OT, finally.

I am home now, into my third week back at work. Many people have been asking me if I ever got to really be an OT on the ship. I realized that I have not blogged about that at all. So, the answer is “yes” the last month on the ship was very busy and I was able to use my skills as an OT to help plastic surgery patients, both children and adults. Most of the patients were burn victims who have had terrible burn scars that impede their function. When a severe burn heals, the body makes scar tissue to cover the exposed areas, but that scar tissue often causes a contracture which is like a tight area of skin over a joint that keeps it from functioning. In areas where good health care is available, sometimes the contractures can be avoided by rehab in the initial phases, but not always. The plastic surgeon can either cut the skin in a Z formation and realign the skin in a way that it covers more area, or in larger areas he/she must cut away the old scar and put a skin graft from another area of the body in its place. The patient then has to have the joint immobilized for several days to let the skin graft “take” or start adhering to the other tissues so it stays in place. Sometimes the joints are held in place by removable wires so they don’t move. So even after the surgeries had started, I still had a lesson in patience until the first patients were ready for therapy. But the day finally came that I was able to make splints to position the joints properly after the wires were removed, start range of motion exercises and teaching the patients how to massage the scars so they would be softer. It was hard work and often times the first few sessions were very painful. But it paid off and by the time I left I was beginning to see some good results for many of the patients and I could tell they were on their way to better function. Sonnie was a lady that I really enjoyed working with. I can’t remember how she got her burn, but her wrist was bent backwards so far that the top of her hand was almost touching the top of her arm. She told me she wanted to go to college, but she quit school after her injury because she could no longer write. Her tendons were also damaged from the burn, but her wrist was able to be straightened and I got to be the first one to encourage her to hold a pen and try writing. She was able to maintain her grasp on the pen and write her name slowly, but legibly. I gave her a pen and paper to take home to practice. She is another patient that I might never hear from again, but I really hope she gets to go back to school.

Me and Sonnie.

Sonnie’s hand with a healing skin graft and K-wires still in place, showing of her pinch.

Adopt a patient

Here on the ship there is an adopt a patient program where crew members pick the name of a patient and befriend them while they are in the hospital. I think it is especially great for crew that do not get to have regular patient contact and it allows them to come experience the ward and build a relationship with a Liberian. Before the work really picked up for me I was feeling a little discouraged, like I was not making a difference. One Saturday I had some plans that fell through and I was a little frustrated to be “stuck” on the ship…but I realized that was a terrible attitude and there were plenty of ways to make a difference in a life right here on the ship. So I adopted Satta, a woman in the hospital for a VVF repair. VVF stands for vesico-vaginal fistula, a child-birth injury sustained by women in prolonged labor. VVF’s are very common in many countries in Africa and in other developing nations where women cannot get to the hospital to have their babies. VVF’s have actually gained a little more awareness recently because Oprah featured a fistula hospital in Ethiopia. There is a PBS movie out called “A Walk to Beautiful” that we were able to see while I was on the ship about the hospital in Ethiopia. It aired on PBS earlier in May, but I did see links on the PBS website where you can watch it online. Anyway, the injury causes the women to leak urine and thus be shunned from their communities and even families because of the social implications. There is a surgery that can correct the problem, so there was a ward full of women on the ship who had VVF repairs. It was a privilege to get to know Satta and become her friend. She spoke very little English, so often times I would just sit with her or make crafts with her. One visit I was trying to find out more about her family and her life, but it was difficult. She finally understood what I was asking and replied, “No, my people have not come to see me, but I’m glad to see you!” That showed me that even though sometimes I felt like our encounters were awkward, she appreciated them and it made a difference to her. VVF surgeries can be life-changing, so when the VVF ladies leave the ship they are given a small ceremony in celebration of their healing, transformation, and new life. They each receive a new dress as a practical gift but also a symbol of a new start. The ceremonies are filled with music and dancing and each of the women can share a bit of her story if she desires. Unfortunately, Satta does not have a phone number or address, so I won’t be able to stay in contact with her, but hopefully her time in the hospital was a little more enjoyable because she had a friend.

Me and Satta out on the 7th deck.

A time of celebration at a dress ceremony.

Me and Satta after her dress ceremony.

Satta and 2 other ladies’ dress ceremony on the hospital ward.

Satta looking beautiful.

Daniel’s Chair

When the work on the ship was slow, God had another project in mind that he allowed me to work on. A few moms on the ship let me know about a little boy in the community who had been to the ship before but was not able to receive surgery. His name is Daniel and he has severe hydrocephalus. Of course I don’t know exactly what is causing his hydrocephalus, but probably the ventricles in his brain that keep the fluid moving properly have a defect and so fluid has collected around Daniel’s brain causing his head to become very large. If he lived in a more developed country, he would have a neurologist and probably would have received a shunt to drain the fluid at a very young age. Who knows, maybe his head would be a typical size and his level of function would be different if he had received the care he needs…we don’t know. Today Daniel is 4 years old and very small for his age. He is unable to sit up, stand, or roll over on his own and he does not talk. He does babble and make nosies, smile, and look around the room. In Liberia people with disabilities are often shunned from the community and some people believe their disability is caused by a curse. Many people in Daniel’s community are even afraid of him, so he does not leave the house…partially because he has no way to get around, but also because many people would be disturbed and even run away from him. The moms on the ship have remained friends with Daniel’s mom and and they noticed that she has been having a really hard time holding and positioning him to feed him. He is getting bigger and his head is difficult to control in an upright position. So these moms on the ship asked me and a carpenter to help them design and build a chair for Daniel. So we went out to his home to measure him and talk about different designs for the chair. He really was in need of a custom chair with the right cushions angle of tilt in order to support him in sitting because he has high muscle tone. I was excited about making something for him, but I was a little apprehensive on how to explain everything and work with a carpenter who had never done anything like this before. I made some drawings and found some pictures out of a book and turned them over to him. The carpenter did an amazing job and really took the design and made it into something special. His wife made water-proof covers for the seat cushions. The end result was perfect and Daniel looked great in the chair. He really liked being able to sit up and look around the room. He even cried when we took him out of it. To me this experience was so neat to see how God took several people with different skills and talents and used them to create something they never could have done on their own. I believe God brought the right people together at the right time to make a difference for this little boy and his family. I was blessed to be a part of it.

The chair on the first fitting day

Daniel’s first time in the chair

The carpenter working on the chair

Daniel in the chair after it is finished

Daniel smiling because he is enjoying the new chair.

The finished product.

Daniel’s house.

Easter: A Celebration of the Resurrection

It was a real blessing to be aboard the Africa Mercy for Easter this year. Even though it was hard not to be with friends and family, I think of all the holidays to be on the ship, Easter would be my choice. It was a privilege to celebrate with believers from so many nations and the chaplains along with many others on the ship worked so hard to make Holy week and Easter very meaningful for all of us. On Palm Sunday there was an evening service where people from each nation got together to share a hymn or praise song from their country and/or in their native language…among others there were representatives from the United Kingdom, The Netherlands, South Africa, Ghana, Brazil…I know there were more, but that gives you a sense of the diversity. For Holy (Maundy) Thursday they had set up an “upper room,” as a place for reflection to go and remember the last supper, wash one another’s feet, and have communion. I was sad to miss the Good Friday service…it was Friday morning and I went with the ortho team to visit a local hospital.

Sunday there was a sunrise service on the top deck and an Easter service on the dock a little later. Following the service there was a huge brunch, complete with white tablecloths and flowers for centerpieces…definitely not the norm in the Africa Mercy dining room. I have posted some pictures that will give you a better idea of what the day was like. It was a great way to celebrate the resurrection of Christ and the abundant life that he gracefully gives.

The Easter service on the dock.

The cross, decorated with flowers in celebration of the resurrection.

The table set up for communion at the Easter service.

Tables in the dining room set up for brunch.

A beautiful sunset to round out the day.

Forgive me, I’m an Amateur Blogger

Hi everyone.  Just wanted to make a few comments on the blog.  First of all, I am amazed at how many people are actually reading it. It inspires me to post more, although it adds a little pressure, too.  I am still getting the hang of this blogging thing, trying new things as I go.  I have found posting pictures a challenge as the internet connection here is slow and downloading takes a while.  I had some success with making slide shows, but recently having some glitches with that, too.  So, it’s always a work in progress.  Don’t be surprised if pictures get added to old posts, so go back and check them (if you’re interested).  Also, you may have noticed that I changed the title.  I never really liked “Emily’s Amazing Race.”  In an effort to be a little catchy and play off of the TV show, I hastily came up with that title.  But, I felt like it emphasized me too much, and this is really not about me.  It is about my experiences, but more importantly it is about what God is doing in the world.  I finally decided on “Blessed are the merciful” because I have been very blessed by this experience and in life in general…it would take me forever to list all the ways.  Although I have been able to participate in acts of mercy, they are minuscule compared with the blessings that have been poured out on me.  So thanks for all the love and support shown by friends and family…I look forward to continuing to share about my experiences in the last 4 weeks.

OT’s…Always Adapting

This post is dedicated to my OT friends…and Laura Rodgers, of course. 🙂 I know some of you have heard about the OT work being slow for the first several weeks, but I haven’t posted much about it. There was a little timing glitch in my arrival…I came when I was told, but the patients I will primarily be working with will start their surgeries this week. As my OT buddies know, we are always teaching people to adapt and we often find ourselves adapting to new and different situations. So I have been able to work as an OT in some unexpected ways…it has been fun and challenging. Mercy ships does a lot of maxillofacial surgeries…many involve fixing jaws that have been ankylosed (or scarred closed/non-movable) because of an old injury or congenital problem. Once the jaw has been operated on…maybe bone taken out or bone grafts put in…the patient needs to exercise a whole lot or the problem will come back. So, I’ve been helping the patients do their exercises; Mainly opening and closing their mouths or stacking tongue depressors to place in between the teeth to stretch the jaw passively and keep the mouth open for a while. There are some patients who have benefited from oral motor exercises to improve oral motor strength and coordination since many of them have never chewed/eaten a variety of foods…so thanks to my speech friends for teaching me about that (there are no SLP’s here). It seems that the concept of prevention is foreign to many Liberians, so teaching them what to do in order to avoid problems can be challenging, but I am doing my best. I have also been continuing to help with orthopedic screening the last few weeks. I have been a runner, a history-taker, and even an X-ray reader in some cases before the orthopedic surgeons arrived. I have found that sometimes in this environment you have to do the best you can with what you have…and then pray. Actually, praying first is helpful. As the orthopedic surgeon keeps telling the patients here…”We are just people; We do the operation, but God is the one who does the healing.”

Today (actually Monday March 31st) I sat with the plastic surgeon while he screened patients to start surgeries this week. We saw a lot of burn scars…many of them are not able to be improved upon, but he will do surgery on the ones who have contractures that are impeding function. I am looking forward to working with those patients soon.

Other fun facts about being an OT in Africa:

• Wearing flip-flops to see patients and rolling your scrub pants up to capri length is perfectly acceptable in West Africa.
• It’s a good thing Ann taught me the value of using regular velcro for straps, because alpha strapping does not exist here.
• You make any type of splint out of whatever material you can find…the varieties of splinting material are limited.
• Yes, you can make a splint by heating water in a kettle and then pouring it into a bowl…you just have to do it quickly. (That was the method I used for the first few splints until someone brought an electric skillet in a suitcase last weekend. I haven’t used it yet, but it will be great.)
• Often you need a translator even when you are both speaking English…Liberian English is quite different…and if another patient wants to translate, embrace it…there’s no HIPPA violations.
• The ruler on the finger goniometers is also very helpful in measuring the distance a maxillofacial patient can open his/her mouth.

The 1/2 circle tent outside the ship is our dockside unit where we will see patients for outpatient therapy after their surgeries.

Inside the dockside unit before it was organized.

That was another one of my jobs while the work has been slow.

Dr. James with the recent shipment of walkers.  Yes, he does wear those suspenders every day.

This is an example of a huge container that contains supplies. They are shipped to the Africa Mercy once every few months.

I spotted these boxes that made me feel at home.

Just another day in Monrovia

Well, my plan to update more frequently did not work out… I’m trying to blog as much as I can so I don’t get too behind. On Saturday Feb. 23 I walked to a large market with some friends. We were exhausted at the end of the day, but we all agreed it was such a great day of experiencing Africa. On the way to the market we met an amazing lady named Mary. She was blind and just walking along side the busy street. There are no sidewalks here really, so when walking you might be on some dirt at the edge of the road and sometimes you have to step onto the road a little to get by. There is unlevel ground, huge puddles (some of which contain sewage), open man-holes…I can’t imagine navigating that as a blind person with only a rolled up umbrella to survey the ground in front of me. Actually, I don’t know if I would have noticed her if my friend on the Mercy Ships eye team had not spotted her and started talking to her. Unfortunately, my friend didn’t feel like there was a surgery to help Mary, but we offered to walk with her because she was going to the same market we were. I am learning so much…a lot of it from the Liberian people but also from those I get to work with. I’m still not completely comfortable walking the streets of Monrovia, so I tend to be very focused on myself and where I am going. I was really struck by the compassion of my friend and her ability to notice someone who needed help and her courage to offer it; Even just a helping hand to guide her along was so much more than she is used to receiving. Turns out she goes to the market every day and sings so people will give her money. Along the way we stopped to sit down for a few minutes and Mary gave us a pre-view of her singing. It was really great and actually drew a small crowd. I inconspicuously took a short video that I will post…not to exploit Mary in any way, but just to demonstrate a once in a lifetime event for me that is a daily reality for her…kind of unbelievable to an average American. It’s so hard to fathom all that we have access to in our country. I think for Mary it is a lonely and dark world…except that she is able to sing about Jesus and has Him in her heart. When we got to the market, Mary went on to walk along the street singing for any who would listen. There were tons of people around and lots of activity. A common item sold is beautiful, colorful fabric, so I bought some to have a skirt made. Then we went up a hill to the Ducor Hotel. It used to be a 5-star hotel prior to the war starting in 1980. People lived there for a while after the war and now it is completely run-down. We ran into some boys along the way who treated us like movie-stars. I think the state of the hotel is a symbol for what has happened in all of Liberia. From there, we could see all the way to the port where the ship was. The pictures posted were taken with the highest possible zoom on my camera. We took a taxi back to the port because we were so tired.

Church…Africa style

I have really enjoyed the privilege of visiting 3 different churches over the past Sundays. They had many similarities, but they were pretty different, too. The first Sunday I walked with a group of people to a small church in the village not far from the port. It was a neat experience to walk along the streets and see the real life of the people in Monrovia. It is a very different world. Dirt roads with very small indescribable houses. It’s really hard to describe. Hopefully I will be able to take some pictures from a vehicle at some point but it is not safe to walk around with a camera on the streets. The people of the church were very welcoming, warm, and friendly. The people sitting in the front moved out of their seats for us to sit there. They had all of the visitors come to the front of the church and introduce ourselves, then each member came up to shake our hands. The music was a lot of fun and actually what I expected for an African church. Very rhythmic with drums and simple, repetitive songs. It was hard to understand the words to the songs and there were no books. But fortunately many of the lyrics are repeated, so by the end I had usually figured it out. From what I have seen, most Africans worship with their entire bodies, dancing in a marching-type rhythm and clapping. It is cool to see the joy overflowing especially in a people who have endured so much.

Last week I went to another church that was a little more “western” and traditional, but still with an African flare. We actually sang some traditional songs like ‘Onward Christian Soldiers’ out if hymnals, but there were also more traditional African songs as well.

This week I visited another church and it was the most “western” of the 3 and very similar to contemporary evangelical churches in the U.S. Of course the building was still open air with concrete floors, but the set up was very familiar to me. I recognized a few of the songs and they had the words projected on the wall. I am not sure of the background of the church, but the pastor was American, although he mentioned another African pastor as well. It was nice to be able to fully understand him. I felt more at home there, but I am now debating where I will end up while I am here. I think it would be fun to be a regular at a more traditional African church in order to fully experience the culture. A lot of where we go also depends on if a vehicle and driver is available…so we’ll see where I end up next week.

One thing that was present at all 3 churches, an instrument that I have figured out is called a “sasa.” I really like it…it reminds me of the sound of maracas, but the person playing it can make more complex rhythms because they can control the netting around the outside. I found this decription on the internet and added a picture because I think its fun!

The Sasa is a whole gourd covered in a netting of beads or shells, and originated in the upper region of Guinea called Guinée-Forestière. It is played by all the tribes of the region (Mandingo, Kisi, Toma, Gereze, etc.) and has been adopted by many other tribes in West Africa, who call it (among other names) the Shekere and the Djabara.

Screening Day

I am learning that I need to post shorter ones more frequently. When I save too much information it makes the posts too long and harder to write. So hopefully I will get caught up this week and then get on a better schedule. 🙂

Monday the 18th we had a huge screening event at a stadium. I really don’t know how many people were there, but probably over 1,000. The lines were very long and people were waiting for hours. Mercy Ships provides very specific surgeries and medical procedures, so there were many people who had to be turned away. There were pre-screeners allowing people with potential problems we could offer help with into the line. Unfortunately there are many conditions that we are not equipped to provide help for, but people often think they can come for basic medical problems. So once they got past the initial screening, they were screened for maxillo-facial, orthopedic, plastic, VVF (fistulas caused by prolonged labor in women), and some general surgeries.

I was helping the team screen for orthopedic surgeries. I mainly helped with the paper work because this was my first screening and ortho is not my strength. But, I was able to get in there and offer some opinions/input on some patients, especially those with hand problems. The screeners were basically the physical therapist from the ship and an internal medicine doctor. So needless to say, we are all amateurs when it comes to orthopedic surgery, so that made things difficult. At the same time, there are very specific surgeries that mercy ships can offer and we know enough about those to be able to make good decisions on the potential for helping most people. Basically we narrowed down the field and got people scheduled to come back to the ship for X-rays and evaluation by the surgeon when he is here in March.

The thing that was the hardest about the day was seeing so many people that we could not help. Some had fractures that were so old and badly healed that surgery would probably not benefit them. There were also several people who had neurological problems. They came hoping that there is some surgery that will fix their problem and I think we might have been the first people to really explain to them what was causing their problem and there is no surgery that can be done. There were so many situations that could have had a different outcomes had the patient been in a place where basic medical care is available. The PT here has told me there are only 2 orthopedic surgeons in Liberia…one of them recently had a stroke and one works privately. So, if people can’t afford it, they will not be seen.

Overall is was a good experience. I learned so much from the co-workers (or should I say co-volunteers) I was working under. We offered to pray with all of the patients and most of them were receptive. There was even a room of people dedicated to praying individually with those who were not able to have surgery. It was great to hear how some of my co-volunteers were able to handle those situations, offering hope in a living and compassionate God, even when the people’s hopes for surgery were gone. I am prayerful that it was a positive experience for all who came.

The basics

(I started this one last Sunday, so it’s a little old.) It is getting to be late Sunday afternoon. I have been here for almost 2 full days, although it seems like longer than that. We had a tour and some basic orientation on Saturday morning. Other than that, things have been pretty quiet and relaxing. There are no patients on the ship yet because it just arrived back in the port last week. This coming week will be more orientation to our jobs and preparing for a large screening event which will be held in a stadium in Monrovia on Feb 18th. I think patients will be scheduled for treatments after that. I am not sure exactly what I will be doing, but it will include helping with orthopedic screening.

The rooms on the ship are small, but comfortable. I am in a room that can hold up to 6 people, but there are three of us now with two more scheduled to arrive next week. The room is divided into three sections with a bunk bed, desk, and closet in each one and then there is a small bathroom. It is nice to be divided up into mini-rooms to have more privacy. I have my own little room right now, but that will probably change soon. We’ve had some talks about the conditions here in Liberia. They said the ship is probably nicer than the best hotel in Liberia, so we are very blessed. I hope to get off the ship more soon. Things are not especially safe and we have to go out in groups. Getting a taxi can be interesting…there are Mercy Ships vehicles with designated people who can drive them, so I can tag along on scheduled outings to church, etc. I guess you have to find a balance of not getting stuck here in the “western bubble” and really getting out to experience the country. I think it will also help when the hospital opens and we start seeing patients. That will bring home the reality that we are not in America anymore.

The slide show in the previous post includes pictures of the outside of the ship and the sights around the dock. Also a few of my cabin. Health care services had an open house night this week where people who serve on the ship could come see the hospital and get a better sense of the work that is done there. We won’t be able to take pictures in the ward once the patients are there, so I took a few of the hospital.