ali's african adventures

Richard and Nicholas have got to be two of the oldest souls I have ever met. Maybe it's the amount of time they've spent in hospitals. Richard (who prefers to go by Richie) has spent a quarter of his life as a patient at the Island Pediatric Hospital here in Monrovia; he's four going on four hundred. Nicholas is the younger of my charges; he's only three, and all his memories involve doctors and tests and medicines and pain.

They both drank caustic liquids over a year ago, and they're two of the worst cases Dr. Jose is working on here in Liberia. They're the reason that I'm sleepwalking right now, almost through my second night after days with no rest. But nine months on board makes me the pediatric ICU nurse with the most experience, so I'm the woman for the job.

It's incredible how fast these nights are passing. Between Nicholas' squeaky breathing and Richie trying his utmost to fall out of bed (despite the fortress of siderails and pillows that I've built for him), they've kept me busier than I can remember being all year. If they weren't both so cute, I might almost be annoyed.

But like I said, they're old souls, and it's enough to amuse me to the point where Richie's constant thrashings and coughings and tuggings aren't quite so frustrating. I've never been able to reason with three and four-year olds before, but Nicholas and Richie (in their more lucid moments) seem to have a perfect grasp of abstract concepts like waiting for their medicine and listening to the nurse when she tells you to stop scratching your skin raw. They look up at me with liquid black eyes as I bend over their beds to rub their backs and straighten IV lines and untangle them from their tubes and wires. The solemnly nod their little heads when I ask them if they're feeling pain. If they want to have medicine. If they want to sleep.

Richie is finally at peace. He and his mama are sleeping top-to-tail in his bed. His limbs are splayed out wildly, except for one little hand, holding tight to hers. Nicholas is draped across his mama, nestled in the crook of her hip, his little teddy bear clutched firmly in his arms.

It's only a matter of time before they both start up again, Richie with his incoherent cries and Nicholas with his coughing. But for now, I'll revel in the quiet.

It seems that a lot of my favourite moments on the wards involve little naked kids running around. Yesterday was no exception.

The wards are full of kids right now. We have a new doctor, Dr. Jose, a pediatric surgeon who mainly operates on babies who were born with gastrointestinal malformations and kids who drank caustic liquids. This latter bunch are a sad lot. They usually go wandering to a neighbor's house and see a cup sitting on the ground. Not knowing that it contains lye, a horribly corrosive liquid used for making soap, they pick it up and take a drink. The result is an internal 'burn,' all the way down to the stomach. When the wounds heal, they're left with scar tissue and tightening of the esophagus. These kids often become malnourished and require feeding tubes because there simply isn't enough space in their now-tiny esophaguses for food to pass.

Mark is one of these cases. He's two-and-a-half and he's been in a few times in the past weeks for a procedure where Dr. Jose uses a thick tube to stretch out his esophagus. He's not a big fan of us, but he's comforted by the fact that he's got friends here, other babies and their mamas who have all been doing the round of local hospitals, trying to find treatment that will prevent their children from starving to death.

Yesterday, close to the end of my shift, Mark was running around the ward, stark naked. Before you call me a bad nurse for letting my children hang out like that (pun most definitely intended) you have to know a little background. We're on a water restriction on the ship right now. The water we use for drinking, bathing, flushing toilets and everything else is supplied from a hydro plant here in Liberia. Recently, the supply has dropped drastically, and so we get announcements at community meeting reminding us that we really can't use more than two minutes in the shower and the tap needs to be shut off when we brush our teeth. We've had low reserves before, and it always resolved within a few days. This time it's different. As of Monday, we had about six days worth of water left on the ship. We're in crisis mode. No one is allowed to do laundry. We're using disposable plates and cups at meals so we don't have to run the dishwashers. It's been suggested that daily showers aren't a necessity. We have no idea what we'll do if the situation doesn't improve.

However drastic this might sound, it did provide the basis for my incredible amusement. Mark had been drinking a cup of water. He's not really the best at drinking anything, and the majority of the precious liquid ended up poured down the front of him. When his mama went to the cart to get a new gown, I gently reminded her that we have no water to do laundry and so he needed to keep that gown. He, however, didn't feel like wearing a sopping wet garment, and so we took it off him and draped it over the end of the bed to dry.

Which is why, as his little friend from the next bed packed up to leave, Mark was running around in nothing but his birthday suit, absolutely content. It was only when his own mama left the ward to say farewell to her friend that Mark realized the truth; not only was his little friend, Momo, leaving, but his mama was disappearing for a while too.

He bolted through the half-open door and took off down the hallway with me in hot pursuit. What followed was enough to make me laugh for days. As his mama and his friend disappeared through the door to the aft gangway, he started yelling and stomping around, NG tube and all his little dangly bits ... well ... dangling. Mama-o! Mama-o! Mama-o! I was trying to hold in my giggles while trying, unsuccessfully, to herd him back into A Ward. He, in turn, was trying, also unsuccessfully, to fend me off with small, flailing arms.

It turns out that it's nearly impossible to reason with a distraught, naked two-year old. I varied my tactics as he ran in circles and we both got out of breath. Hey man, come inside. I will get you gown. You can't be naked in the hall. Don't beat me, man! You're alright. Mama will come back. You're alright. Come inside. You can't be naked. Don't beat me. You beat me, I will beat you. (As an aside, I would never beat a kid. But people were staring, I was desperate, and it's a threat the mamas tell me to use that, while never carried out, generally has enough weight to ensure compliance.)

Eventually he ran out of steam. I knelt next to him in the hallway as he dropped his tired head onto my shoulder. With one last half-hearted call for his mama, he gave up the fight. I carried him inside, found some PJ bottoms for him to wear until his gown dried and climbed into his bed. He nestled into me, head on my chest and little arms wrapped tight around me, and fell asleep.

I think I won that battle, but it's hard to tell. Maybe it wasn't one I should have picked to begin with.

You just can't be naked in the hall. That's all.

This place is such an odd kaleidescope of conflicting emotions. Twist the glass one way and your sides hurt from laughing. Turn to face the light and your heart is shattered. Today was a day of both.

Dawayne is eight. He's in third grade. (Do the math and you'll realize that he's in the right year for his age. It's the first time I've seen it since coming here.) He's a bright kid, and I'm not just talking about the lightness of his skin; he read me the story of Jonah this morning, only stumbling over words like Ninevah and repentance. He's really not too sick; as I was leaving work he was being called to the operating room to have his hernia repaired.

This morning, Dawayne provided me with two of the funnier moments I can remember. I went over to him, needles in hand, and explained to him that I needed to juke him small for an IV. That I would make sure I got it on the first try. And that, if he held still, I would give him not just one, but seven whole stickers. His eyes lit up and he stuck out his hand, brimming with confidence. His bravado failed him, however, as I approached his skin with the needle. His eyes rolled heavenwards in supplication as he screamed out in utter seriousness, JESUS, take me now! I had to stop and compose myself before starting that IV.

A little while later, the mamas in his corner called me over. They prophesied over me that, once I get back to the States, the first thing I will do is born a baby. While my ovaries don't mind the thought of that, I explained that I had to get a husband first. One mama laughingly offered her three-year old son. I told her he was too small and that I needed a big man. At which point little Dawayne rolled over, looked up at me, and with raised eyebrows and a sassy little head tilt delivered a perfect impression of Joey Tribiani. How you doin'? I almost peed myself.

And the kaleidescope shifts and Eddie fills my view and laughter is the last thing on my mind.

Eddie is four months old. From the neck down, he's like any other baby. He's the firstborn in his family, a little porker with chubby thighs and a miniature pot belly. Eddie is cherished. When he was born in the middle of the rainy season, his mama made sure to always cover him with a mosquito net when he slept, to make sure he didn't get malaria. About two months ago, an aunty was doing something by candlelight as the baby slept, secure under his net. She placed the candle on the ground, and in just a few seconds, little Eddie's life went up in flames. The net caught fire around him, and his face and head were horribly burned.

I hold Eddie and rock him and kiss the angry pink skin on his cheeks. I tell him he's beautiful. To anyone other than us, though, he's hideous. He doesn't look like a baby anymore. His eyes can barely open and close. His lips are a static mass of scar tissue. His nose is gone, leaving only two small holes in the centre of his face. The top of his head is an open sore. Everything else about him is the way it should be. His skin is creamy brown, his fingers delicate and perfect. It's just his face, the first thing everyone will see for the rest of his life. It's just his face that's been destroyed.

His mama loves him. She holds him and rocks him and dresses him in little outfits that we've scrounged from the bottom of donation boxes. She can't bear to be there when we change his bandage, so we take him to another room. He wails as we soak the infected sores on his head with vinegar, shaking from side to side, trying to make it stop. And then he quiets, submits, gives up, and that's maybe worse than all his screams.

I'm afraid for little Eddie. I'm afraid of what his life is going to be. He will never know what it means to be normal. He will live forever with people staring at him. People hating him. People ignoring him or making fun of him or calling him ugly. We sit here and we tell him he's beautiful (and he is, really; you just have to ignore the obvious), but he's not going to hear that very often when he leaves here.

Which made it all the more poignant when I heard his mama singing. I looked over to their bed in the corner to see her lying down, Eddie propped up on her stomach. From behind, all I could see was the plumpness of his diapered bottom, encased in a clean, white onesie, and the fresh whiteness of the bandage around his head. She bounced him up and down as she sang quietly.

I am on the Lord's side.
I will never give up.
I am an overcomer,
For the Lord God is on my side.

I pray that Eddie would be an overcomer. That he would somehow have the chance to grow up and go to school to learn to read like Dawayne. That he would be surrounded by people who can see past the scars.

That he would know love.

As if I needed another reason to love my family, my cousin, Becki, recently created this.

It breaks my heart in places I never even knew about, ripping holes in parts I thought were going to be forever sturdy. And it's the reason that, come December, I might not make it home entirely whole.

We've said no so many times that yes has come to feel almost foreign on my tongue. Finally, though, we've been given the chance.

Kwelywoh is back. I saw his name on the admissions list yesterday, and ran down to D Ward to find him curled up in bed 15, looking a little surprised to be on the ship again. I knelt down next to him, and a little arm snaked out from under the covers to curl itself around my neck. The lump between his eyes pressed into my temple as he hugged me silently.

He had surgery today. In another marathon operation (the second in as many days for Dr. Gary) his skull, too, was carefully dismantled. His brain was gently returned to its proper place, and his head was meticulously reassembled.

An encephalocele repair is a surgery so specialized that I've never even seen one in the States. We've done four this year, and there's another waiting to get over his malaria on B Ward. It's incredible to me to think that we're able to do operations like this in a war-torn country with no infrastructure, no electricity and no running water.

Someone on the ship here today laughed at me when I told him I wanted to live out in Liberia proper, out there amidst all the squalor and dirt. I do, though. Someday, eventually, when this season is over, I can't wait to get out of this plush life. But as much as my heart is on land with the people of Africa, I'm coming to realize more and more just how much we're able to do in this floating city.

It feels good to be able to say yes.

Remember how I thought it couldn't get any worse than Monday? It did. Tuesday and Wednesday were filled with their own myriad problems, from sick babies to surprise ICU patients. Today was slightly better, but I have never known the wards to be as hectic as they were this week.

Through it all, I was constantly amazed by the nurses that I work with. We are women (and two men!) from all over the world. We possess incredibly varied knowledge, and we come from all different types of units in our hospitals at home. Here, the patients can pretty much fit into just a few categories, often ones none of us have much prior experience with at all. And yet it works. Somehow, it works.

There's Lanita, who's never worked pediatrics before, jumping in to A Ward (full of kiddos at the moment) and taking such good care of the little ones. Amy never started an IV on a child before coming to the ship from her home in Australia, but she's now earned the nickname Rocky 'The Juker' Balboa, throwing needles in left and right and even helping out in the CT room. Mandy is a midwife; she deals with mamas and their well babies at home. Here, she's been handed plenty of sick kids, and she just smiles and laughs and loves and cares for them. We've got new nurses who have just gotten over their jet lag and they're already willing to work the extra shifts that the full wards are demanding.

And this is to say nothing of the nurses who are working close to their comfort zones. Denice is a pediatric nurse, but she's new to the ship. Which doesn't seem to phase her at all, since she's an amazing advocate for her babies, making sure they get what they need when they're sick. We've got Laura, who loves to work nights, gives those of us who've been here a while a much-needed break by taking our nights for us, and is an oncology nurse at home. Which means she can handle the special IV port that a doctor just placed into a patient who will be coming back next week for more surgery. Brenda has been swapping shifts to make sure that we have enough pediatric nurses to look after the little ones, and when I thank her for it she just smiles and shrugs.

Because that's how it works here. God has pulled us all from our homes and our families and our lives, and he's placed us exactly where He needs us. We are all called to do the work that He's set out for us. Each one of us is here at the right time, not a week too soon or a day too late. All I have to do is stop worrying and thank Him for it.

Easier said than done, but I'm getting there.

We pray before the start of every shift here. It's become routine for me, second nature almost, to pause before my day begins, sit shoulder to shoulder with my coworkers, and lift the day up to God. I'll miss it if I ever work in North America again.

Today I was in charge. Note that I don't say this evening. No, for the first time ever, I was a full-fledged Daytime-During-the-Week (with all the mayhem that implies) Charge Nurse. As is our custom, we started with prayer. Somewhere in the midst of it, I was struck with something that I felt I should really thank God for. So I praised Him that He is deeply concerned, not just with the grand scheme, but also with all the intimate details of our lives and work. We said amen, and the mayhem began.

Now, I'm not trying to complain or get sympathy (although a little bit doesn't sound too unwelcome right about now), but today was the worst one I've had since coming here. And I was supposed to be running the place. There's no way I can put it all in chronological order for you, since the eight hours have all run together into a sort of strange, 'did that honestly happen?' memory by now.

None of the surgeons rounded on their patients before starting surgeries. I have no idea why they decided to skip that critical portion of their mornings, and it didn't help that half of those patients are listed under surgeons who have left the ship. I picked names out of a hat as I called into all the ORs, begging doctors who were in the middle of surgeries to come and write orders for their respective people. Because we were planning on sixteen admissions, and if I didn't discharge a whole bunch, we were going to have to start installing bunk beds.

Somewhere in the midst of this, I heard screaming and ran to A Ward to find out that a patient and another patient's sister had just gotten in a fist fight. A real hair-pulling, face-slapping throw down. The etiology was unclear, but the patient was red-eyed and hysterical, screaming in her tribal language that she was going to pay her debt, while trying to push past me and clobber the sister, who was looking confused and backing away slowly. At which point the toilets stopped flushing and the lights in the hallways and the wards (even the emergency ones, which aren't supposed to ever go out) flickered and died. In a much-needed break from the tension, I then heard a small voice from behind a curtain where two friends were engaged in a complicated wound dressing. Um, can we get a torch back here?

The lights eventually came back on, but the computer system had completely failed, leaving me unable to update our charge charts or print out sheets for the oncoming nurses. We ended up writing all those by hand, and the evening charge nurse got report from me on a series of small pieces of paper, each filled with a to-do list left mostly undone.

Add this to the fact that the power outage had also stopped the ventilators and the gas supply in the OR from working, and you've got a whole bunch of harried hospital workers, to say nothing of my translator who had abdominal pain and ended up in the ICU while we ruled out appendicitis. Or the baby in A Ward whose blood oxygen levels were reading at anywhere from fifty to seventy percent, despite the fact that she was wide awake, pink and looking around at us as we fussed over her, trying to figure out what could be wrong. (Above ninety-five is normal, for those of you not medically inclined; anywhere under eighty-five and we start to get worried. Fifty would be panic mode, if the baby didn't look so paradoxically good.) We never got an answer on that one. Just a call us if she starts to look bad, otherwise we have no idea what's going on.

Really, God? I wanted to yell. Really? We commit everything in this day to You in prayer, and this is what we get in return? Are You kidding me?!

At which point the evening shift came on and we all sat down again to pray and I realized all over again that God is intimately concerned with the details. I'd been seeing nothing but the big picture, a day gone incredibly, spectacularly wrong. God, I think, saw it differently. When a fight broke out, He used it as an opportunity to have us teach forgiveness. When the electricity stopped, He protected every single patient in each of the operating rooms. Even though the baby's oxygen levels were reading low, she was fine. We had just enough patients fail to show up (not really a good thing by most accounts) that we could fit everyone in their own bed, no sharing required. And so what if the computers weren't working? Another nurse had finished her tasks in perfect time to help me write out the handover sheets.

They were just little things, these small graces scattered throughout the day. I could just as easily remember nothing but the frustration and headaches. But added up, taken as a whole, I can figure on nothing but God's perfect provision.

And I'm still so glad I'm not the one who's really in charge.

Remember Yeme? I figure it's time for an update.

She's had more surgery, and the tumor above her eye is gone, the scar already fading quietly into her skin, barely noticeable between her plaits. She's blossomed in the almost-three months she's been on the ward. The walls in her corner of B Ward are covered with drawings and crafts and language charts, spelled out phonetically so we can communicate with her in her own language. (She just laughs when we try, but we're all getting a kick out of it, so no one really minds.) She's learning English, too, picking up one word at a time by mimicking our voices with uncanny accuracy.

It's almost time for her to go home. In the eighty or so days she's been with us, we have had no communication with her family. They haven't tried to call or write or use any other means to find out how she's doing. It's like they don't care, which could be closer to the truth than I want to think.

But she doesn't need us anymore. We've loved on her as much as we can, and her wounds have all healed. As hard as it is for us, the truth is that as soon as we can get her a flight, she'll be winging her way back to Guinea. Back to her village. Back to the people who abandoned her at our gates.

Hopefully, back to love.

We have something here on the ship called the Adopt-A-Patient Program. For those who work on the ship but don't have anything to do with the hospital, it provides them with an opportunity to come to the wards and spend time with our lovely patients. Crew members sign up and get the name of someone having surgery. They visit that person as often as they'd like while they're stuck in the windowless tin box we call our hospital. Some crew members visit once, some end up coming every day for weeks on end. Dorothy is one of the latter.

She's a teacher at the Academy, our on board school for children of the families who live and work here. When she picked up the slip of paper with Mickey's name on it, she had no way of knowing that Mickey would end up being one of our long-term patients. (Forty-nine days at last count.) He's a little man who had plastic surgery to release burn scars on his hand. The first time his bandage was changed, everything looked so good we considered sending him home. The next time we changed it, we were afraid he would lose a digit; infection had spread and threatened the skin grafts between his fingers.

Mickey started out shy. He was tiny, with little stick-thin arms and legs and he screamed every time a white person came near him. Dorothy never seemed to mind. She doggedly visited him, day after day, until finally her persistence paid off. I was working the other day when she called. Is it okay if I come see Mickey boy now? Or course it was okay. It's always okay for someone to come to the wards and tire out the children who seem to be feeding off an energy source I'm sure the US government would love to tap into.

When Dorothy's face showed around the door, Mickey gave a shriek of glee and toddled at top speed across the ward to fling himself into her arms. He's not shy anymore. In fact, he pretty much runs the place, getting pulled around the halls, perched like a sultan atop a pillow in a laundry basket, by willing servants.

One of the other nurses working that night noticed that Dorothy was wearing her white Mercy Ships shirt. In fact, Dorothy wears that shirt every single time she comes to visit Mickey. The nurse, curious as to why her apparel was so limited, asked her about it. Dorothy's simple answer stunned me.

I figure the Liberians don't have a lot of different clothes. And you nurses always wear the same uniforms. It doesn't seem right for me to come down here and flaunt my wardrobe. So I just put on this shirt.

That's the closest thing to Christ I've heard in a while.

I'm trying to resign myself to the fact that I'll never be able to properly explain this place to anyone who's never experienced it.

I was working on B Ward yesterday evening. There aren't so many babies anymore, but those who are there have been there for what feels like forever. Something like a month and a half. They think they run the place, and the noise level was significantly intense for most of the shift.

During a quiet moment close to the end of the evening, an anesthetist came in to speak to one of the patients about her operation in the morning. This particular lady speaks no English and, as it turns out, was holding a small grudge against us for jabbing her with needles to start her IV. Thankfully, my patient in the next bed, a sweet, smiling woman about my age whose face and arms and torso are covered in tumors, could communicate with the surly Oma. The only one she couldn't understand was the anesthetist.

So I stood at the foot of her mattress as the doctor sat on the end of his patient's bed. He asked a question, which I relayed in Liberian to my patient, who then asked her neighbor in their tribal language, Mano. The answer would return through the same channels. The interview took a surprisingly short amount of time, given the convoluted methods we were using. When prompted at the end, the old lady had only one question, and it wasn't for the anesthetist.

She scowled at me as my giggling interpreter/patient translated. She want to know why you people juke her (stick her with needles). She say that thing on her hand is not good. I scowled back at the Oma until we both started laughing and explained through my trusty translator that the thing on her hand was good and that if she took it out, I would come juke her again, any time of the day or night.

At which point she mumbled something and disappeared under her covers. My patient turned to me, grinning broadly, happy to be providing clarification. She said 'good night'. And she will keep the thing on the hand.


It must take incredible courage to come into this ship for surgery. To be surrounded by white people who don't speak your language and who do things to you that make no sense, whether you like it or not. My friend, Amy, took another patient for a dressing change yesterday. When they came back, he was proud to share the new knowledge she had just imparted to him while juggling the gauze and tape.

I learn about my heart. And I learn about my lunges. And I learn ... Here his memory got fuzzy, until prompted by a laughing Amy. You should only have one wife. Two women is too many problems.

When he says he learned about his heart or his lunges (lungs), he's not talking about cellular physiology. Today, Jacob learned that he has something called a heart that pumps his blood and two things called lungs that help him breathe. He didn't even know. Most of them don't.

And yet they gather together their pain and their fear and they walk up the gangway anyway, lured by the promise that maybe, just maybe, they'll get to leave whole again. How can I go back to North America and explain what it feels like to look into a patient's eyes and see that? How can I share my experiences here in a way that will make sense to the people closest to me? How can I make them understand what I've been doing when my own life sometimes feels so foreign to me?

I think I'm going to need a translator.

Musa has been on D Ward for about a week now. He's a quiet man. He spends most of his time in bed, occasionally chatting with neighbors or paying half-hearted attention to the movies we play on the TVs twice a day. He always takes the opportunity in the afternoons to go outside for some fresh air. With patients in the ICU and old ladies absconding in the night, there's enough going on around him that he manages to fade, becoming a part of the background of the ward rather one of its stars.

As I sat at the desk a couple evenings ago (not yesterday; yesterday I was too busy trying to keep the door locked and herding my lady back into her bed and cleaning up vomit and consoling yet another crying baby to pay much attention to the background), I had a quiet moment to watch Musa. He was in his bed, as usual. In front of his face, he held the mirror we give to all of our patients who have wounds they will need to care for at home.

As I watched him for what seemed like forever, he gazed at his reflection in the tiny glass. Every few seconds he would reach up with his other hand to gently touch his lip. He practiced smiling. He practiced pursing his lips, his kisses made slightly unweildy by the bandage under his nose. Mostly, though, he just looked. He couldn't take his eyes off himself.

I sat there at the desk amidst the cacophony of crying babies and laughing mamas, and I watched Musa watch himself. My roommate, who was sitting there with me, noticed my fascination. She looked too, and her eyes grew soft. How old is he? I checked my list, and my heart caught in my chest. Forty-five.

Forty-five. He's lived almost half a century with his face split wide open, shunned and ridiculed from all sides. He's avoided contact with strangers, people who would turn away from his face in horror. He's never known what it means to be normal. And now he's whole, and he can't stop looking.

I can't blame him.


addendum: This is Musa the next day, after the bandage came off his lip. He's still staring, and I still love it.

So it turns out that I'm a good sleeper. Once I enter dreamland, it's no easy task to call me back. I'm the one who can sleep through the alarms for four separate roommates before hitting snooze on my own without ever realizing it. This morning, however, this was thankfully not the case. At the first tone of the overhead paging system, I was wide awake and sitting bolt upright in my bed. Emergency Medical Team report to B Ward immediately. The message is repeated in case you missed it, but by that time I was already halfway into my scrubs and searching desperately for my pants.

I've been on the EMT for a couple of months now. We muster for fire drills and respond to any emergencies on board the ship. It's a good way to keep my ICU skills sharp, and it can apparently function as a fairly foolproof alarm clock.

The situation on the ward was quickly resolved and we went our separate ways. It was only a little after six in the morning, (a morning on which I didn't have to report for work until two in the afternoon) but sleep was far from me. I grabbed a book and curled back up in my bed, making the providential decision to keep my pants on. This came in handy a couple hours later when the speakers came to life again. Emergency Medical Team report to B Ward immediately. This time the patient was a lot worse and was quickly rushed back to the operating room. He's in ICU now, resting quietly, and he should be fine in time. He's not the real reason I'm writing about all this.

As I started packing my bags to come to the ship, everyone asked me what I was expecting for the upcoming year. I told them all that I had no expectations. That I was a clean slate, ready for anything. Truth be told, I had some suspicions. I thought my living conditions would be worse. I thought the hospital would be more primitive. I thought I would feel like I was living in Liberia. I was wrong on so many counts.

Looking back through my blog, I found an entry that makes me laugh now. It was a list of things I was going to miss, and it makes some pretty big assumptions about this place.

. Long, hot showers when I just stand and let the water beat down on my shoulders until I'm done thinking.
. Stretching myself diagonally across my bed, limbs splayed out to cover the entire space.
. My mother's cooking (especially the rolls she just made, the ones with butter melted over their crisp tops).
. Calling a code and knowing that, within seconds, I will be surrounded by nurses, attendings, respiratory therapists and pharmacists.
. A closet so full of clothes that some days I find it hard to decide just how to cover my body.

I've gotten so used to ship showers that leaving the water running for a full two minutes feels luxuriously long. There's a double bed in the cabin they let us use for day sleeping when we work nights. I frequently sleep diagonally across it. Instead of mum's rolls I get fresh croissants and delicious cinnamon buns. As friends leave the ship, they give me their old clothes as mementos; my tiny closet is full to bursting.

But the thing I was most wrong about was the code situation. I'm ashamed to think about how scared I was before I came. I had horrible visions of myself, alone and coding some poor Liberian child who wouldn't have a chance in the world with just little old me there. Instead, I'm living on a ship where, almost as soon as the alarm rings, the wards are filled with people. I think they arrive faster than in my old hospital, if that's possible. The captain comes for an update and he writes it on the whiteboard at the front desk so everyone passing by (who have also been wakened by the announcement) will know what's going on.

My favourite part of all? I run to emergencies knowing full well that all over the ship, people are lying in their beds or stopping what they're doing to lift us up in prayer. At the beginning of the outreach, when I was still a peon, I was mustered on the dock during a fire drill when we heard the team called to the OR. A minute or so later, the captain's voice was heard over the speakers, informing us that there was a child in surgery whose heart had stopped. He asked us to pray. Muster stations splintered into tiny knots as, all over the dock, we stormed heaven. My friend, Mark, was one of the surgeons in the OR that day. He told me later that they heard the announcement too. And seconds later, as soon as we had all started to pray, the little boy's heart started to beat again.

There's such peace in knowing that, no matter what happens, I'm among people who are looking to God for guidance and strength and who are supporting me in prayer.

I just wish they'd pray for me to find my pants a little quicker next time.

It's over.

I'm not sure how, and I'm not really sure I care. But as of yesterday evening, Lourens is in happy possesion of his license, and we have signed releases for the vehicles from the policemen in Totota.

If I ever hear the details of what happened yesterday, I'll be sure to share. For now, all that matters is that this seems to be behind us. And the ridiculous amount of money that we're needing to pay for this and that has already been totally covered from donations that have flooded in unasked.

As my mum says, God's bank is big.

Maybe now I can go back to sleeping at night.

I have no idea what to write right now. I wanted to arrive back from my latest jaunt to Totota and triumphantly record a successful finish to our adventure. All's well that ends well, I could quip from behind my mug of tea, content in the knowledge that we'd done the right thing and that everything was okay because of it.

Instead here I am. Another eight hours in the car, (my third trip up that road, and I think I know every pothole by now) and all I'm left with is a sick feeling that I'm trapped in a corrupt system which I'm implicitly making worse.

Saturday didn't pan out quite as we had expected. I've since learned that expectations are a dangerous thing in Liberia. We got to the police station in good time, waited close to an hour for the other people to finish eating fufu and make their way into town, and finally started the case. We sat shoulder to shoulder on a wooden bench in the heat as the traffic cop scrawled a diagram on a rickety chalkboard. It was fairly detailed; even the popholes were marked. The format was vague. The hearing consisted of different people being allowed to give their opinions or ask questions at seemingly randomly assigned points. The cops shook their heads and pored over photos of the accident scene we'd brought with us. They agreed that a skid mark of six metres probably wasn't made by someone only going twenty kilometers an hour. The man next to me patted me on the shoulder and whispered It's a simple case. Don't worry.

The cops left the station (a rented room with two battered wooden desks at the front and a window behind us through which at least ten people were watching the proceedings) to confer with one another. We felt relieved. It was clearly going to go in our favour. The cops agreed that the other man had been in our lane initially, which was clearly what had caused the accident.

In the five minutes they were outside, something changed. I don't know what happened, but they came back inside and had Lourens and Junior (the driver of the taxi) stand as they pronounced solemnly that Lourens was at fault and would be charged with three counts of reckless driving and misuse of lane and something else. Regardless of the fact that the other driver had been blatantly lying. Regardless of the fact that the damage on both cars showed clearly that the other driver had been in our lane when he hit us. It didn't really matter at that point. All that mattered was that our friend, who had saved our lives, was being charged for a crime and could possibly go to jail for it.

It was here that the intricacies of the Liberian justice system really started to kick in. In a nutshell, it turns out that when a person is charged with a crime like this, the trial would eventually deal with criminal and civil charges. And provided you can settle the civil charges with the wounded party (in our case, replace their taxi) the criminal charges get dropped. We sat down with their lawyer in a dark restaurant next to the police room. (Station seems almost too grand a word for it.) As we settled into our plastic chairs, the passenger from the taxi, the man who had been taken away for stitches, spoke up. Please remember, he reminded his lawyer, that these people are our brothers and our sisters. We have no fight with them. This woman here took care of me. They are good people. At which point I made a mental note never to ignore the prompting of the Spirit, and the negotiations proceeded.

It was decided that they would all return to Monrovia on Tuesday, when a suitable replacement car would be found. They did, and it was. It was decided that, once they had agreed to the car, they would sign documents stating that they released all claims on Lourens. They did this too. (I happened upon the meeting last night as I came from dinner, and ended up playing secretary and getting yet another Kpelle name assigned to me. Keymah. This one, I think, means Whitey. I'll stick with Yongo.) While we seem to be paying a lot of extra charges here and there (why we're covering the bags of charcoal that the police seized is beyond me), none of it seemed too high a price for our friend's freedom.

All that remained was the trip today. We were to go to Totota, speak the the police, hand over the waiver and receive in return Lourens' license and freedom. And it would all be over. Which, of course, is not what happened.

We narrowly missed being in another horrific accident on the way to Totota in the morning (and by narrowly, I mean had we not taken the three or so seconds to switch drivers, we would have been t-boned by a pickup truck and I would have more to worry about than a bruised leg) but drove the rest of the way without incident. The policeman was not in the station when we arrived, so we spent over an hour wandering around the town and waiting. While drinking a coke, we happened upon a man who had been guarding a checkpoint some fifteen minutes up the road from the accident. He remembered me from the car, and told me I was a foolish girl to ride with my feet up like that and no wonder I got hurt. I must have taken my feet down from the dash much later than I thought, and once again breathed a silent prayer to my Protector.

Finally things were underway, the lawyer, James, interceding on our behalf, and it looked as though things were going to come to a conclusion. The papers were signed and practically in the act of being handed over, when the final blow came. Another policeman, this one higher up the chain of command, showed up and demanded that the proceedings stop immediately. We had no choice but to comply.

And so here we are. Waiting, yet again, to find out our fate. No idea how much more money or time or resources are going to be involved. And, with the exception of the passenger from that taxi (the one who could well have died) and a strange man in a down parka and galoshes who stood on the steps of the police station berating the cop for persecuting us when we've done no wrong, no one in this country seems to be on our side.

I don't know if it's because we're white. Would this all have gone differently if the colour of our skin didn't look like dollar bills to these policemen? I have no idea. I'm tired and I'm sore and I want this all to be over, because I'm frustrated with the whole thing.

Soon, please.


(And don't even get me started on the man we picked up off the side of the road to carry to a hospital, the one who tried very hard to snuggle up to me despite the seriously serious pain in his foot. He's a whole different story.)

This is going to be long, but I need to tell this story.

If you grow up going to church, you’re told since infancy that God is always near. That He will never leave you and that He will always take care of you. I believed it, but always in a sort of vague, I’ll-never-need-to-fall-back-on-it kind of way. Until Friday.

We were making good time on our way to Nimba. The other car was ahead of us somewhere. The lush, green countryside flashed past our windows, the air was warm and the road, though pitted with potholes and puddles, was passable. Lourens was steering the right-hand drive Venture, I was in the passenger seat, and I had my feet comfortably propped up on the dashboard, a few toes hanging idly out the window to catch the breeze. We were about three hours from the ship, surrounded by the jungle and the silence of the countryside when a white car rounded the bend in front of us. About twenty minutes earlier, I had heard my mum’s voice in my head. Don’t sit with your feet up like that. Get in an accident and you’ll break both your legs. So I had taken them down, and as we stared at the white car, approaching us at close to thirty miles an hour in our lane, I realized that it was probably going to prove to be a providential decision.

Time began to crawl as the scene unfolded in slow motion in front of me. I watched from my seat in the front of the car as Lourens started to slow down and the white car continued heading straight for us. I remembered that I wasn’t wearing a seatbelt because there wasn’t one in my seat, and I thought of all the kids I took care of in the PICU who had been ejected from their cars. I remembered that the first aid kit was in the other vehicle. I saw the other car flash his headlights, a fairly universal Liberian signal to get out of my way, I’m not moving. And still the white car was headed straight for us and there was no way to stop. A split second before we would have collided, Lourens wrenched the wheel to the left, deciding against a similar swerve to the right that would have rolled the vehicle into a ditch and probably left us upside-down against a palm tree. Safe in the left lane, it seemed like we would avoid the inevitable when the white car rocketed back to his right. The fronts of the cars met with a sickening thud. Glass cracked, metal groaned, the white car spun and we came to rest as our engine sputtered and died.

There was a moment of absolute silence. The clock snapped back to its normal speed and things started to happen again in real time. I looked back to see Emily leaning forward, bleeding from her nose. Ben’s head was dripping blood and Hanna and Jess looked dazed. And the first aid kit was in the other car. We grabbed our only supplies, a roll of toilet paper, and gave the bleeders a wad to help staunch the flow. The passenger in the other car was bleeding heavily from gashes in his elbow and knee, so he was taken to a clinic in the nearby town by the next car that passed.

We gathered together, six souls in a circle on the side of the road, and we lifted up our hearts to God. We thanked him for His protection and we praised Him for His hand that was so clearly on us. We asked for wisdom and we asked for strength. What happened over the next eight hours was incredible.

The rest of the day unfolded slowly. The simple truth is that getting in an accident in the Liberian countryside is not an easy thing to deal with. The policeman arrived from the next town, Totota, in a taxi. He took names and statements and set out drawing a diagram of what had happened. The driver of the white car, a taxi, yelled and stormed and screamed about how we were in his lane, with no mention of why we might have been there. I translated for Lourens, who, with his thick Afrikaans accent, wasn’t making much sense to the policeman. It was determined that we would have to bring both cars to the police station in Totota and that Lourens and the other driver would have to stay at the scene until that happened.


At this point, God started to intervene in a steady stream of occurances that left no doubt in our minds as to who was in control. As Ben’s head continued to bleed through the toilet paper, as MSF truck pulled over to the side of the road. The driver wasn’t a doctor, but he let me use his first aid kit and I was able to clean out the wound and bandage Ben’s head. A truck laden with bags of rice was flagged down by the policeman and the driver agreed to take the other four passengers from our car ahead to Totota to wait for us at the police station. While we had been bemoaning the fact that all of our luggage (food, water, most of our money and pretty much all of our clothes) was in the other vehicle, who weren’t answering when we called their cell phone, it turned out to be perfect, because the other four wouldn’t have been able to carry more than what they had as they climbed on top of the bags of rice and headed off around the curve.

Lourens looked down at my leg and pointed out that the side of my knee was purple and swollen to the size of a small orange. I shrugged. It wasn’t bleeding, and we didn’t have anything to make a compression bandage so there wasn’t much to be done. He smiled, reached into his backpack and handed me a t-shirt and a roll of duct tape. A couple minutes later I felt like Rambo and my knee, although still throbbing, felt much better.

We’ve all seen car accidents on the side of the road. Traffic slows down as everyone cranes their necks to catch a glimpse of what happened from the safety of their own cars. Not so in Liberia. This is a community culture; everyone’s business is everyone’s business. Every car that passed while we were on the side of that road held passengers who called out words of encouragement. At least a quarter of the cars actually stopped, the passengers got out and came to inspect the damage, shake our hands, ask what happened and praise God that no one was seriously hurt. We hadn’t eaten since the morning, and someone passing gave us ears of roasted corn. Another woman, a passenger on a bus that needed a tire changed right up the road from us, came to my side, her eyes soft and loving, and handed me oranges and a cucumber. You are looking hungry. Taking my own cues from their actions, I offered oranges to the policeman and half of my corn to the very surprised driver of the taxi. I was unsure whether or not I should really get involved in too much interaction, but I felt a prompting to reach out to them. When the passenger of the taxi came back, I sat him out of the sun in our car and gave him water.

The Swedish UN showed up. Marie and Paer had met our friends in Totota, brought us word that they had dropped them off at a hotel just up the road to wait for us, and surveyed the damage. They got back into their car after promising to send the Bangladeshi UN to help move the cars out of the road and giving us a much-needed bottle of water. The Bangladeshi UN arrived, about fifteen men with guns, and hauled the taxi out of the way. All this time, mechanics from the town had been working on the Venture, trying to straighten out a bent front enough that the car could be towed to the police station. (No easy feat when your tow truck is a battered, blue pickup.)

We had been in contact with the ship and were finally assured that Carlos was on his way to pick us up in a Mercy Ships car. Another carload of friends who were headed out past where we were stranded for a weekend vacation stopped to give us sandwiches and more water. Eventually, around six thirty in the evening, as dark was beginning to draw near, Carlos and Jim pulled up. They took me on to the hotel where I was able to properly care for Ben’s cut and went back for Lourens.

Finally, as we prepared to check into a room in the hotel, Lourens and the guys came back. They reported that the police had released Lourens to leave for the night, provided that he come back the next morning to have the case heard at the police station. The captain thought it would be best for us to come home for the night. Weary from a day spent at the side of the road in the blistering sun and pouring rain, we agreed, wanting nothing more than to be safe and clean in our own beds. We climbed into the car, navigated the rutted road through the dark night, and arrived back to the ship, shining like a beacon in the night.

There’s more to the story. I’ll tell you about what happened on Saturday some other time. Things aren’t finally resolved yet, and I’m dreading my third trip to Totota, which is going to be on Wednesday. Pray for us all. Pray for peace, especially for Lourens. He’s more shaken up by this than he’ll admit, and he’s facing some serious charges by the police.

The thing is, if Lourens hadn’t acted as he did, I would probably be dead. I’m not saying that to be dramatic or to add flair to my story. It’s a simple fact. A head-on collision at a combined speed of probably close to sixty miles an hour in the Liberian bush with no medical supplies and no seatbelt is an equation that ends badly for me however you look at it, to say nothing of the others in both cars. It’s a miracle that no one was seriously injured (athough my leg does look fairly impressive). God’s hand was so evident throughout the day. At one point, as we stood waiting for the mechanics to come with yet another tool that probably wouldn’t work either, Lourens looked at me and smiled slowly. It’s pretty cool, isn’t it? How all these things aren’t happening all at once, but just one after another?


And it’s true. As soon as we realized a need (and there were many throughout the day), God provided for it. We were thirsty and Marie gave us water. We were hungry and the kind woman gave us oranges. We needed to get our friends to town and a truck stopped to carry them. We needed to care for Ben’s head and the MSF car passed by. We needed to bandage my knee and Lourens, the only one who had his bag in our car, had just what I needed.

As I looked up at the sky shortly before Carlos arrived to drive us home, it was clearing from the latest rains. I lifted my heart in praise to God, and saw there, just at the corner of the clouds, a rainbow. A promise. A confirmation.

You are not alone. Walk through the fires, if you will, but I’ll be there. Think you’re drowning? I’m there. It doesn’t matter what happens. I will move heaven and earth to keep you safe, because I love you. And you’re mine.

Mine.