ali's african adventures

Well, it's Friday, and I'm sitting comfortably on the couch in my cabin on board the Africa Mercy, mulling over the events of the last few days, once again completely amazed by God.

For those of you with long memories (or at least memories longer than mine at the moment; everything they say about pregnancy in that area is true), you'll remember that I was meant to be leaving yesterday. In fact, if I'm doing the math right, I would be about halfway across the Atlantic right now if all had gone according to plan. My plan.

Not His.

Because apparently it's also true what they say about God's plans; they're way better than ours.

As of Tuesday morning, I was fully expecting to get on that plane last night. And then things changed, as things so often do around here. I'm not going to get into the whys and hows; suffice it to say that before I could really wrap my head around it, my ticket had been changed to Monday night. A glorious four-day reprieve, another long weekend to spend with the HoJ before we're separated for ten whole weeks at a time when we'd really much rather be together.

And here's where God come in. Because while I was selfishly celebrating the fact that I get to put off leaving a few days, He was pulling together so many threads in a much bigger story.

Tuesday afternoon, once it was clear that my departure date was changing, I got a call from D Ward. Dr. James is here and he'd like to see you. Dr. James is a Togolese maxillofacial surgeon who Dr. Gary works with every time we come to port here in Togo, and he and I have been trying unsuccessfully to set up a meeting with some other local healthcare professionals for the last several weeks. I ran down to the ward fully intending to make my apologies and tell him that there just wasn't time when I realized that, with my ticket changing, I had all the time in the world.

We don't have a speech therapist on board these days, and so all of the much-needed therapy for our cleft lip and palate patients comes through me. I was trained by the former Team Leader who was trained by our former speech therapist, and you can see where the system might not be quite perfect. Wednesday afternoon, when I was supposed to be packing my things, I met with a local speech therapist and his student advisee. We reviewed our program to ensure that we've been doing the right thing with our patients, and then sat together and worked out a plan for them to continue seeing our patients for therapy long after the ship sails away.

Thursday, when I was supposed to be heading down the gangway, I collected a list of all our patients from this year. The therapist is going to contact all of the old patients to see if they want follow-up, and we'll automatically refer all the new ones to him when they're discharged between now and the end of the year.

If I had been leaving last night, I would have said no to the meeting on Wednesday. I wouldn't have had time to set up the referral or collect information or do any of a hundred things I ended up doing yesterday.

God's plans are so much bigger than mine. I just wanted to hang out with my husband, but God used the extra time to work things together for the good of our patients.

And this morning, when I stopped by D Ward to make sure the charge nurse knew I was available if needed, Esther's nurse called me over. Esther was sitting up in a chair, a cover over the trach that she's been breathing through for the past couple of weeks.

Hello Ali, she said, her voice small and muffled around the tube that's going to be coming out later this afternoon. It's the first time she's been able to speak to me since we stood at the foot of her bed and got her permission to do the surgery that would change her life. And if I had gotten on that plane last night, I would never have heard her voice again.

My heart is full of these unexpected blessings. God, it seems, has opened His hand over me and is pouring out love in such an extravagant manner that it's all I can do to keep upright under the flood.

And now for something completely different.

My brother always e-mails me when we send out a newsletter. Something along the lines of, Nice to hear what you've been doing, but tell the HoJ I really liked his update. He loves hearing what's going on in more than just the hospital, and I figure he might not be the only one. So here, for the first time ever, is something that I hope might start to happen a little more regularly: a guest post by none other than the Husband of Joy! Because I agree with my brother; there's some pretty cool stuff going on on this ship, and not all of it happens on Deck Three.

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God knows. That's all I can think to say when I reflect on events of these past couple of weeks. As everyone knows, I work as an electrician in our engineering department. Most of the time we know what's happening on the deck above (in the ORs and wards and such), but sometimes we lose sight of that because we are very focused on the task at hand.

Usually the only times people realize that there is an engineering department on board is when the power goes off (along with the air conditioning) and the temperatures start to rise within the ship. Power outages are even more dangerous when a patient is on the OR table.

Well, this past week I was given a project to complete. I had to install a variable speed drive for our emergency diesel oil pump. Normally, we run two generators from the main fuel pumps. In an emergency, there are valves that switch over and there is only enough fuel pressure to run one generator, which doesn't provide enough power to run the whole ship. There's a certain amount of air pressure needed to hold these valves over to the 'normal' setting (where two generators will run), but this pressure is hard to come by because the lines get clogged. The variable speed drive would allow us to run two generators no matter what, whether on the 'normal' side or the 'emergency' side because it increases the flow.

[A note from Ali: There is a very good reason I work in the hospital and not the engine room. He's tried to explain all that to me more than once and I just can't wrap my head around it. I'm so glad there are people who can understand these kinds of things!]

So there I was that morning, going down to the engine room, when I noticed something different about the fuel control valves which are on each generator. At first I didn't think much of it; there must be something else going on, but I had this nagging feeling to go and get the third engineer and investigate. So we did that and found out the air pressure which keeps these valves turned in certain direction so that the generators get fuel from the main fuel pumps was dropping.

The third engineer said he would bring it up with the chief engineer, and that we might have to do a planned blackout to clean out the air lines, never something that's easy to accomplish when the hospital is up an running like it is right now. So I went about my work of installing this drive. The plan was for the drive to be installed before intentionally turning off the power so that we could be sure that even on that emergency setting, we'd still be able to run the two generators needed to power the ship.

It was nearly lunchtime so I went up and grabbed some lunch and went to the cabin to enjoy the air conditioning after spending most of the day sweating in the engine room. We normally get an hour for lunch, but I had this nagging feeling again to go and finish connecting the drive I was working on to the emergency diesel oil pump.

I pulled myself off the couch, went down and connected everything, and started up the drive just to make sure the pump was going in the right direction. As I was doing this, people were coming back after lunch and alarms started going off for our main fuel system. Just as I finished checking the rotation of the pump, the power went out.

Pitch black.

The emergency generator kicked in, and we had some lights and power to the systems that we needed in order to start up a generator and put power on the ship, so the engineers tried to start up one generator using the emergency diesel oil pump I just finished working on. It started up and restored limited power to the ship.

They then tried to switch back to the the normal fuel supply, but quickly realized that the air pressure had dropped to the valves and they were stuck on emergency fuel and not normal fuel supply, which meant that on any other day we would only be able to run one generator. There was starting to be a slight panic as to how we were going to get two generators going to power the ship, so I said, Well, I just finished installing this drive. Let's see if it can handle two generators. By the grace of God, the emergency diesel oil pump was able to run two generators and restore power to the whole ship, and eventually, after cleaning the lines and valves, we were able to rectify the underlying problem.

I know you hear a lot of stories about God leading people to other people to minster to them and things like that. This was one of the first times that I can think of where the Lord has clearly guided me not to a person, but to a piece of machinery to help further His kingdom.

Can you say God knows? God knows.

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[Me again: I was working that day, and had just sat down to a late lunch of my own when the power went out. There really is a feeling of panic that rises in your throat when you realize that the lights are taking too long to come back on and that there are patients on the operating tables in the dark, silent operating rooms. I didn't hear this whole story until a bit later, and I'm still blown away by how perfect God's timing is. He called an electrician down to the engine room in the middle of lunch and set him to work finishing the installation of the one piece of equipment that was going to solve a crisis that would begin just as the final tests were run.

God knows.]

Today was another one of the jumbled days, one of the ones where I live a thousand moments that I want to tell you about and then find myself sitting here in front of an empty screen, searching for the words to somehow make you understand what this place means to me.

It never gets old. I've been here for four years, and today I was explaining some of the surgeries we've been doing to a visiting media team and the wonder in their eyes looked exactly the way my heart feels every. single. day. I look around that room at the hope lying in each bed and I can't really imagine anywhere I'd rather be.

My disembarkation form, the one we all have to fill out when we're leaving the ship, was on my door today, Thursday's date printed neatly across the top. I burst into tears when I saw it because it means that my time left is measured in hours now, and hours don't feel like enough.

So instead I measure my time in those thousands of moments.

My mind snaps a photo of a mother and her still-so-sick baby, mama's hands covering her daughter's, protecting her even as she sleeps a sleep born of pure exhaustion. I store the image away to be referenced later on when I need to know how to be the right kind of mama.

Across the ward a teenager returns from surgery. What was meant to be a routine bandage removal turned into several hours on the operating table, but I can't help thinking that Someone planned for this, because the little piece of bone that had to be removed to make room for the muscle that would cover the hole they found was just the right size to give shape to a new nose, one we never thought she'd have.

A newly-minted thirteen year-old is admitted on his birthday, sitting shyly on a chair in the corner, a rag covering the tumor on the side of his face as we dance and clap and sing Happy Birthday in three different languages. His grandma sits by his side, her back ramrod-straight, eyes glittering with the promise that this year will bring for her grandson, for the day coming so soon when he won't have to hide anymore.

Just before shift change, a four year-old taps my leg and lifts up his hands, hope in his still-swollen eyes. I reach for him, settle him on my back, his feet wrapped around my belly, and he rests his head on my shoulder as we gather to pray. From behind me, I hear the amens echoed in his tiny voice.

Soon enough I'll have to open my hands and release this place. But for now I gather these moments like a farmer bringing in the harvest, stuffing my heart until it's ready to burst, tucking still frames and memories into each little corner.

It never gets old.

Tonight marks one week until I leave the ship for at least five months. I hate leaving. I know that it's for a good reason this time, but I'm already dreading the feeling of bumping a heavy suitcase down the gangway, climbing into a Land Rover, and driving away from the port.

One of my favourite parts about this season on the ship, one of the reasons I'm so torn about leaving, is the fact that I've had the chance to be a youth leader again. I love the youth on board here; they're a crazy bunch of kids from around the world, and I've been challenged by their perspectives over and over again. Carys Parker, Dr. Gary's daughter, recently wrote something that was exhibited at the Academy Arts Fair. I stood in the narrow hallway and felt my breath catch in my throat as I read because she's just got it so right.

Africa is my home. She is the sun-scorched deserts and the dripping rain forests, the mighty lion pouncing upon the zebra, the tribes that walk upon her rich, red soil, the palm trees growing strong and tall. The crowded, busy market places, where everything from oranges and mangos to jeans and microwaves are sold. This is Africa. Africa is the people sitting around the fire as the darkness of night closes in, She is the breaking of bones as the women carry their heavy loads high upon their heads, but not of spirit even though death steals so many. Africa is the bright colors and fabrics that blanket the land, she is the laughter of the scantily clothed children as they splash in the waves, She is family, and tradition, and a place of beauty, She is home. This is my Africa.

After years of living here, I have come to look past the poverty and corruption to see the beauty of this cultural land. Africa has forever left her mark on my heart.

Can't you just see it? This is why it's so hard to leave, even when I know I'm coming back. Because my life isn't what it used to be back before I ever set foot on the ship. There's some sort of fundamental change that's been worked deep inside me, some switch that's been flipped and now I don't know where home is anymore. I read Carys' words and I'm convinced it's here, and then I think of the family waiting for me in North America and I can't wait to get to the airport and I feel like I've lost all sense of equilibrium.

Compounding all this is the stark reality that in just a few days I will no longer be working full-time as a nurse. I know they say once a nurse, always a nurse, but I'm not starry-eyed enough to believe that nothing is going to be different. I'm stepping into a completely new reality, and while I love adventure, I'm not so great with change.

And then Lara, another one of the youth, got up at Community Gathering tonight, looked straight into my soul, and spoke to my secret questions. Your story has already begun. God is already doing something in your life. Don't wait for this time to be over. Your story has already begun.

I've been lying awake at night, wondering who on earth I'll be once the title on my badge is different, and all the time God's been writing His story around me and through me. I'm dreading the end of this season when God's already seen past it to the chapters ahead. Why do I doubt Him? This isn't the end of anything.

I'm sitting here laughing to myself as I read back over that last entry, the one where I said I had no idea how I was going to walk away from all of this. I really should stop saying things like that, because this time it resulted in a couple of twelve-hour work days, ever since I hit publish on that entry.

This week, we have a German cranio-facial surgeon on board, Dr. George. When I looked at the surgery schedule last Friday, the boxes marking out his days for yesterday, today and tomorrow were nearly empty, each one saying simply All Day Case. We were waiting to see if we'd be able to get the one neurosurgeon in Togo to come and operate alongside Dr. George and make those cases possible, and right up until Monday, we weren't sure we'd be able to say yes. But those boxes have names now. Rudolph and Maurice and two more waiting to find out whether they'll be able to go to the operating room tomorrow, and as a result our ICU is busier than it has been all year.

Rudolph is four and was born with extra space between his eyes and two holes in the front of his skull where his brain and spinal fluid poked out. Yesterday, Dr. George took apart Rudolph's head and put it back together again correctly, an admittedly meager explanation for an incredibly complex, a ten-hour operation. Rudolph spent the night breathing with the help of a ventilator, but as of this morning we've removed his breathing tube, and now we're just trying to walk the fine line between letting him wake up and keeping him calm enough that he doesn't hurt himself in his quest to get out of bed (something he'd very much like to do, apparently).

In the next bed, three month-old Maurice is snuggled up in his mama's lappa, all seven and a half pounds of him. He was also born with the hole in the front of his skull, but because of the placement, his surgery was much more straightforward. All Maurice has to show for his long morning in the operating room is a little incision curving around his nose, held together with steri-strips and a few IV lines giving him fluids and medications for pain, but he still needs to be monitored very closely to make sure his brain agrees with its new, smaller living space.

Tomorrow at least one of the babies who wait next door in D Ward will join Rudolph and Maurice in the ICU, having also had surgery to reshape their skulls. And I sit here and shake my head, because who would have ever thought that such a thing were possible here in Togo?

I used to work in an incredible PICU back in New Jersey where we had a neurosurgeon who would do cases like these on a fairly regular basis. In fact, when I saw the screening sheets for tomorrow's patients, I just had to smile because craniosynostosis isn't just a jumble of letters to me. But when I quit that job, when I got on a plane to come to West Africa for the first time, I had no idea that I'd be part of that type of surgery over here.

Just outside the ship are dirt roads and tin-roofed houses with no running water. There are six million people in Togo and one neurosurgeon. One, and even if our patients could have found their way to him, the cost alone of an operation like this would have put that dream to death.

Down in the ICU are two little boys who have been given the impossible blessing of having surgery that will give them a chance at life, a chance to look normal and to grow into young men who don't have to worry that their lives will be cut short because of the way they were born.

For once, we get to thumb our noses in the face of that often-repeated lament, that where you're born shouldn't determine the reason for your death. For once, we get to hold out the promise of life to the ones we'd normally have to turn away. I love that I get to be here for this, that in my last days on the wards I get to bear witness to transformations like these.

Esther went outside to Deck Seven for the first time since her surgery today. I can't wait for Rudolph and Maurice to join her out there.

When I opened up the nursing schedule this morning to check staffing for the upcoming week, I glanced up at the top line. It’s the one where my schedule is posted, and I never really look at it because my schedule is the same every week. Monday through Friday, day shift. It’s simple.

Today, though, I looked at my own schedule and it hit me like a fist in the gut. Five shifts left. After four years down in the wards, I have five shifts left until I pack up and fly home for maternity leave. And when I get back, my badge is going to read Primary Caregiver, not Pediatric Nurse or Team Leader.

I’m not saying it’s a bad thing. I’m more than excited about this new chapter in our lives, about the little one growing inside me, about finally getting to be a mama after dreaming of it since I was a teenager babysitting the neighbours. But this morning, looking around D Ward, the thought of leaving it all was a bitter pill to swallow. I’ll still be involved in little ways down in the hospital once we’re back on board with Poppy, but it’ll be nothing like it is now. I get to be there every day, now. I get to work with every patient that comes on board for maxillo-facial surgery. I get to hear every story.

Stories like Esther’s, who, at sixteen years old, came to us from Nigeria with tumors that Dr. Gary ranked in the top five that he’s ever seen. It wasn’t the size of them, although they were impressive by any standards, but the fact that they invaded almost her entire face. Usually we see this type of thing in either the lower or upper jaw, but not both. Esther’s disease had taken over both her jaws almost entirely, and in a marathon, nearly twelve-hour surgery last Thursday, Dr. Gary and two local surgeons took apart Esther’s face and put it back together with metal plates and screws and hundreds and hundreds of sutures.

Esther has been slowly recovering, first in the ICU and now back on the ward, and today I went to stand at the foot of her bed while her nurse changed her bandages and removed the drains from her incision lines. It was the first time I had seen her new face without the bulky layers of gauze and tape, and I couldn’t stop the tears that filled my eyes.

Oh, Esther, I told her, You are so beautiful.

Maybe I’m seeing her through the eyes of a nurse, looking ahead to the future, after the weeks it will take for all the swelling to go down, the months that still need to pass before the extra skin will retract back and tighten. But the little girl lying in that bed is beautiful nonetheless. She no longer needs the scarf that she wrapped herself in when she was admitted, the cloth she’s been using to cover her shame all these years.

Esther’s eyes widened and the hint of a smile crossed her lips as Alana (her nurse) brought her a mirror. She peered into it, just like she has every day since waking up free from her tumors, and dropped it to look back at me. What do you think? Alana asked her. Is it good?

Esther nodded once, that one tiny gesture speaking more than words ever could, and then settled back on her pillows, content to let us care for her.

This is what I’ll miss when I go. I’ve been a part of incredible things like this for so long that I have no idea how to be anything else. And for once, I have no answers for myself, no neat little platitude with which to sum up this entry. Just, I don’t know how I’m going to walk away from this next Thursday.

Today marked fifty-six days since Papakey's first surgery, the one to create a nose to cover the hole left when robbers with a machete made their indelible mark six years ago. Just before rounds, his nurse and I peeled away the dressing on his leg that covered the place where they took the skin that was used to cover the place on his head where they took the nose. (Confused? Everyone is when they first hear about this particular surgery.) What we saw led to much rejoicing. Papakey, self-proclaimed Captain of the Ship (but don't tell the real captain lest I be accused of fostering mutiny) was ready to go home.



We celebrated all morning, wide smiles on everyone's faces every time they looked over to his bed to see him slowly beginning to pack his things. We printed out the pictures we've taken to mark his journey while he's been here. We made sure he had the supplies he needs to keep his new nostrils clean and open.

And when the Patient Life team came into D Ward, we had a party.

The drums were pounding as we clapped and danced and worshipped together, nearly blowing the roof right off that place. As we came to the end of the singing, I felt very strongly that we should pray over Papakey, and the team agreed. They pulled a chair to the centre of the room and had the dear old man sit in it while we gathered around him and laid hands on him. Together we raised our voices and prayed life and protection and continued healing over him. He sat quietly, palms clasped in his lap, nodding solemnly as he caught words and phrases among the cacophony of requests going up around him.

When we finished praying for Papakey, Kodjovi, a patient from the other side of the ward, approached and asked if we could pray for him since he was having some pain. He sat in the chair, we gathered around him and we prayed for him, too. One by one the patients came forward, settled themselves in the centre of the group and voiced their requests. Healing. Safe travel. Encouragement.

Dame got out of his bed, feeding tube pinned to his gown, and told us how he had stopped going to church a while ago, how he couldn't see the need for God. Rebecca translated quietly to me as he spoke. And then I came here. I saw how you care for each other, how you care for each of the patients. I saw the way you love, and I can see the way Jesus loves. He dropped into the chair and looked up at us. I want you to pray for me so I can love like that.

After Dame, it was my turn. The Patient Life team prodded me towards the chair and told me it was time to pray for me and for the baby inside me. I sat in the middle of my ward, surrounded by nurses and translators and counsellors and patients and they all put their hands on me and started lifting us up to God. As they started to pray, Poppy, who had been quiet all morning, responded, jumping around inside me with a strength I've rarely felt before.

I left that chair filled with a joy that's impossible to put into words, no matter how hard I'm trying right now. When I head for the States in just two and a half weeks, this morning is a treasure I'll have tucked deep into my heart, something to carry with me when I'm far from this place.

Because there's something so right about the way God made us to live in community with each other, to rejoice with each other and to carry each others' burdens as we walk towards the Kingdom. Today, down on D Ward, I caught a glimpse of what it'll be like when we're all finally Home. I honestly can't wait.