Given.

What gifts are you wanting this Christmas?

Nothing is more precious than a wanted or deeply needed gift.

In my career as a paediatric anaesthetist and paediatric intensive care doctor, I have met many parents of critically ill children. Most parents would willingly give up their own life if it would save their child's life. The Christmas story is the other way around. A parent gives up the child's life. That is the extraordinary thing about Christmas. A child’s life is GIVEN for our benefit.

Jesus was born for us. His life is a gift to us. A much needed Christmas present. Let me explain why?

Isaiah 9:6 says,

For to us a child is born, to us a son is given, and the government will be on his shoulders, and He will be called Wonderful Counsellor, Mighty God, Everlasting Father, Prince of Peace

In this scripture, the writer is describing a vision he saw. He saw the darkness and gloom of a nation and he saw a child born who would remove the darkness, and bring hope. So we might not be ‘ruled by life’, but instead ‘rule in life’. That is the benefit of Jesus's birth.

I don't have to be 'ruled by life'. I don't have to be a victim of the stressors and pressures of my job, or the bad things that happen, like when children get sick, or when people bully me. Life can be brutal on hope, but I can learn how to triumph in these situations, to overcome and to 'rule in life'. It is possible to rule, even when life is hard. How do I know? Because i have experienced it and because the bible also says that 'He (God) prepares a table for us (ie a banquet, a feast) in the presence of our enemies'. Psalm 23 :5

So how does the birth of Jesus at Christmas make this possible?

1.    Because 'the government will be upon his shoulders'. Someone explained it like this, 'His government consists in ruling in the hearts of his people, in subduing their enemies, in protecting them, their persons and properties, rights and liberties, and in supplying them with everything necessary; and this government is delegated to him from his Father, is not of this world, but is spiritual; it is righteously administered, is peaceable, and will continue for ever'. Jesus was born to rule. And so are we, in his name.

2.    'And he will be called....'. In Hebrew, to be called and to be are the same thing. Names are important. They define who we are and what we carry. Look at who Jesus is and what he carries / comes to bring:

•  Wonderful Counsellor.

Jesus has wisdom and creative solutions, we just need to ask him. As Alan Scott says, 'there are answers in the heart of God that you cannot google'.

•  Mighty God.

Jesus is not just a sweet baby in a manger, but he is the Powerful and Mighty God. He has defeated all the schemes of the enemy.

•  Everlasting Father.

Protection, love, care, and everything you need or want a father to be, Jesus is and will be forever.

•  Prince of Peace.

Jesus is the Prince of Shalom, the Prince of Prosperity, the Giver of all Blessings.

May you know how to rule in life, because for you a child is born, for you son is given.

Happy Christmas

Africa is a continent not a country

Last month, October, I was teaching at an anesthetic meeting in Washington, DC. While I was there I attended several sessions relating to education and safety in Anesthesia. Some related to the use of simulation and checklists in western education; others related to teaching in low income settings. Most of these sessions were excellent, full of dedicated professional people, sharing ideas and desiring to see progress and equality for all in access to education and standards of healthcare that benefit all people everywhere. Much of it was hugely encouraging and inspiring.

There was also talk about standardising both training for the trainers so they were 'acreditted' before they taught overseas; as well as standardising what was taught ie the curriculum. While I unreservedly applaud these efforts, something in me is unsettled. I find myself wondering why people talk of Africa, or other 'low income countries' as all the same? Why do some people 'lump them all together under the same umbrella?' Africa, Asia, South America etc are vast continents with widely differing cultural values and expectations, resources and unmet needs. How can they, let-alone why would they, want to be treated the same? European countries have different standards of education and curricula, and these are different to the US and Canada; Australia and New Zealand etc. Standards are good, but 'standardisation' is not the same thing.

Furthermore, why should we in the West dictate what others need to learn? Western medicine has moved away from the paternalistic model of health care whereby the doctor tells the patient what is best for them and makes the decision. We now have an approach based on patient autonomy and informed choice. I find myself wondering if the doctors paternalistic approach is now manifesting in another format, dictating to Africa (or other low income countries) what they need and how they should be trained. Why not let Africa tell us how we can help?

It is easy to forget that Africa is a continent not a country. Africa is a huge place see the picture below. All the countries that make up the continent of Africa are vastly different, just like different European countries are different. I have spent time travelling in several countries in Southern African (including working in one) and have visited one country in North Africa.  With Mercy Ships I have worked in five West African countries, both the Francophone counties of Togo, Benin, and Guinea, as well as the English speaking ones of Liberia and Sierra Leone. Last month I made my first visit to Central Africa, visiting the Republic of Congo, otherwise known as Congo-Brazzaville to distinguish it from the Democratic Republic of Congo (DRC). Each one is very different. Yes, there is room to improve standards of healthcare, but I am not sure 'standardisation' is what is needed.

I was in Congo as part of a preparatory team for Mercy Ships visit in August 2013. We were doing some diplomatic and logistic work, as well as assessing their medical training needs in the areas where we have expertise, in order to see where we can best be of benefit. Mercy Ships has a lot of experience in West Africa, but one thing we were very aware of, was the culture in Central Africa is very different. Things which have not worked well in West African countries may indeed work well in Congo for a variety of reasons. The reverse is also true.

Mercy Ships and I, will need humility, courage and love to succeed in this new place. Humility to listen to what the Congolese tell us and accept when we get it wrong; courage to try different ways of working and change our existing practices where necessary; love for the people of Central Africa and especially Congo. Because if love is what motivates us, we will ultimately succeed, because 'love covers a multitude of sins'. Love overcomes the paternalistic attitude, the pride and boasting, and egotistical talk that says we know what is best.

"Love never gives up. Love cares more for others than for self. Love doesn't want what it doesn't have. Love doesn't strut, Doesn't have a swelled head, Doesn't force itself on others, Isn't always 'me first,' Doesn't fly off the handle, Doesn't keep score of the sins of others, Doesn't revel when others grovel, Takes pleasure in the flowering of truth, Puts up with anything, Trusts God always, Always looks for the best, Never looks back, But keeps going to the end." 1 Corinthians 13: 4-7 (Message version)

I want to help the countries where I serve to improve their standards not give them a standardised approach. I know I need humility, courage and love. And I think this probably applies not just to me in the continent of Africa, but to all our situations, wherever you are as you read this. Humility to admit our mistakes, courage to break new ground and overcome adversity, and loves that keeps going to the end.

Hospital Hierachy....the poorest of the poor

I have been thinking a lot about training and education.  As a hospital ship we aim to provide surgical health care to the host countries we visit, but we also try and provide education and training for doctors and nurses. However, this is not as easy as it sounds, it is an area we are developing, and it has got me thinking.

Mercy Ships has been in Guinea for 6 weeks. In that time we have set up our hospital and have received over 50 different requests for training, from various sources. We are managing these according to (i) what falls within our areas of expertise; (ii) assessment against predetermined criteria;  (iii) and finally, because of our own limited resources, what we consider a priority.

Interesting that last point…..what we consider a priority……what do you think? Who would you prioritise for training in a surgical hospital?

         i.            Surgeons

       ii.            Anesthetists (doctors or nurses)

      iii.            Nurses

     iv.            Lab technicians for diagnosing with blood tests

       v.            Xray /ultrasound technicians / radiologists for diagnosing using imaging

     vi.            Sterile Processing technicians who clean the surgical instruments

Until last week, I think I would have focussed on the doctors and nurses? Maybe that’s because I am a doctor? But I met someone a few weeks ago who has changed my focus.

Christina is a Canadian who works in Sterile Processing. She is also an instructor for the International Standard qualification. But more than this, she has an incredible passion to help West African hospitals improve their hygiene standards and to take ‘sterility’ seriously. Spending time with her has been enlightening.

I drove Christina to the 3 main hospitals in Conakry, the capital of Guinea. One hospital did not even have soap and water to wash your hands with. Another used laundry detergent to clean the surgical instruments after an operation. There were no brushes to clean the instruments, so they cleaned them with rags or bare hands. There was no disinfectant, let alone any functioning sterilisation equipment of any sort. Dirty instruments were kept close to the ‘clean’ ones, the walls and floors were filthy and there was clutter everywhere. Many of the surgical instruments were rusty. Totally the opposite of what would be described as ‘best practice’. Christina, spent time with the workers and then spent 2 weeks literally ‘rolling her sleeves up’. She helped clean the floors and walls, gave the workers gloves and brushes to clean with, and educated them in simple practices to improve the hospital hygiene.

What amazes me is that the people who act as sterile processing technicians in Guinea, have no training; they are given no gloves to wear even for handling hot steamers so many have burns; and furthermore they are not even paid! They hang around all day, hoping an operation may happen (only if the patient can afford to by the necessary supplies such as drugs, cannula’s and fluid) and then hoping that the surgeon will ask them to clean his instruments afterwards. Then the workers wait to the end of the week and hope the surgeon will give them some money for their efforts, but the surgeon is not obligated to do so. They literally wait around for work, and then have to depend on the goodwill of the surgeon in order to feed their family.

Mercy Ships aims to help the poorest of the poor, by working in West Africa. It struck me that Christina, is also working with the poorest of the poor amoungst the hospital hierarchy. Sterile Processing technicians tend to be the forgotten ones, even in hospitals in England.

My time with Christina has made me think. I can train a surgeon or an anaesthetist, but if the instruments are still dirty how much will it ultimately achieve? As a medical student many years ago in Zimbabwe, I vividly remember a missionary surgeon taking me to a lady whose hip fracture he had expertly fixed. But now she lay dying of sepsis, from bed sores due to poor nursing care, and also no doubt inadequate sterile practice. A doctor can be expertly trained but without the support of his team, he will never reach his full potential.

Training doctors in Africa sounds glamorous, training Sterilisers doesn’t.  But I am not interested in glamour. Neither was Jesus. He rolled up his sleeves, got down on his hands and knees and washed his disciple’s feet. Reminds me of Christina, cleaning the operating rooms in Guinea on her hands and knees. Giving value to a profession that is undervalued. Making a difference.  From now on sterile processing will be part of our medical training initiatives in West Africa because it seems to me, that the poorest of the poor in the hospital heirachy, have been forgotten for far too long.

Thank you Christina for what you taught me these last few weeks & good luck with setting up your charity / NGO: Sterile Processing Education in Developing Countries……or whatever name you decide upon. May God bless your endeavours and make all you do succeed.

Screening

On Monday, September 3^rd, more than 4,300 people waited in anticipation, forming a long queue outside the People’s Palace in Conakry, Guinea. They were looking for help from the Africa Mercy.  It was screening day.

Some waited through the night, but most started arriving from 5am. A few crew members from the Africa Mercy walked the line, gently dismissing those we clearly could not help. Over 3500 were allowed inside the gates and queued to see experienced nurses who further screened out conditions we could not help. Around 1000 people were allowed entry to the building and registered. Contact details recorded, histories taken and finally examination by a surgeon. All specialties were represented in the long lines of people desperate for help: Orthopaedic, Maxillofacial, Plastics, General, VVF, Eye and Dental patients. 

For those turned down for surgery, the disappointment was tangible. Hopes raised over the hours of queuing were then shattered. But African culture values the community over the individual. So, most people seemed grateful we there, because even if we could not help them, we might be able to help the person sat next to them. It was humbling to witness this selflessness.

Some patients required biopsy or blood tests before a final decision on surgery was made.  Those with end stage cancer (on biopsy) were refused surgery and instead referred to our palliative care team, who will follow up and visit the patients in their homes.

 Finally, the lucky ones, went to the scheduling station. Here they received an appointment for either surgery or further investigations such as x-ray or CT scan, on board ship. For these ‘chosen’ ones, their appointment cards are treasured possessions, reflecting hope, where previously there was none.

By 6pm it was growing dark and there were no lights in the building. We continued working using head torches but by 8pm there were still 100 patients still waiting for biopsies/review by a surgeon. We decided to stop, and bring the remaining patients to the ship a two days later to finish the assessments. BY the time we packed up it and returned to the ship it was 9.30pm. Over 200 patients had been scheduled for surgery, with nearly 1,000 others scheduled for further evaluation or treatment.  This represents our first few months of work. Later on, we have an ‘up country’ screening for patients from the northern and eastern regions of the country. And constantly throughout our time in Guinea we will receive referrals from local hospitals, government officials, and simply word of mouth as desperate people turn up at the dockside seeking help.

On Wednesday September 5^th,  the remaining patients were assessed and by the end of the next day, 3 babies had had their cleft lips repaired, other children had burns contractures released, and several young men had hernias repaired…… hope and healing truly was on its way.

It is a privilege to be able to help, but I am so aware that the need in Guinea far exceeds our capacity to meet it. As surgery began in the hospital on Thursday, a mother came to the Dental Clinic for treatment. She brought her one year old daughter with her who had bilateral club feet.  Why, oh why had she not brought her daughter to screening on Monday? Our orthopaedic surgery schedule is full……we cannot help her daughter now. If only, she had turned up at screening on Monday, then we could have helped her……if only…if only… if only. That is the harsh reality here. Thousands queued on Monday, desperate for treatment, desperate for hope, desperate for someone to care. More went away disappointed, then we were able to offer surgery to. But I hope we reflected care and compassion to every person we saw. The mission statement of Mercy Ships is:

 Mercy Ships follows the 2000-year-old model of Jesus, bringing hope and healing to the world's forgotten poor

Guinea is over 95% Muslim, but Jesus is mentioned over 90 times in the Qu’ran. To Muslims, Jesus is ‘the greatest healer’, as he acted with compassion and actually healed people. So Jesus is a good example for all doctors and nurses to follow, whatever your religious beliefs. So that is why, even in a Muslim nation, the mission statement of Mercy Ships remains entirely appropriate.

The vision of Mercy Ships is:

Mercy Ships seeks to become the face of love in action, bringing hope and healing to the poor

 I believe we embodied that this at screening on Monday and I believe that is why the Guinean government have invited us here. I pray for the strength to hold true to the vision.

Icebergs

I am struck by the beauty of icebergs. Each one is unique, and constantly changing. On a sunny day, against a backdrop of blue sky and an even deeper blue coloured ocean, rays of light catch the ice crystals and are scattered in all manner of directions, making dancing patterns on the waves. It is truly a stunning sight. Some are huge, some are small, but all are beautiful. And what's interesting about icebergs is that most of it is actually hidden under the water. We only see a tiny portion. A vast quantity of solid immovable ice is what supports the amazing sight that you see. And the bigger the sight above the water, the bigger the base below.

I have just spent a month at home in England, partly working and partly vacation. I have loved seeing friends and family and I have been totally blown away by people's love and support. Many of you have bought me coffee, lunch, dinner, prayed for me, given financially, and generally encouraged me. I am surprised how many of you have said things like, 'we love your blog'; 'what you are doing is SO amazing'; 'we love hearing your stories of hope and healing and feeling connected'. I honestly hadn't expected such an overwhelming reaction. And the truth is ........I think I feel a bit like an iceberg.

I may be the tip of the iceberg, the one who is seen. But truly, you are all the base that supports me. That was so very evident to me this last month in England. So I wanted to say a huge thank you to everyone for supporting me emotionally, professionally, spiritually and financially. I am only who I am, and can only do what I do, because of all that people have sown into me over the years. Many people have helped to develop my character, my natural abilities and my skills as a doctor, to make this current work possible. The truth is I wouldn't be working for Mercy Ships without this base of support beneath me. When the base of the iceberg melts, the tip disappears. So, sincerely, thank you for being the hidden base that gives beauty and form to the tip.

Another thing that struck me this month when people repeatedly said to me, 'you're doing amazing things', is that actually we are all doing 'amazing things'. We just have to realise it.. My medical colleagues do an amazing job caring for some of the sickest children in England; parents and grandparents do an amazing job investing in the next generation. Even simply having a coffee, a round of golf or a game of tennis with someone can also be amazing if you use that time to speak words of comfort, hope or encouragement. Helping someone by doing their shopping, cooking a meal, visiting them in hospital is pretty amazing too. Why?  Because these things all bring life and hope to others...... and that is good news for those who receive it...that's why it's amazing.

So thank you for being part of my iceberg....for keeping me afloat (and not melting in the heat) so that light can glance off me bringing beauty, dignity, hope and healing to the poor of West Africa.
And I hope you can see your potential as an iceberg too....bringing beauty, dignity and life to those around you.

Josephine and Chara …..inspiration for a vision

I often think about Josephine and Chara. They were both been patients of mine who needed complex surgery.  Complex surgery often requires complex anaesthesia.

Sierra Leone, May 2011: 2 year old Josephine chokes on a stone and it becomes stuck in her lung. There is one surgeon in Sierra Leone who thinks he can help, but there isn’t an anaesthetist capable of anaesthetising her. Mercy Ships and I agree to help. Unfortunately the surgeon can’t remove the stone, so Josephine is left fighting for her life in the intensive care unit on the ship. She needs a specialist lung surgeon but Sierra Leone has none. There is a surgeon in Ghana but, no paediatric anaesthetist for lung surgery. The nearest place would be South Africa, and it would cost over £250,000 ($400,000). So, we flew a surgeon from Kenya to the ship and Josephine made a miraculous recovery.

I thank God that when Josephine needed help, Mercy Ships and I could provide the specialist help .  

Togo, May 2012: 1 year old Chara has Crouzon’s syndrome and needs specialist surgery to adjust the bones of her face and skull. Her bones have developed abnormally and without surgery Chara could become brain damaged and blind. A German craniofacial surgeon came to the ship to perform the major surgery Chara needed. Initially she recovered well but then developed complications of infection and leakage of fluid that surrounds the brain (CSF).  These were difficult to treat and delayed her discharge which was critical because the ship was leaving Togo in June. Chara had to be discharged to a local hospital and she subsequently needed further surgery. But no anaesthetist was prepared to anaesthetise her, and even the neurosurgeon was reluctant to operate on such a small child. So, Chara will be transferred to Germany to complete her treatment.

I used to work in a large university hospital with specialist paediatric services. Children received whatever they needed. Sadly that is not true for most children in Africa, for whom health services are often woefully inadequate. In particular, there is a shortage of surgeons.

Imagine….    England with only 200 surgeons. We would have the same access to surgery as the average African.

Imagine….     England with only 25 surgeons. We would be better off than the average rural African. And the average rural African would have to travel hundreds of miles to see the surgeon and PAY for the initial consultation and surgery. Earning less than $200 per year, they would never afford the cost.

10% of all adult deaths in Africa are due to lack of access to surgery, and 20% of all child deaths.

Furthermore, most anaesthetists in Africa are not doctors. They have done a 3 year technician course and actually do a tremendous job in very difficult circumstances and for very little reward. However, most have inadequate training in paediatrics, so cannot anaesthetise children for complex or life-saving surgery. In Togo, I estimate there were only 2 medically qualified anaesthetists.

Josephine was lucky, but Chara was not so lucky. Chara needs to travel to Germany to complete her treatment because we had to leave. I’d like to see ‘luck’ become unnecessary. I’d like to see at least one specially trained children’s anaesthetist in each African country.  

Too big a vision?               May be.

Is it possible?                     I hope so.

Will I see it happen in my lifetime?           Probably not.

But does that deter me?              No.

I believe we all need a vision, and we all need hope. Hope that will outlast our lifetime. Without vision and hope I don’t think we ever achieve very much. Many great achievements in history took a lifetime to complete, and many were finished after their champion died. William Wilberforce and the abolition of slavery is a great example. And I highly commend the film Amazing Grace to anyone who has not seen it. It is one of my favourite films.

I have a vision – to train anaesthetists to help children like Josephine and Chara.

I have a hope - healthcare in Africa can be transformed.

What is your vision, what is your hope?

Mercy Ships is involved in training surgeons, anaesthetists and nursing staff. We work with the Ministry of Health and the Ministry of Foreign Affairs in the countries we visit, to identify the needs and how we can help. Thank you for reading this and supporting the work we do.

Goodbye: ‘It breaks my heart’ …or does it?

We are packing up in Togo. This field service is over and we are preparing to go to Guinea. What legacy have we left behind? What impact have the people of Togo left on our hearts? As many crew members depart, and less than half of us are left onboard for the sail, I have witnessed many tearful goodbyes.  Many times I have heard the phrase ‘It breaks my heart’. Indeed, I have said it myself.

But is it actually true? Does it really ‘break my heart’ when I say goodbye? Or is it more that my heart is so full, it is simply overflowing.  

Imagine your heart is like a cup full of orange juice. If the cup is cracked or broken, the orange juice spills out. It makes a mess, and my hands get sticky. It the cup contained hot tea, my hands would be burnt and it would hurt. The same would happen if the cup wasn’t broken and I just kept pouring the orange juice in. It would overflow and run down the sides and make a mess, the hot tea would spill over and burn my hands. A broken cup and an overflowing cup can look the same. But the difference is, the broken cup ends up empty, the overflowing cup stays full.

It is the same with my heart. That is why I am growing to dislike the phrase, ‘It breaks my heart’.  I prefer to say, ‘My heart is overflowing’, because I believe that is the truth. When I say goodbye to someone I love, it hurts because I grieve the loss of their physical presence in my life. But my life is still richer, my heart fuller because I met them. I am thankful for the blessing they have been to me and the times we have shared together. Saying goodbye does not and should not ‘break my heart’.

And as a follower of Christ, I remember the promises of God which are:

I am with you always; I have loved you with an everlasting love; I have plans for you, plans to prosper you and not to harm you.

Then the question is, do I believe what God says? It is either true or false? There is no middle ground. No option to think ‘sometimes God’s with me, sometimes He’s not’ or ‘I know he has plans for me, but maybe they aren’t that good  because he doesn’t really  love me’. Little seeds of doubt can so easily creep in, eroding our confidence in God’s word, and ultimately our faith and trust in Him.

So for me, when I say goodbye, I chose to trust what God says is true. He loves me and is with me always.  And God also loves the person I will miss. He is with them always too, and He goes with them in ways I cannot possibly go. I don’t want to cling onto them any more than I want them to cling onto me. I want to be the woman who walks out the plans and purposes God has for me, even if that means leaving and walking away. And I want to release my friends to do the same. When they leave, I want to say goodbye and send them off, releasing them into Gods hands, to fulfil the plans and purposes God has designed for them.

Why is this important? Well it is all about speaking and believing truth versus lies. I believe we need to fight for truth. Why confess a lie, when you can confess truth. More on that another time. Meanwhile, as I say my goodbyes, I am not going to say ‘It breaks my heart’, because I don’t think it is true. The truth is my heart is overflowing and richer and fuller because I have known you. And I release you to go with God, in the knowledge of his love and to walk into all the plans he has for you.   

Fati's story....obstetric fistula surgery

Fati’s story

Fati has 4 children. All were born without any problems, but her fifth child was different. He got stuck. Slowly, painfully, she laboured for 4 days. Her husband found someone to help take her to the nearest hospital, several hours drive from their village. But the hospital turned them away. Fati and her husband did not have the money to pay for the caesarean section she needed. They tried another hospital, and another. But each time the story was the same. No money, no treatment. They became desperate so they lied. They told the fourth hospital they could pay for a caesarean section and so Fati was admitted. Her baby had long since died, but at least her suffering was over, or so she thought. She and her husband sneaked out of the hospital the very next morning before it was light. They ran away because they couldn’t pay. Fati noticed the wetness immediately, but she thought it would heal up as her body recovered from the ordeal. But it persisted. The wetness made her skin sore, but worse, a stench of stale urine became her constant companion. It was overpowering. Her husband left her and people in the village shunned her. She became an outcast, and relying on people’s pity and scraps of food thrown to her, like dog. Her life had changed beyond anything she could imagine. She existed, but wished she didn’t. She had no hope. Fati contemplated suicide. Fati has a vesicovaginal fistula (VVF).

Obstetric Fistula – medical details

A fistula is a hole, or abnormal connection between two structures. Obstetric fistulas (of which VVF is one type), are caused by obstructed labour and lack of access to obstetric care In obstructed labour the fetal head causes unrelenting pressure on the pelvic structures, damaging them severely. The bladder, urethra, vagina, uterus and rectum can all be damaged. The tragedy is that obstetric fistulas are totally preventable by access to appropriate obstetric care, which is why we don’t see or hear of them in the ‘west’. Moreover, there are few ‘western’ surgeons who specialise fistula surgery because there is minimal need.  But here in Africa, among the poorest of the poor, the need is great indeed.

Mercy Ships

I have just spent the last month working with Dr Lauri Romanzi, a fistula surgeon from the US. We have performed just under 50 fistula repairs, and trained a Togolese surgeon, Dr Sewa in both spinal anaesthesia and repair of simple VVF’s. Some of the fistulas we encountered were complex, difficult cases and we worked late into the evening many times to help all the women who were scheduled for treatment. Women with fistula suffer from a huge loss of dignity and self-worth. One of the wonderful things about fistula surgery onboard the Africa Mercy is that it doesn’t just treat the body but also the soul. The women receive a new dress and gifts when they are discharged which signify a restoration of dignity, identity, significance and self-worth. This is a time of celebration. There is dancing and many women share their stories. It is a moving occasion and we call it the ‘Dress Ceremony’.

Togo, Niger, and Ethiopia

Togo has recently made caesarean sections free of charge to all women. That is a huge step forwards in fistula prevention. The next step is to train more surgeons / medical officers /anaesthetists to perform spinal anesthesia and caesarean section, and improve access to these facilities. In the meantime, we will continue to train doctors like Dr Sewa to help his people and we will continue to need facilities like Danja Fistula Centre in Niger.

Danja Fistula Centre in Niger is a fistula hospital which officially opened earlier this year. It was built and is partially funded by The Worldwide Fistula Fund. A friend of mine, Sarah Walker, who used to be nurse on Mercy Ships, now helps run the hospital. They are short of anaesthetists. So anyone wanting to help for a few weeks to a few months would be most welcome.

One of the biggest Fistula hospitals in in Addis Ababa, Ethiopia. A fascinating history of this hospital, and more insight into the lives of women suffering from VVF is given in the book, ‘A hospital by the river’ by Dr Catherine Hamlin. Dr Hamlin has been describe as a ‘modern Mother Teresa’.

You and me
How will you be described?
How do you want to be described?

Introducing Darius

Darius is a 9 year old boy who comes from Cotonou. Cotonou is the capital city of the neighbouring country, Benin.

Today is Easter monday, and two weeks ago I met Darius. His eyelids had fused together last year and he came to have surgery to literally ‘open his eyes’. I don’t know why his eyes had fused together. But that didn’t matter. Here was a little boy, sat in front of me, who once could see but now was blind.

Sometimes making a diagnosis can be difficult in medicine. Doctors are like detectives, piecing together the clues to come up with a ‘who dunnit list’ of possible culprits. Most clues come from what the patient tells us. Examining the patient gives more information, creating a list of possible suspects (diagnoses). Finally, tests and investigations confirm or refute our suspicions.  Like most mysteries, the solving is best done when the evidence is fresh. Trying to figure out what happened years later is much more difficult. That was the situation with Darius.

Darius had been a healthy boy until last year. He enjoyed school and playing with his friends. Then, like many children his age, he caught chicken pox. Because he was malnourished the chickpox became a severe infection. What happened next is unclear. His mother thinks he had a severe allergic reaction to an antibiotic which caused his skin to peel especially around his lips and eyes. His eyes swelled so much he couldn’t open them. When the infection healed it fused his eyelids together so he couldn’t open them. A once happy boy, now sat quietly on the edge of his bed, head hanging down. 

But there was a small glimmer of hope. Darius could distinguish bright light from darkness. That meant it was worth surgically opening his eyes to see if the eyes themselves were damaged. There was a chance Darius might be able to see.

So we literally cut open Darius’s eyes. The left eye was badly damaged, but the right eye less so. More treatment was necessary. Darius would have to come to surgery every day to have his eyes cleaned and cared for under general anaesthetic. The surgery would be painful, requiring large doses of morphine. A tough ordeal for a frightened 9 year old, in a foreign country.

Over the last 2 weeks, there have been ups and downs. Initially Darius made good progress but then the progress slowed and he needed eye drops every hour. We were praying, his mum was praying. She stayed up all night praying when his eyes took a turn for the worse.  She has made a big sacrifice for her son. She has travelled to another country, leaving her other children behind, just to give this son a chance for sight. Darius is that precious. She doesn’t know when her son’s ordeal will end. Nor does she know if it will be worth it. Will Darius ever see again? I don’t know. I hope so, but his treatment continues.

As doctors, we do what we can. We wait patiently. Here on the ship we also pray. His mum does the same. She puts her son’s needs before her own. What parent wouldn’t?

This reminds me of Easter. The bible says God is our heavenly  father. As our dad, God also made a sacrifice for us. Just like Darius’s mum made a sacrifice.

God sacrificed his only son so we could be forgiven. God cares for you and me, just like Darius’s mum cares for him. Darius is precious to his mum. You and I are precious to God.  A parent will do whatever they can to help their child. God wants to help us too. He wants to hold our hand, in his nailed pierced hands and walk life’s journey with us. What parent wouldn’t?

This Easter, do you know how precious you are? Will you take God's hands offered for you?

Happy Easter Darius. See you in surgery tomorrow.

I don’t understand…. but I do believe

My computer is connecting wirelessly to a satellite connection in outer space and allowing me to post this blog for you to read. I don’t really understand how it all works. I can’t see the internet, and I can’t explain all the science behind wireless satellite communication, but some people can. I don’t need to be able to explain it for it to happen. It is a reality. No doubt some of you reading this can explain all the science, but most of us can’t. We just know it is a reality.

Now, I don’t know if you believe in God, but my experience this month tells me someone is out there, and that someone is listening, and actually wants to talk to me. Let me share a couple of stories that happened to me in the last few weeks since my last blog post (the first 2 are from Benin and the 3^rd is from this first week on the ship).

1.       In Texas, we were told we were going to Benin to work in 3 areas: a prison, an orphanage, and building a wall. We also had the names of some of the individuals we would be working with. We asked God if there was any individual in particular that we should pray for. God told us to pray for individual ‘D’.  We then asked God how we should pray for ‘D’. He told us a few things about how she was feeling, and some specific things that had been troubling her. We then asked God which of our team members should try and connect with ‘D’. God said team member ‘M’. So we prayed about that these two individulas would connect and that ‘M’ would have the opportunity to encourage ‘D’. We arrived in Benin and on the very first day we went to the orphanage. At lunchtime ‘D’ was sitting down and beckoned for ‘M’ to join her. They chatted and ‘M’ shared we had been praying for ‘D’, but did not say what we had prayed for. ‘D’ said ‘thank you so much’ and then proceeded to share with ‘M’ how she had been feeling and what was troubling her. It was exactly the same things that God had showed us in prayer.  And ‘D’ said that in the last few weeks things had gotten a bit better. That was the time we had started praying.

2.       We were also practicing this type of ‘listening to God’ prayer before each visit to the prison. We did this as adults and with some of the children in our team who were 7 and 9 years old. We would say: ‘God tell us what you want us to say in the prison’.  We would ‘listen’ for a few minutes and then share what we felt God had spoken to us. Then we would pray those things. One night one of the children was reminded of a story called ‘Footprints’ (click on the page tab above to read this short story). This story tied in with some of the words and impressions that the adults felt God was saying. So we prayed. Then the night before we went into the prison God woke one of us up in the middle of the night with an African version of the ‘Footprints’ story. The next morning we went in to the prison and told the story to the women. Many of these women wept as they listened to the story.  That was something new, they hadn’t done that on previous occasions when we visited. You could feel the presence of God in the place and I believe God spoke to the women through the story we shared. Many of the women were in prison because they had been accused of witchcraft or sorcery. Others were there for simple theft offences.

3.       The eye team on board ship have been very short staffed and the staff we do have are inexperienced. So it has been a difficult start to the work. A friend of mine who is a new member of the eye team wanted us to pray in the eye room, so we did. God also spoke to her about praying specifically in that room. So she obeyed and went to the eye room before work on Monday and Tuesday . On those days there was an atmosphere of peace and even the surgeon (who knew nothing about the prayers) commented on the calmness in comparison to the week before. On Wednesday the lady decided to pray for the day from her cabin rather than actually in the eye room itself. That day things seemed more chaotic than the previous days, and what’s more, many of the patients had problems with high blood pressure. High blood pressure is common as the patients are anxious but it can cause the surgery to be cancelled. The next day, Thursday, the lady returned to the eye room to pray, and the calm atmosphere returned, and there were no problems with blood pressure.

Coincidences?

Maybe. But maybe it is something more….

I don’t know if you believe in God, but my experience this month tells me someone is out there, and that someone is listening, and wants to talk to you.

Just like the internet, I don’t understand prayer …..but I know it works and I am trying to use it.

‘Surely the Sovereign Lord does nothing without revealing his plan to his servants the prophets.’ Amos 3: 7

Now….. if God exists, then that is exciting.

BTS and Screening

While I was undergoing Basic Safety Training (BST) in Texas, friends on board were screening approximately 4000 adults and children in Togo. Approximately about 1500 patients are booked for life-transforming surgeries in the operating room. Thousand more will undergo dental and cataract surgeries as well.

The video (see right) shows footage of the screening.

More photographs of screening can be viewed by clicking on the above tabs, as can photos and video of the basic safety training - fire fighting and sea survival.

All done here in Texas, leave for Africa tomorrow....33 hours and 4 flights later we will be in Benin....and then 20 days later we arrive in Togo to join the ship....can't wait. Next blog post will be from on board the Africa Mercy.

Change

It has been a month of change.

I have been in Texas for 3 weeks at the Mercy Ships International Operations Centre (IOC) undergoing a period of training before I join the ship.

I have changed where I live, who I hang out with, what time I eat dinner. The clothes here are different – Texas is boots and bling. The cars, the roads, the food portions are different. All BIGGER.

We have classes from 8 till 4.30 weekdays, plus some Saturday and evening sessions. Assignments to hand in every week. It is a change from giving anaesthetics and working on intensive care.

‘So far so good’.  Or perhaps I should write with less of the British reserve and say something more American such as ‘So far it’s TOTALLY AWESOME’.  Yes, there are cultural differences and realising they exist is one of the things we have been learning. I have experienced cultural differences through working and travelling to many places overseas. But until now I had little understanding of why those differences existed, or the prejudices that most of us unconsciously hold. Many of us are unaware of how our view of the world impacts our thoughts and actions. I am learning to change the way I think about the world. This is essential if I am to make any lasting impact in West Africa especially with regards training healthcare providers.  

Understanding other cultures starts with understanding our own culture and ourselves. I teamed up with another Brit to present some of the British cultural values – see picture. We’ve also spent time understanding ourselves through personality assessments. I can’t change my personality but I can change the way I interact with others. This will help me bring out the best in them.

There has been a lot of change, or as I like to call it, realignment. My faith has been challenged, my view of the world expanded and adjusted. Realignment.

Change is not a bad thing. It is often necessary. If I need to sail on a bearing of 180⁰ to reach my destination, but I am just a tiny bit off, say 181⁰. After a while I will be way off target and may miss my destination altogether. The sooner I realise, the easier and quicker it is to make an adjustment, a necessary correction. Realignment.

So I am grateful for the realignment, minor corrections and adjustments to my ways of thinking. We all need it from time to time. But sometimes we are too proud to admit it. The only person who doesn’t need correction or realignment is God. He is totally consistent. He never changes. Africans have the phrase ‘God is good all the time. And all the time God is good’.  So I thank God for His goodness and His consistency in times of change.

Every good and perfect gift is from above, coming down from the Father….who does not change like shifting shadows.  James 1:17