It’s funny how fast it happens. You move through life and meet a new face–another local child–another patient–just another face. Then, you see that face again in another context and a spark lights in your eye. Oh, I know, I know! It’s like the awkwardness of seeing your high school teacher in the grocery store. …except not awkward. Relieving, in fact. The relief of seeing a familiar face in a sea of foreign ones.
I am talking about special connections we, as nurses, form with particular patients. It is not every patient, and I simply do not know why or how it happens. However, in one simple interaction some patients and nurses just…bond.
Imagine being in a patient bed
on board a ship
in a ward with no windows
and surrounded by white people (mostly)
who talk funny.
When she saw me, our eyes both registered recognition and our faces lit up. I do not want to say that she is my favorite patient. “Favorite” does not quite describe her rank in my heart. Maybe…precious. Yes, that will do. She is especially precious to me.
I’d like to take you through a rough explanation of what a patient may experience from the “start to finish” of their interaction with Mercy Ships. Some of these details may be vague or inaccurate by way of ommission, but I will do my best to do what the communications team achieves so artfully: Tell a story.
East coast of Madagascar. Madagascar is a beautiful island, the fourth largest in the world. The Malagasy people have been independent since 1960 after being colonized by France for 66 years. As a result, many of the major towns/cities have two names–the original Malagasy name and the French modification. The Africa Mercy is currently docked in the coastal city of Toamasina (Malagasy name) or Tamatave (French name). Both names are used interchangeably. Unlike other countries that Mercy Ships has served, Madagascar does not have a large population concentrated on the coast. Instead, our patients are spread over a span of 226, 657 square miles–over three times the size of New England. The roads are also extremely…not efficient. In truth, it IS kind of beautiful that Madagascar doesn’t have mountains blownup to make way for roads. For those who are all about environmental friendliness, there’s that. However, poor roads are not people-friendly. And I’m sorry (not sorry), but I will always place the health of a human over the health of a shrub. [Do NOT mutter under your breath about how we need trees to breath. My field is scientific. Believe me, I get it. I do not advocate destruction of nature or creation for the sake of vanity for example. However, access to healthcare is not vanity. It is a basic right. *End rant*]. For basic comparisons of life in the US vs. Mada, click below.
Let me explain. With average rates of travel in an automobile through the United States, it would take about 4.5 hours to travel from Madagascar’s central Capital of Antananarivo/Antananarive (fondly known as “Tana”–rhymes with Donna, not banana). How long does it actually take? Nine hours with no stops. Wait, there is more. That road is one of the best and most direct in the country, and it only crosses about half of the country’s width. Forget about the length of the country. Obstacles with travel/access make marketing, pre-screening, and screening much more difficult for our advance team. We know our patients are out there somewhere, but we have major difficulties reaching them. Thank God for MAF (Mission Aviation Fellowship)- we use them often for screenings, education of local hospitals, followup visits by the communications team etc. Check them out: Mission Aviation Fellowship
Extremely rural villages also lend themselves to a very isolated life. Said isolation results in various superstitions and rituals that would widely be considered barbaric (even by those in more populated regions of Mada), lack nutritional variety, lack of health knowledge, and most definitely a mistrust of foreigners.
There is a phenomenon displayed that I liken to seeing a video of something amazing on Youtube–among the first comments you will often find exclamations of “definitely fake” or “that’s impossible, there’s no way that’s real!” I think something inside the human heart has been wounded by “The Fall” of the human race. If something is wholly good or better than we can imagine, we simply do not want to believe it. Rooted in the fear of disappointment and rejection, we would rather set our expectations low and encounter exactly what we imagine.
When we come to a country, Mercy ships offers the services of
doctors (a rarety in itself)…
to perform surgery…
with free food and shelter provided…
It is a thing too wonderful to hope in.
As a result, the enemy successfully keeps some potential patients from us. Rumors have spread that we kidnap/kill patients or harvest organs. The Malagasy “day crew” we work with have even told us that there has recently been an article published in the papers about us–warning Madagascar’s citizens not to fall in our clutches.
Honestly, I just sat here for several minutes fuming. Forming scathing accusations against these enemies of hope, but I refuse to give the Enemy more time in the limelight. Let me switch focus. Although, I am enraged and confused by these “false prophets”, I know that we win! Moreover, for hundreds of the Malagasy people this field service, we have ALREADY given and established a hope that is undeniable. By the grace of God alone, we have treated patients, trained local healthcare workers, taught local farmers, and ministered to local schools, churches and orphanages. As a result of Christ in us, we are unstoppable, undaunted, and force to be reckoned with.
Darkness cannot win.
As for my aforementioned patient, darkness has certainly lost.
To be continued…
This post is just a tidbit for the benefit of my nursing buddies:
I aim to give the very best care to each and every one of my patients both here in Madagascar and back home in Connecticut. I am opposed to favoritism both on a personal and professional level. I usually have to quell my anger when a nurse manager notifies me about a “VIP” patient. Absolutely not! I refuse to dole out special treatment to those with status or money. If my “regular” nursing care is somehow sub-par to my nursing care for a “VIP”, then I should be ashamed of myself. All that said, I can’t help but have favorites!
See James 2
There is something about the people of Madagascar that just makes it easy to care. They’re warm, tough, and grateful. I get greetings, hugs, and thank yous for everything! I’m telling you–I’m totally being spoiled. Sometimes I wonder how on earth I’m going to transition back to nursing in the United States. Nurses back home have (probably) all encountered patients who yell at you to bring their narcotic pain meds (that are not even due yet) for an acute pain of “twelve” on scale of one to ten–while, in a relaxed posture, they chat with their family and chow down on a greasy burger from a friend.
God help me.
Here–pain is mostly controlled with paracetamol (very similar to acetaminophen–the U.S. is like the only country that uses it!) and ibuprofen. You’ll be hard pressed to find a patient that complains of pain above a four out of ten throughout the day.
As a nurse on the dressings team, I take part in some of the more painful aspects of the patients’ care. Therefore, we will sometimes premedicate with oral morphine for kiddos and codeine for adults (low doses, mind you). However, after a few dressing changes we usually downgrade to paracetamol/ibuprofen only. For more intense procedures (look up K-wire removal) or children who consistently thrash and freakout, we use oral valium (adults) or midazolam (kids).
This brings me to another blogpost–a patient who is dear to my heart, Zoeline
I’ve been avoiding this post for a while.
However, I’ve realized that I enjoy realism. I don’t necessarily enjoy every messy aspect of my life, but I know I’m not the only one. I know that an insta-filtered life is far from honest. And I desire to be known–not as “perfect Kirsten”, but rather as “real Kirsten.” I enjoy to be known. I enjoy to be useful. And I enjoy some leftover coffee-grounds in my cup 🙂
Let’s just look at the life of Paul for a minute. How encouraging would his letters be if you filtered out every trial, challenge, arrest, assault, detour, and discouragement? How inspiring would his content attitude be if he made out his life to be a plush, air-conditioned spa-day? Not very.
I won’t even go into the fact that growth and improvement cannot happen without a fiery situation (or 50) to refine your life. I won’t elaborate on the moral benefits of a life of perseverance. Next time you see a person that you presume to be “great” without difficulty, get to know them. I promise you, a great life has never materialized out of thin air, or even luck.
So here it goes. The Africa Mercy has over 400 crewmembers, including local hired-help. The hospital cares for up to 78 patients at a time within the ship, and that does not include the patient’s caregiver and maybe a young sibling that sleep under the patient’s bed. The atmosphere of each ward varies, but on A-ward–it is loud, chaotic, and hot.
I wait in line for meals. I share a room for the first time since middle-school. Managers/directors are still human and occasionally commit a faux pas. Different personalities are difficult to navigate (No, I do not want to make conversation in the breakfast line. I haven’t even had my coffee yet!) Mixed cultures, denominations, and doctrines are a recipe for misunderstandings and offenses.
Yeah we have a Starbucks Cafe (limited hours for the record), but living in community is not all smiles and laughs. Not even for a crew that is majority Christian. Surprised? Don’t be.
On the Africa Mercy there are three weekly community meetings:
Monday at 0745- Brief worship and a themed debrief by our Operations Manager. (This week was 80’s Movies- He stepped up to the podium wearing a jumpsuit and aviators with the Top Gun soundtrack playing in the background!)
Thursday at 1930- Short message, worship, donation opportunity to another charity, and sometimes a short informational presentation to highlight a particular area of Mercy Ships.
Sunday at 1900- Church!
A week ago our Crew chaplaincy team started a series titled, “Community Killers.” Prevention is the best medicine! This past Sunday one of our chaplains, Dianna Cash, spoke about grumbling and complaining. Her message was spot on and God-breathed. In a moment of transparency she shared that she hesitates to share her frustrations with people back home, because “I don’t WANT them to know it’s hard to be here.” I think I speak for everyone in the organization when I say that I want you all to feel that it is constantly wonderful to serve God in this amazing place. But it isn’t. At least, not always.
If living in community wasn’t already hard enough, God calls us to a HIGHER standard than just gritting our teeth and making it through the day without snapping at the “pre-coffee-chatty-morning-person.” Jesus instructs us that the world will know we are His disciples for our love for one another. We are encouraged to “provoke one another to love and good deeds.” We are admonished to bear with one another’s faults, to not be conceited, but rather to consider the needs of others above our own.
How could he ask so much? Why would he ask so much?
Because He is building His Church.
Jesus takes a bunch of broken souls, mends them, and then puts them all together in community to form his Church. Apart from God’s healing hands, it would be a recipe for disaster.
Pondering this reality brings me to the population of patients I am caring for right now on the Plastics Dressings Team. These patients come to us with body parts that are tight–so bound to themselves that they cannot function (much less help anyone else to function). After our surgeons cut away the skin that hinders their movement, they place new skin (from the patient’s thigh) over the freshly created wound.
And then we wait.
The first dressing is painfully removed and replaced.
Therapists teach and perform exercises.
Staples removed. Aza fady (sorry), Dyllan!
Sutures removed. Aza fady, Sabrina!
K-wires (placed during surgery to straighten things out- short explanation: they are a sort of temporary internal fixation device.) removed! Aza fady, Zoeline! You’re such a champ! (More about her later.)
And then, miracle of miracles…
function is restored!
There is so much pain, fear, and waiting involved in the process of restoration for these patients. Apart from God’s healing hands, it would be a recipe for disaster.
In order to reconcile a fully functioning body, a process must take place. Our patients are not always thrilled about each step, but the outcome is worthwhile.
Likewise, in order to reconcile the world to Himself, a process must take place, and we cannot become a fully functioning “body of Christ” without eachother. Just as my patients could not heal and regain function of their neck/axilla/hand/foot etc without the donor skin from their thigh, we must be willing to allow God to do two things:
Cut away places in our lives that are too tightly bound.
& Attach people to our lives who are vital for our restoration.
Confession time: That is not easy for me. In fact, the process is overwhelming. However, if I’m going to put myself in the hands of any surgeon ever…should it not be my sovereign Lord? When the restoration begins to noticeably take place, I will be overwhelmed again…in gratitude. Overwhelming, joyful gratitude.
Below are the lyrics to a song that has been ringing through my head and my heart for weeks now. It also resonates with a scripture that has probably been my life verse for the last year or so. As you read and listen, I encourage you to humbly examine your life–and to courageously go under the knife:
I lift up my eyes to the mountains—
where does my help come from?
2 My help comes from the Lord,
the Maker of heaven and earth.
Knowing who my “source” is–That is what keeps me from being utterly overwhelmed by the enormity of the problems in front of me. Know what He is like–That is what gives me peace and courage.
3 He will not let your foot slip—
he who watches over you will not slumber;
4 indeed, he who watches over Israel
will neither slumber nor sleep.
5 The Lord watches over you—
the Lord is your shade at your right hand;
6 the sun will not harm you by day,
nor the moon by night.
7 The Lord will keep you from all harm—
he will watch over your life;
8 the Lord will watch over your coming and going
both now and forevermore.
Wherever I am and wherever I end up, I can stand firmly planted in the knowledge that God is always available to me. He takes no lunch-breaks. He doesn’t turn His back on me to care for someone else. Wherever you are, God is there and aware. Make no mistake about that.
God, I Look to You by Jenn Johnson
God I look to You, I won’t be overwhelmed
Give me vision to see things like You do
God I look to You, You’re where my help comes from
Give me wisdom; You know just what to do
I will love You Lord my strength
I will love You Lord my shield
I will love You Lord my rock forever
All my days I will love You God
Hallelujah our God reigns
Hallelujah our God reigns
Hallelujah our God reigns forever all my days
Here am I. A young woman in a “man’s world.” Graduate of an average university. Still a relatively inexperienced nurse of 3 years. No special certifications. No advanced degrees. Average performance under pressure–my face still flushes red.
Here I am. Living on the world’s largest hospital ship. Working with world-class, innovative surgeons. Caring for the most grateful patients. Valued in a community of people who are likely more altruistic, generous, and compassionate than I am.
This is what dreams are made of, right?!
Well, this is what my dreams are made of…
I’ve been thinking a lot about dreams lately. All kinds. The dreams we have while we’re sleeping. The dreams we have when we intentionally imagine the future. The dreams we have when we are “spaced-out” or daydreaming absent-mindedly. And well, God’s dreams.
Have you ever stopped to wonder what God dreams of? Before you get all theological on me about how God never sleeps…just hear me out. Have you ever thought…”If God were dreaming about his plans for the world, what would they look like? How might I fit into them? How do I position myself to be caught up in a God-dream?”
Somewhere along the line, I think we convince ourselves that dreams are meant to be drafted by us, proofread by us, approved by us, and sponsored by God. There is soooo much flawed about that mindset.
Whatever happened to “for I know the plans I have for you”? Was it recently re-translated into “for I know the plans you have for you”?
Whatever happened to “in their heart humans plan their course, but the LORD determines their steps”? Was it recently re-translated into “I plan my course, and I determine my steps”?
Family, do not be deceived. We must be balanced. In the body of scripture there is mention after mention about making plans, choosing an upright path, walking with the wise/righteous. None of these are nullified. However, we cannot allow ourselves to slip into a mindset of: “Here’s my gameplan, God. Just sign at the bottom.” (Thanks to Dr. Tertius Venter for inspiring that analogy.) In fact, we really should put in the harder work of straining to perceive God’s biggest plans and craziest dreams…and having the fortitude to say, “I’m in. Where do I sign?”
This is not a confrontation I want to have with God:
“Who is this that obscures my plans
with words without knowledge?
3 Brace yourself like a man;
I will question you,
and you shall answer me.” Job 38:2-3
Now, before anyone starts to think “wow, God’s a control freak”… Every single one of His commands is for our benefit. With that in mind, read this:
The Lord knows all human plans; he knows that they are futile. Psalm 94:11
But the plans of the Lord stand firm forever, the purposes of his heart through all generations. Psalm 33:11
…and yet, He still allows us to choose for ourselves.
God wants greatness for us. He wants us to be established, to leave legacies, and to live fulfilled. But he knows that our human plans/dreams will not accomplish that.
My personal conclusion is this: Living MY dream is not the end I wish to pursue. Mercy Ships is amazing, and I am excited for the days and months ahead. I know I am in the midst of God’s dream, but only a fragment of it. This is not all there is of God’s big dream. This is not the destination. This is not the end.
But he knows the way that I take;
when he has tested me, I will come forth as gold.
11 My feet have closely followed his steps;
I have kept to his way without turning aside.
12 I have not departed from the commands of his lips;
I have treasured the words of his mouth more than my daily bread.
A Pilgrim Song
I look to you, heaven-dwelling God,
look up to you for help.
Like servants, alert to their master’s commands,
like a maiden attending her lady,
We’re watching and waiting, holding our breath,
awaiting your word of mercy.
Psalm 123 (MSG)
“Walk with me and work with me—watch how I do it. Learn the unforced rhythms of grace. I won’t lay anything heavy or ill-fitting on you. Keep company with me and you’ll learn to live freely and lightly.”
So how do we take part “in God’s wil”….*cough*excuse me*cough I mean… God’s big dream? The application will be different for each of us because God’s big dream is bigger than just you or me. However, the principle is the same…
Watch and Walk.