Screening with Hope

The screening team has one of the hardest jobs on the Africa Mercy (along with the people who have to clean out the sewage tanks when they get clogged). I’ve worked only a few days with them, outside on the dock in big tents, but I can tell you already it is a stressful and emotional environment. 

This week they were screening orthopedic patients. Dr. Frank, the ortho surgeon, is here for 6 weeks. Since he was not here for the big screening day at the beginning of the field of service, the patients that the ortho screening team thought might qualify for surgery had to come back once he got here to be seen by him, and given a final “yes” or “no.”

The “yes’” are exciting, even though we know that there is still much hard work and pain ahead, and there are many variables that we hope will work together for the best outcome for each patient. The “nos” are the hard part. For the most part, I don’t have to have those conversations, the surgeons or maybe the chaplaincy team will explain why they do not need or qualify for surgery.

This afternoon, one of the last patients to be seen was a 12-year-old boy. I wasn’t a part of all the medical conversations that were had while his x-rays were being reviewed, but I do know that, for whatever reason, the bones forming his knee joint are not curved like they are supposed to be, instead they are flat, and as a result the knee is not able to bend. He walks around with one stiff leg all the time.

Dr. Frank explained this to him and his father, and said that he can do surgery to release the contracted muscle and remove the scar tissue that has formed, however, “we will pray very hard before we operate and after, because unless God heals, the leg will still be very stiff, and probably not be able to bend."

After the surgeon was finished I sat with a translator, the boy, and his father, to explain to him when to come back for surgery and what to expect. When we had finished describing the wards, what he would feel like after surgery, how long he might be with us, and many other things, I asked if they had any questions. Papa shook his head and said no. I looked at the boy, and placed my arm around him. “Do you have any questions?” I asked him through the translator. He looked up, then quickly back down to his hand folded in his lap and spoke words so quiet the translator had to ask him to repeat what he said. “Will I ever be able to bend my leg?”  Tears started welling up in his eyes.  His papa explained that his son longed to play football (soccer) with the other kids, and he had never been able to.

I wish I could’ve told him yes. Oh man, I wish I could’ve. God and I had a silent conversation that pretty much involved me saying, “Come on God, please heal his leg. I can’t bear to tell him no, he will probably never be able to play football. Every little boy should be able to play football.” 

Instead I rubbed the boys back, and told him that the surgery will help his leg some, but Dr. Frank is uncertain that it will help his knee to bend. However, God is able to do anything, so we will continue to pray that he heals his leg. 

The translator talked in a quiet voice to the boy for a few minutes before I broke in. “Would it be alright if we prayed for you?” Those big, tearful eyes looked up at me, filled mostly by sorrow, but with just a spark of hope. We bowed our heads and I asked God to comfort him, and to please, please let his knee be able to bend. It’s all we could do.

It’s moments like these that remind me how dependent we are on God. The reality is that even the things we think we can control we really can’t. There are no guarantees in life. God, in his graciousness, allows Mercy Ships to perform surgeries that have mostly good outcomes, that almost always change lives for the better. But we never know. 

This is the same in the west as it is in Africa - in the west we just have more things that give us the illusion of control. It takes us longer to reach the point of realizing there's no contingency plan. Even our "advanced" medicine can't heal everyone or make us live forever. 

So do we despair? Do we live in fear? 

I believe that we should continue to hope in the God of second chances, the God who can and does heal, though not always when we think he should. There is power in hope. I have no pat answers or easy explanation for when God seems to disappoint or leave prayers unanswered. What I do know is that I have seen that God is faithful. And while he may not heal every person that walks out of that screening tent, he has promised to be with us, to walk through the hardship and to continue to give us hope for tomorrow.

No one who hopes in you will ever be put to shame.

Psalm 25:3

May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by the power of the Holy Spirit. 

Romans 15:13

Gloire and the Plastics Girls

We’re now on the 4th week of surgery here on the Africa Mercy. Surgeons, nurses and patients have come and gone, and it finally feels like there's at least a little bit of a routine. 

Each nurse is assigned a ward where he or she will work for the entire time they’re here. I am assigned to A Ward, which is where all the general surgery patients (hernia repairs, lipoma excisions, goiters etc) are, as well as all the overflow patients from the other units (this is all dependent on what surgeons are on board at any given time – sometimes A Ward becomes Maxillofacial when there are no general surgeons here).  B Ward is Plastics (for a few more weeks, then becomes ortho, then womens health), and D Ward is “Max Fax” (Maxillofacial).

The wonderful part of being here from the start of the field of service is that, because it takes days and weeks of surgery for the wards to fill up, I spent the first 2 weeks working in other wards, and have been able to see all the different kinds of surgeries. I’ve gotten to take care of babies who had cleft lip/palette repairs (and are ADORABLE), like Daniel

 (seriously, those eyes?!? and that heart shaped nasal bolster?!?)

men and women who have had large facial tumors removed, like Ebeneezer,

(before surgery)

(post op from his tumor removal)

(at the HOPE center, after being discharged, with Tori Hobson)

and children and adults who have had contracture repairs and skin grafts from burn wounds, like Sahara.

(Sahara was burned in a house fire when she was a little girl. Both her parents died in the fire, and she has been adopted by her aunt.  She does not know that her aunt is not her real mother, and that her parents were killed.)

 (Sahara, Graci and Jemina are some of our resident plastics girls - we love them!)

This last week I was finally on A Ward all week. Right now it’s about half general surgery patients (who are discharged 1-2 days after surgery, so we don't get to know them as well), and half plastics patients (who have been here 10-20 days, as their graft and donor sites need attentive care and rehabilitation).

I loved getting to know the patients and caregivers better last week - spending 6 days with them gave us a lot of time to play and laugh. 

One of those patients is Gloire, who I've now adopted as my Congolese little sister :).

Gloire ("glory" in english) is a 14 year old girl who had a release of contractures in both armpits 18 days ago.

I took care of her the day of surgery and the day after. I helped her sit up every time she needed to eat or take medication  (no automatic beds here!), turned her all the way around in bed so that she could watch the movie at movie time (she was on bedrest for 2 days), hung curtains from the ceiling with magnetic hooks around her bed so she could use the bedpan, and tried unsuccessfully to get a smile out of her. Not even my horrific french could get her to laugh.

Last week she was moved to A Ward, and I got to spend all week with her. There are 5 other girls who have had contractures released with skin grafts on Gloire’s side of the ward.  They and their moms all talk and laugh together, and take care of each other.

All of them except for Gloire.

She’s reserved and quiet, and it’s hard to get her to crack a smile.

At least I thought she was quiet.

Last Wednesday I took care of her, and made it my mission to get her to come out of her shell. I took her for a “marche” (walk) in the hospital corridor, and she pointed out photos of the nurses she knew as we walked back and forth.  We tried to communicate to each other with mixed success.

I pointed to one photo and then another to show her which crew are married, which she loved, and then she proceeded to “match make” couples in the photos, which was equally hilarious and awkward (some of them involved her pointing to me and then a photo of a married crew member).  I had to drag her back into the ward when we were finished. 

I've learned Gloire is a typical 14 year old. She's playful, difficult, moody, and loves to test boundaries. She tries to follow me into the hallway every time I leave.  One minute she's laughing and pulling my hair or doing something mischievous, the next she's ignoring me because I let one of the other girls paint my nails, or play a game with me. Then I have to sit with her for 15 minutes before I can finally get this smile out of her again...

Yesterday I was off, and I found myself wondering what Gloire was doing. I found myself wanting to go visit A ward just to see if she was ok, if she was smiling. 

Nursing on the Africa Mercy is a whole different world. While my job is to look after these patients physically, their emotional and spiritual health is just as important to everyone onboard. What a blessing it is to be free to practice nursing the way that I've always wanted to!

Please continue to pray for our patients.  Some of the girls (including Sahara and Graci) have developed infections in their skin grafts.  We are praying that they clear quickly, and are able to continue a smooth recovery. 

Love and joy from Congo, 

Betsy

Patient Story Series #4: the girl with leukemia

When I was in nursing school, we were required to go down to Mexico every semester for clinical hours.

We partnered with a church near Biola who had a relationship with a church in Tecate, and would send a team down about once a month.

The Biola nursing department provided a few faculty and a prolific amount of under-qualified, over-eager nursing students.

To be honest, I dreaded that Saturday once a semester when we had to get up at 5 am, meet at the church, assign jobs and cars, and start the three-hour drive south.

Some days we only spent 2 hours seeing patients, and we wouldn’t get home until 9pm, hungry and exhausted.

This was especially true after they started making us charter a bus down, and having us walk over the border and be shuttled to the church on the other side.

All because one of the professors went to buy some prescription drugs while we were down there, got in an accident and was held overnight in a Mexican prison because he bought the wrong insurance.

Good one, Professor Johnson.

At the clinic a first and second year nursing student were paired together, and would see patients.

In true Mexico fashion, you don’t see one patient at a time, you see one FAMILY at a time.

We’d see up to 7 people from a family at a time, going through each of their problems one by one.

And honestly, we couldn’t do much for them.

We had a large stash of over the counter drugs we’d hand out, and we’d “refer” them to a doctor if their problem was more serious. 

But we all knew they wouldn’t go.

That’s why they were there, seeing us.

They didn’t have money to see a doctor.

One of the last times I went to Mexico, I was working with a first year student.

We were seeing a family – a grandmother and her four grandchildren she was caring for.

It was the end of the day, other students had finished with their last patients and had started cleaning and loading up our supplies.

We finally got to the last child in the family – a 12-year-old girl.

Through our translator, her grandmother told us she’d been complaining of her gums bleeding frequently, and small red spots had begun to form under her skin.

She was tired, and had very little appetite.

We checked her lymph nodes, which were noticeably swollen.

I called over our faculty who specialized in pediatrics.

She assessed her, and took me aside to talk.

She said to me, “We can’t know for sure without blood tests, but she most likely has leukemia.“

She told me to give them a referral to a doctor.

Being careful not to scare them too badly, I had my translator explain to them that the symptoms she described could be something serious, and she needed to take the girl to see a doctor.

I pray she did, but I confess I’m doubtful.

And even if she did, what then?

Could this woman struggling to raise four small children in a third world country afford chemo or radiation for this precious young girl?

I was struck with the disparity of our worlds.

In my world, anything would have been done to save that girls life.

Facebook pages, fundraisers and benefits would’ve been planned to help pay for whatever treatment she needed.

In their world, those options don't exist. 

There are no children's hospitals, no oncology centers, no facebook pages - not for them. 

I wish I could say I spent the next days, weeks and months praying for that girl. 

Begging the Lord to heal her, to reveal Himself to her. 

I honestly don't remember what I did. 

I have no idea why God chooses to place one person in a position of financial comfort and resources and another in poverty.

But if I've learned one thing, it's that God is bigger than any financial constraints or comfort.

He is bigger than our situations, however dire they may seem - like this shy, awkward adolescent girl's. 

I pray God gives us the strength, zeal and endurance to continue to lift up to Him the needs of those in seemly "dire" situation.

He is greater, so much greater. 

Patient Stories Series #3: The man who prayed in his pain

A few nights ago I had a patient who I took care of after he had a below the knee amputation. He was an elderly man, who came up from surgery at about 8pm.

One of the major difficulties with post-op patients is managing their pain.
 We try our best to keep it under control, because the more severe it gets the more difficult it is to bring down to a manageable level.

He was a sweet man, who didn’t complain of much pain until three hours after he came up. 

I gave him morphine, which knocked him out for a bit, but less than an hour later he was complaining of severe phantom limb pain. 

Phantom limb pain is difficult to treat, and I didn’t have a whole lot of options of what to give him based on what the doctor had ordered, and how quickly his pain came back after the morphine. 

So I gave him an oral pain medication called Norco and an Ativan to help him calm down and sleep, since there wasn’t much more we could do for the pain.

I had noticed earlier that he had a bible on the tray table, held together by a rubber band because the binding was falling apart. 

All I could do was wait for the oral medication to take effect, and he was still moaning in excruciating pain. 
I hate that my job means I see people in awful pain on a daily basis.

I asked him if he had a favorite passage he'd like me to read from his bible.
He said Psalm 23. 

I read from his bible by the light from the cracked door - his bible that I swear was a version more ancient than the King James, if there is such a thing.
As I read, I could see him begin to quietly say the words along with me.

When I was finished, he continued speaking softly.

It took me a few minutes to catch enough words to figure out that he was praying, begging God to get him through the pain.

I only caught some of what he was praying, but at one point I heard him say “and thank you for Betsy.” 

I prayed for him as well, and as I left his room, he was quiet.

So many thoughts tumbled through my head as I left his room and headed to check on my other patients.

How humbling to be brought before God by this man I only knew for one night. 

What a privilege to be the one to care for him in a time of incredible vulnerability and pain.

These are the moments I’m so thankful to God for getting me through nursing school, and providing me with a job that is incredibly stretching and difficult, but immensely rewarding.

Nursing constantly reminds me that I am not enough.

I can’t save anyone physically, emotionally, or spiritually. 

I can’t take away anyone’s pain – but I can point them to the one who can.

It was this man’s faith in the God who is greater than all that brought him comfort in his pain.

May we cry out to Abba for our every need, acknowledging our complete and utter dependence on him. 

Thank you Jesus, that you are more than enough.

On Christ the solid rock I stand, all other ground is sinking sand.

Patient Stories Series #2: Her story

 I love that the Bible says that God knows our names.

In healthcare people so easily become defined by their diagnosis, their room number or their situation.

But there’s something so personal, so intimate, so human about calling a person by their name.

I don’t know this woman's name, and I’m sure I never will.

But her life had an effect on mine that can't be erased or ignored.

  

Stories like these I often feel awkward or uncomfortable sharing, because it’s easy for stories like this to become all about the shock value, and that is not my desire.

It’s also not my desire for you to read this and think how strong, brave or great I am, because, trust me, in situations like the one I’m about to tell you, I’d go running if I was leaning on my own strength or bravery.

  

I share this story because I want you to understand the deep, intense effect it had on me. For me, stories that carry so much emotion are often expressed better through writing, allowing you to picture for yourself what the experience was like.

It was at the hospital in Rwanda, where God has done some of his best and most terrifying work on me. One of our last mornings at the hospital, I saw a woman being carried into the surgery area.  I left morning report and went to the wound care room (now functioning as an ER).  Lying on the table was a woman, face covered in dried blood, but otherwise seemingly uninjured.  There was a laceration on her head about 2 inches long, which was not actively bleeding. She was combative, fighting against us and we struggled to help her, so we held her down while one of the nurses shaved her head, and one of the nursing students, Bernard, started an IV. Bernard translated for me as her story was explained and we worked to clean the blood off her face.

He told me that this woman had been hit by her husband, because he caught another man trying to have sex with her.  The husband claimed he was trying to hit the man with a stick, and accidently struck his wife instead.  He had hit her at 11pm the night before, and they were just bringing her in at 7am.

The nurse began to clean the wound as we continued to hold her down, and we quickly realized this was not just a cut on her head.  Her skull had been fractured, some of the bone fragments were likely going into her brain, and as the bleeding began again she started to go into shock.  The surgeon had been called and we were just waiting for him to come and tell us what to do.

What I initially thought was just another patient to stitch up and send out, I quickly realized was so much more.  Bernard told me the doctors didn’t think she was going to make it, but that they wanted to transfer her to the hospital in Kigali, the capital, which is a 3 hour drive on windy, pot-hole plagued roads.  As the gravity of the situation seeped in, my focus quickly turned from her physical condition to the condition of her soul, and my prayers of “help this woman, show us what to do” became frantic pleas for her salvation. 

Still holding her hand, looking into her eyes as she came in and out of consciousness, I wished I was fluent in Kinyarwanda or that telepathy actually worked!  I prayed for a lull in the streams of doctors to be able to say something, anything to communicate to her God’s love and her need for salvation.  My prayers were answered and I was able to kneel down next to her and whisper a prayer in Kinyarwanda, literally the only words I knew how to say.  I don’t know if she even heard or was able to understand my horrible pronunciation. Most times when I pray for patients in Kinyarwada they try to hold in their giggles as they listen to me struggle though.

It was in that moment I realized the depth of my reliance on God, whether or not I am aware of it.  I was helpless to do anything to save that woman, both physically and spiritually.  I couldn’t even communicate the gospel to her.  All I could do was hold her hand, look into her eyes, and beg the Lord to reveal Himself to her.  I don’t know whether she even lived through the drive to Kigali.

I’ve heard it said that compassion is entering into another’s suffering, but that is much more difficult than it sounds.  Because entering into someone’s suffering isn’t about the result.  It’s not about what you can do for them, or how you can meet their needs.  It’s about being present, about coming along side them and feeling the depth of their brokenness and pain.  Jesus saw people’s pain and entered into it.  Through my brief interaction with this woman, God taught me to love, and to show compassion without focusing on the results. 

I was also reminded of how much more important spiritual healing is than physical healing. When it came down to life or death, my priority was much rather to have her come to know Jesus than gain a few more hours or days on this earth. 

Stories like hers are what keeps me in nursing.

Stories that break your heart, but force you to rely completely on God and give you the opportunity to try your hardest to pray someone into His arms. 


I rest in the fact that God knows her name.  
And regardless of what I was or was not able to communicate, regardless of if she survived the ride to Kigali, her present and future are in His hands. 

But now thus says the Lord, he who created you, O Jacob, he who formed you, O Israel: “Fear not, for I have redeemed you; I have called you by name, you are mine."

Isaiah 43:1