ali's african adventures

There is too much to share. Here are a couple more stories.

I spent my two shifts this weekend happily ensconced in B Ward with my wailers. They vacillate between best friends and mortal enemies at the drop of a rattle. But in between, they play and snuggle and crawl around the ward with their little casts banging against the beds and walls. And I love them.


Saturday started like any other. Iron and vitamins all around. Assessments and vitals and over to A Ward to steal some supplies. While talking with the charge nurse, I overheard that President Sirleaf's son was coming to the ship and would be stopping by B Ward. This didn't register until several minutes later when I was standing there shaking his hand, introducing him to all the patients and walking him through the process for surgical correction of club feet. At which point I realized who it was I was talking to and said the first thing that came into my mind.

Your mom is an amazing woman.

Smooth, Wilks. Really smooth. I just said your mom to the son of the president of Liberia. But he agreed with my assessment. Yes, she really is. And she put this on my calendar for me today. Told me, 'Don't forget! You have to go to the ship to visit!' Just another example of how surreal life on board this ship can be.

I also met Alfred on Saturday. He said he would like me to tell his story. Alfred suffers from Proteus syndrome, an extremely rare disorder (rare in the sense that the chances of being born with it are literally about one in a million) that causes overgrowth of skin and bones. You might be familiar with Proteus syndrome in relation to the 'Elephant Man' John Merrick, a circus sideshow in the late nineteenth century. There are only about a hundred or so cases worldwide, and Alfred is one of them. His right femur has been growing too fast, along with the toes on that foot. Two days ago, Alfred had his femur shortened and some of the growths taken off his foot. On Sunday, he went to church on the ward and he gave testimony.

My name Alfred. Praise God. Before I came here, I was having a problem in my leg. Now I had a operation and the doctors they fix it. I want to thank God. I want to thank Mercy Ships. I want to thank my nurse here.

After church, the doctors came to see Alfred, and they removed the dressing from around his thigh. He was disconcerted by the swelling in his leg, more than a little concerned that it was so big. As far as he could tell, the doctors hadn't really fixed the thing after all; it was still so different from the other one. We told him that it was alright, that the swelling would go away. He was clearly skeptical.

In standard little-boy fashion, he had to prove this for himself. Starting with his good leg, he used the span of his fingers to measure the distance from hip to knee. Head bent in concentration, he did the same on the other leg. Paused for a long moment. Looked up at me with eyes so full of wonder I almost started to cry.

It's the same.

If I live to be a hundred years old, I will carry moments like that with me until the end.

Can you see why I would do anything for Sonnie?

This is Patrick. He's from Freetown, in Sierra Leone. I met him yesterday when I went outside for some fresh air on deck seven. He was hanging out with a friend of mine, Liz, who had been his nurse on B Ward for the day. We laughed and joked and danced Sierra Leonean dances and learned how to speak Krio. (More than just how de body.) He only very rarely stopped smiling. More often than not, he was throwing his head back and laughing.

The VVF ladies are all still on A Ward, but I was released back into my pediatric haven (B Ward) today. Patrick wasn't my patient, but when two o'clock rolled around, he was right at my side, waiting to go upstairs. Come on. We going outside. We have to dance. Naturally, I was right behind him as he ran up the stairs.

Patrick told me his story today. The ubiquitous smile was washed from his face as he recounted the story his uncle had told him. He was two when the rebels came to his village. They kill my mom. They kill my dad. They kill my brother. My sister. They try to kill me. He looked out across the harbour, suddenly so much older than fifteen, and he told me how they poured a five-gallon drum of gasoline over his then two-year old body, set him on fire, and threw him back into his house. A grandma was passing. She hear me yell and she throw me in the water.

And, just like that, he was finished, and he turned back to me and started teaching me a gospel song in Krio.

Patrick will be seen by the plastic surgeon when he arrives next week. Once I know what surgeries he'll be having, I'm sure I'll have more stories so share about my new friend. For now, I just wanted to introduce him.

---

As for Sonnie, I have no photos yet of this little girl, but what happened today has to be recorded. STAT. (Figured it was appropriate to throw a nursing word in there...) Sonnie is 22 months old. She was born with a club foot and a hand with no fingers to speak of, and she has huge, bright eyes.

After report, I was greeted by the stereo wails of my two little orthopedics patients. Both sported casts on their twisted feet. Both were unhappy. Jeffeline was a little more pliable and eventually settled in for a nap; Sonnie would have none of it. Legos and teddy bears and balloons and playing on the floor held no charm for this little girl.

Now, being a pediatric nurse, I'm convinced that every child stops crying eventually; I was willing to let her wear herself out. At home, I could have shut the door and waited for the calm to follow the storm. However, for the sake of the other eighteen or so patients and three nurses on the ward (who were getting progressively less tolerant as the volume increased), I knew I had to do something.

Remember when I told you about the fishy rattle? The one my baby at work loved, and the one Jonah and his mum sent to Africa with me? I hadn't brought it to the ward yet. I was waiting for the right moment, and I just hadn't been sure what that moment would look like. Well, I ran to my room and arrived back to the screamer, clutching what I was sure would be purple and yellow magic. I was not disappointed.

One look, and Sonnie was hooked. She shut her mouth, grabbed the rattle, and started shaking it furiously. It wasn't long until I saw her first smile of the day, and not long again after that, she was fast asleep on her mat on the floor. She laid there, sprawled on her back, camo-patterned cast propped up at a wild angle, fishy rattle gripped in her good hand.

And for the rest of the day, I heard the little sound of that rattle shaking away in the background, and I knew it was right.

It's one o'clock on a Wednesday morning, and I should be asleep. But I close my eyes, and all I can see is Esther. I want to tell you her story.

Esther was married when she was fourteen. Her first baby was a boy who died in childhood. Her second was a girl, a fine girl. And then the war came. In 1995, when Esther was pregnant with her third child, the country was being torn apart by rebel forces. So when the pains came, there was no hospital Esther could go to. She stayed home, waiting for the baby to come. It was up so high. It just stuck here, she said, gesturing to her heart. It don't come out. The baby die. And still the baby would not come out.

Help arrived in the form of a man Esther refers to as a 'first-aid worker'. He took a pair of rusty scissors and cut the baby out of her from below, damaging her bladder in the process. Esther was left wounded, broken and massively infected. Urine leaked constantly from her body. She sat quietly today, every eye fixed on her downcast face, as she described being carried out and laid on banana leaves, being washed as the maggots fell from her skin. She let her arms hang heavy as she explained how she had not had the strength to brush away the flies. Her eyes were filled with pain as she told us that she was sure she would die.

Her head snapped up. But Daddy God, He save me. Slowly, Esther regained strength. She was able to start taking food again. Her husband went into the bush one day to find some cassava for her and met a band of rebels there. He never came back, and Esther started her new life as a widow. She went to her family's town to tell them of her problems, and they wept together, knowing all to well what it meant for her life. She journeyed to Ivory Coast to seek treatment and was met only with disappointment. For ten years, Esther lived the life of an outcast. When men found out about her problem, she was left alone, clutching a broken heart and empty promises.

When hope seemed lost, Esther heard about a ship that was going to come to Liberia, a ship where they could help problems like hers. She made her way to Monrovia and inquired at hospitals about how she could come to the ship, but greed had reared its ugly head. Extortionists set up shop, demanding outrageous sums of money (fifty, a hundred, even a thousand US dollars) for the chance to register for an appointment. Esther didn't know any better. Didn't know that the ship would come full of people who wanted to love her and have a hand in her healing and who would ask nothing from her in return. She went back to the bush and began burning charcoal to sell so she could scrape together the phony registration fee.

Enter the Ghanaian. A man of God, when she told him about her problem, his response was love. You are my true love. Your problem is my problem. I will wait for you. Together they discovered the truth about Mercy Ships, and Esther got an appointment card, a ticket to freedom from the bondage of her body's betrayal.

So, in 2005, Esther came to the ship. And she had surgery. And she was dry. At which point in the story, the twenty or so ladies packed into our half of A Ward erupted into shouts and laughter and clapping. And Robert, Esther's ten month old son, looked up from his place in her lap, grinned a mostly-toothless grin, and clapped his own pudgy little hands.

Because there is life after VVF. There is hope and there is healing. No, not for everyone; there were a few ladies who silently listened to Esther's story, stoic faces masking their own disappointment as they felt their beds grow wet again beneath them. But Esther and Robert reminded us today that new life can come from brokenness. Healing can come to even the most shattered places.

(This may be the best story I will ever get to share.)

We set off on Friday morning for a weekend camping excursion to Robertsport. A group of about twenty eager Mercy Shippers piled into four yellow taxis (and one white one), starry-eyed and ready for whatever adventures the Liberian roads might throw our way.

Or so we thought.

We started out in real style, siphoning several mayonaise jars' worth of bright pink gasoline into our tank and heading out into the great unknown. The first flat came around two hours in, shortly after exchanging the paved road for an exponentially dustier dirt one. Watching the taxi drivers change out the spare with speed comparable to that of any Nascar pit crew, we got the feeling they'd done it before.

We eased back into our cars (rattling around empty by Liberian standards, since we only had one person sitting to a seat) and took off down the road. Our driver (who we think was named Suri, although he seemed unaware that he shared a name with such a famous baby) seemed to have taken driving lessons on Route 22. Following Jersey-close on holey dirt roads didn't seem like the best idea to any of us, so we urged him on to ever greater feats of speed, egging him on to pass the other drivers until we rode at the front of the pack. This had two benefits; we weren't getting covered in the cloud of dust kicked up by the other cars, and we weren't going to rear end anyone. We settled back to enjoy the ride.

The road to Robertsport is punctuated by some seventeen or eighteen small, numbered bridges. I'm not sure exactly which bridge we were crossing, tires steered carefully onto the wood planks that pass for steel girders here, when we felt the impact. The dirt cloud had done its worst, and we had been hit from behind by another taxi.

I've never been in a real accident before. (Just like I had never had a needlestick injury before, so I suppose it's par for my Liberian course here.) It's interesting to note that time really does seem to slow down. I had a series of several quite coherent thoughts (interlaced with several not-so-properly-worded ones) in the time it took our car to break through the railing on the side of the bridge and fly off the road, coming to rest firmly in the bush. My favourite of those thoughts was probably Dang it. This means we're going to have to cram more people into the other taxis, and I really don't want to do that; I'm hot enough as it is.




Sitting there in the green light of the tall grass, we took stock. No one injured. Peggy perhaps took the brunt of things, since the back of her head absorbed the inertia of the guitar perched on top of the luggage, but no one was even bleeding. As we climbed back onto the road, our heroes came along. Clad in camo and their distinctive baby-blue hats, the the brave (and brisk) men of the Pakistani UN army rolled up in their truck and stopped to lend a hand. There was a moment when we thought Beardy (not his real name, although there's a photo of him in my Robertsport album) was going to pull the car out with his bare hands. With a little explanation from our Hindi-speaking new friend Phil, Beardy was convinced to wait. I don't know if it's because we were all from NGOs or if they were having a good day or if it's just their custom to pick up dusty, stranded travellers, but before we knew what was happening, we were cozily seated atop a load of bamboo, pressed up against new friends carrying large guns, and making our way along the road towards Robertsport to the sound of a soldier singing a quiet song. It was one of those moments where you're reluctant to blink because missing any part of what's happening just isn't acceptable.

We eventually made it to the Pak-Batt 7 base, packed into the remaining cabs and rattled off towards the beach. A testament to the hardiness of Liberian taxis, our original car eventually rejoined the group a kilometre or so away from the campsite. A testament to the hardiness of Mercy Ships doctors, nurses and HR reps, we redistributed ourselves, everyone arriving triumphantly in their original cars.

The next twenty-four hours were spent in an idyll of sand, surf, and Liberian villages. We swam and sunned and built campfires and walked to town amidst the customary throng of kids. Honestly, if someone had decided to create my idea of a good time, it would have looked just like this weekend. Didn't quite get to fulfill my dream of sleeping out under the stars, since there were no stars to be had. We did, however, get treated to a lightning storm followed by torrential rain, so it was a good thing we had been provided with tents by our friendly 'campground manager' Dominic.

Yesterday we decided to leave early, just in case we met with more troubles on the way home. Providential decision, that, although not quite on the scale of the journey there. Another tire fell victim to the dirt road, and this time there was no spare. (And I have no photos of the action, since my camera was tied up in my bag which was covered in a thick layer of orange, Liberian dirt, compliments of our taxi's glaring lack of back window.) We left the other car and drove the half hour to the paved road where we found a roadside mechanic shop. I use the term shop fairly loosely. It was a wall-less palm-frond-and-bamboo hut with several guys huddled underneath hitting tires with hammers. I'm not sure what exactly it was they were doing, but our taxi driver seemed satisfied, because he grabbed a tire, left us sitting on the side of the road and headed back out to the bush.

As we waited, I, true to form, started making eyes at a small baby. I told his mother he was beautiful and she responded in what seems to be typical Liberian style; she untied him from her back and handed him to me. His name Jusu was all the introduction we needed. We played for a while, and when I went to give him back, she asked me if I would carry him with me to America. It took some time to explain that I actually didn't live in America at the moment and that my five roommates on my ship wouldn't really appreciate the addition of Jusu, however cute he may have been.

The fearless taxis rolled up, we piled back in (rather more crammed than on the way out, since we were, this whole time, one taxi short; it had been 'arrested' following the accident) and headed home. With the exception of one small hiccup where our driver got impatient in bumper-to-bumper traffic and decided to lean on the horn and drive in the left lane for a while, people and cars just barely scattering out of our path, we made it back without further incident.

I've said it before- I may never come home; I love this too much.

There's a documentary about VVF that will be showing on PBS in the States on May 13th. It's called A Walk to Beautiful. Fire up your TIVOs and grab your hankies, folks.

Once again, I find myself in the middle of a stretch of nights. This time it's a little different. I've been stationed in B ward, a hodge-podge of cases thrown in and shaken together. Last night I set a new personal record- ten patients, and only three of them were kids. Five of the others were ladies who came in for surgeries to repair vesicovaginal fistulas (VVFs).

Here's the thing- I am a woman from a developed nation. If, someday in the future, I am having trouble delivering my baby, I will have access to healthcare, and I will be able to get to a hospital. Pardon me for going a little statistical for a while, but this is important. According to the WHO and UNICEF, I will have a one in 28,000 chance of dying trying to deliver that baby. If I had been born in Northern Africa instead of the US, (if my heart really was African like some of the Liberians delight in telling me) that chance would jump to one in 210. I really can't comprehend those odds.

But our ladies with VVF aren't among those who die in obstructed childbirth. They are the survivors, huddled and shattered on the edges of society. After enduring up to ten days of labour, the woman is left exhausted and for any number of reasons, unable to deliver the baby. Locked in the birth canal for days on end, every contraction pressing its head against the bones of the mother's pelvis, the baby eventually dies.

Once the baby is finally delivered, (often by force, which causes even more trauma) the mother is left with a broken heart and a hole between her vagina and bladder or rectum. She cannot hold her urine. It leaks constantly, running down her legs, soaking her clothes, effectively shutting her away from society.

I know this is graphic, and I apologize. I would love to sit here and just write happy stories about Abraham and Anthony, but there are other realities to come to grips with here in West Africa. So here I am, trying to understand why women suffer for years on end, unable to be part of society because they don't have access to a surgery that costs, by most accounts, less than 500 dollars.

All of our women on the wards right now are repeats. The chances for a successful closure of the fistula decreases with every operation performed, so report in the mornings has felt like a long, sad string of defeats. Wet. Wet. Wet.

Last night I took care of a woman who's on her third surgery. She wouldn't meet my eyes for the first few hours of the shift as I settled her in for the night, medicating her pain and emptying her catheter. Around two in the morning, I saw her lying awake and went over to her bed. I held her hand for a moment and then slipped my other hand underneath her sheets.

You're dry.
Thanks God.

And she turned over, closed her eyes and didn't wake up until after I had left for the day, secure in the knowledge that, for the first time in many years, she had slept in a dry bed.

I'm on my way back in to work now. Back to my ten patients and my screaming babies and my spinning head. And, hopefully, back to my dry ladies.

At home, working every other weekend means that I get to church only twice a month. Here in Liberia it's similar; I get to venture out into the churches of Monrovia every second weekend. On the other Sundays, I'm working. And we all throw infection control to the wind, pile as many patients as can walk into one ward, and have church.

We were three deep on the beds this morning, hoping that God really wanted us all in there, because we had dental abscesses sitting hip-to-hip with VVF ladies. The translators and disciplers beat drums and shook shekeres as we clapped and sang about God's love and provision; the same song the kiddos at the orphanage taught me a few days ago, sitting around in the sand as three or four of them simultaneously tried to plait my hair.

My lifetime. I will give God my lifetime.
And if I give God my lifetime,
He will take care of me.
He will never, never let me down,
If I give God my lifetime.

And then Victoria got up to testify. She told about the two years before Kumassah was born. How she didn't pray and she didn't go to service and she wasn't grateful to Daddy Jesus. And then Kumassah came out, and she had the growth on her head, and Victoria definitely wasn't grateful then.

So they came to the ship. Kumassah had surgery, went home and then the wound got infected. Her neighbours started telling Victoria that the baby's brains were coming out, and that the people on the ship weren't going to help. She didn't think God deserved any kind of thanks, but she came back anyway.

She told about how she cried and didn't know who to turn to. And then a nurse came and sat with her and talked with her and gave her a Bible to read.

And now, her smile breaking wide across her face, I know who I will be saying my prayers to every day. And I know who I need to thank.

...

And then, of course, came the rest of the day. I could write you out a long list of things I never thought I'd really have to do. Making beds with flat sheets and hospital corners. Calculating IV rates based on the number of drips that fall every minute. Introducing myself in Liberian English and feeling for all the world like I'm not saying anything, only to have a patient's mother grin and shout, "She speak clear!" Coming back from dinner to find that I've gotten eight new admissions at the same time. Things like that.

When the IVs had been started and the new kids had been tucked into bed, I looked around for Abraham. His aunt pointed to the bathroom. He don't come out.

I opened the door to find my little boy, clad in his yellow and blue gown, looking for all the world like a thundercloud about to break. I tried everything, all my tricks and all my coaxings, but he refused to say a word. Just stood there, orange slippered, fingering the knot on the tie of his gown. I led him out of the bathroom, Hansel following a breadcrumb trail of stickers, and over to the other side of the ward where I sat him on a bed next to me.

Finally, I heard his little voice. Despite my sheer fluency in Liberian English (sarcasm, that) I couldn't make out what he was saying. He pulled my head close and whispered into my ear.

This not a man clothes. This a girl clothes.

So we got him another gown. He picked it out himself. It's covered in pink flowers. Somehow, this one is a man clothes.

I was looking forward to posting the rest of Shidou's story for you. I couldn't wait to tell you all about how I went with him and they took off his bandages and we saw each other for the first time.

Instead, like so much else here, the story of Shidou is touched with sadness. I overslept yesterday and when I made it down to the ward, it was to find out that he had already been discharged. I ran out to the eye tent, hoping against hope that he would still be on the dock. Of course, this is Liberia, and nothing moves quickly; he was still very much there. Instead of the blue and white bug-like eye shields he had been sporting the night before, he now wore the coolest pair of silver sunglasses I've seen for a while. His mom recognized me right away as I slipped into the seat next to him. The exchange went something like this:

Shidou! How you feeling?
Fine. (As behind the glasses his eyes rolled, unfocused.)
You see me?
(His mom) Shidou, you see your best friend?

Nothing. Just a little body curled up against my side, fingers laced tight through mine.


Because sometimes the optic nerve doesn't form when the cataracts start so early. Sometimes it takes a while for the child to get accustomed to seeing when he's spent so long in darkness. And sometimes the surgery simply doesn't work.

So I don't know what the outcome will be for Shidou. Just like I don't know what the outcome will be for Liberia.

But I do know that this country has a heart deeper than I anticipated. Like the woman who paid for an almost hour-long taxi ride for a friend and I yesterday, refusing our offer of money as she thanked us for helping her rebuild her country.

Or Victoria, the mother of one of our smallest patients. 'Kumassah's Mom' (as she is more commonly known) rarely stops smiling, and she never hesitates to lend a hand around the ward. She translates for me, laughing with her head thrown back at my floundering attempts at Kpelle, as I try to explain things to my 84-year old friend. (No such thing as HIPAA in Liberia.) We call on her all the time, and she has not once uttered a grudging word.



Liberia stands on shoulders like these.

And she smiles through the faces of little boys like Abraham.

Before I came to the Africa Mercy, a friend gave me some advice. If you ever lose sight of what you're doing there (interesting choice of phrase, that), just go down to the eye tent when they take the bandages off the cataract patients. Seeing that will totally renew your faith in your mission.

I'm not quite to that point yet. (And the more babies they pile into B Ward, the less likely that is to happen.) But, since kids stay overnight after their cataract surgeries, I do get to be part of the 'eye reveals' at times. There's one in particular that I'd like to be there for.

I admitted Shidou yesterday. I greeted his mother, and in his upturned face and milky eyes, I could read Shidou's story. He's eight, and ever since he could crawl, his world has been growing steadily smaller, shapes and colours fading as the cataracts thickened in both his eyes. He was scared, and showed it in true Liberian-boy style; he wrapped himself tightly in his mother's lappa and pretended to sleep. I was busy, with meds to give, dressings to change and old men to help to the toilet. (The stories of my adventures with 84-year-old patients will have to wait. Suffice it to say that I am learning a lot over here.) So Shidou was left to himself for a couple of hours. He stayed still, shielded from the ward (probably mostly from me) by his mother's cloth.

Once things had calmed down and the baby was alseep and the papa was safely back in bed, I went over to Shidou, a bucket of lego like a peace offering in my hand. I gave him a piece. He rubbed it on his cheek, the closest thing to sight he has right now. I gave him another one, and he repeated the drill. I took his hands and guided them to click the pieces together.

His head snapped up. Blind eyes searching out my face. Serious as any world leader declaring war. I gave him another piece.

He took his time with this one. Felt it all over, making sure he knew just what he was dealing with. His little fingers explored the tower taking shape on the bed in front of him, probing for the best spot for this new brick. He locked it into place.




If you have never seen a blind child smile with his whole body, eyes included, you are missing out on what I just discovered to be one of the greatest joys in life.

(Except maybe for slow-dance shuffling across the floor of the ward with an ancient Liberian man. But, like I said, that's a story for another day.)

Remember how I told you I'm a lover of stability and a sender of roots? Well, Liberia hasn't managed to change that quite yet.

I've been here a little over a month now, and I'm settled into a routine of sorts. Of course, being a nurse, nothing is ever totally routine. Patients get sicker, extra shifts have to be worked, and there's always the few who decide that the floor of the ward is really the bathroom. But apart from these small hiccups, there is a rhythm to ship life that has started to soothe me into something dangerously like complacency.

There's something so comforting about mandatory community meetings and scheduled devotions and strict mealtimes. It means that I don't have to think. (Not much, anyway.) I can sit back and let myself be carried along by the current of life here. And that's not a good thing.

A bunch of us had church on the beach this past Sunday. We sat under the shade of a low-swinging palm tree, listening to praise music piped through IPods and watching the waves break gently on the rocks. We talked about God's love (anyone starting to see a theme yet?) and we talked a long while about complacency. It was no great surprise to realize that I'm not the only one who's been getting a little too settled.

It's strange, really, how forgetful I can be. When, from the dock, I can look out across the bay at the Ducor Palace. Before the war, it was an international tourist destination and a symbol of Liberia’s prosperity. Now its empty rooms are filled only with the echoes of gunfire and the ghosts of refugee families.

And you remember Grace, right? Anthony’s mother? I sat next to her on her bed one day last week, and she told me stories about her family. Matter-of-factly explained how her nephew lives with his mother in Norway now. Because someone sponsored them to go there. Because he needed surgery. Because there was a rocket during the war that had taken his arm off. Also twisted his foot (Like so, she said, curling her fingers into an unnatural claw by way of explanation. When he was just almost two years old.)

And I sit at my computer, wondering when the café will be open, because it’s the next thing that’s supposed to happen around here.

Give me one pure and holy passion.
Give me one magnificent obsession.
Give me one glorious ambition for my life.
To know and follow hard after You.

That’s it, isn’t it? That’s all that matters. Anywhere I am, whether in the comforting routine of ship life or in the swirl and bustle of the streets of Monrovia, I should be running towards my Saviour. That’s the only way I’m going to find sure footing.

I don't know exactly when joy came back to the wards, but I know when it came back to me.

Today I got to take care of the smallest patient in the whole hospital. Anthony is six days old and had surgery to repair a meningomyelocele. Now, instead of fairly certain paralysis and almost certain death from infection, he's snuggled up next to his mum, making small, squeaky baby noises. When I move his blankets, he kicks his feet. Both of them. Hard enough to dislodge the wires hooked up to monitor his heartrate and breathing patterns.

I sat with Anthony's mother, Grace, after I changed the dressing over his surgery site, and I explained how the surgery had gone. How, instead of the golf ball-sized lump protruding from the bottom of his spine, Anthony now had flat skin. How his legs were working (and so was his bladder, since, in true little boy fashion, he had tried to pee all over me twice during the dressing change). How everything looked good. A wide smile broke across her face.

Now, something the Liberians love to do is shake hands. We greet each other constantly in the streets and on the wards. In general, handshakes here are rather sedate affairs. In fact, by American standards, they're often downright limp. The only real exception I've seen to this 'rule' is in cases of extreme excitement.

This was one of those cases. She pulled her arm back as far as it would go, her smile got even wider, and she shook my hand as hard as it's ever been shaken. Laughing, she pointed to her name tag and said, 'The Lord has shown me mercy, and He has given me Grace.'

I'm going to take Grace to the Sunday meeting here on the ship. She wants me to take a picture of myself and Anthony for her. 'I will show him when he grows old. This is Alice, and she cared for you.'


'She cared for you.' If that's all the legacy I leave here in Liberia, it will be more than enough.

It's hard to know just what to write right now. I feel like I've lived seven lifetimes over the course of this past week, and I don't know how to communicate that in black and white.

When I left home, we had just spent several weeks studying love with the youth group kids. We learned what love looks like in the world, and we learned what it means for God to be love. Little did I know how much those lessons would come to mean.

Here on the ward on the Africa Mercy, the charge nurses pick a "word of the week" for us to focus on. I found out yesterday that the words were chosen some time ago, which makes it all the more significant that last week's word was love, and this week's is joy.

Last week was one of the hardest of my nursing career. I realize more and more that, despite my best efforts to stay open and neutral, I came to Liberia with some pretty strong expectations of what this hospital experience would be like. I expected smiling faces; cleft lips being closed and club feet being straightened. I expected, if not an easy time, at least a less intense time. I expected to leave the moral and ethical issues of the PICU at home. After all, the motto of Mercy Ships is Hope and Healing, not Hope, Healing, and Helping Small Boys Slip Quietly Into the Arms of Jesus.

I was, of course, wrong. I had to come face to face with my own fallibility and weakness during the long, dark nights last week. I sat there next to Sadie’s and Benjamin’s beds and I just felt so inadequate. Knowing that God had called me to pour out my soul on these boys, but faced with the stark reality that all the love I could ever give, whether in prayer or in tangible, medical intervention, was going to fall short of making them whole again. I couldn't understand why a God who claims to be Love would let it happen. I searched the pages of Scripture backwards and forwards, frantically reaching for a toehold in the swirling mess of anger and heartbreak.

And so I learned something about God last week (perhaps not for the first time, although it felt so utterly new when I came across it again). He is Love, this much I had already accepted. But alongside His love, bound up inextricably in His character, He is also a strange God. He says so Himself. My ways are nothing like your ways. Your grandest thoughts don’t compare to mine. How high would you say the sky is? That’s a good measure of how much bigger my plans are. (Isaiah 55:9) He’s simply not bound by my expectations or my limited understanding of His heart. And He whispers to me again and again from that heart. I knew Benjamin and Sadie. Every hair on their heads. Every move they made, every day of their short lives, I knew. After all, I'm the one who wove them together; I'm the one who decided the number of their days. I wrote down each one of those days, recorded them faithfully in my book before one of them ever came to be. (Psalm 139)

In the wake of tragedy and uncertainty and feelings of failure, I am comforted by that knowledge. And I am ready for joy to come back to the wards.

Watching a child die never gets easier.

I sat by his bedside all night, flipping through my Bible, reading him psalm after psalm. I read to him about God's love, and I read to him about heaven. I held his hand and I cried and I prayed.

And now he's gone. And we are left, bewildered. Watchers from the shore, holding tight to hearts' seams ripped wide. Wondering just how this abrupt crossing has come to pass.

I was planning on saving the world; I would have been content with saving him.