ali's african adventures

This is what a birthday looks like in Liberia.

I turned twenty-five two days ago. When I woke up for community meeting, I was met by two bleary-eyed roommates, a pile of balloons, a plate of made-from-scratch raspberry muffins (which tasted amazing despite looking slightly gory) and a six-pack of diet coke. Over the course of the day I got a chance to visit with Marion (which I'll write about later), ate a fresh birthday coconut and delicious African food, played touch rugby, went for a swim in the pool and just hung out with friends who have become family. I will submit that birthdays don't get much better than that.


Or so I thought. Because the mail came today, and in it were two boxes for me. One contained all the music ever and a drawing from my little cousin Cammy. The other was possibly the best package ever, for reasons which follow in an itemized list. (Click the photo to see what I'm talking about. I numbered it all to make sure there's no confusion.)

1. Comfy t-shirts are my uniform around here. Adding one more to the pile is always a good thing.
2. The kids on the ward go absolutely nuts for colouring books and crayons. Come to think of it, half of the sixty-year olds do too.
3. Perfect size candies for bribing small children with.
4. Speaking of going nuts, the patients play Uno like it's their job, but there's only one set of cards at the moment, which means that squabbles sometimes erupt. Not any more!
5. Pajamas. I need not say more. (Especially since I wore jeans the other day and no less than eleven people asked me where I was going so dressed up. Apparently I've stopped trying.)
6. A happy birthday napkin is cheery yet also so practical! I'm sure I'll need to mop something up around here soon, given the rate at which I spill things.
7. This is my favourite kind of gum! They used to have it at the ship shop and ran out a couple months ago. My stash has just been effectively replenished.
8. We also just ran out of post-it notes for phone messages in our cabin. This bad boy even has a magnet on the back, just like everything else on this ship. Perfect.
9. Anyone who knows me knows that I'm absolutely obsessed with coloured markers. I label things. I write signs that get posted all over the ward. I use them in any way possible. Now I have an entirely fresh pack, just when the ones I brought with me from home have started to go dry.
10. And who doesn't love gummies? My roommates and boyfriend, apparently, aren't numbered among the haters, since I'm sitting here looking at suspiciously half-empty bags at the moment.
(Please note, there was also a pair of flip-flops in the box, but they didn't make it into the photo because they were already on my feet.)

Colleen and Pam - a thousand thanks. What an absolutely amazing surprise.

And to everyone else at home and elsewhere who took the time to send a card or write an email or message me on Facebook - being 4,500 miles from home has never felt so good. Thank you.

I feel like I don't know anyone on the wards these days. The last of our long-term plastics patients have been packed up and sent home (just in time for Dr. Tertius to come back in a couple weeks), and Greg is with Jesus. The surgeon we have at the moment has been doing lots of hernias, who only stay overnight after their operations. Hardly time to forge deep, meaningful relationships.

Relationships like the one we have with Joanna and her daughter, Angela. Joanna is better known as The Queen of Mercy Ships. It's a well-earned title; she's been a patient every time the ship has docked in this port. During this outreach, she received a skin graft to cover a chronic ulcer on her leg. The graft failed and she spent long weeks enduring painful dressing changes and more surgeries. At some point in the process, her daughter, Angela, came to live with her. In an endearing role-reversal, Joanna (the caregiver) slept in the bed while Angela (not a patient, but definitely not old enough to be running any kind of show, despite her own best efforts to the contrary) camped out in her little cave underneath. My roommate, Jenny (who I'm eagerly looking forward to working with again next year in Benin, and I'll try to limit my use of parentheses from this point forward), left today, and Joanna and Angela, long since discharged and living at home, showed up to say goodbye. That's Liberia all over. It doesn't matter how far you have to come or how hard it's raining (forgive the parentheses yet again, but one of my favourite moments of the day was when Joanna looked around at us, huddled on the dock like drowned rats, and suggested we move under cover because this rain is getting too serious, a phrase which perhaps loses a little when taken out of Liberian English), relationships are hallowed.

Still, these stranger-patients manage to have an impact. I was at ward church this morning when a man stood up to give testimony. He was well-spoken, a college professor in fact, and he wanted to let us know that he was grateful. He plans to write a report on Mercy Ships and send it to Dr. Gary when he gets back from his vacation. In it, he's going to explain how he came to screening and was told that there was no doctor to do his surgery. How he went back home and laid the problem in God's hands, trusting that he would be taken care of. How a doctor then came and he was called back to the ship to receive his surgery. How the doctors and nurses work with joy in their eyes and love for their patients so evident in what they do. How he's traveled many places but never been treated as well as he's been treated in the one day he's been on the ship.

How Mercy Ships lifts burdens from bodies and from spirits.

This may have been just what I needed to hear. Because it comes hard on the heels of losing my little man, when all I can think is that we've failed. Failed Marion, failed her family, failed to make an impact. Failed.

I have to remember, though, that that man has been with us for just under two days. He's seen us love for less than forty-eight hours. We had Marion and Greg with us for over a month. A month of days filled with countless moments of care and compassion and pure, unfettered love. I can't help hoping that, once the raw edges of this terrible grief have been worn down some by the passage of time, Marion will be able to look back to this month and see Jesus. Not nurses and translators and crazy, hare-brained schemes to keep a little boy alive. Just Jesus. Arms stretched wide, love poured out like rain.

It is raining all around me.
I can feel it; it's a lot of rain.
I ask Jesus to send more rain.
Until we are filled,
Until we are filled
With a lot of rain.

The past twenty-four hours have been so hard. I've lived the last ten minutes of Greg's life over and over in my head, staring at the ceiling all night long as I fought back the panic that threatened to overwhelm me when I turned out my light. But there's something utterly strange about this community I live in. I seem to be among people who have forgotten that our world is broken beyond recognition. Or, at the very least, if they do realize, they've chosen to live as though it were whole.

You see, grace has been poured into my spirit from every source imaginable. In the moments after Greg flew last night, there were a hundred things a nurse needed to do; I've done them all so many times before. But I was given the gift of being able to stay with Marion as long as she needed me while so many loving hands swaddled Greg and wrote out the death certificate and cleaned up his stuff and got Marion's bags packed for her. Hugs and sad looks and pats on the back and genuine, sincere questions about the state of my heart have bombarded me from every side. We have cried and laughed and prayed together, and I can't help getting excited for heaven. If this is 'a foretaste of glory divine,' Christ can't come back fast enough.


In the midst of it all, there's another, wild note in my soul; spilling out past the raw hurt is a kind of pure, fierce joy. I realized at some point as I sat there and sobbed for Marion's broken heart and my own that the pain I'm feeling is a privilege. I grew up in a country where I was safe, secure, loved. I've never known war (not really), and I've never watched my life fall to pieces in front of me. I have no idea what it truly means to hurt. Marion does. Every member of her family does. Grampa said it last night, his words halting and small. We have all lost someone. Every time, there is someone who can die.

I count it a joy that my heart feels like it's been shattered. It means that it's still soft, and it means that my life has been blessed. I must live the rest of my days in the light of that blessing.

I am utterly undone.

Baby Greg, my little Baby Greg, went to be with Jesus this evening. As I sat there on the bed next to him, in the time it took me to put a new monitor on his little toe, he seized the small moment that I was in the dark and slipped away. No fighting. No flailing. No fuss. He just. Stopped.

A thousand moments run on an endless loop in my head. Marion, brought into the empty ward where I waited for her, seeing my tear-stained face and falling to the floor, my arm the cushion for her head as we laid together and sobbed. His little mouth and nose and fingers, still and peaceful. Finally. Walking with him in my arms, a red-blanketed bundle, down the gangway and into the waiting car. Driving through the Liberian night, using my body to shield his from the jarring roads, errant lights from passing cars illuminating the curly wisps of his hair. Sitting by the light of a single candle, the flame still in the airless room, as all around me people cried quietly. Greg in his Grampa's arms, stripe-socked feet sticking out of the bottom of the blanket, as Grampa rocked him back and forth back and forth, crooning soft words in Kpelle.

Some of the children got to go back.

God, why?

Why are we left here with hearts poured out like water on the world?

Dr. Gary, our chief medical officer on board, is in Wales at the moment. He just did an interview with All Things Considered on the BBC. He gives a great overview of Mercy Ships and paints a little picture of what it's like to live and work here. About half an hour long, but totally worth checking out, as he has one of the more amazing hearts I've ever come in contact with.

Enjoy!

(It's only available until the thirtieth of July, so it's not my fault when the link goes defunct after that!)

My Granny just wrote me an e-mail and asked for an update on Baby Greg. It's funny, really- I've lost sight of the fact that there are people in the world who don't eat, sleep and breathe this situation. People who have to wait and read a blog entry before they know what's going on. I've become so entangled in his small life that I don't know that I'm ever off duty anymore. It's draining, and I know I've said this before, but I'm tired. I watch my fellow nurses getting days off and playing with their patients and having fun at work, and I'm wishing myself back to the days when my biggest worry was whether or not my little ortho patient was going to wipe out on her crutches.

Baby Greg has been up and down the past few days. He rarely has two good shifts in a row, but he's starting to gain weight and his breathing is markedly improved when he's able to tolerate being off the CPAP. (A photo of which I have included just so my esteemed PICU colleagues can laugh at my creation; it might not be pretty, but it gives him PEEP!) His g-tube isn't leaking like it used to, and we're working on getting him a different one from the States. He needed a transfusion yesterday; the charge nurse jumped at the chance, left the ward to donate and then came back to finish her work just feet away from where Greg was receiving her blood. The ship has taken Baby Greg under their collective wing, praying for him non-stop, twenty-four hours a day. All these little details and myriad more swirl and mix and have become second nature to me; reciting them comes as easy as breathing.

Phil came to visit the ward last night and hung out with Baby Greg for a little while. I was talking about it all with him over cinnamon toast at some point during the shift (which has stretched on so long I've absolutely lost all concept of time). Ever pragmatic, he just patted me on the back and told me not to worry. I can see why you're attached to him. It makes sense when he looks at you like he does. But just keep serving. You'll find your inspiration again.

Right now, I have to smile. Because it just happened. He's had a good night, honestly. He's slept comfortably most of the time, only thrown up once and never had the panicked look of a baby who can't get enough air. (That look breaks my heart every single time he brings it out.) About an hour ago, he decided to wake up and be angry. I changed him and patted his back and snuggled him on his side and did all the things he usually likes. No dice. So I climbed into his bed and pulled him into my arms. Whereupon he put on little hand on my chest and immediately fell asleep. And I was left there in the dark, my heart a puddle in my chest.

I'm in Africa in the first place because God told me to pour out my soul. To kick over my heart and let everything spill out. I remember talking about this with my youth group girls last year. We all came to the conclusion that we should go to bed every night absolutely empty, completely poured out on the world and relying on God to fill us up again for the next day. I'm wondering whether or not this is the first time I've really managed to do it.

I've never been on this side before.

I just got an e-mail from my mother. My cousin, Katie, has a rare (one in more-than-a-million rare) lung disease. She's been stuck in limbo, waiting for the one thing that has a shot at saving her life. Last night, a pair of lungs 'came available.'

I've never been on this side before.

I've been in the PICU, trying in vain to keep the soul of a teenager from slipping away, only to have to turn to her parents with useless words of comfort. I've held sobbing mothers as they agonize over the decision to give pieces of their child's bodies away to utter strangers. I've helped to get kids ready for transport to the operating room, given fathers a chance to say their last goodbyes as we push their flesh and blood away down the hall to be cut and sorted and distributed.

I've never been on this side before.

Reading those words, they have a pair of lungs for Katie, was an immediate rush. Joy like I've rarely known it. I dropped to my knees, praying that they would be compatible, that her body would withstand the operation, that her life would be spared. Hoping against hope that this is yet another miracle that's been granted in my life.

I've never been on this side before.

The only thing I know is the shock and anger and pain of losing someone dear to me. The strange, almost eerie realization that someone I love has become replacement parts for another. The coming to terms with the fact that someone else is seeing through eyes that used to shine at me from across a hayloft at my Grandpa's farm.

This will take some getting used to.

I sometimes catch myself bitterly regretting the fact that I grew up in North America; the sad reality of American life is that we have completely forgotten what community looks like.

When I first started work here, I was amazed by the little 'families' that seemed to grow on the wards. As the beds filled up, patients started to band together, joined by the bonds of age or dialect or physical deformity. It was a joy to watch former strangers talking and laughing like old friends, but I figured the party atmosphere would taper off as the patient dynamic changed. I was wrong.

Actually, it's becoming fairly standard procedure for me during a shift to stop what I'm doing, look around me, shake my head and smile. I can't help it. The wards are full of gangs. We've had the B Ward Boys' Club, made up of three long-term guys, all in for complicated wounds. By the end of their stays, it was a common sight to find Henry holding the gauze for Andrew while he had his dressing changed. We had The Eight-Year Olds, a little mob I'm tempted to put in all capitals, if only as a lame attempt to show just how explosive that group really was. They rolled together, encouraging each other during wound care and stealing crayons in less philanthropic moods. Recently, it's been The Girls. Young mothers and a token single woman, they plait one another's hair, pass children back and forth and have real, honest-to-goodness sleepovers, mattresses and beds pushed close together, stifling giggles long into the night.

I've never gone through a shift without watching one of the patients look out for another one in some way. They translate for each other. They comfort each other's crying children. They pray for each other. They share food and stories and lives, and I've never once heard a complaint. Because this is what community means. It means living in a hospital bed in a windowless ward along with fifteen-odd strangers and not batting an eyelash when one of them throws up on your foot. It means sitting in a circle and cutting string to make friendship bracelets all afternoon long, laughing and joking with the white girl who thinks she can speak Liberian English. It means taking a child away from a tired mother and feeding him from your own plate.

I forget sometimes that our patients didn't know each other before they came to the ship. They ease so gracefully into this strange community here that I assume they have spent their whole lives living just houses away in the same villages. I sit and marvel at their effortless hospitality and the candor with which they share their burdens, and I'm humbled. I would do well to learn from their love.

Baby Greg smiled at me this morning.

It was at the end of a long night shift, the last three hours of which I had spent with him nestled in my arms, trying to get him to sleep. He, as usual, was fighting. It's what he does best, really, with a strength that belies the twiglike construction of his frame. He'd managed to pop himself off the CPAP mask four or five times in rapid succession, and so I decided that he could have a break. I released his face, stuck some oxygen in his nose and settled in to pat his bony little back. He figured it was a good enough deal, and decided to stop flailing around.

At shift change, when all the new nurses were trickling in, sleepy-eyed, I was sitting on the end of his bed, replacing his soother when he dropped it and suctioning out his throat when he choked. He was propped up on a throne of blankets and pillows, the smallest sultan ever to lord it over B Ward. The charge nurse came over to see how he was, and I displayed him proudly, sucking away on his soother like a champ. Not crying, not squeaking, not flailing. Just being a baby. A quiet, wide-eyed baby.

I keep getting the feeling that he's going to smile at me, I said to her, rolling my eyes to acknowledge just how ludicrous I found my own statement. She smiled wryly back at me, agreeing without words that I was asking too much. I turned back to look at him, just to revel in his peaceful wakefulness and the softness of his hair and the tiny grace of his fingers. Hi, small boy.

He looked up at me as the soother dropped out of his mouth. And his face broke into a real, honest-to-goodness baby grin. The ear to ear, tongue half sticking out with the effort, eyes crinkled almost shut kind of grin. And then it was over, and I sat there, tears in my eyes, my heart shouting a thousand praises to a God who really does give more than I can ask or think.

Baby Greg smiled. This too is what a miracle looks like.

Today marked my five-month-aversary here on the ship. Five months ago, I landed at Roberts Airfield and walked off the plane into the dark, sticky Liberian heat. Five months ago I drove for the first time through the dim streets of downtown Monrovia, arriving to the port to see the ship, lit up like a beacon in the night. Five months ago I walked up the gangway and into the dining room, explored the ship and tried vainly to find my way around. Five months ago, I ventured outside the port gates and walked down the road to the market for the first time, fearing for my life almost the entire way. Everything was new. Everything was strange. Everything felt larger than life. Everything was an adventure, and I was an unsure pioneer, stumbling through my days as I searched for the path under my feet.

I’ve come a long way, baby.

Today, I made that same walk down UN Drive to Duala Market. Jenn and I ran down the gangway into the cool Liberian air. (In reality, it was probably around eighty degrees, but the overcast sky and slight breeze made us briefly consider going back inside for sweatshirts.) We wandered down the road, circling enormous puddles of muddy water and garbage, and figured we’d been given an extremely wide berth when a taxi scraped past us with about a foot to spare. We stopped at a bakery and the supermarket and the UNMIL store, chatting in Liberian English with the workers there and buying cinnamon buns and Jello and screen-printed t-shirts, three for five dollars. We wended our way through the stalls and wheelbarrows in the market, buying slippers and lappas and hairbands for Jenn’s Bible study group. And then we hailed a cab, jumped in and got ourselves dropped off at our gate, handing the driver our fare without ever having to ask what he was charging. It all felt so normal.

Jenn said it best, somewhere between the port and the bakery. If you can do this, you can do anything. If dodging Liberian taxis and speaking English so garbled I sometimes don’t understand myself can be second-nature, what can’t I do? If bartering for prices and buying flip-flops out of a rusty wheelbarrow can seem commonplace, what can’t I get used to?

I was just writing an e-mail to my travel agent, asking about booking a ticket home for Christmas. It’s been five months, and it’ll be almost six more before I fly, back to what we wryly refer to as the Real World. When I look at my life now, this new normal, I have a vaguely unsettled feeling that I don’t belong there anymore. But, like so much else that’s changed over the past five months, that thought doesn’t scare me half as much as it did on the day I left. I’m just not sure I really want to go back.

Greg took a walk in the hall yesterday. They hooked him up to a portable oxygen tank and Teresa (a proud PICU member of Team Greg) busted him out of his B Ward prison for a glorious fifteen-minute stroll around deck three. He even came to visit Jenn and I (although I wasn't home when he came knocking).

So. This is what a miracle looks like.



In other news, the men's Wimbledon final was also on Sunday afternoon. A group of us were in the lounge watching when it started to pour rain outside. Not exactly a surprise, given that we are in the throes of rainy season. But as the wind picked up, the satellite feed stuttered and snapped to black, leaving ten or so very disgruntled tennis-watchers who had been rather interested in the 5-5 match.

What happened next was classic Mercy Ships. We gathered around a computer, logged onto Wimbledon.com and proceeded to 'watch' the remainder of that match. We stood shoulder to shoulder, cheering on our favoured players and promising ever greater feats of bravery (beard shaving and such) should our man take the day. First, the serve speed showed on the screen. Seconds later, either Federer's or Nadal's score would update itself, followed by shouts and groans from the collected group, which gained curious onlookers until the final point. Nadal carried the match amidst cheers and catcalls from close to thirty-odd people squinting at tiny print on a computer screen. And none of us really thought it was strange.

We talk about the real world quite a bit around here. I have no idea what it looks like anymore.

It's hard to know what to write about Baby Greg sometimes. Hard to know how to sort though the good and the bad and the just-plain-confusing and distill this whole situation into just a few words. When the truth is that I spend most of my moments thinking thousands of words about all this, and I could write forever, trying to explain my feelings and experiences and emotions. And still I don't think I'd be able to properly convey to you how it felt to walk onto the ward this morning for ward church and see Baby Greg. And have his nurse tell me that yesterday he was able to drink from a bottle. (Not much, and he still choked a bit, but he did it on his own.) And this morning he was able to come off his breathing support for over an hour. (Granted, he still sounded a little like a sick duck, but he was doing it without the mask completely covering his little face.) And he's able to be awake and looking around and not crying. (Not for more than a few minutes, but it's the first time in weeks he's had that kind of peace.)

To sit here and actually be able to honestly type Baby Greg is doing better seems like some sort of weird dream. I know he's on a long road, one on which he's only taken a couple of very small steps, but right now he's going forwards instead of backwards. I say I have faith, and I say I believe that God can work miracles. Why is it that I'm so shocked when He shows up and does what I ask?

I was talking with Marion and a couple of the translators yesterday while I visited a sleeping Baby Greg. Marion was asking me some questions about Greg's condition and I was answering as honestly as I knew how. Hope is sometimes a dangerous thing; believing that her baby can get better is important, but not being prepared for the opposite outcome would be absolutely devastating. At some point, my words failed me; there was nothing more to say, so I repeated the mantra we've practically been chanting over the last days. God can make a way.

Cynthia, one of the translators who was sitting with us around Greg's bed, put her hand on my back as I sat there on the floor. No, Sis Alice. He has already made a way.

And it's true. Because miracles aren't always Lazarus emerging from a tomb or thousands of fish jumping into a boat. Miracles can be smaller than that. They can be a baby drinking a thimbleful of milk or a mother laughing for the first time in days. God has already made a way for Baby Greg. And all I can do is let my heart sing the praises He's been waiting to hear as I keep praying and waiting for Him to continue making His way.

I've never been much one for postural prayer. I don't always bow my head when I talk to my God, and I sure as heck don't find myself on my knees very often. Today was different; I spent yet another twelve hours at Baby Greg's side.

He didn't have a very good day. Once lunchtime had come and gone, Greg decided that he hated everything about life and would just cry for the rest of the afternoon. This meant CPAP that didn't work properly and a heartrate that had me wondering just how much longer he could keep it up. Beds in our wards are low to the ground, and I've never really been short, so by about one o'clock, my back was screaming and my legs were ready to give out. And still Baby Greg cried and thrashed and fought.

So I knelt next to his bed, leaned over his little body and started to pray. I patted his chest, the span of my hand measuring exactly space between his skinny shoulders, and I cried out to God for peace. Peace for Baby Greg so that he could just find sleep. Peace for his mama, facing the loss of yet another child. Peace for us nurses, shattered yet again by a baby who might not make it. In the midst of it all, Greg managed to work his arms free from the blanket swaddling him. As I knelt there, my eyes shut tight, I felt two feathery hands curl around my fingers. I looked down into the wide open eyes of every baby I have ever cared for, and he was pleading with me, like they all do, to just make it stop.

This is not what I thought I was getting myself into when I came here. Truth be told, I was maybe ready for a small break from the intensity of the PICU. Some time away from telling parents horrible news about their children. Hope and healing. Instead here I am, stuck in yet another situation where hope seems the very thing we can't grasp.

We took Marion, Greg's mama, into another room to talk with her about Greg's condition. We sat with her and explained that it's not her fault and it's not our fault and it's not anyone's fault. But things aren't good. And she sat with that stone face that so many mamas wear to mask the hurt. And I felt my life repeating, a record skipping over and over, and I wanted to scream.

And then something happened that I've never experienced before in a family meeting. One of our disciplers, a woman named Lucy, got down on her knees in front of Marion's chair. She took Marion's hands in her own and began to sing quietly.

Able.
Able.
I know He is able.
I know my God is able,
to carry me through.

We joined in, voices quavering and small, and Lucy prayed as tears slid down our cheeks. She prayed strong prayers to a God she was fully convinced was just waiting to work miracles. And then it was finished and we went back to the ward and Marion took Greg in her arms and nothing had changed and I'm left wondering where my miracle is.

Because I know God is listening. I spent hours today at that bedside, my hands covering Greg's body, like so many mamas, thinking somehow my hands could be enough to protect this little one who isn't even my own. I knelt there and prayed over and over the words from a song I once sang in a candlelit church in Germany. Oh Lord, hear my prayer. Oh Lord, hear my prayer. When I cry, answer me. Oh Lord, hear my prayer. Oh Lord, hear my prayer. Come and listen to me. And I knew He was listening. I knew His heart was breaking along with mine. And I know that He can do the miracle we're all asking for.



I'm just trying to come to terms with what it will mean if He doesn't.