone to our screening yesterday because his eyes were bothering him. Who knows if he has parents, or why they were not with him? If he has parents, did they send him to fend for himself, or did they perhaps not even know that he came? We had a crowd of several hundred people yesterday, and this little guy just waited at the end of the line for the crowd to clear so that he could make himself known and present his request.  His eyes were itchy, probably allergies, so we gave him some soothing drops. 

But how many eight year old kids do you know who can navigate to a destination, negotiate a crowd of hundreds of competing adults, wait patiently for hours by himself, and then present his medical situation and request in a clear and concise manner? Mark my words, that young man is destined to be a leader someday, if he can navigate the treacherous waters of childhood without capsizing.  

Blessings to you all,

Marilyn 

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

 

Africa Mercy - First Week of Field Screening: One Nurse's Journey

More from Marilyn on board the Africa Mercy. The crew is overwhelmed by the number of people still seeking a medical screening--an impossible task it seems. I feel for the Africans living there. How frustrating it must be to live in a country where your only medical resource is a hospital ship. Sharon

(This is a running post about a nurse's journey on the Africa Mercy, a hospital ship that travels up and down the coast of Africa)

9/7/13

First week of field screening

 

We have begun our twice weekly field screenings, looking for more cataract patients.  These screenings are being held at five different locations in various churches around the city.  Tuesday we went to St. Marie's Cathedral, a huge compound not too far from the ship.  More than a thousand people came--too many for us to see them all.  Screening was scheduled to begin at 9:00,but many people had already arrived when our security people got there at 5:00 AM.  We got them into lines and got started about 7:30, but they came faster than we could see them, so the lines kept growing.  Finally, we had to close the lines and send the rest away.  Matt, the head of security, tried to hand out flyers with information about the next screening dates and nearly had a riot on his hands. I think they thought it was a ticket to get into the next screening, not just information, so they pushed and shoved to get one. 

Fortunately, all the churches where we will be screening have high walls and gates.  We were able to get our people inside and get the gates closed without injuries to anyone.  We stayed until we'd screened everyone inside the gates, but many unhappy people were left outside.

Wednesday's screening was even worse!  There were already more than 300 people inside the gates when the security team arrived at 5:00 AM, and the crowd was growing rapidly.  Matt just shut the gates at that point.

The crowd outside continued to pound on the gates and to climb the walls, but the security team was able to keep it under control inside the compound, so the screening process proceeded in an orderly fashion for those 300 people already inside.  Unfortunately, there was no safe way to bring any more people in once the gates had been closed, so we saw somewhat fewer people than we might have with better crowd control.

By now, I'm sure the word is out that you'd better get there the night before and camp in the courtyard if you want to be seen, so I expect that the problem is going to get worse.  Matt is talking about having the gates to the church compound locked the evening before a screening so that at least the crowd is outside and won't overrun the screening stations.  One problem, though, is that each church has daily early morning church services.  How does one admit the congregation but not our patients?  I would suppose that the pastors will have to agree to cancel church on screening days, at least until the crowd size diminishes to manageable levels.  Hopefully, with continued screenings, we'll eventually get the crowd processed and/or enough people will get discouraged and stay home.

Our problems with crowd control certainly underscore the desperate need for cataract surgery and eye care in this city, so I am glad that Mercy Ships can begin to meet that need.  I wish we had the resources to at least screen and interact with everyone who comes--but we don't.  Angry, disappointed, disgruntled crowds are inevitable at this point--but it's heartbreaking.  There is no Plan B, both for the people we have to turn away and for the people we cannot even find time to screen.

On Friday we held a bit of a debriefing for the eye team.  One person after another talked about the heartbreak of having to turn people away--and then we started remembering the people for whom we had been able to say yes, the people who will eventually have their sight restored through surgery. We remembered several who came to screening with vision-threatening infections whose eyes we were able to save.  An eye drop in time saves sight!  Anyway, as a team, we seemed to get our emotional balance back, ready to face another week of screening days.

If a potential patient makes it past the first cut on screening day, they are given an appointment date to be seen at the eye clinic for a more thorough eye exam.  At this clinic exam, we will make a final decision on whether they are a candidate for surgery or not, and if so, they will be given an appointment date for coming to the ship for surgery.  These clinic exams will begin next Monday.  So, beginning next week, we will be screening for two days a week and running clinic for two days a week.  I'm not sure what will happen on Fridays--but I'm sure something is scheduled, and I'll find out eventually.

Meanwhile, we have been using every spare minute to train ourselves and our day crew in all the things we need to know and do for clinic appointments.  There is a lot to learn!  Language barriers make everything more difficult, and medical terminology can present problems even if English is your first language.  But, our day crew are now trained in such things as using charts for visual acuity tests, using tonopens to check for glaucoma, using auto-refractors to measure refraction and corneal curvature, and A scans to get the measurements for the intra-ocular lens to be implanted during surgery, not to mention all the vocabulary that needs to be translated in taking medical histories and in explaining everything to the patients.  Are you impressed?  I am!  Perhaps I should mention that I didn't know all these machines a week ago either--I'm learning right alongside the day crew.

I would like to end with a story. "E". traveled from Nigeria to Guinea last spring, hoping for surgery on his large facial tumor.  Alas, the surgery schedule was already full, and there was no room for him. Undeterred, he arrived here in Congo just about the time the ship came into port, with little money and no place to stay, but full of hope that this time we would help him.  Perhaps by divine appointment, he encountered some incoming Mercy Ship people in the airport, and they could tell that he would be a likely surgical candidate for us.  He became our first customer at the Hope Center (normally used for post-surgical patients needing ongoing therapy) as he waited for us to get the hospital up and running.  I met him in the hall a few days ago--he was on board for surgery the following day.  I hear it went very well. I expect he's a handsome fellow now--I hope I get to see him again before he leaves.

 

Blessings to you all,

Marilyn

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

 

Africa Mercy - Selection Day: One Nurse's Journey

More from Marilyn on the Africa Mercy. It's hard to imagine, but 7000 came for the screening in Pointe Noire, more than 4000 of which received doctor's appointments! 


I am thankful for people who give of their lives and time to help those in need in such a far away place. It is humbling to say the very least. Not that all of us have opportunities to help in this way, but it does give perspective. I guess it comes down to this: we can all do something to help others where ever we are......a neighbor, a friend, a family member or even a stranger. One person at a time. It all adds up, no matter how small our contribution may seem. Anyway......this and the last post sure got me to thinking. Sharon


(This is a running post about a nurse's journey on the Africa Mercy, a hospital ship that travels up and down the coast of Africa)

8/31/ 13

Selection Day

Last Wednesday was the day of our big screening, the day we selected patients for the various types of surgeries in the coming months.  By government request, our advertising poster depicting the types of surgeries available did not have a date or place for the main screening event, so I wondered if the people would know to come.  They came--more than 7000 of them.  I've attached a picture which suggests the size of the crowd, but one picture doesn't really capture it.  The line of people wound all around the wall of the selection site, doubled back, down a second street and back.  It made the longest Disneyland lines look short!  

I've heard that we had about 350 crew members plus 100+ day crew translators working on site that day.  We needed every one of them, both to manage the crowd and to do the actual screening procedures. We screened for more than twelve hours, from dawn until after dark, to see as many people as possible. More than 4000 people got appointments, either for further medical testing or for the surgery itself. 

Altogether, it was a very successful screening day.

The hardest part of screening is having to turn people away.  They come so full of hope.  They wait patiently in line for many, many hours to be seen.  Then, some of them have to be told that we cannot help their particular problem.  More than half of the people in line for eye problems didn't have cataracts, or their cataracts were not sufficiently ripened so that our procedure would help, and they had to be turned away.  Some had corneal scars--a corneal transplant would restore their sight, but that is not possible to do here.  Some were blinded from untreated glaucoma--irreversible damage was already done. Some were blind from injury that couldn't be fixed.  So many reasons to say no...and every "no" hurts.

 We saw a fair number of children with evidence of Vitamin A deficiency. The poorest people eat mostly white starchy food because it is  cheapest, so even though they get the calories, they lack the vitamins  they need.  Vitamin A deficiency in children can lead to blindness, but  it is preventable.  One thing we try to do is to educate parents about  Vitamin A and where to get it.

 Because cataract surgery is quick and patients are released the same day, we can do a lot of eye surgeries.  So, we will continue to hold field screening to gather more patients throughout the months that we are here.  Our next eye screening is scheduled for next Tuesday.  There will be hundreds of people there, but not the thousands that gathered for the main screening, because only one type of surgery is being offered.  Still, it is likely to be another emotional day.

Let me end with a couple of stories from previous years.  Many of our cataract patients are old, of course.  One year a man a wife both received cataract surgery the same day.  When the eye patches came off the next day, the grandpa turned to his wife and said, "you are as beautiful as I remembered you to be."  They were very much in love.
 

Next year, another old couple had surgery the same day.  When the eye patches came off, the old fellow turned to one of our day crew people and asked her to marry him!  Needless to say, grandma was having second thoughts about having his sight restored!  People are people, the world over, aren't they?  Well, we screened an old couple this year and scheduled both of them for surgery...

More another day...

Oops..."They" won't let me send such a big file, with the picture attached.  So here's the email, and I'll work on how to send the picture separately.

Marilyn




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

Africa Mercy - The Big Day: One Nurse's Journey

Another email post from the Africa Mercy in the Congo. What do you do when you can only admit so many patients? The 'big day' is here and maybe over (but unlikely; it's 7pm in the Congo). The excitement prior as the crew prepares for a 'massive screening' of potential patients is described in this post. Marilyn gives a detailed account of what to expect during the screening, when thousands of potential patients line-up and Mercy personnel are given the daunting task of deciding who can be admitted. She has asked for prayers. They can only help so many . . . Sharon 

 

(This is a running post about a nurse's journey on the Africa Mercy)

 

Our heroes, the Africa Mercy crew. Doesn't it just make you want to
shout "Hurray!?"

The Big Day

 

8/27/13

Tomorrow is a big event for us, the biggest event of the year.  For weeks or months, we have been advertising about Mercy Ships and the types of surgeries that we can do, inviting people to come for screening to see if they can be helped.  Tomorrow is the day of that massive screening.  Thousands of people will come.  Some will camp in line overnight to be sure of their place.  If it is like other years, they will wait patiently for hours to spend a few minutes with our doctors, hoping fervently that we can transform their lives.  Some, we can help.

Many, we can not.  It can be a heartbreaking day, having to turn away people who have nowhere else to go for help. But it is also a joyous day, seeing so many people for whom we can make a difference--a huge difference.

Why must we turn people away?  We try to advertise the types of surgeries we do, but many people come with other health problems, hoping that we can help anyway, or they have a problem that looks like the posters but is not the same, or they have additional health problems that make surgery not an option...or...sometimes we just don't have enough time and surgeons to handle all that could be done if we had those resources.  You've heard the story of the boy on the beach tossing stranded starfish back into the ocean...we can't save them all, but we do what we can.

Screening day is a massive logistical operation.  Think of a football stadium, and thousands of people all trying to get in through the gate in time for the game.  Consider--all they need is a ticket, and their place is assured.  All they have to do to qualify for that ticket is to pay money, which they have.  And if per chance the game is sold out, they can go home, none the worse for wear--probably even to watch that same game on TV!  The stakes are pretty low, really.  But you've been there, felt the crush of people pushing to get in the gate, heard the noise and felt the energy of so many people in one place.

Now think of those thousands of people vying for a once-in-a-lifetime chance to get a desperately needed surgery.  So many hopes and fears, so much at stake for each of them.  Try as I might, I cannot really put myself in their shoes to understand the depth of this experience for them.  For those of you who pray, please pray for our prospective patients tomorrow--especially those whose hopes are dashed as we sadly send them away.

On the ship, we have six operating rooms.  They will be in constant use, beginning next Monday. There will be a whole parade of surgeons coming and going throughout the 10 months of field service.  Most can only break away from their practices for 2-4 weeks at a time.  We have a stream of eye surgeons doing cataracts, plastic surgeons doing burn contracture repairs, orthopedic surgeons fixing dysfunctional limbs, general surgeons doing thyroids, tumors and hernias, surgeons who do vaginal fistula repairs, maxiofacial surgeons working on cleft palates and facial problems of all sorts, and so on.  So, in screening, we need to look for patients whose needs match the specialties of our surgeons, and we need to schedule them for surgery at the right time for the right surgeon!

A little bit about the flow of screening day:  We have the use of a large school compound with walls and gates.  That's important for crowd control.  Security people establish the lines and keep people in order.

Pre-pre-screeners walk up and down the line, eliminating those who are obviously not candidates for the surgeries we offer.  Eventually, the people get through the gate to the pre-screeners.  Those folks gather enough information to send the person to the correct station for further assessment, or out a different gate, if we can't help.  Eventually, after a medical history and basic nursing evaluaton, surgical candidates are seen by a doctor.  If he approves for surgery, the patient gets an appointment card to come to the ship at the proper time.  There's a prayer tent for those who would like prayer.  There are translators working with each medical person, of course.  There are people passing out water and bread for these people who have been waiting for hours.

There are escorts to lead people from one station to the next throughout the whole process.  We have hundreds of crew members on the ship, and we all have a specific job to do tomorrow.  Hopefully, it will be like a well-oiled machine!  We expect to process thousands of people in one day--it had better run smoothly!

Many, many of these hopeful people have eye problems.  Those are sent into a separate line to come to the eye team for evaluation.  We expect to process thousands of people just in our area, and hope to select about 500 of them to come to the clinic on other days for a more complete eye examination, with the hope of cataract surgery for many of them.  I filled out 520 appointment cards to give out tomorrow, for clinic days from now until mid-October.  It took several hours to fill out the cards--and each card represents several people who will need to be seen tomorrow, since there are probably more rejects than acceptances.  Obviously, our optometrist is going to have to work fast tomorrow!  In fact, we all will have a very long, very busy day.

I've attached a picture that they took today of the Africa Mercy crew. If you are looking for me, I am about half way back in the crowd directly under the "r" of ".org" painted on the ship.  White hair, green shirt... All these people, plus about a hundred more Congolese day crew (translators, etc.) will be working tomorrow.  If I can, I'll send pictures of screening day a little later this week.  Meanwhile, appreciate your prayers that it will go well tomorrow, and that we will select the right people for surgery to do the most good possible while we're in Congo.  Thanks.

Blessings,

Marilyn

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