Explaining the inexplicable

Unexpected champagne.....warm crusty bread, Camembert, Gruyere cheese, red wine, chocolate mousse, coffee, more chocolates.....and unlimited free Internet access courtesy of the african airline, Air de Côte d'Ivoire. In the west we use words such as 'luck' or 'chance' or 'fate' to explain the inexplicable. Many people are uncomfortable with something being inexplicable. We want answers, we want to understand. Nothing wrong with that. But why, in a rather bizzare way, when we cant explain something, do we make up another inexplicable concept and call it luck or fate. What is luck and who gets it? What is fate and how do you get good fate not bad fate? Where I work in Africa, people don't believe in abstract concepts such as 'luck' or 'fate'. It is more personal. It is all in the hands of the God or gods, so the fundamental question when things happen is, 'who did this to you?' When bad things happen the mindset is often 'who cursed you?' And when one encounters a series of 'lucky events' the response is 'wow what favour you/I have!' What do you think? I ask because I am interested in how you might interpret the week I just had? Good luck or bad luck? Fate? Miracles? Blessings or curses? You probably know what I believe, but I will tell you at the end! I am writing this on a plane to Conakry, Guinea having travelled from Pointe Noire, Congo via Gabon, Ivory Coast, and Mali. Five flights and I am sitting in Business Class, seat 1A, having just been served champagne, European cheese, wine and chocolate truffles. My chair is so big and deep that my feet barely touch the floor and if I sit back in this giant seat my thighs are not long enough to reach the edge of the seat so my knees can bend properly! I was finally on route to Guinea three days later than planned. On Monday evening we had an emergency in the Operating Room (OR), which consumed my whole week and delayed my trip to Guinea. Simon was a young man with a severe abscess in his jaw which needed surgical intervention. When the team woke him up and removed the breathing tube from his mouth he suddenly and unexpectedly could not breath. A crisis call to the OR came over the ships loudspeaker. None of the 4 anesthetists including me were unable to reintubate the young man (put the breathing tube back in). It was also very difficult to assist his breathing using a mask or other airway device. So two maxillo facial surgeons performed an emergency tracheostomy (cutting a hole in his windpipe to place a breathing tube) just in time, to save his life. Simon had a lot of blood and pus in his lungs and we tried as best we could to wash this out and then supported his breathing using a ventilator (breathing machine) and kept him asleep with sedation and pain killers. We had great difficulty keeping him alive even with all our equipment. Even in England it would have been a struggle as his lungs were so damaged they could not absorb the oxygen well enough. I really thought Simon might die. So we cancelled my flights to Guinea, the team would have to go without me. Patients come first. Now was not the time to be planning future healthcare education when someone's life hung in the balance. Many people were praying for a miracle. By Thursday morning Simon had made a miraculous recovery, his airways pressures were lower, oxygen requirement halved, drains no longer bubbling and saturations the best for the last 3 days. At 5pm Friday (4 days after the emergency) he was sitting in a chair, without any of our machines and communicating with sign language. A miraculous recovery and I have not seen one so fast and neither had Alan, another consultant anaesthetist and intensivist from England. We all think we witnessed a miraculous recovery. From my perspective it was a busy and stressful week. Responsibility and worry on weighing on my shoulders. And then there was the visit to Guinea. Three of us were going to re-establish relationships with the Guinean government, port and logistics, and make a more formal healthcare education assessment (my role). The other two had left early on friday without me and my ticket was now booked for Sunday evening with teh remaining connections on Monday. That felt like good luck....or could it be miraculous provision on a more personal level? Simon was better, and I now had time to catch up on some much needed sleep. Fate or favour? And the story continued with the provision of free Internet at the guest house on Sunday evening after I flew to Brazzaville. Monday morning, free unlimited Internet at Brazzaville airport ( better than the with 45 minute time limit at Heathrow). Then my flight from Abidjan was cancelled so I was put on a later one, given a VIP pass to the airport lounge and upgraded to Business Class. Hence the champagne.....warm crusty bread, Camembert, Gruyere cheese, red wine, chocolate mousse, coffee, more chocolates ! All the free Internet access and flight delays meant I managed to catch up with all my backlog of emails and design some more training plans. Was this my lucky travel day....was the patients recovery just fate.....maybe? Or maybe there is a God who knew what I needed? God doesn't make people sick, that is the work of the evil one. But God does work all things together for good for those who love him. God worked a miracle to save Simon's life, I got a weekend I didn't deserve but did need, and even played a game of tennis and went swimming. Gods favour was on my travels, redeeming my time. I took 5 flights and ate 4 croissants (courtesy of the French influence on African airlines). I believe that God worked it to save Simon's life ( we don't normally do his type of emergency surgery on the ship), and so that I could still travel to Guinea and not be totally exhausted. We are building relationships in Guinea and asking them what would they like us to do to help, not just with surgical services but also with training. The saying 'give a man a fish and feed him for a day, teach a man to fish and feed him for a lifetime' has never been more true. One of our objectives in Guinea is to seek to understand what the training needs are as perceived by the ministry of health, the hospital directors, and individual doctors/nurses/other departments. Then we can try and match their needs to our training resources. Training is about change, not just of systems but of ourselves. And that is part of our vision, to 'transform individuals and serve nations one at a time'. That's why we are here. That's why I am here. And even though it is actually incredibly difficult to make a difference, to see the application of the things we teach effect lasting change, it is worth the effort. I believe in a God who really can do 'more than all I ask or imagine according to his power at work in me'. I am very grateful for the miracles I have seen this week in Simons's life and in my life - in real, tangible and personal ones that God gives me because he loves me. You see, I believe God is still performing miracles today. He hasn't stopped and he never will. What would it take, I wonder, for you to believe the same? To believe His love for you and his desire to bless you in the same intimate and personal way.

Grace

This month story is written by Catherine Murphy one of the ship writers, and I have added a few medical details and personal reflections at the very end. I have chosen this story because it typifies why I do what I do and have chosen to serve with Mercy Ships. Grace was one of our first patients up the gangway in Congo. On September 10th, we removed the massive tumor from her face. It’s been several weeks since her surgery, but 17-year-old Grace is as sassy as ever – and she’s looking like a whole new young woman. “God is good because He did a big thing for me. I did not believe that I could be saved, but God has had grace. Mercy Ships arrived in Pointe Noire, they treated me, and I am better today,” Grace says. Grace’s journey to the Africa Mercy began with an email. A hospital chaplain from neighboring Democratic Republic of the Congo met Grace at a hospital there. The chaplain, Pastor Gregoire, was shocked by Grace’s facial tumor, which weighed 4.9 pounds (2.2 kilos.) Pastor Gregoire came alongside Grace, counseling and praying with her. He says she was often so distraught that she cried all night. Sometimes she refused to eat or drink. “Indeed, she suffered,” he says simply. Pastor Gregoire took a photo of Grace and published it on his blog. A reader responded to his post, recommending that he visit mercyships.org, an organization that might be able to help. From there, Pastor Gregoire contacted the Mercy Ships Swiss office and exchanged emails with Christophe Baer. Through Christophe, Pastor Gregoire sent Grace’s medical records and reports to the Africa Mercy. The response was positive. Grace and Pastor Gregoire were asked to arrive in Pointe Noire, in the Republic of Congo, on September 2nd. Grace’s story is a chain of mercy forged by compassionate hearts, and their efforts were rewarded. She has been recovering in the Mercy Ships Hospital Out Patient Extension Center (HOPE Center), where she has become the champion UNO player. As Mercy Ships nurses will tell you, Grace dominates every hand – and don’t even think about challenging her to Jenga! Grace’s tumour was involving her jaw bone, so the first surgery (hemimandibulectomy) removed the tumour and replaced the jaw bone with a metal titanium plate. Three months later the second stage of the surgery takes some bone from the hip and puts it around the metal plate. The bone they grafts onto the metal and gives the jaw back it’s shape. This procedure is called an ‘iliac crest bone graft’. It is done three months after the original surgery to allow the mouth wounds to heal and to reduce the chances of infection in the new bone graft. Grace had this procedure (her second operation) just before Christmas. And she is recovering well on the ward and always says ‘hello Dr Michelle’ whenever I walk by. She is a very happy lady who brings joy and hope to the ward and the other patients. Near Grace’s bed lies, Angelique. Angelique is 22 years old and has a large tumor, rather like Grace, but Angelique’s tumour is coming from her cheek bone (maxilla) instead of the jaw bone (manidible). In a few days we will operate on Angelique and Grace will be discharged. This is why we are here. This is what I have spent the last two years doing. Someone once said, ‘transformed people, transform nations’. In another month, Grace will return home and begin school. She wants to be a nurse. May she go on to do that and transform many others people’s lives through what she does.

Contrasts

I have just spent two weeks in the Democratic Republic of Congo (DRC), which is the poorest country on earth, according to the United Nations Health Development Index (UN HDI). I was visiting the capital city Kinshasa and the port city of Matadi as part of a Mercy Ships Assessment Team. We were invited by the Ministry of Health to (i) build relationships with them as they have invited Mercy Ships to work in their country (ii) assess how the surgical services and healthcare education Mercy Ships offers can help their nation; (iii) assess the logistics of transporting in excess of 1000 crew backwards and forwards from Kinshasa to Matadi approximately 500 km away; (iv) assess feasibility of having 400 crew in Matadi with respect to food, water, leisure acivities etc. What struck me most was that Kinshasa was a city of contrasts and the DRC is a stunningly beautiful country. I admit to being a little scared beforehand. The DRC was afterall the poorest country on eart and I fully expected to be shocked at what I might find. I imagined a mixture of Freetown, Sierra Leone (people everywhere so it is hard to even walk in a straight line in the street) and Monrovia, Liberia they had not had running water of electricity for years making it impossible to deliver quality healthcare. Kinshasa was a sprawling city but despite 10 million people it was not as busy as Freetown, and the infrastructure was better than Monrovia. However, poverty was evident with some hospitals struggling for electricity, and equipment. As is common in other hospitals in west and central Africa the operating rooms are stark and bare…..and could be what you imagine a torture chamber to look like. But two hospitals in Kinshasa were some of the nicest I have seen in Africa. I was truly impressed, by renal dialysis units; neonatal intensive care units; CT scanners, MRI and mammography; fully equipped laboratories with PCR the only major diagnostic technique that was lacking; and fully equipped operating rooms and sterilising machines that seemed to work correctly and at the correct temperature. What a contrast between neighbouring government hospitals in the same city. Loic, one of our translators had grown up in the DRC as his parents were missionaries there and still are. His insight and understanding of the culture was immensely helpful in deconstructing the prejudices and fears I had arrived with. Rebels, rape, massacres. That is what we read in the news about DRC. A country ravaged by internal conflict, unstable, unsafe and corrupt. Foreigners advised not to travel here. TRUE, but all the trouble is far away in the east, near the borders of Rwanda, Burundi and Uganda. This is almost as far from Kinshasa as New York is from Texas. Yes, we did see evidence of corruption, and yes we had the inevitable border hassle as we crossed the Congo river from Brazzaville, Republic of Congo into Kinshasa, DRC and back again. But all the people we met in the hospitals, the port, guest houses, local workers such as taxi drivers and shop keepers, everyone was helpful and polite. A country of conflict but also one of kindness and hospitality. A country of contrasts. Matadi is in Bas Congo province. I was impressed by the beauty of the region and the kindness of the people. Rich green fertile hills and countryside. Towns of subsistent farmers, selling produce all along the road from Matadi to Kinshasa. Apparently the 3 countries, DRC, Zambia and Zimbabwe have the potential to feed the whole African continent. Having been to all three countries I can believe this. And there is a new hydroelectric dam near Matadi with huge potential for providing the region with electricity. The port in Matadi is having some renovations and will be ready for us by January 2015. So I am praying that our International Management Team decide to come here soon so we can have the privilege of walking alongside the people of the DRC and sowing seeds of hope and help them realise their amazing potential. The DRC, a country of contrasts. Jesus, a man of contrasts. Born into poverty in a stable yet he was a King. Eternal yet temporal. Life in heaven versus life on earth. And as I ponder these contrasts, I am also reminded of my own life. Poor yet rich. Earning no salary but witnessing the generosity of others who provide for all my needs. Sharing a cabin instead of living in my own house. Giving up everything but somehow gaining everything. The DRC is the poorest country on earth yet with great potential. And this Christmas, no matter what contrasts you see around you, may you know the potential and the hope that is in and around you too.