Sparkles...

One cannot work all the time. Just like at home, somedays you are too tired to be social or go out. Somedays, however, you just need to get off the ship. Believe it or not, you would never have to leave the ship as food is cooked and served. You walk down some stairs or down the hall to work. Laundry, library, and friends are all on the ship. Included are just some of the sparkles of the past week or so outside of the smiles and bright eyes of the patients here. 

This week, I have taken several opportunities to enjoy the area. Last Sunday, Kalinda and I went to a local beach where we could swim. The sand is white, the water blue, and the water sparkles. There are golden specks in the sand that are stirred up by the crashing waves. The water is full of them when the water recedes. So beautiful. Sorry...no picture.

The reason we went to the beach was to participate in a surprise birthday celebration of the ortho team lead. She was surprised. Kalinda and I enjoyed a new restaurant for us. It was a delightful day in the shade with a breeze and delicious fish and fresh vegetables.

The next day, the true surprise occurred. Noel stated in October that she missed going to scary events in the fall. Her husband organized a scavenger hunt around the ship and dock to be scared at every stop. The last stop was the warehouse on the dock where we all gathered after scaring her for treats and slacklining.

Tuesday, Dean and his wife went into town and found candy canes and popcorn kernels. When he came to show his finds to us, we immediately said, "We should have a movie night." Tuesday night The Rehab team gathered in Dean and Marcia's room. Kalinda and I popped popcorn on the stove for the first time. Dean and Marcia provided orange Fanta and Coke with ice cubes. I brought my laptop and Kalinda brought her speaker and Sister Act II. We all settled in to the cabin and enjoyed the movie and each other's company. Community at its best!






Another evening, I was invited to enjoy fondue. I am often marveling at the cultural melting pot I am living in here. A Swiss, two Canadians, two Americans eating cheese fondu and zebu (a type of cattle) in a open air restaurant owned by a Swiss (I think) by the beach in Madagascar. The Swiss friend confirmed that the cheese fondue was authentic.

Yesterday, a friend who is a nurse and I took the opportunity to go to the beach with the sparkling water. It is so relaxing as there are not people coming by asking you to purchase knicknacks. In fact, we had the stretch of the beach to ourselves expect for two young boys who parked themselves beside us. We were very mindful of our belongings and nothing happened. I enjoyed watching the younger one play in the waves; jumping, kicking them, diving under them. They both would come out wet of course and roll around in the sand covering their entire bodies with sand. They were throwing sand at each other, digging holes, piling it in their heads. Boys will be boys in any culture :)

Other daily happenings: I have also enjoyed having some deeper conversations with crew members. Conversations beyond...how long are you here? Where do you work? Where are you from? What do you do at home? Last night and tonight two different cruise ships were docked beside us. Usually we have other commercial ships. With the internet at our finger tips, information about the ships was quickly found out and spread. Both were long and very expensive cruises. The port we are in is very clean. I was reminded again today as I was walking in the port just how clean. Every week, workers sweep the sidewalks, clean the chains and posts that hold the chain and wash a white metal fence that separates an area of the port from the sidewalk all by hand. They also edge the grass with a shovel.

Ship Boutique Finds. There is a thrift store of sorts where crew who are leaving donate their unwanted things. Every Monday and Wednesday evenings and Friday mornings, it is open for crew members to look for treasures from shampoo, food storage containers, shoes, clothes, yoga mats, books, games and the like. It is a wonderful system.

Well, I hope you enjoyed my sparkles...I will try to get photos for the next blog post.

All in a day...

This is a glimpse of what I do in a work day here. We are in full swing now with many patients on the ward, several returning for the first follow up appointment after surgery, and several continuing to receive Ponseti style casting for club feet. As is common anywhere, we can lose perspective. We see forests instead of individual trees.

This week, I was reminded of the miracles we are seeing and part of doing. One of the people who work in communications, Eunice, came down to interview the Vanya as it was her first cast change after surgery. Vanya's legs were exposed yet stable in splints. Eunice began crying happy tears when she saw the Vanya's leg straight for the first time. The Vanya's mom sweetly gave Eunice a hug in celebration. Although the rehab process is just beginning, it is good to step back and remember what the legs were like before.  Perspective...miracles are happening by the Grace of God we get to participate. 

Vanya while she was still on the ward (photo credit: Mercy Ships)

Ambre's mother expresses joy each time her daughter's casts are changed. Her feet are moving and flattening each week. Her mother's laugh is contagious and brightens my day and Ambre is cute herself.

Kalinda mobilizing a club foot prior to the casting. (Photo credit: Mercy Ships)

My buddy Ismael came for his first outpatient visit after surgery and was so brave. He only cried briefly when the staples were removed. Bubbles still are his favorite and calm him down quickly. He is standing and walking independently with the cast. 

Several teenagers are on the ward now. It is so different working with them than the young children. I have been enjoying reading French and English children's books with Mariette during her breaks while walking long distances in the hallway. She has a huge smile when I come to her bed with a new book. We have read Finding Nemo, Aladdin, Daniel and the Lion's Den, Paddington Bear, and the like.

Nestore is one of the teenagers, He wants to be a doctor and has gotten an early start on his dream (Photo Credit: Mercy Ships)

Here we encourage walking very soon after surgery to help facilitate the bone growth. With younger children we start with walker. Depending on the age, we progress to crutches or hand held walking. Next is walking independently. For the older children, we try to begin with crutches.

Sometimes we witness sit down strikes; sometimes screaming fests, but it leads to...(Photo credit Mercy Ships)

Moms' hard work and children learning to walk. (Photo credit Mercy Ships)

I am learning new skills daily here. We cast with plaster and fiberglass. Different techniques are required for both. I am getting better at both, but still working on making good casts. It definitely takes a team to up them on. Now that we are more than three weeks out from the first week of ortho surgeries, We are pulling Steinman pins, removing staples, looking at xrays to assess bone growth, and changing the cast to fiberglass cast when able. (We are running low on supplies as we are waiting for the container that has most of them to arrive. It was shipped ahead to Benin. When we switched countries, it did not switch as quickly as we did :) )

Translator/knee stabilizer, someone to maintain the foot position, and someone to apple casting material (photo credit: Mercy Ships)

Bubbles often help. (Photo credit:Mercy Ships)

Oh yeah, we progress walking and standing balance. The physical therapy that I am used to does not occur until a couple months after surgery when the bones or tendons have healed and the casts come off for good. This is when the range of motion and strengthening are in the forefront.

Photo credit Mercy Ships

Walking for the first time with a short leg cast (photo credit: Mercy ships)

The children have fun too. All lined up watching a movie. (photo credit: Mercy Ships)

In the evening visitor including relatives come. Stickers, bubbles, hugs and laughs with family. (Photo credit: Mercy Ships)

The babies and young children we have been casting weekly with the Ponseti method are also entering a new stage. They will be having small surgery (tenotomy- cutting the tendon in the back of their ankle) to gain the last of the needed motion. This surgery is performed under local anesthesia in the physical therapy treatment room by Dr. Frank with physical therapists assisting. The children are then placed in another cast. This one is worn for 3 weeks to maintain the stretch while the tendon repairs itself. The child then has to wear braces for several years.

One of the patients we have been casting for bilateral clubfeet. (Photo credit Mercy Ships)

Our youngest patient (Photo credit: Mercy Ships)

More of Eastern Madagascar

 Last weekend was a wonderful weekend relaxing and seeing God’s creation. Good company, boat rides, laying in the shade on a beach, tasty local food…Oh yeah and lemurs in the trees. There is a natural river very close to the east coast of Madagascar. A canal has been dug by hand and with machines to extend the river 10 km to a local port. Many people live along the canal. Some fish, some transport leaves and bamboo and the like up and down the river/canal.

Six of us (one from Netherlands, one from England, One from Australia, One from Canada, and two from United States…me and one from Wisconson) left the ship to find a tuk-tuk to take us to the port. The tuk-tuk three of us were in sounded like it would not make it to the destination. It never drove more than 10 mph. We made it to the port and found our guide. The guide was there early! Amazing. We all plied into the covered boat and got our cameras ready.

Many of the people along the canal wave and smiled as the Vazhas (us) went by. We also saw evidence of an interesting fishing technique. Tops of wooden sticks were in V shapes above the water. Hanging on several of them were basket/square nets that the fish would swim into and get stuck. 2.5 hours later we arrived at the hotel with a beach.

We were greeted warmly and enjoyed soursup juice prior to going to our rooms. We had rooms with decks and hammocks next to the river shore. We could hear the pleasant sounds of the water lapping yet had the privacy of tall trees. After enjoying relaxing in the hammock and on the deck, we decided to go for a swim. When Tracy went into the room to change, we heard a noise come out of her mouth. We then all realized a dancing lemur had come to visit on the window sill.

Although they are used to humans, they are still wild. Tracy thought ahead and brought bananas to feed the lemurs. We quickly grabbed our cameras and a banana. Soon another dancing lemur appeared. We were able to pet the first one. He was very soft! Much softer than a cheetah for those of you wondering. After watching and interacting with the lemurs for quite some time, we made it down to the river beach. We were glad to see there was shade on the beach.

We applied bug spray and grabbed our cameras to attend the Aye-Aye tour. Aye-Ayes are nocturnal lemurs. We went for a brief walk in the woods/jungle to a place where coconuts had been placed in the trees. We waited until the sunset. Not long afterwards, we heard the rustle of aye-ayes jumping in the trees. They sure enjoy coconuts! Aye-ayes have very sharp front teeth and long middle fingers which allow them to bite through the coconut. They scoop/dip their long middle fingers in and out of the coconut quickly to eat/drink the liquid and meat.

Upon return to the resort, children and adults from a nearby village performed songs and dances. They highly recommended audience participation. Dinner was vanilla chicken with vegetables followed by bananas foster.

We left a banana out on the deck. I was awake around 4:30 hoping to see the sunrise, but it was pouring down rain. I did receive another neat surprise. In the half-sleep state, I had heard jumping around. I told myself it was cats like in Guatemala. Then I realized it had to be lemurs. Sure enough, there was a black and white lemur sitting on the banister on the deck enjoying the banana.

After a delicious breakfast of fresh fruit, fresh bread and cheese, we watched lemurs jump around in the trees, jump on our shoulders, jump on the ground. They put on quite the show. We then had a tour that lead us deeper into the jungle with our guide calling the lemurs. After awhile, we found three brothers and sisters high in the trees. With maximal prompting and tempting with bananas, one came down closer to us.

Just prior to lunch, lemur calls could be heard. Kalinda grabbed a banana. Melissa continued to call them with the lemur call she was perfecting. Tracy and I grabbed cameras and hurried into the trees. What treat to call and feed the lemurs ourselves.

After a tasty lunch, we had a lovely boat ride back to the ship after a relaxing weekend. 

Bravery

We are all works in progress. We all learn something every day. This week many of the children have made significant progress. It has been neat to see the change. After many tearful and loud (screaming) attempts a day for several days, they overcome their fear and walk around with the walker at will. Once they figure it out, they often ask to get up on their own. Two of the little ones who were on the ward at the same time journeyed together walking and learning to trust. One was up often walking in the hall. She went home walking with just one hand held assistance and could stand alone without a walker. Such transformation. She also had transformation from a screamer to a cutie who gave high fives, brought many laughs, smiles, and hugs. We will see her again in a few weeks to change her cast and see how the bones are healing.

Mercy Ships photo credit

Overwrapping a cast. Photo credit Mercy Ships

Another young boy who would scream if you simply looked at him when walking past is now walking well with a walker. I was praying for a technique to help him overcome his fear of falling. One day, I decided to lower him down to the ground every time he did not keep his balance. I continued to ask if he was OK and if he was in pain. After he responded,  "No," we got back up and tried again. When I walked by the ward that evening, I saw him up walking around with the other children with a smile on his face. I am reminded of a quote my mom would say, "Triumph is simply trying with Umph behind it." This is what he did.

Mercy Ships photo credit

Another girl who is a bit older has also been fearful with anything new. She and her mom are good sports and let me practice my Malagasy with them. It usually brings a large smile and a laugh to their face prior to their response. She has rarely shed a tear, but she expresses her emotions on her face. She has done well with looking up at a sticker of her choosing to encourage walking with her head up. Today she progressed from walking with a walker to walking with forearm crutches. Mom and her were very happy. Her confidence will continue to build with the new mobility devices. She saw her pre-op and post op xrays side by side and was amazed at the difference.

Admisson Day (Mercy Ship photo credit)

Walking to the ship on the big day. Mercy Ships photo credit

Mariette has also been working hard. I was so glad to see her beautiful smile return after a couple of difficult days. Today she was up and walking with crutches and strengthening her non surgical leg all while teaching me a couple of words in French.

Today, I too progressed. I began learning how to wedge casts. It is a technique used to achieve the final correction of alignment in tibial osteotomies. The correction achieve in surgery is usually to neutral. Before they go home about 2 weeks after surgery, we wedge (open) their casts on one side to push the bone into overcorrection. This insures that as the bone heals they will remain in neutral alignment rather than return to the position prior to surgery.

Another change which has been great to see it the changing of the foot position in patients with clubfeet. I have been surprised the difference in the feet from week to week. I hope you enjoyed a peak into some of what the Rehab team has been doing.

The children get to have fun too. (Mercy Ships Photo Credit)

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.