A Drink From A Fire Hose

Wednesday felt a little like trying to take a sip from a fire hose or maybe learning to swim by being dropped off in the midst of the ocean.  What a day!  What a week!

But first, many, many thanks to all of you that have written such kind comments about my meager offerings in these blog posts.  We also treasure hearing from you and knowing that you are holding us close in your hearts and in your prayers.  We also have to send a huge thanks again to our friend Brian and my sister Jenny for keeping an eye on our home.  Apparently the large rain storm that hit southern California did some significant damage to our swimming pool so we’re thankful for our trusty, albeit slow internet connection to manage things at home.  I’m also glad that on a lark I decided to give Peter a handheld scanner for Christmas.  It’s come in handy a couple of times in the past few weeks when we had to send a copy of a document back to the states.  No idea how people would negotiate their lives from 1000s of miles away without the ease of technology.  One of these days I’ll write up a list of the best stuff we brought with us here. 

hospital crew

If you recall we’ve spent some time grousing about being underemployed since our arrival here.  All of this changed this past Tuesday.  We had official Hospital crew pictures taken and had a crew and hospital evacuation drill to satisfy the maritime inspectors.  Then Tuesday night after dinner there was a work party to make peanut butter sandwiches for the following day.  When we made well over 1500 sandwiches I started to get a sense of the enormity of what we were going to face on the following day. 

By this time the first group of pre-pre screeners had left for the enormous Togo International stadium to meet with the eager patients that we knew would arrive the evening before the screening day started.  Even though it made for a very long day for those out overnight I was glad to know that people who got in line with problems we were not going to be able to help would be sent home right away so that they would not spend hours and hours waiting to be seen only to get bad news in the morning. 

Hours and hours went into the planning of the screening flow due to some horrible results that happened last year in Sierra Leone.  Apparently the line into the screening site doubled back on itself so people taken in were not always the ones that waited the longest so a riot ensued. Sadly, many got trampled and one patient even died!  It was clear that the folks in charge at the ship took great pains to make sure that a similar incident had no chance to recur and the patient queues, the security and the set up for each station went better than anyone expected.   

The pre-pre screeners went through the line outside the stadium with pictures of the types of maladies that we were planning on offering surgeries for.  If the people in line had something other than what we could treat they were asked to go home since there was no need for them to stay.  I’m glad I didn’t have that job.  These folks were out in the sun all day long, mostly giving people the bad news that they couldn’t be helped by us. Approximately 3500 people came to stadium on Wednesday.  Of these only 1600 were admitted for further screening. Once these people entered the main stadium entrance they were met by a screener that then confirmed if they had a problem we were going to screen for that day. After this they were told to wait to be seen by a nurse that would do their initial history.  For each person that we had talking to a patient we had a local interpreter to help make sure that the patient understood what they were being asked.  There were probably 30 nurses with interpreters doing history screening.  There were rows and rows of people patiently waiting to see a screener.  I can’t begin to tell you how amazing it was to not only see so many people but to see how patiently they all waited.

After a patient had their history form done they were directed to the specialty screening for the different types of surgery being done.  Peter and I started out with the Maxillo-facial team as many of the surgeries that are done on the Mercy are head and neck tumors.  We had three oral surgeons evaluating the patients and determining if they had something they could surgically correct.

In the same room a visiting cytopathologist did needle aspirates of tumors if the surgeons wanted more information to guide them. I was surprised to learn this wonderful man takes his vacation time every year and comes to this massive screening for Mercy Ships.  His lovely wife assists him by staining and labeling the slides and doing the paperwork.  I spent much of the morning with him doing aspirates and looking at slides.  Yes, this was a blast from the past and I never expected that any of my path skills much less long lost cytology facts would be dragged from the mothballed areas of my brain during this mission trip.  Who says God doesn’t have a sense of humor? 

Peter was assigned to do the physicals on these patients with two other doctors but within 30 minutes he saw that the poor crew physician was inundated with the general surgery patients and he moved over to that room to see the multitudes that presented with anything that wasn’t to be cured by the head and neck guys.  There was also a plastic surgery room for some burn patients and a few other maladies but I never got in that room during the day. 

We had a steady but not unmanageable stream of patients and the cytology was very interesting.  We worked from about 7am until 11 and broke for a quick peanut butter sandwich.  As soon as I left my room I discovered that the room Peter was working in was overrun with patients and had a line out the door.  Probably at least 100 patients were waiting to be seen and there were many, many more on the way!  So- after my sandwich I moved over to the general surgery room to help with the screening there.  Most of the patients here came in two types – either a giant goiter (very enlarged thyroid gland) or very, very large hernias.  Since we were primarily just screening to see if we needed to see these patients back at the ship at a later date for lab tests and other work up we spent very little time examining them.  In all we estimated that about 500 patients came through that “clinic”.  All of them seen by two and later three docs. 

After the patients were accepted as a surgical candidate some were sent to have labs and possibly x-rays on the ship at a later date.  They were also sent to the scheduling people to determine when they could be set up with a surgery date!  These were the ecstatic, fortunate ones.  Sadly, many, many more patients were told they would be put on the waiting list as we are only here in Togo for 5 months and have a limited number of docs and nurses that will be coming for this mission. 

I can’t tell you how heartbreaking it is each time I would see someone I felt desperately needed surgery and the best we could tell them was we prayed more surgeons would come and open more spaces for surgery.   

We finished up around 5pm for the long, very dusty ride back to the ship on the crowded, bumpy roads.  In a future entry I’ll write some about the local city of Lome’ and what it’s like to be here.  I think we were a bit dehydrated along with being exhausted as we both had a headache and felt sort of spacey.  Fortunately nothing was scheduled for Thursday as I took most of the next day to sort of “reboot”. 

Today – Friday the 3^rd, the first wave (30) goiter patients came to the ship for intensive physicals, blood work and in some cases ultrasounds to determine who will be put on the surgery schedule and when.  There are three more screening days for these thyroid patients and the operating rooms start taking care of the patients we saw last week on Monday so well be really in the thick of things then and I’ll write more about those patients later. 

Well – that was lengthy but so was the day!  It was sort of what you’d expect on a day where nearly 4000 patients from three or more countries have come for surgery to correct a lifelong problem.  It was very hot and kind of humid but at times there was a nice breeze that blew through the building that seemed like the gift you always wanted.  The flies were pretty out of control but that same wonderful breeze sort of sent them on their way.  The people were amazing.  The crew, the entire crew from the school teachers to the engine room guys to every sweet nurse was thrilled to be a part of this amazing day.  The patients were inspiring in their hope and trust that we could fix their problem and incredibly gracious when they were told, “I’m so sorry.  We can’t help you.”  I just wish there was more we could do.  More I could do.  In addition to wishing I remembered more cytology I also wish I’d paid better attention in creative writing as I would love to give you all more a sense of the spirit and the aura of the day.  I guess it’s one of those things you call a “once in a lifetime” sort of experience.  Then again, maybe it won't be….