ali's african adventures

There are so many things I love about this place. A few of us sat together after church tonight and just shared stories of D Ward, and I realized again that there's nothing else I'd rather do. It's a hundred things a day, and as I live through it all I tuck them into the back of my mind so I can tell you all later.

There's Nurse Shaka, a patient who had a huge tumour removed from the back of his neck and who may or may not actually be a nurse in real life. We've caught him adjusting the IV fluid rate on the patient in the next bed, and just today I found him, along with two other patients, in the isolation room where the lady with the fast-fast is staying, having a little chat. When I mentioned the reason for her isolation, I have never seen anyone move quite so fast as they all did when they realized that they could be catching the fast-fast too. (Have I said fast enough yet?) Given the fact that Nurse Shaka speaks her language, I kept him outside her door for a little while longer to translate for me. Community is alive and well on D Ward, folks.

Speaking of the lady in isolation, she tried to kick me in the head today, and I learned the value of therapeutic yelling. Now, I don't generally condone yelling at patients, but a needlestick way back in Liberia has made me a little jumpy around people who flail when sharp things and blood are involved. I was in there to restart her IV, and when the needle touched her skin, the leg closest to me came up in a decisive kicking motion, and it was at this point that I decided to employ the therapeutic yelling technique, regardless of the fact that she doesn't speak a word of English. It seemed to work, because when I moved to the other arm for a second try, she screwed up her face and glared at me, but kept perfectly still.

Fanta Man is doing better. He has a caregiver here with him now, a man who may or may not be his son. When I came back into the ward from the near-kicking episode, I had one of the funniest moments of the day when I found the caregiver helping Fanta Man drink tea in an incredibly unique way. There was a large syringe (the same size as the one he was drinking Fanta from the other day) filled with milky tea, and attached to the end of that was a piece of IV tubing about a foot long. Fanta Man had the other end of the tubing in his mouth and was sucking back tea, gesturing all the while at his son to speed up the process, please, and mumbling something about how the tea just wasn't coming fast enough. (There's that word again!) It's hard to picture, I know; just trust me when I tell you that it's one of the best moves dear Fanta Man has pulled since arriving.

Once I had finished laughing about Fanta Man, I headed to the recovery room to check on little Kadiatu, who had to go to the OR this morning because she basically removed everything possible during the night; feeding tube, IV, bandages. Everything. And because she needs to wait for surgery to build her a nose, inserting a feeding tube that goes through the nose and into the stomach isn't something that can be done just anyhow. I heard her yelling before I even got into the room, and she was already starting to reach for the new tube, so I did the most obvious thing. I ran to the ward for a safety pin and I pinned that tube to one of the braids in top of her head. Only in Africa.

Four moments out of a hundred, and I head to bed exhausted again but happier than ever that this is the place that God wants us to live out the love He's given us to share.

Today was another busy day. We really could have used another nurse, and we were all running from the moment we came in until long after the shift was over; it might be enough to mention that I just ate lunch. At four thirty in the afternoon.

There were problems to be solved and issues to be dealt with left and right. Sia got her chemotherapy last night, so her medication record has grown to span three pages as we work to keep her system running properly. Kadiatu, a little one who had surgery to basically create a face where noma had taken hers, screamed whenever anyone even touched the feeding tube that she needs until her new mouth heals. Baindu's tongue has a dead spot in it that needs to be dealt with, and one of our patients who has been staying in B Ward needed to be brought back down the hall and placed in isolation in the ICU for a raging case of what the Sierra Leoneans politely refer to as fast-fast. (Hint: it comes out of the backside at precisely the speed indicated.)

Add to this the fact that there's a massive jigsaw puzzle to be fit together every weekend in order to get the new admissions in for surgery on Monday, along with all the administrative tasks that our admin assistants take care of during the week and notes and orders to be written for thirty-five patients, and you can start to see why I might have been a little busy.

Handing over the reigns to Jenn at shift change was a good feeling, and included my favourite problem of the day. Abu in C Ten is ready to go when his brother comes to pick him up. We just have to find him a shirt. Abu is from Guinea, and I've been serving as his interpreter for the last few days since he only speaks French. My language skills were sorely stretched this morning when he explained that his shirt had disappeared and that he didn't really feel like going home topless. I assured him that we would make it our top priority.

Forget kids with cancer and dehydrated old ladies; getting this guy a new shirt is probably the most important thing to be done.

Jenn agreed with the urgency of the task and dutifully wrote it at the top of her list. It's comforting to know that the ward is in good hands for the evening.

Some things are just unfair. It's not the she got the green cup and I wanted the green cup kind of unfair, but something much more heartbreaking. It's Sia, downstairs in D Ward right now, her baby sister probably curled up with her, mama keeping vigil on a chair beside the bed.

Sia is eight, and where her left eye should be is an angry red tumour. Her belly is swollen with more cancer, and because she was born here in Sierra Leone, she might well die because of it. It's deeper than that, though. It's not just that Sia is West African; it's the fact that she came to us at the end of October. At any other time in the year, we would have entered her into the Burkitt's Program, and that would have been that. Our incredible palliative care nurse, Harriet, would have overseen her care at the local hospital, Sia would have received chemotherapy, and she most likely would have been cured.

Instead, we are faced with the reality that we have only three weeks of surgery left. The hospital will close a week after that, and then we will sail away and little Sia will still be here. How is it possible that a matter of months, weeks maybe, might be the difference between life and death for this little one?

She's getting her first dose of chemotherapy here on the ship as I type this, but all we're hoping is that it buys us a little time. Time to figure out what to do with her after. Time to find someone who will make sure she gets to the hospital, to find someone who will pay for the treatment. How can we be sure that she'll get what she needs when we're so far away?

I stood in the hall with Dr. Gary and Stacia, the oncology nurse who's giving the chemo, (yet another example of the right person being here at the right time) and he said something that makes the way forward just a little more obvious.

Eight years is too short.

Sia means firstborn girl; if it were me instead of her in that bed, I'd be named the same thing, and I don't know what to do with that. What I do know is that eight is not enough.

And the crazy days continue. This one wasn't so much because of Fanta Man or Bed Fourteen, although both are still here and both are still problematic behaviour-wise, but more because we had a rather prestigious visitor to the ship. Princess Anne came and spent some time on the Africa Mercy this morning.



The place has been buzzing with news of nothing else for the past few days. The hospital was a flurry of activity right up until the announcement of her arrival as day volunteers scrubbed away errant scuff marks on the walls and patients were tucked firmly into their beds. A few people (Brits, for the most part; my accent isn't nearly posh enough) were chosen as representatives of the hospital and donned crisp navy scrubs for the occasion. (This was a matter of much hilarity among the rest of us, who were somehow less classy in royal blue.)

We spent the morning practicing our curtseys, debating whether or not Americans should do so, and deciding which patients would be appropriate for the princess to meet. Unsurprisingly, Fanta Man was not on that list. In fact, we figured it would be best just to keep her off his side of the ward altogether, since his chats with the soap dispenser have now extended to include the water filter, too. It's just too hard to know how he would react to a real, live princess given his frustration with inanimate objects.

When she did arrive, Princess Anne was lovely. She met the two patients we had picked out for her, and then just kept right on going around that side of the ward and met all the rest of them, too. I got trapped in a corner, and so when she got around to the lady in Bed Twelve, I was the one the princess turned to when she asked about the patient's surgery.

I got to talk to the princess, bright blue scrubs and all. I've done come crazy things here on this ship, but explaining oro-nasal fistula surgery to the daughter of the Queen of England? That's right up there with the rest of them.

We herded her out before she had a chance to ask about beds one through five, and the visit can therefore be called a success. Fanta Man drank the rest of his purple Fanta in celebration, and Bed Fourteen (who is now in one of the smaller rooms off the ICU) slept through the entire thing.

The whole thing, having a royal visitor in our floating world, just seemed so surreal. Kirstie, the Ward Supervisor, put it really well at a nurse meeting this afternoon. I know we do this all the time, but as I was explaining to her that we just took a big tumor off this man's face, I realize how incredible it really is. All of this, Fanta Man and Bed Fourteen and changing bandages and taking temperatures, all of it is part of something so much bigger than ourselves, and we can't lose sight of this.

I heard a voice thunder from the Throne: "Look! Look! God has moved into the neighborhood, making his home with men and women! They're his people, he's their God. He'll wipe every tear from their eyes. Death is gone for good—tears gone, crying gone, pain gone—all the first order of things gone." The Enthroned continued, "Look! I'm making everything new. (Revelation 21:3-4, The Message)

He is making everything new, and we are a part of it every single day. Whether we're performing for princesses or sitting in the dark at the bedside of a confused old man, we are part of the making new of all things.

You didn't think yesterday's post was it, did you? That Fanta Man would just go to sleep and wake up clear-headed and bright-eyed this morning? Folks, if you were expecting that, then you have come to the wrong blog post, because this one is a straight-up continuation of yesterday's antics.

When we all came on shift at seven this morning, things seemed like they were set to run much more smoothly than yesterday. Fanta Man was tucked into bed, fully clothed, not a trace of orange on his dressing. My little man from yesterday was assigned to a different nurse, but he was off his morphine pump and feeling much better about life. Everything was quiet. Until breakfast.

Fanta Man produced not one but two Fantas from who knows where, purple this time, and proceeded to pour one of them into his bowl. He crumbled up his bread into it and then called over his nurse, Jess. I was upstairs getting my own breakfast when she showed up in the dining room in search of a spoon. Apparently Fanta Man wanted a spoon to eat his purple bread with, and when Jess didn't produce one right away, he pulled a huge wad of cash out of, well, somewhere. (There are no pockets in hospital gowns, so we're not sure where it really came from.) He had 92,000 Leones, and it was all hers if she could just find him a spoon.

Since we don't really take bribes, she offered instead to lock up the money in the safe where it belongs. That went well for about fifteen minutes until he decided that he did not trust us at all, and started yelling that he needed his money back. When it wasn't immediately forthcoming, he threatened to call the army on her, which only resulted in her bursting into laughter. Not terribly professional, I know, but it was really the only response given the situation.

Unfortunately, this didn't help Fanta Man's mood, and he headed over to the sink and started yelling unintelligibly at none other than the soap dispenser. He kept pointing over at Jess with a disturbed look on his face, and turning back to the soap dispenser for some sort of acknowledgement of his feelings.

The soap dispenser didn't have much to say.

So Fanta Man did what any confused old man would do; headed back to bed, donned a pair of bright pink pants under his gown, after which he rifled through his bag for a while and pulled out a book that he had been reading. He had apparently been marking his place with a piece of bread, at least a week old and as hard as a rock with a little hole eaten out of the center, which he pulled out and waved at Jess, who was pretty much unable to keep it together at this point.

It was shortly after Fanta Man pulled on the second pair of pants, bright blue over the pink ones, that confusion broke out on the other side of the ward. The patient in Bed Fourteen, the guy I used yesterday to translate for my patient in Bed Nine, was fully dressed and halfway down the hall, heading home before anyone noticed. One of the translators ran after him and returned with his bag, but not with him. At least now he will not go far, was her matter-of-fact explanation of why she chose luggage over patient.

Somehow, overnight, the tables turned, and now Bed Nine was able to speak more French than Bed Fourteen, and so I used Nine to talk to Fourteen as I tried in vain to convince him to stay. It was slow going, since both the men have recently had surgeries on their jaws that have left them mumbling and near-impossible to understand in any language. The three of us stood in the hall for a while, working on communication when a third patient showed up from B Ward on crutches. She also spoke no English, but her French was perfectly West African, and clear as day for me to understand.

Unfortunately, just understanding the language doesn't mean you can convince someone that they're at risk for infection if they leave the ship, especially not when Fanta Man is escaping D Ward through the back door to the ICU and needs to be caught. (Incidentally, the only way to get Fanta Man out of the ICU and back into bed was to convince him that not only the ICU but also his home and the entire country of Sierra Leone were, in fact, closed for business.)

At some point, we just kind of threw up our hands and yet again admitted that only the essentials were going to get done today. Keeping Fanta Man and Bed Fourteen in the ward were the only real priorities, and it seemed like it took all of us all day just to make it happen. When I went down just now to retrieve a water bottle that I forgot at the end of the day Bed Fourteen was still there, his bag hidden under another patient's bed, and Fanta Man was sitting with a translator next to his own bed, a classy coral jacket added to his ensemble over his gown.

I'm not going to lie when I say that I'm glad I have the day off tomorrow.

Tomorrow I'm going to see if I remember how to be a real nurse.

Famous last words, those.

Today was a shift unlike any I've had in recent memory. It wasn't that I had a bad assignment; a pharyngoplasty two days out and three grownups who could, for the most part, express their needs and didn't have a lot of care to give is a great set of patients. Except it's never that easy, is it? Of course one of my patients only spoke obscure tribal languages, and the only other person around who spoke those same languages was another patient (not mine) who also only spoke French. I didn't really hesitate, since the kid who had had a pharyngoplasty (a nasty surgery, by any account) was vomiting on the other side of the room, and pulled the French-speaking patient to the bedside of my old man so I could do a quick assessment. That other patient has apparently been here long enough that he started anticipating my questions, and was able to tell me not only that my old man had opened his bowels, but what the consistency of said action was.

That being sorted, I turned to Alpha, my poor little man in Bed Twelve. He was a sorry sight, with a soft plastic 'trumpet' in one nostril so he could breathe, a feeding tube in the other, an IV of morphine running into one little hand, and a pathetic look on his face. Although, to be fair, if you had a flap from the back of your throat cut off and sewn to the top of your mouth, you'd probably look a little pathetic, too. It was one thing after another with Alpha today; everything I put down his feeding tube came right back up, and since kids aren't really picky about where they vomit, he got numerous baths and two complete linen changes.

All of this would have been fine, honestly, if it hadn't been for Fanta Man in Bed One. He wasn't my patient, but it quickly became apparent that he was everyone's problem. He started the shift with a heartrate over 130 (not good) and breathing that sounded like a sick duck (very not good). He was becoming increasingly confused (also not good, although in my case it's fairly normal), and wouldn't keep the oxygen mask on his face. Just try, if you can, to picture the scene. An elderly gentleman with his gown around his waist and his head wrapped up in a huge white bandage sitting on the side of his bed. A wheelchair is waiting to take him to x-ray, and there are at least five nurses and doctors around the bed. Sheets in absolute disarray, monitor showing crazy numbers, egg smeared all over the floor (not sure how that happened), and a puddle of something best not mentioned on a family blog also all over that floor. And in the middle of all this sits Fanta Man, oxygen mask firmly pulled away from his face, pouring an orange Fanta in the general direction of his mouth, missing completely and soaking his bandage in the process.

Somehow, I don't think we'll be seeing him in the Fanta ads.

It was quickly apparent that Jenn (who, I must add, is a NICU nurse, and not really the first one you'd imagine taking care of a confused old man) had to focus completely on this guy, so we each took one of her other patients, giving me the barfing boy and four grownups with two dressings each to change.

Folks, I'm officially recovered from that arthritis, because I did not stop moving for eight hours straight. They were possibly the fastest eight hours of the past year, and only when it was over, Fanta Man tucked into bed with a clean gown and bandage, a new IV started on my little guy by Jenn (who is, honestly, a rockstar) and all of my tube feeds were given did I realize that I'm still a nurse.

I guess there are some things you don't forget, no matter how long it's been. Changing bandages and holding barf buckets and titrating morphine and juggling the needs of a whole row of people seems to be, at least for me, like riding a bike. I'm just hoping that tomorrow I can ride a little slower.

In the hospital here on the Africa Mercy, we have a policy that anyone fifteen years old and younger be admitted with someone to care for them. It's the reason we have a column on our computer census marked caregivers, where we keep track of those extra bodies on the ward. If a mama is admitted for her own surgery and she's still breastfeeding a baby, that baby gets entered on the caregiver list, too.

Today, in Bed Twenty, we had what must have been a record number of caregivers: three. A mama was admitted for surgery and she has twins who are breastfeeding. But because these twins aren't tiny babies but rather wild, crawling near-toddlers, she also brought along an Aunty (a female of undetermined relation) to watch over Hassan and Haja when she went to the operating room.

Let me tell you something here: there is not much that I like more than a good set of African twin babies. Especially when they're as beautiful as these two. This morning, while mama rested and Aunty took a bath, the Patient Life team came onto the ward for morning devotions. Patient Life is a team of crew members, both African and Western, and local Sierra Leonean day volunteers who take care of the spiritual and emotional health of our patients. While we change bandages and give pain medications, they're on call to counsel, pray and sing with our patients.

This is the first morning I've been on the wards, and when they started to sing, I couldn't help myself. Right away, I was clapping and dancing and singing along, and it was the most natural thing in the world to grab little Hassan and strap him to my back with a colourful lappa. (Here in Sierra Leone it's called po-po'ing, as in I po-po'ed Hassan.) I could feel him rustling around until he got his little thumb into his mouth, and then he relaxed and fell asleep as all around us voices raised in harmony, singing praise to Papa God.

Tell am tenki, tell am;
Tell Papa God tenki.
Wat He do foh me,
I go tell am tenki.
Na wat He do foh me,
I go tell am tenki.
Tell am tenki, tell am;
Tell Papa God tenki.

It was one of the first songs I learned back in Liberia; we sang it at the very first community meeting I was a part of. Now, more than three years later, I'm singing it again. Everything so much the same, and somehow so different. I didn't need help to get that baby on my back. My feet know instinctively how to move, my hands how to clap out the three-beat rhythm. It's the most natural thing in the world to stop dead in the middle of a day of work to have a dance party.

Who wouldn't want to live like this?!

And the icing on the cake, despite my love for my little twins, is the fact that today was my last official shift on B Ward. Tomorrow I head back down the hall to the land of maxillo-facial surgery and the patients who have the biggest place in my heart. Next year in Togo I'm going to be taking over the role as Team Leader, and Natalie, the current queen of the NG's, has a whole lot to teach me before she leaves.

Tomorrow I'm going to see if I remember how to be a real nurse.

If there’s one thing sure in an uncertain life, it’s that it will move on. James passed away yesterday morning, and the same afternoon a little almost-two-year-old with the same name was admitted to B Ward. Sporting curly hair and a miniature pair of sunglasses, he spent the evening laughing, stomping around the room and snuggling with me. (You can probably guess which was my favourite of his activities.) James had cataract surgery a while ago, and was back to have the sutures taken out of his eyes. It was clear from the way he grinned up at me that he could see perfectly, but he flat-out refused to let anyone touch those glasses, which earned him the nickname Baby Ray Charles. His mama approved.

By the time I came in this afternoon, Baby Ray had been to the OR to have the sutures taken out of his eyes and had already been sent home, so I had no one to play with. The shift turned out to be busier than I anticipated, though, so I didn’t have much time to miss him.

It was one of those shifts so full of both good and bad, one of the ones that has you reeling from the near-whiplash of emotions. For some patients, it was good news. Surgeries to be performed, stubborn wounds healing. For others, it meant heartbreak. We turned one guy away because of a tooth abscess that would make anesthesia too risky, told another that he’s HIV positive and watched his world crumble around him. It’s almost impossible to go from that to a particularly funny ward round where the surgeon tried his hardest to talk like a Sierra Leonean, and I was told in no uncertain terms that I speak Krio like a Liberian.

But that’s the way it is here. Life ebbs and flows and sometimes the only way to survive is to just let it wash over you, arms open wide to receive the joy along with the pain. The sweet and salty mix and it’s a drink that doesn’t always go down easily.

Kisses from freshly-repaired cleft lips help; I got a few of those today, along with a little three-year-old dance party in the now-empty ICU. I printed out the discharge papers for the boy with HIV, and as I headed home down the hall after handover, one of the day volunteers called out after me. Goodnight Liberian woman!

And so it goes on.

Thank you for your prayers for James; please pray for his family now. He passed away this morning, but he was not alone. That's all I think about, haunted by the memory of the others who have died downstairs. He didn't collapse in the street or die curled up in a corner somewhere. He was in the best hospital in the country, given every possible medical chance; there was nothing more we could have done. He was cared for until the very end and he died surrounded by love and prayer. I wasn't there, but I have been before, and I know how it is here.

And still it seems so wrong. I think I say this every single time, but this is not what we all sign up for when we come to Mercy Ships. We think we're coming to watch cleft lips be stitched back together, to see crooked feet straightened and blind eyes given sight. Nowhere in the orientation packet does it say anything about how, sometimes, they die.

It's jarring, the disconnect. Last night I went down to D Ward to get the keys for the pharmacy, and a little girl with an as-yet-unrepaired cleft lip lifted up her hands to me. She wound her skinny arms around my neck and planted a series of sloppy wet kisses on my cheeks, and right behind her was the door to the ICU where James was dying and it just seemed so unreal.

So please keep praying for his family. It rained all night, and it's still raining this morning, so I don't know how the roads will be when they try to take him home. Strange, to have to think about that, too. At home it's all so simple; you call the funeral home, and they take care of it. Things are messier here. We're more involved, more a part of our patients' lives than is considered really proper in the 'real world.'

I think it's how Jesus would have wanted it. I look into the Gospels and I see Him weeping outside the tomb of a man He was about to raise from the dead, fully present in the moment, sharing in the grief of his friends. And I think of the ones who stood vigil around James' bed this morning, present in his last moments, and I know that this is the way it should be.

We're not on this earth to live our own lives, untouched by what goes on around us. If that's the example we were to follow, Jesus would have lived his thirty-some years out in a monastery. He didn't. He lived in community with the world; He got dirty and He got hurt. Some days it felt like too much, but always compassion moved Him to give more. He loved the unlovable, had parties with sinners and wept with those who mourned.

This is the way it should be.

There's a single tone that comes over the ship's intercom that marks the beginning of a ship-wide announcement. Usually you hear it when we're taking on fuel, or when the garbage container is full or things like that.

When it sounds at eleven on a Saturday night, you immediately assume the worst. Last night, that's exactly what it was. Emergency Medical Team to the ICU. Emergency Medical Team to the ICU.

We arrived quickly (not hard to do when you're living directly above the ICU itself) and everyone fell into place around the bed as we sought to save the life of the man lying there. I won't go into much detail, as I honestly don't know him, apart from everything that happened last night. Suffice it to say that he has an infection in his brain, and after a late-night trip to the OR, things don't look good.

He's being cared for now in the ICU, his family is on the way, and we're all praying for a miracle.

It's strange, this life. There's a critically ill man just below where I'm sitting, and I'm finding it hard to really care. I know that sounds awful, so please let me explain. For some reason this all feels so different from other times. Maybe because the first time I ever saw him he was unconscious and we were breathing for him, but I don't feel the same way I normally do when someone is so sick. There's no background, no common experience apart from that one, long, frantic hour before we turned him over to the OR staff. He's not a baby that I've held in my arms; I don't even know if he has family apart from the brother we were able to get in touch with this morning.

And despite all this, he is just as important as any of them. I am called to love this stranger in the same way I loved Baby Greg or O'Brien or Anicette, but I don't know how. I stood by his bed this morning, my hand on his arm, and I prayed for him. And I still don't feel anything.

Call it compassion fatigue, call it what you want, but you can't always care enough. Or at least you don't always, even if you should. It's one of the hardest things about this life, a life where you come face to face with pains and death on a consistent basis. Sometimes you just step back, throw up whatever shield you can and go on living despite the fact that there's a man fighting for his own life not fifty steps away. And you feel guilty for doing it, but there's no other way.

This is hard, not because I know him, but because I don't.


Please pray for James and his family. I'll update as I know anything more.

It's a little after three in the morning, and the wards are quiet. I'm working my last night shift in A Ward, since one of their nurses called out sick, so I'm not taking care of little Taslim tonight. I checked on her a little while ago, and she was fast asleep, the steri-strips holding her top lip together looking for all the world like little kitten whiskers. I'm also happy to report that the oldest of my nine patients tonight is fourteen. It would be the understatement of the year to say that I'm relived not to be in charge of any grown men with hernias.

Don't get me wrong; general surgery is an important part of what we do here, because sometimes transforming a life isn't as dramatic as rebuilding a face or straightening crippled feet. Sometimes it's the unseen troubles, a hernia that's caused years of pain for a man, destroying his ability to work and provide for his family. When we can step in and fix that, we give life to that family again. But really, at the end of the day, I'm a pediatric nurse. Call me crazy, but I'd much rather be wrestling with a three year-old who's bent on kicking me in the face because she doesn't want her temperature taken (true story, that) than watching a grownup sleep quietly. Seriously, where's the fun in that?

The little ones here in A Ward have all been here long enough due to different complications with their plastic surgeries that they know the drill. (Whether or not they choose to comply with said drill is entirely up to the whim of the moment.) There's something incredibly endearing about a one-and-a-half year old who sees you coming with the monitor and smiles up at you as he holds out his chubby finger for the oxygen probe. Or the six year-old who insists it's cold enough to be wearing a knitted winter hat and then needs to be tucked in when he falls asleep and kicks off his covers.

I'm sitting here, reading down this list of kids on my clipboard, and it's like reading a promise.

Instead of ridicule and stares and whispers behind their backs, they're being rebuilt now. Extra digits removed, fingers burned by fire made straight again, wounds covered, fingers created from webbed masses of skin and bone. These are the things that make you hated here, the things that keep you from school because of the fear that other people feel when they look at you.

Here on the ship, we speak to them of a new reality. We hold their mangled hands, touch their scarred cheeks where skin has hardened like wax, snuggle them into our laps no matter what they look like. We change their bandages, help them bathe, look them in the eye and acknowledge their worth. We who are filled with the love of Jesus can't help pouring that out on our patients and the result is that these nine names on my clipboard are now kids who fully believe that they deserve that love.

It seems like such a small thing, but it's everything. I've been at this for more than three years now, and I'm blinking back tears as I sit here and think about what this all really means.

This place is a promise.

This evening, we had a little excitement, Africa Mercy-style. I was eating dinner with some friends in the cafe on Deck Five when one of them casually mentioned that the retrieval efforts were still going on outside.

Retreive what? I asked, naively.

It turns out that one of the forklifts we use to unload containers had fallen into the sea between the ship and the dock and was buried in five feet of mud at the bottom of the port. The divers (my boss' boss Dan, and dear Aussie friend Tim) were suited up and getting ready to head into the murky water to see if they could attach cables so that the Terex (a huge container-moving machine found in ports, and yes, it's pronounced like the dinosaur) could haul it up.

What followed was easily the most entertaining night in AFM history. The rescue efforts went on until after dark while those of us watching were also treated to a beautiful sunset and a lightning storm off the port side. There were enough people on deck that it looked like we were getting ready to raise anchor and sail away, but really, it was just curiosity and lack of anything better to do. (We're easily amused over here.)

I stayed until the divers resurfaced and it became apparent that the Terex wasn't the man (pardon me, machine) for the job and then watched the lightning storm for a while before work. I headed down to B Ward for my second night shift in a row fully convinced that I had seen the most exciting thing that would happen for a while.

Until I picked up the chart for my little four-month old patient in bed twenty. Taslim was all tucked in and sleeping soundly, making little whiffling, sleepy noises through her cleft lip and palate and when I got to the part about family history I stopped cold.

Adopted. (Child was abandoned.)

Just that. Nothing more. When Taslim was born with a face split wide, her mama couldn't bear it. I dont know why. I don't know what kind of fear or anger or feelings of inadequacy were going through her head when she bundled up her baby in the middle of the night and left her on the doorstep of a woman she knew was a nurse. All I know is that she couldn't see her way clear with a baby born so broken. They found her there the next morning, crying for hunger, and they took her in, fed her, loved her. When the rest of the world ran away, this family ran straight for Taslim, scooped her up and poured life into her.

She'll have surgery to correct her cleft lip in the morning. Tonight she sleeps in the care of her new family.

That's the most exciting thing.

I just finished another delightful shift on D Ward. I spent most of the morning trying to think of games and crafts to amuse Comfort and Abiba, completely forgetting that they were due to be moved to the HOPE Center before I ever arrived on shift. The HOPE Center is something we have in each country we work in, a necessity in a place so different than anything you can probably imagine. In the first world, if you're sent home with a bandage to be changed or a cast to be looked after, there are services in place to make that happen. There are visiting nurses to come to the house, clinics where you can be seen after hours, pharmacies open all night where you can get medications if you're in pain. You have food on the table and a clean place to sleep, and so you don't need to stay in the hospital.

Here in West Africa, we send our patients home to dirt or concrete, to five in a bed and nothing on the table, to raining season and malaria and malnutrition and no money to set any of that right. And so we can't actually send them home. Enter the HOPE Center. It's always packed full of patients who are either being fattened up so they're healthy for surgery or finishing their recovery afterwards in an air-conditioned room with three meals a day. They receive health education while they're there, and each one goes home with a mosquito net.

It's a wonderful place, but I had totally forgotten that my two little models were going to be strutting their stuff over there instead of in the hall on Deck Three, so I was a little disappointed when I arrived. I was looking forward to a rather boring shift when I looked at my clipboard and realized that, of the five new admissions waiting outside, four of them were under three years old.

When their beds were made, I ran outside to where they were all waiting, huddled under the tent on the dock. Three mamas and a papa, each with a cleft-lipped pikin in tow. I felt like the Pied Piper as I led them up the gangway and down into the hospital.

I'm not sure how the children felt about the Pied Piper initially. In my case, the pikins were more than a little nervous, taking in the situation with wide eyes and a few cries from the safety of their mamas' backs. But I've said it before and I'll say it again: I have yet to meet the kid who isn't friends with me. It just takes some of them longer to realize it.

I am happy to report that all four little ones are tucked into bed as I type, having spent the afternoon playing peekaboo, riding around on every toy with wheels (whether or not said toys were even close to big enough for such a purpose), or snuggled into my lap while I charted. I know I'm not supposed to have favourites, but Philip would totally be mine if I did. He rolled onto the ward sporting a crack that would make any plumber green with envy. His belly was just too big for his pants to sit high enough to provide any kind of coverage, and because big bellies aren't usually the result of too much food here, he won himself a prompt dose of worm medicine. We were quickly forgiven for that, and he turned out to have the cutest little laugh, which he showered on us at intervals in the running monologue he chirped out from his nest of blankets. If I can find a photo of Philip, I will most definitely post it; he's too good not to share with you.

Unfortunately, I don't get to watch over them all after their surgeries; I'm heading back up to B Ward tomorrow night to fill a hole in the staffing schedule for a couple weeks, and since that corner of the hospital is mostly filled with men having hernia surgeries, I don't think I'm going to have as many cute stories to tell.

Wish me luck. I'm about to be working three nights in a row, and I haven't worked a night shift in over two years. Since getting dengue fever, it seems I need about ten hours of sleep a day to be functional, so I haven't quite worked out how I'm going to make it until Thursday morning.

This could be interesting.

In the middle of our shift today, one of the nurses I was working with turned to me and said something that I consider a real compliment, considering the way things were going.

You see, right at that moment, I had just returned from the hall, where I had been swaggering up and down with Comfort and Abiba, both of whom had blankets tied like capes around their necks. We were practicing our model walks; Comfort's posing far outshone Abiba's tentative attempts, but both were giggling. My hair was up in wild, uneven pigtails, tied with purple string, courtesy of the two girls, and I had stickers on my forehead and cheeks.

I was breathless and laughing and one of the nurses turned to me and said, Jenny (one of the nurses who knew me from before) described you exactly right.

If people describe me that way, the way I was halfway through my shift this evening, then I am exactly who I want to be and I am exactly where I want to be.

Comfort is eleven. She's from Nigeria, and when she was four, a tumor started growing out of her cheek until it was the size of a grapefruit. It swelled out from the left side of her face, disfiguring her and condemning her to a life of shame. Two or three years before that, in the bush here in Sierra Leone, Abiba fought a battle with noma that ate away most of her top lip. Both have been here for a while as our surgeons cut away disease and worked to reconstruct their faces. Both have known ridicule and hate, and today we wanted them to know love.

And so we laughed. Rosie and Robyn (two women who work in other areas of the ship) came down to give foot and hand massages, we painted nails in pretty colours and then we headed out to the hall to practice our swagger. Abiba's normally withdrawn demeanor gave way, just for a moment, to a little diva in a red cape. It's the first time I've seen her come out of her shell, and Comfort is now far enough out of hers that there's really no going back. I never feel more like myself than I do in moments like this, in the times when I get to watch little girls laugh and play the way they should after years of not being able to look other people in the eye.

When I walked into the dining room to get some water after my shift, one of my friends did a full-on double take. What happened to your hair?!

Nothing happened. This is just who I am, apparently. Lopsided hair and all.



This is exactly who I want to be.

When I arrive in a new African country, I like to leave my camera in my cabin the first few times i go into town. I can hear from a million people how safe (or not) a place is, but I like to suss it all out for myself, so I go out with nothing on me the first few times while I get the feel of a place.

Today, that was a terrible decision on so many levels.

It started when we left the port gate and found a poda-poda half-filled with our friends, who were heading out to spend the long weekend at the beach. They offered us a ride to town and so we hopped in. There was music blaring from crackling speakers, a wingman to open and close the door (except they call them apprentices here) and I had to brace myself to stay seated while the bench I was on threatened to tear free from a shaky welding job at any minute. I stared out the window beside me at the streets, more colourful and vibrant than I remembered, filled with people selling anything and everything. Tissues and tank tops and flip flops and feather dusters and cookies and crackers and I could go on. We were ten minutes into the day, and I was already regretting my decision to leave the camera behind.

Once we piled out of the van, I was enveloped by it, by the rush of West Africa. The heat, the smells, the open sewers to be dodged, the quickstep out of the path of oncoming trucks, the hands always reaching for me, to touch my arms and grab my attention for a quick word. How de body? I wan talk small wif you. When I got separated from my group by a few steps, a man grabbed my wrist, and instead of the typical greeting, launched into song. (This is the next moment I was wishing for a camera, set to record.) You are beautiful, white woman, he crooned, and without missing a beat I sang back to him. My husband thinks so too! My marital status seemed to have no bearing on the state of his heart, because he sang right back to me: I don't care; still beautiful!

I extricated myself from that situation, and we made our way to a place commonly known as Fabric Street since all the shops and the little stalls set up in front of the shops and some of the kids walking past with bowls on their heads are selling brightly-coloured fabrics in any pattern imaginable. We browsed for about an hour when we looked up and saw a whole group of white people, a camera crew with fancy equipment and intense looks on their faces. And right there, in the middle of the muddy, dirt road, was Eva Mendes, interviewing a woman selling fabric. The girl from Hitch, on the streets of Freetown. Strike three for camera-less me.

We stood staring for a minute until one of the assistants kindly asked us to move aside. It turns out we're a little too white to be in the background of a movie about Sierra Leone. Eva (we're on a first-name basis by now, I'm pretty sure) was filming for a PBS documentary based on the book Half the Sky, which I don't know much about, but seems to be pretty awesome. It's about women's issues around the world, things like child prostitution and maternal mortality and gender violence, and from what we learned, they're flying around the world with different celebrities, doing interviews in lots of countries and bringing many of these untold stories to light.

At any rate, we got the chance to say hello to her, and it turns out she really is very pretty, totally down to earth, and couldn't have been more excited to hear that we actually had Starbucks coffee on the ship. (Honestly, she almost lunged at me when I said that.) When she found out that we consider these crazy, muddy streets home, she asked about what we do, so we told her a little about Mercy Ships. You want to know what she said?

You guys are freaking rad. Except a different word. But this is a family-friendly blog, so you get the point. Eva Mendes thinks we're all 'freaking' rad, and I couldn't believe I didn't have my camera right then.

The rest of the day went as expected until we were on our way back to the ship. We caught a ride home in a Landrover with some other friends, and were nearly there when, for some unexplainable reason, it just stalled and refused to start again. No one hesitated; all of us girls jumped out and pushed the dang thing a good ways to the HOPE center, where we left it to be sorted out by the transportation guys. I was pretty much past thinking about my stupid decision to leave the camera behind, but did wish I could have shot a video of us ladies heaving on the huge, white vehicle. (Interesting note: it's actually better for guys to push cars not because they're stronger, but because the wideness of women's hips means we can't actually fit so many of us back there. Consider yourself informed.)

This has been set of experiences more deserving than any of the title TIA: This is Africa. So naturally it just ended with Jenn calling me down to D Ward to bring the IPod for an emergency dance party. The sight of a little boy who just lost an eye to cancer dancing his heart out in little stripey socks while another pikin sporting a matching tiger-print gown and tiny black loafers looked on approvingly was just the thing to round out the whole day.

(Sorry I don't have any photos to go with all these words. Did I mention I left my camera behind?)