Very Dirty Feet

I have had some very dirty feet days but I think this one may have topped them all. There was dust in my mouth and eyes so thick my eyes burned and my teeth felt coated. It was Monday and my 3rd day in Nairobi, Kenya. The first 2 were spent getting a feel for the city, the church, my host family, and preparing for the week ahead. As we toured the city over the weekend we saw the downtown with it's high rises and the affluent neighborhoods with their mansions. Then as I thought of the apartment I was staying in with hot water and reliable electricity, I could not have been ready for the complete opposite I would witness on Monday. The day started with a 4 plus hour walking tour of Kibera, the second largest slum in Africa. Nairobi has many slums in fact about 60% of the population live in the slums but Kibera is the largest.

Kibera Facts:
Approximately 1.5 sq miles - the land is government owned yet someone is charging rent
Population: between 800,000 and 1.2 million
Average Home: 10 ft x 10 ft
Average Home Population: 7
Electricity: 20% of homes
Water: untreated and only available sometimes (according to one resident about 3 days / wk there is water)
Drugs/Alcohol: very widely used
Unemployment: 50%
Sewage: 1 latrine per 50 households - once the latrine is full it is emptied into the river that runs through the slum
Pregnancy: 50% of women age 16-25 pregnant at any given time. Many as a result of rape - it is estimated 1 women is raped a minute in Kibera.
HIV: rates are high across Kenya but women are at a 5x greater risk of infection

So we walked around this place for 4 hours and we could have kept going and going and still not seen it all. We walked up and down hills, over some very questionable bridges (where I had very vivid images running through my head of me taking a sewage river swim), across some still functioning train tracks (no warning system mind you), and leapt across running sewage. The slum is composed of 13 neighborhoods and they vary greatly by socioeconomic status as well as people and language groups. Some of the areas had paved walkways wide enough to fit a cart and reliable electricity so much so that people had televisions. Then some are far worse off, these areas seem to be located on the steepest terrain and in the deepest valleys.

The government is trying to slowly change and relocate the slum by building concrete high rises and slowly relocating people. These high buildings although composed of very small apartments have proper sanitation, running water, and electricity. This sounds good in theory but they have found that the people are moving back to the slum quickly after being relocated. One resident of Kibera said to me "why would I live up in those high rises when I could rent out my high-rise apartment for double what I pay in Kibera, then I have money in my pocket and food in my stomach." Someone else I spoke with said many are not comfortable in this new setting, it takes them away from all they have ever know. Generations have lived in Kibera.

There is lots of work being done in Kibera. The Nairobi Baptist Church (NBC) runs a clinic in one of the muslim neighborhoods of Kibera. It has taken lots of time, sweat, and tears but it is now well respected in the community and doing some amazing work. They are also starting a church after a bible study took off. Originally with 5 members, meeting one evening in the clinic about a year ago is now up to 300 people. Outside of NBC and work being done by the local church there are tons of Non-governmental organizations (NGOs) operating within Kibera. We had the opportunity to tour a couple of schools that are completely NGO sponsored and they were very nice. In fact they estimate there is 1 NGO in Kibera for every 10 households.

As I stood up on the top of the hill where these new buildings were located looking down over the vastness of Kibera, I wondered what is the solution? Is there a solution? Who is to say how these people should live? And on the other hand something clearly needs to be done. But the truth is many people are trying. The government and the innumerable NGOs along with the local church. It all felt so useless and helpless as I stood there just staring out. I must admit I felt angry as I thought of the huge amount of resources being poured into this place and the corruption and mismanagement and waste, as many of the resources simply disappear. These are the times I cling to Isaiah 55:8-9 "For My thoughts are not your thoughts, Nor are your ways My ways." says the Lord. For as the heavens are higher than the earth. So are My ways higher than your ways and My thoughts than your thoughts."  I know I could think on this all day and talk it over with the greatest big thinkers of this world but none of that could add up to a solution without the One who is Greater, the One who knows intimately each of those million people. He knows their thoughts and worries and even the number of hairs on their heads. I am so thankful that He is He and I am not. He sees it all and yet I can cry out to Him in frustration when I am looking out over this city and He will lovingly comfort me all the while continuing to hold the whole world in His hands.

* Images from google images

Kenya

God has placed another amazing opportunity before me. This time it is a bit different. I am traveling with a group of 20 from Park Community Church in Chicago through March 20th. Now you might be wondering why Kenya, that is one of the wealthier countries in Africa as well as one of the most reached by the gospel. I wondered that myself. Park Community has partnered with a local church in the capital, Nairobi Baptist Church. The churches are quite similar; both located in an urban setting and financially well-off with a congregation comprised of young professionals. Neither church "needs" the other. Both have a vision to spread the gospel to unreached areas on the continent of Africa. God in a unique way has brought the two together with a vision of partnership and a future of moving into a neighboring country such as Somalia or the Sudan that is less reached.

This partnership is less than a year old and this trip is a first. So this trip is mainly a relationship building trip. There will though be good work to be done while there. The team will be split into two once we arrive, half staying to work within the city and half traveling to a coastal rural village. Nairobi has a well established medical clinic within the Kibera slum in the city. This slum is the second largest in Africa with possibly a million people living within its boarders. The clinic operates full time and those of us who stay in Nairobi which includes myslef will be helping supplement those who work in the clinic. The other group will be traveling to a coastal village named Kwale. Nairobi Baptist has been taking a team here yearly for the past 10 years, and this year they have been given some land on which to set up a medical clinic / pharmacy. We will be helping establish this clinic and possibly aiding in a medical clinic for the school children in the area. Both Kwale and the area of the Kibera slums we will be working in are primarily Muslim and this is the reason that Nairobi Baptist has chosen to focus on these areas.

God has brought together a great bunch of people and I am excited to see what He has in store for this upcoming week.

Out of my hands...

Right now I feel like this phrase describes everything in life. If you know me at all you know I like to stay in control. I don't give it up without a fight. But the circumstances of life are currently teaching me a lesson about things I cannot control.

The Danja Fistula Center is opening in early February and my heart and mind are there with the project but my body is very far away. I know God has me here for this time and has blessed the project there with very capable hands but I still feel removed. I am planning a trip to Kenya which is keeping me distracted along with finishing school but my heart is still yearning to be there with the ladies at this exciting time. Please keep in your prayers the center as it opens. Here a links to blogs from my two dear friends who are already on the ground preparing for the grand opening and the next 6 months of work there in Niger. Ashley Sellars  and Sarah Walker. 

So here I am in Chicago and planning to graduate from my Nurse Practitioner / Midwifery program in May! This is contingent upon me delivering 30 babies by the end of April and it seems that for the last 2 months the babies are on strike. I need to get about 1 delivery a week and I have been getting 1 a month despite putting in lots of time at the hospital. Now I suppose I had better get used to this as I have chosen to delivery babies for the rest of my life but just for the next 3 months I really wish they would cooperate and come out on demand. I currently am at 8, but these each have been great. Being a labor and delivery nurse for the past 5 years I knew I enjoyed this work but I wasn't sure I would like being the actual one to catch and have this added responsibility. I have found it to be such an honor and hope that my future life consists of helping many women through their birth process and even possibly teaching others to do the same. 

All of this said about this lack of control really became much clearer as I sat in church this evening and listened to the message. I was reminded so clearly that all of this is not about me. God doesn't need me in Niger right now and God knows exactly when each and every one of those next 22 babies will come into this world, all I need to do is stay focused on Him and the rest are all details He already has in control. 

"Whom have I in heaven but You? And there is none upon earth that I desire besides You. My flesh and my heart fail; But God is the strength of my heart and my portion forever."

Psalm 73: 25-26 

 

Lonely for the ladies

It's been two days now since they danced. Since the 12 of them stood there in the brand new hospital all dressed up in new clothes with necklaces they had each made by hand. I hope I can hold onto the memories of that day like I do right now.

To memories like that of the oldest lady of the bunch putting on her own dance show right in the middle of the ceremony, swinging her hips a little extra and simply stealing the show after sharing her testimony of how after 30 years of leaking she is finally dry. She is this sassy old women who stole my heart, as I fear I will be just like her when I am her age. Every time she saw you she would call you over often by name pronounced in her own unique way with a  little scowl on her face. She wanted her pot emptied or for you to do this or that, whatever it was that she thought was so important at that moment. Her unique name pronunciations have now given my good friend Kathleen the nickname of Kapleenchy which I plan to use for the rest of her life! Once she got your attention she was not letting you go until you got it right even if it was 3 in the morning. Then once you had accomplished her requested task she would just beam a big smile of praise. Dealing with a little extra sass was worth every second as I watched her dance.

Then there was the memory of another lady whose little girl won you over with cuteness as she worked so hard at remembering our names and then shouting them loudly to get our attention even from across the compound. Every dress ceremony is filled with more than a couple potty breaks, but for women who haven't been able to go like the rest of us for the past however many years it is a welcome interruption. Well mama took her first potty break by walking to the bathroom but then decided she wasn't going to miss the action so the next time she just went right there in the room in a little pot tucked behind a bed. Just as she went she realized the other ladies were headed over to shake the doctor's hand and to show him their gratitude and so she quickly jumped up and ran over giving everyone in the room a laugh.

Lastly I hope I never forget the smile and look of joy as I caught the eye of and gave a quick wink to our smallest patient of this trip. She found some physical healing but also some spiritual healing and the truth and power of Jesus in her short time with us.

It has only been two days but I find myself missing them already.

Freedom to dance

I don't know what it is about these ladies that makes me feel just a little bit more free. When in my day to day life back at home I find myself a little more reserved and I hold just a little more back. But here with the ladies I make a fool of myself with motions and facial expressions just to get a point across with overcoming the language barrier. My Hausa is still kudunk kudunk (small small). I let myself dance and laugh and giggle just a little bit easier. Today was visiting hours on the ward and we had all the ladies family members come in. We got all the patients out of bed and into this room with a few benches. We had a radio with some local praise cassettes and we turned the music on and had a great time. The ladies led us in some dances that mostly consisted of shuffling around in a big circle and spinning around every few beats. Then we decided to show them some white girl dancing which ended up consisting of country line dancing, the macarena, and the hokey pokey. They thought we were crazy but we all laughed until our sides hurt. These women who by our western standards and even by their own cultures standards have nothing, they are the lowest of the low but they seem to teach me everyday a little more about life, resilience, happiness, and laughter.

Can I go home yet?

Before I left for this trip I found myself selfishly fighting this feeling of wishing it was over already. I felt this way because I knew that at some point I would get to my breaking point where I feel completely and utterly exhausted and frustrated. I can't even find the right words to describe that feeling, I just feel done. This point came after 5 days of working long days in the heat and 2 nights of very interrupted sleep with trips to or calls from    the ward. The one good thing about getting to this point in the trip is that I then get over it. I found  some space, talked to God, and took a nap and now I find myself on the other side of the mountain and I like it here. The surgeries are done, there is time to play games in the evening, time to dance, make necklaces, and sit outside with the ladies. Time to breathe. I love this time when you realize why you pushed so hard. God teaches me a lesson in those times. He reminds me that He is the one carrying me, I am not strong enough to simply push through as I often fool myself into believing. I need His grace and strength to fight my way to the other side of the mountain.

Potential

As I first stepped into the completed Danja Fistula Center, where back in March it had been just walls with unfinished rooms now there was a hospital. There stood a clinic, an operating room, a ward! I walked around this big empty space and just felt in awe of the potential of this place. Lord willing this will be a place of healing. In time it has the potential to help hundreds and then thousands of women that will walk into this place in search of a new beginning. My prayer of dedication for this place is that it will be exactly that, a place of healing for bodies and for souls. As we got started working for the first time in this facility we found as with any trial run many kinks; sinks that leak, fuses that blow, things that don't work, and a very confusing system of a different key for every one of the more than 30 doors. As I sat and thought about this new place and all it's problems and how they are trying to hide the potential it made me think of how we are as humans. God created us in his image and then in our humanness and sin the kinks come out and they try to obscure the potential and hinder the good we are capable of accomplishing. We sin and break down and turn away and we break God's heart. But hallelujah this is not the end of the story, Jesus died and rose again and his blood covers our imperfections. I believe that despite the trials and struggles of this first week that this new hospital can reach it's potential even with the bumpy road ahead. I know that at least for the 12 women that we operated on with this trip that they did find hope here in this place. They found laughter and friendship and healing and that is a great starting point.

The Middle

Right now I feel like I am just stuck in the middle, the middle of everything. I am halfway done with graduate school which in turn makes me feel stuck in the middle of being student and professional. I feel in the middle of what I need to be doing here and the work that needs doing there (wherever there may be). I just feel stuck and I do not like being stuck. I am the girl that likes to have an exit strategy at all times and there is no exit in site.

But the good thing is right here in the middle of the middle is a little escape! My bags are packed and filled with needles, medications, and supplies. I have turned in my final summer paper, finished up my final clinical hours, finished up my last 3 night shifts and I am ready to jet! In a little over 12 hours I am getting on a plane and headed back to Danja, Niger. Somehow everything feels a little more right within me. I've got that little spark of excitement that comes with the inevitable drama of international travel. I am excited to get back and see how the project has progressed since we last left it in March. They say the building including the OR and the patient ward are ready for us to use and we are going to give them a try.

As with any trial run we are sure to encounter some hiccups. The first of which has already begun as the prep team who headed out a couple days ago in order to set up before surgery next week has yet to make it to Danja. Weather and lost luggage are the culprit and we are praying for swift resolution to both.  As I read the email this morning explaining that the set up team was yet to get there my heart sunk. They were supposed to make sure we had everything we needed so if not the remaining members of the team could bring it with us. Now I feel like we are going in blind. As I read on Dr. Steve so beautifully reminded me that yes this trip is about surgery and healing but even more than that this trip is about learning to look a little bit more like Jesus. This is so true and struck me so profoundly. Every trip I have taken has done this. Every time we seek to do His will and we follow His lead no matter the outcome He is using that time to teach us even in little ways to love a little more like He does.

I'll be gone 2 weeks. This next week Lord willing we will be doing surgery and the following sticking around for the ladies to finish healing do a little dancing and celebrating, planning for the future of the site and then coming back. I won't be able to blog while I am there but please cover these next couple weeks in prayer. Pray for the ladies; that God will begin the healing within them. We ask for not only physical healing but also for emotional and spiritual healing as well. Please pray that we can use His discernment to know who to help now and who can wait. And lastly do please play for the travel; for good connections and for arrival of supplies.

See you in a couple weeks!

Procrastination

So it turns out I am pretty good at procrastinating, excellent at it in fact. This is definitely one of my not so great traits. Somehow this thing happens when you start putting something off, the longer you put it off the easier it gets to just keep putting it off. I seem to always have at least 2 or 3 things sitting in the back of my mind I should be doing and that I am actively putting off. Updating this blog has been one of those things for about 3 months now ... some others include cleaning out my email/facebook inboxes, returning about 3 phone calls, reading through what assignments will be due this summer for my classes, and getting a text book for a class that started 9 days ago. Wow that all seem ridiculous when I write it down.

So if you are wondering if I am still freshly jet lagged in Niger ... nope. I have been there and back again, finished my second semester of graduate school, started doing clinic work for school, and am planning my next trip back to Niger with these last 3 months of blog procrastination time! 

I am so excited about the work going on in Niger with the Danja project, if I let myself think about it too much I get completely distracted from life and don't get a thing done. Worldwide Fistula Fund has been working on building this freestanding fistula hospital in rural Niger for the last couple years and we are soon going to see it operational! The trip in March was very successful. We were so blessed to be able to help 18 women in the 2 weeks we were there. At that time we were still using the facilities of the existing leprosy hospital that is run by the missionary organization SIM. Lord willing in August we will be using the new hospital facilities that are being built for the fistula hospital and then by November we plan to have the grand opening! The hope is that by November we can start continual operations. God has provided a gifted African surgeon who will be working with us, but a big prayer request is that we can find and train the remaining support staff. 

The March trip was really my first look and experience with fistula work in the land based setting. To say that it is different then working on the Mercy Ship is an understatement. It has different challenges and different strengths but I think that this model will in the long run be a much more effective method of providing good care with good follow-up for the ladies. The 2 weeks were fast and furious, filled with very long hot days and some long nights. It was filled with trying to pick up Hausa (the local tribal language), remembering how to drive a manual, and a camel ride. Just as a side note my favor Hausa phrase so far is Babu Wahala, it means no worries. 

On this trip the fact that this project needs someone who can make a longer term commitment of a couple years to come in and help get everything running, staff trained, and the kinks worked out came up. Now at this point in my life this is not an option for me, I am in graduate school and this has got to be the priority. Now of course the thought of possible long term service in my future has crossed my mind and the truth is I don't know if that will be my future life or not, but for now I am so grateful for those people like my friend Ashley who are praying and seeking about possibilities of long term service. 

I thought I would walk away from this trip with a better idea about if this is what I wanted to do with my life or not and the truth is I walked away with many more questions than answers. There were a couple of experiences on this trip that really helped open my eyes to what day to day land based missionary medical work looks like. There simply are not enough supplies and resources to do somethings we need to do, so you make the best of what you have. But that is easier said then done. It is completely maddening to be in those situations where "if I only had..." it would be so easy to fix said problem or situation. I distinctly remember one moment when our anesthesiologist had just gotten on a plane and we all of a sudden had two patients that needed to go back to the operating theater. I remember standing in the operating room holding this patient's hand while I looked the surgeon in the eye and he said, I'm not quite sure what to do. It is in those moments when you have to make the hard decision, those moments when you do the not so nice thing to a patient even though it is best for them, those moments when you simply have to make do that you really find out what your made of. In that particular moment all I could think to myself is do I have the stomach for this, can I do this? Well I guess the truth of it is I was doing it, I did make it though. The patients did fine and it all worked out, but it is in that moment that it hit me square in the eyes, if I continue to do work like this eventually in one of those moments it won't work out, something bad will happen, someone might die. This is a reality that I have to face and I have to work though.

So in the end I walked away with more questions but this thing I know, God walks ahead of me and He is in all those moments and I will trust Him to guide me through it all. 

To see all my pictures from my trip check out my facebook album.

4 a.m. or 10 a.m. ???? I just don't know

When I work the overnight shift, I usually do pretty well until about 4 a.m. then I hit the wall and until about 5:30 my body screams .... you should be sleeping!

So the first day of surgery started early for me with the alarm at 0600. We have 4 surgeries today and in order to get them all in we need to start at 8. So for me this means I need to get down to the ward and get the first patient ready. She needs a shower and an IV and time for the IV fluid to get in. I am greeted warmly as I come around the corner into the ward at 0630.

I make it to 1000 and the first patient is in the operating theater and the next two are ready and here comes the wall. I feel like it is 4 in the morning ... wait it is 4 in the morning or at least it is on the other side of the world where I usually lay my head. But here in Danja it is 1000 and hot and muggy and quiet and my body is saying sleep! So while I have a quick moment I lay down to close my eyes for a quick rest on the bench in the ward and the minute I do the patient returns from surgery... it's ok this is her 3rd attempt at having her fistula fixed and it is time to get back to work.

It is good for the next 3 ladies that this lady with previous surgeries went first, she isn't nervous about the process she just takes it all in stride and with a smile. She even takes it upon herself to help explain what will happen to the other ladies and demonstrate for them some of the things we ask them to do in preparation for surgery.

One of the other ladies who is next for surgery was anxiously watching on as the lady next to her had her IV started. The whole time she watched her neighbor, I was watching her face. Her face read fear. As a nurse I don't even think twice about these things I consider routine everyday procedures. But for especially these patients this may be their first time ever in a hospital or to see an IV needle or a blood pressure cuff and the inside of an operating room. How crazy scary this must be for them and how much trust it must take for them to let us... these people they don't know, that speak a different language, and are a different color come in and take control from them and then trust us to care for them. As the IV is finished on her neighbor she looks up and catches my eye, I smile and she giggles like she was caught cheating on her fourth grade math test. Fear will not rule for today she is taking this chance for hope and as I write this her surgery went well and so far she is dry!

African Sun

There is this distinct feeling that comes over me when I take that first step off the plane into the hot West African sun. It's this hard to describe moment of yep I'm here. One of the team members asked me in the car from the airport if my heart was tied to West Africa and as I thought about it for a moment the response that came was my heart is fully tied to VVF and caring for these ladies. So far West Africa has given me the opportunity to do that but I think I would be happy wherever doing whatever so long as I am doing something to serve these women.

Screening day started very early before 6 with the small flight from Niamey to Maradi and then the drive to Danja. When we arrived we found the ladies waiting for us, approximately 40 of them and some of them had been waiting for us for two weeks. They were waiting for us under the big shade tree (pictures to come soon). We were greeted in a whirlwind of Sannu (hello in Hausa) and handshakes and giggles.

It was after lunch when we got started but we hit the ground running, screening all 40 women. Screen day in a word is exhausting. More then the jet lag and dehydration and the heat, it is emotionally draining on me. We saw these 40 ladies and had only 18 surgical spots. The silver lining in this here at Danja is that we are building this clinic to stay and be a permanent thing here so we are not saying no to these women we are just saying not right now.  So with all 18 spots full surgery starts bright and early the next morning.

I do not like breakfast at midnight

So the road to Danja well more like the airplanes to Danja came in 4 parts. Chicago to New York - New York to Paris - Paris to Niamey (capitol of Niger) - Niamey via 6 seater (including pilot) SIM missionary plane to Maradi (second largest city in Niger) - then finally a drive to Danja.  The big time change comes in the flight to Paris. These flights are always this strange disorienting night in fast forward. They feed you dinner, shut the lights off and tuck you in for a nice nights sleep, then a couple hours later, around midnight turn the lights back on break out the coffee and serve breakfast. This always brings up this great dilemma; sleep or coffee.... sleep or coffee.... I choose sleep! Then you land and get off the plane and everyone is alert and just starting the day and its annoying... so I went in desperate search of some coffee and paid like $5 for basically a double espresso and milk. It helped but even more than that finally seeing all the team as we met up at the gate to board the flight to Niger. It was a great reunion!  On to Africa!

Danja Bound

Some how writing this now feels almost forced. I haven't updated my blog since I left Africa and now the only reason I find I can make myself write again is that I am getting on a plane in the morning to go back. It's not that I haven't thought about sitting down to write a hundred times but what could I say that would compare with the work and the stories that went on with Mercy Ships. To be honest I have let this  idea take over since I returned from Africa. It's not as though nothing has happened, I have started a master's program in nursing, got a new job, moved to a new city, and even survived a blizzard.  I am settling into life here in Chicago but something feels a bit off. There is something missing. I think when you are doing something that fills you so fully and consumes all of you and then you step away from that, there comes with it this sense of loss and an emptiness. This transition has been something for me to really work through over these past seven months, and it has been anything but easy. God has been using this time to teach me new and different life lessons. The gypsy soul in me has been learning what it looks like to have to make an effort and invest with a longer term outlook. I will be in Chicago for years not months and although at first this caused me to have little heart palpitations, I am slowly coming to the point where the idea of being able to invest in relationships in the longer term is really exciting. God has blessed me with an amazing roommate, great classmates, and solid friends at church and somehow I have managed to find a community to live in that doesn't float, and I am very thankful for it!

So since I left Togo in July, I have known this trip to Niger was coming. I knew before I even came back to the states that this trip coincided with my spring break and there was no way I was missing it. In fact I have been clinging to it. When I got my plane tickets I was dancing around my apartment like a crazy person. Now it's here... it's tomorrow... and I am very excited. 

I have the opportunity to work with Worldwide Fistula Fund and their Danja Project.  I am headed out for two weeks to be doing more fistula work and reuniting with the old team of sorts even though it is with a different organization and in a very different setting. The same surgeon Dr. Steve will be our lead surgeon, and my fellow nurses are old friends, Beccy, Karin, and Ashley and I could not be more excited to be working side by side with them again caring for our ladies that we all love with all our hearts.  This trip will look a lot different as it is in a rural area at a land based clinic. The organization has been working on the building of the free standing fistula clinic in a small rural community of Danja, Niger. This trip, Lord willing, will be the final one before the clinic opens later this spring! We will be doing 5-7 days of surgery and hopefully helping about 15 women!

While there I will have some intermittent internet access so I will try and blog and post pictures as I can. Thanks in advance for all the prayers... I know that the Lord walks ahead and I am excited to follow Him on the adventure of the next two weeks! 

Say Good-bye and Go

So my time here has come to an end. My bags are packed (and not as heavy as I anticipated!) I am avoiding good-byes in my typical fashion. The last two times I left this ship were very different than this time. The first time I was leaving but didn't feel ready. The second I knew I was leaving with a date to return. This time I am leaving with no plans to return, but I am ok with it. I feel ready. I feel as if this season is coming to a close.

I will miss this place and these people fiercely but I will take so much with me. I know that God has used this time to prepare me for what lays ahead.

I know my transition back into life in the states will be tough, it is just so different and it's hard for me to switch my brain back to life there. So please pray for me as I have a whirlwind transition ahead, from life here to life as a graduate student in downtown Chicago in under 1 month.

As I go I just wanted to share with you one last look back and give a quick summary of what the VVF program accomplished. I like the numbers because they make me feel like we really did something, but they mean nothing without the stories and the faces. I have shared many of those so now here are some numbers.

6 weeks of surgery

120 surgical procedures on 99 women.

2 VVF surgeons

4 African surgeons trained in VVF surgery (2 Benin, 1 Rwanda, 1 Nigeria)

4 African nurses trained in care of the VVF patient (2 Rwanda, 2 Nigeria)

80-90% successful (success rates in VVF are debatable, so let me explain this a little. 90% of our surgeries were successful in that we closed the hole in the bladder. Many women leak some after surgery because of weak muscles or any other number of causes, to these women the surgery was not completely "successful" so if you include those women in the numbers than about 80% went home dry!)

Here is a collage of all of their faces. It was an honor to care for every one.

If you were praying for a specific women I should have emailed you with an individual update on them. If by chance I didn't and you want to know what happened with your lady, please email me or comment and I will try to get back to you.

Josephine Adankpo

The drums were beating a glorious praise to God. People crammed into the ward to celebrate the joy of the women who received successful VVF surgeries. Josephine stood happily among them. Dressed in a lovely new green dress, her head wreathed by a matching headpiece, she flashed a brilliant smile as she came through the door.

Josephine and her husband had four children when she discovered she was pregnant with a fifth. Despite the fact that she had a C- section in the hospital, her baby died, and Josphine suffered a childbirth injury called a vesico-vaginal fistula. This injury is all too common in poorer countries. It is caused by prolonged or difficult labor without timely medical assistance.

The constant leakage of urine resulting from VVF disgusted Josephine's husband. Because he had never heard of anyone ever having such a problem, he decided his wife must have been unfaithful. He accused her of being a prostitute and kicked her out of their home.

She and her three younger children went to Benin to live with her father. To support them all, she made tapioca to sell. But customers were repelled by the smell from her wet clothing and wouldn't buy any food from her. With no other resource, she was reduced to selling trinkets by the roadside.

Gossip and hurtful remarks followed Josephine wherever she went. She was so overwhelmed by shame, she hid in the house. She described her despair. “ When I slept and then I woke up, m y bed and everything around me would be wet. I would say to myself, ‘ What kind of life is this?' Then one day I heard there was a hospital ship coming to Benin . ”

Her hopes were raised when her aunt told her to come to Cotonou, because the Africa Mercy was coming to Benin to offer surgeries free of charge. She went to a screening and was accepted for surgery. But the first procedure didn't eliminate the problem. Disappointed, but undaunted, she went back for a second surgery. But by then, the ship had gone, and she was advised to travel to Togo, the site of the ship's next Field Service.

When the Africa Mercy arrived in Togo, Josephine called to say she would come to Lomè for the VVF surgeries. This time, her persistence and hope were rewarded with a successful surgery.

As she celebrated the wonderful gift of a normal life, Josephine exulted, “ I want to thank God. I want to thank the doctors and all the day-volunteers.” After seven years, she was dry!

Story by Elaine B. Winn

Edited by Nancy Predaina

Photos by Liz Cantu

Lonely

The past 6 weeks has been many things.... it has been hectic... it has been joyful... it has been heartbreaking.... and I know deep down in my soul it has been life changing. Not only have I had the privilege of being a little part of the process that has reached into the lives of 105 women from West Africa, but each and every one of those 105 has reached into my life and changed me a little too.

I can barely fathom that its all over.  Toward the end of the final week I knew it was time to be done. I was tired, no I was more than tired I was exhausted... I had poured out all that I had. It had taken every ounce of my energy, every critical thinking skill, and pulled from my whole spectrum of emotions. God has provided me with a good support system here and my "mom" here on the ship Joy (who happens to also be my boss) gave my strict instructions that I was to take this whole week off. I have taken her up on that!


So with my days off, I have gone to the pool and gotten a sunburn.... I have slept in and read a book... watched a movie and worked through some of the details for school. Tomorrow I am headed off to Ghana to visit a friend Alyse from home and will be there for 4 days and could not be more excited to be off this big white box for a while.

All that said I have noticed this little aching in my gut and I haven't been able to quite put my finger on it.  Tonight I let myself walk into the wards for the first time in a few days and as I walked in I found before me a room full of middle aged men (we transition from VVF surgery to general surgery which is a lot of hernia repairs). And as I walked in, it finally hit me. I miss them. I miss my ladies. What used to be 2 full wards, up to 40 of them at one time has now dwindled down to 5 and I miss them. I miss their faces and the giggling, the parades and dancing in the halls all the while holding catheter bags... the daily 4 pm praise session with the drums and the races to the bathrooms. These ladies have consumed my thoughts and my prayers and my everything for the past few months and now its over and they've gone home. I do realize that is the point and I praise God for all the wonderful things He has done in their lives but its like any of those experiences in life that comes to an end and you feel a little bit of sadness as it goes.

Last December the ship sailed away from Benin and I had this big decision in front of me as to either come back to the ship and coordinate the VVF program or to head to Sierra Leone and help with the maternity clinic there, or to stay home. God clearly told me to go to Togo and at the time I felt completely out of my league and confused as to why he wanted me in this position. But now half a year later and looking back it all seems so clear. There is no doubt I was completely under qualified for the job I just did, but God wasn't. And I have learned so much from this experience. I have skills I didn't have before and confidence I didn't possess before. I also have contacts with people and places that will be a big part of my future. The surgeon I worked with these last 6 weeks, Dr Steve is also working on a project in Niger where his organization is starting a VVF clinic there. As of now I have plans to accompany him and some of my good friends from here on a trip there in the spring!  I also am finally feeling ready to be packing up and heading home and this time I know I am headed back for years not months and this does not scare me in the least! (Are you excited to read that mom??)

I want to thank everyone for all the prayers you have sent up on mine and the ladies behalf. They have without a doubt carried us. For those of you who prayed for specific women, I think that has made a big impact on the whole thing and it has meant so so much to me. Next week I promise to email you all with updates about your ladies. As I mentioned before there still are 5 ladies here on the ship, so be prayerful for wisdom for the team as we decide how to tie up the loose ends pertaining to their care.  Thanks again...Maggie

Rikiata

RIKIATA BAWA

Rikiata is a spirited and capable woman, full of good humor and common sense. The mother of four children ranging in age from 6 to 17, she discovered almost two years ago that she was pregnant again. Although she had a C- section in the hospital, her baby died, and she was left with a vesico-vaginal fistula (VVF). This is a very common problem that occurs in poor countries where medical assistance is very limited or inaccessible. The injury is caused by prolonged or difficult labor. Often the mother is too small or too young for unassisted childbirth.

VVF results in incontinence. The constant leakage of urine soon destroyed Rikiata's trading business and her life. So, she went to visit her mother and stayed there.

Rikiata knew about Mercy Ships and called to see about a screening, but at that time the ship was in Benin. When the Africa Mercy came to Togo, the doctor called her and told her that she should come to a patient screening. Mercy Ships provided transportation for Rikiata and several other people from her village in northern Togo.

In just a few days, her life was dramatically changed! Her surgery was successful. During her recovery time in the ward, she was a great help as a translator because she knew the languages of the northern part of the country. Overjoyed that she was dry once again, at meal time she would say, “When they give me food, I tell them I am already full of happiness.”

All the women who have had a successful VVF surgery participate in a dress ceremony in the ward. They are each given a new dress and a chance to share their testimony. The drums begin, and the singing and dancing follow, as the ward echoes with the joyous sounds of happy women celebrating the return to a normal life.

Resplendent in a royal blue and gold dress and matching head-wrap, Rikiata led the group into the ward. Her brilliant smile reflected her great joy as she gave her testimony, “I wake up dry. I am overhappy! I can start my business again . Even my children are happy!”

Story by Elaine B. Winn
Edited by Nancy Predaina
Photos by Liz Cantu

Akissi

Akissi Nalalene

Akissi is a spirited teenager. Her gleaming white teeth brighten her contagious smile. Some things get lost in translation, but not Akissi's gregarious behavior. When asked for a photo, she swiftly poses with clenched fists showing off her buff arms – accompanied by her award-winning smile.

However, Akissi's life has not always been filled with smiles and laughter. She grew up in a rural village in the northern part of Togo. From a family of farmers, she learned to work long days under the brutal sun at a very young age.

At sixteen she moved to Cote d'Ivoire to be married to a man there. When she went into labor with her first child, she struggled for several days before finally going to a hospital. She received a cesarean section, but the baby was stillborn. Akissi was devastated.

Akissi noticed that she could no longer control her bladder. Her condition is called vesico-vaginal fistula, or VVF, and is caused by damage resulting from obstructed labor. It is very common in countries where there is little or no obstetric care.

At this point, Akissi's husband no longer wanted her, and he sent her home. It was a very long voyage from Cote d'Ivoire back to her village in northern Togo. Akissi did her best to cover up her condition. But the other people on the bus noticed the foul smell coming from her, and she was humiliated.

Finally she was back with her family in her village, Pkaple. Akissi struggled to endure everyday life. Her vivacious personality was stifled, and her head remained bowed in shame.

Then Akissi heard on the radio that doctors from Mercy Ships were coming near her village to see women with a leaking problem like hers. She attended the patient screening and received a date to make the journey to the hospital ship in Lomé. Excitement and hope filled her heart.

Mercy Ships arranged transportation for the women from the northern areas to get to Lomé. When Akissi arrived, she was overwhelmed by the bustle and commercialization of a large city, but she remained focused on her hope that in a matter of days she would have her life back.

VVF surgeon Dr. Steve Arrowsmith performed surgery on Akissi. When the nurses removed the catheter a few days later, Akissi was cured! For the first time in a year and a half, she was dry!

A few days later Akissi took part in a ceremony honoring the women who were blessed with successful surgeries. The sounds of drums, clapping and singing echoed through the ward as the women filed into the room in traditional African dress. Akissi wore a new cobalt blue gown with touches of golden yellow. Her face was lit up with joy.

Akissi stood up among her peers and a large crowd attending the ceremony and said, “Thank you to all the doctors and the nurses. Now, I can be among people. I no longer hide at home. Thank you Mercy Ships for all you have done.”

Thanks to the entire Mercy Ships VVF team, Akissi will return to her village and regain her sparkling, bubbly spirit. She looks forward to a normal life – a life free from shame and filled with joy.

Story by Claire Bufe
Edited by Nancy Predaina

Stories

Here on the ship we have a marketing department with writers and photographers that try and keep up with all that is going on around the ship and life here and document it. They have written quite a few stories about VVF and now that we are just finishing up and I am trying to catch my breath after a whirlwind 6 weeks. I find myself having a hard time putting it all into words. So while I process it all I will post some of the marketing stories for you, so you can see the faces and read the stories of a few of my ladies.

Hope Reborn

Akissi, an 18-year-old girl, waits patiently in line. Slowly, she moves closer to the examination area. She thinks back on the four months since her first medical screening near her home in northern Togo. She has been anxiously awaiting this day. The moment has finally come, and she prays that the doctor will say to her, “Yes, we can help you.”

Akissi is one of many female patients that arrived on the dock of the Africa Mercy with the hope of being reborn. These women are being screened for a debilitating condition called vesico-vaginal fistula, or VVF. Such a condition is common in African countries because of the lack of obstetric care. The Mercy Ships program, aptly titled “Hope Reborn,” will ease their suffering.

VVF is usually caused by difficulties during childbirth. Some women writhe in agony for several days before giving birth to a stillborn child. The prolonged, obstructed labor causes a hole to form between the bladder and the vagina, making it difficult to live a normal life. The women experience an involuntary discharge of urine, causing an unpleasant odor.

Maggie Schrenk, VVF coordinator and a volunteer on the Africa Mercy , has also been waiting for this day for several months. “These women are very special. I hold a special place in my heart for them. Today starts 6 weeks of surgeries that will repair their lives.”

VVF is a stigma in African society. Although the condition is prevalent, it is not a subject for discussion. In fact, people try to ignore it. Women suffering with VVF are usually shunned, becoming isolated from everyday life.

If more doctors knew how to repair fistulas, many women could be released from their lives of separation and despair.

That is why Dr. Steve Arrowsmith spends much of his time educating local surgeons. Dr. Arrowsmith is a VVF surgeon from the United States and has spent 23 years performing VVF surgeries and educating African surgeons about the technique. Teaching other doctors onboard the Africa Mercy is a unique opportunity that Dr. Arrowsmith appreciates very much.

“The ship is an amazing training platform,” Arrowsmith says. “You take these African doctors out of their home medical facilities, and all their distractions are taken away – no cell phone coverage, no pagers – and all their other needs are taken care of. It's a unique niche for the ship that nobody else can match.”

Screening day onboard the Africa Mercy is a long arduous day, but Arrowsmith and the VVF team are prepared and up to the challenge. By 11:00 a.m. they are two hours ahead of schedule.

Lindsay Nelson, VVF Assistant Coordinator, explains, “We are moving through the exams quickly, which is great. We will see about 60 women today. After Dr. Arrowsmith examines each one, the team will convene and decide who we will bring in for surgery, and who are inoperable.”

Spirits remain high throughout the day, and examinations are completed by 4:00 p.m. Maggie comments, “We will have ceremonies celebrating the ones who have received successful surgery. That day marks a new life for them and those are the moments I live for.”

There will be many of those moments onboard the Africa Mercy in the next few weeks … thanks to the hard work of the amazing Mercy Ships VVF team.

Story by Claire Bufe
Edited by Nancy Predaina

Cautiously Optimistic

The morning after I wrote the previous post about Nimambe, I walked into B ward around 0745 as I usually do to get a quick briefing from the night, before rounds start with the surgeons. I sat down with the charge nurse and looked over at bed 3 where Nimambe had been an occupant for the past 3 weeks, for the first time there wasn't a catheter bag hanging off the side of the bed. 

I hadn't quite worked up the courage to ask yet if she was leaking since the catheter came out 2 hours before. So I asked about a couple other patients then when it could no longer be avoided I asked. Yes so far she was dry and she was peeing!!!!!! Around here we get really excited when someone pees. 

All day I kept checking on her, she was dry.

 I couldn't bring myself to write about her that night. What if I celebrated too early and the first night she started leaking again. So I told myself I would wait until the next day. So Friday morning I went for mourning rounds and she had been dry most all night. She did leak but just little little bits, this is quite normal for these ladies as their bodies are relearning what it is like to keep urine inside, especially over night. 

That same day was a dress ceremony and today Nimambe would dance! In her time here she had seen more than 5 ceremonies of women who had come with her or after her. All the time she was just waiting, but today was her day. 

She almost seemed on the edge of tears all day. She barely even cracked a smile. I had this internal conversation. Why isn't she happy? Isn't only leaking a tiny bit so so so much better than she was before? It has to be crushing to have had this be your one hope and expect to be completely healed and then be so close but still not be perfect? 

Then I think I put my finger on it. She had her game face on. This had been such a long emotional journey for her and now here she was nearing the end and couldn't quite let herself get her hopes up. I totally get that. So she got all dressed up and went to the ceremony. She stood and quietly said she was thankful to God for letting her come all the way to the ship and thankful that she was getting better. 

Even though I understood why she wasn't more joyful, inside I selfishly wanted her to be. So last night as I sat to write an update about her I didn't know what to say. So I put it off again one more time. 

This morning I walked into B ward and there was a completely different Nimambe. She was joking and laughing and smiling. She was like that all day long. She got to go outside today for the first time in over 3 weeks and she had no interest in coming back in. I think she is finally allowing it all to sink in.

Early Monday morning she will be on a bus of other ladies going back north, going back home. I pray that will be a joyful reunion.