Nous Fixerons Votre Hernie!

Mercy Ships brings hope & healing to those that often get overlooked & out casted.  We provide life changing surgeries to the people of West Africa at no cost to them.  Some of the big things we do have drastic outcomes- facial tumors removed, cleft lips repaired, limbs straightened, eyes made to see again.  These are the "glamorous" surgeries.  And then you have the hernias, the not so glamorous, exciting & less "photogenic" surgeries. 

I spend most of my days in the general surgery rooms fixing inguinal hernias, a very common, very dangerous condition here in West Africa.  Because of the West African work ethic of carrying very heavy items on their heads, starting at a very early age, they often end up with hernias.  This condition impacts their lives greatly.  The pain keeps them from working as hard as they used to, or even from working at all.  The hernias go left untreated for years, getting bigger & bigger, until its noticeable outside their clothes.  The patients, usually men, can't provide for their families, often turn to drinking because they have nothing else to do.  If left untreated, they could have serious complications that could make them very sick &/or kill them.

Dr James & Dr Nabil hard at work

On the ward with the General Surgery Team-
Dr Nabil, Jen, Raphel, Germain & Annika

We had one gentleman come from a neighboring country for his hernia repair.  He had had his hernia for about 5 years & it was quite large.  The day he was being admitted for surgery, he suddenly felt sharp pain in his hernia.  He collapsed & was rushed on board.  He was quickly diagnosed with an incarcerated hernia (the bowel gets trapped & twisted, cutting off blood supply to that portion of bowel).  He had surgery almost immediately.  An hour later he would have had, at the very least, a bowel resection (removing the sick portion of bowel).  If he had been at home or any place other than our dock, he probably would have gotten very sick & possibly died.  We were able to save his bowel & he made a good recovery.  He left 4 days later praising God & saying that Jesus saved his life. 

The general room can be very busy.  We can fix 3-5 hernias a day, some are small & take about 45 minutes (these are usually kids)  & some are the size of footballs & can take 3 hours to repair.  Even though these cases sound routine & mundane, by fixing one hernia, we allow one man to go back to work, thus helping not just one person but numerous people because now he can provide for his family.
Blessings

Akpe Dada

February just flew by. Our first month of surgery has passed, we are starting week 5! Only 12 more weeks to go before our time here in Togo is finished. My job as OR general/VVF team leader has gotten more exciting & busy about two weeks ago when we got our first general surgeon.  We are quickly becoming the inguinal hernia repair team!  On average we will do about 20 general surgery cases a week, 19 of those will be hernias.  It’s not a very thrilling surgery, but it’s a much needed surgery here.  Without the surgery these men won’t be able to work, thus not being able to provide for their families & if left untreated, they could develop complications that could kill them.

Dinner on the dock with our Day Workers

Last Thursday we had our weekly community meeting out on the dock & invited our day workers (the local people that help us take care of the patients, cook, clean, do maintenance work around the ship & teach us about their culture) to join us for dinner & worship.  It was so much fun!  We grilled hotdogs on the dock & soon after everyone was up dancing & praising God in English, French & Ewe (one of the local languages).  We danced until well after dark, listened to a message & then danced some more.  One of my new favorite songs, that I can’t get out of my head, goes like this:

The music starts & everyone is one their feet

"Akpe Dada ye dze ne

Yesu de mi tso kume

Eye nami agbemavo

Y ate Akpe dada a edze ne"

"Akpe Dada" (pronounced: Awk Pay Dada) is Ewe for "Thank you Father"

Last weekend was a ship’s holiday for us, meaning we got a 3 day weekend!  Time to get away & explore Togo.  A small group of us went north about 2 hours to a nice town called Kpalime (pronounced: Pal lo may), known for its waterfalls & mountains.  We stayed at a YWAM (Youth With A Mission- Mercy Ships used to be part of YWAM when it first started) base outside of Kpalime, up a steep road on the side of a mountain, away from the hustle & bustle of city life.  The only sound we heard up there was birds, crickets & the wind blowing up the mountainside.  A very relaxing time.  The base was situated halfway up the mountain.  The rooms were sparse, but very comfortable with 2 sets of bunk beds, windows with screens & even electricity!  The food was wonderfully simple & filling. 

The YWAM base

The group @ the base of the waterfall

Saturday, we went into Kpalime via Zimmy Johns (motorcycle taxis) & found someone to take us to one of the many waterfalls around the town.  A short drive up a bumpy dirt road, we came to a small cement building with a small stream running next to it.  The building was a water treatment plant that the village used to treat the water before piping into their village.  A very simple, but effective system, using settling tanks & chlorine to purify the water.  We followed the trail upstream through the dense jungle until we came to a beautiful waterfall.  We couldn’t get in because it was the village’s water source, but being near the water’s spray cooled us off nicely.  We ended our time in Kpalime stopping at a local restaurant for coca colas & fanice (frozen yogurt-type treats).

The waterfall

Hiking up the mountain

Sunday, we decided to explore the mountain above the YWAM base.  We asked for directions to the trails to the top & set out a little after 8am- before the 90+ heat set in.  It was a pleasant uphill hike through the jungle; occasionally through the trees we could see the valley below.  We climbed higher & higher until the trail came out behind a local church building in a small mountain village.  As we emerged from the trees, the choir in their cap & gowns (think graduation) were singing & dancing into the church, a small one room building made of wood boards & a tin roof.  We stood outside watching & listening, because we weren’t dressed appropriately to go to church, but soon we were invited in by the congregation.  The small building was crowded with the alter- dressed in bright pink alter cloths, a 6 piece brass band playing on one side & the choir in their cap & gowns on the other side.  The choir would sing one song, the band would play another song with the congregation singing along (songs that we recognized like “Onward Christian Soldiers” & “Thine is the Glory”)  Every once in awhile, another choir would stand up in the middle of the congregation & sing some songs before sitting down again.  The service was all in Ewe & French, I had no idea what the sermon was about, but it was fun to just listen & watch the pastor get so animated with his talk. 

With Christian, our village guide

After the service, a gentleman came up & offered to give us a tour of the village.  The village of about 2,000 people was situated on the side of the mountain, just shy of the top.  From the town square, we could see for miles, even in to Ghana, & the view was amazing!  The village was none like we have ever seen.  The houses were in good condition, the streets clean & there was electricity & running water.  A large school building was next to a new church building being built, with a large soccer field that had the same amazing views that the rest of the village enjoyed.  The people were very friendly & we were invited back anytime to visit.  Heading back down the trail, we all decided that if we could all live there & be quite happy.

The mountain village

 Blessings

Week 1



Team Awesome in OR 3

I'm back to being an OR nurse.  I'm so excited to be back in an environment that I feel I belong.  Our first patients came into the OR around 0830 Monday morning, a little baby with a cleft lip & a little girl needing a CT scan under anesthesia for an encephalocele.  

Our staff is from all over, USA, UK, Germany, Australia, New Zealand, Malaysia, & Holland.  Soon we were falling into a routine, one that we all were familiar with- no matter what country we were from. 

Number 2- Jen

Number 5- Tina

We had some long days, & some big cases- all turned out well.  We had 3 maxfax (facial) surgeons this week, we did some cleft lips & palates, removing some jaw tumors & other large facial tumors.  With one week down, we only have 16 more weeks to go.

We are still in desperate need for some general surgeons to come & work with us.  Please pray that our needs will be met.

Blessings

Screening Day

Part of getting ready to become a hospital ship again, is to find patients we can help with surgeries. This is a time consuming & often heartbreaking job, with thousands of people turning up with the hope that they might be one of the lucky few that get chosen.

The line outside the stadium

The screening process this year took place at the local football (soccer) stadium here in Lomé. The night before the screening, lines started to form outside the stadium. We had the military on hand for security & some brave souls out there all night to tell the people what conditions we can help with. When the first of us arrived Wednesday morning at 0515, there are just shy of 1000 people outside the gates.

Pre Screening Patients

My role during the screening process was that of a pre-screener. It was my job, armed with a clipboard, tickets & a translator, to do a quick interview with each patient that came into the stadium & determine if they had something we could fix. They entered through the gate & got into 4 lines, where a pre-screener would look at them & say “yes” or “no”. If they were a “yes”, they were given a ticket & able to move on. If they were a “no”, they were escorted to the prayer station, where we would pray over them & then they would leave. This by far was the hardest. During our pre-screening briefings, we were told that people in Africa are used to hearing “no”. They hear it quite often, but they will still come with the chance that this time they might hear “yes”.

We had certain criteria that had to be met, depending on what they were presenting with. We only do certain types of surgeries & it was our job, as pre-screeners, to “weed” out those that we might be able to help with those that we can’t help. We not only looked at what they had, but how old they were, how big the issue was- meaning was it something that was impeding their movement or left them horribly disfigured.

I had a mother bring her tiny baby up to me, I didn’t even ask her what we could help her with, I just took one look at that baby & realized that this baby was dying right before my eyes. This 6 month old looked like a skeleton, he was so emaciated & frail. I turned to my supervisor & we quickly took the baby to the nutritional tent. Not sure if he’ll make it.

My beautiful Yellow Angel

I had a little 2 year girl in a beautiful yellow dress come with her mother. She was perfect, beautiful & with the biggest smile. She wasn’t afraid of the strange Yovo (white person) standing in front of her. Under her dress, I could see that her legs weren’t right, they were bowed, giving her a weird waddle when she walked. Normally, this would be something we could fix, but since we are only in Togo for a short 5 months, we are not doing any ortho, because we won’t be here long enough for physical therapy. My heart broke when I had to send her & her older sister (with the same issue) away. It’s not fair.

As the morning wore on, I saw so many people that if we were somewhere else, wouldn’t have to stand in long, long lines waiting to be seen in the chance they might get the surgery they so desperately needed. If they had been born in the States or in Europe, they would have gotten the care they needed. Thank God for my translator, Frank. He made things so much easier for me. Since I don’t speak French or Ewe (one of the local dialects), he learned what I would say & then say it without me having to say it first. I felt bad that he was the voice that said “no”, but I got to the point where I didn’t want to anymore.

Pre-screening went from 0545 to 1245. Of the 3,000 people outside the gate, 1,600 made it into the pre-screening lines. Of those, about 1/3 made it past that. Those that got a “yes” went on to be registered & have their history taken. They were divided up into specialty groups- max-fax (ie: cleft lips, facial tumors, etc), general (hernias, etc), plastics (burns, keloids), VVF (female fistulas) & goiters. They would then be seen by the different surgeons & doctors. If it was determined that yes, we can help them, they would continue on to get scheduled for surgery.

When I was done with pre-screening, I went to help with surgery scheduling. It was a nice change to be on the other end of the process. I didn’t have to say no to anyone who came to me. I would see when we had an opening & give them their appointment card, telling them what day their surgery was. These people had beat the odds & made it to the end & now knew they would be changed forever.

At the end of a long, but successful day

The day ended around 1900 (7pm), a very long, but successful day. We got a lot of people scheduled for the next 5 months; others will come back for a smaller screening with the individual surgeons when they arrive. The screening process went smoothly, no issues with crowd control or safety. Even though it was hard to turn people who we can't help away, we are still able to help so many people that it makes the day worth it.

We are EXTREMELY short on general surgeons. We had some surgeons back out at the last minute. So if you or if you know someone who would like to come & play with us here in Togo, let me know ASAP! It was hard enough to send people away at screening we don’t want to send the people we promised to help away just because we
don’t have a surgeon. Thank you


Blessings

How to Turn a Ship into a Hospital

The AFM at dock

Over the past month & a half, our ship has been just a ship.  We’ve sailed around from one country to the next.  We know we are a hospital, but it didn’t look like it for quite awhile.  Once we arrived in Togo, we began the long process of turning this ship into the world’s largest NGO floating hospital.  

Going from this....

To this

How do you do that you ask?  A lot of hard work. 

We had to strip & wax all the floors in the ORs, check all the equipment, restock supplies, clean & clean & clean.  Who would have thought that a ship at sea could get so dirty!  Each week, we would get more & more help as nurses would arrive, which made things easier- many hands make light work.  We met & greeted our day workers, local people who have been hired to help us communicate with our patients & help with keeping the hospital running.  One morning, we had a practice hospital evacuation drill, where we practiced what we would do if we had to abandon ship with all the patients, some on the wards, some in PACU & some still in surgery.

Resterilizing all the instruments

Evacuated patients on the dock

Meeting our day workers

The last thing we do is bleach everything down, making it completely ready for patients.  Before that though, we were open for tours & activities.  One evening we invited our partners in Togo to come visit the ship, giving them tours of the hospital.  The next night, we opened up to the crew to come down & see the side of the ship that many won’t get to see unless they work in the hospital.  We had games & activities like- “be a nurse for a day”, a suturing station, an intubation station, bed pan toss & dress up like a surgeon.  It was a big hit. 

Welcome to our OR

Visitors learn how to intubate

Become a surgeon

Learn how to suture

The next day, we went sterile.  We’ve spent 2 days completely bleaching the ORs from top to bottom, twice.  We now look like a hospital.  The wards are set up, PACU is clean & unpacked, the ORs are sterile & ready for surgeries.  Now all we need are patients.  Screening day is coming up & soon the wards will be full.  Can’t wait!

Blessings

Bienvenue vers le Togo

We arrived in Lomé, Togo (the capital) safely around 6pm Jan 5, 2012, after a full day of sailing from Tema, Ghana.  We had a nice reception waiting for us on the dock when we arrived.

Carrying the Togolese flag down the gangway

I want to share a little about my home for the next 6 months.

During the time of the slave trade, Togo was a popular trading center, earning the name “the Slave Coast”.  In 1884, Germany declared Togoland a protectorate, but after WWI, it was given to the British & the French in 1914.  Togoland was then split by the 2 countries into the French-speaking Togo & the English-speaking Ghana.  Togo became an independent country in 1960, followed by a military coup in 1963 that put Eyadema Gnassingbe in power.  This dictator served until his death in 2005.  Elections were held soon after in a bid for democracy. 

Togo is roughly the size of West Virginia at about 22,000 square miles, with a population size comparative to Washington State (roughly 6,619,000 people- or 302 people/sq mile).    It is divided into 5 regions or states.  French is the official language, but several tribal languages are the primary language in the different regions.  Approximately one half of the population lives below the international poverty line of $1.25 a day.  About 51% of the population has indigenous beliefs, 29% is Christian, and 20% Muslim.

Infant mortality was at 78 per 1,000 live births in 2005.  Male life expectancy at birth was at 56 in 2005, whereas it was at 59.6 for females.  There were 4 physicians per 100,000 people in the early 2000s.  As of 2010, the maternal mortality rate per 100,000 births for Togo was 350, compared with 447.1 in 2008 and 539.7 in 1990. The under 5 mortality rate, per 1,000 births is 100 and the neonatal mortality as a percentage of under 5's mortality is 32. 

The Harmattan Winds create a hazy, grey day

The Harmattan winds (theses are winds from Northern Africa that pick up sand & fine dust particles from the Sahara & blow it across West Africa) have been blowing since we’ve gotten here, making it very hazy & the air is full of dust & sand, but it keeps the heat down, even though everything gets very dirty & dusty.

Things are progressing well as we get ready to start surgeries.  I’ll update soon with some of the details what that entails. 

Blessings 

Why We Do What We Do

Hi all,  it's been almost a month since we've had any patients on board & it'll be another month before we have any again (this time in Togo).  This transition time is hard on people, especially nurses, who are used to working & caring for patients.  So I'm posting a story that one of my friends from Gateway (who is one of the ship's writers) wrote about a patient to give you (& remind me) an idea of why we do what we do....

Mamodu Mattia

Mamodu & Mohammad wait anxiously
for the admissions process to begin

Mamodu Mattia is a teenager with an amazing smile, but you would not see it if you passed him on the street. He covers his front teeth with his lower lip, trying to hide the fact that he has a cleft lip – anything to keep the attention away from his mouth. His brother, Mohammad Mattia, stands watch over him, trying to protect him from harm.

The last time Mamodu and Mohammad’s family needed a doctor was three years ago when their mother was going through a difficult labor. She died, and the baby died several hours later. Sadly, their father was killed on the same day in a farming accident when a tree fell on him. Mamodu was only 14 when these tragedies struck.



Their extended family refused to take care of Mamodu for fear of any curses associated with his cleft lip. They felt his parents’ death was Mamodu’s fault. The brothers’ situation was made even worse by the fact that Mamodu is deaf and has no training in sign language. How could he take care of himself when he could not communicate with anyone?



So Mohammad left their extended family to take care of his brother. They have been on their own ever since, trying to make a way for themselves.



Before his parents died, Mamodu attended school. He loved school, but, after his parents’ death, he could no longer afford it. Mohammad worked tirelessly in the fields trying to save enough money to send Mamodu to school, but there was never enough. When Mohammad realized that Mamodu was too old for school, he taught his brother how to farm so they could work together. This helped Mohammad keep an eye on Mamodu at all times. Their extended family and other villagers were always mean to Mamodu, and the fact that he couldn’t hear them made him an easy prey.

A man named Abu Yeva changed everything for the two brothers. He told them about a medical screening conducted by Mercy Ships. It seemed too good to be true, and Mohammad was afraid to allow himself to hope. He did not know how much his brother understood, but he could already envision an easier, better life on the horizon. After receiving an appointment, they traveled for five hours to the ship. They were filled with a mixture of hope and apprehension.

Mohammad watches as Mamodu has blood samples taken

When it came time for the nurses to take blood samples from Mamodu, Mohammad instinctively stood guard over his brother. He was still unsure of what they were going to do to Mamodu. He had years of experience protecting his brother from the cruelty of this world, but now Mercy Ships was treating him with such care and kindness. As their time with Mercy Ships continued, both brothers’ spirits started to lift, and they began to trust the help offered to them.

Mamodu takes the first steps onto the gangway

while Mohammad stands back apprehensively

Mamodu is curious about what the nurse is doing to him





Ever-vigilant Mohammad watches carefully as
Mamodu finishes admissions



Mamodu’s stitches come out!

On their last day on the Africa Mercy, Mamodu was found looking in the mirror, admiring his new face. Mohammad was playing games with children on the ward.






After the stitches are removed, Mamodu & Mohammad
see the amazing transformation for the first time

Mamodu & Mohammad admire
Mamodu’s new reflection

Mamodu takes one last look at the ward
before he is discharged

Now both brothers are filled with more joy than they have known in years, as evidenced by their constant smiles. As Mohammad holds a child from the hospital, he says, “If it weren’t for Abu Yeva and Mercy Ships, Mamodu would not have been helped. I am so happy for my brother! Thank you Mercy Ships!”




Mamodu & Mohammad final walk down the
gangway with spirits lifted high



Mamodu & Mohammad leave for home one week
after their lives were transformed

December 2011
Story by Nicole Pribbernow
Edited by Nancy Predaina
Photos by Debra Bell  

Hope you enjoyed your holidays.  Happy New Year!

Blessings