Dry Dock

Anticipation mounts as the day we sail to Madagascar draws closer.  We, a seemingly random collection of people from all around the world, are anxious to leave, to go, to do that thing which we believe that we have been called of God to do.  Yet in a strangely familiar echo of last August, we find ourselves having to wait longer than expected.  The best laid plans of mice and men... have gone awry.
This year's plans were to go into dry dock in early June, finish shipyard repairs with the ship in the water in July, and happily sail back to Madagascar at the beginning of August.  Thanks to unforeseen events and challenging repairs to the propellor shaft and chain locker, instead we are still sitting in dry dock and hoping, nay, praying that putting the ship back into the water tomorrow will be a smooth event.
For those of us with hospital jobs, one of the things we seem to automatically dwell on is the patients we won't get to see.  Every day of delay is more people in need that we will never get to meet or help.   Every week of delay is a tragedy that plays out in our heads as we tally the numbers.
In truth, we try not to focus on the negatives.  A few extra weeks here has allowed all the repairs to be completed, which is a blessing.  It also means extra time for planning and figuring out details that might not be priorities if we didn't have the time.  The kind of details that make our quality and standards rise in the hospital.  Things like policy and procedure revisions, adding to the manuals that include detailed descriptions of the surgeries done on board, and discussing new and better ways to accomplish things in the hospital.
It also gives us time to fall to our knees in prayer.  Because truly, how often do we forget who is really in charge of all things?  We start to believe that we might be able to make plans without God's help.  As we have dealt with changes again and again to how much longer we will be here and whether we can get the right parts in a timely manner, we have found ourselves in deep and fervent prayer for swift and safe solutions.
It is just possible that the discomfort of living in dry dock is the kind of thing that brings us to our knees that much faster.  What discomfort?  Well... in dry dock we need to rely on electricity from the shore and pay heavily for every bit of water waste that needs to be pumped off the ship.  Water and electricity restrictions mean things like: No air-conditioning, hallways that aren't lighted, laundry and shower restrictions, paper plates for one to two meals a day, no hot food at lunch, only one stove available in the crew galley.  Dry dock is considered a construction zone, which results in the requirement of wearing a hardhat whenever we leave the ship, and the families are all required to be off-ship until we're back in the water.  No families makes this a much more quiet, somewhat more serious place.
 The lack of air-conditioning means my cabin gets to a blistering 32.5C at night when I'm trying to sleep.  I will be so very thankful for air-conditioning once it is turned on again!
On the plus side, beyond the extra work we're getting done, I have had the chance to do a little exploring, going to the local aquarium and to a game park just outside of town.  We've made the most of it and had fun, but I am really, really looking forward to getting this ship moving and back to Madagascar! Hopefully arriving before September!
Here's dry dock in picture format!  Captain Jurian was kind enough to give regular tours around the bottom of the ship!

The wall that holds the water back!  It's at the aft (or back) of the ship).

Notice what's missing?  The left propellor!  This is just before they removed the left rudder in order to pull the propellor shaft out for repairs.  (It is all back together already, this picture is two weeks old!)

The stairs to get down to the dry dock area!

Some of the cranes that surround the area where the ship is.  They are all on rail tracks to move big equipment around.

Another view of the missing propellor

Port side of the ship.  You can see the back-up emergency exit, that involves scaffolding and ladders.  I'm very thankful to never have climbed down it!

Pieces of propellor waiting to go get worked on.

This is what holds the ship up.  They are all placed according the the original ship manufacturers's diagrams of how to place them and at what angle.  They are placed before the ship is brought in, and it gets settled on them very carefully while being held in place by strong ropes until the water is all drained front the dry dock area.

This is midway down the ship on the port side looking towards the aft.

Some of the many water intake grills.  These let water for cooling systems in, and need to be cleaned regularly by our wonderful ship divers.  (it's not an official job, just an extra duty that people with diving experience can sign up for)

Bow thrusters.  They let us move sideways away from the dock!

That's how much dry dock is left in front of the ship... we're pretty small compared to the size of ships that they can bring in here!  It's one of the largest dry docks in the world!

This is the bow of the ship!  

Here she is, sitting out of the water!

The gangway back on to the ship.  Sturdy and safe.  I'm very, very thankful not to have to climb 5 or 7 decks worth of steps like in some dry docks!

Today...

This happened today:

After joining some friends for coffee this morning, I set myself up in the cafe (a very central location on the ship) with this sign and a small variety of lotions and oils.  Since it was a Sunday morning and a lot of people go off ship to local churches, it's not surprising that I only got a handful of people that took me up on my offer.  But I realized something after one of these people bounced my request for a "God story" back at me.  I'm craving a little reassurance and deeper connection.  I want to hear more from people than just how tired they are of having chicken almost every night this week, I want to go past the regular discussions of who's working what shift and how the patients are doing and what amazing restaurant someone just discovered in town... even though these things do interest me.  

I want to hear about the big things.  I want to know about the way God is leading a nurse to apply to a university for her masters and how she needs to learn to trust God for more.  I want to hear about the guy who found himself with exact funding for his time on the ship, with only a dollar to spare.  I want to know more about the educator who was told that the class she taught to local doctors a few months ago is already saving lives.

I think I may have benefitted more from this morning than the people who got the hand massages.  So this might become a regular thing.  

In the meantime, I have something else to think about.  I've had the chance to shadow (follow) some local midwives at the local teaching hospital. In fact some of them have come and followed me around our ship hospital as well.  It's a bit of a learning exchange, and a big part of that will happen tomorrow.  Tomorrow we are holding a class for them on any topics they want (within their scope of practice).  We have already taught NRP (what to do with a newborn who isn't breathing) a month ago.  Tomorrow's class will include a range of topics including VVF anatomy & causes, Obstetric Emergencies, Pain control in labor, and Postpartum Hemorrhage.

Pray that we present the information in a way that helps the Midwives to understand and remember it.  Pray that we would be culturally sensitive and yet able to show them ways to work within the limitations at their hospital.  Pray that we are able to speak TRUTH into their lives.  

Night shift

Night-time noises fill this space.  The consistent hum of the air-conditioning, the rustle of people in their beds, the ticking clock, all punctuated by random alarms going off on another deck, infants crying out in the middle of the night for their next feed, and the rustle of paper as we flip quietly through charts.  At the moment the noisiest thing in the room is my fingers tapping on the keyboard (though the snore of my 7 year old patient may be good competition). 
This ward is made up of two side-by-side spaces about 20x24ft each (very rough guess) that are joined by a small space filled with a nursing desk and countertop with cupboards and a sink.  Myself, another nurse and the translator working with us bring the total population of the ward tonight to 40 people.  Most of our patients have a caregiver (or two, if there is a baby sibling) who sleeps under their bed, and so our ward with 19 patients means double the number of people filling the space. 
Soon I will be checking on my one-year-old post-operative patient who had his fingers separated a couple of days ago.  He was born with his fingers stuck together, and this surgery should allow him to use his fingers separately, giving him more dexterity.  For babies and small children, I try to avoid waking them in the middle of the night unless they need medications, so my personal challenge will be to check his fingers, watch his breathing and check pulse and saturations without waking him. 
...
Alas, I failed, and he's still crying in the background.  Ten minutes of crying when you have your milk supply warm and sleeping in the bed beside you, attempting to comfort you, results in a nice big dose of pain medication from your nurse.  I'm confident that he'll settle soon. In the brief time that I left the computer, 3 of my patients received pain medications (amazing how many people wake up to a crying baby!), I checked on 4 sets of fingers and toes and one wound vac, I did two sets of vitals, and I only used the translator once. 
It is truly amazing how much you can get across with pantomime and gestures mixed with a handful of useful words.  My current favorite two: Marare = Pain, Vita = Finished/All done/End.  The first word helps because I know when the children are moaning it, or the adults come and just say that and I GET it!  Then I pull out the pain scale pictograph with faces and they show me how much pain they have.  The second word helps mostly with small children, so they know I'm done bugging them.
Ahhh, silence reigns again.  My little one has fallen asleep!
The ward is once again at peace.  People are settling back into their beds and re-entering healing sleep.  There are no surgeries happening in the morning, so we'll let them sleep a little longer before turning on the lights. 
As they sleep, would you pray for the ones here with infections that need to heal?  And for the ones that have been here for 3 or 4 weeks, some are getting a bit of cabin fever and becoming more and more frustrated with the long days in here.  Pray for calm hearts and respectful interactions.
Thanks.

Recap of the last few months...

There is a feeling of too much to say, too much to share, and no idea where to start.  Since my last blog I have made new friends and said goodbye to them, only to find more new people to spend my time with.   All while trying to maintain the old friends as well.  And in the midst of it all, it's been work as usual.  Or perhaps not.  The longer I live this life, the harder it is to pick out the amazing, because it masquerades as normal.

* And yes, I realize the chance to see, touch, pet, hold Lemurs is definitely in the "amazing" category!

In the last year I have moved from the beauties of home:  (I took this picture last spring a few hours from home)

To the wild beauty of Madagascar (also taken a few hours from "home", or my home here at least):

Life in Madagascar is lived in seasons, not as I grew up with (spring/summer/fall/winter), but rather dry season and rainy season.  Converse to everything I tend to expect, the rainy season is the  hotter of the two seasons. We are currently in the rainy (and cyclone) season.  The other day it was so hot outside that as the rain started, we had a thick mist/fog rising at our feet because the rain was instantly evaporating off the scorching hot ground.  The wind kicks up and it's a hot wind, not cooling in the least.  And that confuses me.  I'm not complaining, it makes a walk in the rain almost pleasant, and the ship kids love to play in the rain here.  

I made the most of an opportunity to make a little extra cash on the ship when we had a festive day in December called "winter wonderland."  Crew members could sell crafts or food to other crew, and it was a fun time to mingle and browse.  I made Ginger cookies and Chai tea, which sold out half way through the night.  This brought in enough spare cash to allow me to go on a short (4 night) trip to a local island with some friends and enjoy time on the beach in hammocks, snorkelling in the ocean and just generally relaxing away from the ship.    The owner of the place gave discounts to all local missionaries, which was a great blessing.  Oh, he also had the cutest little bamboo lemur that he has raised since it was a few weeks old.  Mikey (the lemur) is very comfortable around people and takes every opportunity to steal food off of our plates, or uses people as jumping off points as he rockets around the room!

But enough about the beauty of Madagascar (for now) what about the work we do?

Sadly, my timing (or that of the photographers) is horrible, and I have NO pictures of me at work.  Far too busy for that, I suppose.  

In the hospital, there are seasons as well.  We go from specialty to specialty, balancing to fit the patients in the bed spaces onboard.  Because we made such a last-minute choice to come to Madagascar, the influx of patients has been slow, as we spread the word and search for those on the outskirts of the country who need help the most.  And little by little we are filling to capacity.  We have just now finally overflowed all of our regularly open wards, and have started to fill E ward as well.  

The hospital opened in November, but before we could open we needed to screen (find and assess) people.  This year is a different set-up than the last few years.  This year we had almost a month of screening days in the city we are in.  The hope was to give more people a chance to make it here, and decrease the size of the crowds.  I got the opportunity to help as security on the first day, when about 2000 people showed up.  The numbers were down to between 200-600 a day (in line) during the next few weeks.  I must say, I'm impressed at the calmness of the people here.  There was never any upset or problems in line, and stepping out of line to grab food and water was respected by those around you who would save your space and welcome you back to where you came from!  Since December, the screening team has moved from one area to another across Madagascar, spending at least 3-5 days seeing local people and picking those we can help.  Here are a few pictures from the local screening days:

Orthopedics, General surgery and Maxillofacial surgery were the specialties that we started with.

B ward was full of beautiful children and their smiling faces!  

To be fully honest, they didn't all smile right away, they don't like most of us the first few days while everything hurts.  A few games of Memory, Jenga, and Connect 4 can go a long way towards making friends though.  A majority of the children we helped in orthopaedics had club feet, as it's a very common condition worldwide, and when it's neglected as an infant then surgery is necessary to repair it.

These children in their casts are back and forth on the dock for months, and our rehab team (physio and occupational therapy) are still seeing them regularly.  We have some beautifully straight legs and feet walking around down on the dock these days.  

The patients from A ward are beautiful too, but I have less pictures of them.  As per usual, they are often in and out so fast that it's harder to build relationships and we get far fewer pictures of them.  One little beauty that stayed for a few weeks until she was well enough to go home: 

This beautiful girl rarely slowed down!  And she had a smile for everyone.  Happily, she's not in hospital anymore and should be returning home soon.

That's it for now.  

Please remember to pray for healing for our patients.  And for calm seas as the cyclone season has just started and every week we've had cyclones brushing just close enough that we need to keep an eye on them.  No emergency sails yet, but they are always a possibility here.  

And finally, pray for me as I make choices in the next few days/weeks about when to return home this  summer, and what kind of challenges to take on next year (on the ship).  

Thanks!

From Gran Canaria to Tamatave

I must admit to having neglected this space horribly in the last two months.  One of the new nurses called me on it... apparently she reads my blog regularly. So to all of you that I have left hanging, I'm sorry.  Life happened and I'm still re-learning how to balance my time in this place.  A day can feel like a week and yet I blink and somehow I've been on the ship for 11 weeks!  

I'm not going to reiterate all the changes, since that seems to be my theme each time I write a blog.  And I'm not going to go into detail about South Africa yet, because that really deserves it's own blog. 

On September 13th, we set sail from Gran Canaria Spain, to Cape Town South Africa.  In total, that was the furthest sail that this ship has ever travelled in one trip since it became the Africa Mercy.  September 29th we arrived to our destination, grateful to feel solid ground beneath our feet.  The first 13 days of the sail were pretty much idyllic.  Calm seas and a following wind, warm sunny days spent on the bow whenever I could make it out there, fresh food that somehow lasted most of the sail... it was FUN!  We had activities planned every night, and filled our weekends with things like a Dutch Blitz tournament for a friend's birthday.

I worked hard with the engineering team, helping with repair work that included removing the "dome" ceiling in reception where we vacuumed out piles of accumulated dust, replaced insulation and re-insulated pipes.  The plumbers replaced leaky pipes and there was way to much work involving ladders that we had to balance on and buckets that needed to be held and moved to catch the dripping pipes as we swayed.  We finished up before things got too rough.

Somewhere about a week into the sail, there was one lunchtime where the captain announced that we were in one of the few spots along the way where your shadow will be DIRECTLY beneath you.  The sun was literally in the middle of the sky and there was no angle to shadows.  It's really hard to get it in a picture, but here's my attempt...

Sunsets from the bow were spectacular...

And then we got close to the rough currents and wilder weather around South Africa.  Our typical sail includes seas that make the ship tilt to around 5-10 degrees, with occasional times as much as 12-15 degrees.  This last weekend included a few times where we were up to 22 degrees, and resulted in a lot of things moving that hadn't moved in years (or ever), and some damage.  Happily no major injuries.  We re-tied things and did our best to be cautious, and the galley crew didn't cook for a day or two, instead serving things that didn't need much prep work.   We made the most of it and moved things like worship on the bow inside to the international lounge.

We arrived safe and enjoyed almost three weeks in South Africa where more crew joined us.  And then... we set sail for Tamatave, Madagascar.

We had plenty of warning that this was going to be a rough sail, in part because of currents, and in part because of the weather system that was chasing us.

I have almost no pictures from this sail.  It was rough, rainy, and windy for a majority of the sail.   We had multiple days where we were almost always around 10-16 degree rocking.  There were a few large rolls that had some serious damage, including a broken cappucino maker (in our starbucks cafe which has since been fixed), broken bread slicer and broken meat slicer.  There's some debate on what degree those rolls were, no one had a true measurement (beyond poorly calibrated iPhones that stated up to 33degrees which is doubtful), though it was at least 25 degrees on one roll.  Even the captain admitted to being unable to stand up in the shower for most of the sail, if that gives you an idea of how rough it was.  There were several days with no hot food.  I may have required daily naps to make it through, but the seasickness medicine I was on kept me going (if drowsy).  We had nursing orientation through the sail for all 40 some nurses currently on board, which if nothing else has gotten me excited for this field service to get moving!

Early this morning just before 7am the captain announced that the pilot would be boarding soon, so I pried myself out of bed to enjoy the (calm) sail into the harbour.

As we got closer, I took a few pictures of the coastal areas we were close to (that are likely part of the city), and it does remind me strongly of a west african city, with some differences in infrastructure.

Once we finally approached our (first) dock, the first part of the gangway was lowered into position.

It's a nice dock, that appears to have been freshly paved for the ceremonies around our arrival, including the visit of the President and his kicking off the "Year of the Volunteer" in Madagascar.  We will move to a nearby dock on Monday and that's where we'll stay for the rest of the field service.

There was plenty of media presence, including an absolutely fascinating drone camera that flew around taking pictures (or video?) of the ship as we sailed in and tied down.

The advance team was eagerly awaiting our arrival, and were able to board soon after we were safely tied down.

The rest of the day has been full of ceremonies (one at the dock and another in the town centre that some of us were shuttled to) to celebrate the year of the volunteer.  We also had a 2 hour meeting this evening where the advance team explained the miracles they accomplished in 6 weeks, and we were given a short lesson on safety and culture to prepare us to enjoy our freedom tomorrow.

Over the moon to have finally arrived!  More stories and pictures another time.  But it's bedtime now, and I think I'll need to explore a bit tomorrow!