Presidential Visit

This evening, the President of Benin, Dr. Thomas Yayi Boni visited the Africa Mercy Ship and expressed his gratitude to the crew in his address, stating that Mercy Ships is a true friend, as this is the fourth visit of a Mercy Ship to his country. The President was given a guided tour of the Africa Mercy’s hospital, including one of the operating rooms and a visit to patients in one of the wards. In his speech, he quoted from Psalm 41: "Blessed is he that considers the poor." Nearly a third of Benin’s population of 8.5 million residents live on less than $2 a day, according to UN figures. For the past decade, Benin has been at the forefront of African democratization. Yet, the country remains beset with numerous problems, as evidenced by its ranking of 163 out of 177 countries on the Human Development Index.

Not in Kansas anymore

This week I began caring for post-surgical patients on the wards, the moment I have been waiting for. I have enjoyed the work very much, so much is different. My first day on the job I was laughing at myself, very much out of my element and comfort zone. My female patient was in the operating room having surgery and left there in her place on her bed was her baby! The baby was crying and crying and I learned that I would be looking after him until mom returned. He was very hungry indeed and would be staying here with mom as he was breastfeeding. I picked him up and carried him around with me as I tried to look over patient charts and get oriented on my first day. He continued to howl, anxiously awaiting mom's return. Someone suggested I attach him to my back using a cloth, that he might be comforted by this West African traditional carrying method and it would allow me to continue my work. Thankfully mom soon returned from surgery. I felt a bit forward giving her baby back to her to breastfeed soon after her arrival back on the ward after surgery but this did not seem to surprise her in any way. Mom and baby were reunited. My patient then asked if I could give her baby a bath. I was surprised when the patient in the next bed offered to bathe her baby. We had been taught during our training that the care of children in this culture is quite a communal effort. Soon after the bath, one of the male translators was sitting on my patient's bed, holding her baby and feeding him some of my patient's African traditional dinner using his hand. All of these practices were quite culturally appropriate but I confess I found myself wondering what Florence Nightingale would think of all of this, knowing that from a Western perspective, multiple breaches of infection control and HIPPA violations were taking place all around me!
I have encountered some other cultural surprises during my first week. The expression of pain is often communicated with an, "Aye yi yi!" while shaking one's wrist in the air. Patients under age 15 are required to have a guardian present with them on the ward. This guardian may be a parent, older sibling, relative or friend. The guardian spends the night with the patient and sleeps on a mattress under the patient's bed. Mothers will often sleep in the same small twin bed with their child and may have a second younger child who they are looking after staying with them on the ward. I had the opportunity to care for 4 year-old twins who had surgical repair of bowlegs. They and their mother all slept together in 2 twin beds pushed together.
The national languages of Benin are French and Fon. Many other tribal dialects are spoken as well. Translators are an essential presence on the wards as rarely do patients speak any English. Translators are also responsible for laundry, mopping and cooking a traditional African meal for the patients at dinnertime. They will often play with the children as well. This makes for a very busy ward with people on beds, in beds, under beds and playing down on the floor. The nurse must step carefully so as to do no harm as people and toys are everywhere! Sometimes it is difficult to know who is a patient, patient's child, visitor or translator! I am definitely being stretched here, not having cared for children since nursing school. It's Pediatrics 101, African style. Some things are culturally universal such as the fun one can have drawing on his leg casts with markers and crayons or playing with Legos or throwing teddy bears around the room. I feel like I am in a scene out of "Curious George Goes to the Hospital (in Benin)". (a fine read, but you don't have to take my word for it, da da dunt! Courtesy of Reading Rainbow. Thank you LeVar Burton.)

Surgery Begins!

Surgery officially begins today aboard the Africa Mercy Ship. Ginger (2nd from left) and Operating Room crew ready for action.

Many children will receive surgical repair of bowlegs and club feet

Ward Nurses officially ready to begin caring for patients

Sunday Best

I have enjoyed attending church in Africa with beautiful children, wonderful singing and dancing and trilingual sermons in French, Fon and English. The Mercy Ships crew has been warmly welcomed and received with gratitude.

Waterworld

We took a boat ride up the river in Cotonou to the stilt village of Ganvié whose name means "the collectivity of those who found peace at last". This lake village was built in the 17th century by the Tofinu people to protect themselves from being captured by the Dahomey kingdom and sold into slavery. The Fon warriors of this most powerful kingdom along the slave coast of West Africa were forbidden by their religion to enter the water making the lagoon a safe territory for other tribes. The village has a population of 20,000 and contains around 3,000 stilted buildings on Lake Nokoué. The people in this unique village live exclusively from fishing (along with a little tourism), use pirogues (wooden canoes) for transportation and have a system of underwater plantings that form fences to trap and breed fish.

Going to market on the water

Plantings in the mud to create fences to trap fish

Dwellings of Ganvié

(Many people in this village do not wish to have their photograph taken.) In the background are the dried bamboo poles used to create "fish fences".

We encountered this stunt fisherman on our boatride up the river. He performed headstands in exchange for a monetary reward.

How I love to watch the skilled throwing of fishing nets

Fish fences

Babies go everywhere!

Home Sweet Home

A video about Screening Day in Cotonou, Benin can be viewed online @ http://www.youtube.com/watch?v=prJxp346a6U

Screening Days

February 19th and 20th were Screening Days for surgical candidates in Cotonou, Benin at the Hall des Arts stadium. People waited in long lines in the hot sun to be screened. Over 2,000 patients were screened for the different surgeries performed aboard the Africa Mercy Ship including cataract removal, cleft lip and palate repair, removal of facial, head and neck tumors and goiters, repair of club feet and other orthopedic complications, hernia repair and vesicovaginal fistula repair (featured in the film, "Walk to Beautiful"). We distributed information regarding weekly eye and dental clinics held throughout Benin at local churches and clinics by Mercy Ships staff. Individuals were pre-screened by experienced Mercy Ships nurses outside the stadium and if they were considered surgical candidates, they received a ticket to enter the stadium where they circulated to different stations to complete patient interviews, assessment by physicians, laboratory blood work and to receive iron and multivitamin tablets to take for 1 month prior to surgery. I was so encouraged seeing hundreds of patients being scheduled for surgery. If it was determined during the pre-screening or screening inside the stadium that a person was not a candidate for surgery, he or she could receive prayer at a prayer station. Translators who spoke French, Fon and other dialects of Benin were essential. On these screening days I participated as a patient escort, bringing patients from pre-screening outside the stadium into the stadium or to the prayer station. I also participated in praying for patients. Quite a moving experience to observe both the accepting and turning away of patients. Many people reported feeling loved, respected and treated with dignity whether or not Mercy Ships was able to offer them a surgical resolution. These were days of hope, relief, joy, gratitude and sadness.

Starfish

Today I had the opportunity to participate in screening patients at a community center in Cotonou, Benin for orthopedic surgeries and was reminded of this story by Loren Eisely in his book, The Star Thrower. The author finds himself with writer's block and decides to take a walk along a sandy beach where hundreds of starfish had been washed up on the shore overnight. He noticed a boy picking up the starfish one by one and throwing each back into the ocean. Observing the boy for a few minutes Eisley asked him, "What are you doing?" The boy replied that he was returning the starfish to the sea, otherwise they would die when the burning rays of the sun hit them. The beach was miles and miles long and the author questioned the boy as to whether he was making a difference. The boy bent down, picked up another starfish and threw it into the back into the ocean and said, “it matters to this one.” Eisley left the boy and went home to continue writing, only to find that he could not type a single word. He returned to the beach and spent the rest of the morning helping the boy throw starfish back into the sea.

I was reminded of this story today in the midst of screening patients for surgery as people with various physical disabilities and deformities due to the effects of spina bifida, cerebral palsy, scoliosis, club feet, polio and other unknown causes travelled to be screened with the hope of being healed through surgery. Some people were carried on the backs of family and friends while others crawled or used their arms and upper body strength to be there. I was moved by their dignity and strength. I felt overwhelmed by the number of people we could not restore function to through surgery due to neurological causes for their conditions or to the debilitating effects of polio. We were able to schedule 20 or so patients for surgery, many of whom were children born with club feet.

Tomorrow is the big patient screening day at a stadium in Benin. We have been told that patients have already started lining up to be seen. We are expecting thousands of people to be there. I have heard that the most difficult thing about screening day is turning patients away who we cannot assist through surgery. I continue to reflect upon my reasons for being here and all of the beautiful starfish here in Benin.

Rice is Nice

This is my favorite sight to see in Benin: wooden fishing boats with their raised sails made of rice bags sewn together. Absolutely beautiful at sunset.

A Walk to Beautiful

One of the surgeries performed aboard the Africa Mercy Ship is the repair of obstetric fistula in women who have endured prolonged labor. We watched this awesome documentary following the stories of 5 Ethiopian women with this condition. To learn more, you can view the film's trailer @ http://www.walktobeautiful.com and clips from the film @ http://www.pbs.org/wgbh/nova/beautiful/program.html

A Week in Review

My first week in Benin has been a week of transition and adjustment: adjusting to ship life and close quarters: living, working, eating, recreating and communing with 350 crew members and taking in the culture on the streets of Benin. Work this week was all about cleaning, disinfecting and setting up the patient wards as all of the equipment and beds were secured and tied down during the sail. We stripped, mopped and waxed all of the floors and man, do they shine! We set up the beds in the patient wards and now the Africa Mercy Ship is really looking like a hospital! I ventured out into the port city of Cotonou to encounter a whirlwind of sights, sounds and smells. Imagine brightly colored clothing, hundreds of motorcycle taxis, diesel exhaust, music blasting in the streets, people carrying baskets and boxes of all sorts of goods on their heads to sell, anything from bananas to sunglasses to yams to smoked fish.

Brightly painted wooden fishing boats in the port of Cotonou with flags from different nations of the world blowing in the breeze.

Exploration through the winding streets of Benin landed us first upon these boys playing soccer. We walked further and found ourselves in a village and were soon being followed by a group of 20 or so children who were smiling, clapping their hands and singing this song, universally known and sung by all Beninois children:

“Yovo, Yovo, Bon soir! Ca va bien, Merci!”

Children will call out “Yovo” when they see white-skinned people. This song is suggesting that these are the only words Yovos know how to say in French. In my case, the kids are right, this is just about all I have retained from my French classes in high school:

Good Evening, I am well, Thank you.

Motorcycle Madness! Zemi-jahns are the main form of transportation around here. Drivers of these motorbike taxis wear bright yellow shirts. I saw 1 child, 2 adults and one baby secured with cloth to one of the adult’s backs riding on a motorbike. Other people ride while holding onto giant sacks of lettuce from the market. Most impressive are women dressed up, riding a motorbike while wearing high heels. No license, age requirement or registration to operate one of these vehicles! Mercy Ships has strongly urged us to refrain from using zemi-jahns as a mode of transportation due to the large number of accidents as there really are no rules of the road.

For now, as Bob Marley sings it best, "my feet is my only carriage."

This young boy is performing an impressive feat: walking over a bridge while balancing large metal objects on his head AND playing a handheld video game!!!

Buffing up the Ward

B is for Benin!

Great news!
Our ship has landed!
We are officially docked in the port
of Cotonou, Benin!

To be continued...

With Benin in sight

This afternoon, after 9 days at sea, we shouted, "Land Ahoy!" seeing Benin on the horizon. We were scheduled to dock on the African continent today. We have been sailing for most of the voyage using 2 of our 4 engines. This afternoon 1 of the engines was found not to be working properly and because all 4 engines are needed to navigate through and dock in the busy port of Cotonou, the Africa Mercy Ship is currently anchored for the night in the Gulf of Guinea with Benin in our sights. This evening we watched the sun set and moon rise over Benin. We long to be there, so close yet so far away. Please keep our ship and its needed engine repair in your prayers, with the hope that we can arrive in Benin tomorrow as the engineers work through the night.

Free Bird

"If I leave here tomorrow,
Would you still remember me?
For I must be traveling on now,
'Cause there's too many places I've got to see."
~Lynyrd Skynyrd

One of my favorite "pass the times" while sailing for 9 days aboard the Africa Mercy Ship is keeping my eyes peeled for flying fish. I couldn't believe what I was hearing aboard about these incredible creatures until I saw them with my own eyes. They launch out of the water when they get all stirred up, usually seen in front of the bow of the ship and literally "fly" above the surface of the water for incredible lengths of distance.

or Free Fish???

In this tribute to the Flying Fish, I thought I would share some fun facts with you: Flying fish can be seen jumping out of warm ocean waters worldwide. Their streamlined torpedo shape helps them gather enough underwater speed to break the surface, and their large, wing-like pectoral fins get them airborne. Flying Fish use this remarkable gliding ability to escape predators, of which they have many. Their pursuers include mackerel, tuna, swordfish, marlin, and other larger fish. For their sustenance, flying fish feed on a variety of foods, including plankton.There are about 40 known species of flying fish. (Here you will see their size relative to a tea cup)


Beyond their useful pectoral fins, all have unevenly forked tails, with the lower lobe longer than the upper lobe. Many species have enlarged pelvic fins as well and are known as four-winged flying fish.The process of taking flight, or gliding, begins by gaining great velocity underwater, about 37 miles (60 kilometers) per hour. Angling upward, the four-winged flying fish breaks the surface and begins to taxi by rapidly beating its tail while it is still beneath the surface. It then takes to the air, sometimes reaching heights over 4 feet (1.2 meters) and gliding long distances, up to 655 feet (200 meters). Once it nears the surface again, it can flap its tail and taxi without fully returning to the water. Capable of continuing its flight in such a manner, flying fish have been recorded stretching out their flights with consecutive glides spanning distances up to 1,312 feet (400 meters). Flying fish are attracted to light, like a number of sea creatures, and fishermen take advantage of this with substantial results. Canoes, filled with enough water to sustain fish, but not enough to allow them to propel themselves out, are affixed with a luring light at night to capture flying fish by the dozens. There is currently no protection status on these animals. (Thank you National Geographic)

(After all we have seen and learned, Ginger and I have decided to start an International Society for the Protection of Flying Fish)

Wildlife at Sea

Jane "Spuds" of Ireland, Alainie (Boston represent!) & Sharon "Snuggles" of North Carolina

It's a Dolphin!

It's a Killah Whale!!!

Knit One, Purl One

During this week of Nursing Orientation, we have been learning to knit and crochet. Once we master the art of yarn craft, we hope to share these skills with our patients as they recover.

Satellite

Thanks to the conveniences of modern technology, we are able to track our location with GPS, talk on the telephone and surf the internet, all from somewhere in the Atlantic Ocean. How cool is that? In the words of Dave Matthews:

Satellite in my eyes

Like a diamond in the sky

How I wonder

Satellite strung from the moon

And the world your balloon

Peeping Tom for the mother station

The Glorious Heavens

Tonight we had the privilege of stargazing out on "The Bridge", the highest viewing point above Deck 8 on the ship, right in front of the command center.

Through binoculars I was able to gaze at the moon and Orion's belt. Truly a breathtaking sight being out in the middle of the Atlantic Ocean with no land in sight, the starry heavens above and the light of the moon reflecting upon the water.

Training Begins

Today nursing orientation began with a discussion about the culture of Benin and a tour of the patient wards. Note the donated hand knit teddy bears awaiting the patients of Benin. Today we learned how to make friendship bracelets to share this craft with our patients as they recover. Tomorrow our orientation continues with crocheting and knitting lessons! If only nursing orientations in the U.S. were like this!

A Day of Rest

Another beautiful sunset over the Atlantic

Our second day at sea with nothing but ocean in every direction and no sight of land. A very restful day, reading, reflecting and lounging on the deck. This morning during breakfast, I saw a pod of dolphins jumping in and out of the waves.