VVF Fundraiser

As I am preparing to leave for Danja, Niger I wanted to let you in on an opportunity to learn more about VVF and find out how you can support me and the operations in Danja.

On December 10 there will be a spaghetti fundraiser dinner and you are all invited. It will be at Waypoint Church in Gig Harbor, Washington (12719 134th Ave KPN Gig Harbor, WA 98329). There will be dinner, a presentation about what I will be doing in Niger, and a pie auction to help raise the support needed for me to work in Danja. Tickets are $7 and you can either purchase them from me before hand or at the door. Please RSVP to sarah_daphne@hotmail.com if you are planning to attend so we can have an idea of how many people to plan for.

Thanks again for all your support!

New Beginnings

I feel like I am entering into a new chapter of my life. That isn't a huge surprise knowing I am home now and getting ready to leave again soon but knowing where I am headed next, I feel like the experiences I have had thus far have been preparing me for this. The challenges, the new experiences, the cultural issues I have encountered have all been preparing me for what is to come. I wait in eager expectation for this next adventure.

Being home has been good. I have already spent some time in Coeur d' Alene with my sister and family and played with my niece and nephew there. They are both three and I can see how they are learning more about what I am doing. Whenever I left the house my niece would look at me and ask multiple times if I was coming back.

After staying with them for a short bit I headed to Kentucky for an international medical missions conference. The week I was there was just what I needed. I reconnected with some great old friends and was encouraged beyond measure. The times of worship and speakers had the words I know so many of us there needed to hear. Throughout the day there were sessions you could go to to hear speakers on different topics dealing with medical missions. Everything from how to minister to the Muslim community to worms to dealing with ethical issues. So much was presented that I am still processing through it all. I was excited before but now I have a greater excitement boiling inside me for all that could possibly be accomplished next year.

I am back now in Western Washington staying with my brother and his family. My nephews here are great. It's been wonderful reconnecting with them. I will be here for a few weeks to rest and play with them.

Mid January I will be leaving again for Niger. Until then I will be reconnecting with friends and doing fund raising. There will be a small team of us going to open a VVF hospital in Danja where I have visited and worked twice before. I am having to raise my own support for this so if you feel called to give there is a red tab on the right under my picture that you can click to give. Any gifts given through there are tax deductible and you will receive a receipt. Thank you for your help in changing lives of VVF women in Niger.

I will be in Western Washington until mid December then I am headed back to Coeur d' Alene for a bit. If you would like meet up and chat about any of this or just meet up for some coffee, please leave a comment on here and I would love to catch up. Thank you all for your prayers and support during this time!

Goodbye Sweet Salone

Yes, again it has been awhile since I last updated on here. Sorry-o. I am now home in the USA. I will say it is nice to be home but in all honesty, it was very hard to leave. Many tears were shed and my heart hurt as I got in the water taxi to go to the airport Wednesday night. I'm still not fully home. One more flight to take me to Spokane and to bed.

One of the reasons I haven’t written on here in so long is honestly because I didn’t have time. The last month in Sierra Leone was c-r-a-z-y! You could say it did not end how I had hoped it would or in the way I had imagined. When the thought came up of me coming home early, I should have come home in January, I knew it was right. I had trained up a national nurse to be the ward supervisor and I had full confidence she would do a great job. I knew I could leave knowing she would be fine and the other nurses looked up to her and respected her. I felt like I had accomplished what I went there to do.

About two weeks ago this all changed very quickly when it was found out that many drugs were missing from the pharmacy and she was the reason. To say I was devastated would be an understatement. After learning this, more lies just as horrible were brought to light as well. I felt like the last six months I had spent training her were all of a sudden a lie. Like the work I had been doing was a waste of time. I don’t believe that now but it was a huge struggle for me for a time. After this all came out I laid in bed and went through every conversation we had and wondered if all we talked about and all she shared with me was a lie as well. When we realized medications were missing I told people it wasn’t her. I couldn’t believe it could be. I felt completely let down but I know my nurses did as well. They all trusted her as much as I did and I know this all came as a shock to everyone who worked at the centre.

God really is so good though. As I was training this nurse, I was training up another nurse along side her as well. She did not have as much training with me as this first nurse but I really do believe that she will do a fabulous job. The areas she struggles in are areas where she will have much support from others at the centre. Computers, paperwork, those lovely things.

Many people have asked me in the last week what I will miss about Sierra Leone: the patients, the nurses, my friends, beautiful Sierra Leone beaches, Thursday and Friday lunches (groundnut and rice and beans and rice), the sense of community in the ward where the women take care of each other, VVF women who come back to have their babies at the centre-- just to name a few. I do find comfort in knowing that come January I will be headed back to Africa, Niger this time, to open the fistula centre at Danja. I am so thankful that my time working with VVF women has not come to an end although my time in Sierra Leone is done. I have learned so so so so much this year and I know I can take most of that with me next year.

My current plan is that I will be in the states now until mid January before I leave for Niger. I will write a post soon about what that is all about. I will be home visiting family and friends and doing fundraising. Back at it! Thank you all for your prayers and support during my time in Sierra Leone. In all honesty, I don’t know if I would have survived without all your prayers and support during the past ten months.

Oh, and my bruise is much better. It’s still there but now it just looks like a large birthmark on my back. Still tender to touch it but I know that will get better with time.

The Fall...

I started writing this the day after I got injured. It is now three weeks later and I am ok...

Before I start this post, I want to say that I am ok.

Yesterday (as in three weeks ago when I started writing this) I went to my room to eat lunch. After lunch I grabbed my umbrella and headed back to work. It had just started raining. I opened my umbrella and started down my steps. Crocs on, umbrella open, carrying my water bottle and empty bowls. I made it down the first set of stairs then turned the landing and as I started down the second set of stairs my feet went out from under me and I proceeded to hit every step on my way down. Cement stairs covered with tile. My left flank and left elbow hit every step on the way down.

When I got to the bottom I could only swear. I could move and feel my legs but I knew I couldn’t get up. Luckily I had my phone in my pocket and I called Jude, my boss. I told her I was hurt and told her where I was. My umbrella landed right over the top of me so I was able to stay mostly dry. She came quickly. I couldn’t get up. Dr John and Maggie and Simon and everyone else showed up out of nowhere. I was told they were going to get the stretcher but I kept saying that if I just sit for a few minutes I would be ok. Deep down I knew that wasn’t true. Any movement and I started crying. The decision was made that Simon would pick me up from behind and someone else get my legs like a fireman hold and get me in a chair. From there they would carry me up the stairs to an empty room. The pain was unbearable and only got so much worse when they tried to put me in the chair. I couldn’t sit. The stretcher showed up and I was laid on it. When my tears came they couldn’t stop. The pain, the embarrassment, everything that started running through my head about being in Sierra Leone and what could go wrong.

They carried me on the stretcher to Orange Ward which was empty. I told them to just put me on the bed on the stretcher but they wanted to get me off it. Profanities ran like a river out of my mouth. I could only lay on my right side. Esther showed up and I realized that things that are said that annoy me so much, annoy so much more when I am hurt. I really dislike it when I am told not to cry when you know that crying helps so much to get the emotion and even pain out. To tell someone that you will be fine or that Jesus will heal me so I don’t need to cry or worry about anything. You don’t know if I will be fine. You don’t know if I will be ok, will need surgery, or if I broke something. You don’t know. Jesus does heal. Miracles happen. God can deliver you from your pain. Does He do it for everyone? No. That is His choice, not mine. I know I shouldn’t worry because God does have a plan, but don’t tell me that God will heal me and I won’t need surgery and I shouldn’t cry. I know she was trying to help and just doing her best to comfort me. A clash of cultures which wouldn’t be the only one of the day.

Jude and Dr John decided pretty quick that I needed X-rays. The ship has a machine but they wouldn’t be able to be read until a day later. I looked up and Dr Lewis came in and told me I was going to Emergency Hospital. I cracked a smile, thinking she was joking. Emergency Hospital is the hospital we send our VVF patients to if they have an RVF. A local hospital which is run by the Italians. When I heard I was headed to Emergency, I have to admit, I got scared. I would have preferred the comfort of the ship where I know people. Where I have friends. Dr Lewis’ husband works at Emergency as a surgeon. She was confident that this was the best place to be seen. There is an orthopedic surgeon there and she was certain this was the place for me to go.

Back onto the stretcher. More tears. More language. Out of the heart the mouth speaks. I was loaded into the back of an Aberdeen Women’s Centre car. All the long ones were out so when I was put in the shorter one, the doors wouldn’t close fully. The back doors were tied closed with wire.

The trip to Emergency was unbelievably painful. Every pothole and every bump was felt and received with tears. Dr John was sitting next to me and held my hand the way there. It was comforting. I felt like a little kid continually asking if we were there yet. I could tell where we were at times. I knew we were on the long stretch of road that passes right in front of the ocean when it felt like we were driving over a cheese grater. We were in Lumley when I saw the colorful umbrellas from the sellers in the market. Laying down in the back I could see full taxis and busses passing. Babies carried on backs and women with large baskets on their heads.

When we arrived at Emergency I was taken out of the AWC vehicle on the stretcher and I felt like I was dumped onto the Emergency stretcher. They wanted me to lie on my back and straighten my legs. Ow. No fun. It’s a very vulnerable position to be in when all you can see are the people pushing you into the emergency room and the white ceiling.

Although the pain in my back was excruciating, the pain from my full bladder was increasing. HR 106, BP 140/80. Yes, I do remember this. I don’t remember when I so aware of what was going on. Needing to know what was happening. I was laying against the wall with the air conditioning unit right above me, dripping water from the unit collected in a bucket below and every now and then I would get a drop on my face or arm.

The doctors were Italian and the nurses were from Sierra Leone. They were all so good to me. After the doctor examined me I was finally given diclofenac IM. That helped with some of the pain. The worst was yet to come though. X-rays were needed. I was wheeled into the hallway and parked there to wait my turn. The pain was already returning. I was crying as I pounded my hand against the wall. At this point I think it finally hit me that this wasn’t a good situation to be in. If something was broken, what were my options? Would I have surgery here or be evacuated? Why the heck did I fall? How ridiculous was this?! I knew it wasn’t good. Every small move brought forth a pain I couldn’t stand to bear. It was finally my turn in radiology. The men were very nice but to turn onto the hard boards was not something I enjoyed doing. This was the worst pain yet. After it was finished, about an hour later, more x-rays were needed to back in I went and more pain had. After the x-rays were done, I was taken back into the emergency room, the large open room, and my wet x-rays were brought and hung on the IV pole at the end of my bed with the chemicals dripping down onto me.

While I laid there waiting for the results, some interesting patients were brought in. Like I said, this was an open room. No curtains. Nothing to separate you from the patient next to you who broke his wrist. Three doctors surrounded this calm looking man and as two pulled traction and the other casted, the man screamed and screamed and screamed. I couldn’t help but watch. My stretcher was the table for the bandages. When that was done another man was wheeled in. His mud house fell in on him the day before. He was unable to move his arms or legs since. He was taken to a local healer who poured boiling water down his back in an attempt to heal him. This is not uncommon here. I looked over when he was rolled onto his side and the skin was all burned off his back. A woman came in who had fibroids which needed to be removed. I guess they can do them at Emergency. I wish I would have known that earlier. I was always told no where in Sierra Leone could this be done. We get so many women here in Aberdeen with this and no where to send them.

The docs finally came to look at my X-rays after giving me a shot of tramadol. That is great stuff! They finally said I had a broken iliac wing. Three Italian docs looking at my many films all decided this. Dr John and Jude were finally allowed back in to see me and we decided I would head to the Africa Mercy to recoup there.

When I got to the ship there was a good amount of people waiting for me. The tramadol stayed in my system for hours it felt so the ride there wasn’t bad. It took just over an hour or so to get there with the traffic. When I arrived, the side door opened and I saw Jane, a wonderful friend there who worked to get things situated for me to arrive. When the back door opened there were four big Ukrainian guys ready to carry me up the gangway on the stretcher. I will say this many times, but this was the most humbling experience of my life.

To speed up the story now...

When I got to the deck 3 hospital, I was taken to C ward where my friends had made me up a bed with a bright green apple comforter. I was taken first to get new x-rays of my pelvis and left elbow which had a great tunnel formed in it. My films from the ship were sent to the orthopedic doc who comes to do the ortho surgeries on the ship and to another radiologist in Canada. The ortho surgeon said I had broken my pelvis and I had a funny looking SI joint which I would need a CT scan to fully see if it was broken, and the radiologist in Canada said everything looked fine. All I knew was that any movement and I was in excruciating pain. The iliac wing fracture which was my diagnosis at Emergency Hospital turned out to be a smudge on the films. Kind of funny to look at now and see this smudge which brought me so much anxiety a few hours earlier...

For seven days I was on bed rest on board the Africa Mercy. If the ship was not here I would have been airlifted to Europe somewhere for scans and treatment. Finally on the seventh day I had a CT which showed nothing was broken. Seven days later it still hurt so much to bend or move certain ways but the pain was improving. Those seven days in the hospital I was shown such love. The friends I have here are incredible. I never ate a meal alone. We had picnics for lunch and dinner where friends would bring me food from the dining hall. We celebrated two friend’s birthdays while I was there with cake and watching Planet Earth. Documented my bruise which grew and changed to the prettiest blues and purples. They came and watched movies with me. Brought me a fake plant to brighten the room. Talked. We figured out how I could turn a bit so they could wash my hair. They listened to me and advocated for me and listened more to my frustration as I knew I was going to have to cancel my flight home for my brother’s wedding. All such amazing women.

On day seven, after the CT results, physical therapy came to get me out of bed. Jane helped as well as I first stood and walked with a walker then crutches. After I could do this, I moved to a guest cabin and saw rain and sunlight for the first time in seven days. I spent another week in that cabin sleeping mostly and moving more.

I’m now back in Aberdeen. It’s amazing to hear all that has happened in the last three weeks. The week before I fell I had to fire two nurses. Esther hired two more while I was away. I wasn’t expecting this at all. She told me the questions she asked and reasons for not hiring certain nurses who interviewed. I am very impressed with her and proud.

Now it is slowly getting back into work. On the 8th we will be launching a hotline for VVF throughout Sierra Leone. A toll free number where people can call if they think they know someone with VVF. It should be a wonderful day. Please pray for this opening that it goes smoothly and women hear about this centre who need to.

Blood

I have talked about blood before. How if a patient needs blood, we are the walking blood bank. I know the blood type of my colleagues. You never know when you will need to call them up and ask when they last gave blood because you need theirs now. Usually people here will have to bring in their own blood donors if they go into a hospital knowing they will need a transfusion. Last week a VVF patient needed one so we asked her to call her family. She needed two units so we needed two people to come in. Even though she was from Guinea she still knew enough people in Freetown that her family was able to call around and find two people to come in. Even though they were not the type we needed, it still helped to give us blood in our bank and we were still able to get her the type she needed.

The blood drama of the day started yesterday. When a patient needs a blood transfusion, you know it is going to be a long day. Yesterday there was one patient and today another. We still had not finished with the blood drama of yesterday before today had started. Both the VVF patients who needed blood did not know anyone in Freetown. We did not have the correct type of blood in our bank. Next step, ask those who work at the centre. Ok. I still don't understand what it is, but giving blood is taboo here. Even the woman who is going into the community to advocate for blood donations would not give today even though she knew she was the right type. I asked probably thirty people today if they would donate. Only five people were willing to even be tested to see if they were the right match.

Here are some of my favorite excuses:

I'm fasting.

I have high blood pressure.

My menses stopped yesterday.

I don't have enough.

I am not the right type. (After hearing that we couldn't take someone with AB blood,

all of a sudden eveyone had AB blood)

I am not prepared to do it today...ask me tomorrow.

I gave a year ago and I'm still working on getting it back.

Yes. Some are legit excuses. Most just made me laugh. One man I found to be tested was a caregiver of a sick child in the outpatient pediatric clinic. He didn't work here. He was just willing to help. Too bad he wasn't a right match! Now we have him to call if we need him though. I'm sure some had health issues they didn't want known even to the lab guys and that is completely legit. It just surprises me that it was so difficult to find someone to help another person when there is so much suffering here to start with. With everyone I talked with I tried to teach them the fallacy in their thinking but there is something is so engrained in their thinking that donating blood is not something you do.

How do you change this?

Sisters. Sisters. There Were Never Such Devoted Sisters...

I can't help but picture Bing Crosby and Danny Kaye singing this song as I sit down to write this... (if you have seen White Christmas you would know what I am talking about.)

Anyway, moving on.

We have a patient advocate who brings us many patients. The last group of women she brought were all from Guinea. Three beautiful women, all with the same last name. I didn't think anything of this since Barrie is a very common name especially if you come from Guinea. I quickly found out that these three women were related. Two of them sisters with the same mother and father and the other was the daughter-in-law of one of the women. They all came from Kaiyako, a samll village in Guinea. Fatmata Barrie was examined and it was seen that the extent of her injury was too much for Dr. Lewis so she had to return home. The other two, the sisters Mariama and Zainabu are still here and they even had their surgeries the same day. They both speak Fullah, the common dialect of Guinea. It is difficult to speak with them but we do have one woman who works in the office who can communicate with them. They both lived together in the same house before they got married. They never attended school.

Mariama met Bobakar, her husband, and became pregnant very soon after they got married. She stayed with her husband during her pregnancy and during the ninth month she went into labor. She was at home for six days in labor before it was decided to take her to the hospital. She did not make it to the hospital before her mother delivered a stillborn baby girl on the road. After arriving at the hospital the doctor told her to return home. At home she felt the urine starting to leak down her legs. When she told her husband, he sent message to Mariama's mother and told her to come. When the mother arrived she asked Mariama to explain the problem. After explaining to her mother, the mother and Bobakar discussed what they could do for her. Bobakar told her mother that he did not want her anymore and she would have to care for her. Mariama's mother took her in and cared for her.

Zainabu also became pregnant very soon after marrying Ibrahim, her husband. Again, she carried her child for nine months and during the ninth month she went into labor. For seven days she labored. On the seventh day she birthed a stillborn baby boy. If the child would have survived he would be twenty years old this year. Hew was delivered by Zainabu's mother in their home. The day after delivery she noticed she was leaking urine. She never went to the hospital to see a doctor about this. Her husband did not abandon her but they are not able to sleep in the same bed because she has this problem. Zainabu is one of three wives to Ibrahim. She is the only one not allowed to share a bed or even enter into his room.

Mariama and Zainabu were met by a woman who knew about this centre and she brought them down here from Guinea. They both had surgery on the ninth of August and they are doing well. They will be here for at least another week. All I can say to them is 'jarama', meaning hello. It always makes them laugh. Usually when I tell the women I want to take their picture they stand side by side with their arms to their side. When Mariama and Zainabu stood to get their picture taken they immediately put their arm around each other. It was really cute.

On a side note, the rain today was unreal. It has not stopped! Not just a drizzle. Torrential downpour. Even the locals say this is one of the worst rainy seasons.

Thanks and Goodbye

Five of the women sportin' their Lutherhaven gear

Some thanks are in order. Not just from me but from the patients as well.

First, thanks to Camp Lutherhaven for the t-shirt donation for the women. They are now nicely decked out in Cut, Crop and Quilt weekend and Great Escape t-shirts. Lovely! A bit of home for me to look at daily as well.

Also to my mother for the donation of crochet hooks. The women are loving them and making many chop covers,covers for their food. Thanks!

I have to share a story from today which brought me to tears. We have had a patient on the ward for two weeks now. She arrived from a screening trip completely wet and completely unable to walk. She could barely move her legs and had difficulty moving her hands as well. After being seen by the surgeon it was seen that she did not have a fistula but had completely lost all sensation to her bladder and the obstructed labor completely took away her ability to walk. We do have two physical therapists here at the centre who have been working with her and although she has a very long road ahead of her to recovery, in the last two weeks there has been such an improvement. Today when she left, she could sit in her wheelchair and use her legs to push or pull herself around the ward. She always smiled and thanked everyone for everything done for her. I have seen her cry more than any patient before. You could sense the frustration but she would never show it. She was just full of thanks. A few nights after she arrived I was visiting the ward in the evening. She waved at me and told me to come over. She took my hand and said she was going to call me her momma. Today her aunt and brother came to take her home. All the patients said and waved goodbye as she left. They have all been great with helping her with whatever she has needed. I cried as Haggar prayed for her. She has an appointment to come back in three months for follow up. Please join me in prayer that she will be walking through the door at that time.

Burqa

This thought has been going through my head since I was on fabric row on Saturday.

As we walked past an outdoor shop selling fabric I noticed two women dressed as many Muslim women are, in their burqa. Completely covered from head to toe in black. You can not even see their eyes through the veil covering the thin slit for their eyes. It was a beautiful sight to see though as they were looking through a pile of bright, colorful fabrics. It seemed like such a clash of cultures. It completely caught me off guard to see this. It made me wonder what they wear under their black coverings. I picture colorful clothing that will liven their spirit when they are able to remove their burqa.

Today

This is one of the babies of a mamma on the ward.

I love his Obama diaper!

What a great Saturday! It started with me walking to the roundabout to get a taxi to Bliss to meet Sandra for lunch. I somehow got a free ride from someone I didn't know. Olga, but there is the Sierra Leone hospitality for you.

I was on a mission today to find fabric. I need to get a skirt made for my trip to Niger in November. It's never a bad idea to plan ahead. In my six months here I have not been to the big market yet or to fabric row. I always heard crazy stories of this place and how crazy it is. It was fine. There weren't many people there today so that made it nice. This market is multiple stories. From what I saw of it, the main floor is crafts and upstairs is mostly fabric. I'll have to go back sometime when I have more time. The fabric row was great too. Found some fabric now I just need a tailor!

After shopping I took a bus back to Aberdeen. A bus. Another random mode of transportation in my day. It worked though. Cheap too.

The patients watching me get my hair done.

Everyday my patients say they want to braid my hair. Today I let them. I let Mariama. She did a fabulous job. Last year in Togo I was in tears when I let a patient braid my hair. When Mariama did it, I felt nothing. Loved it. It actually feels good having my hair braided. I was the source of amusement for the day. All the

other patients came out to watch and laugh. It was great. It was great talking with Mariama too. She spoke very good english. She is 32 and has only been pregnant once. Her baby was born alive but died two days after she was born. It was really interesting talking with her about relationships and boys and how she can't find a solid guy. She was saying that whenever a problem comes, the guys up and leave and find someone new on the streets. She was so frustrated with it. I was asking her where her worth comes from. I always hear how for women, their worth here is found in how many children they have so I found it intersting that she is 32 and has only been pregnant once. In her family they stressed education. She works for a mobile company and supports herself and her mother. She told me that if she lived in the villages, she would have many babies. Here, her family was able to give her an education and she only wants two children. She couldn't take care of more than that. It was really encouraging for me to hear. It's not like the stories I usually hear from the women here.

After she was done it was time for dinner. I don't usually eat dinner on the ward. Tonight I didn't recognize what it was. Yele I was told. Cassava, mango, fish, potato and palm oil. I was nervous to try it but it was good. Really spicy. Not all the women liked it so I bought them boiled groundnuts from outside the gate and we all ate those too.

Great end to a great day.

The Grace

The grace of our Lord and saviour Jesus Christ

And the love of God

And the sweet fellowship of the holy spirit

Bless your name and abide with us all

Now and forever more

Amen

Rain on a Tin Roof

When it rains here I think of the Julie Roberts song, Rain on a Tin Roof. I like the song and I've always liked the sound of rain on a tin roof.

I sleep under a tin roof.

It's rainy season.

I don't think my love for the sound of rain on a tin roof is the same as it used to be.

Pekins Post Fistula

(Pekin is Krio for child)

I knew there was one more story I wanted to share yesterday...

I was sitting with the women yesterday evening right before dinner. When the dinner cart comes rolling out, all the women sit on benches on the opposite side of the wards and wait to be served. There was a maternity patient and her new pekin who was staying on the fistula side since maternity was full, and she came out and sat down with her child. Haggar, our main teacher for the patients, was there. She told us that this woman had a fistula, was healed at the centre, and returned to have her pekin here. Haggar went on to preach to the patients about how there is hope and possibility to have more children after having a fistula. Some women can't, but this woman did and now she has a beautiful child. Do not lose hope!

It's neat how having a maternity centre here brings it all full circle. After the women have their fistula surgeries they are given a card which will allow them to have a free c-section if they ever become pregnant. If they were to try and have a child again vaginally, the chances of getting another VVF or going into obstructed labor again are very high, putting the mother and child at great risk. If a previous VVF patient registers with us they are admitted at 38 weeks. They will wait until they start feeling labor pains and then they will have a caesarean. While the women are waiting they usually wait on the VVF side since we usually have extra beds. It's a great example to the patients waiting for their surgery and wondering if there is hope for another pregnancy since one of the major ways a woman has status in this country is by her ability to bear children.

Stories

Yes. It has been a long while since I posted on here. So much has happened and so much has changed. My attitude being one, but more on that later.

I went home for four weeks from mid June to mid July. I actually had known since about two weeks before I arrived that I would be coming home. I wanted to make it a surprise though so no one knew. It was wonderful being back on familiar soil for a bit. It came at just the right time as well. To tell you the truth, when I left I didn’t know if I wanted to come back. So much was happening and I was struggling to keep my feet under me. Rest came at a perfect time.

Home was great. I spent four weeks with my sister and her family and was able to see all my nephews and niece. Many friends came to visit as well. I ate a lot and slept. Celebrated the 4th of July. Cooked on a campfire. Canoed. Hiked in the forest. Went fishing. Stocked up on some goodies for friends back here. It was great, to say the least.

I have been back a few weeks and honestly, it has been great being back. Having a time of rest, of real rest, renewed my strength. It helped too, that when I returned back here, nothing but good reports came from when I was gone. Bernadette and Esther, the two Sierra Leoneans I have been training to be the ward supervisors have been doing such an amazing job. Truly. It couldn’t have gone better. There was a visiting surgeon who came while I was away and he did 22 surgeries in a week. That is double what can be done on a good week, which we don’t see too much, but all my nurses pitched in and did a fabulous job. They told me that now that I am back, they can slack off. I told them absolutely not! And they haven’t. They are really showing me what they can do. It’s been great for me because I have been able to do more teaching and more detailed things to encourage and really try to get things right into place for when I leave in December. I pray this all continues.

Updates from the ward:

You wouldn’t believe it. So there was a woman who showed up with her sister and her daughter-in-law. All with VVF. The daughter-in-law has already gone home. Her injury was too extensive and there was nothing Dr. Lewis could do for her. The other two, sisters, both had their surgeries yesterday. Both are dry and doing great! More to come on them in the future...

Seibatu. The visiting surgeon attempted her again. Her third VVF. When I came back she still had her catheter in and was becoming wet. I decided to leave her catheter in longer than normal because she had said that her wetness was improving. The first thing I had noticed when I returned was that she still had her colostomy! She was soposed to get it reversed the day I returned home, four weeks before. Nope. They saw she still had a small hole so they left it longer. She was given another appointment at Emergency Hospital where she was going to get her reversal and last week she did!!! Two days ago I went to visit her so I could change her catheter but when I showed up they said she wasn’t having any urine from it so I just took it out. Her surgery failed, once again. Dr Lewis will examine her again this week and see if there is anything more she can try. Her colostomy reversal was a success though! Her RVF was closed!! The good news is that Seibatu has pooped! This is such a victory! For the last year it has all been coming out of her vagina and now, with the colostomy giving her bowels time to heal after her RVF surgery, she has pooped, three times! Every time is a victory for her! Chances are she will go home soon. After six months, she needs to go home and visit her children and husband and family. She told me she will not go if she is not dry. It will be hard to see her go but sometimes there is nothing more that can be done here.

It is Ramadan. In a country where you are either Muslim or Christian, this is a big thing. I have had old patients call me and ask if I am fasting. Nurses taking time in their day to pray. Breaking their fast in the evening. Having a VVF patient find out she is pregnant and the only question she has for us is if she can still fast. It’s a different world here sometimes...

This woman who found out she was pregnant, I was in tears. We do pregnancy tests on all our women. She came back positive. The obstetrician did an ultrasound but couldn’t see anything, so she did a vaginal one and yes, I got all choked up. So tiny on the screen. About six weeks along and you could see the tiniest little flutter of a heartbeat. It was incredible. She was given an appointment to return to have her baby here.

Oh, and last week we had such an overflow of patients that one night two beds were pushed together and three women shared and the next night an mattress had to be put on the floor! A full week this week and next week we already have a full OR schedule as well!

Last week Jane stayed with me for a bit for her vacation time. One night we were walking down the street and passed the side gate to the centre. There were five of my women there staring out and said they wanted groundnut. Jane bought them groundnut and we shared with all the patients. Now everyday they say, ‘Sarah, I want groundnut.’It makes me laugh whenever I hear this.

More stories to come. Off to bed for now though!

Seibatu

It is hard to know Seibatu’s age. She has a very thin frame despite our attempts to fatten her up. She carries her perfect apple cheek bones without any trouble and she has had five pregnancies. I would put her into her mid to late twenties, although she could not confirm nor deny this. Here is Seibatu’s story…

Seibatu has been here at the centre for 153 days. Yes, you heard me right, 153 days. Her first surgery took place on January 19, 2011, but I am getting ahead of myself. Like I said, Seibatu has had five pregnancies. From those five, she has four daughters which I am sure are as beautiful as she. Zainab, Fatmata, Isata, and Jariatu. It was during her fifth pregnancy that she came into trouble. She went into labor at home. For three days she labored before she went to the nearest government hospital to her home. There she had her child without a caesarean section. The baby was born alive. A boy. Within one day he died. The next day Seibatu noticed she could not control her urine and one month later she realized she could not control her bowels either. She had both a VVF (vesico-vaginal fistula) and an RVF (recto-vaginal fistula). This happened ten months ago.

Soon after her problems started another woman in her village returned from Freetown where she became dry after having this same problem. Seibatu was taken to the Paramount Chief of her village by her in-laws to seek help. He told her to go to Aberdeen to get help like this other woman had done. She was brought by her husband, Umaru, a very thin man like Seibatu but with the same infectious smile. At home they work together as farmers: cassava and rice. Since Seibatu has been here they have not been able to farm. Umaru travels between home and Freetown to visit Seibatu and care for his family. He has been seen on the ground here cutting her toenails and taking care of her, a beautiful sight to behold.

January 19, 2011 Seibatu had her first VVF surgery. She came out of surgery with two stents and a foley. Quickly we noticed her surgery did not work as her bed was still wet. After she had time to recover from this first surgery, on March 1 she was sent to a nearby hospital to have a colostomy placed. When the colostomy was placed, her RVF was closed. To give her body time to heal she would need to keep this colostomy for three months. Three weeks ago she went back for a check up and it was noticed that the RVF was only the size of a pin point! This Sunday she will return to have the colostomy reversed. The first step to full healing. Her RVF is closed!

May 18 she went back in to have her VVF attempted once again. Again it failed. Seibatu does not have a lot of healthy tissue to use to close her VVF. The greater part of the VVF was healed though. That was great news. Next month another surgeon will be visiting the centre and hopefully he will be able to do the final part of her healing, to finally close her VVF once and for all.

I asked her how she feels about being here for so long. She said she is happy. She wants a ‘well body’ to take home. She desires healing so much. There have been many tears shed on behalf of Seibatu by her, by myself, by the nurses. Seibatu has come so far and we can only pray that she will leave here completely healed and she would go home dancing.

Rapunzel

I have a hard time knowing how honest to be in my blogs. Honestly, the last week and a half has been great. I've been having a lot of fun with the patients. It seemed like my nurses were starting to get it. It has taken a long time, almost five months in, but I'm finally feeling like I can see a purpose and although it's not what I thought it was going to be, I'm here and I'm growing and learning and serving and it's not for myself. It's me, growing closer to God and learning to trust and rely and although I'm just starting to learn this, I'm learning to persevere...so I can be mature and complete... True, my time here is about the women as well. That is why I am here, and they are wonderful. It's about training up nurses as well, but there is so much more.

I am in a wonderful Bible study with amazing women. We met tonight. It's funny because one thing we talked about was how we once desired something and how we saw it come to pass. That's me here. I remember being young and desiring to "come to Africa". It's great to look back and see how it came to be... first turning my life over to Christ. Dropping out of college. Doing YWAM. Living and working at camp. Becoming a nurse. Doing Mercy Ships. Two trips to Niger... and here I am. Living with two feet on solid ground on a continent I once only dreamed of. Your desires can take a long time to be brought to fruition. When David was anointed to be king, it took him 22 years between the time he was called and actually being crowned. It all takes time. I'm digressing a bit.

So here I am in Sierra Leone. Not living on a ship. Living on land. Loving life on land, but struggling so much with my nurses and even more so today as I learned there is more dishonesty and lack of caring and concern and passion for the patients. How do you teach compassion? You can't. I've learned that. Most people here don't become nurses because they want to. They don't usually grow up thinking, I want to be a nurse. No. They have three options: lawyer, nurse or one other thing I can't remember right now. In Sierra Leone there are not many options. You go to nursing school because that's actually one of the three options. You either have compassion and a drive to work and do a good job, or you come to work and sit and talk on your phone and watch as your patient's surgery fails. The second someone isn't behind you telling you to get off your phone, fix the tape on the catheter, is the urine draining, maybe you should give your patient pain medication since they are obviously in pain, yes, constipation can ruin a surgery and maybe you should do something about it, and on and on and on.

Today I told myself over and over to persevere. Persevere not just for my sake, but for the sake of the VVF women. Persevere.

At Bible study tonight it was good to share and see how it's not just me not being able to handle it. Tonight there were five of us from four different organizations. We all deal with the same sort of issues. It's hard to see any sort of change even from those who have lived here for years. How do you change generations of corruption and bitterness? You don't. You can't. I can say with full confidence that only God can do that and I pray that a miracle will be done.

Constipation

The best cure for constipation (for the patients) is water and a large dose of singing and dancing...

In case you were wondering...

Persevere

Consider it PURE JOY, my brothers,

whenever you face trials of many kinds,

because you know that the testing of your faith develops

perseverance.

Perseverance MUST finish its work so that you may be mature

and complete,

not lacking ANYTHING.

James 1:2-4

Hawa

I asked one of my nurses yesterday to write a patient story. I thought she did a great job especially since she wrote it as if it was the patient writing. Here is Hawa's story...

My name is Hawa Sheku. I am twenty five years old. I live in Gborbu Yawee chiefdom, Kailhaun district. I attended the Methodist primary school, Malayma Yawae. I stopped at class three when the war broke out in my village. That was the end of my schooling. I am a farmer and housewife but I want to learn a trade like hairdressing or dress maker, seamstress.

I am married to Sheku Ngebga. I was fourteen years of age when we got married. I became pregnant at fifteen and was happy. I have been pregnant twice and the second pregnancy gave me this VVF.

The start of the labor pains came for some time and bleeding followed. That was the time my family traveled with me to Kenema Government Hospital. I spent one night in labor pains and I was operated on for caesarean section by the doctor. I was in labor for two days overall. My husband did his best to bring me to the government hospital to save the life of my baby and myself but it was rather unfortunate that we lost the baby. He was alive for three days and on the forth post-operative day, I lost my baby. Also, that was the time I realized I had urine incontinence. At that moment I told my husband and we explained to the nurse who told the doctor. The doctor now explained to me what brought my problem, that during my prolonged labor the pressure of his head compressed my urethra and damaged it. He told me it was not his fault. He also told me about a hospital where they could fix it. It was only urine leaking from me, not feces.

My husband felt so bad because of the constraints, pain, finances and the loss of our son. My family members felt bad for me and since that day they have been having sympathy for me. My husband and my family supported me fully. I have had this problem for six years. The only problem now is that I don’t have a living child. I have never attempted VVF surgery before. This is my first time.

I heard about the Aberdeen Women’s Centre through the radio and a team from the centre picked me up and brought me here. I’ve been here for twelve days. When I came I was afraid I would not be healed. How was it going to work?

Now I know I am cured because since after my surgery I’m dry and observed no wetness. I am really cared for by the doctor, nurses, international staff, teacher and the other patients. My best friend here is Massah Saffa.

My husband will be very very happy. My relatives will also be happy. Some of my friends will be happy. Yes, they will welcome me.

I will be very happy to reach my home healed because I came sick.

Bits and Pieces

I was so proud of one of my nurses today. She came to me and told me, calmly, that a patient had no urine output for two hours. I looked at her and said, do you realize this is an emergency. She said yes as I was getting irritated as I was almost running to the patient to see what was wrong. A blocked catheter, one that is not draining, can harm the patient and ruin an entire surgery if it is not fixed right away. I got to the patients bedside and I could tell she wasuncomfortable, another sign the catheter wasn't draining. I also noticed that on the end of the bed was a syringe with sterile water and a pair of gloves. I looked at Fatmata, the nurse and asked what that was. She said it was the sterile water and gloves so I could flush the catheter. For a second I felt like crying, then got over it, but I was so proud of her. Proud that she knew what needed to happen and had all the supplies there. I walked over to get another pair of gloves and she said she had some already for me. I told her those were hers since she was going to flush it. She looked surprised. I just don't get it. Fatmata knew what to do. She knew this was an emergency and to get help. I don't think her or the other nurses have been empowered to take the next step to follow through. She flushed the catheter just fine and the urine flowed and the problem was solved. Check. Now it's just taking her to the next level.

Massah, oh Massah. Massah is a patient who was here many months ago. She left dry but came

back after she had a small issue at home and her repair was reopened. Funny, funny woman. She speaks Mende, another language I have not and probably will not master. She likes to say words with funny sounds and I will copy her and we all laugh. Today I kept hearing a baby crying, no, screaming, so I went to see what was happening. Massah was sitting on a bench holding this screaming baby. The baby was just perched on her knee and the screams didn't seem to bother her in the slightest. I walked over to her with my fingers in my ears and said, "Massah, feed your baby!" I said this jokingly because I knew it wasn't her baby. She looked at me and smiled and said, "Not my baby. This my baby..." as she picked up the tube to her catheter and shook it a bit. Ok, fair enough.

Massah and Seibatu are friends. They both started their journey's out here together about three months ago. After Massah had her surgery, Seibatu would come and sit on the bed next to her and they would chat. Seibatu had her surgery yesterday. Things could be going better for her. Her catheter is bothering her quite a bit and today she started leaking. It's hard to tell at this point what it means but prayers for her would be great.

Birthday Babies

I had mentioned in a previous post watching a birth on my birthday. Here they are. The baby on the right which the mother is touching is my namesake, Sarah. Although the mother is also named Sarah, this Sarah is named after me, according to the mother, Sarah. The other baby, guess the name... Rebecca. Sarah didn't know I had a sister named Rebecca and now there is another Sarah and Rebecca running around, or sleeping eating and pooping, in the far reaches of West Africa.

Yeama

Meet Yeama. Yeama says she is 60, but I am willing to bet she is a little more than that. She no longer is a patient here but she always made me laugh. She spoke Mende so a few nurses could communicate with her. When she arrived here it looked as though she had scoliosis. She was very very hunched over. As time went on and Yeama spent more time here she stood straighter. She finally told us that she had her fistula for so long that she became hunched in a way to protect herself from humiliation. She left last week not yet completely healed. She says she will come back in three months and I hope she does. On rounds in the mornings you could tell what mood she was in by the glare in her eyes or the pursing of her lips. The day her catheter came out, even though we had explained what was going to happen, about five minutes after it came out you could see the fear in her eyes as she looked around for this tube and bag which had become her constant companion for twenty-one days. She had forgotten we had removed it after she had done such a great job taking care of it.

Touched

On rounds today, Dr Lewis decided it was time for Seibatu to have her follow-up appointment from her first VVF surgery since it has been about three months. Her first surgery was big. The hole she had from her VVF was really, really large. There is still a hole but hopefully Dr Lewis will be able to close it. She decided she will take her back to surgery TOMORROW! She is so happy. I almost broke out in tears in the office. She has been here so long and we all desire so much for her to be dry! Please pray for her surgery tomorrow that she will have no problems. That Dr Lewis will be able to complete the repair which has been started and that Seibatu will be dry! In the photo, Seibatu is the one touching my back, second from the right.

Newbies

Last Thursday ten new women came back from the screening trip to Pujehun, a province in the northeastern area of the country. I have to admit, when I heard there were ten, my first thought was, great, now they are bringing back women just to say they tried, but I'm sure they are not really actual VVF cases. I confess, I was wrong. All ten women have VVF. There are a few that are not ready for surgery since they are less than three months post-partem but they will stick around here until they are ready. One of them said she didn't mind staying here a month before her surgery since no one at home wanted her around anyway. That surprises me since this young woman has a smile that doesn't end. She is always smiling and on the verge of laughing it seems. I would love to know what she is thinking.

These ten women just make me laugh. There is something different about them all. Even the two frail looking young girls who speak only fullah are always smiling. The first two of the ten went to surgery today, the two who speak only fullah. It absolutely cracked me up when I was wheeling her back to her bed in the stretcher after surgery. We were on one side of the enclosed area which forms a rectangle with the open sky in the middle, if that makes any sense, and the rest of the women were eating lunch on the other side. When they saw her going back to her bed, they all stopped eating, stood and peered and stretched to see her. The patient got a large smile on her face and waved. It was like she was a princess or something. They were all smiles seeing her so well. The second patient went to surgery and came back without problems as well. There was a third who went to the OR for an exam with sedation but I was told that as she was going in, the other patient who was in recovery wanted to see her as she was walking by into the operating room to show her she would be ok.

This part of the day I would have paid to see, but I'm sure it happened... I was talking with one of the evening nurses tonight and she told me this story. She said one of the women who came back as one of the ten walked into blue ward after the two fullah speaking patients came back from surgery. She walked over and looked at one. She had a catheter and two stents, meaning there was a small tube going into each of her kidneys with a small bag attached. She walked over to the other. That patient just had a catheter. This women proceeded to walk out to the rest of the women and tell them, "Some of you will come out with only one tube coming out of you. Some of you may have one large one and two small ones. I don't know what this means but you will be ok." I can imagine this and it makes me smile. The women really take care of each other.

Quick Seibatu moment today...I was walking close to her and put my arm around her as we walked. I looked at her and said twelve days. She smiled and said, "Just tell me the day I have to go. Say today you will go and I will go. " That makes sense. No more countdown. Just enjoy each day without the stress of wondering what tomorrow will bring.

13 Days

Yesterday Seibatu went to Emergency Hospital for a barium enema to see how well her RVF has closed. This past week I have found her numerous times sitting outside alone crying. I know she really wants to go home but she just can't right now. These tears weren't for loss of home though. When I would sit with her she would look up at me with her fragile frame and say, "No operation". She knows the time is coming for her to return to Emergency to have her colostomy reversed and be freed from her RVF, although her VVF is still terrible. She is so fearful of another operation. Yesterday when she went for her check up, it was found that her RVF is just a pinpoint hole now! That is wonderful news! They told her to come back in 14 days, 13 days now, and she will have her colostomy reversed. I went down to see her on the ward this morning and she was sitting outside alone, again. She wasn't crying this time, just looking sad. I looked at her and said 13 days and she just kind of smiled. Please pray for a peaceful heart for her, for comfort of mind, and for quick healing so she can go home soon. Her husband came to visit her a few times this week. I love seeing them together. After her colostomy is reversed, since she has been here so long, it's time for her check up from her first attempted VVF repair. PLEASE pray that Dr Lewis can attempt her VVF surgery again and that this time she will be completely healed! I will try and get some pics of her this week so you can see her beauty.

Birthday Weekend

Yesterday was my birthday. I will admit, this was possibly one of my favorite birthdays. Not just the actual day but this past birthday weekend was amazing. I went with eight friends back to Samso's, a place at the far end of Lakka beach, and we rented a house for the weekend. This trip I also became an African driver. I have driven in Niger but only on the hospital compound. Here, I drove down the crazy streets honking my horn at every person, at every car. I am told that as long as you honk your horn, if there is an accident then it is their fault since you warned them. I love that logic. 34 km total and no accidents. Admittedly, I kind of enjoyed it even. I still don't have enough guts to drive through the city though and I'm ok with that.

I woke up Saturday morning to the sound of heavy rains on my tin roof. Bummer. The rainy season has started and I was worried about that for the weekend. By the time my friends arrived from the ship the rains had stopped. We went by the store for some drinks and snacks for the weekend and made our way to Samso's. This great house I have stayed at before. Three bathrooms, two bedrooms, and many mattresses. Just about a two minute walk to the beach. Not bad. When we arrived it rained a bit again so naps became the ticket for the afternoon. Even after everyone woke up and the rains continued, we still ventured to the beach for a swim. Warm water. Big rain drops. Lovely.

Later in the day we set ourselves up under a small hut to watch the sunset and have dinner. Right before dinner came a man came to the table and said rain is on its way and we must move now. Um, ok. Twenty seconds later as we were in the midst of moving, the sky opened up and the rains poured down! He was right. We still enjoyed our barracuda and fries on the deck of a cabin though. One thing I was really looking forward to was a bonfire and smores. That's becoming a birthday tradition for me since I have been spending my birthdays in warmer climates. With all the rain on Saturday this wasn't an option. Back at the house though, someone had brought big candles so we roasted marshmallows over candles and had smores that way.

After we went to bed and started struggling with the heat, again, the rains came. Not only did the rains come, the wind did as well this time. I had positioned my bed right in front of the open door to hopefully get a cool breeze through the night. Never did I imagine this. I laid there and watched at the trees blew around, mangos fell, branches broke, and fear of a mango tree falling on the car worried me. It wasn't safe to move it so I just hoped for the best and it all came out ok in the end. This storm lasted a long time and the winds were incredible. The next morning it was easy to see the damage. On the beach there were to covers which had been torn up and they were laying on their tops. Leaves everywhere. Debris everywhere. Joseph, the man who runs Samso's and wanted me as his wife, said storms like this only happen once a year and they usally happen over three days. This year it all happened on one.

A day of swimming and exploring rocks and playing scrabble on the beach ensued before we packed up and headed home. Lovely weekend with great friends.

Yesterday was May 9th, my actual birthday. Hettie had baked me four cakes. I couldn't believe it! Two for the weekend and two to bring back with me to the AWC for yesterday. I frosted them and shared them with the patients. They were excited to have cake but when I asked if they liked it they all just said it was so sweet. The did sing happy birthday to me twice and that was nice. Another patient called me to wish me a happy birthday as well. After work I decided to go stand in maternity. Sometimes I do that to think. The screams and "WHY, WHY, WHY" always help me to ponder life. As soon as I got in there I knew I wanted to see a birth on my birthday. I was told twins were on the way! Yes! The girl in labor was named Sarah as well. Go figure! She had been in labor since 3am though and it was 5 now. So yeah, any minute! Or so I thought... I stood there and watched for about an hour and heard major screaming down the hall so I ran down there just to see a little girl being born. I was excited to see the placenta as well but it was taking too long and I wanted to see babies. I went back to Sarah and her rocking and saying "what is wrong? what is wrong?" Nothing was wrong. Just your first babies taking forever to celebrate their birthdays with me! I left to eat dinner and came back and she was still there...By 7:30 and an episiotomy later, the first little girl emerged! Kate wrapped her up and put her on mama's chest then gave the baby to me so they could work on baby B. What a cute bundle of baby! I wasn't able to stick around for the send birth but I went and visited them today and they are all doing well. Twin girls. Super cute!

To wrap up the day we had oreo milkshakes at Katies. A-m-a-z-i-n-g! Great way to wrap up the birthday weekend followed by a great birthday!

Worms

While I am waiting for the nyquil to kick in I thought I would share a story from last weekend...

Last weekend Katie, the head of the maternity side here, and I hosted seven friends from the ship. We barbecued a large barracuda and just talked all weekend. It was great.

On a side note, I have always had a small fear of creatures which may decide to crawl up my shower drain or even up my toilet. I have heard of stories of people going into their bathrooms and finding a snake which had crawled up their drains, or creatures crawling up shower drains. I don't hear of that in the states, but here it can happen, and it does and did.

So when my friends were here I was hoping to give a good impression of what life is like living off ship. I wanted to make it seem perfect so they would want to come back and visit me. Well late in the night on Saturday, before going to sleep, I went in to take a shower and the shower floor was covered in worms. Not cute little earthworms, not that I think earthworms are cute by the way, but small black wriggly nasty worms. Hundreds of them. It was absolutely disgusting. Even though it may have killed my chances of my friends returning, I had to show them. Ginger and Jane came in and together we tried to hose them back down the drain. Gross. All that happened was more came bubbling up. Gross again. Either the drain was clogged with hair or more of these gross worms. I didn't care to know either way so we left them and showered somewhere else.

Monday I told maintenance about them. They came to my rescue and told me the worms were coming up from the room below me. Gross. Gross. And gross. I haven't seen one since but I do keep looking down the drain when I shower to make sure no other living creatures are coming up...

Nope

No beach day today. I feel like I have been hit by a truck. No, it's not some crazy African bug, I think I just have a cold that has hit me hard. Left work after lunch and have been in bed since. Sometimes this is a good place to be. It's hard to lay here and keep thinking about all I have to do down in the ward but it's hard to be on the ward when I don't have the strength to stand...

This past week was amusing. I hired three nurses and only one is still working here. On Tuesday two nurses started. One, the one still here, I'm very excited to see how she does. She has had a lot of experience in the OR and not much on the ward but she seems to be picking it up quick. The other nurse I hired who started on Tuesday was a sweet girl I interviewed two months ago. When she showed up to work I didn't recognize her. She had this big belly. I promise you, it was not there when I interviewed her. Within her first few minutes here she asked if we hire pregnant women. Oh, no. I asked when she is due and she told me next month. Oy. Small small thing which would have been nice to know a bit earlier. After the birth they get three months maternity leave. She promised me she would be back to work the day after her birth. This is her first child. Oy. I told her to come back three months after her birth. I had one other girl to hire who I had interviewed the same time as the pregnant nurse. When I called to offer her the job I asked if she was pregnant. She said no. I asked if there was anything stopping her from taking the job now. She said no. I explained to her it is a part time position but as soon as a full time one opens, which one will be soon hopefully, she can have it. She said great, she wanted the job. Lovely. She came in. We did a day of paperwork and she was to start the next day. Thirty minutes before she was to start she called me to clarify...yes, after this month of training, we could call you when we needed you to work. We had gone over that numerous times. She said great, that wasn't a problem. She would be in to work in thirty minutes. Ten minutes later she texted me and said I was too nice a person that she didn't want to tell me in person that she didn't want the job. She would only want a full time position. Thanks anyway.

It really surprised me, this second nurse who just would take a full time position. She is twenty four. Fresh out of nursing school and jobs are not easy to come by. She has been sitting at home doing nothing for the last two months waiting for a job to come to her. It did. Not a bad job at that. I can understand wanting a full time position but in a country where I have a huge pile of resumes sitting on my desk from nurses pleading for a job, it just really surprises me. Maybe she has other reasons she was too scared to tell me as well... Back to the drawing board...

Cold Drink

I sat down next to Seibatu today. She was sitting outside in a chair alone. I just sat next to her, not talking, when she looked over at me and said,

"Sarah, buy me cold drink."

I had to laugh. Where in the world did she learn that? She is really picking up on English. Maybe tomorrow I will buy them all a cold drink. Maybe tomorrow we will go on a field trip to the beach. Maybe, maybe, maybe. I've been thinking and talking a lot about taking the women to the beach. It's a two minute drive, if that. Most of them have never seen the ocean. I can't wait to see their faces...

The Same in Any Language

Yes, it has been a rough few months. It is my prayer that God would show me why I am here. What my purpose is and what the ultimate goal is. I feel like I have been spending so much time behind a computer screen and not enough with the patients and nurses. Late this afternoon I decided to just sit with a few patients at the tables they use for crafts and teaching. Seibatu was sitting there alone and although I know I should not have favorites, I really have a special place in my heart for her. Once I sat, a few more patients came up to sit as well. Seibatu has been here for months, it seems, and she has at least another month to go. Her VVF is too bad for Dr Lewis to fix but she also had an RVF where she was left leaking stool as well. She was sent to another hospital where she had a colostomy placed and her RVF fixed. She will have the colostomy for three months to give her body time to heal, then later this month she will have it reversed. She can't wait. She speaks Mende or Temene, I can't remember but I can't speak either anyway. My krio is still awful as well. Seibatu has been here long enough that she is turning into my translator for certain things. She has picked up on my sign language and I hear her yell across the ward sometimes when she knows I am struggling to speak to a patient. She is starting to learn English as well. It makes us both laugh. I have spoken of her a few times before but I laugh right now because I just realized she has been one of the constants in my life since I got here. I have no idea how old she is. I asked her today "how many years?" and she looks away shy and flips over her hand to let it fall on the table in a sign that she doesn't know. She is old enough to have four children. The oldest is maybe up to her shoulders in height so whatever that means in years... she only looks about fifteen or sixteen though. Her husband still comes to visit at least once a week when he can. In two weeks she will head back to get her colostomy reversed then come back to the centre for dressing changes, then home. She was telling me she would come back two weeks later for her VVF to be fixed. She kept telling me she is so ashamed. So ashamed. It is hard for her to understand and accept the truth. She is beautiful.

The longer I sat at the table, the more women appeared. Haua came and sat across from me. She took my hand and stretched out my arm. She pointed to my white skin and kept saying, "Fine, fine." I pointed to her black skin and said the same thing. We were bonding. She then opened my hand and looked confused as she looked at her hand then back at mine. She felt hers. Then felt mine. I could tell what she was getting at. Her hands are rough and calloused from years of work. Mine are not. She took my pen and pretended to write. She then put it down and pretended to be chopping things. She was telling me she works hard with her hands. I work hard with my pen. All the women laughed. How true was that comment? They all turned over their hands to reveal years and years of hard physical labor. I turned mine over to reveal a different world.

Another West African country. Another fish lips moment...The time had come. I looked at Seibatu and did fish lips. She looked at me confused until I said her name. She smiled and after a little struggle, hers too appeared. Haua... crooked, but there. Satta...Satta took a bit of time but eventually she too could speak the language of the fish. Everyone tried. Everyone laughed. This was good, especially for Haua who when she said down I asked, "Haua, you happy?" "No." She wouldn't tell me why and she had this concerned looked on her face but she wouldn't talk. She laughed though. Someone walked by and asked if I was teaching life skills. No. I wasn't, but the women laughed together today and I think that was big in itself.

Friday

It's Friday. I have to say that not only am I excited that today was the royal wedding and my dad's birthday, but it's Friday. I don't like 'living for the weekend'. I don't like living, hoping the weekend would come faster. I think that if you live like that then what are you doing in your life? I do believe you need to live each day, not just in anticipation for your days off from work. I will admit though, today I am really glad it's Friday even though I am sitting on my bed still thinking of all I have left to do in the ward or in my office. This week, oh, this week... Started off amazing. Spent all last weekend on the ship with friends and chocolate. Tuesday was going to be a big screening day here at the centre for VVF in the Western Province. One woman showed up, thanks for sending her Sandra. We did have seven women to screen which came from the screening trip the week before to Kambia. Three were suitable for surgery. Oh, Monday Ann Gloag arrived as well, the founder of the Freedom From Fistula Foundation, the founder of this centre. I honestly didn't feel much stress with her coming. I know I am here doing the best I can and that's all I can be doing. Wednesday was the 50th birthday of Sierra Leone. Music and celebrations galore. Wednesday, two nurses quit. Today, one more. When I found Sia's resignation letter taped to my computer I had to laugh. I laughed only because I knew that if I took too long to think about it, I would cry. Sia is the woman I have been training up to be the ward supervisor. She had been doing an amazing job in that position and I knew she was going to be the right person for the job. I was mistaken. Two more nurses as well... I had interviewed a few women not too long ago so I already had some in mind and at the top of my pile to hire. I found as I was calling them to offer them positions that hiring people is so much harder than firing. As it is anywhere, some people can interview really well but come to work and it's a different story. I really pray that the two nurses I hired today will fit well into the team and will be hard workers. Now I am on the prowl to find someone else to fill the position of ward supervisor. A national nurse. Please, please, please, join me in prayer for this.

On top of it all I am deworming. I know that probably sounds gross but I think it's time. I just hope this doesn't mean I am going to start gaining weight...

I have to share part of todays passage from My Utmost for His Highest:

To be certain of God means that we are uncertain in all our ways, we do not know what a day may bring forth. This is generally said with a sigh of sadness; it should be rather an expression of breathless expectation. We are uncertain of the next step, but we are certain of God. Immediately we abandon to God, and do the duty that lies nearest, He packs our life with surprises all the time.

So, so true...

A 50th Celebration

Today marks the 50th anniversary of Sierra Leone's independence. You are not allowed to forget it. For the past weeks everything has been getting painted green white and blue. I walked to the beach last night to watch fireworks, which never happened, and the two roundabouts by the centre look like Christmas with lights and flags and freshly painted cement. Driving down the roads you are met by traders selling green, white and blue necklaces, buttons, t-shirts, pens, underwear... you name it. Ann Gloag, the founder of the AWC is here right now for the celebrations as well. I walked onto the ward yesterday to the sound of the patients standing in a circle waving their freshly painted flags and singing the national anthem. Monday night a group of us went to dinner at Alex's, a restaurant close to the centre. Stepping out onto the street was crazy. The amount of people walking up from the beach as we walked down was incredible. The mix of having it be Easter monday and celebrations for the 50th brought the entire country to Lumly beach, the beach just down the road from the centre. I felt like a fish swimming up stream with the amount of people I had to dodge. The funniest thing I saw was when I passed by the gate to the OPC, the children's centre here. All my VVF women were standing there just staring out the gate at the mass of people. They love to people watch as much as we do.

The women make their Sierra Leone flags.

Easter was great. I spent four nights in a guest cabin on the ship. It was such a great retreat. Friends, food, scrabble, movies... The past few weeks have been challenging and this weekend was a great getaway. As soon as I set foot on the ship I dropped my bags and headed to deck 7 for foot washing, then to a communion station and time in the garden of gethsemane to just sit in the quietness and presence of God.

Sandra, Mikey, Francis and I decorated Easter eggs.

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