Tuesday, April 18, 2017


In Madagascar last year, we ate a lot of ice cream! Ice cream is one of my favorite foods; so when you can walk for 15 minutes and get a delicious scoop of creamy goodness for less than $1, it happens a lot. It's also a great excuse to spend an afternoon off the ship in the fresh air and sunshine after work or on a day off. I think I even made it a mission to try every ice cream shop in Tamatave while we were there, and I got pretty close (you'd be surprised how many places have ice cream!). Anyway, one of my favorite spots to stop was actually a pizza restaurant with a freezer out front. The ice cream wasn't that great and you could only get it in a cone (gross) but it was super cheap and would cool you off on a hot day. But the best part about this place was that you could order a scoop of ice cream with every flavor they had mixed together - it was called mélange, which means mixture in French. Ever since I heard that word the first time, I loved the sound of it and I always felt fancy ordering "the mélange" at this shop.

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This is not THE exact Mélange ice cream, but it's close to what it looked like!

It's still one of my favorite French words to say and it seemed appropriate to describe the past few months in 'A Ward' as a Mélange. For the first 6 months of the year, I worked in 'B Ward' but in January, I moved to A Ward to fill a gap. The wards are basically all the same except for which type of surgical patients are housed there. A Ward is home to General surgery, however, the 'general' ward also gets a piece of whatever else needs space at the moment. This is something I had not experienced during my time in B Ward where the patients had been almost exclusively from plastic or orthopedic surgery. Here's a taste of what the mélange of A Ward is like:

When I first arrived in my new home, we had a combination of the last few plastic surgery patients (the ones who have complications, infections or multiple surgeries can stay up to 2 or 3 months) and a surgeon who specialized in goiters, or enlarged thyroid glands. The thyroid is a gland located in the front of your neck and is important in many hormone functions. For many reasons, including genetics, disease or poor nutrition, the thyroid can start to grow too much creating a large tumor-like mass that is often not working properly. Occasionally this causes hormone issues, but mostly it is a benign issue until it grows so large that it puts pressure on the airway and suffocates the patient. The physical deformity can also cause the patients to hide away and become outcasts, many times losing jobs or being abandoned by their family. While the surgery to correct the problem is not too difficult, damaging or removing parts of the gland can cause lifelong health problems if not done properly. Without the hormones from the thyroid gland, some patients will have to go on medication for the rest of their lives or followup with blood tests occasionally for monitoring. The doctors on the ship have developed a good technique for avoiding this problem but it is one of the risks of this type of surgery - the alternative, though, is to not perform these surgeries and risk many patients suffocating from this deformity.

Some of the A Ward nurses gather in the hall with the last few plastic surgery patients.

Several goiter ladies during screening.

Mama Adiza had the largest goiter we'd ever seen. She had difficulty eating, sleeping and even breathing.
She had a new lease on life after a very difficult surgery to remove her enlarged thyroid!
After a few weeks of thyroid patients, we had a gap between general surgeons so A ward was mostly full of overflow Maxillofacial patients. As I've mentioned previously, Maxfacs covers a variety of deformities all effecting the head or neck. Many of the surgeries are high risk and complicated, but those patients thankfully stayed on their own 'D Ward'. We got to care for things like cleft lips, removal of parotid glands (a gland in your cheek) or small facial growths. These things don't sound too complex but they definitely pushed me out of my comfort zone. Even after being on the ship for 16 months and seeing all that I've experienced, I'm the first to admit that I don't know much about these types of surgery and I had a lot to learn!

Cleft lip patients recovering on A ward after their surgeries.
Next up we had a specialty brand new to me - and new to the majority of the ship since it hadn't been done here since 2013: Pediatric cataract surgery. The eye surgery program has been running on the ship since January. The majority of the patients are adults who get cataracts from old age or diseases like diabetes. A few of the patients are children who were born with cataracts or developed them at a young age from infection or genetic predisposition. Since most cataract surgery takes about 5 minutes and is done without anesthesia, the patients do not generally stay in the hospital. But for the children, it is necessary to use general anesthesia to perform the surgery without them moving. These kids would come in the night before their surgery to get prepped, then stay one night post-op to recover and monitor them, and get discharged the next day. I don't know anything about eye surgery so it was an interesting area to learn about. Thankfully, we got a little education before and there were always one or two of the ship's eye nurses around to help us. Even though it was very different to what I'm used to, it was so exciting to see the children come in with little to no vision and leave being able to see - some for the first time ever!

Anna and Dorcas are two sisters born with cataracts who received surgery on the ship. Patients with cataracts may seem like they are not looking straight at something but it's actually because they only have peripheral vision and have to turn their eyes to see around the cataract. After surgery, they must retrain their eye muscles to look straight and focus on objects.

Anna and Dorcas with their mother at the final eye checkup.

Finally, at the beginning of April, our general surgeon gap ended! Once again, A Ward is full of hernia and lipoma patients. While these surgeries are minor, the benefits are great. Us nurses try to have a lot of fun in the midst of the chaos - sometimes 6-10 patients coming and going each day! And it's such a privilege to see the relief on each patient's face as they realize this problem that has plagued them for so long has now been removed and they can go on with their lives again.
Hernia patients ready for discharge with the General Team Leader, Jane (left) and my friend Mary (right).
So that's the mélange of A Ward. It's been exciting to try some new things and mix up my experiences here on the ship. This time has made me appreciate how different we are...every person here - patient, crew, translator, caregiver- is in this place at the exact time God has prepared for them and in the exact area that fits their talents and skills. While life serving on the ship has its challenges and stretches me in many ways, it's wonderful to see how we all fit together in this crazy puzzle of Mercy Ships and how God holds it all together in a way that brings Him glory!

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