Sunday July 19

The last two weeks have been just as hectic especially this last week as I have been the only anaesthetic nurse in the department.

Enough of the excuses and on with the news.

First I need to make a correction to my last entry (July 4). The story about the newborn baby with a problem with her eyes was incorrect. The cause was not as I stated but was in fact an infection that occurred in the womb and caused her conjunctiva to swell. Sorry about that mistake.

A couple of weeks ago I went to the ward service and to simply be apart of a service that was being simultaneously translated into 3 other languages certainly adds time but is also interesting to hear. English to French and then French to Fon and another dialect which is spoken by only a few but means that all can take part in the service. probably part of the service that most remember is the worship time. Seeing ladies up and dancing while holding onto their catheters is indeed a memory to treasure. The rhythm is something else. The whole translation thing can be time consuming as sometimes to interview patients can take 5 translations then of course we don't always know how accurate the translations are and coping with languages that have no future tense...

All the VVF surgeons have left now and for the last 2 weeks we have had just general surgery and eyes so we have been able to run 2 rooms for the general surgery too. This has proved remarkably effective as a patient can be anaesthetised in the one room while the other room is completing the surgery of their patient. This means that there is less time lost for the surgeon who moves between rooms.

Last weekend we had to close down the water,power and evac systems while the cooling system was cleaned out. Just about the entire crew left the ship for the day. I was no exception and had a very enjoyable day at a place called Casa del Papa. Basically a beach resort with swimming pools and a very pleasant restaurant. Even more importantly the coffee is good too!

Last Sunday I went to the morning service at church as Christian was back and then during lunch was invited to walk to one of the local hotels for a swim. We actually had a lift as one of the drivers for the hospitality centre was just about to go there and dropped us off on the way. Having swum, drunk coffee and chatted we decided to walk back. On our way,we called into the hospitality centre as the doctor I was with had not yet visited. I walked her through the centre and we saw some of the patients there who were busy playing cards. One lady was outside preparing the evening meal for them. On our way out we thought that by turning left we should be able to walk back to the road we needed without doubling back on ourselves. We soon realised that we were unsure of where to go next so did the female thing and asked for help. A young lad - young to me - shewed us the way through and we would undoubtedly have got very lost without him. The narrow streets and alleyways were reminiscent of a Charles Dickens novel except that it was much warmer. We later discovered that we had walked through the fishing village. In fact it reminded me very much of areas of Uganda that I have visited in the past. we had a few children calling us "Yovo" but this is simply a term meaning "white person". But far more importantly these single roomed dwellings, some with a a thatched roof others with tin, are where many of our patients live. These are the poor communities we have come to serve.

As I have mentioned there are always staff leaving and in the last two weeks more friends have left and the community of the ship continues to evolve. Sometimes its hard work having to constantly introduce oneself without it sounding either trite or too well rehearsed.

On Friday the program reporting was about the new dormitory that is being built to house "Train the Trainer" courses at the new Agricultural Centre that has been developed by Mercyships. These are programs designed to teach the locals "how to fish". The programs are going well and there were the usual collection of photos, some quite amusing - like the lorry with a delivery of stand not being able to quite reach its destination because the back wheels were in a ditch. The rainy season has been the heaviest for 10 years. Waters levels are up everywhere and in fact a state of emergency had been declared by the government. Probably the safest place to be in heavy rain is on a ship, at least it floats!

Just occasionally we have emergencies to add into the list. This lady who really is smaller than me had VVF surgery 3 weeks ago but was having problems passing urine adequately. The surgeon on board agreed to attempt to place a special kind of catheter and the result is...one very happy patient, relieved of the stress and pain. I had looked after her while the small procedure was carried out under local anaesthetic. along with a brilliant translator called Bridget. We sat either side of her, comforted her and held her hand. This picture says it all and is what "makes my day"


This next week sees the return of Esther the lead anaesthetic nurse and I am hoping that over my last few weeks here I can go and visit some of the projects that the organisation is involved with. We also have a max-fax surgeon joining us so that will create more diversity for us again. At the end of the week the main eye surgeon is going on vacation for a few weeks to attend conferences etc so the following week will see more changes.

This weekend the ship was supposed to have been to the filling station for fuel but was postponed Friday lunchtime. So hurried plans were made for day trips out and I was invited to return to Casa del Papa. Such a hard decision, it took me all of half a second to say "yes please". We had a delightful day and the sun shone for us, unlike the previous weekend where it put in only a brief appearance. Today I went to the family service. This is a new initiative for this outreach. Each family takes it turn to organise the service which is aimed very much at the children. Some weeks there are craft activities, this week we had a game of bible trumps with each family. I was simply "fostered" by one of the families. It was great fun watching the children become involved, happy to put actions to the songs and generally enjoy themselves. Afterwards I was invited to join them for snacks in the dining room and then spent a happy hour just chatting to the other mums. Children don't change that much from one generation to the next in some of the things they do or say.....

Saturday July 4

Independence Day if you're American. The ship is strangely quiet as we have a "ship's holiday", in effect a 3 day weekend. So yesterday was an extra day off and felt like Saturday too. I remained on the ship after my morning run as I was on call and am so today. Not unfair as I swopped calls with others.

So having left everyone in the lurch wondering what was happening now seems a good time to catch up. There have been moment s of joy, sadness, long nights and early mornings so situation normal really.

The workload has not been arduous but simply long days with VVF surgery running late several times simply because the nature of the surgery is complicated. The surgeons often struggle to find anything that looks like normal anatomy. But the work is rewarding. One lady who had such surgery did become quite ill one night and required a special intravenous line called a central venous line to be inserted. (CVP) Although called at 10.20pm on the Saturday evening to help with this procedure the decision was then made not to go ahead. However she deteriorated later that night and so I was called at 2.30am to help insert this line. I stayed up the rest of the night as by the time we had succeeded, having had to give the patient a general anaesthetic, and cleared up there really wasn't much point in going to bed. I did sleep well that night and had snoozed during the day.

We are very fortunate to have some excellent consultants who give of their time and one such came from Canada for a month. He specialized in paediatric anaesthesia and having several sick kids was put to the test. This included putting a CVP line in when no easy access could be found for a regular cannula. A week later I was helping him in the intensive care unit (ICU) to place another CVP. The baby was 14 months old but weighed just 5kg. She had a particular bowel problem that in the US or the UK we would deal with at birth. That she had survived this long was a miracle. Heinz and I worked with others for over 2 hours before we succeeded. Sadly later that night she died. It took both of us quite sometime to recover emotionally from that experience. It's difficult when one is holding a child and as she did, see them looking straight through as if to say" I've had enough" and not be affected.

The following day we were talking to each other and supporting each other as we tried to put our own thoughts in to some sort of order. One fights so hard to give these children the best opportunity of life but God decides in the end we accept that for her, it was the time for her to be with Father. She's probably gurgling now very contentedly!

The photo below is a much happier one. One contented 3 hour baby who was brought in from one of the local hospitals as an emergency. Normally we do not accept emergencies but this an exceptional situation. The baby had been born with her eyes the wrong way round. I deliberately haven't included the "before" photo but the "after" one is kind of cute and what we strive to achieve. Again we saw God's timing here as we had the appropriate surgeon onboard to carry out what is actually a simple procedure - if you know what your doing!



There have been yet more departures of longer term staff and a couple of these have been from the OR. Pam and Margreet left during the same weekend, leaving a huge hole in the department. With facebook, keeping in contact is so much easier these days. We knew almost immediately that they had arrived home safely and are now busy re-adjusting to life at home. Others will come and fill the space but they had been a part of the orthopaedic team and then had taken up roles within the VVF and paediatric general surgery rooms which were new areas for both of them. It can be difficult having spent 4 or 5 months working with a team that all sings from the same song sheet to suddenly be thrust back into a world where minor details seem so important to others. Keeping the mouth shut can be very hard!

In the last 3 weeks it seems that we are hot news, at least in Gloucestershire. I have had a story put up on the local BBC news website about my blood donation. Paul and Rebekah have spoken on the local BBC Gloucestershire radio Sunday morning religious program about their visit and article also appeared in the international version of Christian Today about their trip. I have also been invited by the Association for Perioperative Practitioners to speak at a conference in Harrogate during October.

This last week has seen the visit of the President of the American Association of Perioperative Nurses (AORN). Mercyships has partnered with AORN and this visit was in connection with this process. We had a great time together sharing information and learning how the association could help us to improve what we are doing. Along with him there was a group that came from Instruments of Mercy and Integrated Medical Systems. They refurbish old instruments so we are hoping that they will be able to help us prolong the life of the instruments we use. thankfully they also repair endoscopes so our 2 endoscopes that we use for difficult airway intubation can also receive some TLC! Having the opportunity to chat with this group made me feel very much like home, talking about repairs and loan instruments..

As part of the eye team although not a constant member depending on the needs of the department, I am able to attend a small group that we have, led by the main surgeon, Dr Glenn Strauss. This group meets weekly for bible study for an hour and then an eye team meeting when we can discuss any problems that are arising. having the chance to share in a small group like this is all part of community living but adds to the team spirit and the sense very much of working together as a team. Opportunities occasionally arise for us to visit other parts of the team and its always good to see what is happening. It would be easy to become blinkered in our view.

The other group that has established itself to a routine now is the 6.00am running team. As people come and go the team members change but this morning has to be the most memorable. Only 2 of us met as the others were away - it being the long weekend - and being Saturday it was the long run day. Having not run for about 15 months I have been gradually building up my running again and this morning we went about 14.5k (just over 9 miles) in the wettest conditions ever. The two us were soaked before we reached the end of the dock, 500 metres from the gangway. The rain is warm so not a problem other than running with wet feet, with the best will in the world it's impossible to remain dry. The great advantage is the rain although warm keeps us cool so the long distance is easier. For the pair of us it was the longest run we have done. Sadly for me this mornings partner returns to South Africa on Thursday so next week the pace will be a little faster so I'll have to work harder. We do take small water bottles with us, the idea of which probably ought to be patented. They are empty 250ml bottles which held saline to which are then attached pieces of velcro. One piece of velcro is then wrapped around the hand so that they are easy to carry. We were dripping as we came up the gangway and stayed in the dining room just long enough to collect water and cups of tea but not long enough to create puddles of water. We really were that wet! Since then the sun has shone and dried up the puddles. Now the last Lions match to look forward to this afternoon. On call has its advantages - it gives a valid excuse for staying onboard and having to pass the time by watching such games on the screen!

Amazing to realise that I have only 6 weeks left onboard.