ali's african adventures

Ingrid puts it best.

we are so fragile
and our cracking ribs make noise
and we are just
breakable
breakable
breakable
girls and boys

I had one of those awful, frustrating days today, where nothing is wrong and nothing is right. It wasn't a bad day on the wards; I wasn't even working since, in a rare twist of fate, my weekend off actually coincides with a real Saturday and Sunday. I just felt absolutely, entirely too small for what I'm doing here, too stupid to make a difference, too broken to do any good.

It's an old fear of mine, this feeling of not-enough. I've struggled with it my entire life, for reasons that even I don't understand. Call it culture, call it teen angst that never quite went away, call it any of a million names, but the truth remains that I believe lies about myself. Instead of seeing myself as a child of God, cast in a divine mold, I stare at my face in the mirror and see only what I lack. Beauty, brains, charisma; I've been shortchanged in every department. (At least, that's what I tell myself.)

Some days are better than others. Some days I can rest confident in the knowledge that God made me, and He don't make no junk, a saying that I had printed in every colour of the rainbow on a t-shirt I used to wear as a child. But the bad days? They're no joke. They're the days that make me retreat into myself, turning over all my past failings and sins and shortcomings, holding each dark secret to the light and hating myself all over again for things I had thought were forgiven.

It all came to a head during our Sunday evening service. We were getting ready for communion, and the bread and wine lay covered with a clean white cloth on the table as I fought with myself during worship. You know you can't take communion tonight. You're not allowed if there's something between you and God. And, holy cow, is there ever a lot between you two. Don't try to fool anyone. You'll never be good enough.

When the speaker started outlining the form of the Trinity, listing characteristics of each facet of my God, I started to cry. Just turn to the person next to you, tell them which part you need the most tonight, as I rubbed my eyes and hung my head and ever-so-quietly admitted.

Forgiveness.

Comfort.

Truth.

And while the man in the front of the room held up the round loaf, tore it in half and repeated the age-old request to do this to remember, I sat in my seat, paralyzed with fear. Because I knew I didn't deserve it, that I wasn't allowed to join in the ritual without a clean heart, and that my heart was just about as full of pain and lies and ugliness as I've ever known it to be.

Until God, sitting next to me in a form that looked strangely like my husband's, took my hand and whispered in my ear.

You're more than enough.

I had a good shift today. The kind where it's not too busy, the nurses you're working with are lovely, and the babies aren't screaming more than entirely necessary. It was one of the shifts where a running joke between a co-worker and yourself involving Doing Awesome Things and a little starfish sticker makes everything more fun, even things like calming that one child who didn't get the message that we were only screaming as much as was entirely necessary today, thankyouverymuch. The kind of shift that starts with mamas around the ward grinning and shouting to you when you walk through the door, chanting the name of your favourite, kind-of-difficult little boy in the corner who wants to play shy, but can't help smiling from behind his blanket.

I had time to sit by Saibou's bed and make faces at him, to watch his eyes light up and his little arms and legs flail wildly as he belly-laughed his approval back to me. I gave discharge instructions to the mama of another impossibly fat baby. In French. All by myself. And she actually understood me to the point that she could repeat all the different medications right back to me, only with better grammar. I brainstormed ideas for how to get Maomai's mama home to her other kids, ways to teach an illiterate woman how to manage the precision of NG feedings, ways to teach a mama from a fatalistic culture how to care if her baby lived or died. And when I couldn't come up with a solution right that second, I settled for wrapping her up tight in a blanket, plopping her into a plastic bowl and weighing her on a scale we borrowed from the galley, one that usually holds carrots and lettuce, while her mama looked on and smiled, pleased that she had managed to gain fifty whole grams.

Nothing special happened today, and everything special happened today.

I stood at the counter, mixing up meds while a little boy fell asleep, tied tightly to my back in his mama's bright blue and yellow lappa. The mama of the tiniest baby (aside from Maomai) went home, but not before hugging me, giving me a kiss on the cheek and patting my rear end affectionately. I mastered my first words in Fon, the largest tribal language hereabouts. I have no idea how to spell out the guttural sounds; the closest I can come is kpwede kpwede, where it sounds like you're swallowing the first half of the word, the d sounds like something halfway to an l and the second part of the word comes up off your tongue, not straight out.

It means the same thing as the Liberian small small. The mamas seem to use it for everything including, occasionally, my name, because Alice apparently gets too difficult at times. Take your time. Go slow. Just a little at a time. Today, it meant more than that. As I moved through my shift, and all the mamas greeted me with those words, they were so much more than just the only thing I knew how to say.

Kpwede kpwede. Stop. Look around. Realize that you are one of the privileged few in this world who can say that they are living their dream. Don't rush through your days, just trying to get through the shift with all your tasks checked off. Don't lose sight of the fact that you're only here for a season, that your days won't always be lived out on the ever-shifting decks of a ship in West Africa.

So take time. Take time to mix up bubbles for a little boy to blow. Take time to tell a mama that she is doing a good job. Take time to make sure another mama really does understand what's going on, even if it means hunting down an extra translator. Take time to tickle and laugh and snuggle and burrow your nose into the folds of a freshly-washed baby neck.

The tasks will get done eventually. There are things more important. Your life will pass you by if you let it.

Kpwede kpwede.

Bright and early on Saturday morning, we got our whole group down to the dock to find that, in typical West African fashion, the drivers we had chartered were ready to go, but refused to leave until we paid them an extra ten thousand cefa (about twenty US dollars). It was seven fifteen in the morning, the wedding was scheduled to begin at two thirty, and we were off to a promising start.

Things only got better from there. We finally convinced the drivers to abide by the original arrangement and loaded into the vans under the agreement that we would head straight for the church in Togo, no stops along the way. Our driver, dressed in a snazzy suit, complete with vest and tie, assured us that he would get us there as soon as possible.

Meaning, of course, that we stopped shortly thereafter at a gas station. Getting fuel in Benin is a lot more high-tech than Liberia, where it's siphoned into your tank from a large glass jar by the side of the road. Here in Cotonou, there are real gas stations, like Total and Shell, with lots of people working at them; the full staff is kind of a hazard in a relational culture, because our driver felt the need to chat with everyone in sight. We finally managed to fill the tank and headed towards Togo. Our next stop was at the office. But, you must be thinking, didn't she specifically say they weren't going to stop there? Good point. But you're probably not reading from West Africa. Things are a little different here.

After a few more conversations, we were properly on our way. If any of you have been reading for a while, you'll know that I don't have the best track record when it comes to driving in cars in West Africa. This being the case, I was more than a little nervous as we wove in and out of traffic, coming dangerously close to the thousands of zemidjahns that swarm the roads like bees. (I'll tell you all about them another time; I've even got pictures.)

We were making good time until we got to the border between Benin and Togo. I knew it might take a while, so I grabbed some cefa to buy plantain chips off a little girl at the side of the road and settled in on a wooden bench in the heat to wait it out. Customs here consists of hand-writing tons of information out of everyone's passport onto wrinkled sheets of paper while the border guard throws questions at you in French. Once you get across the border into the next country, the process is repeated. Since there were around twenty of us, this took a fair amount of time, but we were finally on our way, getting close to Lome where the wedding would take place.

We passed the port where we'll be staying next year, and were getting close to our destination when our driver stopped again, this time at the Togo office. To get directions. Because he had no idea where we were going. One more stop by the side of the road to make a phone call and get something absolutely unessential fixed on the car, as he assured me: Mais, oui! C'est nécessaire.

By this time, I was getting a little antsy. It was getting close to the hour of the wedding, I was the photographer, and we were driving around Lome in circles as our driver refused to admit that he was lost. I know where I'm going, he repeatedly told us, but when pressed, admitted that he wasn't quite sure how to get to that place. After a hair-raising u-turn in the middle of a crowded market and a lot of honking and angry yelling when the second car in our caravan (which contained someone who actually knew the way) took the lead, we arrived at the church campus, safe and sound.

The wedding was absolutely amazing. Esther is Swiss and Israel is Togolese, so it was a sweet mix of African and European, and it went on all afternoon and into the night. The groom walked down the aisle as Jabulani Africa blared from the speakers. They sat in chairs up at the front of the church while a choir and a band, complete with African drums and a trumpet, played worship music and ladies in lappas every color of the rainbow left their seats to dance at the front of the church. There was clapping and cheering and ululation, and when it was all over, a radiant Esther walked slowly out of the church on the arm of her new husband.

The first part of the reception took place under an open pavilion. Esther and Israel snuggled on a couch and shared bottles of Fanta while we all sat around them and ate sandwiches and drank our own sodas from cool, glass bottles. There were speeches and prayers and a cake with chocolate and vanilla icing on the different layers. The night fell as we laughed and listened to words being translated from German to English to French and back again.

After a little break, we headed to another part of the campus, to another open-air room that was decorated like a fairy land. Candles glowed on the tables, and balloons and flower petals added colour to the concrete room. We enjoyed traditional Swiss bread and a delicious meal of rice and turkey and vegetables, while Esther and Israel sat at the head table, so much in love it made my heart sing. There were more speeches and skits and songs, and then Esther and Israel made their way around the room, serving cake to their friends and family.

It was beautiful, and I was so honored to be a part of it. The rest of the photos are here.

I'm back from Togo, and the wedding was amazing; I'll post pictures once I've managed to get them uploaded. Which could be a while, if the speed of the internet here has anything to say about it.

For now, I have something else I'd like to share with you. This is Jonah. My cousin is the nanny for him and his twin brother Marco, and his mama is the one who gave me the fishy rattle when I left for Liberia last year. Those two boys are two of my favourite people in the world.

Jonah was born with esophageal atresia and a tracheoesophageal fistula, and spent the first months of his life in the hospital. He's been home for years, though, growing stronger, playing with his brother and loving everyone that comes into his life.

My cousin emailed me on Saturday to let me know that Jonah was sick. He was in the hospital, in the PICU, struggling to breathe. When I got back from Togo this afternoon, there was another e-mail. Jonah has gotten worse, and he's now on a ventilator.

Please pray for Jonah. Pray that his little lungs would rally and that he would be strong enough to fight this. Pray for his mama and daddy, Jennifer and David. Pray that they would find peace in situation that is anything but certain. Pray for Marco; he's only three, and his brother isn't at home to play with him right now.

Let's storm heaven together on behalf of this little boy, and let's watch God work.

This crazy week is finally over, and I've got the whole weekend off. Naturally, I'm going to get up around six tomorrow, jump in a bus and head to Togo. My friends Israel and Esther are getting married, and I have the privilege of not only being there to celebrate, but also being one of their wedding photographers.

I'm taking a borrowed camera, because that's the only kind I could find a flash for. I've got a visa in my passport, and I'm hoping the border guards don't notice that whoever put it there spelled my name wrong. The wedding is tomorrow afternoon, and we should make it on time, barring unforseen circumstances. Which, when I'm in the car, is exactly what you should be expecting.

This should be fun.

The baby I mentioned yesterday, the one who I said was so sick, went to Jesus last night. Her little body just wasn't strong enough, didn't have enough reserve, couldn't take any more. It's all over now; the monitors have been disconnected, the last of the supplies cleared away and the sheets on the bed have been changed. Her family is making their way back to their home in Togo, their shattered hope wrapped in a little blanket. This is when the questioning sets in, when I start going over everything in my head, examining my steps one after another, reassuring myself that I did all I could. This time, I'm not sure I did.

Just typing those words makes me want to scream. To throw myself on the hard floor of my cabin and weep for the family that can never be the same again. Everything inside me rises up in revolt against the idea that I did things wrong, and a hundred reasons spring to my lips. There was no way she could come back from that kind of deficit; it's not your fault. She came to us already malnourished; it's not your fault. This would have happened no matter what we did; it's not your fault. There were other patients, other sick children who needed you, and it's okay that you were caring for them, too. It's not your fault.

Intellectually, I know that all of those statements are true. But intellect is a force that pales in comparison with guilt and grief. I know that there was nothing I could have done to change the course of Akouvi's passing, but my conscience burns me, peering into the dark corners of my heart and holding my fingers to the flame.

You knew her potassium was already low on Tuesday night. You should have pushed harder, told more people. You knew she was sick when Andrea called you over to her bed early yesterday morning. You knew she looked bad, and you should have said something. You let her lie in the corner all day, and you knew something wasn't right. You were so busy with your patients, with the babies who would have been fine if you had left them alone. You failed her. You failed.

As I curl up into myself, ready to shoulder what I can only see as my rightful share of the blame, another voice starts to make itself heard. This voice is softer, barely audible through the accusations flying through my soul, and I'm so weary from blaming myself that I would have missed it had He not been so insistent.

Child, stop. Quiet now. Just stop. Don't you know Me by now? Haven't you seen enough to know that I don't make mistakes? When have I ever given you cause to doubt Me? And as much as I want to be calmed and reassured, I'm still crushed, because it's not Him I'm doubting this time; it's myself. I'm the one who messed up here, not You.

Again, the voice, a whisper in my heart.

You think this was your fault? You think there was anything you could have done or anything you didn't do that would have changed that little one's outcome? Don't you know Me by now? I am the Author; I am the One who wrote Akouvi's story. I wove her together in the secret places, when she was nothing but a carefully nurtured dream in her mother's heart. I opened the book of her life, and I penned every beautiful page before she was even born. I knew the number of her days, dear one. I knew the days she would laugh, and all the days she would be in pain. Today, so early in the morning, her days were finished, her story ended.

I knew.

I have always known.

I am a pediatric nurse. For me, that description is on par with I am a woman, or I am left-handed. I didn't sit down one day and decide to have an insane love for taking care of sick kidlets; I just do. Today, however, was a shift that made me question myself just a little. Nothing drastic, just the kind of questioning that prompts things like, Wouldn't it be cooler if I were ambidextrous?

D Ward is officially a pediatric zone. Up until yesterday, the oldest patient was six. One poor old man ten times that age (literally) spent an uncomfortable night with us after getting his hernia repaired, but I think the noise was too much for him; his smile was pretty wide when he shook my hand and headed out the door this morning. Now that he's gone, our average age is back where it should be, somewhere not even halfway to ten, and the cacophony of sixteen kid and babies all crying or laughing or yelling at once (to say nothing of the mamas) has reached new levels.

Into this melee I waded today, and my fellow nurse, the other one with seven patients on her assignment sheet, wasn't looking too excited. I chalked it up to the hour (seven is entirely too early for enthusiasm in my books) and started off with my morning tasks. Shortly into the shift, she came to me to check a dose of tylenol. Which is when, since this is standard policy for all non-pediatric nurses, I remembered that Andrea doesn't take care of kids. I looked around me at the swirling mass of babies and groaned inwardly. It was going to be a long shift. Especially since one of her patients was The Sick Baby, a little one who came out of surgery yesterday with a hemoglobin of 3.something, and who had a potassium of 1.9 this morning.

So there we were, up to our ears in babies and kids and mamas, all demanding attention, a few needing more of it than we could spare. Blood had to be drawn, dressings had to be changed, tube feeds needed to be given, IV fluids needed to be mixed. And I was the only pediatric nurse in the place.

In the midst of the chaos (controlled, I promise), we ended up working as a pretty awesome team. We had not one but two charge nurses today, since the usual charge, Red, was training one of our other ICU nurses, Sarah. And Andrea, it turns out, is a rock star, who refused to be overwhelmed by it all. We found veins on babies that didn't have any veins. We mixed antibiotics in mugs of tea for little boys to gulp down. The lab ran blood tests for us with only a drop in the tube. We tag-teamed on medications, wound care and discharges, but by the end of the shift we were all exhausted. I felt lost, because like I said, taking care of kids is what I do. It's what gets me up in the morning, and I've always loved it. It turns out it's not so easy when what feels like five hundred mamas have come to you for une couche (a diaper), when the baby in the corner really isn't looking too good, when your normally cheerful patient just turned into a screaming lunatic and when you're five steps behind while the next shift is walking through the door.

I was standing in the space between beds eleven and twelve when I found myself again. On either side of me were little brown boys playing with long blue balloons. They had the same surgery a few days ago, and they spend their days chattering back and forth, shooting each other with lego guns and generally carrying on like any five year-old boys would. I had just finished emptying one of their catheters, and I straightened up and headed back to the desk. I'm not sure whether they planned it or not, but just as I turned to go, little Bligoni and Edoh both launched a full assault on me with their balloons.

I stood there between their beds, a five year-old boy on either side of me, beating me with a long blue balloon, and I burst out laughing. I got Andrea's attention and she started laughing. Bligoni and Edoh were already hysterical, and it wasn't long before their mamas joined in. When I was able to compose myself, I leaned down to whisper a secret in my patient's ear. Edoh, je t'aime. I love you.

He responded by planting a huge, wet kiss on my cheek and bashing me in the head with his balloon once more for good measure. Which, at the end of the day, is why I love being a pediatric nurse.

I'm sitting here in the wee hours of a new week, waiting for my pager to go off and summon me back down to the ward, wondering if I'll ever be able to go back to The Real World.

We talk about it all the time around here, usually with some measure of disbelief, sometimes even disdain. I can't believe I'm going back to The Real World next week. I forget; is that the way they do things in The Real World? Who really wants to live in The Real World? I'm not saying that life here isn't real; sometimes the reality of it is more than I can bear. It's just, well, it's different here. I live my life in a dimension that no one who hasn't experienced it could never understand, and most days I'm okay with that. I'm okay with the fact that I'll never be able to really explain this place to someone who's never spent a week or a month or a year on board a floating city in West Africa.

To explain what it feels like to go to work and be the charge nurse in a place where in charge means so much more than it ever did on land. Sometimes, on top of all the rest of my duties, it means hiking up and down a few flights of stairs, bringing bottles of medications to an illiterate mama, so she can identify by color which one she'd been giving her baby. Sometimes it means trying to explain to another mama that, even though she has twins, I will not let her be admitted with an entire posse: herself, the two babies, her husband and another caregiver. We just don't have the space. Sometimes it means volunteering to keep the pager overnight after I've finished my shift, ready to get out of bed and throw on scrubs any time during the night that the ICU nurse has to pee, because there isn't anyone else who can cover her patient while she takes a break.

And sometimes it means stepping out into the damp, hot evening air to find a little boy on the dock, the cast on his leg giving off a sharp, sour smell, his mama next to him gesturing wildly in the dark. Sometimes you have to get that boy down the the ward to asses the leg, which would mean first getting up the gangway and then back down two decks to the hospital. And sometimes there's really no good way to do that other than to bend down and let the little boy climb on your back, to make your way carefully up the gently moving stairway and then down to the ward.

As I pushed past the people in the reception area, the boy's cast sticking straight out from my side, his little hands threaded under my arms to clutch my shoulders, (standard piggy-back style here in West Africa) I started laughing. I laughed all the way down to D Ward, where I gently deposited him on a bed and went to copy his name down onto my charge sheet. (Incidentally, I can't remember his name, just the fact that it started with a D.) As I stood by the desk, I realized that the sour smell had followed me across the room, and when I touched my back I realized that it was damp. Par for the course really, so I thought no more of it until I went to pad the sharp spot on his cast, and saw that D's clothes were dirty and wet, that he probably hadn't been washed in days, that he didn't have a shoe on his uncasted foot. D's mama watched me stuff gauze into the top of his cast and secure it with tape, and when I finished, she fired an angry question at me. My translator shook his head as he relayed the message. She wants to know why the cast smells so bad.

I thought about being sad for D, for letting myself enter into the pain of his situation. Trying to grasp what it must be like to live for days in the same clothes and have no one care if I was clean or not. But right then, after everything else that had happened during the shift, I didn't have the energy. So instead I just laughed. I laughed at the fact that none of this would ever have happened in my old life, the one I used to live in The Real World. I laughed at the fact that this is all normal to me, that I think nothing of carrying my patients into the hospital on my back. I laughed at the fact that I used to get stressed out in a job that never required me to give the following explanation:

It's not his cast that smells bad. It's his clothes. You need to wash them. I don't care if they're his only clothes; he can go naked while you're working. But you need to wash them.

Now if you'll excuse me, there's an ICU nurse downstairs who really needs to pee.

Some days here are filled with dramatic stories, like the ones about Maomai or Genevive. But even though I live on a ship in West Africa, some days are mundane, even a little boring. I'm not sure what this evening will hold, (I'm in charge down in the wards) but this morning was definitely nothing out of the ordinary.

I had to chuckle though, because it felt like one of those logic problems they used to give you in middle school. Remember the one about the farmer with the fox and the chicken and the sack of corn? And how he only had one boat, a boat that could only carry two things at a time, and he had to figure out who he was going to take on each trip across the river? Cue my life.

I had 7 things to do this morning, a limited amount of time and only two hands (which are attached to admittedly weak arms):

1. put my laundry in the washer
2. move the laundry from the washer to the dryer
3. take the laundry out of the dryer and fold it
4. cook some noodles for my lunch
5. return books to the library and get some new ones out
6. vacuum my cabin
7. clean my bathroom

Add in the fact that the laundry room is on deck 6, and the cycle takes about an hour, so no way was I going to sit in there the whole time, watching the clothes spin. The crew galley, where I could cook my noodles but not eat them, is also on deck 6. All of my cooking supplies, including my fridge with the butter and milk, plus the desk that doubles as my table, are in my cabin on deck 4. The library is on deck 5. I have no vacuum in my cabin, and have to borrow one from the laundry room (back up on deck 6) and return it as soon as I'm finished with it. Add in the fact that the laundry room is on a strict schedule, and you need to be present on the hour promptly to switch clothes into the dryer and take them out, and I had a real puzzle on my hands.

I'm pleased to announce that I got everything done without carrying more than two things at a time to and fro between the decks on each trip. And I didn't have to make any extra trips. That, my friends, is the first step in my quest towards becoming a domestic goddess. I know you're jealous.

(Bonus points to anyone who can figure out what order I did things in.)

Her name was Genevieve. She was a little older than my own mother, her eyes hard and dark and just a little desperate. The card above her bed was printed with all the details that defined her. Name. Age. Surgery to be performed. Left mastectomy. She sat silently, her hopes and fears hidden behind her impassive front as the evening wore on in its predictable pattern. Patients came back from surgery, anesthesiologists made their rounds, surgeons interviewed their new admissions. When Dr. Bruce made his way to her bed, Genevieve made her move and threw the wrench into the next day's carefully planned surgery schedule.

Non, she told us, her voice steeled against a hidden pain. Je ne veux pas. I don't want to.

We sat with her, reasoned with her, explained that her chances of survival, even in this country that has patchy access to a grand total of two different chemotherapy drugs, would be incredibly high if she let us do the operation. That the surgeon's knife was her best shot in an uncertain world. But Genevieve was adamant; she refused to sign the consent form.

Dr. Bruce eventually gave up and came to tell me the plan. Don't put in an IV yet. Feed her dinner. Give her time to decide. She'll let us know in the morning. So we put away her chart, gave her a plate of fufu and sauce and left her to her thoughts. Later in the evening, her nurse, Ursula, had a quiet moment and pulled a translator over to Genevieve's corner. After a long talk, she came back to explain to me why Genevieve would refuse a free, life-saving surgery.

It turns out that Genevieve isn't alone in her sickness. She had a sister, but her sister had the same problem. She waited too long, and by the time she had her surgery, it was too late. Genevieve also had a mother. Same story. They both had the surgery we were recommending to Genevieve. They both died. The family must be cursed; it was no wonder she was scared.

But I work with an amazing team of nurses, women from around the world who are filled with love and compassion and who will do anything to see their patients be healed. By the end of the evening, Ursula's quiet persuasion had broken through Genevieve's fear, and the next day, she went to the operating room as planned. The day after that, she was sitting up in her bed, calmly fashioning basket holders out of yarn and rope. In anyone's books, this would be counted a success.

The thing is, Genevieve also has a daughter. Her daughter also has a lump in her breast, has also been living under the same fear as the rest of the women in her family. When she came to visit her mama, Genevieve sent a translator to ask me if her daughter could also have surgery. My heart sank, and I replied with what has become our rote answer. Je suis désolé. There are no more doctors. Their faces fell, and they shrank back into their corner, defeated yet again.

But you see, unlike so many tragedies I have to share with you here, that wasn't actually the end of this story. We told Dr. Bruce about Genevieve's daughter, and he agreed to meet with her and assess the extent of her disease between his surgeries the next day. She had tears in her eyes when I handed her the little card that would give her admission to the ship the next morning, and Genevieve paused in her rope-weaving to flash me an enormous smile.

When I came to work the following evening there were a million other things to claim my attention, and it wasn't until visiting hours rolled around and Genevieve's daughter showed up in her now-familiar orange-printed dress that I remembered the appointment. Dr. Bruce was also in the room, so I shot him a questioning look. His smile told me the end to the story. It's just a cyst. She's not sick. Genevieve, already in happy possession of the news, beamed at me from her corner as her daughter hugged me and we danced across the floor of the ward together. Merci, she called to me from her corner, and then, summoning up all the English that she knew, Thank you. Thank you too much.

Because some days are way too long, and we tell far too many people to go home, to take their carefully nurtured hopes and throw them out with the trash. And other days are a celebration, a joyful dance across a ward with two women who have been saved from the curse of death and disease. I love the dancing days.

I was in charge of D Ward last night, and one of my new admissions was a little boy who's going to be having surgery today. My report to his nurse, Lee Ann, was brief. His blood was drawn and he's super-cute. Within minutes, Lee Ann had him shrieking with laughter, coming dangerously close to throwing himself out of his bed with his wild attempts to pop every single bubble she was blowing over him. He and I spent a while waving to each other from our respective seats in the ward, and when I had a minute, I went over to say hi. Bonsoir, I told him, offering him my hand to shake. Good evening.

I expected him to take his left hand, the one he'd been furiously waving to me with, and use that to say hello. What I somehow failed to realize was that the index finger of his other hand was buried way up past the first knuckle in his right nostril. As I stood there smiling like a fool, he carefully removed the finger from his nose and wiped a huge booger in the center of my outstretched palm.

Bonsoir.

I can't stop thinking about yesterday. I'm sitting here by the side of a pristine, blue pool at a posh hotel here in Cotonou. I just finished eating some pita bread with fresh humus, my skin is starting to turn brown from the sun, and I can't shake the feeling that something's not right at all.

There were over a thousand people in that line yesterday. Our hospital manager, who spent the entire day making his way up and down the line, handing out cups of water, showed me the final figure that he had scrawled on his hand. 1,150. And we sent them all away. All except for the ones whose names we put on waiting lists, the ones whose hopes will almost surely be dashed even harder when they realize that the ship has sailed and they never got the call to come.

My alarm rang at seven this morning, plenty of time for me to grab breakfast and make my way to community meeting with the rest of the ship. But as I swam into consciousness, before I even sat up, their faces were before me, their eyes silent and reproachful. I saw the old man whose hernia bulged through the cloth of his pants who put his hand on my arm and pleaded with me. Je souffre, he told me. I suffer. I saw the little boy with pale skin, hanging limply on his mama's back. He had a problem when he was born, she told me through my translator, and he didn't have enough oxygen. He doesn't walk. He should walk. I want him to walk. I saw the young girl, her back twisted by the most severe scoliosis I have ever seen, bent forward and to the side, leaning heavily on her stick as she stood for hours in the line with the rest of them, uncomplaining in the heat. I saw the old woman, her legs swollen and infected by tropical ulcers who took every step in pain. She refused to leave the line even after Abdel and I had explained that we didn't have the right doctor to help her condition. That she would need to go home. Her voice was soft, and the language she spoke made it sound like she was literally trying to swallow her disappointment as she begged us to reconsider, refusing to understand the truth.

I saw them all and a thousand more, and I couldn't face their pain. So I turned my alarm off and went back to sleep. I, at least, have that luxury, and it's hard not to resent myself for it. To hate the vast divide between rich and poor. To rage and rail against that impossible fact that I'm once again so squarely faced with; that where you were born is so often exactly what decides how you die.

I know it's good to be faced with these realities, to be forced to confront, even if it’s just 1,150 at a time, the billions of people in the world who scrape together their livings from hopes and prayers. I know it’s right to wrestle with the sadness and the outrage that I feel when I realize that I’m not going to be able to fix it all, that so many will die disappointed and unloved. But in the early morning hours, when their faces scream a silent pain, I want to put my head under my covers and hide from it all. I can’t hide from His voice though, and it breaks through my fears and my walls and my stubborn resolve to shut myself away.

Have you forgotten what I’ve called you to? Pour out your soul for the hungry. Invite the homeless into your house and clothe those who go without. You think this is too hard? If you but try, your light will rise like the sun, your healing will soon be evident; the very God of Glory will secure your path. You’ll pray, and I will answer you. You will call out for help and My voice will be in your ear before your tongue has fallen silent. I’m here. I have always been here. And I will never leave your side.

So I guess it’s going to be okay.

This year, with our ship running at an even higher capacity than last year and all six operating rooms filled with patients most days, we didn't think that even the 1,900 surgery cards we gave out during our first screening day would be enough to fill the schedule. So we put out the word that there would be a second screening day, at the Hospitality Centre, a warehouse off-ship that we've converted into an outpatient eye clinic and ward for patients who live too far away from the ship to go home between dressing changes. By the time my friend left the Hospitality Centre yesterday evening, she figured there were already about four hundred people planning to spend the night in line, waiting to be screened this morning.

But today's screening wasn't like other screenings. Between that first day in February and the second one today, we did what we hadn't anticipated; we filled the surgery schedule. From now until when the ship sails in December, every spot has been filled, every operating room booked, every surgeon's day planned out. We went to the Hospitality Centre this morning knowing that we would be faced with hundreds of people, and knowing that, except for a select few who would be placed on a waiting list, just in case, we would have to turn every single one away. And so when we got into our Land Rovers, we didn't have any supplies with us. No needles or lab tubes or stethoscopes. None of the normal paraphernalia that goes along with seeing patients and ensuring that they're fit for surgery. The little green appointment cards stayed tucked away in their box on the ship, because today we were going to say no.

I started out as a water-passer. We plied our ware up and down the line, dipping the same few cups into coolers over and over, collecting the cups from outstretched hands and filling them again. Empty, fill, repeat. I was wearing blue scrubs, the trademark of Mercy Ships, and as the sun beat down on my shoulders and the sweat and dust caked my feet, I felt hands pulling on me every time I got within reach. S'il vous plait, they pleaded, eyes dark and tired, please. But I was trapped, stuck in some weird in-between place where I could understand what they were asking me, but had no words at my command to answer them. It takes so much more than bonjour and au revior to communicate the end of a dream.

When I reached the end of the line, which seemed to stretch the length of a city block, I stood for a moment in the dust and the heat, looking back. Mamas and papas and tiny babies. Old men and women, little kids, all clad in their finest suits of brightly printed cloth. All waiting to hear the same thing. No. I was there, lost in thought, when Bibini grabbed my arm. She spoke enough English to understand me when I explained that there was no more space for her to have her goiter operated on. Her eyes filled with tears. You mean I should go? Something inside me broke, and I put my hand on her shoulder, asked her if I could pray. I prayed the strongest prayer I knew, claiming promises from a God who I'm fully confident can deliver. And then I sent her away.

I spent the rest of the day at the front of the line, working side-by-side with a tireless translator from the ward, Abdel. His massive frame let me feel safe in the middle of a small stampede, when about a hundred mamas, babies bouncing on their backs, charged the gate. His head was shaded from the sun by one of those cheap, silly umbrella hats which poked me in the eye several times. But no one was laughing. Pretty soon Abdel was able to discern just by looking at tumors whether or not it was something that could go on a waiting list. If he was unsure, he asked me, but mostly I stood by his side, my red eyes hidden behind sunglasses. Nous sommes désolés, I murmured over and over and over again as they turned to go, having waited for hours in line to be crushed and sent home. We're sorry.

I'm sorry. I'm sorry we can't help all of you. I'm sorry that your baby may never walk on straight legs, that your body is covered in tumors, that your hernia will keep giving you pain. I'm sorry that people stare at you, spit at you, hate you. I'm sorry that you came here today, your hope in your hands, and I'm sorry that I've just taken that hope and thrown it in the dirt. (I know that's where it is now, because that's where you look while Abdel delivers the news; you never meet my eyes.) I'm sorry that it's not enough, that we're not enough. We don't have enough operating rooms. We don't have enough doctors, enough nurses, enough beds. It's never going to be enough.

I'm sorry.

(I'm editing this post to add a photo of Liz, Abdel and myself after the screening was over. Liz and I are clearly sporting forced smiles and Abdel just looks tired, but what I want you to notice is that hat. Hundreds of people managed to take him seriously while he was wearing that hat. That is something that would only work in Africa, and one of the many reasons I love it here.)

I'm starting to get my feet back under me, and I don't think it's just because the ship has been rocking less these past few days. Over the last four evenings, I've had to do almost everything I had grown used to doing during the last outreach. I've worked on the wards, in the ICU, on the wards with an almost-ICU patient, and to top it off, I was in charge tonight. Just one more shift to go, and I can call two glorious days off my own.

But the best part of all this re-learning is knowing that I really am back in West Africa, that the Beninois are just as wounded, just as needy, just as loving as my Liberians. It's different here, but the heart of it is the same. While Liberia as a country was still clawing her way out of the vast hole left by more than a decade of civil war, Benin has enjoyed those same years in peace and relative prosperity; the people here have been to school instead of hiding in the bush from the rebels. But that doesn't change the fact that an entire ward is filled with VVF ladies, women who didn't have the money or access to healthcare that would have allowed them to bring their children into the world without tearing holes in body and soul. Maybe some of my mamas have come in with more than one outfit to their names, but that doesn't change the fact that, in an unspoken tradition of making the most of everything they have, they won't ask for a new diaper for their baby until the old one is literally falling off. But I think my favorite thing, the thing that most reminds me of Liberia, is their spirit.

One of the littlest patients in the wards is a tiny baby named Benedicte who just had her cleft lip fixed. Benedicte's mama died giving birth, so she's joined in her bed by a great auntie, a large woman in a blouse and skirt of matching, incredibly bright fabric, who cheerfully informs me in French that she never expected to have another baby. That her oldest child is in his thirties, her youngest twenty-one. But when your niece dies, someone has to take the little one, and, (as she expertly juggled small Benedicte from hand to hand), could we have some more milk please? I call Benedicte ma petit cochon, which, unless I'm insultingly wrong, means my little piggy, because of the vast amount of formula she seems to be able to hold in what must be a very small stomach. Benedicte's aunty just smiles and laughs and pats my rear end as I walk past (another trend that seems to be West African, rather than solely Liberian). She challenges me to complicated games of tic-tac-toe, ones in which you only get three pieces which can move around the board at will, and when I give up, she cheerfully bathes and feeds and changes her tiny charge without a single complaint.

It's easy to forget that this is a woman who has had her own children, who has finished raising her own family. Saddled with another infant to mother, she acts as though she couldn't be happier about the sudden turn of events. As though it had been the plan all along. In her cheerful countenance, I see all my Liberian mamas mirrored back to me, their stoic resolve in the face of unspeakable tragedy.

And I am suddenly and fiercely homesick for another West African country, not so far from this one.

She's smaller than he was, but her tumor was bigger. It jutted out from the side of her tiny jaw, as big again as her head and wrapped inside around bone and blood vessels. She was the kind of baby whose mother Dr. Gary sits down with before surgery, trying to explain, often through several translators, that this time it might not work. That we might not be able to fix it, and that she might not get her second chance. Invariably, the mamas sign the forms anyway, pressing their thumbs hard into the pad of ink and mashing them onto the page, their eyes steely and determined and sometimes a little hopeless.

So Maomai went into the operating room yesterday, and I took care of her today. Fitting, that in this land of French speakers, the phrase thrumming through my mind all afternoon was deja vu. It all felt so much the same that I half expected the crew nurse to appear through the door and give me some more bad news to top off my day. I wish there was some way to explain how surreal it all felt, using the same instruments, seeing the same numbers, hearing the same things. Haven't I been here before, bent over a tiny, brown bundle engulfed in blankets and tubes and surrounded by the hum of machinery? Don't I know that sound all too well, the sound of a baby who can't quite get enough air into his lungs. No, wait - her lungs. This isn't Baby Greg. This is Maomai, whose name is a lilting song on her mama's weary tongue. Maomai, a person of God, as the translator explains while I curl my body over hers, stroking her tiny, fuzzy curls in an effort to calm her cries.

I'm sitting in my cabin right now, tired and happy and perilously close to tears. Maomai is doing well. Her mama trusted me enough to leave her side and sleep this afternoon, the first sleep she's gotten since her little one went into the operating room almost thirty-six hours ago. Maomai's breathing is calming and she's starting to tolerate some milk through the tube that leads to her stomach. (Just like Greg, we're cutting out the middle man, letting her devote all her energy to that ever-important task of getting air into her lungs.) I should be happy. I should be elated that, at least this time, everything seems to be going well.

But all I can think of is that night, almost a year ago now, when I sat in a dark, hot room and saw grief all around me by the light of a single candle. Because I can't do it all again; I'm just not strong enough.

So either my little person of God keeps getting stronger and eventually goes home with her brave mama, or I'm going to claim Maomai's name as my own. In this place where names mean so much, I'll claim to be a person of God, and He will not let me fall.