Tuesday, 4 September 2012

Guinea Screening day

Sometime before 5am, my alarm starts to go off.  Gently at first, the volume keeps rising until I'm awake enough to make it stop.  It doesn't take long.  Even though it is far earlier in the morning than I would normally wake up, this morning is different.  I haven't had a really restful night anyways, and have heard at least one of my roommates rustling around in their section for a little while already.  It's screening day, and we all need an early start. 
Knowing my brain perfers not to function first thing, and that I would want to sleep as late as humanly possible, I set out my clothes the night before.  Heck, I even ironed them! (owned my own iron for two years... never used it so I sold it! hehe!)  I got changed in the back room, waiting for my turn in the bathroom.  (Four girls, one bathroom... it gets tight sometimes!) Then went upstairs for one of the fastest breakfasts that I've had in a while.  About 5 mins later I was filling my two waterbottles and grabbing my bag for the day, leaving the light on in my room to help my last roommate get the energy to get out of bed. 
Then it was upstairs to the cafe to gather with my assigned group and then off to our landrover.  As a teamleader, responsibility fell on me to be in the first half of those going to the screening site.  It was my job to get my station prepared and my group ready to go.  Still pitch black outside, the landrovers lined up in a big convoy, which is definitely one of many highlights of the day.  Cruising down the pre-dawn streets, I'm reminded that all big cities seem to be full of people who don't sleep.  Pedestrians are all around, no matter the hour!
As we approach the entrance gates, people along the street start running, as though our arrival means they might be too late to join the long line.  Gazing off into the distance, it's hard to make out due to the low light, but I'm fairly certain I can see the line disappearing around the curve in the road.  And my heart lifts in praise, it looks like the word really did get out!!!
The People's Palace (Palais des Peuples) where we are holding our screening day is the size of a concert hall or mega church.  We are not using the auditorium, but instead use all the spaces around it.  Three floors tall, there are plenty of areas to fill, and we do fill them.  My space for the general team is on the second floor (floors are numbered as Ground, First, Second) on the far right, a large hall-like area beside the upstairs entrance to the auditorium.  I've set up four curtained off cubicles in the back area of the hall, with a table and chairs right nearby for our team to sit and write notes or schedule patients into slots.  There are about 40 chairs set up for patients, in long rows.  And I am alone.  It's 6am, and they are getting ready to open the gates and start patients through the beginning of the screening.  As the gates open, gendarmes are at the ready to try and prevent any riots.  Our security are all along the line and throughout the site.  People are guided along a long path that snakes around a bit to allow large numbers into the secure area.  Once they reach the front of the line, they are assessed by a nurse and a translator is present to help both sides understand.  One by one, they weed through the patients, sending away those that we definitely can't help.
Next they are led to the building where there are chairs set up for waiting, and multiple tables for registering patients. 
They move station to station, getting info taken, vitals and history, and finally they are divided by which surgeon station can help them.  This is when they come to me. 

The rest of my team doesn't arrive until 7am.  By this time my dayworkers/translators had arrived already, and I had spent some time getting to know them and explaining what our day would look like.  I did a little teaching with my team on the plan and what to expect, we prayed together, and by then we had about 5 patients waiting in the chairs.  And so we began.  My memories of the day are all over the place.  I spent a lot of time trouble-shooting and answering questions, many of which I did not have answers for.  There were far, far too many difficult decisions to make that day. 

Sometimes, the choices were obvious.  The medical problems are not within our scope.  Much as we would like to help the man with Hepatitis or the child with cerebral palsy, we do not have the properly trained staff or the resources.  How many times did I have to explain to someone that we are a specialized surgical ship, there are only very specific things we can do.  And yet, for the most part they were gracious.  They understood.  Many had stood in line since before we arrived, and travelled hundreds of kilometers to reach us.  I spoke with a few that had travelled from Sierra Leone.  Some pleaded, some explained again and again in hopes of a different answer, but none were angry.  They were simply hoping for someone who could help.

I think there were 4 different women that we found to have such advanced breast cancer that even a mastectomy wouldn't have prolonged their lives.  Each of these was escorted to the palliative station.  Now, we had a series of escorts set up around the compound, each assigned to an area, each would pass off patients in an efficient chain of people to make sure that no one got lost.  But somehow, in my eyes, this chain of escorts wasn't right for the palliative patients.  Each one of these women was escorted directly from our station to the tent outside for palliative.  Two of them I walked out myself.  Gently sobbing, the one walked beside me, mourning that her last hope was crushed, beginning to recognize that this problem wasn't going to be fixed.  The second one I walked out was more upbeat.  It helped that she spoke french, so I could talk to her, explain where we were going, ask her about herself.  And as I handed her off to the palliative nurse, I was able to tell her, "this is my friend, she will take care of you."  She gave me the biggest hug, a big grin, and happily went to the other nurse.  Knowing the heart of the friend I handed them off to, I know they were in good hands. 

On the more upbeat side, there was one woman I noted in the general station with a small baby.  After she fed the baby (and when I had a little spare time), I walked over and asked if I could hold the baby.  She happily handed it over and proceded to stretch her arms in relief with a great big grin on her face.  The baby was too small to strap to her back, so she had been holding that baby for at least 10 or 12 hours at that point.  No wonder she was so happy to share!!  Chatting with her, I found out the baby was only 3 weeks old, and still had no name because they hadn't yet baptized it.  It wasn't until I handed the baby back to her that I found out it was a boy.  He slept so well in our arms (I did have to share him with the other nurses).  I love those little ones!!!

Here's one question from the day... what is it about famous people that make them believe we all know who they are?  Hm.  I suppose that's the definition of famous?  Whatever.  I could probably take care of Tom Cruise and not realize it.  My friends know the truth in that statement!  Anyways, as a charity ship, there is always a lot of promotional stuff happening, and you never know who will be brought on a tour of the ship (or the screening site).  A few times through the day, various media showed up, always escorted by the communications team from the ship.  At one point, after being introduced to an official-type person with his own security and camera crew, I turned to the others in my team and whispered "who was that???"  We made some educated guesses, but found out later we were off a bit.  It was the Minister of Health. 

At one point in the day, I was escorting a small family that had ended up in our area to another area that was more appropriate.  As I arrived there and talked with the team leader about what was going on with them, I heard our dietician (Jessica) getting all excited as she walked up behind us.  The mom turned and let out a squeal and her and Jessica embraced.  Then in a broken french combined with HILARIOUS sign language, mom turns to me all excited and tells me how Jessica is "mama" to her baby boy, who had a cleft lip that was repaired while we were in Sierra Leone.  She indicated how Jessica had fed her baby and made him nice and fat!  It was soooo neat to see! 

I was a little greedy, and managed to snag myself a combination of 5 physicians and surgeons for assessing patients at my station.  It was an amazing group, and there were many points of laughter, and soooo much hard work.  As the leader, I had final say in a number of things, and it's mildly boggling to me to have surgeons coming to me requesting permission to do certain surgeries or to treat certain patients.  More often than not, it was an answer that they were expecting, or we reached a compromise that worked well for everyone.  Sometimes it was something that sent me on a wild-goose chase across the compound, looking for the right person to get me specific info or permission.  I kind of enjoyed the random runs to find other people, because it allowed me to be nosy and see how everyone else was doing.  It's an amazing operation, when you think of the hundreds of workers we need to run a screening like this! 

Through most of the morning, we never had more than 10-20 patients in our section.  A steady stream, but never overwhelming.  Somewhere around 4pm things changed, and the numbers got bigger and bigger, ending in a lineup that queued down the stairs.  We changed strategies a few times, and the main thing that slowed us down was a lack of translators.  Four translators for 5 doctors and one scheduler doesn't work all that well.  We went through a quick blitz of goiter patients, where we pulled them out of line and did a very quick assessment and added them to a clinic list.  For all of them, we will do much more indepth testing in about a month, so even if we don't do a lot now, so long as it is definitely the thyroid, we can plan on adding them to our goiter clinic.  I was amazed at how many goiters we saw!  I think almost half of the people we saw had goiters.  And the exciting thing with that is that there is a guaranteed supply of thyroid medications (which we couldn't get in Sierra Leone), which make it safe to do the surgeries.  Due to all the testing and medications the patients will need, we won't do those surgeries until around January at the earliest. 

I was surprised at how few hernia patients we had, but the doctors were saying many people had scars from previous hernia surgeries.  I'm hopeful that that means we have some local surgeons that are taking care of those needs!  What we did see a lot of was lipomas (fatty tumors that are benign).  There was actually quite a bit of variety in what we saw during the day, which I'm hopeful will mean a lot of variety on the ward.  I need variety, hence the random array of jobs I've had over the years. 

Somehow... we managed to screen everyone in line, and ended the line where it came to a natural end, closing the gates at that point in the early afternoon.  I've gotten a lot of random reports about how many people were seen.  Over 3000 for sure walked through the gates to be seen.  We have a meeting tomorrow morning that will give us a better idea of numbers.  What matters is, we pushed through and saw them all.  A day that started before 5am, we were hoping to be finished around supper.  At 6pm they came around to say we would cut off at 8pm, if the people already in our station weren't all seen, they could come for a smaller ship screening another day.  I counted shortly after that.  We had 64 people left.  The challenge was on.  I was kept running to fix up little details, a biopsy that we needed results on, a patient directed to the wrong area, another patient that needed to get special information.  And each time I returned, it felt like half our patients were gone and more of the room had been cleaned in my absence.  Finally, at 7:40pm, by the light of a small flashlight, the last forms were filled out, we assessed our last patient, and pulled down our screens, packed up our table, filled our supply box with what was left and grabbed our bags.  Our job was done. 

The hall echoed as I walked out, carrying the collapsable table between myself and another nurse.  We walked past others packing and cleaning other stations.  Dropping off our table downstairs, where the last patients were receiving instructions and patient badges, we proceeded down the long hallway to the landrovers.  A small cheer went up from the landrover as we walked up, because the 5 of us that left together were exactly enough to fill the vehicle and they weren't allowed to leave until it was full.  Driving back in the darkness, our driver had a little difficulty and turned left a few too many times, resulting in us almost returning to the palace.  Finally, the right road was found, and at 8pm, we wearily walked up the gangway and onto the ship.  My first stop was my shower.  Even two minutes of water can feel heavenly!  And then off for supper.  It's the ONE time when supper is served late.  They save food for when we finish the screening, and serve it until we all get a chance to eat. 

Sitting around tables, all of us weary and half-awake, we told story after story of the day.  Some were heart-breaking, some funny, some encouraging.  It was a mini-debrief.  And by 9pm, we were all splitting off, wanting nothing more than our beds.  Tired, yes.  But satisfied in a job well done.  And so thankful for all the prayers that went up for our safety, which was maintained, for good weather (cloudy but not raining, thank you JESUS!), and for energy, which was just enough. 

1 comment:

Matt, Kara, Hunter and Cavan said...

How exhausting and exciting! What a turn out- amazing!