Saying goodbye and driving

We've started the process of saying goodbye to our patients and families because we will be leaving Liberia soon. Today we said goodbye to our first family because it will be unlikely that we will be able to visit them again.

In this family, I never got to meet the patient, Liaa, because she passed away before I started working in palliative care. Liaa left behind three small children and now her mother Theresa is caring for them (the husband left her when she got sick). Mercy Ships helped Theresa to start a small market business since she now had three more children to feed. She makes 'small small' profit but it isn't really worth all the effort. We've offered her ideas on how to improve her business but she has resisted them. For example, she will buy 10 of something for 100LD and then she will sell the 10 items for 100LD. Obviously that doesn't make sense to spend your time on a market business like that.

Anyways, she is doing what she can and the oldest child at least is in school this semester. Here's a photo of the baby, who will never know her mother. Her name is Chinese Girl (yes, that's her real name) and she cries everytime she sees me. She has TB and she also just spent a week and a half in the hospital for respiratory distress. She is absolutely adorable!
Here's a photo of the entire family. Jerry (our translator), Josephine, Dorcas, Theresa, Chinese Girl, Rebecca and Jean (my partner).

It was a really good visit and it was nice to kind of bless them and then release them back to their normal life. I think as long as we visit them, we keep them from their post-mourning life. It would be different if we were friends. We like to think of our families as friends but I don't know that they see us that way. We're in this awkward position of having things they need and want and they are in the position of always asking us for things. It makes for an unbalanced friendship.

The other exciting thing that happened today is that I took the driving test and passed so I am now officially a Liberian driver. I didn't actually have to get a license here or pass a Liberian test. My drivers license from home is valid here and I had to pass the test by taking out the Mercy Ships head of transportation so that he could evaluate if he wanted to entrust a valuable Land Rover to me:)

So I hopped in the Land Rover and he said we were going to the police station. I'm thinking 'uh oh' that's downtown and there's a really steep hill where I have to stop for traffic (the car is a stick shift). But it went fine...I didn't kill any pedestrians or hit any taxis or stall the car. So I will officially be driving starting Tuesday. (BTW, the reason we were going to the police station is a long story but let me just say it wasn't pleasant and I kept thinking about the guns they were carrying and that we were making them mad!)

You may be thinking that driving isn't a big deal but you've never been here to see how bad the streets are and how crazy the pedestrians are and the fact that you share the streets with taxis, people, cows, goats, wheelbarrows, street vendors, humongous overloaded trucks and tons of broken down vehicles. You don't go fast enough to hurt anyone if you hit a taxi but people (kids and adults) run out into the street all the time without looking.

The other scary part is that we are frequently on roads that are so bad that we have to be in four-wheel drive. Just today, the road to get to Theresa's house was bad and I'm really surprised we didn't get stuck. Here are some photos of the road so you can see what I mean.

So I hope I survive the next couple of weeks driving.

More goodbye stories to come!

Peace,
Michele

Levi

We got a new patient today, a 10 year old boy named Levi. Levi came to the ship to have a tumor removed from his face. They got him into surgery and found that the tumor was very invasive and probably cancer. He had part of the tumor removed here. He's been preliminarily diagnosed with Burkitts lymphoma and will get chemo. We took him and his mother to the hospital this morning to start his chemo treatment.

Please pray that this cancer is Burkitts (any other and there is no chemo treatment for it) and also for him to be completely healed. Also please pray for his mother Grace who is fully aware of the seriousness of what is going on. Her faith is very strong but she is understandably very upset.

Here's a photo of Levi taken by my roommate Megan.


Peace,
Michele

Random photos

Here are some miscellaneous photos of places I've been, things I've seen and people I've met:
Pigs just walking down the street next to our car
Our patient Sah's daughter T-girl and a neighbor kid
A bathroom in the middle of a swamp

A little girl following us at Mary's house

Boys watching us at Sah's house

Sah with two of his daughters (VeeVee and T-girl)

A view of the ship from the roof of Fatmata's house

Grace with the many children she is raising

Gracie's house (at least 5 kids and 3 adults live here - I'm not sure how)

Wearing my sunglasses at Gracie's house

Baby George learning to walk

Rose getting her hair platted (braided). I love the baby - he wants to know what's going on!

Peace,

Michele

Another Monday

It seems that Mondays have become the day on which we have to attend a funeral. As I expected and discussed in my prior post, our 19 year old patient Gbah died Sunday evening. We called at 5:45 Sunday evening to find out how he was and was told he had died at 5:30, just 15 minutes before.

So our morning started off by attending a funeral. When we got to the house where Gbah was, there were probably 60 people sitting outside on the porch and in the yard. We sat next to Morris, the father, and talked for a while. He told us what had transpired since we left him at the pediatric hospital on Friday. The doctors at the hospital spent the weekend trying to stabilize him but were unsuccessful. A doctor called Morris into his office on Sunday and told him that they had done everything they could but Gbah was going to die. They suggested that Gbah go home (the cost of dying in a hospital here is high - it would cost about 2000 LD which is $33.00 USD to transport a body...people here don't have the kind of money). So Morris brought Gbah home and he died later that day with his family around him. If Gbah had remained at the first hospital, he would have still died but he would have died alone.

For the burial service, they couldn't get a hold of their pastor so they asked us to pray. I read two Scriptures and Jean prayed. Then six men carried Gbah to the gravesite which was just a 1 minute walk and we followed. The burials here are so fast...you take the body to the grave, fill in the dirt and then you leave. It took less than 10 minutes. It just seems like there should be more - I'm not sure what there should be more of but it seems too fast. They will have a memorial service in their church later this month. They do this because many relatives will come from up-country and must have time to travel.

Even though I've only known this family for six days, they treat us like we are someone important (this happens a lot, now that I think about it - all of our families treat us this way). It's humbling and uncomfortable. I'm not sure if they are being hospitable or if they really actually think we are important people. I wish they knew how much we are just ordinary, normal people. And in the case of our patients who are dying, we have almost nothing to offer them from a tangible perspective. But the great thing about this job is that we get to tell them that God loves them and that we love them.

We're getting another new patient in the morning, a 10 year old little boy named Levi with Burkitts lymphoma. We'll take him to the hospital for chemo and pray that we have a different outcome from our two patients with this disease who have died in the last two weeks.

I'm finding that every single day here is really, really difficult and I almost dread people asking me how my day was. But I wouldn't want to be doing anything different at this moment in time. I feel like I'm here for a reason and that God is really using me - I'm not really sure how He is using me but I'm greatly confident that He is.

Peace,
Michele

What the lack of healthcare looks like

Before I came to Liberia, I liked to complain about our healthcare system, our insurance companies and our hospitals. I complained every year when I had to choose a healthcare plan - that it didn't fit my needs, it was too expensive, it didn't cover my meds and on and on and on. And I know I'm not the only one with these complaints.

We are an unbelievably spoiled and privileged society - and we don't know it. This is what it looks like in one of the poorest countries in the entire world where there is no healthcare. We have a 19 year old patient named Gbah (pronounced jeeba) - we just met him for the first time on Wednesday morning. He has Burkitts lymphoma and was so weak on Wednesday that a family member had to carry him on his back to our car. Gbah is skin and bones and couldn't hold his head up. It didn't take a medical degree to tell he is critically ill.

We took Gbah and his parents to a local hospital here so that he could get chemotherapy and maybe have a chance to live. We always take our patients because you have to know what you are doing or they will not admit you to the hospital and no one will help you. So it took awhile but they finally took him up to the ward where we left him with his parents.

Late Wednesday night, Jean got a phone call from the father saying no one had seen Gbah that day and no one had started any treatment. We have no authority over the hospital so there was nothing Jean could do. Thursday morning we went to the hospital to admit another patient so I went up to the ward to talk to the nurse before talking to the father. She told me that Gbah was going to get a blood transfusion before starting chemo. I went to the father and Gbah and tried to reassure them that the doctor had reviewed his chart and that he would be getting a blood transfusion that day and that he needed to be stronger before starting the chemo. I noticed that Gbah did not have an IV started. This young man had critically low sodium levels (a level lower than any I have ever seen before) - he should have had IV fluids started the minute he was put on the ward. 24 hours later he'd not had any kind of treatment. I know his lab values were critical because we did the blood tests on the ship so that the hospital wouldn't have to do them.

Early Friday afternoon, we received a phone call from the father. He had taken his son out of the hospital and was now trying to find another hospital to give his son a blood transfusion. The phone service here is horrible and we couldn't get the whole story but we couldn't meet the father until 4:00 pm. So we finally got to the father and found out the whole story.

The lab that takes care of the blood said that the father needed to pay 1025 LD (about $17.00) up front for the blood. He only had the $5.00 we had given him for food (food here only costs about $.75 for a meal). But if a family member donated the blood, they would only have to pay for the bag the blood goes in. They tested the mother and an aunt and they didn't match. They wouldn't let the father give blood because they said he was too old (he's 50). When he realized the family couldn't give blood, he went back to the lab and then they told him they had no blood for him to buy. So he told the doctor he was taking him from the hospital since they couldn't give him a blood transfusion. The doctor told him to bring Gbah back on Monday if he could find another hospital to give him a blood transfusion. Yes, the doctor let a critically ill person leave without doing a single thing to stabilize him.

So now the father was in our car at 5pm on a Friday asking us for help and we had no way to help. None of the hospitals have labs that are open after 4 pm. None of them are open on the weekends (even though they technically have emergency rooms). None of them will transfuse blood over the weekend. Jean actually has the type of blood Gbah needs but there isn't a hospital for us to take him to. The father also told us that Gbah has had constant diarrhea for two days which means that the critically low sodium levels from Wednesday have to now be extremely critical. The father was actually giving Gbah ORS (a sodium replacement drink) himself in the hospital.

We told the father we couldn't come up with any options. So I told him that he must tell us what he wanted to do. The father said he wanted to take him to the pediatric hospital to see if they will help. His son is 19 but he was going to say he is 15. The pediatric hospital here is run by MSF (also known as Doctors Without Borders), it's free and they actually have a real emergency room.

A family member carried Gbah to our car and all I could think of is that he is going to die in the car. He was obviously in critical condition. We drove as fast as we could to the pediatric hospital and stopped out front. You can't actually park by the hospital - there are gates and you can only walk to the hospital. So the family got Gbah out of the car and carried him to the ER. Jean followed to find out if they will admit him. She met the ER doc who said they will only tranfuse blood over the weekend if he is in critical need of it and the family must donate blood to replace the blood that is used.

We left the family there to deal with the nightmare. I fully expect to receive a phone call this weekend from the father to tell us Gbah has died. I'm not hopeful at all. If they can stabilize Gbah, he will have to be returned to the original hospital because it is the only one who can give the chemotherapy he needs.

As a nurse, there are so many things that occurred with Gbah that I can't even comprehend: a hospital that doesn't rehydrate a critically dehydrated patient while in their care for two days, a hospital that doesn't have blood because people here don't donate blood, a doctor who allows a critically ill patient to leave (in a taxi, no less), hospitals with ERs that can't treat emergencies after 4 pm or on weekends, nurses who won't tell a worried father a single thing that is going on, a hospital that doesn't give a single pain medication to a patient in serious pain.

This is what it looks like in a country without a healthcare system. This is what it looks like when the people of a nation live in extreme poverty. The only reason Gbah even has a chance is because Mercy Ships has made chemo available to people with Burkitts and that Gbah came to Mercy Ships to even know that there was chemo available. Everyone else in this country with cancer just dies a painful death at home.

This whole situation is not an isolated incident. We have a little patient, Survivor, who is also receiving chemotherapy. His father is critically ill with cardiomyopathy. His family took him to 2 different hospitals for help and was turned away because he didn't have the money to pay up front. The second hospital sent him home after he sat outside the hospital all day waiting to see if someone would help. They gave him some meds without even evaluating him or doing labs (3 of the 4 drugs have nothing to do with helping cardiomyopathy and the one that could actually help is such a low dose every other day, it will have no affect). We haven't gotten a phone call but I expect we will get one saying he has died.

We live in a privileged and wealthy country with our own problems. But the amount of injustice here is horrendous. Some days I feel like there is no hope and this is one of those days. But the more injustice I see, the more I want to be part of the solution that brings hope. I think the more injustices I see, the greater my desire is to continue to serve here.

I'm ending with my favorite Bible verse and my philosophy of life, Micah 6:8 - 'He has told you, O man, what is good; and what does the LORD require of you but to do justice, to love kindness, and to walk humbly with your God? (NASB).

Peace,
Michele

New patients

We're winding down with the outreach in Liberia but you'd never know it because we are still getting new patients every week! Last week, we received a new patient named George who was 15 years old. When he came to the ship seeking treatment, he was already so weak he couldn't even walk - his uncle carried him onto the ship. He had Burkitts lymphoma (a fast-growing cancer) and it had only started growing 3 weeks prior. We took him to St. Joseph's hospital on Wednesday to start chemo and on Sunday he passed away at the hospital. On Monday morning, we phoned his mother to see how he was doing (we were on the way to the hospital to visit him) and she told us he passed away. So instead we went to visit her to support her. It seems like we've done this a lot lately.

Tomorrow, we are getting another patient with Burkitts lymphoma who is 19 years old. His name is Gbah. He is also too weak to walk and has much pain in his abdomen (exactly the same as George) so I'm not very hopeful about his prognosis. We will be taking him to the hospital in the morning to start chemo.

I know I've said in the past that there is no cancer treatment here in Liberia and that is 99% true. However, a Mercy Ships doctor procured some chemo drugs last year but they are chemo drugs that work only for Burkitts lymphoma. So any person who comes to the ship and gets a diagnosis of Burkitts gets free chemo treatment at a local hospital who we have arranged to administer the drugs. But it's not a guarantee - almost all of our patients who are getting this chemo have died.

We also got a new patient today named Fatmata. She is 67 years old with some kind of cancer (the exact type is unknown but it's not Burkitts). We visited her today along with her daughter and son-in-law and went through the whole explanation about her diagnosis and prognosis (she is going to die from it). When they asked whether there was any medicine anywhere for this disease, we had to give them an answer that is difficult for anyone to hear. We have to tell them that, yes, there is medicine for this disease but only in places like America, and England, and Australia but not anywhere in West Africa.

Fatmata and her family are Muslims and they welcomed us, as Christians, with open arms (and hopefully we did the same). They were so grateful that we cared enough to come and visit them even with bad news. Fatmata cried and cried but she also just kept saying thank you, thank you for coming. At the end, we did tell them we are Christians (I'm sure they knew this because it's very evident to anyone who comes to the ship which she had) and asked if they would allow us to pray for them. Surprisingly they did!

I'm only pointing this out because this is the first time I have personally sat face to face with a Muslim family where God was any part of the discussion. And, at least in the U.S., we are so inundated with negative news stories about Muslims that it was a really good experience for me to meet this family and see how they are normal, everyday people just trying to make their way in the world. It was good to be able to hug Fatmata and to put our arms around her while she cried and to just love her for who she is, a person created in the image of God.

I'm going to end with a few photos so that I end this post with something upbeat - I know my posts can be depressing and sad sometimes so I'm trying to balance it with something to make you smile!

This says 'to be a man is not easy.' Sorry men but it is way, way harder to be a woman in Liberia than a man.

I'm not sure why but this made me really laugh! So does this mean the dog is good during the day?? And how are they supposed to see this at night when there are no lights because they have no electricity? And I'm glad they have the arrow or someone might miss the words below it!

Peace,

Michele

Noma

What's noma you ask? I'm guessing most of you have never heard of it - I'd never heard of it until I got to Liberia so this will be an educational post. Noma is a disease that exists in the poorest countries of Africa, a disease that has been eradicated from developed nations for over 100 years (except it was very common in the Nazi concentration camps). It is a disease of malnutrition and poverty and usually affects children. It is a disease we face here on the ship.

Noma comes from the Greek word that means 'to devour.' This disease affects the face of a child and basically eats away at the tissue. A simple round of antibiotics could stop it but you have to have access to healthcare in order to know this. The usual course of getting noma is like this: a child is who already malnourished and immuno-compromised gets a systemic illness (usually measles - of course, we don't see measles much in the U.S. since we are all immunized against it). If they survive this illness (most don't), they are susceptible to infections in the mouth. This infection turns into noma which eats away at the face (mouth, nose, cheeks). The mortality rate from noma is about 90% - if the child survives, they are left with a very disfigured face.

There are an estimated 400,000 children affected by noma in Africa. However, there is only one hospital in all of Africa (in Nigeria) that can perform surgery to restore their faces. And there is Mercy Ships.

We currently have at least one child on our ward who survived noma. Her name is Mathlyn and she has been with us for quite awhile as the reconstruction of her face will take place over many operations. Here is a photo of my roommate Amber and Mathlyn after her first surgery. Mathlyn had noma when she was 2 years old - she is now 11 years old and weighs only 61 pounds. When you are missing your lips, palate and part of your nose, it is difficult to get an adequate amount of nutrition. Currently her mouth is sutured shut so she is being fed through a tube in her nose and she has a trach so she can breathe.

Dr. Gary Parker, our long-time maxillo-facial surgeon, gave a presentation to the medical staff about noma and how they reconstruct the face in surgery. It was absolutely amazing. If you are the queasy type, you may want to skip over this part! I'm not sure I can explain this very well but I'm going to try to give a very oversimplified explanation.

The surgeon basically has to use other parts of the face to replace the parts that are missing. For example, if you are missing your upper lip, they use part of the bottom lip. They can't just cut out part of the bottom lip and reattach it to the upper lip because the tissue would die if you cutoff the blood supply. So they cut part of the bottom lip but leave part attached and flip it upside down to attach it to the upper lip. So at this point, it is attached to both the bottom lip and the upper lip. This remains this way for 21 days. This is the stage Mathlyn is in which is why her lips look so odd. After 21 days, another surgery is performed where the tissue is cut from the bottom lip. This tissue now becomes the upper lip (the bottom lip is now smaller).

If more of the face is missing (like the nose), then the surgeon uses a flap of skin and muscle from the temple region (it's called a scalping flap - I think the name says it all as to how they remove the skin) and reattaches it to the the area that is missing in the same way as the lip (they don't actually completely detach it from it's original place for 21 days).

Sorry if that makes you queasy but I personally am amazed by the techniques used in reconstructive surgery! The goal for these surgeries is to help that person become part of society again. Their faces will never look exactly 'right' but hopefully they are repaired enough so that the person can eat, drink and talk normally and can go out in public again.

So there's your African disease lesson for the day. Another reason to be thankful for living in the richest countries of the world.

Peace,
Michele