Yeme

Looking at these pictures you could be forgiven for thinking this little girl is not the one I spoke about in a previos entry. Yeme is the little girl who arrived with extensive neurofibroma to her leg, and a smaller one to her head (you can see it in this picture!). She is a little girl who I wrote about as a scared, frightened little girl, with no English to speak of, left at the Ship's Mercy to have her surgery, with no caregiver with her.

This little girl had a 7kg smelly ulcerated tumor extending from upper thigh to mid calf removed in surgery. She walked hunched over, unable to lie or sit, constant ooze from her wounds. Since her first surgery this little girl has truly become a gem and a shining light in the ward.

She now stands tall for most of the time, her limp lessening by the day. Her frightened look is now replaced with the cheekiest of grins, and her tears replaced with th emost delightful and infectious laugh. She loves to peer around the door frame and giggle whilst we hand over. She has become queen bee at making bracelets, and at plaiting barbie dolls (and nurses!) hair! she is beautiful and becomes more so by the day. She will soon be having surgery for a skin graft to a small patch on her leg that needs a bit of help along the way to heal, and her characteristic lump to her head will be removed. This young girl is such an inspiration, makes me wonder how I complain about such little things as I witness her plight daily!

Noma

Noma is a flesh eating disease which has been the reason several of our patients come through our doors. One such young lady was my patient last week. In the west the condition if treated early with antibiotics will not develop into anything serious. Here where medicine is costly and treatment and consultation is also at a price, noma takes it's holds regularly.
Beindhu is a young girl with a 4 month old baby. She arrived to us with a hole in her cheek, through which you could see the inside of her mouth and her tongue. After extensive surgery she has had a muscle flap and skin grafts to reconstruct her face.
As her case was handed over to me I was more than a little apprehensive. She would be a complex case to care for. She had a drain, NG feeds (food through a tube in her nose) and medication to be given via her NG tube, dresssings to be done, intravenous antibiotics to be given, a catheter for her to pee, a nasal 'trumpet' through which to suction her airway, nebulisers to give, regular mouth suctioning and mouth washes needed doing, plus her baby needed looking after! Her baby, Mary, had been a little distressed as her mum was in surgery so would not have milk from a bottle spoon or by any other means, but was crying out in hunger. She in true '2 for the price of 1 patient' style, ended up having an NG tube inserted so we could make sure she got fed! So I had feeds for her to give, as well as 3 other patients to care for. It was however, a challenge I need not have worried about. As Beindhu looked at me through puffed up lips and tight head bandages and drips and drains of all kinds, she was clearly overwhelmed, but quickly we were able to get into a pattern of pointing and prompting so I could suction her when she needed it. As I organised myself I found that I loved every minute of the busyness!
As the shift progressed, so did her condition, she became more alert and ready to hold her baby. I had the task of trying to get Mary to breastfeed without yanking at Mama's various tubes adn drains, and without her getting upset at her Mama's looks. Thankfully it went like clockwork and a look of contentment passed over both Mary and Beindhu's face as she snuggled once again with her Mum. Beindhu was able to have her drip down and her catheter out during my shift, and I was able to take her for her first walk. Now she will continue to be cared for as her wounds heal.
Her first dressing change was done after I left, but was reported to be looking very good. It will be a long recovery, but quite an amazing feat!

Me my boys and their Mama's!

Oscar and Prince. My 'terrible two'. A handful but such a delight!

Oscar and I

Quite possibly the most beautiful little boy! His newly cast corrected club feet. Sadly Oscar's Dad left him and his Mama when he was born because of his feet!!

It's a small world...

One of my new admissions over last weekend was a story in itself! His name was Amos from Zimbabwee, and as I admitted him for the second surgery to reconstruct his jaw, we talked. He asked if this was my first trip to Africa. I explained about my several other trips, and my trip to Swaziland, and the project we visited. As we talked, I explained that the man who we met who ran the project was from South Africa, now living in Swaziland. As we continued to chat about the name of the project, he explained to me that he had travelled from Zimbabwee to a conference in South Africa, and that he was pretty sure he had met this man.
I couldn't believe it, a girl from the UK, a man from Zimbabwee, meeting in a hopsital ship in Liberia, talking about a guy from Swaziland that Amos had met in South Africa. I CAN'T BELIEVE IT!!!

Some more orthopaedics

Between my VVF shifts, I have had several days on B ward where most of the orthopaedic surgery is. In fact, over the ships holiday weekend I had 4 days in a row with the same patients. 2 of them were toddlers who had had club feet repairs, the adults were gentlemen who had had serious accidents causing non union of femur and humerus which our surgeons were endeavouring to fix. One of the men had had a below knee amputation. The days were very intense, despite being quite quiet. I spent time with the gentleman who had had his leg amputated. He had adapted so well to the surgery and was really keen to get up and about. He will eventually have surgery to his arm also.
My two youngest patients (Oscar and Prince) were waiting for cast changes and so were very well and full of fun and antics. trying to keep two 2 year olds off their casts and not allow them to crawl and even try to walk on them was impossible! Oscar, one of the boys is an absolute bundle of giggles. A very very strong willed young boy, but absolutely beautiful. Both Oscar and Princes mum's were very young. Oscar and Prince's mums spoke Kpelle/Basa and very very little English. Somehow over those 4 days we all bonded incredibly. Each of us laughing at the other whilst trying to work out what all the arm flailing was about. I was in awe of these two young mums (much younger than me). Both boys clearly a handful, and Prince's mum 7 months pregnant with her 2nd child. I saw the struggle in their eyes at times, especially Prince's mum. The children here can be quite 'attached' to their mum's as they are virtually never away from them, normally in a lappa on their back or sleeping next to them. I saw that Prince especially was very demanding of his mother, and being 7 months pregnant her patience at times wore thin. The other patients made 'comments' and I just really felt for her as I could see she at times was made to feel inadequate. I determined to spend time just investing in encouraging her and nurturing her and telling her she was a good mum, for her new baby's sake as well as Prince's. I have no clue about motherhood but I do know when people need some love and attention. It was such a privelage to be th eone to spend time doing that. This is on e ofthe things I love most about being here - the opportunity to invest time adn love in people other than the patients. Investing in family life and futures.

VVF

I had a very challenging experience last week as, unbeknowns to me, a new group of VVF ladies arrived, a week in advance of their operations. As I walked down the corridor to the hospital wards, I was struck by a phenomenol smell, one I had never smelt before. It took my breath away. A little later I had the same thought again as I was walking down the corridor. I mentioned it to someone, and she said, 'the new VVF ladies have arrived'. The bottom seemed to fall out of my stomach. I felt sick. The thought hadn't even crossed my mind. It was then that I had a new appreciation for what the ladies experience every day. The disgust of others, their judgement and the reason that they are belittled in their society. Believe me, at that moment I felt hideous. It took me a few days to really take stock and try and process that event, trying to use it to make sense of so much going on in my mind.
A little later that day, I went along to D ward (currently closed) where the new VVF ladies had been admitted to from another hospital, a week prior to their surgery. I went along to help with the mountain of admission paperwork. I was only there for an hour but it was a great time. I didn't notice the smell that had earlier been so intense. As I pottered around filling in papers and putting on wristbands, I chatted to the ladies. They were all curled up in their beds with their blankets tight up around their necks. Quiet, and looking a little apprehensive. Clearly they were very cold with the airconditioning! So I did a round of giving out blankets. As I did so, I asked how each lady was and their smiles grew as we talked. Some giggled nervously, others needed new pads, and others snuck off to the bathroom. The tension in the room became less and less.
A few hours later I returned to put on the televisions in the ward with the afternoon movie for them to watch. I popped my head in later and each one had rearranged their pilow and their bed so they could see the screen well. There was much giggling as they laughed at the 'muppets' (cartoons!) in the movie Madagascar.
It was such a beautiful sight to see these ladies that had felt so alone in their plight, surrounded bythose in the same situation as them. Their emotional healing begins just by meeting eachother, and it is such a privelage to be a small part of that.