Amazing Grace
Amazing grace! How sweet the sound
That saved a wretch like me!
I once was lost, but now am found;
Was blind, but now I see.
'Twas grace that taught my heart to fear,
And grace my fears relieved;
How precious did that grace appear
The hour I first believed.
Through many dangers, toils and snares,
I have already come;
'Tis grace hath brought me safe thus far,
And grace will lead me home.
The Lord has promised good to me,
His word my hope secures;
He will my shield and portion be,
As long as life endures.
Yea, when this flesh and heart shall fail,
And mortal life shall cease,
I shall possess, within the veil,
A life of joy and peace.
The world shall soon dissolve like snow,
The sun refuse to shine;
But God, who called me here below,
Shall be forever mine.
When we've been there ten thousand years,
Bright shining as the sun,
We've no less days to sing God's praise
Than when we'd first begun.
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Mercy Ships has taught me more than I can put into words but one thing that is forever emphasized is that grace is a gift from God, and it is offered to everyone freely! This well renowned song celebrates the fact that humans have been promised forgiveness and eternal life- they may have been lost, but now they’re found, blind, but now they see. In this blog entry I hope to share what I’ve been doing on the ward onboard this unique hospital ship. I have been working on B-Ward the last 7 weeks and over this short time it has transitioned from VVF patients to plastic surgery patients. As a pediatric nurse, both specialty areas have pushed me out of my comfort zone, in the best sense possible.
When I first arrived in February, VVF surgeries had just finished and the ward was occupied by ladies who needed a bit more recovery time post- operatively. VVF stands for Vesico Vaginal Fistula, and refers to an abnormal opening between the bladder and the vagina (RVF = Rectal Vaginal Fistula). For most women, this is caused by prolonged and complicated childbirth where the baby gets stuck in the birth canal and causes internal damage to the mother. This hole causes a woman to leak urine, feces, or both; and almost always the death of the child. It has been estimated that there are nearly 1-2 million women in Africa suffering from incontinence due to obstetric fistulas (other causes may be related to gynecological surgeries, cancer or trauma such as rape). The effects of this extend far beyond the physical dysfunction and often leave women being shunned and rejected by their husbands, isolated from their community, and ultimately become social outcasts with little hope.
Mercy Ships started performing reconstructive VVF repairs in 2001 and the program was named “Hope Reborn”. The name is perfect and reflects the vision to see that these women be treated and cared for in a way that brings hope and healing for the future.
Out of 63 surgeries done this field service in Guinea, the success rate (success = dry) was close to 40%. Many of these women had had previously attempted repair surgeries (an overage of 3-4) in local hospitals over the years and therefore left them with a lower success rate upon arriving. Although not all surgeries ended completely successful, even those who left incontinent of urine spoke of the improvement they had experienced. Prior to leaving the ship, a traditional dress ceremony is held to celebrate the inner healing and inner change of each patient. I was very fortunate to witness the final dress ceremony in March. The women looked absolutely beautiful in there new dresses, own jewelry, make-up and smiling faces. After a few songs and prayers, each lady was given the opportunity to say a few words. There was a common theme of thanks and praise for Mercy Ships and all those that cared for them throughout their journey- physical change, new acceptance, regaining confidence, finding hope and moving on. The dress ceremony represents a new day. A day where hope is reborn! It was a pleasure to work with a group of women who had grown so close and bonded in such a unique way.
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| My lovely friend Steph (Nurse Team Leader for VVF Surgery)- accompanying Nana upon discharge to her village. Nana had 3 VVF surgeries during her stay on the Africa Mercy and is a story of success! |
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Since the beginning of March, B-ward has been the home to plastic surgery patients of all ages. The 20 bed ward filled up quickly and has remained full ever since (and at times extending into other wards). Under the plastic surgery realm, our patients are here due to the effects of Noma, burn injuries (many related to uncontrolled seizure disorders- i.e. had seizure while cooking), accidents (i.e. motorcycle, vehicle), Neurofibromas, large tumors, extra digits (i.e. removing extra digits from hands/feet), Elephantitis, cleft lip/palate, keloid overgrows, and for various other reconstructive type surgeries needs (i.e. facial trauma, creating a thumb out of a finger to give a person the ability to pinch and pick up objects).
One of the most devastating conditions we see on the ship is called ‘Noma’. It is a gangrenous disease that essentially eats away the tissue around the month and cheeks. Unlike most infections, Noma is able to spread through anatomic barriers such as muscle. The mucous membranes of the mouth develop ulcers, and rapid, painless tissue degeneration occurs in varying degrees; in some cases it destroys tissues of the bones in the face. I’m not sure how best to describe it but to say people are ultimately left with holes in their face! There are a number of factors that may cause this but it’s typically a combination of malnutrition or dehydration, poor oral hygiene, poor sanitation, unsafe drinking water, living in close proximity to unkempt livestock, recent illness, malignancy, and immunodeficiency disorders such as AIDS. Though we see many cases on the wards (also on D-Ward- the maxillo-facial surgery ward), this only represents about 10 % of those affected in West Africa.
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Mareme- 4 years old from Senegal
(Before Surgery)
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| Mareme- After first Surgery |
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Mohammed- Neurofibroma - Before Surgery
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Moussa (17 years old) - Before surgery
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With every surgery the first priority is to restore function and movement; while the second priority is to address appearance. The recovery period from these surgeries is often a long process and may take weeks to months to see significant improvement in function. In fact some people require a multi-stage procedure (2 or more surgeries). Alongside the ward nurses we have two physiotherapists (to cover inpatients and outpatients), one hand specialist (also a trained PT), and one occupational therapist that work hard with patients to implement exercises, make and fit splints and monitor progress.
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Moussa with his mother- experienced a
burn injury leaving him with contractures
to his axilla (armpit), elbow, and writst
(Surgery = release of all 3 contractures)
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Fanta- a beautiful young lady who wore
multiple scarves to hide these large keloids |
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| Fanta & Steph (Nurse Team Leader for Plastic Surgery Ward- B Ward)- Fanta after surgery with compression garment on- she has been at the Hope Centre post operatively and comes to the ship for steroid injections to her neck in hopes that the keloids won't grow back in the futures. |
There are 3 different shifts that we cycle through. Day shifts hours are 0700-1530, evening shift hours are 1400-2230, and night shift hours are 2200-0730. In between day and evening shift we have an overlap period where we take patients up to deck 7 (sea side) for phone time (call friends and family on their cell phones), games, and fresh air! On day and evening shift the nurse to patient ratio is usually one nurse for 4-8 patients (depending on acuity). On night shift the ratio may go up to 8-12 patients per nurse. My first set of four nights with Jaclyn absolutely flew by! Pain control, pain control, pain control! Let’s just say we administered a lot of narcotics over those first few nights with many of our patients being fresh post-ops (recently operated on). The pace of the ward varies shift to shift but I always seem to keep busy whether with nursing tasks/duties or just taking the time to sit and play a few rounds of cards or simply cuddle the kids.
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| Group photo on B-ward- nurses, day workers, patients and caregivers |
This field service we have trialed having a designated team of nurses to make up the ‘dressing team’. This group of 4 nurses takes patients throughout the day to the treatment room, which is much cleaner and quieter than the ward for their dressing changes. Depending on the type of surgery and the state of the wound (infection, drainage/bleeding, stage of healing, etc.) each dressing change could take between 15 minutes and 2 hours- and they may do up to 25 dressing changes in one day! The concept of having a dressing team has created continuity of care, consistent techniques in dressing and assessing the wound and lower infection rates!
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| Plastics Dressing Team- Danielle, June, Amy & Karin |
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Baby Kadiatou (8 months old)- Amniotic Banding Syndrome caused her left upperarm to look as though an elastic band was wrapped around it and in utero only 4 fingers developed.
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| Daloba (11 years old) - Before Surgery |
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Daloba- facial reconstruction to repair
the effects of Noma |
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| Fidele (29 years old) - Before Surgery |
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| Fidele- he had a large neurofibroma debulked/removed from the right side of his face. Both Jaclyn & I had the opportunity to work with him post-operatively when he required blood transfusions and a nasal airway. It has been a long recovery but he is doing really well! |
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Deb & Oumar (11 years old)- Oumar had a neurofibroma
to the left side of his face/eye. He is such a sweet boy!
Deb is a ward nurse (and good friend of mine) and often
takes pictures on the wards. |
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M'Mah- 18 years old- had a neurofibroma debulked/excised
from the left side of her head |
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| Kristy, baby Kadiatou & I- Such a happy baby! |
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Patient Stories:
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| M'Mah- my little 'starfish' |
One of my little ‘starfish’ of this field service is Mareme, but we call her M’Mah. She has travelled from Senegal with her uncle who speaks French (unlike her parents who live in a small village and have stayed home to work and care for her siblings). Over the past several weeks she has undergone a 2-stage surgery to repair the hole in her nose created by noma. This four year old girl has truly won the hearts of many! She is definition of ‘busy bee’ and gets into all sorts of trouble; but at the end of the day she loves to cuddle! Despite upsetting her at time with nursing procedures (i.e. cleaning her face and applying ointment- which sometimes takes 3 nurses) she is quick to forgive and her tears dry fast. So often I think to myself, “monkey see, monkey do” when I feel a tug to my shirt and look down to find her taking alcohol swabs from my scrub pocket to clean the thermometer or when I look across the room and she has my stethoscope in her ears. Her affection makes it impossible not to love her as she clings to us like a little monkey, like she never wants to be let go!
After a busy stretch of four night shifts (with 10-12 patients each), I was officially ready for bed and a day off. As I was busily finishing my last minute tasks before the day shift arrived, I turned and a young man waved me over. He had had a burn contracture release to his foot the previous day and pain control had been a main focus over the night. In my mind, I thought to myself, “oh no! I’ve given him all the pain medication I can…..what am I going to do or offer him…..I don’t have time for this”. As I walked over and approached his bed, he put out his hand and said, “Good morning!” Without hesitation I reached out and shook his hand. This was a moment of perspective and truly a life lesson to simply 'be present and slow down'!
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“Amazing Grace” has survived centuries of social and political turmoil to become one of the most recognizable hymns of all time. John Newton’s personal account of Spiritual redemption has become something universally cherished. It is remarkable to think that it all started with a boy who wanted to become a sailor like his father.
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Check this out! PHOTOS….
Stephan Vanfleteren is a renowned photographer from Belgium and spent some time on the ship at the beginning of the field service in Guinea. While onboard the Africa Mercy, Stephan took a selection of amazing pictures of patients and has since won the World Press Photo 2013 Competition for staged photographs. A little story about the patient is also provided with each photo. I hope this provides an insight into some of the beautiful people we are blessed to meet and help!
