The following is a collection of my update emails sent out while I was aboard the Africa Mercy in the Republic of Congo:

be forewarned. Its LONG!

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^UPDATE No.1^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

Where to begin??

I have been onboard the ship for 3 weeks exactly now and they say that is about the amount of time that it takes to get adjusted. I think I would agree with that…When I first got here, I really had a hard time figuring things out. It was all such a foreign concept! I had flown all the way to Africa, to serve the Congolese people and provide medical care. But, I felt very separated from all of Africa! It is about a 20-30 minute walk to get out of the port and into the city (its rather civilized too. You have to drive a little to see the Africa you typically think of. Not the safari kind of Africa though!). On the ship there are 3 meals- buffet style in a cafeteria, some serious air-conditioning (its so cold on board!), a small gym, laundry room, crew galley, computer station, pool, a midship lounge and snack bar, and a “Starbucks” (Fun fact: the owner of Starbucks is on the Mercy Ships board and donates all the coffee! It is the only Starbucks that has a different logo because the mermaid in West Africa is typically associated with demons/evil spirits). It seemed to me that you could spend your entire time here hiding away from the culture and the people! Over the past few years I have grown to love the model of serving by being IN the community you are serving by seeing it demonstrated in Nicaragua- Pinas de Paz, through Parker Street Ministries in Lakeland, and through so many other examples. But this seemed to be the opposite! It was at this time that I had to accept something that was kind of hard to swallow: Even if this trip was a total bust…even if I left here at the end of 8 weeks and said “I will NEVER go back there”…it was okay! I learned to trust God a little bit more and accept the fact that His plan is good and he wanted me to be here for a reason!

So, that was my mindset the first week….UNTIL I was off orientation and on my own in the hospital. THIS is what I came for! And then I realized, THIS is why all these other people are here serving too!

Almost the entire “deck 3" of the ship is the hospital (with the exception of a few cabins…mine included. I could literally roll out of bed and be at work in 2 minutes). There are 5 operating rooms, (they are tiny from what I hear! But fully equipped!), a radiology department, pharmacy, lab, PACU, eye clinic, ICU and currently 3 active wards for patients. We are about to open C ward Tuesday! (the Christmas “slow down” is officially over) D ward is the maxillofacial (MaxFax) ward. This holds the patients that Mercy Ships is often known for- the ones that have facial tumors, etc. B ward is the plastics ward. Different than plastics back home (or in “the states” as it is referred to here), these surgeries often include burn contracture releases, skin grafts, and reconstruction of certain birth defects. A- ward (the one I am on…the best one of course! ;)) is the general surgery ward, which means that we get a little of everything (kinda like Moffitt’s 5 North!). This includes plastics, max fax, as well as hernia repairs, orthopedic follow up patients, thyroidectomies (also not like the states…they are often HUGE goiters!), and anything else. There are 20 beds in the current units (in one large room with a 1/2 wall in the center). The beds are maybe 2 feet apart, with adults, kids, male, and female all 2 feet apart! If the patient is <18, they have a caregiver with them on the ship. They sleep on mattresses under the patient’s bed. I can’t tell you how many times I have accidently stepped on a hand early in the morning!

Congolese people speak a few different languages…French, Kituba, and Lingala to name a few. Often the kids don’t speak French until they go to school. Thankfully we have translators in the wards with us! They are our “day workers”- Congolese men and women who speak all 3 of those languages as well as English. They are HARD workers, who translate, clean, entertain, and often do more nursing than we can! It has been fun to get to know them while I have been here. They tell me that this kind of experience looks great on their resume, and really helps their English. I am trying to learn French! While I am here I can use Rosetta Stone for free, which has been a nice resource. But, I have to say, in the heat of the moment, Spanish often comes out of my mouth! The other day I just started teaching one of the patients Spanish because I wasn't getting anywhere with French!

The types of patients we see in the wards/in the OR depends on the surgeons on the ship. There are a few “long-term” surgeons, a few that have committed to a few months/the whole field service, but often they come for 2 weeks and the patients for their speciality are scheduled to return to the ship accordingly. It is a very detailed and well thought out process. From screening, to follow-up appointments, it is very organized. (yet there is a little room for flexibility…It has to be in West Africa!) From what I have gathered, Mercy Ships has had to alter their care a little bit for Congo. Since it is a more developed country, the need hasn’t been as great for surgical care closer to the port city. Therefore, the government has requested that we reach out to “upcountry.” Multiple screenings have been done in Brazzaville and other “up country” cities. Because of this, the government has converted a portion of the local hospital into a dorm for a lot of pre op patients that have to travel far to get to the ship. Also, our “Hospital Out Patient Extension” (HOPE) Center which typically houses long term recovery patients, has been expanded to house patients that live too far to travel for post-op appointments.

Details about the hospital:

-The crew is the hospitals blood bank! If your blood type matches a patient’s, they contact you and you are “on call” during that patients surgery!

-My shifts are 8 hours. I typically work 5-6 days a week, rotating between days, evenings, and nights. The day shift and evening shifts overlap an hour and a half so that the stable patients can sit up on “deck 7" for some fresh (and REALLY hot and sweaty) air.

-I monitor post-op patients for complications- Lots of vital signs, and neurovascular checks on plastics patients. I also turn into the bad guy when I make them walk or do exercises. Bed rest is also REALLY hard to enforce here. They hate it!

-Discharges occur in the afternoon, and admissions typically happen in the evening. They are usually so happy to have a bed on the ship! They have been waiting a long time for this. Instead of the “white coat syndrome” where you have anxiety when medical personnel are in front of you, some of the patients on the ship have “white boat syndrome” and tend to have high blood pressure upon arrival!

-Meds. This is so interesting (for all my nursing friends!) The MARs are paper, and the medications are in a cabinet. The narcotics are locked in a box on the wall, while the key is kept in the med cabinet. We have to cosign all peds meds and narcotics on the MAR, and for narcs we have to cosign in a book how much we take out and how much we use. I am still learning how to get kiddos to take meds! Its really hard! (especially when you don’t speak their language!) Maybe one day I’ll be a peds nurse..

-Since the nurses are from all over the world there leaves room for some interesting practices and terms. For example, to “cannulate” someone means to start an IV ;)

-I get time for a coffee and lunch break….WHAT!?

-I am a nurse, respiratory therapist (I did my first nebulizer my first day!), physical therapist (doing and encouraging patients to do exercises), and play-mate. I get to make glasses out of pipe cleaners, cuddle with patients on the floor (NEVER would THAT happen back home), color, play hours of connect four and Jenga, and so much more.

-Supplies. I have learned that “containers” are like Christmas presents. The whole ship waits on the arrival of containers like it contains gold. It may hold chocolate (that tends to run out here), or hospital supplies!! We also have to be very careful of what we dispose of where.

-Its a totally different work environment. Everyone is PAYING to be there and WORK! No one minds when their pager goes off, or if you need a question answered. It can be a little weird because you practically live with the person you just asked a stupid question to, and you WILL see them at dinner! hahaa!

I could write you FOREVER about the little stories from the ward, but I’ll spare you! I’ll just include a few of the things that have made me smile through my time here so far…

-Ward service. Every Sunday they have a service in the ward for the patients and caregivers. It has been so fun to join them! Often you are singing and dancing (and I mean DANCING, getting low and all) next to a man who has a tracheostomy and an NG tube, and a kid on your other side with her arms casted from axilla to fingers, unable to bend her elbows at all. It is really great! I think heaven is going to be just like this…chaotic and full of joy. Only everyone will be whole with NO sickness or sadness. I can’t wait!

-”B.” This brave little girl had burn contracture releases on her chin/chest and both arms. Basically, she came out of surgery in a head brace, and arms sticking out from her at 90 degrees. She has a graft donor site that is almost the size of her whole thigh circumference. To put this in perspective: if this surgery was to take place in the states, it would be done in probably 3 different stages, at least. This case required care more like nursing at home- placing NG tubes, managing morphine infusions and all. At one point she said, “if this is what being well feels like, I don’t want to be well!” Through everything, this little girl has remained so strong! Last Sunday I asked her if she wanted to be wheeled down to the ward service. She nodded yes, so we wheeled everything down with her and stuck her in front of the “OR theater.” She had a huge smile the whole time and wiggled the only part of her body that could move…her left foot. So much so actually that her IV pulled out ;)

-Over the last few weeks, a few teenage boys filled the beds in A-ward. One of these guys was referred to as a “street kid” by the day workers. Kinda a tough guy. I believe he was abandoned by his parents and burned badly after falling into a fire trying to find them. He was so quiet, barely even making eye contact with anyone. Another guy was a typical 16 year old, except for the fact that he had an extra thumb. He hid this at all cost! It has been AMAZING to watch them come out of their shells! I listened to one of the plastic surgeons give a talk while here. He explained that there is something about beauty that is deep within us. We appreciate it when we see it…a beautiful sunset, a beautiful face, etc. This is because God is beautiful and he enjoys beauty. His main point was that when you change the outside of a person so they have a chance to return to their original beauty, they are often accepted as a person, and then can feel that they are cherished by God. Of course, this has been twisted by our crazy society and gone to the extreme! And God cherishes each of us, no matter what our outside appearance is. But sometimes, when the outside can change, the inside is able to change as well. “Y.”, the street kid, now grabs my arm on the way to and from deck 7 so that we can walk arm in arm the whole way there. He often consoles the other little girls and boys when they are having pain. And the other day, “G.” confessed his love for me. Either that is the only thing he knows in English, or his confidence is really great now ;)

here are some other ship life/fun facts:

-All of the crew sleeps in multi-berth cabins (usually 6), I was placed in a 4 person cabin however

-There is limited water, so we have to take 2 minute showers! The most effective way is to take “military” style showers…rinse off, soap up, and rinse again. For birthdays, often friends will forgo their showers that day and “give” their friend a 10 minute shower!

-EVERYTHING is magnetic! The walls, doors, ceilings, everything!

-Flies: often the only thing that reminds me that I’m in Africa. They are EVERYWHERE!

-Friends: I have made great friends! It is such a transient community, people are in and out so fast that friendships start fast. I have more international friends than ever before!….friends from Australia, Canada, Holland, Norway, Denmark, England, and Scotland to name a few. I may have to do a bit of traveling now ;)

-Gurkahs. “What?!” I know. That was my reaction at first too. These are warriors from Nepal whose job is to protect the ship. This position is actually only one of 2 paid positions on the ship. They are great- they know everyones name! And are in super good shape. I tried to run with them a few times…a typical run includes an 8 K at 0600. They are very patient men, because obviously I can’t run that fast or that far!

-Sometimes I think to myself….“Am I really here?!” It seems like I have been planning to come for so long. It is so great to be finally caring for these patients! Every week we have 2 mandatory meetings. I have been surprised at how much they have included the entire crew in Mercy Ships decisions.

Now that I have been working hard in the ward, I don’t feel as bad about relaxing on the ship or exploring on my days off, that way I can serve even better in the ward! Some adventures include…

-A river “cruise” up a river which included a long wooden boat with a motor hooked to the back!

-I got to attend a Congoloese futbol match…a local game, and then the Mercy Ships team played! (on a turf stadium!)

-Ultimate Frisbee with other crew mates

-movie nights in unoccupied conference rooms

-Bible studies and small groups

-Trips to various bakeries (french influence…yumm!) and restaurants

-beach bonfires

-“Mercy Ministries” to local orphanages and community centers

- Sunday trips to a local churches

-There is a beautiful gorge here that runs into the beach to hike

-My friend Becky somehow landed us a secret tour of the bridge!

-Some things that always make trips into adventures is catching a taxi! and chancing the rain! It is rainy season here, and even if you manage to catch a taxi, you get dropped off at the beginning of the port and have to walk 20 min in the pouring rain! There is a lot of walking here, unless you are lucky and can catch a ride with a Mercy Ships Landrover

All this to say…Mercy Ships has a different model for serving. And while it does not work for all ministries, it does for this kind of medical care. How else could you get “1st world” surgical care to a “3rd world” country? It has helped quite a bit to spend time in the wards with patients, as well as to get off the ship and walk around…in a group of course! It also helps me get a better perspective when I hear the large scale plans/goals of Mercy Ships at the community meetings. I have learned that we are very involved in local nurse and surgeon education, to equip them to provide quality medical care in their country. There is also a agriculture site in country to help the local agriculture develop.

If you made it this far….THANK YOU!! Seriously, it means a lot to have your support and prayers.

As the Congolese kids say…”bye-o!”

Marris

^^^^^^^^^^^^^^^^^^^^^^^^^^^UPDATE No. 2^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

Hi all!

So I am about to head into my last week here on the Africa Mercy, so I thought I would send one more [and final] email update. (plus I am on night shift now with lots of time on my hands as I am the only one awake in a room full of sleeping patients and caregivers!) It won’t be as long as the last, I promise!

I really just want to fill you in on the patients and stories that have made everything worth while! Yes, of course I am having fun on the ship and around town. I’ve tried all kinds of food while being here, slack-lined on the beach, and this weekend I will participate in “the AFM Amazing Race” all around Point Noire. I loved getting to watch the winter olympics with people from all over the world (35 countries are on board this week!) Who would have thought that I’d come to Africa and learn all about curling!? The Italian Navy docked next to the ship for a week, causing quite a stir on the Africa Mercy (especially with the ladies on board!). They even invited us to come and take a tour..200 people at one time! And I am certainly learning a lot and growing personally. But the patients and their stories…that’s why I am here! The other day, a friend of mine said that one of her friends back home told her, “I’m so jealous. Your life is so exciting! You get to see and do all this cool stuff every day.” It is true that we get to be apart of something amazing, but….it is just like any other job and in any other city. There are good days and not so good days. Exciting moments, and boring weeks. There is drama and entertainment on the ship, and at the same time responsibilities and chores. The cool pictures that people see (especially when they are paired with the dramatic background music ;)) only highlight the major events. Most of the days here are pretty typical. Transformations take weeks and months! So much of what happens here is about the little things.

A friend of mine is a writer for Mercy Ships and she asked me to answer this question for an article she is writing:

Can you share one of your most memorable moments as a nurse for Mercy Ships? And/or as a volunteer here in Congo for Mercy Ships?

I thought I would use some of what I wrote for her to fill you in as well…

In looking at my entire experience here in Congo on the Africa Mercy, a few moments stand out. While these are memories that I will cherish forever, I’m sure to everyone else they seem small and insignificant. However, when I look at the big picture of all of these “little moments” I find a common theme, a lesson of sorts to take away from this experience.

The ward is constructed quite differently than back home. It is one large room with 20 patients and their caregivers. Yes, this would be an “experience” for most of us from the western world, but it does not end there. What is so amazing is that these patients help each other. Let me paint a picture of these moments that I have been privileged to watch:

“E.” She is a 26 year old woman who had both feet operated on. She was to remain bed rest for 2 days, and eventually was taught how to use crutches and bear her weight on the better foot. Just to get into the restroom was an obstacle for her! With about a foot of a ledge to climb over, she needed some assistance from the staff. The second day I turn around to find another patient who was awaiting her surgery the next day assisting “E” down from the ledge. And I’m not talking about merely lending a hand. To assist her required us to grab her under the arms and hug her entire body to safely move her.

And just the other day, as I was helping distribute dinner plates, I looked to one side of the room and noticed two women sitting on a bed, both in hospital gowns. One was recovering from a contracture release of her neck, and the other had both arms operated on in order to correct injuries contracted from a severe burn. Her hand was wrapped entirely on one side inhibiting her from using her hand, and the other arm was wrapped in a way so that she could not bend her elbow. The woman with a neck bandage was spooning the other woman’s food into her mouth, recognizing that she needed help.

When I first began, I was extremely nervous about the language barrier I would face. Here in Congo and on the wards, the primary languages spoken are French, Kituba, and Lingala. We even had a patient who was deaf and had never been taught any official form of sign language. What I have found is that there are some things that are universal- smiles, laughter, prayer, and even dancing. I have cherished many dance parties with patients and have laughed with the patients and caregivers as I TRY to ask “have you had a bowel movement today?” in their language!

A precious memory that I shared despite language barriers, was with “Mama C.” I admitted this woman in her late 70s the night prior to her surgery. She had the largest goiter I have ever seen and needed to have her entire thyroid removed or eventually it would totally cut off her airway. Through everything that night; pre-op pictures, starting an IV, and discussing the surgery with her surgeon she remained calm. She was so excited for the surgery and couldn’t wait for this life change. This little lady was so full of life! While the photographer wanted a few medical photos, she tried to throw in a few crazy faces to surprise her. We were all laughing so hard we were crying that night!

Perhaps the dearest moment to me here on the Africa Mercy was shared with “C” and his mother. This teenager had been severely burned earlier in his life, leaving his right hand unusable. His fingers were contracted back to his wrist. Postoperatively, “C” began having severe pain in one of his fingers. He soon developed other complications and both he and his mom became solemn and anxious. One night before bed, after I had given him every pain reliever I could, I bent down to him and asked, “Would you like me to pray for you?” So we prayed. I prayed in English while “C” and his mom prayed in French all at the same time, all without translation. But it didn’t matter! They knew I cared for them and was doing everything I could. God speaks all the languages anyway! Over the next few days, it became necessary to amputate part of one finger. Through those days, he and his mother seemed to be at peace with it all. When chaplaincy asked “C”, “Do you understand that you may lose a finger?” he replied, “Yes, but I trust whatever the doctors say.” He went back to surgery and made an excellent recovery, eventually becoming pain free. Today he can be found on the ward rolling with laughter, challenging his neighbors to a game of Connect Four, and performing his prescribed finger and wrist exercises, looking forward to the fast approaching day when his hand becomes functional once again.

I imagined that I would be challenged in the way I viewed and practiced nursing, but not like this. In the western world, we have a rather “sterile” view of medicine and even compassion. There are certain ways we are to interact with others and certain unspoken codes or practices that must be followed. What I’ve learned on the Africa Mercy is that, in a nutshell, people matter more than all of that.

And just a few more patient stories (seriously, I could go on all day!)…

If I am allowed to have favorite patients, I will say that I definitely have a few! But one in particular I wish you all could meet! She brought me SO much joy and laughter. Typing the stories won’t even do her justice. “N” is a teenage girl who is deaf, and slightly mentally delayed. She has a seizure disorder, which was extremely uncontrolled- having 1+ per week! At some point she had a seizure and fell into a fire (its pretty common to see a history of seizures with burn patients), which brought her and her mama to Mercy Ships to repair a contracture on her neck. She had a few seizures while on board, but as a whole, she began to have fewer with better medication management. After a few days of being on board, we started to notice that “N” had quite the personality. She would scream and laugh and make ridiculous hand gestures, expecting us all to understand them. This girl had no formal sign language training, so no official form of communication…but that didn’t stop her! The day crew was exceptionally good with her and would make hand gestures with total seriousness, having a complete conversation. She started to venture away from her bed, sitting next to the charge nurse, drawing all over our papers. She would give us a friendly whack when we passed by or hip-check us when we were standing by her. And she was no weak thing!! At one point she was standing next to me during our hand-off prayer time. We were going back and forth hitting each other playfully while my eyes were closed and she was sitting quietly. Then I peeked at her only to find her grinning with a sharp knitting needle an inch from my face! She roared in laughter and our prayer was officially over! I went to the HOPE center the other day and as soon as I stepped out of the car, I heard a familiar yell and found myself smothered by my friend! She was so excited to see me! I realized then that this experience with Mercy Ships might have been the first time in her life that she didn’t have to worry about being picked on…the first time where she knew that everyone around her loved her. I am so happy that I got to be apart of that. And believe me, I was just as excited to see her as she was to see me!

“C.” He is also a favorite of mine! and he currently is a Mercy Ships poster child. I’m super proud of him!

His hands were contracted so that he could not use them because of a burn. But now he is able to use his fingers and wrists! He is still working with PT and OT, but making huge improvements! If you can’t tell by the pictures, he is quite the ladies man and a little trouble maker too!!

NURSING & UPDATES:

Since the last email, A ward has continued having plastic surgery patients and we just finished up with a few weeks of thyroid surgeries.

“B” -just look at this picture!

This was the little girl I wrote you about in my last email- barely able to move and on a continuous morphine infusion. She has a long way to go for total healing, but she is walking and giggling, moving one of her arms really well, and only on as needed pain relied. Her future is so bright!