Some of the small things in life...

Weekend treat: Mango ice cream and strawberry juice. There is debate about where the best ice cream in town is located. I think this place has the best tasting and the best deal :) Mango and passion fruit have real fruit pieces in it. 

Wild flowers on the way to the market

One of the large ships beside us. We look like a toy ship next to them

Beautiful flowers in the market. Fresh flowers always bring a smile to my face

It is Lychee Season here! I had never had them before, but they are delicious fruit. 

This is one up close. Below is a series of photos to show you the inside. This, however, is not the proper way to eat it. 

Kalinda and I bought bikes with personal money (not support money). Yesterday, we rode for 1.5 hours. Today, we were able to go for a ride to the market and back in no time. It is so nice to have wheels of our own and another way to exercise and see the area. 

Advent is one of my favorite times of year. I was sharing with someone at dinner Saturday that I wished I had one. Sunday on an outing, the Lord provided one at the front of the first shop I entered. Thank you God for letting me know you know and care even about seemingly little things

During a difficult day, I started gathering things I was thankful for in order to change my perspective. Here are a few: soft pillow case, fresh local mango, bedspread with mint green, bag just the right size for use on the ship, water bottle that reminds me I am here on Mercy Ships for such a time as this. 

Also thankful for generous friends who loaned me a kindle to read Crazy Love by Francis Chan. A book read at just the right time. 

Thankful for a satellite phone with United States number that allows phone calls from friends and family

Thankful for the selection of nuts that are provided on the ship daily.

One at a time...

This week was a roller coaster. Many wonderful moment; many challenging moments. I had to remind myself multiple times one step in the process, one moment, one cast, one patient, one standing or walking or mobilization at a time. Below is some of the details of this week in Rehab.

We are all learning and improving each day. Last Monday proved to be Monday in fine style. All but two children cried or threw tantrums. I am sure part of the crying is due to fear as the mothers say, and part is 3-4 years expressing their strong wills. I am sure it is scary to be on a big white ship with strangers and casts on your legs, having to stay in bed for a day or two and then be told you have to get up and walk. I am sure it is scary to have to lay down for a noisy cast saw to be used and then another heavy cast put on. There are some babies and toddlers which usually calm with nursing. The older children are able to understand what is going on and what is expected. The 3-5 year olds can't understand very well.  

We had a difficult time figuring out what would calm the children. Music, balloons, bubbles, coloring stickers, moms, no moms, were all tried. Sometimes, however, we just had to perform our part despite the crying and screaming. The children on the ward are seen daily. It has been neat to see the daily changes in some of them. They have gone from full on 40 minute tantrum with just standing with support to walking independently with the walker all over the ward. The mom's continued encouragement has also contributed to them overcoming their fear and walking. One evening, I walked by the ward and rewarded by seeing one of them walking in the hallway with their mother without tears.

Still not sure about walking, but mom is doing a great job encouraging her.

Another little boy was hesitant to weight bear. Due to other complications, he is unable to use a walker or crutches. I showed his caregiver how to facilitate walking with him. The next morning, we walked 15 minutes decreasing his assistance to one hand held assist. He could even stand by himself for a minute. I told him it was time to return to ward. He began crying. His caregiver reported he wanted to continue walking. He walked for another 15 minutes with her with a big smile on his face. 

This is one of the little boys I met at screening and have been able to follow his care. 

Yesterday, I took the opportunity to go up to Deck 7 and play with the children. I was hoping to be able to interact with them without making them do things they do not want. One of the girls  who was having difficulty walking even sat on my lap and gave me a hug.  I also played Jenga several times with an adult maxfascial patient.  Good medicine for my soul. Two of the girls who were expressing fear and crying/screaming were walking all over the ward by themselves with a walker. So neat to see.

Fun after walking

Today, I had the opportunity to help a 8 year old stand for the first time since surgery. She stood with help with her eyes fixed to her feet. I asked her what she was thinking, and I received "I am so happy they are straight." She is beginning the road of rehab. She worked so hard to stand and take a few steps. Most of the time she had a smile on her face expressing her thankfulness and excitement for the first few parts of the process being done.

It is moments like these that make the difficult moments worth it. I am so glad God is near all the time. He does not change. Therefore, He is good all the time: good during the difficult days of frustrations in my skills and tears from the children; good during the celebrations of first standing, first steps, changed foot positions, and more.

Lemurs and More

One quality of the Madagasy culture that I enjoy is Friendship before Function. Greetings both when arriving and leaving are important. With this in mind, all the physical therapist shared their story in about 15 minutes. One story per day allowed us all to see that we have more in common than we thought. After all, we are all humans living life with ups and downs. We invited the day crew to share if they wanted as well. God truly has blessed our team with friendship. We work hard but also laugh and play.

Another way to foster friendship is to go on adventures together. This weekend, the Rehab team went on an adventure to the Lemur Park. One of the goals of this park is to facilitate breeding of the lemurs. One of the day crew is a guide. We agreed to meet at a taxi station farther away from the ship than the one we found a couple weekends ago. We packed our lunch, cameras, sunscreen, and water to begin our trek at 7:15am. We walked out of the port. Usually just outside to port gate several pouse-pouses and tuk-tuks are waiting for customers. Due to the distance, a tuk-tuk was necessary. There was only one tuk-tuk in sight. Tuk-Tuks are considered full with three adults. We asked the driver if he had a friend he could call as we were a party of 5. He looked at us and said, "I can take all of you." Switched we were, but all in one tuk-tuk. Our party of 7 including the day crew joined another couple in a small hatchback car that had seen better days.

We got out of the car where a dirt road branched from the national paved road about 4km from the park entrance. Walking the road enabled us to see and hear the local happenings. We saw fisherman, bamboo spliters, basket weavers, rock spliters, chickens/roosters, zebu, children, adults, churches, lychee trees, unique trees and more. We turned into the jungle/forest where we had lychees fresh off the tree, enjoyed seeing and learning about trees and saw reflections in ponds. We arrived at the Lemur Zoo.

Immediately upon entering, we saw a constrictor snake in the grass. We continued on to the lemurs who to our surprise were awake. We had been told that the lemurs are usually sleeping after being fed around 9am. Despite seeing them in cages, it was neat to see them up close. They are pretty cute! Some even had babies. We also saw turtles native to southern Madagascar.

We saw at least three lemurs jumping in the trees. They had collars on. Because there were not too many people present, they gave us bananas to feed them. We held the bananas tightly to entice them to sit on our shoulders. After being passed around, they had the treat of the banana. We also enjoyed watching and interacting with a chameleon. He crawled/walked all over hands, arms, back, backpacks, and even started to go down my shirt.

After our picnic lunch, we hiked to a small waterfall. The cool water felt wonderful on hot feet. After resting by the waterfall, we continued our adventure up, up, up to a beautiful view of the trees around the lemur park and the Indian Ocean. We ended the our day at the park with time on a swing. We then hiked back to the agreed upon meeting place for our ride back. We arrived 30 minutes early fully expecting to wait for him. Surprisingly, he was already there. A wonderful day seeing new things in God's creation and strengthening friendships.

This is Why...

This week we had the last day of orthopedic screening in Tamatave. Surgeries began which meant the hospital was open for patient care! Rehab team had a great week overall getting into the swing of things with some outpatient coming for treatment of their clubfeet; some coming for their pre-operation assessment; and some patients being treated in the ward after their surgeries. 

This is one of the boys who was selected to have surgery waiting patiently in the general screening line. Photo credit to Mercy Ships

One of our jobs it to take measurements of strength, range of motion, and functional abilities prior to surgery. It is important to document a big overall picture of the joints and spinal alignment and strength on paper. Most of the physiotherapists here now will not be the ones discharging the patients (sending them home in several months at the end of their treatment). We take turns performing these. Each day, one of us will have the chance meet the children the day before their surgery. It is a joy and challenge to make them feel comfortable and get all the measurements when they are young and often scared. The day workers have been so helpful with playing them while we get the information. Balloons and speaking to them in their native language usually works wonders.

This is a little girl who was here for her pre-operation assessment. Hard to get a smile. (Photo credit Mercy Ships)

This is her a day or two after surgery. Skilled surgeon, loving care from nurses and challenge and love from rehab go a long ways. (Mercy Ships photo credit)

I met this little boy at general screening. His smile and joy for life made my day. He was such a blessing to me (Photo credit Mercy Ships)

Although everyone has an important story, each year Mercy Ships chooses a few to highlight. The little girl below is one of them for this year. I had the privilege of performing her pre-operation assessment. She entered with a stoic face. After batting a balloon back and forth for awhile, she did eek out a smile. It is those smiles that let you know the patient has allowed you to enter their world even if just a little bit.

At her home. This was her facial expression when I met her at pre-operation assessment. (Photo credit Mercy Ships)

Her and her sister at home. I got a little glimpse of this smile.(Photo credit Mercy Ships)

Her foot is in this position as it is paralytic secondary to an equinine injection used to treat Malaria. (Photo credit:Mercy Ships)

The Rehab team has a unique place on the ship. We are able to follow the patients from screening, admissions day, first day post op, through cast changes and outpatient rehabilitation, and discharge home healed. It is very neat to be able to be with the patients throughout we watch the transformation of mind, body, and spirit unfold. Sometimes quickly; sometimes slowly.

This week, I was able to continue practicing cast skills. Casts are applied at the end of surgeries by the surgical team. Due to the trauma of the surgery, the leg or foot often responds with swelling. The swelling is compensated for by bi-valving the casts (cutting both sides open). It is then overwrapped with an Ace bandage. This way if the swelling increases the nerves and arteries are not compressed. After a day or two, the swelling has decreased enough. If the cast can be squeezed together without wincing or pain, if is overwrapped with fiberglass insuring a tight cast to facilitate proper alignment and healing. I was able to overwrap with fiberglass reinforcing the knees and heels.This gave me an opportunity to work with the material without the danger of putting it on too tightly and navigate ankles and feet. Reinforced knees and heels gives the cast a better chance of staying intact for several weeks in active children who will be crawling or scooting on their heels and buttocks.  I also was able to continue working on applying plaster of paris casts to clubfeet. This requires rolling the plaster snugly and maintaining new position of the foot.

Dr. Frank and the surgical team hard at work (photo credit Mercy Ships)

Skilled hands and mind use by God to bring hope and healing. (Photo credit Mercy Ships)

Dr. Frank loves to teach. I have learned a good amount in just a week. I was able to see a surgery this week. I got to see a good surprise. It was expected to be a large bilateral foot surgery in order to achieve flat feet. Dr. Frank started with the most conservative procedures examining the amount and type of motion achieved with each. The less surgery the better. To everyone's amazement, the child's feet gain significant motion and achieve a good position with to smaller procedures. Dr. Frank decided to stop there. We will continue with the Ponseti procedure to slowly gain more motion. Dr. Frank was pleased we had the luxury to of patience and time to treat this way. If the child needs another surgery later, he will be able to receive it. As always the less cutting, the better especially in growing children.

As I was reflecting on this week, I was struck that miracles were occurring before my eyes. Feet were being moved and flattened, legs being straightened, love being given and received on a two way street (patient to crew and crew to patient), dark eyes starting to transition to light in eyes and smiles. A surgeon stopping earlier than the had planned on surgery because it was best for the patient. People from 4 countries speaking 3 different languages working together as a Rehab team.

Still not sure about all these white people on a big white ship.(Photo credit Mercy Ships)

What a difference a day can make. (Photo Credit Mercy Ships)