hope

I always find it much harder to blog once the wards have emptied for the year. It's as if their lives and stories are so much more important than my own. Or, at the very least, a lot more interesting; I can't deny the truth of that. But once they go the place is quiet and dark. Except for the emergency lights of course; you can't turn those off, and they stand constant guard over the empty rooms.

I've been thinking about light a lot in recent days, in large part because of the Advent services that started last week. You know, the ones with real candles. Candles are a big deal around here; open flame is prohibited on board except for these five small candles once a year (and sometimes the ones in Santa Lucia's crown, but that's a whole different tradition for a different day). The International Lounge, where we have Sunday services, is darkened and each week another candle is lit. Last week was the candle of Hope, and as I sat there watching the tiny flicker of the flame, it hit me again what a tremendous thing hope is.

We use the word all the time. I hope it doesn't rain. I hope dinner will be good tonight. I hope this brownie doesn't make me fat. We use it so often that, like so many other weighty words, it's lost much of its impact. I looked it up just now because I love words and all their shades of meaning. The first was unsurprising.

A feeling of expectation and desire for a certain thing to happen.

It makes sense that the first little candle throwing its light into the darkness of a new year is the one christened hope. Hope is that longing for something new, that breathless anticipation of something you can hardly bear to speak aloud.

The second definition was the one that set my heart spinning in my chest.

A person or thing that may help or save someone : Their only hope is surgery.

Hope is so much more than just a feeling, more than an idle wish or a passing desire. For so many, hope is all that's left when the rest of the world has turned away. Hope is what gives a mama strength to hide her baby in a back room rather than bury him in the forest when he's born with a cleft lip. Hope is what keeps a seventy year-old woman walking, all the way from one country to another, seeking help for the tumor growing on her hand. Hope is what whispers in the ear of a man as he lies awake at night, desperately wishing that someone would look past the scars on his face.

Hope is the light in the deepest night, the single flame in the face of crippling despair. It's the unwavering promise that, yes, salvation is possible, that there is a way out, no matter how dark the path might be.

Matthew wrote that nations would put their hope in the name of Jesus.

Is it any wonder that He called Himself the Light of the World?

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.

I was sitting at my desk in the office today, working on some mind-numbingly boring paperwork revisions when I felt a tap on my shoulder. I pulled the headphones out of my ears and turned around, expecting to be answering a question about where some box of supplies should be stored for the sail. Instead, a little girl clad in matching fabric from head to toe threw herself into my lap, shrieking my name.

Balkissa's tongue looks incredible. This second surgery has been a success by any standards, but it turns out God had bigger plans for little Balkissa than just the reshaping of her mouth.

The first time we met her, the doctor examining her heard something worrying through her stethoscope; the whoosh-whoosh of blood coursing through a heart formed wrong. And although the medicine we practice here is, by most standards, first-world, there are things we can't do. Diagnosing and treating congenital heart problems are definitely on that list.

Balkissa's not the first little one we've met with a faulty heart, and so we made sure she was strong enough for surgery and went ahead, leaving the murmur filed under the category of Things We Can't do Anything About. Her surgery, as you know, went well, but when she got home her tongue split apart again. A failure.

And this is where God's planning becomes beautifully clear.

When Balkissa came back to the ship for her second surgery, nothing had changed. Nothing except one of the anesthetists, a doctor named Paul. Paul wasn't here when we first met Balkissa, first heard her broken heart, but because she had to come back to us, he met her too and heard for himself.

Here's where it gets good, because Paul knows of a charity that does work here in Togo, a charity that takes kids to hospitals in the first world where they can get the treatment and surgery that they need for their heart defects. Today, one of our outpatient nurses took Balkissa to the clinic where they'd do an echocardiogram of her heart and decide whether or not the defect was something that could be treated. If it is, they'll make arrangements for her to fly off to another world, to another hospital (this one on land) where she'll be given yet another second chance.

There have been so many times that I've wondered whether any of the complications we see are for some sort of other purpose, whether God has plans for their coming back to us that go beyond just an infected wound or a broken-open suture line.

Today, I have proof. Proof that the hands weaving this story are so much more skilled than our own, that the heart loving through us is so much deeper than any I could dream up.

And speaking of hearts, I'll let you know what they find out about Balkissa's as soon as I know.

Every single day, broken babies are born into this world. Here in Togo, no one knows how many. Often, no one marks their coming but their mamas and the village chief, the one who hands down the proclamation that this baby is cursed, that he cannot stay in the village or the sickness will spread. And so many babies are abandoned, left to die because they were born with a cleft lip or clubbed feet or crossed eyes. In the West, we can't comprehend this. We've gotten to the point where people with special needs are being referred to as "differently abled," and this is a good thing. It reminds us that they are human, that their lives are worth just as much as ours.

Here in West Africa, things are often so different.

Which is why, I think, I'm so giddy when we take care of the littlest ones. When their mamas love them enough to scrape together the money for transport to Lomé, to wait in long lines at screenings in the blistering sun, to endure days and weeks on board the ship while their babies get better. I love knowing that they will never have to know that other life, the one filled with ridicule and shame. The one where they can't make friends, can't go to school, can't find love and get married.

And most of all, I love knowing that they'll know any life at all. Because for Kossi, life wasn't a guarantee.

He was born five days before we met him, in a hospital way up north. Doctor Russ works there, a man well known to Mercy Ships, and when he saw the growth on Kossi's tongue, how the brand new baby couldn't suck and couldn't get milk, he e-mailed us right away. The surgeon's schedule was already full, but everyone involved knew that we had to at least see Kossi; saying no meant that he would starve to death, sharing a fate with so many other of these cast-aside babies.

When he arrived, our littlest man couldn't close his mouth over his tongue. It's a good thing newborns have to breathe through their noses, because there wasn't enough room in his mouth for much other than that growth. We didn't know exactly what we were dealing with, so we decided to do a CT scan of his head and neck to make sure it wasn't a tumor that extended any further. Since he was so small, making sure he stayed still was easy; I swaddled him tightly in a receiving blanket (the only one I could find in the entire hospital) and started a pump that delivered milk through the tube we'd placed in his nose, right to his stomach.

It worked like a charm and Kossi slept through the entire thing, his whole body fitting into the part of the CT bed meant just for the patient's head. The next day, Kossi had surgery and returned to the wards where his mama and papa were waiting. Instead of the mass on his tongue, there were just a few sutures. Instead of a death sentence, life spread out in front of him.

Kossi's still struggling to learn how to breastfeed, and since his family lives so far out of town in a village where formula isn't really available, (even if they had the money to buy it) we need to make sure he's a champ at it before we can send him home. Which means that we get to keep him for a few more days, bundled up in his blankets in his little corner of B Ward where his mama watches over him.

And every time I catch her eye, she looks up at me, the scars on her cheeks lifting with her smiles, and she moves aside the blanket so I can see his little face.

Because she knows I love him, almost as much as she does.

The ladies danced today.

To you, that might not mean much. It might conjure up images of women in a club, dressed far too scantily for their own good, gyrating to repetitive beats from over-sized speakers. Here, it is so much different and so much more.

Our ladies are the ones forgotten. I flip through their charts and see their pain in black and white on their screening forms. When was the pregnancy? The answers vary. Five years ago. Seven. Fifteen. The baby? Stillborn. Stillborn. Died within one week. Very seldom is alive circled, and these women have carried their sorrow like a cross pressing heavy on their shoulders. Do you leak urine constantly? Yes. Yes. Yes. And with each yes, another reason to stay hidden, another board across the window and so daylight barely reaches their souls.

But today they danced.

Five of them gathered in an empty ward, a tray of makeup on a bed in the corner. Each woman donned a brand-new gown, the fabric still stiff with wax, the colours vibrant against their dark skin. Around their necks handmade necklaces, jewelry crafted while those of us not cursed to live apart whispered words of hope to their upturned hearts. Loving hands wrapped and re-wrapped headdresses, fabric formed into peaks that nearly brushed the low ceilings of Deck Three when they stood to admire themselves.

One by one, we held up the mirror. One by one, the women gazed into it, seeing, maybe for the first time in five, seven, fifteen years, their own beauty. Eyes bright with hope. New cloth unstained with urine. The chairs dry under their legs as they sat and stared.

I didn't have a chance to sit in B Ward while they danced, while they told their stories of joy and triumph. But I was there while they prepared. I was there in the quiet moments while they breathed deep and composed themselves before taking the stage in front of nurses and doctors and sisters still in bed, catheter tubing running from beneath blankets, hope growing with each hour that passes dry.

I was there. I felt the grip of arms thrown around my neck, the softness of freshly-combed hair against my cheek. I saw the smiles, first hesitant, but gaining strength the longer they looked at themselves, transformed. I shared in their joy and could not begin to understand the pain that made it so unbearably sweet.

For all of this, I count myself blessed among women.

I feel so silly today, like a little kid who threw a tantrum because she didn't get her own way, when really her papa was planning on giving her a second scoop of ice cream all along.

I got the call late last night, while I was lying awake in bed and worrying about Maurius. Just so you're aware, he's had another episode, and they're taking him back to the OR to put in a trach. For Maurius, an episode is nothing to be scoffed at, nothing like on TV, where everything is neatly packaged by the end of the show. In this case, nothing has been that simple. He'd somehow managed to block off his breathing tube for the second time in less than eight hours, and the doctors were simply unable to get another tube in its place. There were no other options.

Sleep was a long time coming last night as I sat on my couch and prayed even as I raged at God, unable even in my anger to stop asking Him for hope. Why can O'Brien have a miracle while Maurius suffers through yet another traumatic procedure? Why one and not the other? And yet I couldn't stop myself asking Him for wisdom, for skill, for sure-handed surgeons. Questioning His will and asking Him to provide all in one long, jumbled-up prayer that I'm sure the Spirit had to interpret for me because I know I wasn't making any sense.

So many of you have written and reminded me that it's okay to question, that it's okay to be angry, and I'm so grateful for that reassurance. Your words mixed with His in the dark of the night, and I found that I was able to trust even through my hurt. Remembering that the promised light is only for the next step. That even though right now all I can see is the snake across my path, the step after that, when the Light moves forward with me, might be something so incredible that I'll wonder why I was ever scared to begin with.

And so of course, with the morning came the light. Mercy new with the dawn, and Maurius is surprising us all. I sat with him while his nurse took her lunch break and the ventilator continued its relentless pulse. His bottom lip stuck out in a constant pout, and he kept trying to pull on the tubing connected to his new trach. The solution was obvious, although I'm not sure who ended up benefiting more from it when I stuck my finger in his chubby little hand and he held on with all his strength. His forehead smoothed out and his heart rate inched down a couple points and I sat there, the pain in my heart easing just a tiny bit, hardly daring to breathe while I watched him do so effortlessly. Such a change from yesterday, and his soft fingers clenched around mine let me hope in a way I hadn't dared before.

It appears Maurius has decided to stay with us, because when I checked on him again before leaving for the day, the ventilator sat in the corner, unplugged and silent. Maurius was wide awake, glaring at us with his furrowed brow, needing just a little oxygen blowing into his trach to help him breathe. He's apparently not a huge fan of all the fuss, and would most likely prefer to be in his mama's arms, chugging a bottle.

All that will come with time. Maurius is at the start of a long road, but the Light that's shown us the path this far will lead us home, I'm sure. And somewhere, in the background, I can almost hear God laughing at me. Not mocking or derisive, that laughter; just the amused chuckle of One who could see from the beginning that there was really nothing for me to get mad about in the first place. The One who knew I was going to get that second scoop of ice cream, and forty seven more, if only my bowl were big enough to hold it all at once.

I'd like a bigger bowl, please.

This morning, in the corner of A Ward, a little baby smiled at me. Not a huge accomplishment, you might think, since I'm goofy enough that there are very few babies in Africa who won't give me a grin, given enough time and stickers. For this baby, though, it was more of an effort. His top lip just barely moved, held in place by the steri-strips covering a neat row of sutures. The smile was fleeting, the smallest of moments, but his mama saw it and turned to me, her eyes full of wonder.

Konu, she whispered to me, hardly believing that her little broken boy was learning to smile like all the rest of them. A smile. She grabbed my hand and held it tight, gazing at her son who lay on the bed in a pile of blankets, kicking his legs contentedly. She let go after a while, and started to pack her things.

And so, once again, life comes full circle. The little baby who met us on the dock when we arrived (see his tiny little legs?) was back out there today, resting in my arms again. Only this time, he didn't feel like he was going to float away. This time, I noticed the weight of him, felt his soft, round cheek squished against my arm and the rolls of his legs in my hands. This time, instead of a lip split wide, his nose sits atop a perfect, unbroken line.

His mama climbed into the car first and turned immediately, holding out her arms for her baby, her face alight with the promise of new life. I relinquished Francois willingly into those arms because I knew that her heart was as new as her joy.

Just a few days ago, the nurse asked a question of the mama who had tried to leave her baby boy in an orphanage, afraid of his split lip, afraid that she couldn't live with a broken baby. What will you do, she asked. What will you do when you go home? And Pirette, her smile small, revealed that life had won, that hope had finally found a place in her heart.

I want to take him home.


In this season of Lent, I think that mama's words are so much more profound than she will ever know. Isn't that exactly what God said to all of us over two thousand years ago? Isn't that what held our Saviour to the cross while thousands of angels waited with bated breath for Him to ask for it to stop? I sit here, centuries after the fact, and in a mama's words I hear God speak to my heart and it's a revelation all over again.

I want to take you home. I will risk everything to do it. I don't care that you're still a little bit broken. See? I have started to mend you. I have started to make you whole, and I won't stop until you're perfect. I just want to take you home.

Pirette and Francois will come back at the end of the outreach for Francois to have his final surgery, the one to close the hole in the roof of his mouth, the surgery that will finally make him whole again. And until that day and for the rest of her life, that mama will love him with a love that has won out over death.

There's no way I can fathom how much more my Papa loves me.

Last week was hectic, to say the least. After all the rigamarole of opening the wards, orienting new translators (so many of whom don't seem to speak English) and ironing out the kinks in a system that seems to change on a daily basis, I was exhausted. Knowing full well that it was only week one out of thirty for the outreach, I was well aware that I needed to rest or else I wouldn't be able to head back down there this morning. To that end, I spent the weekend in my cabin. I ate zero meals in the dining room; the HoJ brought provisions and I subsisted on popcorn and garlic bread.

This morning, feeling well-rested and energized, I walked onto a completely different ward than the one I left on Friday afternoon. The patients were quiet and relaxed. (All but Bobo, who felt the need to cry all. day. long. The photo to the right is of Bobo; it was not taken today.) The translators moved about their work with quiet efficiency, and the nurses were confident in their tasks.

The best part of the day was the very end. As the evening shift nurses filtered in, I realized that two of our ward disciplers were there too. Could we have worship, I asked them, and before I knew what was happening we were packed into the ward, singing and dancing. Someone had brought a drum from D Ward, and the sasa was shaking. We clapped and shuffled and belted out sings in three or four languages.

In my arms I held two-year old Kodjovi. He had his cleft lip fixed on Friday, the steri strips and little sutures sticking out of that lip the only indication that anything was ever wrong. When I moved, he bobbed his little head in response. When I held up my hand he used it to clap, his little feet rustling against my hips as he danced along with us.

We stood there, all of us, raising our voices to God at the start of the new shift. We put our arms out to each other, and all around the ward we joined hands. Small and tall and brown and white, some laying in their beds, others sitting on stools beside them, we intertwined our fingers and bowed our heads to pray.

While all this was going on, Francois peered over from his bed in the corner, his bright eyes making him look for all the world like a little baby bird. Our little chicken baby, once so scrawny, now weighs in at over eight pounds, complete with round cheeks and little rolls on his thighs. His mama mixes his bottles and baths him in a blue bowl and covers him liberally in baby powder. He is absolutely thriving under all the love.

Tomorrow, Francois will go to the operating room to have his cleft lip repaired. The mama who tried to leave her baby in an orphanage will have the chance to take him home with a smooth, straight lip. So while we all stood around praying, I snuck a peek over at Francois. His grandma was holding him, his mama's eyes shut tight while she mouthed the words of her own prayer along with us.

Tomorrow, we're going to see that prayer answered.

Yesterday was the first time I sailed into Africa. I've flown in to meet up with the ship for the past two years, going through the rigamarole of airport security and baggage claim, the sticky drive to the port to finally walk up the gangway. Yesterday was different.

As we sailed in to the port, I heard the sound of trumpets, too faint to make out a tune. We passed the familiar canoes, at least one fisherman in each invariably bailing out the water while another stood to wave to the Yovos lined up at the railing. The water was aqua under an overcast sky and the Togolese flag flew proudly from the tugboats.

As we drew closer to the dock, the indistinct sounds from the band took on shape until I could pick out trumpets and trombones and maybe even a tuba. They were waiting for us on the end of the dock, playing African worship songs and drumming until I thought they would break their sticks. The women waved handkerchiefs wildly in the air and everyone was dancing the unashamed dances of the truly joyful.

As we pulled alongside our berth, they walked with us up the dock, shouting and waving and welcoming us to our new home. They joined up with another, much larger group, one with twice the drums and even more dance moves. My shoulders were warm in the sun and I was sweating through my shirt and I couldn't stop dancing with them, my cheeks hurting from the smile I couldn't stop.

Later, much later, when the sun was almost down, the dock was deserted. The drummers had long ago piled into their buses and the marching band had marched off to rest their tired lips. I was waiting in line for dinner when a friend caught my eye. There's a baby on the dock. Needing no further encouragement, I ran out into the sticky air to find Francois.

He's very small, our Francois; he'll be two months old on the nineteenth, and he weighs a little over five pounds. Huddled around him was a much smaller welcoming committee than the one before. No drums, no fancy clothes, no dancing. Just a mama, a grandma and a little baby, all skin and bones, his lip and palate split wide, his future hanging in the balance. With them was a nurse, who I later learned works at the orphanage where Francois' mama was planning to leave him. She didn't want a broken baby, but the someone had heard that the ship was coming, convinced her that there was another way.

I took him in my arms, his little scrawny legs hanging out the bottom of the damp piece of cloth he was wrapped in. I buried my nose in the cloud of his hair, black and curly and softer than anything I've felt before, and I breathed deep before handing him over to our feeding program nurse who was going to be overseeing his care.

I wanted the drums, then. I wanted the handkerchiefs waving in the air and the ladies dancing in their finest African clothes. I wanted the whole world to know that here on our dock, a mama was choosing life for her baby. But they just climbed into a Land Rover in the gathering dusk, heading to the off-ship house where he'll stay until the wards are open.

And like that, it has begun. Welcome to Togo.

Little Wasti is doing better than anyone expected. He spends much of his time propped up, sultan-like, on a pile of the softest blankets we've scrounged from whatever linens haven't been washed and packed away for the sail. His mama dresses him in a motley assortment of clothes, and she makes sure to tuck the pillows securely around him when she leaves his side.

Today, Wasti was also wearing eyeliner.

This might seem strange, wrong even, that a six-month old baby should be sporting charcoal rims under both his wide, black eyes. Over here, though, it means everything. It means that his mama has decided that he's hers, decided that she wants to mark him as belonging to her, with all her wild, tattooed beauty. It means that, for the first time in his short life, she sees his future.

Over the course of the day today, Wasti's story was fleshed out, the pitiful bones we'd heard on Friday taking on heartwrenching shape. His mama is one of many wives. I'm assuming her husband is well-off, because when each wife came to stay, she was given a cow and a small piece of land, a pittance with which to scrape out a livelihood for whatever offspring she would produce for him. Wasti's mama made nothing but broken babies, and one after the other she sold her land and her cow, trying to find the money to put together the pieces of her shattered children.

It wasn't enough. It's never enough, here, and so she was turned away, sent from the village. I'm guessing that the sum total of her possessions is represented in the two small bags and several bowls that are tucked beneath Bed Twenty right now.

The ship was her last chance. She came on the razor's edge of too late; his would be the very last surgery of over six thousand for the year, and we almost said no. Go away. Your baby is too sick. He's too broken, just like everyone has always told you. No.

But instead, in the corner of B Ward today, there's a tiny family on its way back from the darkness. Wasti's mama looked hopeful as she told us that she's almost sure that they'll let her back into the village. That there's more than a good chance that she can go home again. I just have to figure out how much a new cow is going to cost so we can take up a collection for that little boy's mama. But all that will come in time.

For the next few days, my job is just to sit back and watch. To watch Natalie, our pediatric coordinator, work her magic as she teaches a completely illiterate woman how to tell time, how to count precisely, how to measure water and mix the formula so that her baby will get enough food. To watch a little boy soak in all the love he's never known. To watch hope grow in a barren heart.

To watch a mama find her way home.

My heart is so full right now that I don't know how I'm keeping it in my chest. It's threatening to burst, spinning colours and light into every corner of this ship.

It started last night when, in a truly symmetrical end to my day, I got wind of yet another baby on the dock. I headed out into the damp night air to find Wasti, a little one who had come to the ship from way up north earlier this week to have his cleft lip repaired. He was too sick, though, and so he was sent away to a local hospital. We knew it was too late, that there was no way he'd be well in time. And yet there he was, his eyes bright, his skin hot, but not burning like it had been. We brought him on the ship.

All through the evening we pondered, weighing life and death, trying to decide what to do. You see, Wasti is not a normal little boy. As far as we can figure, he was born with a condition known as holoprosencephaly. Normally this is fatal, but the fact that he just had a little cleft lip pointed to a less severe case. Either way, this little boy has a brain that is not normal, and a life expectancy even lower than usual here in West Africa.

As Wasti's story unfolded through no less than four translators, our path became clear. His mama is strikingly beautiful, her face covered in tribal tattoos. She has two children; Wasti has a big sister who was born with some kind of eye trouble. Much of the family's money was spent on her treatment, and when Wasti was born broken, too, his mama was cast out. Abandoned by her husband and shunned by her village, she had nowhere to go. Sending her home with a baby still broken on the outside, whatever might be happening inside, just wasn't an option, because unless he was repaired, there was no home to go to.

And so we prayed. We prepared little Wasti for surgery and we prayed strong prayers to Jehovah Rophi, the God Who Heals. There are currently three pediatric ICU nurses on board the ship, so the three of us got together and worked out who would be on call for all the shifts over the next few days, should anything go wrong. I drew tonight, and so I donned scrubs and booties and headed into the OR to see how the surgery was going and whether or not I was likely to be needed.

As I stood in the corner, quietly observing, the anesthetist, Michelle, called over to me. You can see much better from my seat if you come ventilate. I laughed, assuming she was joking, since the little boy, no bigger than a newborn at six months of age, was already totally covered with sterile drapes, a breathing tube in place. When she held out the bag attached to the tubing, I knew she was serious, and so I moved around to the other side of the table and took her place on her stool. She coached me for a while until she trusted me, and then she stepped away, leaving the bag in my sweaty little hand.

Throughout the entire operation, I sat no more than three feet from little Wasti, pushing air into his tiny lungs, my eyes torn between watching the monitors and staring at Dr. Tony's hands as he meticulously stitched Wasti's lip back together. I couldn't keep the grin off my face, incredulous at the thought that I was a member of the team performing the last surgery of the outreach, the surgery that seems so symbolic of everything we do here. Neat rows of sutures. A ticket home.

When the surgery was over and the breathing tube removed and Wasti was making a mockery of all our worries, I left to eat dinner. I shared the news of success with so many people I passed, people who had been upholding us in prayer. And when I had finished eating, I went back down to the recovery room to check on him.

Now, I know that God provides. It's just that I don't always see it as clearly as I did today. When the recovery nurse called the ward to ask if she could bring Wasti back, the ward told her no. That there was another sick baby. That the nurse didn't have time. I headed over to help, and ended up admitting Wasti back into his bed while his nurse worked with a team of anesthetists and other nurses to stabilize her other patient. Just the right people, at just the right time.

I settled Wasti's mama on the bed, propped up on a throne of pillows, her baby in her arms. I cooed and kissed, changing his diaper and mixing formula so she could start feeding him. And for the first time, I saw her smile. The austere beauty of her face was transformed, softened, as she gently touched her son's downy cheek with a finger roughened from hard work. She looked up at me with wonder in her eyes, and she laughed. She laughed and stuck her thumb in the air, repeating a word over and over in her language. Through those four translators, I learned what she was saying.

It's good. It's good. It's good.

And so surgery is finished for the year, and I can't think of a better way for it all to have ended. My hand is stiff from pressing the ventilation bag for an hour. My arms smells like sour milk from where Wasti drooled on me while I held him and his mama ate her dinner. My back is sore from bending over the bed, trying to get him settled.

But my heart is full. Full of hope and light.

The ladies are back.

A Ward has been filled with a sense of anticipation for the last few days as women wrapped in their best lappas have shuffled in and out, answering endless questions about their medical histories. The stories vary, but the end result is the same; I was pregnant, and now I am wet. Some ladies come with babies and little children, but these are the rare ones. Mostly, they share the same thing. The baby died. It was inside for too long and it died and now I am wet. When I meet their eyes, I read fear and rejection and despair and this unquenchable, overwhelming hope.

(Just know, as a caution, that I'm going to get slightly graphic in this paragraph. Not so much information for the kids.) Women with obstetric fistulas (we call them VVF ladies, as an umbrella term) are the modern-day lepers. During a prolonged and difficult labor, the pressure of the baby's head against the bones of the pelvis causes soft tissue to die. When the baby is finally born (almost always dead), the woman is left with gaping holes between her bladder and vagina. The rectum or urethra or any combination of all three can be affected. This, effectively, tears a woman's life apart, because when she develops a fistula, a woman becomes an outcast. Often, she is turned away from her family. Her husband leaves her and she lives on her own outside the village, smelling of urine and feces. Unable to stop the flow of her humiliation.

Maybe you've never heard of vesico-vaginal fistulas (VVFs). I'm not surprised. It's a problem that's almost unheard of in the developed world, where woman have access to medical care and hospitals and cesarean sections when things go wrong. Here in developing nations, it's estimated (by the WHO) that fifty to a hundred thousand women every year develop fistulas. There are over two million living with fistulas. And there are only about thirty thousand surgeries being performed every year.

You do the math.

We're standing in the gap in one of the biggest battles you can imagine. We've screened and selected twenty-one ladies. Twenty-one, in the face of a hundred thousand. I look at the statistics and I want to cry, knowing how many more will go to sleep tonight, weeping her shame as the bed underneath her grows wet again.

But for these twenty-one, we are offering the world. We are offering love where they have known rejection, acceptance where they have known disgust. We are going to try and put back together the ruined pieces of their lives, and I've got a front row seat.

The first lady came back from surgery this morning. She rolled into the ward on the OR stretcher, grinning at anyone who would look her way. I grabbed her chart and flipped to the operative report. Words like excellent, and full closure stared up at me, and I grinned as her nurse tried to straighten out the absorbent pad on the bed. The nurse smiled back at me. We might not need this.

Because this lady, and twenty more, might go home dry.

(For more on VVF, there's an amazing documentary about the fistula hospital in Ethiopia. If you've got a big enough stock of tissues, go check out A Walk to Beautiful.)

This is Aime, the little boy with Burkitt's Lymphoma who we lost a little while ago.

When one of the ward nurses, Hannah, started talking about hope in devotions today, all I could think of were his little round cheeks, his swollen belly and his sad-faced mama. How on earth are we supposed to hope when we see pain and despair like that over and over and over?

And of course, just like always, I'm stopped short by His words.

May the God of Hope fill you with all joy and peace as you trust in Him, so that you may overflow with hope by the power of the Holy Spirit.

And suddenly it doesn't seem so crazy after all, hope in the face of all this darkness. It feels like I'm learning this for the first time, but I've finally realized that it's not up to me. I'm not the one trying to grow hope in a broken heart; it's Him.

My heart is held in the hands that threw stars across the night sky. My heart is hidden beneath the shadow of wings that reach from eternity to eternity. My heart is mended by the Carpenter, pieced back together with the same nails that pinned Him between heaven and earth.

I've got to believe that He's not going to let me be emptied.

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.

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

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

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

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

Hopefully, back to love.