Man from Guinea

A couple days ago I admitted a patient from Guinea who had a large mandibular tumor.  Mercy ships is actually doing a story on this man.  The writer was down in the ward, but I was too busy to listen in on the interview.  Fortunately I caught up with the writer at breakfast and she told me his story.  Three years ago George* started developing this facial tumor on his chin, which kept growing and growing.  His wife and children were so ashamed of him that they left him.  He lost his job and had to sell a lot of his possessions in order to live.  I don’t know honestly how he lived for those three years, but he did.  During that time he visited numerous hospitals and everyone said it was going to cost a lot of money (way more than he could afford).  A couple months ago he was riding in a taxi, when the taxi driver told him he just took a few people with facial tumors to a hospital ship in Sierra Leone.  He then spent the majority of his time asking people to help fund his trip to Freetown, Sierra Leone.  He didn’t know how he would pay for the surgery, but thought if he could figure that out when he got there.  George finally raised enough money to make the trip down from Guinea and when he arrived at the gated entrance to get to Mercy Ships he was shocked that he didn’t have to pay a fee.  He was then taken to the screening area and had some head scans done.  By now he thought we were just adding up the bill and it would come after his surgery, but then he found out that our services were free!  He was so ecstatic!  He was so grateful and appreciative and couldn’t stop saying , “God bless you!” to me.   He’s now had his facial tumor removed and is doing well.  George is hoping to return to Guinea and be accepted back with wife and children.  What a story.

*names have been altered. 

The Nerve

Over the past couple weeks I’ve had a patient who had jaw cancer resected and despite the fact that the surgical incision has not been healing properly, she’s remained positive.  Everyday I’m working she greets me with this huge smile and now she’s started giving me hugs on a daily basis.  She does this with numerous other nurses as well as she just loves people.  What a great patient.  Anyways, a small area of her surgical incision on her jaw line started becoming necrotic as the blood supply was very poor.  The surgeons who performed the surgery thought that they could resect all the cancer, giving her a cure.  Because of this they did a much more extensive surgery than they would have for palliative measures.  However, the more extensive surgery comes with greater risks, one being the possibility of poor wound healing.  As we waited for the suspicious looking tissue to declare itself, it finally became completely necrotic looking and a hole between the inside of the mouth and the outside of her jaw had now formed.  On morning rounds the surgeon wanted me to remove the dead tissue.  He was like, “do you feel comfortable with that?”. And I finally agreed after asking a few questions.  OK, so I cut around the area until she starts to bleed a little.  Got it.  I premedicated her with as much codeine and Tylenol that I could give.  She shouldn’t feel the necrotic tissue being removed because it’s dead, so that was slightly comforting.  The middle of the necrotic tissue came out quite nicely, but I had a much more difficult time cutting the edges.  I got to this one section and I couldn’t cut through it and I finally noticed this string hanging out where her jaw had been resected.  Hmmm…it finally dawned on me that maybe this was a nerve!  I touched it with tweezers and she grimaced.  I called my charge nurse over and she told me to stop cutting, continue with the wound care and that she would let the surgeons know we think we found a nerve.   I felt so bad as I had actually tried to cut the nerve!  How terribly painful that must have been!  The next day, they discussed it on rounds and the surgeons agreed it probably was a nerve, but that there wasn’t anything we were going to do about it.   They’re hoping that the wound will heal from the inside out.  If it doesn’t, we may be in a worse situation than when we started.  Please keep this patient in your prayers as she has quite the journey ahead of her.  We are hoping and praying that her wound will heal and that all the cancer is gone. 

This past weekend I went to the beach.  4 hours there and 1.5 hours back.  Only in Africa. That’s a story for another time though. 

 

one month

It’s crazy to think that I’ve been here for almost a month and feels more and more like I’m settling in.  I don’t go through as much culture shock every time I step off the ship and go for a walk in town.   I’m getting used to the work and living with 6 roommates.   I really do feel like I’m back in college.

I went to the craft market the other week and was it a CRAZY experience.  So most of the roads in town are pretty terrible.  Imagine a forest service road with huge pot-holes and that’s what a lot of the streets are like here. In addition the sidewalks are often non-existent or if they do exist there’s a huge sewage ditch below.  You have to watch your steps because sometimes the sidewalk ends or is missing a portion of cement.  The streets are wide enough for one car, but because there are so many pedestrians, there’s really no room for cars.  Despite these conditions, trucks, vans, and taxis are not deterred from driving up the street.  In fact, I really don’t get the impression they really care that much if they run you over.  They’re not going to stop so you better get out of the way.  So when a driver drives down one of these narrow market streets, everyone squishes together as the car or truck passes by missing you by a couple inches. I feel like the walk to the craft market should really only take 30 minutes or so without any traffic, but it takes close to an hour because you have to continually dodge these cars.  It’s also very easy to lose your group as you’re constantly weaving in and out of people.  Definitely not a place for kids.  My friends and I finally made it to the craft market incredibly hot and sweaty.  We had lunch at a Lebanese bakery and I had the best food since I’ve been here. I don’t think I’ll be going to the craft market on a regular basis, but it’s definitely an experience.

Anyways, let me update you on the prayer request situation.  We were unable to operate and so had the boy transferred back home with his grandma.  The first plane didn’t want to let him on because the tumor smelled so bad, but he made it out this past Monday and will be back at home with the rest of his family.  Praise God for that. It’s still a difficult situation, but I have to keep trusting that God is good and works through hard times and situations.

Two weeks ago I had the opportunity to go with a group to visit the “Missionaries of Charity”, which is a group of four nuns from Mother Theresa’s order that have started a home here for the sick.   Each of these nuns is from various parts of the world.  I think that two are from countries in Africa, but am not sure where the other two are from.  They each take a vow of poverty and therefore only have two different dresses, wear only sandals, and trust that God will provide for their needs.  They can be placed anywhere in the world and have no say in the matter when they make this commitment.  Pretty amazing.  Anyways, at this house or care center there are men, women, and children that need to be nursed back to health or are sometimes there to die.  A lot of the women said they were leaving soon and only needed to be there a couple weeks in order to get back on their feet, but others are there for longer and may never leave.  Most of the kids that we see on the ship are underweight and malnourished, but seeing the kids there takes malnourishment to a whole new level.  Most babies in the US have fat rolls, which is good and normal, but here the skin was sagging off the babies and you could clearly see their skeletal structure.  Many had the big bellies and stick legs and arms from parasites.  While we were there were sang some songs of worship, discussed a Psalm with them, and helped them with a craft, which they all loved. It’s difficult to see the poverty, but I am so thankful for the work these nuns are doing.  I am also continually amazed by the joy many have and by their resilience.  I am also continually reminded of God’s blessings in my life.  I have so much to be thankful for.

Last week I went to a dental screening on Thursday.  The screening takes place about a quarter of a mile away from the ship.  We got there at 8 am and already had huge lines of men, women, and children.  Some said they had been there for 3 hours.  I was basically helping out with crowd control as the dentists go through the entire line of people. They first are checking for the most severe cases (infections), and then other dental problems.  I felt like every mouth I looked into had at least one black tooth. We’re only able to take a limited number patients and had to turn many away.  If you don’t like the dentist, then the room where the dentists work would be your worst nightmare as there are 8 chairs in one room all buzzing with their dental instruments!  I don’t particularly hate the dentist, but this made me cringe a little J.  I can’t remember what someone told me, but I know they’ve extracted thousands of teeth. Unfortunately we’re not able to do dentures though.  I don’t know what kind of dental work they have in this country, but it must be pretty poor.  One of the dentists also said that a lot of people drink soft drinks as they’re almost cheaper than water and they also eat a lot of hard candy. Overall, it was great to see what another branch of our organization is able to do for the people here.

This morning I was able to go to the Mercy Ships eye screening at a local hospital.  Apparently, there is a decent eye physician here in Freetown and so the patients we can’t help, we refer to him.  We only take patients with bilateral cataracts and some patients that have a growth over their entire eye.  I forget what you call this growth, but it’s a result of dirt and dust getting into your eyes and not cleaning them.  The eye screening worked a lot like the dental screening as there is one big line of men, women, and children and two people screening for the bilateral cataracts.  After the initial screening, we take the patients to another area where they do various vision tests, eye pressure tests, and dilation tests. If after these tests, we determine that we can help this person then we make an appointment for them to come to the ship for surgery.  One of the people on the eye team said that of all the people we screen, we end up only being able to operate on about 6% of them.  Fortunately, there’s a good eye doctor here that she said really tries to work with patients especially if they can’t afford the surgery. I met one of the eye surgeon’s wife on board and she was telling me that her husband was operating and saw a parasite swimming in the patient’s eye!  He decided to squirt a sedative drug at it and fortunately made it hold still so he could remove it!!!  I thought that was so crazy!  I asked one of the eye team members about eye parasites and he said it’s pretty common here.  There was also a significant number of people that looked to be in their 20s and 30s who had cataracts, which kind of surprised me.  Some of the patients were completely blind.  I’d love to see these patients after surgery when they see for the first time.  I bet it’s an amazing experience.   Anyways, it was again great to see another branch of Mercy Ships here.

The work on the ward has been great.  These past couple weeks I’ve seen some incredibly huge tumors removed from faces.  These patients look so much better after surgery; it’s amazing.  There’s this 11 year-old girl that was my patient this last week and she had a tumor on her face that obscured half of her face.  I think someone said it was 15cm x 15cm!  It was huge as I saw her pre-operatively and honestly couldn’t believe how big it was.  I wish I had a picture to show you all.  But anyways, I had her after surgery and she just looked so much better.  However, I was also reminded that even though these surgeries may be physically transforming, living with a huge tumor on your face for over half of your life causes more than physical disfigurement.  I found out through talking with this patient’s sister that they are from Nigeria and had saved money for them both to fly here and have surgery done for her sister.  It’s so cool to see how much this older sister cares for her younger sister.  She’s been so helpful in her care.  I’ve tried to imagine such an experience with my brother or sister…

I had this weekend off and so went to one of the nearby beaches for some rest and relaxation.  It was beautiful and super sunny on Sunday.  Consequently, I am quite burned despite the numerous reapplications of sunscreen! 

Thanks for all the prayer support.  It’s been a privilege to be her and be a part of this work. God is good-all the time.

 

Aminata-one of the translators I work with

Some patients-the one on the R had a nose constructed as he previously didn't have one

More patients-the little girl had a cyst on top of her head removed and the man on the R had a facial tumor removed

Sunset at the beach

Sunshine at the beach

prayer request

This is going to be a short blog as I am running out of energy to type, but I wanted to ask you all to pray for a specific situation.  In our ward we currently have a 10 year old boy with a brain tumor rivaling the size of his brain.  He's from the Democratic Republic of Congo and they flew him here hoping that we would be able to help him.  Unfortunately, it is malignant and they are unable to operate.  Even if we did have a neurosurgeon onboard who could operate, he would still need chemotherapy and radiation treatment, which aren't available.  I don't know what the plan is for this boy, if we're going to try and transfer him home or if he'll be here until the end.  Please just pray for this boy, his family, for us as medical staff to show him God's love, and that God would be at work in mighty ways. 

Life here

So I wanted to briefly share about one of the patients that I had on orientation.  My real work starts tomorrow, but for now I can give you a little info on the diseases prevalent here.  On Friday one of my patients was a woman in her 40s who had originally had a partial thyroidectomy.  She wasn’t healing well post-operatively and so they ran some tests and discovered that she had malaria and HIV, with a CD4 count of 140, which I think is technically considered AIDS.   She also started having pretty severe diarrhea so then they did some more tests and found out she had typhoid as well.  A chest x-ray revealed that she had pneumonia as well, which was most likely due to the AIDS.  Despite all this she is getting better…well that’s relative since I don’t even if she does get better and get started on ARVs how much that can help her immune system.  This culture is very different from ours in that they aren’t direct especially when relating bad news.  In light of that, our social worker is working hard to make friends with the family in order to drop hints and tell them after getting to know them better.  It’s quite the task.  Anyways, despite all these things, this woman greeted me with a smile and she seems to keep fighting. 

I’m told malaria is quite common here and supposedly it’s the worst type.  Typhoid has to be common as well since the sanitation here is pretty bad.   There’s trash everywhere and there’s a stench throughout the whole city.  Sometimes my lungs really long for some fresh, cool air ;).  I’ve included a few pictures of the city.

On Saturday I went to one of the orphanages that Mercy Ships is partnering with while we’re in Sierra Leone.  Most of the orphans are war orphans.  There was a civil war here from 1991-2002 (think those are the right dates.  I might be off by a year or 2), which left a lot of orphans and a lot of people without limbs.   There were about 30 orphans ranging from 3 or 4 to late to mid teens.  They were all so kind and the little ones just hung all over us.   They just come up to you and hug you.  Our leader taught on the fruit of the spirit, which was a great lesson for me as well!  We also sang some African worship songs and did a coloring exercise, which they all loved.   There was also this teenage boy there who was in a wooden wheel chair. It’s kind of difficult to describe the wheelchair, but it looked ancient and very difficult to maneuver.  He looked like he had clubbed feet. His calf muscles were completely atrophied.  I just thought how I wouldn’t see this in the U.S. and about all the resources that would be available to him.  Really, he is very fortunate to be at the orphanage even though he is still so limited in his mobility.  (Jen you really could some amazing things here).  It’s tough to deal with stuff like that here because there’s often so much more we know we could do, but we don’t have the resources to do them.  I wish I had some pictures to share, but they discourage us from taking pictures, so I didn’t take any.

I was able to go to a local church today, which was quite the experience :).  The church service was about 2.5 hrs, but I think that’s on the shorter end compared to some of the other churches.  Church was pretty much structured the same way it is here.  We sang some songs, had a message, sang some more songs, had a time of testimony sharing, prayer, had the main message, communion, and then shared a meal together.   Somewhere in there they passed the offering bucket 3 different times.  As it was passed by for the 3^rd time I thought to myself how this would go over in the U.S.  Maybe people would be more likely to actually give 10% or maybe they would still give the average 3%.  Hmmm.  The music was incredibly loud-I don’t think their music is ever loud enough ;).   Everyone was incredibly friendly.  They called us the V.I.P.’s and served us the best of everything.   Lunch was one of their typical dishes here-rice with some green sauce that had to have some peppers, fish, and some other green leafy vegetable.  It was pretty spicy and wasn’t bad except for the fact that my second bite I got a mouthful of fish bones that took me a while to get to a point where I could swallow them. ;).  Oh the experiences in a new culture.  I’ve included a few shots of the church service.

I took a few pictures of the ship so you can all see where I’m living.   We’re docked at the largest port in West Africa.  I found that out today from one of the nurses that went to church with me.  I’ve been able to run along the ship on the port.  It gets boring real quick, but at least I can run!  Life on the ship is real nice.  I have internet, a warm, dry bed, air conditioning, decent food, and people to hang out with that speak English.  There were about 9 of us nurses that all arrived together and so we’ve all been hanging out and are becoming better friends.  God is good.  Thanks for your prayers.

This is me and a friend with one of the facial tumors that was removed! 

where i go running

eating after church

our meal at church

the kids with one female pastors

one of the nicer streets, most don't have two lanes

another street

my dorm

my room.  i'm on top

our transportation

these cargo are supposed to be stacked 4 deep and 2-3 tall for our safety

Arrival

Well after something like 30+ hrs of travel I finally arrived in Freetown, Sierra Leone exhausted and ready to go to bed.  There was a group of about 25 of us that flew from Brussels to Freetown on the same flight, which made the flight in less stressful. Customs at the airport was non-existent and because I was with Mercy Ships they collected all of our passports, stamped them, and let us through.   After pushing my way through the crowd to get my luggage, we left the airport and all walked to the parking lot where they loaded all of our bags about a couple feet above the bed of a truck with a person sitting on top so it didn't fall out!  it was kind of comical.  we then all loaded into multiple vans and cars and headed to the ferry.  Driving in third world countries is always an experience-there were bikers everywhere (it was completely dark) and multiple motocycles that we were weaving in and out of.  Fortunately, we didn't crash nor did we crash into anyone.  I've determined it's almost better just not to watch the road.  We finally made it to the ferry boarding after about 20 minutes, but unfortunately we just missed the ferry and so had to wait another hour for the next one to leave :(.   We were all super hot and sweaty now as the humidity here is about 90% or higher.  After a 30 minute crossing we unloaded all our luggage and got into the Mercy Ship SUVs that were waiting for us.  In a few minutes we were at the ship...finally.  It was now about 10:30 pm.  We did some paperwork, took our pictures for our IDs (awesome since we all looked terrible after traveling for over 24 hrs).  I went to bed at midnight and then got up around 7 am for breakfast and then headed to nursing orientation at 7:30am. I had nursing orientation the next two days and then started on the ward doing clinical work the next two. I'm been assigned to the maxillary-facial team or maxfax team and will also be working int he ICU.  I'm pretty excited about it because our pt's undergo such massive transformations as they have incredibly huge tumors removed and their lives transformed because of it.  Dr. Gary has been here for 20 years and has really lead his field in surgical techniques and removal of these types of tumors as well as other facial deformities.  He did a lecture for the crew the other night and brought in one of the tumors for us to touch, which was really awesome!

As far as living situation is concerned, I live in a room with 5 other roommates and one bathroom.  We have to take 2 minute showers to conserve water (and yes dad, I've been complying with those rules ;). I've been able to run outside in front of the boat, which is better than not being able to run at all.  Anyways, it's getting late and I'm getting tired, so I'll try to blog more after the weekend.

This weekend I'm going to one of the orphanages that Mercy Ships is involved with and then will be going to one of the local churches for Sunday service.  I'm excited to experience more of Sierra Leone as most of my time so far has been spent on the ship.   I hope all is well back home.  Feel free to email me at h.j.yamamoto@gmail.com.

My next adventure

On September 4th I am leaving for Sierra Leone for 3 months where I will be a volunteer Adult Intensive Care Unit (ICU) nurse with Mercy Ships. For the past 2 years I have been working at Harborview Medical Center in Seattle as a Neuroscience ICU nurse and felt like this was a good time to take a leave of absence and see what volunteer opportunities may be available around the world. I decided to apply to work with Mercy Ships as I could use my skills as an ICU nurse, where with other organizations I would not be able to use those skills. Mercy Ships is a non-profit Christian organization that provides healthcare to the poor specifically in Africa. They have a mobile ship hospital and provide medical care to those affected by blindness, cataracts, corneal growths, crossed eyes, deformities, tumors, cleft palate/lip, congenital abnormalities, and burns/leprosy. In addition to the medical care, teams work to provide medical training and mentoring to the locals, medical tools and resources, dental care, community health education, clean water and sanitation, agricultural assistance, and leadership development for the entire year in country they choose to serve.  
This year the ship is stationed in the West African country of Sierra Leone. They chose this country based on it’s UN Human Development score, which is lower than the Sub-Saharan African countries’ scores. Sierra Leone has the 14th highest infant mortality rate in the world and a life expectancy of fify-six years. The major infectious diseases that exist there are Hepatitis A, bacterial and Protozoa diarrhea, Typhoid, Malaria, Yellow Fever, and schistosomiasis. In rural areas on 26% of the population has access to clean drinking water. The Predominant religions are Islam (60% of the population), Indigenous beliefs (30%), and Christian (10%). For more information on this country you can visit :https://www.cia.gov/library/publications/the-world-factbook/geos/sl.html

As I am away, I ask that you would please pray for me and the crew on the Africa Mercy. Prayer is the foundation of all missional work and absolutely essential. Please pray that God would be glorified, that we would be agents of love, that I would be selfless and seek to serve others especially when I am tired, that there would be great team unity among the various healthcare providers, and that God would be at work in Sierra Leone. Please also pray for great community among the volunteers, that we can encourage each other to grow in Christ more. Also, please pray for my health and safety

If you are interested in contributing to this mission, you can do so online at http://www.mercyships.org/page/outreach/splash/crewmates and search for Hannah Yamamoto, or you can write a check to 'Mercy Ships' and write my designation code: 3101 on the check. Please do not write my name on the check. Mail checks to:

Mercy Ships
P.O. Box 2020
Garden Valley, TX 75771-2020

Thank you for your prayers and support.

I just wanted to share the lyrics of a song by Tim Hughes.  You can also listen to the song at: http://www.youtube.com/watch?v=1TCh31xg4vA

God of Justice, Saviour to all 
Came to rescue the weak and the poor 
Chose to serve and not be served

Jesus, You have called us 
Freely we've received 
Now freely we will give

We must go live to feed the hungry 
Stand beside the broken 
We must go 

Stepping forward keep us from just singing 
Move us into action 
We must go

To act justly everyday 
Loving mercy in everyway 
Walking humbly before You God

You have shown us, what You require 
Freely we've received 
Now freely we will give

Fill us up and send us out 
Fill us up and send us out 
Fill us up and send us out Lord