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.