I' m all settled into my routine

Hello everyone!
Things are going well in Tamatave, Madagascar. I have found a good routine of working, enjoying free time and getting lots of rest.

My cabin has been great. I have a wonderful roommate, Mary, who has been really easy to live with. I was lucky enough to get into a cabin of two people and this has worked out well. Most people have at least 4 in their cabin, and as many as six. With everyone working all different shifts, it is difficult to sleep especially on night shift. I have been really blessed with Mary. We are very conscientious of each other, especially when it comes to sleep.

Work has been good. We are still doing plastic surgeries, but our plastic surgeons finish up next week and so we are winding down with the larger cases.

The surgeries being done are things like polydactaly  and syndactaly cases. Polydactaly is when a person has extra fingers or toes. Sometimes they have bone in them, and sometimes not. If there is bone involved, it is a more difficult surgery. Syndactaly is when fingers or toes are fused together. The surgery to correct this is opening up the fusion and doing a skin graft to cover the uncovered skin. The skin graft is taken from the abdomen or the thigh. Since it is a small piece of skin, the graft heals well at both the donor and the recipient site.  One of the children we had this week had syndactaly on both of her hands, and when her mom and baby sister came in, I noted that both the baby and the mother had the same. The mom had it on both hands and feet. We see this in the states, but I haven't seen it often. I don't know the cause, whether it's from poor nutrition, poor genetics or both.
We also are doing surgical resection of lipomas, which are fatty growths. We had a man who had these on his neck -- very large and he was dancing on his way to surgery yesterday.
I also took care of a 10 year old who had one on his hand.


More about the hospital teams on the ship.

Surgery-- we have 5 operating rooms - not all of them are being used right now. We need more surgeons. We have OR nurses from all over the world and their required length of service is only 2 weeks, so we see more of them come and go. We will soon start doing eye surgeries and when plastics finishes, we will be performing Vesico- vaginal fistulas. This is a very common problem here. I will tell you more about this surgery next time.

Wound care does all of our wound dressings. They have been specially trained to do the dressings and for the continuity of care, this is best.
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We also have a dietary team, physical therapy, hand therapy and day workers. And then there is chaplaincy. We have full time volunteers on the ship, but we have many day crew chaplains who come to worship and play music for the patients every day. They also visit with them throughout the day.

We have separate staff for admissions and outpatient discharge care. These are all RNs who provide care pre and post op.When the patients come back for dressing changes they go to a warehouse which is next to the ship. The ship is too small to accommodate these patients for follow up.

I have more information about our day crew-- from a friend's blog. We have many of them on the ship and they all work so hard and bring such joy to the ship. They work in many roles, from deck hands to patient care, to chaplaincy. I have been wondering how much they get paid, and I have learned from one of my fellow nurses this information. They get paid about 12,000 AriAri per day - this is the equivalent to about $5 U.S. per day. It's above the income average of $2 per day and they are very happy with their jobs.  They are excellent patient care techs for us on the ship and invaluable in translating everything we need our patients to know.

I have learned a couple of Malagasy terms--
Chara bey-- OK
and Misotro-- thanks-- ( it sounds like Minnesota!)
and a few more. I have a list I keep in my pocket.

All of our charting is on paper- We have clinical pathways which we use as checklists and charting. Vital sign graft sheets and medicine sheets. things I haven't done in nursing on paper for at least 6-7 years. We reuse medicine cups. They get rinsed and put through a dishwasher. We don't reuse any syringes, or any thing which could convey any infection to a patient. We cut IV bags when done and tubing also. If we have a vial, we puncture it. We also put a slice into our Promod nutrition bottles. This is to prevent this being refilled and sold as "Mercy ship medicine"  on the black market here. All patients get axillary temps and we save the thermometer probe covers in a place behind their beds. I though this was odd and when I asked why axillary temps I was told that many patients had never had their temperatures taken and when taken orally, they bite the probe. -- causing probe breakage, and then not able to take temps.
We have nice vital sign  machines like on the divisions back at home, and pulse oximetry is done on everyone. I suspect all of these machines were donated by the companies.

Medicines for the patients consist of mainly pain medicines and nutritional supplements.
The patients get a lot of oral Morphine, Tylenol and Ibuprofen.
Nutritional supplements everyone gets are multivitamins, vitamin C, zinc. Adults get  Juven-- a nutritional supplement to support healing and Promod- a concentrated liquid protein. Kids get Mana-- a peanut butter protein supplement packet to promote calories and healing.

Most of the patients are very small in stature and in size. I would guess probably due to poor continued nutrition. I asked about vaccinations for children. They are given vaccinations usually when a clinic or other group, like a Peace corp group come around. Therefore it is very sporadic for these kids. Which is why I had to be sure I had updates on all of my vaccines, so that I don't expose them to anything. A measles outbreak would be devastating here. Devastating.

I have become close to these patients, and am so enjoying this. I have a favorite -- his name is Andre and I always kid around with him. We played Uno yesterday and he and the others playing were having a blast. I have additional rules here! I lost badly!  I love the kids, but I seem to have a bit more rapport with the  adults than with the kids. The communication is a bit easier. I have reconnected with my Uno, coloring and Connect 4 playing skills. The down time is frequent and often, especially on evening shifts. Things I wish we had time to do at home.

As for fun-- I went to a place called the Palmerium last week. It was an ecotourism place, famous for its lemurs.I fed them, and had them all over me. It was great fun. I also saw the night lemurs, the Aye Aye lemurs who are pathetically scrawny and pretty ugly animals. It was all really great fun. To get there we took a 3 hour boat ride down a canal. About 20 of us went.

Well that's all for now--have a great week! Thank you all for your continued prayers for my patients-- and me too!
There is so much good being done here for these people.  When I pray, I think of these words--


“Let no one ever come to you without leaving better and happier. Be the living expression of God's kindness: kindness in your face, kindness in your eyes, kindness in your smile.” 
― Mother Teresa

The lemurs!!!

The canals-- Their boats are made from trees hollowed out. 

Finding my way

This has been written over the last few days  January 30 through February 3rd.


Well, I have now been here going on 2 weeks.
I have worked on getting to know the routine of the ship and becoming proficient at my job. Another big part of the ship for me is making friends and "fitting in". I am a very social person and love to make new friends and things are going well. I have met people from all over the world here.

Many are full timers, who have made the commitment of staying on the ship full time and many are short timers such as myself. Ward nurses must commit to 8 weeks on the ship, while operating room nurses can come for as short of a time as 2 weeks. When people have full time jobs back home, this works out very well. I have learned there about 600 people on the ship during the day. Of theses 600, 400 are volunteers and 200 are day crew workers. Day crew workers are people who are hired from the local country or city, can speak English, and have a desire to work full time for Mercy ships. They earn a wage and go to their homes each night. On the surgical wards where I work, we use them as patient care techs, but a large part of their job is translation. The patients all speak Malagasy or French, and I know neither of these.So their job is an important one and it would be very difficult for me to function without them. We have what seems to be 2 day crew for each 10 patients.

There are also many day crew hired for cleaning crew, in the food galley, up on the decks -- ( don't know what they do up there) and all over the ship.

We also have Gurkhas for our security of getting on and off the ship. The are soldiers - I think from Nepal- who monitor the admission door into and out of the ship. They make sure we scan our badges when we go out and come back in. We also must sign out and check ourselves back in. They keep good track of us and keep the ship generally safe. We are in a port at a dock about 1/2 mile from the gate and then the city of Tamatave is right there.


One of the most impressive things that I have witnessed is the wonderful spirituality that is here on the ship. Everywhere throughout the ship we pray. When I start a shift working, the nurses and day crew gather together before we do report and pray. We pray for the general good of the patients and their continued healing. We pray for some of the specific ones who are going through a difficulty in their healing or having some sort of difficulty in their lives. And we pray for us to have the knowledge and outpouring of our hearts for these people who have such difficulties. We also pray for ourselves to stay well and strong and Jesus centered. It is a wonderful way to start out the shift. ( I know this would never go over in the U.S., but wouldn't it be just so great?)

Mid mornings- around 9:30- a Christian worship group of day workers come and sing worship songs with the patients on each ward. The spend about 15 minutes singing, playing the guitar and preaching encouragement to the patients. Everyone joins in and even those of us, who don't know the words sway and clap hands and join in. It is so joyously uplifting.

When we go up to deck 7 each day- often time the day workers sing together - making wonderful harmonies of song.

Prayer and celebration of Jesus is everywhere. It needs to be. These people are so disfigured, it is truly amazing that they have come this far. And I am loving it.

There are also scheduled church services here on the ship- Sundays, down in the patient ward at 10:30 there is a service with music and up in our meeting area at 7 pm there is a church service that is interfaith for all. We also have service on Thursday nights. So lots of opportunity to grow spiritually here, and it is wonderful.

I am currently on a string of 4 night shifts. I haven't worked a night for over 12 years. They are 8 hours shifts and so far, so good. Most of the patients sleep most of the night. Many require pain control and vitals signs. (They all have skin graft sites to their burns and skin donor sites, mostly on their thighs. Many have K wires in place to straighten out damaged fingers and toes. I imagine that their pain is pretty intense. We use the Wong-Baker Faces scale to determine pain, since they speak Malagasy or French. Prior to surgery, extensive explanations are done between nurses and patients with translators.)
 Dressing changes are done by wound care during the day, so not much going on at night, which is good, because my usual patient assignment has been around 7- 10 patients. We do track neuro vascular status closely with these post op patients, but they are here for usually 2-3 weeks, so are generally stable. The small beds are filled with moms and kids all sleeping together in the same bed, or the moms sleep on a small thin mattress underneath their kids. There are many breast feeding babies here, all the kids breast feed. There are 2 nurses here for our ward of 20 patients, and we have 2 day crew with us. The day crew help get people up to the bathroom. They also do all of the laundering of our scrub uniforms at night. tonight they are washing all of the curtains between the rooms. All is well, although I must say the night shifts have been difficult for me. I have thank goodness been able to sleep well during the day. Probably because our cabin has no window and is really dark. My roommate Mary, from England has been great about keeping things quiet for me.




here is a pic of a child using the Wong -Baker pain scale

a picture of the local hospital, about 3 miles from the ship down the beach road

The beach road and some of the foliage around the area. There are many of the same plants that we have in Florida 

And of course Frozen is here!

Here are some pictures of the ship

Besides working, I am making lots of new friends from all cultures. Tonight, I am going with group of people to a French restaurant. Last week we had a class on how to order and so tonight is our big test!
Also, I'm going to a " resort" for the weekend to see more local culture and meet more lemurs. So even though I am working hard, I've been able to have some fun too.
Keeping in touch with my husband has been pretty easy with good wi-fi and facetime. I also have a phone card that is based out of Miami, so I can call the states at only about 2-3 cents per minute. So all is good. Please feel free to ask any questions you may have, and have a good week!

First days of working

Hi everyone!
I had my first day of working today. I was working with another nurse, she is an RN from Virginia. She showed me a lot and was very patient with me. We had 5 patients to care for today. Three adults, and 2 children,  all with burn injuries. They were either scalded with hot water from a stove, or were burned from a campfire. The people mostly cook outside of their huts - which are usually thatched and use coal fires on the ground. Very dangerous. These people have major, major burns which have severe contractures like I have never seen before. Contractures are basically  formed when the burn is healing and the skin and muscle shrink, causing severe deformity. These patients were difficult to see, and my heart was extremely sorry for them.

The day went well.
Here are some of my observations..
All the beds are extremely low and all of the small beds are on bed risers like we would use at home. Otherwise the beds would be about 1 foot off of the floor, and would kill all of our backs bending all day. No electric bed, no head to raise up, no side rails.. different.
In my ward, there are 20 patients. 5 patients on a side of a room in 2 small rooms. The beds are about 1 food apart and there are caregivers - usually parents, but sometimes older siblings, at each child's bedside. Kids and adults are mixed in together- something that would never happen in the U.S.

The nurses are all in these rooms, and there are no chairs, or any places for us to sit. So we stand all day, -- although we are very busy all day also. We never are more than 20 feet away from our patients.

Water-- there is one water faucet on each side of the ward, and one sink between the wards. The water at the shared sink is fine for washing hands, but not drinkable. The patients all have plastic cups on a wooden tray which is attached to the side of their beds. The cups have their room number on them with tape like bed 9 and bed 9 C for the caregiver, so lots of constant filling of these cups.

I worked day shift today- 7 am to 4 pm. The patients are on mostly pain meds which are scheduled at intervals for 2 days post op and then they are prn- as needed. They are also all on nutritional supplements twice a day. Nutrition is a big issue, as most of these people eat mostly rice or corn and they don't get much protein into their diets.

 At 2:30 we have all of the patients who are able to move go up 4 flights of stairs to sit outside to get fresh air for 1 hour. If patients can go, but can't walk, they go up by elevator,but these today were only ortho people on crutches. Patients don't go up until they are post op day 7. They stay on the ship for weeks-- like 3-4 weeks and then go to our rehab center on shore. Going up to deck 7 was something to see. While outside, they have games to play, mostly with us nurses-- Jenga, connect 4 and dominoes. there are also riding toys and swings for the kids to play on. There are deck chairs for all and they enjoy the fresh air. No incentive spirometers here, they all move around quite a bit.

After we bring all of the patients back down, we hand off to evening shift, who arrive at 2 pm, take report and stay with those who can't go out, only about 1/3 of the patients.

These pictures are official Mercy ship pictures and so therefore, I'm not in any of them. but I do know these patients.

This little girl had boiling water spilled upon her, and she had 4th degree burns all over her neck and chest. She had a contracture release and skin graft from her thigh.

This woman had a large tumor removed from her face.

 Here is Jenga on the ward...

 and on Deck 7... play time. the patients also get music going out there and dance around.

 A rousing game of Jenga between patients and nurses.

 This girl is 21-- she had a huge tumor on her back a neurofibroma. It looked like dreadlocks down her back and weighed 5 kg-- about 11 pounds when removed. She is so happy it is unbelievable.

This is Marie Silvie- I admitted her on Thursday evening. She has scarring all over her left side of her head, and burn contractures all down her left arm and chest. She had her surgery on Friday with skin grafting from her thigh. She did well.

I have gone into town a few times. These are our modes of transportation--

The yellow is called a tuk tuk and is gas powered. 

The blue is called a push-push and it is a bicycle powered cart for 2 people. 

 

I went to a Lemur park today. There were many in the wild, but some were in cages for tourists to be able to see them up closely.. That was pretty neat!

It's rainy season and we went on a big hike -- our guide cut us some walking sticks-- bamboo--

I am having a great time and learning lots, please feel free to add questions!

DISCLAIMER

Although I am currently serving with Mercy Ships, everything communicated here strictly reflects my personal opinions and is neither reviewed nor endorsed by Mercy Ships. Opinions, conclusions, and other information expressed here do not necessarily reflect the views of Mercy Ships.

To Madagascar today

, January 17

Today I set out for Antanavaro, the capital of Madagascar. It was a sad day as I left John behind to start my adventure.  We had stayed for two nights exploring and touring Johannesburg after our safari all week. I took a train to get from our hotel to the airport and was a bit nervous about it, as I had been told that the crime rate here is high. When traveling in another country when you are unsure of what to expect and bit of anxiety comes with the territory. Especially when every thing of value to you and highly needed like your passport, phone, money, credit card, and all electronics are on your back. 

I'm glad to report that all went very well, and there were no mishaps. Here in South Africa the poverty level is high and the unemployment rate is about 40%. There are people all over the airport dressed in business attire, all wanting to help you, all for a tip. I kept my head up and just read where to go, and avoided them as best possible. 

I met 3 others heading to the Mercy at the gate. Leah, from Missouri,-she's a lab tech, Derrick from Toronto, Canada an engineer, and Yong, an operating room nurse from Dallas Texas. Derrick and Yong have worked on Mercyships in the past. Derrick has been in Madagascar and is returning back from being home for the holidays. Yong worked last year and is returning to the ship for 4 weeks this year. 

I am excited! I was a bit nervous to transport to the airport, but now I am fine, and ready for this exciting time. I can't wait to meet the patients, their families, and my coworkers. 

Sunday January 18th

I had a great nights sleep in our cozy hotel. We woke and had breakfast at 6 am, to ensure an early start to the day. Our breakfast of bread and jelly was a bit of a scarce breakfast, but luckily I still have some apricots and almonds left over from the week. 

As I sit here in the middle of a hot 8 hour ride to the ship, I am wondering if we will ever get there! 

We are on the middle of a tropical, mountainous forest. The road is not bad, one to two lanes, and paved so far. The people live in great overtly here. Ninety percent live on the equivalent of one dollar 

Per day. They smile at us as we pass by, and seem happy to seea bus full of about 20 people passing by. We are a majority of women with 2 men. One of the men is a guy named John, an ear nose and throat surgeon from Seattle. The rest of us are mainly nurses and lab people. 

As we are driving, I see many bananas, this seems to be a main crop. Out here in the country, I wonder what their livelihood  is. I think they live off of their land -hunting, raising chickens, growing crops and selling whatever abundance they have. They are washing clothes down on the river. For lunch we stopped at a pagoda type restaurant for more bread, cheese, jam and bananas. 

We are all tired... 

After much travel we have arrived. 

I am in my cabin, my roomate is from London and is a pediatric nurse in her 50's, so a good match for me. My room is a cabin for two with the bathroom down the hallway. Many of the nurses are informs of six with two bathrooms. 

Yesterday was spent in orientation, hospital, regarding types of patients and charting and then hospital charting. I had to do a math test! The problems were like all of the math taught in the associates nursing program, so I'm glad I know how to do my math. The type of questions were safe dose range, drip factors mcg to mg, and those types of problems. 

I learned also that the lab is also the blood bank. The crew is asked, if they desire to donate blood for the patients. Many of the patients come and are malnourished and anemic and need blood before surgery. Many of them need extensive surgery and need this boost before they can be done. 

The surgeries for these next few weeks are plastic surgery, cleft palates, lips, large rumors and many burns. From campfires. 

That's all for now, please feel free to Facebook me or email me at jesser40@yahoo.com

My first day of work is tomorrow! 

These are two of my fellow nurses. Beth from London and Marieka from the Netherlands at lunch yesterday. 

Although working on the mercy ship this blog is strictly my personal view and observations. None of this information is an official view of the mercy ship

Getting Ready to serve

 I will be serving on the Africa Mercy ship this winter. Here is some information about me. Who I am, the opportunity which has been given to me, and where I am going. 

 I am a nurse. As a nurse, I have always had the desire to help people in any way that I can, with the skills that I have been blessed with. A dream that I have always had is to volunteer my skills in a significant way for others in a nation other than the United States.  One year ago, I applied, and was awarded, a one semester sabbatical from my work as nursing faculty at St. Petersburg College, (in St. Petersburg, Florida, U.S.A. ) to pursue this dream.  This sabbatical is allowing me the opportunity of a lifetime to provide my nursing skills for others much less fortunate than me. 

I  applied, and was accepted to join the Africa Mercy hospital ship. The ship usually serves in West Africa, but with the outbreak of Ebola,  has changed their planned field service location several times and is now docked in Madagascar, Africa.  I will travel to Madagascar on January10, 2015, and spend 2 months on the ship.  I will be working for 4 weeks in a pediatric ward and 4 weeks in an adult ward, caring for people who will receive significant surgeries which will greatly enhance their lives. 

The mission of the Africa Mercy Ship (per their website) is “To Change the world… one nation… one community…one life at a time.” This mission statement aligns with my own beliefs, and being a participant will be a life-changing opportunity for me.

 For more information about the ship, please see this link- 

http://www.mercyships.org/who-we-are/our-ships/the-africa-mercy/ 

The opportunity to work on the Africa Mercy hospital ship will be gratifying for me both on a personal and professional level. The idea of making a positive difference in a person’s life is a goal each day as I care for patients and work with nursing students in my current working career.  Working in a third world country will enable me to impact lives in a meaningful way, fulfilling what nursing is all about for me. Bringing the mercy of Jesus to those less fortunate on the other side of the world will challenge me in immeasurable ways. 

I am excited, and nervous to go on this trip. Even though I teach nursing, and am in the hospital with patients often, am I up to the challenge of caring for these people? I hope so. I hope I can be an effective helper to those I meet, both care givers and patients. 

I will be writing here about my preparation for the trip and updates from Africa- stay tuned! 
And-- thanks for your thoughts of support for me while I am gone. 

DISCLAIMER

Although I am currently serving with Mercy Ships, everything communicated here strictly reflects my personal opinions and is neither reviewed nor endorsed by Mercy Ships. Opinions, conclusions, and other information expressed here do not necessarily reflect the views of Mercy Ships.