Cassava Leaves

With the help of a ward nurse, I guided the stretcher with Mabinty toward orange ward. She was our second patient today in theatre and I opted to take care of her in recovery while the other nurses ate lunch. On Mondays, the kitchen prepares cassava leaves for the patients and staff; and on Mondays, I find something else to eat. I still have not mustered up the courage to try the greenish brown slimy substance. It is a local favorite, but once you get a whiff or a look of it- your hunger pains cease. 

So Mabinty and I missed out on lunch today, but she got the better deal because she had her fistula surgery. I went to the ward this morning to check on her paperwork and walk with her to theatre. She was a little nervous and even more so when her blood pressure skyrocketed while the spinal was going in. One moment, I stepped away to tie the scrub nurse’s gown and she grabbed my arm. I held her hand until the spinal was over and she was positioned for surgery. Mabinty is only 16-years old and her life changed forever just three months ago when she tried to deliver her first baby. Sadly, it’s the same story for these ladies with losing the baby and leaking urine for a long time. However Mabinty heard on the radio about our fistula hotline and called AWC to speak with a nurse. She came just after the fistula formed and received surgery three months to the date. Mabinty was all smiles in recovery and I tried the krio and Temne I knew, but no response- just a smile. I looked over her chart and under language was “Limba”- that was a new one for me. With both of our broken krio- I learned how to ask, “How are you?” – Sounds like “wall-e, walle” and the response of “fine” is the same!

After surgeries wrapped up for the day, I found myself at my desk working on an assortment of projects. Today, like most days, is catching up on data entry. Once a lady is discharged home, their chart is inputted into the computer. It’s tedious, however I remember each of these ladies as I look over their charts and am thankful they are going home. Once the five o’clock whistle blows (in my head) and my eyes are going cross staring at the computer, I leave the charts for the next day and walk out to greet the ladies. They are patiently waiting for their dinner and tonight, its leftovers, cassava leaves. I notice there is only one kitchen lady dishing up dinner, so I head over to help. I hold my breath as I pour the slimy mixture on to bowls of rice. I manage through the twenty-five servings and I start to head toward the exit, but one of the ladies Fatmata calls me over. I sit down on the bench between Fatmata and Hawa. All the ladies giggle, as I practice different greetings. Fatmata drills me every time we cross paths on my Temne. I then try Mende, Lucia taught me in recovery when I took care of her. I thought she was motioning with her hands that she was going to be sick, but instead “Ka ya Gorama” really means, “Thanks to God.” Lamrana, I notice sitting across from me and I greet her “Jarama”- this is Fullah spoken in Guinea. Last week, I wheeled Lamrana back to the ward after surgery, while passing the other ladies at the craft tables they sung songs of celebration for their fellow sister.

I was brought back to the present moment when I was handed a bowl of cassava leaves and rice. I thought about it- I never really tried the concoction, so with all eyes on me, I made the plunge. First impression: oily (hence the slimy appearance), peppery, and then the burn came soon after. I enjoyed a few more spicy bites and then Isatu noticed I probably wouldn’t finish my portion. She asked for it and I happily shared since she is the one that needs to put on more weight before she has surgery. As I sat with the ladies, this evening, I couldn’t help but smile, I was happy just to sit there and watch them eat their cassava leaves. 

Dry and without shame...

Fistula camp is finally wrapping up here at AWC. Although, camp surgeries ended two weeks ago, the ladies are still here recovering. While some think March Madness has to do with basketball, for me it had to do with one thing: beds. I would go bed to bed each morning with the doctors on rounds to check on all the patients. For camp, we tripled our numbers and quickly we ran out of space. At one point, we had 80+ women staying overnight and that was a number I had hoped we never reached. The wards- orange, blue, and green- all added another bed. The classroom was converted into a ward with 15 beds. The team house dining room was literally a camp with mosquito nets draped over mattresses on the floor. Excel workbook became my best friend as I moved ladies around the five wards based on acuity and the surgery schedule. I knew each lady by name and where each was sleeping. One day, as I stared hopelessly at my color-coordinated charts, I thought we might not have enough space. Then the door between the doctor’s and my office opened- and out came a patient. Adama was dancing and singing tenki to Papa God because for the first time in ten years she was dry. She came over to me and gave me a great big hug- at that moment, I realized, I would make bed space wherever I could find it for these ladies.  

So, I’ve shared stories of young girls that have come for fistula surgery and the majority are teens to twenty-somethings. However, there are ladies that have suffered from fistulas longer than I have been alive. Galleh came all the way from Guinea in hopes of finding help in Freetown. Her chart was nearly blank- she did not know how old she was and she had lost count how long she had been leaking. The top of her head wrap would reach my shoulders as I gave her a hug everyday. I called her my Fullah (Guinea tribe) grandmother. Galleh had her surgery during camp, but unfortunately we could only do a little to help the leaking due to the extent of her injuries. She would tell us on rounds that her leaking was lessening everyday and even the surgeons were amazed with the outcome. I couldn’t help from smiling whenever Galleh flashed her toothless grin.

When I first met Yeama sitting on the clinic benches, she gave me a quizzical look- probably the color of my skin. Yeama looked like any other seventy-year old women, however, when she stood up- she was bent at the waist almost to ninety-degree angle. (Think back to geometry- right angle) I questioned if it was just severe osteoporosis. Her story brought tears to my eyes. Yeama could only remember she was a young girl trying to give birth for two days. She eventually delivered a stillborn baby; this would have been her first and only child. Her husband left and abandoned by her family because she was leaking urine. Yeama did not feel worthy to look into people’s eyes so she bent down to avoid their judgment. Over time, possibly 40+ years, the shame crippled her so much she could not stand up straight. As she recovered on the ward, I saw her transform as she interacted with the other ladies and even gave me a smile when our eyes met. Although, Yeama will never stand perfectly straight again, I could see that a weight had been lifted. As her name was called out at the Gladi Gladi, Yeama stood up for the first time dry and without shame.  

Wordless Wednesday: Gladi

"Hannah" & "Obama" 

Class

Yeanoh, Posseh, & Hawa

Simmity, me pady 

Baby Moses

Tewah, Kadie, & Posseh

Worth it

Today marked the second week of fistula camp. By your prayers and “by God’s grace”(that is how the national ward supervisor responds to anything you ask of her) we made it through the first week of camp and will do the same for the week ahead. Since I posted the last blog, we have not run out of diapers! I never made it in the OR, instead I was asked to run the camp on the outside- making sure patients had beds to go to and helping the ward nurses with the extra workload. There are long days, as we screen women for surgery, play “musical beds” with patients, and make-up nursing rosters, but I must say it is all worth it.

Sama, was our first patient of the camp on Monday. She has been here waiting for a month seeing other ladies come and go. Often I would have to encourage her that her day will come soon. I think it was Wednesday night and I was utterly exhausted, but got a call from the ward. I headed over after dinner, to supply diapers and drugs for the nurses. I took a moment to sit with the ladies as they drink their tea and right next to me was Sama- I saw a glimmer of hope in her eyes as she was out of bed for the first time after surgery. She held my hand and told me, “My body fine.”

Korea and I

Then there is, Korea and Bintu,- they are not like any other fourteen year-old girls I know. Both married young and have suffered unimaginable treatment- just because they could not deliver a baby a normal way. Bintu suffered through days of labor, being beaten until the stillborn baby was forced out of her body. She came to us in December, leaking urine, and barely could walk. With the help of physical therapy she gained strength and was able to return home to wait for an expert surgeon to do her surgery. That day came this week and what a joy it has been to see her smile everyday as she tells us “I’m dry.” Korea has a similar story of being too young and small to deliver a baby. After the fistula formed, she laid on the ground for months, not moving, because that would cause her to leak urine and stool. She has severe leg contractures preventing her to walk, but she is a “tough cookie” doing her physical therapy while recovering from major surgery this week. I pray one day Korea can walk out of the clinic fully healed.

Throughout the busy day, I love the moments that I have with these ladies. Gbassy hands me her little boy, Murray that I bounce around awhile while she rest. Mariatu grabs my wrist and she teaches me her local languange, Mende. I can always count on Simmity, sitting at the craft tables watching the sunset. I snuggle up next to her for a few minutes to enjoy the view before I head back to my office. I would of never thought I could keep track of 60+women, but now I know each of them by name.

It’s not about how much I work or the numbers of patients we get through this camp, but for each of these women- a chance to be normal again. A chance to live again. They do not have to worry about leaking urine and ruining their clothes. One day, they can go back to the market to be part of society, selling and buying goods. They can take public transport because there is no longer a foul odor following them.  I pray villages and families will accept these ladies as they go home. It’s a long difficult wait and recovery for these women and some may have to endure multiple surgeries- but they will say it is all worth it. 

Impossible

Since I’ve been here at AWC, a team of us has been working toward something impossible in my mind and unfathomable in West Africa. We sat down at the drawing board to sketch out a plan to triple our numbers. I did the calculations in my head and was first one to say- this will not work. There are not enough beds on the wards, nurses to cover the shifts, and supplies to do sixty operations in two weeks. I try to keep a positive outlook on most things in life, but this has been a time to trust God down to the tinniest details of this Fistula camp. Daily, I have been reminded everything is possible with God as we overcome the hurdles.

Our hospital director, Jude, went to a meeting with the ministry of health and through a series of events- we received twenty hospital beds. Now, we already have about 12 beds in each ward- where are we going to put twenty more? So, the hospital classroom and eventually our team dining room will become makeshift wards. On Thursday evening, I helped set up the classroom after our amazing maintenance guys constructed all the beds. It took me a minute to remember how to fold hospital corners on the flat sheets, but after twenty- I was pro. One bar of soap, a toothrush, a lappa (African skirt), and a t-shirt was placed on each pillow. The mosquito nets were hung and by the time VVF ladies arrived from the screening trip- the camp was ready.

As nursing supervisor, I had to make out the duty roster for a normal week on the wards- and that took me all day. As I was working on placing nurses on day, evening, and night shift- it came to be, we wouldn’t have enough nurses to cover two more wards for the camp. I found myself next to Bernadette, the national ward supervisor, on Friday night making a roster for Fistula Camp. Finally, at eight o’clock we completed the impossible task- and had just enough nurses to cover five wards. Another setback until God provided just this week, six on-call nurses that have experience in VVF. The supplies will be stretched thin (pray for diapers-is my new motto) and staff will work extra hard, but at the end when these women celebrate their healing in the Gladi-gladi ceremony- I will be giving thanks that “With man this is impossible, but with God all things are possible.”  Matthew 19:26