I’ve been gone a month.  Can you believe it?  This is longest I’ve ever been in another country.  The time has flown by, I still feel like I just got here.  A lot of people ask me how I feel about this experience; people both back home and here.  It’s hard to give a response because I feel like I’m still trying to take it all in.  Maybe in my heart I’m still in “self-protect” mode and I’m not allowing myself to be overwhelmed by all the changes I’ve experienced in the month before I came here and the month that I’ve been here.  It’s like floating in a river; I’m letting the current just move me along.  Without doing the hard work of actively swimming into each change in my life, I’ve not taken the time to fully comprehend everything I’m seeing and doing.  I suppose over time my mentality will flip and I will have a lot more reflections to share with people.

  I had my first ICU patient this week.  It was a man receiving a reconstructive surgery of the face and neck.  He remained intubated post-operatively and lost large amounts of volume in the OR.  When we received him we had to do some fast fluid resuscitation so things were tense for a little while.  The blood that we give to patients in need comes from the staff here.  We’re all encouraged to join the blood donation registry so we can donate to a patient that has the same blood type.  For this patient in particular we had to transfuse a few units of blood.  Each bag of blood has the donor’s name, so it was really cool to see which one of the staff was participating in saving this man’s life.  I have not joined the donor registry yet.  I hate to admit it but I’m afraid of donating blood, those needles are just so big.  I guess that makes me a hypocrite or a poor example for healthcare. Even nurses can be afraid of needles though.  The patient did end up recovering well.  He is now in the general patient ward and continuing to heal.

   On my post last week I mentioned story of a 2 year old boy who was sent home with palliative care.  We had a nurse debriefing session this week and we talked about him.  One of the nurses that had taken care of Sam was able to find some hope in the situation.  She pointed out the immensity of love this boy has in his life.  His father is the only parent caring for him and it was amazing to see how much love he poured into his child.  Whenever his child was happy and smiling you could see how much joy it gave him.  The nurse said that this child is so blessed to have such a father.  All he will ever know in his life is love and as he passes on to his Home he will know even greater love.

  Please pray for us here.  First, that we continue to fill the schedule with surgeries, we still have openings.  Second, for our safety, there is some political tension in the country right now.  The tension is causing people to act out in riots.  All the staff has been safe and we’re taking extra precautions.  As of now were limited in how much we travel off ship and how easily we can be accessed by people on land.

   Some of you may be curious about the people I’m meeting here.  In the picture I posted last week there were a number of people.  I will post it again and tell you the names, professions, and nationalities of everyone.  I'll try harder to get more pictures with people.  There are many more people from many more countries.

 From far left: Rachel (dental hygienist, New Zealand), Emily (nurse, WA state), Jen (nurse, MA state), Ann (nurse, NC state), Hannah (nurse, IL state), me, Lydia (MD, Germany), Tjeerd (MD, Holland), Emily (nurse, IL state).

  Have a nice week.

As I post this it is 7:20pm here in Guinea.   I have some downtime before I will head into work at 10pm.  Tonight will be my fourth of four night shifts.  Unlike back home I am actually sleeping pretty well before my night shifts, so hopefully tonight will go well.  Night shift here isn't too busy because for the most part we can actually allow our patients to sleep.  Back  home when I worked in the ICU we would wake our patients every 1 to 4 hours for blood draws, neuro checks, vital signs, medicines, turns, mouth care, bed baths, etc.  With all those interruptions patients never got solid sleep, hence the phenomena ICU delirium. 
  I don't feel that there is too much to report from last week.  I feel that most of my time has been spent working.  Of note was the sad news given to a father and his son this past week.  A young 2 year old boy, we'll call him Sam, came to our screening day on September 3 with a strange mass in his mouth.  He was assessed by our surgeons.  Their preliminary findings indicated that they thought surgery was a therapeutic option for him.  He was scheduled to come to the ship with his father last week for surgery.  When he arrived his mass had nearly doubled in size.  The surgeons were concerned by this finding.  A mass that grows that fast is likely metastatic.  They don't operate on metastatic tumors here, because they have no ability to do the necessary follow up treatment of chemo and radiation.  There is no place in the country that offers chemo or radiation either.  They did do a biopsy, but the findings would take about 2 weeks to come back. With the size of the mass at this point they couldn't wait 2 weeks to perform surgery.  After much thought and reasoning the doctors decided to inform the father that they couldn't do surgery, and that he will likely die soon so he should take him home.  We have a palliative care team and they were able to consult with the father and inform him that they will follow up after discharge.  As one would expect, the father was in much denial upon this news.  After many conversations with various support staff here he was able accept the immediate reality.  How he accepts or copes in the long run I do not know.  Many of us nurses have talked about this case this week.  It's a sad feeling when you see the advent of devastation in someone's life.  We all wish this innocent child was located somewhere in the world where more hopeful interventions could be offered.  Unfortunately I think there will be more cases like this one throughout our field service here.
  On a lighter note I have more pictures to post.  Enjoy.

I got my hair plaited by a patient's mother at work.

The pool where I love to spend my free time.

At the stern of the ship I'm watching a new ship come in.

Hanging out with friends on deck 8.

View of a ship from our port side.

Buoy!

Sunset tonight.

Per the request of my father I am posting another Mercy Ships video.  This one was made in honor of nurses for Nurses Week last spring.  Also, about 3 or 4 nurses shown in this video are still working here.  It just goes to show that this experience is so special that people keep coming back.  Enjoy.
http://www.youtube.com/watch?v=Vv4QkqCxS8Q&feature=relmfu

Here's a link to a video of the Guinea screening day. Hopefully this gives you a better idea of what I tried to describe from that day.  If you watch carefully you'll see me for about 2 seconds.
http://www.youtube.com/watch?v=xBf_T7KvHZo

  I have officially completed 2 weeks of life on the Africa Mercy.  For many of you the past 2 week flew by, but for me it feels like it has gone so slowly.  As I mentioned in the previous post I have experienced many new things.  Each day is a journey in itself, for example Monday of last week.  The day started about 5:15am for me.  I got up, got dressed in my scrubs, ate some breakfast, and then headed out with other coworkers on one of the Mercy Ships Landrovers.  Our destination was The People's Palace where were going to take part in on of the most important days of Mercy Ships' service in Guinea, screening day.  We arrived before sunrise and on our way through the entrance I could see people running to get in line to be seen once we opened.  The electricity wasn't turned on in the building so we had to set up in the dark.  My job was to take histories and vital signs of patients waiting to be seen by one of the doctors.  I worked alongside translators that all combined spoke one of the 5 local languages.  That's right 5 languages.  I only came prepared with a French to English translation book, I forgot my books about susu, fula, pular, and maninque languages :)  The translators were such a great help for us.  I believe they did the most work, because they had to do most of the talking. 
  As you may have seen in my previous post over 3,500 people entered through the gates to be seen, but only several hundred people qualified for further assessment.   What happened to the thousands of others you may ask?  Well they were informed that their illness could not be treated by us.  Some people came with long-term health conditions like hypertension, heart disease, and kidney failure.  We don't have the capacity to do the primary care and follow-up for their conditions.  Others came needing surgeries that we couldn't provide.  And unfortunately many others were sent to our palliative care team because their diseases weren't treatable and would shortly end their life.  I heard one of my fellow nurses lament that she had to escort a few children to the palliative care team.  I can't imagine the pain of the let-down after waiting in line for hours.
  While in histories I primarily saw people with head and neck abnormalities.  Many children had facial masses or cleft lips, women had goiters, and a mixture of men and women had facial abscesses.  There were also many children with bone growth abnormalities like club feet.  I had a realization while looking out at the people waiting to be seen by us.  I realized that this may be the first time many of them have been around others with the same problem.  Like in most cultures there is a lot of fear and aversion towards people with deformities.  In some cultures people even believe people with deformities have been cursed or are evil.  As a result many of these people don't go out in public, and if they do they try and cover up.  They are very isolated people.  I hope that some of them felt relief and peace in knowing that they're not the only one. Maybe for a day they even felt normal.
  The hospital is now officially up and running.  The surgeries began on Wednesday and so far I think all of them have been successful.  I worked my first shift on Friday.  I took care of a woman with a mandibular tumor needing to be removed, and a man who had a forehead mass removed the previous day; he had the mass for 30 years.  The woman went off to surgery first thing in the morning so I didn't see much of her. The male patient didn't require much care from me.  I did get to take down his dressing for the first time though.  Once the dressing was removed we handed him a mirror and he saw his new face.  He was so happy and so grateful.  It was a wonderful moment.  I spent most of the day just hanging out with all the patients on the ward.  I got called "the baby whisperer" because I consoled a hungry infant waiting for surgery.  I just sang her songs and bounced her till she fell asleep.  I love holding babies, especially crying ones.  I love the challenge of easing their distress.  (Easing distress is also why I love palliative care.)
  This weekend the pool opened up.  Yay!!  I may have been the first one in, I'm not 100% sure though.  It was so refreshing.  I swam laps for a while, and then just sat and read a book in the shallow end.  I plan to go swimming there a lot more.  On Saturday, in addition to swimming, I also traveled to one Conakry's largest markets with some friends.  It was quite an experience.  I've been to markets in many countries, but nothing compares to this.  It was jam-packed with people.  It was very hard to take in everything.  I think we only lasted 45 minutes there.  Maybe I'll go back there.  Maybe.  Today, Sunday, I attended church on the ward.  The patient life team here holds a church service for patients and their families every Sunday.  It was a fun and uplifting experience.  After I'm done posting this I may go back out to the pool to swim and read, and then this evening I got invited to get Chinese food with friends.  Chinese food in Africa, hmmm.  I hope it's not regrettable.

Becky and I set up new toys for the young patients. We were a little nervous about completing this task within a reasonable amount of time.

Success!  We even finished before lunch, with only a few mishaps.

This is a picture of the entrance to the People's Palace where Mercy Ships held the screening day on Monday Sept, 3 in Guinea.  Over 4,000 people entered through there.  Of that number about 3,500 were coming to seek treatment, and the other 500 were caregivers or family members.   The majority of patients were seen on Monday, but there were a few left over that hadn't been seen, so today were completed the screenings on the ship. We now have hundreds of patients scheduled for surgery over ther next few months.  The wards officially opened today, and the first few patients will be receiving surgery tomorrow.

I'm in a completely new environment.  It hit me last night that my life is entirely contained within this ship.  If I need to go to the grocery story I travel to the ship-shop on deck 5.  If I decide I want some Starbucks coffee I turn around and cross the hall to the cafe.  If I need to go to the bank I walk down the hall a few feet and I'm there.  If I need a little exercise I walk down to deck 2 and lift some weights.  If it's time for me to work I go to deck 3. And at then end of the day if I need some fresh air and quiet time I walk to deck 7 and sit outside.  I spent about a week straight on the ship; never setting foot on solid ground.  It was a strange feeling.  I've never been on a cruise before, so for those of you who have you probably think that's nothing.  But it's amazing that my life can pretty much be completely contained within a steel case.
  On Friday it was the first time I stepped off the ship.  I actually got off the ship twice that day.  The first time was for a emergency evacuation drill.  We all had to exit through the gangway and stand on the dock until everyone was accounted for.  It was really cool to see the whole crew in one area.   I never realized how many of us there really were.  Later in the day I left the ship to play ultimate frisbee.  Yup, ultimate frisbee in Africa.  I barely played it in the US, even though I had many opportunities, but because I'm in Africa and it gets me off the ship I'll play it here.  The field we played on was about a mile away. Walking to the field was almost as stimulating as the game itself.  I found myself having to dodge cars, people, puddles (it's rainy season right now), and trash.  The field we played on was of course a soccer field.  It was all dirt, with a few puddles scattered throughout.  There were hundreds of children playing soccer on the field and on the sidelines.  Arrangements were made for us to have the space for a little while, so everyone moved to the sidelines.  We played for about an hour.  It was very refreshing to have space to run and fresh air to breath.  I hope to keep playing every Friday.
  This past Saturday a large group of us were given a tour of Conakry by a local man who is volunteering on the ship.  We left about 9:30 in the morning.  It was muggy and rainy, but  despite the discomfort I was excited to be shown around the city. The first place we stopped was a museum.  It wasn't very large, but it contained artifacts from the French colonial rule that ended in the 1950s, and it contained traditional tools and ritual headdresses.  I was surprised to learn that a lot of the ritual headdresses and masks are still in use today.   After the museum we walked a while to a cafe where we were able to get out of the rain, enjoy a coke, and eat lunch.  While we were there some local men offered to play music for us.  They played with traditional instruments and sang in tribal languages.  The only instrument I recognized was the djembe, but all the rest were unfamiliar. I have a couple pictures to post of the cafe.  Once we finished our lunches we walked to a local market.  It was a traditional market where people sell food and household items, so I didn't find any curios to purchase.  We made it back to the ship by 2pm.  It was a very long day, but worth it.  We wrapped up the evening by playing a large game of Dirty Uno (the name sounds bad, but it's just Uno with a few twists), and then Dutch Blitz.  We've played games pretty much every evening here.  We don't have regular TV to watch, so games are our form of entertainment.
  Today, Sunday, I went to an African church in the morning and now I'm here writing this blog. Tomorrow we begin our screenings for patients.  We'll be leaving the ship at 5:45am and traveling to a building where a triage will be set up to see people wanting help.  Unfortunately only specific surgeries are performed here, so a lot of people will be turned away.  In the end hopefully we'll reach the large population of those that can receive help in this region.  I think things will start to become more real for me tomorrow.  I'll be seeing the patients before they've received help, and then later on I'll be seeing them on the ward after their life is transformed from surgery.  It'll be cool to be involved in so much of the process.
  That's all for now.  Please excuse my poor grammar all you grammar fiends.  I'm sure that some who read this blog would love to take a red pen and scribble corrections all over it. I am not a writer, nor do I claim to be a writer. I'm just a nurse who occasionally puts down sentences of what I do. So, hopefully you can overlook my errors or poorly written sentences.
 

Here is a picture of 2 of the 3 ICU beds.  This is where I'll be working when we have ICU patients.  I'm told they don't have them very often.  When there are none I'll be working with maxillo-facial surgery patients.

Me and a few friends at the cafe after our long rainy walk. 

 

A view of the ocean from our seats at the cafe.

Another shot of the cafe where we were sitting.