VVF Land

VVF, what does it stand for? Vesicovaginal fistula

Wikipedia explain it as this "VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault"

The ladies waiting to be seen on screening day!

In normal terms it means that there is a hole between the bladder and the vagina, this means urine leaks through the vagina, therefore the ladies have no control of their urine.

How does this occur? Mainly it occurs when a woman is in labour for a few days, the baby gets stuck in the birth canal, the baby's skull puts pressure on the pubic bone, the surrounding tissue dies due to the pressure which then leaves a hole. The fistulas can also occur in other areas such as the rectum, uterus, urethra and ureters. This problem mainly occurs in under developed countries where obstectric care is minimal. For a lot of the ladies they have to walk for days to reach the hospital and then they are faced with huge bills.

Dress ceremony

They come to the ship to have surgery so the hole can be closed so then they can pass urine normally, instead of leaking all the time. The ladies come having had a difficult life, most of them would have had to grieve for the baby that died, but the main problem is that the families and communities they lived in before the problem started have rejected them. The community sees this as a curse so they do not want the woman to be there. They struggle to live as they cannot get a job, who is going to employ someone who constantly is peeing and therefore smells all the time of urine???.

Most of the husbands leave them as well, there is no one there to love them and care for them, while they themselves are thinking why me?
The first few days on the ship they are quiet and withdrawn, but as time passes there is a change in them, they start smiling and singing along to the worship. They start chatting to the other ladies who are in the same situation as them. Us nurses and crew members who come and visit them show them the love they have not experienced for a long time or maybe never, they start hugging you and kissing you and saying thanks! I have come to love these ladies so much, they may have had a physical and emotional change but I have also learnt so much from them; there is always hope!
Unfortunately not all have had a successful surgery and it is very hard to see them discharge knowing that they are going back to the same place they came, but hopefully they will know that there are people who love them unconditionally and more importantly that God loves them for who they are.

After they have had their surgery and are doing well they are ready for discharge. We have a dress ceremony for them, this symbolises the new them.. They receive a new dress, a bible, soap, mirror and lotion. At this time they can give a testimony, there is usually a tear shed as they tell what they have gone through. It makes you think how lucky we are in "the west". These ladies have had it rough but they still thank God.

One of the ladies who is dry and is celebrating in the dress ceremony!

I have had shifts where I was so busy and things kept going wrong, and at one stage I really did not want to carry on nursing the VVF ladies, but I carried on and I am so pleased I did. I really want to say thank you to the people who help me through this difficult time. The pleasure I have now of knowing these ladies is great, they give you a big smile when you walk in to the ward and hug and kiss you, and I am so blessed to have been a part of their lives!

The last 4 ladies on the ward

Mark 5:25-34

a friend who will not be forgotten

A patient who I had the pleasure to look after and take care of her wounds went to be with the Lord yesterday. Many times I have questioned "why God?", but as our ward superviser said to us it is in God's hands, he has a plan, it may not be our plan, but he has the plan. That is what keeps me going, knowing that she gave her life to Jesus while she was here and now she is with Him, makes me realise how God is in Control of everything!
I will remember her with a smile on her face, singing along to the worship and actually dancing in her wheelchair! We will miss her but knowing that I will see her again brings a smile to face!xxx





Psalm 10:17LORD, you know the hopes of the helpless. Surely you will hear their cries and comfort them.

Washing Hair!

I had been doing dressing changes to my patient for the last 4 weeks. Because of where she had the surgery she had a bandage on her head, this meant she could not wash her hair as it was alsways covered by the bandage and also we did not want to get the surgery site wet.



 I had tried to wash her hair before as if I did it I could be careful with her wound and be able to rebandage her after. Through one of the interpreters we realise she would not let me wash her hair as culturaly this was not acceptable. I had a lot to learn about cultures! Only her or her husband could do it. So we compromised and I put a wet cloth on her hair to get rid of some of the dried blood which had been there since the surgery.

Unfortunetly her husband had been involved in an accident when traveling form the ship to their home to see their daughter. This meant he could not come and be with her.

She was desperate to go home and see her family but her wound was not healing as fast as we had hoped so she had to stay on the ship until it was all healed.

A few weeks went by and we decided to ask her again about the hairwashing, this time we went through our patient life workers, they are the one that come and do worship time and prayer time on the wards, they come and speak to the patients and encourage them. Through them she agreed to let me wash her hair!

I got everything ready for her, got the bowls, towels, shampoo and conditioner, one the patient life crew let me borrow some of her cream to put on my patients hair post hair washing. I brought her into the room and realised she had nothing with her to brush her hair, so I quickly went upto the ship shop (good thing it was open!) and got some combs!

We were ready, she laid down and I started to wash her hair, after weeks of not washing it and after the suregery and all the dressing changes the hair was pretty dirty but by the time I had finished it was clean and smelt lovely. She was very relaxed and closed her eyes a few times enjoying it!



One of the many dressing changes!

 At the end the she thank me in English!!!! This lady had not spoken any english or french before coming to the ship. She somehow managed to say 'Thank you very much'. I nearly cried with happiness. This lady had hardly said anything to me in the weeks I had changed her dressing and would not hug only shake your hand. That day was different she gave me a hug and said Thank you, wow. I felt very priviliged to be able to do her hair and see her smile.

Dressings!

I think it is about time that I told you all what I am actually doing on the ship now that the hospital has been up and running for 7 weeks. I am working in B ward which is where the plastic surgery patients are. At the start of the hospital being open I was a ward nurse, looking after the patients pre and post-operatively. It was a great time to get to know the patients, learn new skills and new ways of doing things. Working with different nurses from around the world makes for interesting times, discussing how we do things at home and what they call it, I didn't realise how many ways you can call Paracetamol!

The good thing about working on the ward is that we start the day with prayer, the handover time were the nurses from the shift before and the nurses taking over have a chance to share information and then give the shift over to God. This is so different from back home, but it makes for a good start to the shift! Then I do all my checks of the patients and the paperwork, during the shift Patient life come in and start a worship time right in the middle of the ward. The patients all start singing and praising God, I love this time of day. Then the rest of the shift continues on until the next handover!





One of my little patients, playing on deck 7!



       After 3 weeks of being on the ward my role changed from a ward nurse to a dressings nurse, for those who do not understand what this means, it does not mean dressing someone! It means I  change bandages and look after the surgery sites/wounds post operatively. I really enjoy this work and having experience from work at home it has really helped. Things are different but it is a rewarding job most of the time. As you see the patients wounds healing and being able to discharge them from the ward, but in some cases they are slow to heal as they get an infection or their bodies have not got enough nutrients to heal their wounds. I am so happy that I can make a difference in someones life even if it is a small part, and as some dressings take over an hour to do you get to know the patient very well, in that time you try and talk to them, through a translator (as my french is not good enough), some have had a hard life but hopefully having this surgery will change this. They are so thankful at the end of the dressing change, even after I have hurt them (as unfortunately it does hurt sometimes to change their dressings).



A patient who has just had a dressing change!



I work with a great team, in the dressing area we have Physician Assistant from the USA (who changes the dressings with me) she is a great encouragement and and so helpful. Then we have the physiotherapist from South Africa, she makes the day so much fun. We have also an OT (occupational therapist) from Australia, who makes all the splints for the patients who need them! We have such an international team doing the dressings, and this is not including the nurses who come with their patient from the ward!



Well that is a small overview of what I am doing on the ship! But this is going to change as the Plastic Surgeon unfortunately has left, so as the patients heal and leave the ward there will be less dressings to do. I will be moving back to the ward to start the next surgery which will be VVF, I will explain this in a later blog!



The middle of nowhere!

The day started well, my friend Julie and I met at reception, we walked off the gangway, we made out of the port when a landrover stopped beside us and offered us a lift to near the place we where headed to, the Benin Embassy. As we started chatting, they told us they were headed to a village to do some evaluation work. They work with the agricultural team and they are following up on projects they did in Togo in 2010. The driver then told us he would take us to the embassy as he is from Benin and he would like to see where his embassy was. We were so grateful for a lift all the way to the embassy, they dropped us off, we said our goodbye's and then Julie and I walk in to the office to be told the lady who deals with the visas was not going to be there until 4pm, the time then was 10 in the morning. As we walk out of the embassy the driver who had given us a lift tells us that won't get the visas and would we like a lift to the main road. We of course said yes. So we got back in the landrover. As we drive, they ask us what we are up to next and we explain we had to go to the craft market to pick a few things up, then no plans after that. They both then say if we want to join them for the day and go an hour away north from Lome. Julie and I look at each other and say yes!!!!!!! (the market can wait!)

So all the plans were changed! It was great to leave Lome and head north, to see new places and see the differences as we leave the city to the fields. As we turn off the main road, the road becomes a dirt red road we pass one village and then nothing for a few kilometres. We turn off this road and go through a smaller village, at this time I am thinking to myself should a car even less a landrover go through here, as there is no clear path for a car!

But then we leave the village and we head into the bush, the path is just a walking path, and thank goodness we have a landrover!! We stop and get out and are met by a farmer who then takes us to his field where him and his dad farm. We walk for about 10 mins (and this is in the middle of nowhere!) he shows us what he is growing and how the teaching he had in 2010 has changed the way he grows his crops!

We sit underneath a tree, next to a stream. It is a beautiful place to sit and discuss the way they are farming and how it has improved their life's by changing it. They both agreed that it was a better way of farming as now they have food to feed their families and to sell, this was great to hear. The family then started to come to see us and they even made us some corn on the cob to eat! Straight from their land! I even got to have a cuddle with one of their children who fell asleep in my arms!

One of the good things about the project was that they taught some farmers so they could go and teach the other people in the village, the project is called food for life, and that is what it meant to be teaching new techniques so they can have food for them and their families for life and be able to live from it too.

After the food and the discussions we head back to the landrover, we drive for a few minutes and stop at another farm. We are not as long at this one as time is going fast and we still have to go and see a King!

Yes it is right I did write King! The last village we had come through has a King and he had been to the ship to see if he could have his eyesight fixed, so we where going back to see the outcome. As we walk through the village all the children look at us and call out "Yovo" (meaning white person). We get directed to where the King is, he is sitting in what looks like the village conference area. It looks like they village men are having a meeting but they let us sit down. The King then starts to explain what had happened at the ship, unfortunately they are unable to do anything about his eyesight, but we get a telephone number so we can call to let them know for definitely if this is true. They make us feel welcome but unfortunately we have to make our way back before it gets dark, they offer us a place to stay the night, but we decline nicely!

We head back through the dirt road and then meet the main road to Lome. We make it in time for dinner and before it got dark! Julie and I thank both for a great day, and I let them know that I would love to do it again!

It was a great to be in the middle of nowhere in Togo and meet the people living there!

Photos from the screening day

As promised these are just some of the pictures from the day:


 The convoy of land rovers going into the stadium on the Tuesday to get things ready for the screening on the Wednesday.

The registration area were their details are taken,

This is the history taken area, were vital signs are taken such as pulse, blood pressure, weight and any medical history.  

My first job of the day get all the patient escorts together.....The queues were long but the people were very patient, which was amazing.

This little girl became my first patient on the ward, unfortunately we can't do much for her, please pray that a miracle will happen for her.

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These are only a few of the pictures but hopefully you can get an idea of what the day was like

Screening day!

The day started for me at 3:30 am; the alarm goes off and I think to myself it can't be the time already! I look at my clock and sure enough it is time to get up and start the day, and what a day it was!!!!!

The first team gets into the landrovers at 4:15am and all in convoy we head to the National Stadium. It's still dark outside so we cannot get a good view of the people waiting in line. We get dropped off and get into our teams. I am in the escorting team (will explain later what this means!!). It's only a small team at the moment as the next wave of landrovers will have most of our team. As I had been to the stadium the day before to set up I knew the route the people would take to be registered and seen by the doctors so I hang back to make sure the escort team was all together. After the tour of the stadium and the set up of the day I take the team I am allocated to registration and history areas. We were here to escort the patients who had been through pre-screening and were waiting to see the doctor to see if they would have the surgery they so needed. The registration area was to take their details, such as their names, address and telephone numbers. From here they are given their papers that show what surgery they are going to be screened for, such as goiters, general surgery; this is mainly hernia's, burn contractures and other plastic surgeries, max fax; this includes cleft lip and palates.

Being in this station of registration meant I could see the people who had been told there may be a possibility of them having the surgery that some had been waiting for years to have. You could see the hope in their eyes at the thought that they may have it done. They varied in all ages, from babies only months old with cleft lip's and palates, to elderly men and women who needed a hand to take them across from registration to the history area were they have a set of vital signs done and a quick medical history. From there they are taken to the appropriate areas where the Doctor's are waiting to see them and make a final decision if they are able to have the surgery on the Africa Mercy.

Throughout the day I am able to have cuddles with some of the babies and what cuties they are!! Laugh with some of the people waiting in line, more like them laughing at me trying to speak French!!!

Helping the people across to the next area was such a pleasure to do, even though it was very tiring especially as the sun was beaming down hard and the sweat was coming down my back. I was still thankful that I could be there and experience this; the hope we were giving to so many people. Around 3,500 peopel came to the stadium looking for help, 1,600 of them were given appointments to come to the ship to have their surgeries or have further follow up. This means that a lot of people were told 'no' - this was the worst bit; knowing so many could not be helped by us. If they were told no they were taken to the prayer area. This was an opportunity for them to be prayed over.
The last few people went through our section at 3 pm. By this time my feet were aching, but it was great to see them through. I can't wait now to see some of them return to the ship and be able to look after them on the ward.
At the end of the day when I got back to my cabin I thought things through. I had mixed emotions; an amazing feeling of being able to help and give people hope but also upset at the thought of the people who we were not able to help.

Thank you all who prayed for this day, it went very smoothly. They had problems last year at the Sierra Leone screening so many were apprehensive about this one, but God was in control and it went well.   

I will post more pictures of the day as they come out, so watch this space......