Translation Trials or E18

As I researched Benin, one of the things that I most wondered about was the language that was spoken. According to everything I had read, most of the population speak either French of Fon......I'm here to tell you that most of my patients speak neither. According to the translators, there are 62 different languages spoken in a country the size of Pennsylvania. Last night there were 14 ladies on the ward. They spoke French, Fon, Lopa, Pilla, Fulani, Foun, Kabye, Wama, Bariba, Lamba, and Titamari....14 ladies, 11 languages. Most of our translators speak English, French and Fon. Very rarely do they speak a northern language. We have gotten very creative miming "I'm going to give you a suppository now". I'll let you picture how it's done. "You need to take a sitz bath" and "have you had a BM? are also amusing and cross cultural. When I need to convey more complex instructions such as pelvic floor exercises, and pain scale, it really needs to be verbal. So picture this scenario..... a crowded ward, a curtain (hung with magnetic hooks so it can be moved) drawn around the bed, the patient laying in bed with myself, the translator, another patient and yet another patient.....that's right 4 of us gathered around this poor woman's bed. So I say "we need to teach her how to do exercises that will help her to be able to hold her pee after the surgery". The translator repeats (I hope) what I have said to patient #1 who repeats it (I hope) to patient #2 who repeats it to the awaiting recipient of my nursing knowledge (I hope). Now I feel fairly comfortable with the process except for when: 1. the translator gives me a blank stare, 2. I say one sentence and they talk for 10 minutes, 3. I talk for 10 minutes and they say one sentence. All of these happened during the course of the conversation...I mean instruction. Anyway, I eventually felt that I had conveyed as much information as the format was going to allow, I shued everyone away and indicated to the patient that I would like for her to demonstrate the exercise to me.....I then discovered that it can be very difficult to ascertain as to whether pelvic floor exercises are being done properly and then 2 hours later she mimed to me "can I go to the bathroom now?"

One of the things that we learned in Perspectives was how much more effective sharing the gospel was when it was done within the same culture. They had ratings from E0 to E4 whereby in E0 the Evangelist and the recipient where the same culture, E2 slightly different cultures, etc. I think that having to talk through 3 people has to be at least an E18...don't you? But sometimes God doesn't read the books. A few Saturdays ago, myself and another nurse where working together on the ward, our work was completed, I'd already amused the ladies by teaching a few of the translators the electric slide, but we where running out of things to do. Well, then my partner did the most amazing thing. Somehow we had the right mix of people and she was able to just start talking with them about Christ. She told them of his love for them and about how He knows all of the hairs on their heads and He knows how long they have been wet and of their grief at being wet, and then she told them how to receive Jesus into their heart. They told her that they had heard of this Jesus but didn't know what to do about it until she told them.....it was just the most incredible thing, watching God use this willing nurse to spread His wonderful gospel....E18 indeed!!






The lady in the middle was kicked out of her husband's house after she became incontinent. The man holding her baby is her brother. He brought her down from up north and stayed while she had her operation and recovered.

Some of the faces of the north. The tattoos and scars indicate what tribe they come from. It is my understanding the the government is outlawing this practice as it can be used as a way of "profiling", almost a caste system.

It's late and I need to go to bed....hope all is well on that side of the pond.

Noma

Noma is a disease of poverty. You will not find it in a developed country. It is a bacterial infection run rampant. Many times it occurs when a malnourished child has one of the common childhood diseases such as measles. With the additional insult to their immune system, the normal oral flora overwhelms the body's natural defenses and eats away at the flesh. It has a predilection for facial tissue. It will kill most of it's victims, those that survive will be scarred for life. I just goggled it and the world health organization fears that it is on the rise. While it could not be eradicated, a 10 cent vaccine for measles would greatly diminish the number of children afflicted by it. Unfortunately, the poor cannot even afford that much. The local people call it the melting disease. On Monday, you have a beautiful child, on Wednesday, his face has been destroyed, he no longer has lips, sometimes the nose is gone as well...that is, if he is still alive. A nurse with antibiotics could cure it if caught within the first 24 to 48 hours. Goggle it if you want to see the devastation it can cause. Most children die, those that survive live on the outskirts of society. They hide as much as they can. They are ashamed of their appearance.

Christine is the only Noma patient I have taken care of, and I had her the day she went to surgery. Please don't think I am heartless, but I want you to get a feeling for what these people live with every day. She truly defined the word "hideous". She had a hole in her cheek the size of a lemon. Saliva seeped out from it and from between her lips which she could not close because of her swollen gums. Her facial skin was drawn so that it caused her to not be able to shut her eye which was red and weeping. Without the push back of her lips and cheeks, her teeth were pointing randomly, some through the hole in her cheek, some out the front of her mouth. She would not look you in the eye. I first saw her as she lay in bed, facing the wall, covering her face with a sheet, a dirty rag clutched in her hand. As I would work with her, she would uncover herself (I learned that she used the rag to wipe at the drool), and whenever I was done, back went the sheet as she tried to hide herself. Over 20 years of rejection, pain, and suffering where reflected in her eyes. I saw no hope in them even as I prepared her for surgery. I think I wrote earlier how the surgeons took the temporalis muscle and made her a cheek and then grafted skin on top, many teeth had to be removed. I just spoke with the nurse caring for her tonight and she said that she was just looking at herself in the mirror. I wonder, how does it feels to her to want to look in the mirror? Slowly she is emotionally recovering. Dr Gary says that she is getting a little sparkle in her eyes, the eyes that had been so hopeless.

Mercy Ships saw a lot of Noma in Liberia, a country that has had most of it's infrastructure destroyed by many years of civil war. Thanks goodness, Dr Gary says that he has not seen nearly the number of Noma patients here in Benin. He says this is a reflection of improving health care. Let's pray that it continues to improve... that no more children will suffer as Christine has.

I am at work again tonight. It is my second night of 4. We always start out our handover with a prayer but tonight we had a special treat. Two of the translators had brought guitars and they, with several others, sang. Although, we may not have understood all the words, it was obvious that they where praising God. It was an awesome way to start the shift.

God is good all the time, all the time, God is good.

Social life on the Africa Mercy

Disclaimer, long post, more chatty than mission...may want to skip...



Now I know that many of you think I'm a saint and that I am working all the time....hey I heard that!!! Actually there is an active social life on the ship and since I have partaken of it heavily last weekend, I thought I would share.

Meals come at regular times on the AFM. Breakfast 6:30 to 7:30 (pancakes on Wednesdays), lunch 11:30 to 1:00 and supper at 5 to 6:30. The only variation is the weekend when breakfast is 30 minutes later and you fix lunch at breakfast as the cafeteria doesn't open at lunchtime. In the cool of the evening after supper, the families with small children tend to gather on deck 8 which is open to the air. The kids have several choices of what to do. There is a round above ground pool (just put up last week) and a jungle gym that was erected last year, as well as many riding toys (which I have seen some not so young crew ride). I think that it is wonderful for the 50 or so kids to have this area as they do not have a backyard or traditional playground anywhere in Cotonou.

The rest of the crew who are not working tend to gather in the midships lounge where the Starbucks and Internet cafe is located. Starbucks is open for about an hour and a half most evenings and I must admit, many of us are just devastated on the few nights that it is not: ) We have to have a trained barista to operate the coffee machine and it is a volunteer job, so occasionally it won't be staffed and there we will stand with our coffee cups (we have to bring our own cups to cut down on waste). It would be amusing to watch if I weren't one of the devastated. After coffee, one can usually join a card game or find someone to walk the dock with. We had a British dentist here for a few weeks who was quite the game master. One night he had a group of about 30 or 40 of us hooting and hollering as we played a game where you ended up sitting in each others laps (the record was 8 people in one poor soul's lap) as you tried to make your way around a circle of chairs, yours truly won...whoo hooo. Myself and a few friends usually end the night up on deck 8 aft enjoying the breeze coming off of the ocean before retiring to bunk at about 10:00.

Last weekend I ended up with a very busy schedule! Friday night after work, the ward nurses went out to eat at Livingston's which is an English Pub. It had many of the traditional food items (I got a thin crust pizza which I thoroughly enjoyed) but the surroundings where definantly African. Saturday morning, a group of us went to a large craft market (about a 45 minute walk from the ship) and spent a few CFA. Then, at 3:00, I went on an organized crew activity to Obama Beach. We are not allowed to swim as the currents tend to be pretty strong....but we did some high wading, watched people, drank coconut milk from fresh coconuts and then had the fellow who brought them chop them open for us so we could eat the nut part. That was a little scary as he whacked into the middle of the coconut with a machete while holding it in his hand...I just knew that us nurses where going to be called into action but he never misjudged the force required to cut half way rather that all the way through to his hand. We then partook of a fairly traditional African meal before adjourning to a bonfire and then limping home to gratefully take showers at about 10:00 at night. I enjoyed all of the meal except that I have to say, I am partial to chicken with a little more meat on it. The chickens around here are called "bicycle chickens" as they are always running about. They tend to be....shall I say a little scrawny. Of course, then I felt guilty for not fully appreciating the meal as there are so many who would have considered it a feast. Just so the night wouldn't end on a boring note, one of the Land Rovers broke down and we had to find a rope and tow it back to the ship in the dark hoping that no scooters would try and cut between the cars.

So Sunday, I had planned to go to the local church I had gone to previously, but couldn't get a ride....so....I went to Bab's dock. what a lovely piece of the world! We took a boat ride through a mangrove swamp and ended up in a large, shallow brackish lagoon. A Belgium couple have built a dock with a restaurant which was just lovely. It was so wonderful to hear birds again. I don't know where the birds are in Cotonou, but I had only heard one since I have been here until then. There where loungers, hammocks, kayaks, and even a sailboat to enjoy. The younger set played water volleyball while the rest of us napped, turned over, and napped some more. The peacefulness was only occasionally broken with a shriek when one of the numerous lizards decided to scamper over a sunbather. I got to where I didn't mind them so much unless they decided to stop and bask. We had hamburgers and french fries for lunch which where perfect (even if there where no buns....did you know that much of the world doesn't have bread with their hamburgers?) They also made a nonalcoholic drink from hibiscus flowers and lemongrass which was really good and refreshing. We just had the most relaxing, wonderful day away from the ship and got back at 6PM just in time to have supper and go to church at 7:00.

Then it was work on Monday and Tuesday. I worked evenings this week, so Tuesday morning I got to visit the dental clinic, the eye clinic and the hospitality center. I will post more about those later. Wednesday morning, I went back to the orphanage. It is so impressive (and very cute) to see how scheduled the nuns have the children. We arrived at about 9:30 and played with the young ones (about 2 to 4 years of age) for a few hours before lunch. They where given large bowls of a reddish gruel (can't think of a better word) which they ate every bite of. After presenting their empty bowls they where given a glass of water. They then pulled off their underpants (some of them needed help) and walked to the next room where there was a line of pottys. As we left to go back to the ship they where each sitting patiently on their potty until it was time to go and take their naps.....where where the nuns when my kids where young???? I saw Ibrahim, the young boy I posted about earlier. He is such a pleasant chap and I'm sure he will have many visitors when he comes in April for his surgery.

So that was my week. Life in a small community such as the ship has proved to be wonderful in so many ways. You can almost always find a playmate or prayer mate (depending on the need) and there are a variety of stimulating activities....but I do have to admit....sometimes.... occasionally...... truly only once in awhile...... it feels like you can't fart that someone is going to smell it.

On a more sober note. Please pray for Wessegui. She is one of the VVF ladies. She is an older women but just such a delight. I think her VVF surgery was successful, but she has an infection somewhere in her body and is having a difficult time. As always, thanks for any and all prayers.

1.5 kg tumor

I almost got called to give blood yesterday. When our patients need blood, guess where it comes from? The different, neat, Africa thing is that we (the crew) give it, and the patient receives it while it is still warm. You know, at home, you are far removed from ever seeing who will receive you life giving gift. Here, there is no delay! Yesterday, this lady had a 1.5 kilogram (about 3.4 pound) tumor removed from her face. She was in the OR for quite a while and ended up having to have 5 units of blood. If she had needed 6, I would have been her girl. They thought for awhile that she would need to go to ICU, but she recovered nicely and ended up going to the ward with one to one nursing. Last week, there was a patient who had a large tumor removed and when she went to recovery my roommate (Linda from the UK) was her nurse. She got out a mirror for the patient to look into and was very moved by the pleasure that she saw in the patient's face as she felt the bandages that covered the part of her face where her tumor had previously been. I don't know, how do you put a price on being a part of such a ministry? I can't. It has and continues to be a wonderful blessing.

So, I'm on call for blood tomorrow. Now I don't wish anyone to do poorly, but if they need blood....I think that it would be very cool to provide it!

Sorry I'm not replying to any comments. I have tried several times, but I think the Internet here is slow and it keeps bumping me off. I do read each one and very much appreciate the kind words and that we are remembered here.....although I think some of you may be just a touch blind: )

Ganuvie and Dr Gary

These are the Land Rovers used by Mercy Ships. They can be signed out by the staff for 4 hour increments as long as the gas is payed for and it is a registered driver.

On my first weekend here, I managed to snag a spot on one of the Land Rovers that was taking an excursion to Ganuvie (the stilt village) which is close to Cotonou as the crow flies (but an hour or so away through traffic). I actually got to sit in the front next to the driver so I had a very good view of everything along the way. As I have posted before, the traffic here is quite amazing (for lack of a better word). Our driver was a young man who had grown up in South Africa and was very comfortable driving in the traffic. Well let me tell you, it was very much the adventure. I have never been so close to certain death so many times in the course of one hour in my life. We drove on sidewalks, pulled in front of lorries, threaded our way through zimanjons (still don't think I'm spelling that right), came withing inches.....no... inches would be an overstatement....of collision after collision. But our driver never broke into a sweat, not one gesture, not one curse word, he just drove and in the end, he got us to the village safe and sound. About half way there, I just had to ask him if he had EVER driven in the US or UK. He said no, that he had never been out of Africa. I told him he would be very bored!

Once we arrived, our drivers negotiated with the "tour operators" and I use that term lightly, and we were taken on boats to the village. The village is on stilts in the middle of a lake (an African version of Venice). I've heard a few different stories of why the village was begun, but the one that makes the most sense is the one where people began building houses in the middle of the lake to get away from the slave traders. The people that lived in the village now get most of their income from fishing. They take reeds and make "fish corrals' out of them. Somehow and I'm not sure how (although our guide spoke English, it was heavily accented and being the Yank I am, I couldn't always understand him) they raise fish in the corrals and harvest them when they reach the appropriate size. It was an interesting trip although it reminded me of Myrtle Beach in that they took us to 3 different houses, but each had a souvenir shop. When we got back to the dock (which was how the locals got back and forth to the village, it must have been rush hour as we couldn't actually tie up to it and had to walk across 3 different boats to disembark.

The nurses have been having a series of talks by the doctors educating us about the surgeries they do along with special nursing care and typical complications. Dr Gary Parker is a maxfax surgeon (operates on facial tumors) who has made Mercy Ships his life's work. He originally came 22 years ago right after graduating from school and worked on the Anastasis for many years. Just to give you an idea of the conditions he has lived in these many years, up until the Africa Mercy was commissioned 2 years ago, there had never been air conditioning.....aye yi yi...I cannot imagine. He is a wonderful person, very respectful of the nurses, a wonderful manner with the patients. He told us about some of the amazing surgeries that he does. He works on the huge facial tumors that you have seen in some of the pictures. He had us sitting on the edge of our seats as he talked about removing jaws and replacing with titanium seeded with bits of bone from the patients hip. (Apparently, if you don't cover the titanium, it will eventually wear through the skin and be exposed.) He also told of huge facial tumors he removes (routinely I might add) and how he reconstructs the person's face by taking the temporalis muscle, reversing it and attaching it in such a way that it gives substance to what would have otherwise been a gaping hole. Just last week he used the temporalis muscle to fashion a new cheek for a woman who had suffered Noma as a child and had a hole in her face. He then used a graft from her thigh skin to make her a 'new face'. Awesome, stupendous surgeries.......I think that Dr Gary would be very bored in the US or UK : )

More pictures

When you don't want to write....send pictures....


The line at screening. It was probably a good thing that those of us in screening didn't see this on the day!!

One of the wards. Wonder whats under the beds? Mattresses for patient caregivers, or relatives.

2 of the ortho kids that Dr. Larry operated on. They have straight legs now!

As promised, pictures of the ceremony.

Party time on the VVF ward.

Dr Steve praying with the ladies.

God will have to thank you , I cannot thank you enough.

And that's when the crying started.

Just a kid

Being at the beginning of an outreach has been an unexpected blessing. I have been able to participate in the screening day which only happens in the beginning, there were less people on the ship, ergo less people's names to learn (and of course now all of us that came before the hospital opened feel like real experts). Also, we were able to ease into our roles a little easier and orient a little longer. So, I am so very glad to have come when I did. There are however a few things that are not as good. One of which is that the crew activities are not in full swing as yet. One of the things that the crew does each outreach is find a few local charities and partner with them. This has been a little slower than us who are anxiously awaiting oppertunities to serve off the ship would like, but they really want to make sure that the charities we partner with are in line with the model of Jesus and that we will not have to back out later.

Yesterday, the first one actually occured and, as I was off work, I was able to participate. Mercy Ships will partner with a local orphanage run by the same order of nuns that Sister Theresa was in. We left at 8:30 and drove about 20 minutes away through the crowded city streets (always an adventure). Our driver was a petite British blond who has been on the ship with her family for several years. She and her husband have 3 children one of which they adopted in Liberia. She kept us in stitches as she made comments about driving in an African country. I can tell you that I WOULD NOT want to drive here. When a 2 lane road becomes a 6 lane road....Scooter, car, scooter,other direction, scooter, car, scooter....not me! Oh my and never mind the pedestrians. It makes for quite the adventure each time we venture out. Anyway, I digress...



Having arrived at the orphanage, we were ushered into the courtyard and then got to play with the children for the next several hours. (actually since there where so many of us, a few of us cleaned the nursery. It is cleaned once a week from top to bottom. We left it cleaner than my kitchen..please no comments from all of you who have seen my kitchen. Later we had time to play with a few of the children. Several had been orphaned within the last few weeks. You could tell they where new as they were underweight. Me and 2 others played and sung any childhood song we could remember. They particularly liked the Itsy, Bitsy Spider and Brother John (which I could sing in French). Actually that was a song that everyone knew, it was just some knew it in Dutch, some in Norwegian, and some in French. I plan to google songs and simple games before I go back. We forget so much from childhood don't we? We helped to feed them lunch which was awesome. Sometimes I think I missed my calling as an Italian mother....eat, it's good for you! And then there was one special little kid. He was shy at first just like any other kid. He smiled, played ball, and sang just like any other kid. But I was so glad to see him there. I was especially happy because the last time I had seen him was on screening day, and seeing him there at the orphanage on Wed. meant that sometime in April, Dr Gary and the Mercy Ship team is going to give him life saving surgery,,,

More experiances

Well I've 2 more experiences I wish to share...as I left off last post, I was going to church. Let me tell you, people in Benin worship! There was dancing and singing and amening...well whatever amen is in French and Fon and I want you to know that a joyful noise was raised to the Lord. I'm also here to tell you that real men where pink...I know this because the dynamic "minister of music" was dressed fully in pink! I wish I could have gotten a picture of him..he was really good but pink obviously is not a cultural taboo for men here as it is in the states. After about 40 minutes of singing, they brought a young woman up and told the story of "how a motorcycle can defeat a car", the gist of which was that this person had been struck by a car, had actually gone completely underneath the car and neither she nor her motorcycle was hurt or damaged in anyway. After the request number of announcements, the pastor got up to speak. He would speak in French, a translator would repeat his words in Fon, and then another translator would repeat in English. He started out welcoming us from the Mercy Ships (there was about 20 of us) and then he told us that the Lord we worship is also in Benin. Well that was obvious to me from the way He was being worshiped here! He then started his sermon. He told us all that he did not doubt that we had faith, but what was our faith in? Was it in the things that we can see? Or, was it in the unseen things of God. It was a good sermon, although I must admit that some of it was lost on me as we where sitting near the children's section and suffice it to say that children are the same all over the world....I'll let you figure out what they where doing.

The second experience I want to share happened on the ward today. I saw 2 women get their lives back and yes, I wept, but I wasn't the only one. The women had both had VVF (vesico vaginal fistula repair) surgery. Just to back up a little, because of the lack of physicians and funds, when women have difficult labors here, they may be in labor for literally days. Often when this happens, the children are stillborn. During this time, because of the pressure put on the vagina, the tissue dies and a hole or holes (fistula) develop between the bladder and sometimes the rectal wall. This causes these women to be incontinent of urine and/or feces. They are often thrown out by their husbands and become outcasts in their villages. They may live like this for years. (We watched a documentary called A Walk to Beautiful which I highly recommend. The film followed a few women with this problem.) Today was the dressing ceremony for the first 2 women this outreach who had repairs. During the ceremony, as a symbol of their new lives, they are given a dress and there is much rejoicing. I remember last week as I first went into the ward they were in, the smell was strong. I could not imagine living like that for the years that some of these women have. But today was a happy one! The praise team led by Clementine, sang and talked with them about the love of Jesus. As many of the crew as could came to participate. The most poignant moment for me came late in the ceremony. The women each came up to sing 'her' song. The first lady was a petite individual dressed in a brand new beautiful yellow dress. She was shy at first, but as she began to sing, she became more confident. She began to go around to each person and would sing the same phrase (which I couldn't understand) and then point towards heaven. One of the translators told us that she was saying that she could not thank each person enough, that God would have to thank them for her. When she got to Clementine, she grasped her hand and tried to fall to the floor on her knees, but Clementine rushed in and pulled her up before she got there and gave her a long, wonderful hug. Well, I thought I was the only one crying until I looked around and saw nurses, translators, and yes, even one of the surgeons weeping. It was one of the most special moments of my nursing career and I will remember it always.

I'll post pictures of the ceremony when they are put out. My love to all...

First week on the wards

I have now completed 4 days on the wards. It has proven to be very different and very similiar...I mean nursing is nursing all around the world....but stepping over people asleep on the floor, hearing a cacophony of different languages, reusing anything that can be reused...that's different. Sometimes it is wonderful different, sometimes not to wonderful.

The first two days I had adults and a large 11 year old and simple surgeries. I discharged 3 on my second day and it was great to see how happy they were to be "fixed" and leaving. So going into my 3ird day, I felt comfortable and completely at ease until....my assignment was a 5 yr old, a fresh postop 4 year old, another preop 4 year old, and (horrors) a 5 month old. Now for those who don't know, I have NEVER done pediatric nursing and they quite scare me. I even took my paper to the charge nurse just on the off chance that a horrible mistake had been made...which it wasn't. Well OK then, deep breath, I can do ALL things through God who strengthens me, so I did. I discovered that nursing children is like nursing adults except that you are MUCH more careful about their meds and their smiles come quicker and are, I must admit, sweeter and more infectious. The mothers stay with the children and actually do much of the care for them. I just give them meds and play with them. My preop child was delited each time someone got water from the fountain and would scream with laughter. She was here to have her leg staightened and that would be her last night of bearing weight for 3 monthes. The mother was warned that she would have to carry her .

Gotta to go to church, I will post more later...