My First

You were my first.    The first patient to recognize me.  The first patient to break into a massive smile when we locked eyes on each other.    Me in the doorway, you in bed 15.    We live vastly different lives.  On the opposite sides of the world.  Yet our paths have crossed.   There is a part of me that doubted.  Doubted I could truly fall in love with a patient here.  Surely the cultural and language barrier is just too big.  Its too massive a gap to feat.  Too wide a bridge to narrow.  I'd continue to tell myself there is no way I'd make a connection.  Until you.  

    And you, this infectious little boy with a smile and a laugh that would leave me in continuous fits of giggles.  You'll never have before and after pictures.  You won't be a media patient.  Your condition is... well, too private.  This struggle you've kept hidden for so long is kept to a quiet hush.  I remember the first day I was assigned to you.  The terror in your eyes when I asked to see your incision site.  The shame.  The embarrassment.  It broke such a huge piece of my heart.   And that shift I'll never forget.  A last minute bedside procedure from a complication with your incision.  

    Your body seized in fear, your veins forming an endless map scaling up your arm.  You gripped my hand, your huge dark, seemingly endless eyes locked on mine.  And in that moment I would have done anything to protect you.  And you're not even mine.  Its that nurse instinct.  The protective, fierce love that could never be taught in a nursing textbook.  The IV was successful on the first, quick attempt.  You immediately giggled at the completed feat.  You looked inspired, awed and even captivated by your own bravery.    And then it was your chart.  In your results.  While silently praying for benign, I was greeted with that dreaded word.  Malignant.  And in that moment I realize we're not going to be able to save everyone.  I know deep in my soul that your days are numbered.  And I fight back these feelings of anger, of resentment.  And wanting nothing more that to figure out some way to protect you.   

     You don't get the endless opportunities and future that I've been blessed with.  We just happened to come into existence on opposites of the world.  Me in a lap of luxury, you in terrible poverty.  You and me.  We're really the same aren't we?  Just battling the realities of the human experience in different environments.  Disappointment, fear, anger, hope, resilience, acceptance, love.     I remember for a still moment that the world is broken and I can't save you.     I watch your beautiful momma with two babies slung on her hips follow chaplaincy down the hall.  Walking into a conversation that part of me would rather be left silent and unknown.  Let's go back to before.  When you didn't have to know the possibilities.  When a huge, white hospital ship came ashore in your home, promising hope and healing. When you expected healing.   And she moves on.  Your mother, I mean.  Resumes the only role she knows, her role as a mother.  Like the earth didn't shatter onto her shoulder from a conversation five minutes ago.  I remember staring at her in awe.  I was witnessing the bravest person I'd ever met.  That language of motherhood that knows no cultural divide.   

     She proceeds to pick up her devastation off the floor, kiss you on the head and decides to continue fiercely loving you, just as she did before we came ashore.   We can never promise physical healing.  But we can promise spiritual and emotional healing.  You are just as loved, just as accepted as those we are able to physically heal.  You are just as important in our eyes.  Just as brave.  Just as inspirational.  Because your laugh, your infectious, playful soul that walked off this gangway is still intact. It's teaching us resilience and love in the face of a harsh, broken world.  

    Hopefully you left us with hope.  With a profound sense of being loved.  Not only by us, but by a God who restores our broken world.  For while the world may be so incredibly broken, it is also so incredibly beautiful.             “We are just two people. Not that much separates us. Not nearly as much as I'd thought.” -Kathryn Stockett  

September

Here is a recap of all the incredible things that have happened in the month of September! It's not only important to give testimony to some of the miracles that have happened here but I also want all of you who have sacrificed so much for me both financially and in prayer to see where your support has gone.  I wish I could bring each of you here individually, show you around the ship, take you to Deck 7 where our patients get to play and breathe fresh air and teach you all the malagasy words I have been learning!

Fast Facts on September 2, 193 dental procedures were completed Plastics, Maxillofacial and General Surgery screenings started 129 patients recieved free surgeries that were life changing and in some cases life saving procedures 88 cases of club feet were treated using the Ponsetti method Clubfoot and Intensive Ponsetti method training for Malagasy health workers held Essential Surgical Skills course held for Malagasy health workers in the capital, Tana The Obstetric Fistula clinic opened 2 World Health Organization Checklist classes held for Malagasy health workers  
Screening for plastics was held and surgeries have started!  I currently work in the plastics/ortho ward (A ward) at the moment and I cannot even begin to tell you how quickly I fell in love with plastics patients.  We have had numerous patients with burns to their necks, faces, arms etc. that we have been able to graft and release their contractures.  Contractures that have created intense shame and the inability to perform simple day to day tasks.  Many of our patients walk onto the ward wearing clothing or scarves to hide their burns and my heart breaks at their shame and fear.  I want nothing more than for them to leave this ship knowing they are truly loved and that their burns are not ones of shame but scars of survival.       

In addition to plastics, A ward has had its fair share of general surgery patients.  This included a lot of hernias, circumcisions and benign tumor removals.  These surgeries are generally quicker and less involved but nonetheless have powerful, life changing outcomes.  Large hernias and benign tumors can impede every day life in a significant way in developing countries.  The inability to remove or surgically fix these problems can lead to multiple negative effects including public shame, isolation, and the inability to work which can thrust an entire family into even further poverty.  Some of my favorite, impactful patients were here only a short while...

Meet Mariette.

Man was this woman incredible.  She came to our gangway with a large lipoma gracing her back.  If ever I needed a smile or an encouragement during a stressful shift, she would be who I'd turn to.  It's incredible that despite the communication barrier, love didn't need a common language.  With a reassuring squeeze of my hand or giving me a huge smile that would light up the ward, she never ceased to remind me why I've left so many I love.  She was the reason.  She was so deserving of this chance to receive free surgery.  Many would see her as the lucky one, yet I saw myself as the one receiving so much blessing from her.  

Mariette rejoining her family, lipoma free!

The Ponsetti clinic opened!  The Ponsetti method is a non surgical approach to managing and correcting congenital club foot.  By creating long leg plaster molds we can correct club feet in a slow, non surgical manner.  We are not only treating patients with the Ponsetti method but we are educating Malagasy health care workers so that they can carry on the Ponsetti clinic long after we sail away.

This is only a small glimpse of the life change that is happening on the ship and I am so very blessed to be a part of it. 

We do not want merely to see beauty, We want to be united with the beauty.   To pass into it. To become part of it.  -C.S. Lewis

Tiny One

The following post was written by a friend on the ship who found the perfect words to describe this tiny patient that boarded our gangway.  At 7 months old, this baby is struggling to keep her weight above 5 pounds.  As a NICU nurse my heart broke at the thought of her and her mother's struggle for 7 months.  And the thought of the numerous other babies around the world who have no access to health care.  I can't imagine the pain her mother has felt watching her baby fade away in front of her eyes.  The fact she is still alive shows the immense strength in her little body and her mother's unwavering perseverance and love.

To see the original post click here.  Shelby has so many beautiful things to say about the work we are doing here in Madagascar.   -----------------------------------------------
"You came to the ward this afternoon.  There was talk on the ward about your arrival.  Someone said you had been found while the advance team was looking for patients.  They didn’t expect to find you.
You came with your mom to the ship, wrapped in a pink blanket so tightly that I couldn’t even see you.  You were just a bundle of pink in your mom’s tiny arms.  At not even five feet tall, your mom is small to me.  But you were so much smaller.  I heard your cry from your blanket and your mom began to breast feed you.  Still, I did not see your face.  You were in a corner in the room.  Many doctors came to see you because you were special.  But special isn’t always something good.  It means you had to be poked several times to draw blood because your veins are so small.  Your little cry became much stronger as we attacked your veins for blood.  This was heartbreaking to hear.  It’s the worst part of our jobs.  But you are so small and need so much care that we had to keep trying until we got enough.  There is no way to explain this to you.
I finally see your little feet poke out from the bottom of the blanket.  They are beautiful feet.  Tears well up in my eyes even though you aren’t my patient, but that doesn’t matter.  I still find that I love you and I haven’t even seen you.  I automatically think of God and how much he loves each one of us.  How much His heart breaks for us when we are hurt.  How much he wants to heal every one of our pains and put us back perfectly together while we trudge on in this fallen world.  I am overwhelmed by how much I can be loved by God, who created me and knows me intimately, if I love you as much as I do and I haven’t even seen your face.  

You have a dirty diaper.  Despite getting hardly any food, you manage to void and get a diaper change.  I see your long legs and again hear your plea.  Your little legs shake from the cold of the room as we obtrusively undress you. The diaper you are wearing is for a newborn, but it is huge on you, swallowing up over half your body.  Your mom goes to redress you in newborn clothes, which look like they are made for a two year old they are so big for you.  She places a bonnet on your head to keep you warm.  She is doing her absolute best.  She goes to breastfeed you again.  She continues this routine nearly every thirty minutes.  I don’t know how she’s been doing this for seven months.  I don’t think she’s slept, but by her quiet and continuous care and obvious fierce love for you, she doesn’t show the wear it has put on her.
Finally, your little head pops out from the blanket.  My heart melts.  You are the most beautiful baby girl.  Your small face and wrinkles on your forehead make you look like a tiny newborn, but your long feet and hands reveal your age.  You are seven months old, but your eyes carry sorrow deeper than I knew they could go.  Your seven months have been a battle.  Your little body, somehow surviving, is the proof that you are a fighter.  And that your mother is fighting with you.  The cleft on your lip tells the story of why your life has been such a battle.  You have a bilateral cleft lip and palate.  It’s an opening in your mouth and lip where your lips and mouth bones didn’t fuse all the way, leaving a gap that travels from your nostril down to where your lip should end.  But this is split for you, on both sides and under both nostrils.  And because you don’t have a contiguous mouth, the little free-floating piece of upper mouth below your nose sticks far out.  Your tongue has been pushing up against it in your attempt to get food and no lips exist to help push it back.  Our lips are the reasons all of our upper jaws and teeth don’t stick straight out, but because you have no such barrier, your maxilla just keeps extending forward.  The holes in your mouth mean you can’t make a good seal in order to breastfeed and because you can’t eat, you are starving.  I hear you were born weighing eight pounds, but at seven months old you weight under five.  In seven months you’ve actually lost weight, even though you’ve somehow continued to grow.  Your long skinny fingers and beautiful feet tell you are not new to this world, and your body bears the scars of one who has had to fight for every day of life.
Our goal on the ward will be to spend the next few months attempting to get you as much nutrition as you’ve missed since birth.  We will give you formula to help supplements your mother’s milk, carefully watching your weight and lab levels to make sure you will tolerate your new feeding program.  Our goal is not only to get you healthy, but healthy enough to have surgery.  Surgery that will fix your cleft lip and palate.  Surgery that will allow you to eat and speak.  There is a possibility you will have hearing damage due to improper drainage for your ears, and speech problems due to the loss of your palate, but these are issues we can’t now address.  Our goal is to get you to surgery.  Our goal is for you to live.
And so we pray for you.  We pray you will tolerate the new feeds.  We pray that you will gain weight.  We pray that you will recover fast enough to make it to surgery while we are still here, that we won’t have to leave you behind knowing you regained your health and your strength but are left with a cleft.  We pray that you will survive."