ali's african adventures

Some things make night shift totally worth it.

It was five-thirty in the morning, and I had to start getting my patients up and washed for surgery today. Benjamin was in bed three, and he's first on the list, which means an early start. I pulled back the covers to find him there, swathed in a heart-printed hospital gown and a lavender, fleece-lined hooded parka. I guess it gets cold here at night. I handed him his cup of water, the last he'll get until after his operation. He drank it quickly but refused a second, so I told his mama it was time for him to take baf. (This phrase, accompanied by a motion that looks like throwing water over your shoulders, was one of my first in Liberian English and has never failed me yet.)

I bent my head to my charts, and when I looked up again, little Benjamin had doffed his hospital-issue gown and was wrapped in a clean, white towel, the ends tucked securely under his armpits. He held his toothbrush like a trophy in a tiny clenched fist in front of him as he padded in his neon orange slippers towards the bathroom. The door shut, a series of yelps emitted (for which I can hardly blame him; having your bits scrubbed with a betadine-soaked brush can hardly be pleasant first thing in the morning), and Benjamin reemerged, clad once again in his gown and parka, hood up to ward off the arctic chill.

I put him back into his bed, pulled the covers up to his chin and planted a kiss on his soft, round cheeks (pretty much the only part of him still visible). Two solemn, brown eyes peered back at me from the pile of blankets and he grinned briefly before turning over and settling back to sleep.

Mandy, my roommate and night shift buddy this week, put it best after I pulled her onto my side of the ward a few minutes later to see Benjamin and his mama, kneeling side by side on top of the bed, praying that Jesus would protect him in the operation room today. Why can't our jobs be this much fun at home?

There's something so wonderful about these people; it defies my best efforts to describe it. But it's going to break my heart to leave them in December.


Addendum:
As we nurses sat in a circle getting ready to pray before report, my little friend appeared from his side of the ward. He made a silent beeline for me, pushing aside my startled-but-rather-amused head nurse's chair to make a path for himself to get into the centre of the group, and came over to rest his head on my knee. Instead of a toothbrush, he now held a crumpled five LD bill. When I asked him what he was planning to buy he whispered back. Col' wata'. Which didn't seem to make sense in light of the parka.

Living in Liberia (or, at least, somewhere not too far off its coast) has changed my perspective in so many ways. I've gained a broader understanding of war. Of poverty. Of forgiveness. And, interestingly enough, of body image.

I grew up in North America. New Jersey, to be precise, a stone's throw away from the bustling metropolitan streets of New York. Before coming to live on a ship in West Africa, I spent every single day of this life of mine being bombarded from every side by images and advertising. Rail-thin girls, the kind that look like they would break in a strong wind, peered back at me from the pages of magazines and gazed down on me as I drove under the billboards they adorned. I was taught, although never aloud, that being skinny and having long, straight hair and perfect skin are the tickets to happiness.

I, unfortunately, grew up in a body that was too big. I was taller than all the girls (and most of the boys) in my class. My teeth jutted out at odd angles and my eyes squinted behind thick, plastic-rimmed glasses. (As an aside, I don't regret the glasses. If not for their orange-framed glory, I might not have formed one of the most important friendships of my life. Yes, Audrey, little kids can wear them and they were real.) Once I hit puberty, things only got worse. I started to fill out as my knobby knees and sharp elbows were gradually covered in a layer of (gasp) fat.

I spent years hating my body. I wanted to be beautiful, and if I was reading the signs right, I wasn't. Nothing in my culture told me that I was desirable or lovely or worth looking at. I don't write this to prompt my family to leave me gushing comments about how cute I was or, worse, how I had such shining inner beauty. Truth be told, I was a homely kid, and there are plenty of photos to prove it. (What you can't see in photos is supreme social awkwardness. Thankfully.)

You grow out of self-loathing, eventually. At least I hope you do. I did. I realized that my height was an advantage; you didn't see me needing a stool at my patient's bedsides just to reach my IV pumps. The extra padding on my body honestly just means that I can sit longer without getting uncomfortable. But there's always been a voice in the back of my head, reminding me that I'm just fooling myself. That I don't really look right and I never will.

And then I came to Liberia, and my paradigm shifted. Here, people don't make the choice to starve themselves in order to be thin; there often just isn't food to put on the table. The billboards lining the streets remind people to wash their hands after using the toilet, that the president is working to bring electricity to the country and that you should always report rape immediately. Newspapers and magazines are torn up to wrap the loaves of bread that sell on street corners for 10LD apiece.

I realized recently that quite a few of my translators on the ward have taken to calling me Beauty. I couldn't figure out why, seeing as how it's never been a word I associate with myself. Somewhere in the middle of my shift tonight, I wandered over to the kitchen to get hot water for my tea and found six or seven of them crammed in there, laughing and talking as they washed the plates from dinner. I exchanged greetings with all present, made my tea and was about to walk back to the ward when Judy, a short, round, perpetually-grinning woman called out Bye-bye Beauty! I turned back. Why you call me Beauty? I wanted to know.

Her smile got wider. You beautiful because you speak our English. You not just speaking the American English. That how we know you are beautiful. I gave her a hug and turned to leave, when she shouted after me. Hey Beauty. You know why you beautiful? Because you got a fine African shape! The kitchen erupted into shouts of laughter and hearty assent. Three or four of the ladies reached out to pat me on the backside and the lone man present nodded his head in solemn agreement.

For the first time in my life, I'm being told that my body is not too big. That, in fact, it's perfect and healthy and beautiful. And when I go back to my own world and my own culture, I'll take this name, too. Beauty.

It happened again.

I made a conscious decision not to get involved. I listened as my roommates and coworkers shared stories about their efforts to save his life, but I refused to allow myself to care. It's happened too many times before, and my heart is still too raw, the wounds from Greg's passing too fresh. I couldn't be a part of it.

And, of course, I failed to stay away. I poked my head into the ICU to find someone yesterday and saw them huddled over his bed, fumbling with a finnicky piece of equipment, a piece of equipment I know all too well from my time as a transport nurse back home. I stepped up to lend a hand and introduced myself to the slightly-confused anesthetist who, no doubt, was wondering who this random girl in sweatpants thought she was playing with the I-Stat. (And, in a surreal moment, when I told him my name, he grinned. I know who you are. I read your blog.)

Once the results were back, I stayed for a while, helping his nurse untangle wires and get him settled. I made the mistake of touching his tiny hand, and my heart dropped out of my chest. He was so small. Insubstantial. Hardly there at all, a feathery jumble of bones and skin, and I knew that I cared and I knew that I would hate that I cared.

He went to Jesus later in the evening. Quietly, too. Like Greg, he just stopped. And they let him. They took out the tubes and the wires, all the invasions making their marks on his little body, and they let him go. He was too small and he was too sick and he went back. Some of the children got to go back.

They prayed over his twin and over his parents and over their lives and they sent them off into the sticky night air. And they cleaned the bed and put everything in its place and sent the parts of the ventilator away to be re-sterilized. Because it's probably going to happen again. And again. And I don't want to care.

But I do.

I've been hesitant to write about this. Truth be told, I've spent the last four months or so hiding it all away, and so the prospect of spilling my proverbial guts on these pages is a little overwhelming. However. I find that I no longer want to keep this to myself.

It started a few months after that needlestick. I was always tired, and every time I worked night shift I would spend the next couple days recovering from violent illness. I caught every cold going around, and I felt like an absolute weakling. It all seemed easy to explain, though, since I live on a ship and breathe the same air as four hundred other people.

It was around the time that Baby Greg first came to us that I signed up to be a blood donor and gave a sample to the lab for routine testing. I was sitting by Greg's bedside in the ICU, willing him to breathe, when the crew nurse poked her head around the door and asked me to come to the clinic. I figured my hemoglobin was too low or my electrolytes were out of whack from my latest round if sickness. I just wasn't expecting Dr. Craig to say what he did.

You have Hepatitis B.

My world quietly crumpled and I sat, numb, while he drew more blood to repeat the test and explained to me that the man whose blood I had injected into my finger must have been very recently infected. That there was only a small chance of the virus going chronic. That I would probably recover.

And the whole time, all I could see in front of me were the yellow eyes and swollen bellies of patients I've cared for with liver disease. I found my way back to the ICU, back to my critically ill baby, forcing myself to concentrate. Willing myself to believe that it was going to be okay.


But it's hard to believe that things are going to be okay when you're a couple months away from your twenty-fifth birthday, living on a ship off the coast of West Africa, and infected with a potentially deadly virus. I'll admit it now; I was angry. Back when I was preparing to come to Liberia, people constantly told me to be careful. It's so scary over there! I can't believe you're doing something so dangerous! Anything could happen! I smiled and shot back the same glib answer every time. If God wants me there, He'll protect me.

But He hadn't. I'd somehow slipped out from under the shelter of His hands and into the big, bad world where things like incurable diseases lurked. I couldn't figure out why He would let it happen.

I spent the next three months waking up in cold sweats, wondering how I'd be able to afford a liver transplant. (I'm not sure Talent Trust covers that sort of thing. They do, however, make provision for repatriation of mortal remains. Which I was also thinking I might have to use, in a worst-case fulminant-hepatitis sort of scenario.) I dodged questions as to why I was drinking soda instead of Club beer with my dinners when we went out on a Friday night. I held on to my little secret, feeling dirty and diseased, and I tried to pretend that everything was all right.

Which, in true I-worried-about-this-for-nothing style, it is.

I'm now, as of a couple weeks ago, the proud posessor of another little pink slip of paper that bears my latest test results: negative. Just like over ninety percent of everyone who gets infected. (Those odds, interestingly enough, don't seem so great at three in the morning when your cabin is dark and your mind won't stop racing.)

I still don't know why it happened. I'm still a little bitter, if I'm being totally honest. Because I can't help thinking He failed me.

But, oh, His voice speaks into the silence of my pain. I know every hair, He reminds me. I knit your body together as you grew in the secret places. Every day and every moment of your life, I planned it all. Have you ever known me to make a mistake?

No. No. A thousand times no.

Saying no never gets any easier. The plastic surgeon has boarded a plane for his home in South Africa, and Abraham's arm is no better. When I opened up his chart at the beginning of my shift, I found a handwritten referral letter for the MSF pediatric hospital in town. He'll leave in the morning.

We're not going to have another plastic surgeon here during this outreach. The ship is going to be in Benin next year, Guinea the year after that, and then we don't know. But probably not Liberia. So Abraham will probably never get his surgery. There's a good chance he'll prove to be a prophet (albeit one with a twisted hand) since he told me last night, after tomorrow, you will not see me again.

I tucked him into bed with a heavy heart. It's not fair that a little five-year old boy should be tearing through life with one hand just because he lives in the bush and got in the way of a snake while he was playing football with his cousins. I hate that we're sending him home with open sores on his arm. It doesn't make any sense that, no matter how hard we tried, we couldn't fight off the infection and we can't do his surgery.

And still he laughs and kisses me and makes silly faces and seems to have no idea that he's crippled. Which is why saying no feels so wrong.

Reason Number 4,571 that I Love My Job:

As I walked onto B Ward this evening, admittedly less than excited to be starting my second of four long night shifts in a row, my little friend Abraham caught sight of me. He jumped up from his place on the floor, thought briefly about putting on his slippers, decided against it and danced across the room into my arms, blowing kisses the whole way. Emmanuel, Mercy's proud big brother, was close on his heels and little Mickey, a small one who used to be screaming afraid of white people, toddled along behind. Within fifteen seconds of stepping foot onto the ward, I was on the floor with little brown boys draped across every part of me they could attach themselves to. Probably the best way I can think of to start a shift.


I'm sitting here in the darkened ward, the generators once more beating out their insistent pulse, and I'm so happy. I can hear little Mercy crying like a small kitten in the corner, quieting as her mother reaches for her. I had to settle an argument between Mercy's mama and Mickey's grandma earlier in my shift. They called me over to their corner, and I took Mercy in my hands, curly-haired and feather-light. It turned out they were in disagreement over how long I'd been in Liberia. Mercy's mama figured I'd been here before, but Mickey's grandma stauchly proclaimed that this was my first visit. I have been here since February. I were not here las' year. Mickey's grandma looked triumphant. That how I tol' you. She jus' speaking Liberian. Yongo a clever girl!

Abdullah, the man in the next bed over, decided it was time he got involved. What mean Yongo? he wanted to know. Mickey's grandma explained to him that it was my Kpelle name. Abdullah looked confused for a moment, scratched his head through the bandages wrapped around it, and wanted to know why that white girl needed a Kpelle name anyway. The answer came swiftly.

Because her heart Liberian.

And somehow, after that, the nights don't seem so long after all.

I was fast asleep last night when I heard the phone's insistent ring. I pressed the light on my alarm clock, stifled a groan and rolled out of bed. 4:15 in the morning. Whose crazy family member did the math wrong and called us before anyone has any business being conscious?

Hi, this is the Ward. Is Mandy awake? I looked over at the closed curtain in my dark and silent cabin. Of course Mandy wasn't awake. It was four in the morning. I'll go get her.

An equally bleary-eyed Mandy was soon clutching the phone. Yeah. Yeah. Okay. I'll be right there. It was only after she had disappeared out the door towards the hospital that I remembered that Mandy is a midwife back in Australia. And one of the patients on B Ward, Emmanuel, was being cared for by his eight-months-pregnant mother.

When we woke up in the morning, Mandy's curtain was shut tight again and a note on our bathroom mirror told us the news.

We had a beautiful baby girl at 0445. Pink and perfect with curly black hair.

When I went down to the ward later on to meet with one of the disciplers, the baby was wrapped up in a blanket and lying (all four and a half pounds of her) in a laundry basket on the end of the bed. Her exhausted mother was curled up next to her, and big brother Emmanuel, the real patient, had been relegated to a mattress under the bed. Everything on the ward was business as usual, except for the fact that a brand-new life was sleeping quietly in the corner. I touched her mother on the shoulder. You have done well. She answered with a tired smile. What the baby name? I asked, as Emmanuel poked his head out from under the bed, proclaiming to anyone and no one, That my sista! I love her!

The mama smiled again.

She will be called Mercy.

I journeyed up to Ducor again today. We drove through the streets of Monrovia, mentioned Joe's name at the 'gate' (which is nothing more than a man in a blue uniform who stands holding a rope stretched across the street) and continued on up the hill to the hotel. Peter, the guard who had been holding the rope, appeared at the entrance to the stairwell and indicated that he would show us around.

The place was much as I remembered it. The view of the city from the rooftop was just as serene, the breeze just as cool. Inside, everything was just as sad, just as broken, just as desolate. Remnants of abandoned life littered the floors and crunched underfoot as we picked our way through the empty spaces. It wasn't until we reached the third floor that everything changed.

I walked into room 332 and I was immediately and entirely eight years old again. The pile of discarded and forgotten things in the corner filled the space with the same musty smell that used to mean summer to me, and I closed my eyes and breathed deep the draught of childhood.

We used to go to the Farm every summer. Eight kids and two mamas, we would pile into a big blue van and drive out of the sticky confines of the city, into the freedom of July. I have no idea, now, how far away the property was. It could have been fifty or five thousand miles; all I knew was that it was an escape.

Being at the Farm meant two straight weeks of running wild. Our days were filled with exploring fields, rolling hay bales, building forts and fires and wading in the creek. Every afternoon we would pile back into the van and one lucky kid would get to sit in the driver's seat and steer the pack of us down the grass lane to the road. My mum would reclaim her place and position the van at the top of the hill that led into town. Ready? Her eyes would light up, we would start cheering, and she would take her foot off the gas, letting us coast down the slope, always trying to make it all the way to the pond we were going to swim in and never quite succeeding.

On the days when it rained, we sprawled out on the pile of mattresses that covered the floor of the bedroom where we all slept at night in a jumble of blankets and limbs. We played board games or listened to old records on a player that skipped if you rolled over too hard, laughing hysterically at the chipmunk voices when we accidentally played one at the wrong speed.

But my favourite place on the Farm was the barn. It was falling apart, pitted with groundhog holes and overrun by the bees that Grandpa kept in hives out back. The log beams that lined the walls had been worn smooth over time and we dug our toes into the cracks between them as we climbed up into the hayloft. That barn was filled with the same old hay, year after year, and it was packed down so tight that I used to lose my breath in a hard gasp if I landed wrong when I jumped out of the loft. I would lie there, momentarily stunned, the air around me alive with dancing dust and the musty smell of old hay. And then I would pick myself back up and climb to the top of the wall again.

Standing there in that dim room in an abandoned hotel that stands sentry over a ruined city, everything was somehow right again. Because it smelled like summer, and it smelled like innocence.

It seems that I forget where I am at times. Life on the ship is so modern and comfortable that I lose sight of the fact that I am, indeed, docked in a West African port.

Until something goes wrong.

Thankfully, the issue at hand was nothing disastrous. Not in the grand scheme of things. But it posed something of a quandary to me, living on a ship off the coast of Liberia.

My MacBook has been my trusty companion these many months past. I use it for everything from music to photo editing to writing this blog. About a week ago, I was happily employed, in the throes of my latest creative urges, when I felt my leg getting warmer and warmer. I looked down and noticed that my power cord was resting against my calf and that it was heating up by the second.

I traced the cord back up to where it plugs into the computer, nearly burning my fingers in the process, to see this. Melted plastic, exposed wires and a fire hazard if I've ever seen one. I unplugged and spent the remainder of my battery power researching the problem.

It turns out that lots of Mac cords suffer from this haphazard suicide. So many, in fact, that they promise you a new one when it happens. No questions asked. All you have to do is bring the melted specimen in to your nearest, friendly Apple store.

Which would be a simple task, if the nearest Apple store weren't 4,500 miles away, as close as i can figure.

It's the little things that remind me just how good I've got it. I got on one of the computers on the ship, fired off some photos to my dad in New Jersey who, in turn, brought them to that aforementioned friendly Apple store. The manager, Ross, took one look at the picture and produced a spanking-new cord, which my parents will send to me, hopefully in a box that also contains some Twizzlers. (Let's face it- it's been a while since I've had those, and a girl's gotta get her fix somehow.)

Thanks, Ross. My sad, silent MacBook will soon come back to life, and you saved me trying to coerce some poor soul into carrying the melted remains of my power cord back to the States.


I just wish it didn't hit me like a sucker punch in the gut every time, this realization that I'm so far from home.

There's something very important about names in African culture. People don't necessarily go through their lives with just the one name they're given at birth; depending on events and circumstances, their title can change. I remember how, in Zambia, women were renamed with the prefix Nyaka once they grew old. You knew, just from hearing their name, that they were mature and respected.

Here in Liberia, I've had many names. Not many of my patients seem to be able to stop at Ali, choosing instead the more Liberian Alice. The small ones call me Auntie Alice as they cling to my legs while I try to go about my work on the wards. My other favorite moniker is Alaji, a name from a song that often plays on taxi radios as we bounce through the streets of Monrovia.

This weekend, the mother of one of my small boys beckoned me over to their bed in the corner of the ward.

Alice, when you learn Liberian?
I have been here ever since. Seven months. That why I can speak small small.
I tell you Alice, you can speak clear! I t'ink you are Liberian.

She went on to tell me that, since I'm officially West African now, I need a name from her tribal language, Kpelle.

You will be called 'Yongo'

It's nothing special, this new name of mine. It means Tall One, which makes a lot of sense to anyone who's ever stood next to me. But to me, it means so much more than that. Having a name says that I belong here; it gives me a place. When I walk into the ward to shouts of Yongo! I know that I've been invited to stay and take part in these people's lives.

Which is all that I can ask for.

This is Abraham. He gives me more smooches than I've ever dreamed of.

His wrist was bitten by a snake a while ago and healed in a frozen mass of scar tissue. We had him with us at the beginning of the outreach; he was one of my balloon party friends. And now he's back, because he has infected ulcers on that arm that just wouldn't heal.

He endures two dressing changes every day. Ten minutes of his arm being soaked in vinegar while he winces and yelps and then comes back to the ward proclaiming cheerfully, They finish changing bandage. My hand bettah nah. I wan' stickah. I wan' go outside. I love you very much, Good Charge Nurse.

He never stops loving.


The plastic surgeon will be here for two more weeks. We have fourteen days to get rid of his infection (an infection that has lived on his arm for months) or else the doctor won't be able to do the surgery to release his wrist back into a normal position.

And whether or not he ever gets that surgery, we'll keep changing his bandages, and he'll keep slipping his twisted hand into mine as he throws his good arm around my head to pull my face close for yet another kiss.

And we'll both keep loving.

I survived my first shift in charge all by myself. It was slightly hectic, as only caring for forty patients, six nurses and the odd extra baby can be, but I'm happy to report that everyone is alive and accounted for. Only one lady got diagnosed with typhoid, so I think, altogether, it was a pretty successful shift despite the eight hours of nearly nonstop fire-dousing.

My favourite moment of the day came when I returned to my pediatric heaven (B Ward) after dealing with the latest crisis on A Ward. I sat down at the desk to update the census on the computer and briefly considered handing in my resignation. Maybe I'm really just cut out to be an ICU nurse, I thought, in charge of myself and my one patient, blissfully unaware of what's going on in the rest of whatever hospital I happen to be in. I just wasn't convinced I was getting it right.

At which point three little kids in matching, bright blue and green frog-printed dressing gowns sidled up to my chair. One after another they gave me the lopsided, one-armed hugs of the recently-reconstructed burn patient. Their faces squished flat against my cheek as they kissed me soundly and proclaimed You are a good charge nurse. I love you very much.

My roommate, Rachel, looked up from where she was charting at the end of the counter. Her eyes met mine, and she turned back to her paperwork, hiding a conspiratorial grin.

I'm glad I have a roommate who loves me, and I'm even more glad that right down the hall is a ward full of Liberian kids who will greet me in the morning with kisses and hugs and shrieks of Auntie Alice! See mah stickah! Because I love them. Very much.

I'm starting to wonder how anyone can live their lives without getting ridiculously excited by the fact that God is in control.

Today was my day off this week, so I decided with a group of friends to head into Monrovia for lunch. As we passed through town on the way home, my friend Tim and I jumped out of the car on Broad Street, bent on trying to find Cathi and Matthew. I knew what hotel they were at, but we weren't quite sure where that was; we set off on our adventure through streets teeming with people and taxis.

After a short trek up the hill led us to the abandoned Hotel Ducor and a dead end, we realized that we were probably lost. But Liberia is a friendly place, so if you're ever at Hotel Ducor, ask for Joe. He's the commander up there, and he'll be happy to show you around. Or, if you're stuck in our boat (the boat of the directionally challenged), he'll be happy to recruit a nearby friend who knows which winding path to take down the other side of the hill, between concrete and tin houses and over piles of garbage until you're safely deposited on the right road.

We made it to the hotel and called Cathi's room. She came downstairs to meet us in the lobby, Matthew asleep in his little quilt, arms folded contentedly across his small chest. She explained that she hadn't come back to the ship yesterday (as was planned, for a checkup with our doctors) because she'd gotten a major electric shock as she first moved into her room. She touched the corner of the blanket Matthew was wrapped in, a blanket quilted by loving hands somewhere else in the world, donated to Mercy Ships and given to him when he came in out of the rain on Tuesday. The blanket you gave him saved his life. I got shocked, but I wasn't touching his skin. I think it's what saved him.

We discussed plans as Matthew gurgled and coughed and smiled in his sleep. Because they were already in the process of adopting, she has all the paperwork she needs to get him home except for a visa. This could take a while, so we exchanged numbers and I'll speak to Dr. Gary about repairing his cleft lip if they're still in Liberia when he's old enough for the surgery. Tim stood next to me, a wide grin across his face as we chatted, reaching out occasionally to touch Matthew's silky hair. It was easy to forget that I met these people just days ago.

And here's where God showed up yet again. It was five thirty, rush hour in Monrovia, and we were getting ready to hand Matthew back and try to catch a taxi home to the ship. No easy task on a good day downtown, finding a car during the busiest time of the day is an endeavor that can have you waiting hours. I looked out the glass doors into the courtyard of the hotel to see a tiny blond girl playing with a puppy. She looks familiar, I thought to myself, a split second before realizing that she was accompanied by her mother, Katharina, and that they were standing next to their Mercy Ships car.

In any other situation, I might have been tempted to call it a coincidence. You happened to be at this hotel, and they happened to need a bathroom and you got a free ride home. So what? But when you factor in the baby with my brother's name in my arms, his weary mother sitting on the couch and a big white ship who just might be able to help after all docked across the harbor, things just don't add up properly.

We sat in the back of the car, bouncing home over the rutted roads. Tim caught my eye, and his grin spread even wider as we repeated one of our favourite Liberian refrains to each other.

God is good?
All the time.
All the time?
Good is good.

I seem to have made some kind of breakthrough.

Up until now, I've been speaking to my patients using only the odd phrase in Liberian English. The reactions were varied, some laughing heartily to hear this white girl try to speak Liberian, others staring blankly at my increasingly red face. So I would retreat back into my standard American English and get a translator to help me. But those of you who know me in the real world know that I'm something of a communicator. I love to talk and I love to be understood. It seemed like neither of those things were really happening.

I think it might have been partly because I thought that Liberian English was just an accent. That if I cut off the ends of enough of my words and always sounded slightly angry, they'd magically get me. It didn't occur to me until recently that this is almost an entirely new language, complete with its own horribly incorrect grammar. And when the Liberians talk about speaking English, they're not talking about the language we speak in America. It's something altogether different.

I figure the best place to start learning a lanuage is with kids. They don't laugh too hard at your mistakes, and they love to chat. B Ward is packed full of Liberian-speaking kids right now. They've overrun the place, much to my glee, and they all love talking to me. Abraham explains to me about his scarred hand and Charles asks me when we're going outside and Tenneh wants to tell me all about the movie they watched yesterday. And they, in turn, want me to tell them about every single thing I'm doing.

All this playing with children seems to have had an effect, because somewhere in my brain, a switch seems to have been flipped. When I walk onto A Ward to check on the VVF ladies, I'm greeted by a chorus of voices shouting Liberia Woman!. A new translator who I introduced myself to yesterday stared in confusion at me until one of the patients helpfully explained that that white woman can speak Liberian, at which point he laughed and agreed. She speak clear! I was able to translate for an anesthetist this evening with a patient whose card said he only spoke a tribal language.

My words are punctuated with odd gestures, strange noises and raised eyebrows, and for the first time since I've been here, I feel like I'm finally making sense.

I can be too happy. Which, I think, is Liberian for I never want to leave.

Funny how I was just commenting on my cathartic need to write. Because today will take some sorting.

I've been here almost seven months now and I'm one of the more experienced nurses around. Scary, I know. So they've asked me to start doing some charge shifts. It was inevitable but, truth be told, I'm not jumping out of my skin with excitement. I'm much more content pottering through a shift with my four or twelve patients and not really worrying about anything else. God, however, knows what's best for me, so off to charge-land I shall go. Today was my second day of orientation, and I was starting to get a feel for things. At which point, The Call came.

Hi. This is Reception. There's a patient out on the dock.

I asked my boss yesterday what I should do if I ever got The Call while in charge. She made it sound so easy. If they're not someone we did surgery on, tell them no. Send them away. Be firm. Be kind. Tell them no.

And when we went outside there was a white woman holding the smallest brown baby and it was raining and all her suitcases were huddled around her like sentries and he sounded like Baby Greg when he breathed. I took him in my arms, stood there on the dock and my prayer was a silent scream. God, no. I can't do this again. I can't watch another one die.

We found shelter at the top of the gangway and discussed what to do. The little one in my arms gasped and coughed, his lip split in two angry gashes, his palate a gapaing hole and his hair soft in tiny ringlets against my arm. We couldn't admit him; we don't even have enough beds for our own patients right now. So we brought them inside to wait until we could find someone willing to drive them to the MSF pediatric hospital where he could be seen by a pediatric doctor.

I stood in the cafe, my body swaying in a rhythm I didn't know as the small one's cries quieted and he fell asleep. The woman sitting in the chair in front of me, eyes tired, shared her story with me.

She wasn't planning on any of this. She was just a mother from Minnesota, a mother with one child alive and two taken from her in a car accident a few years ago. She was just a nurse, an ER nurse who wanted to come and serve God for a few weeks in Liberia. She had been working up country at a bush hospital when she heard of this little one. He had been abandoned by his mother, convinced that her own pregnancy had been stolen from her and this evil spirit baby with the hideous face replaced in her womb. Of course she didn't want him. (At which point the little one grunted and settled closer into my arms, one tiny hand curled up against a mocha cheek.) Cathi, the woman sitting in front of me, explained that they were just feeding him water, waiting for him to die.

No, she said. He needs milk. I will give him milk. There was no milk at the hospital, and if she wanted him to have it, she would have to take him home. So she did. She got back to the house where she was living, and her understandably surprised roommates asked her the baby's name. She pointed to the two men who had seen her home safely; Matthew Steven. 'Left with adoptive mother' is what the note in his chart read, and she figured Why not make that truth?

You see, Cathi has a room in her home in Minnesota all ready for a baby. She and her husband have been working for years to adpot a baby to fill that room; she just wasn't planning on finding him in the Liberian bush, clinging to his little life with dogged persistence. God, however, seems to have had other plans, because all the paperwork for the adoption was finalized within two weeks. I'm not going to lose this one, she told me, her expression unreadable, somewhere between despair and determination.

We drove through the market traffic to the MSF hospital, descending from the car into a sea of babies and mamas and little children swathed in thick bandages, the edges of their burns showing angry red where the gauze had slipped. We opened the door to the ER to see skeletal children being fed through tubes, babies lying listlessly, two or three on each low cot, and a group of doctors and nurses quietly trying to save the life of a newborn on a table in the middle of the room. No, this isn't urgent. We'll wait outside.

Back out into the damp heat to smile and pull faces at the little kids surrounding me, trying to ignore the thoughts in my head. These are the kids who will need Mercy Ships later on, when their burns have healed badly and their little fingers and elbows and necks are locked in scars. These are the babies who need to be fed every few hours, but there might not be enough milk here either. These are the ones you can't help. You aren't doing enough.

Matthew was seen by the ICU doctor. He didn't have pneumonia and wasn't sick enough to be admitted. We brought them back to the ship and another crew member drove them to a local hotel where Cathi is going to continue her vigil until he's well enough to fly home. And I went back to work. Played with the kids on our wards. Put in some IVs, answered some questions, fought back tears.


How is it okay? How can I go to sleep in my room tonight knowing that Cathi is in town somewhere, fighting for little Matthew's life? I'm sitting here and I can't erase the images from my head. All those kids. Waves of suffering and humanity and hope and we drove up in our white Landrover and they surrounded me and then we drove away and some of them looked bewildered. Because we're supposed to help. We live on the white ship and we have white skin and we're supposed to be able to help.

Sometimes it feels like we're making some kind of difference; our wards are full right now. Kids are bouncing off the ceilings and the VVF list reads like an awards ceremony. Dry. Dry. Dry. But it's not enough. It will never be enough. This world we live in is so hurt and broken and I have no idea where to start in putting it back together.

I'm glad I'm not the one in charge of that.