Thursday July 22

My! How time flies. Already packing go home and yet I feel like I have only just arrived.

So I spent my last weekend in Kpalime a town 2 hours drive from Lome and very close to the Ghana border. I travelled with a friend from my Gateway class who has been to the town most weekends that he has been here. A short ride on a zemijhen (motorbike) and then a shared taxi to the town, total cost $6.00 We stayed with a family he has got to know who live on the edge f the town. Jeff, the husband is a local high school teacher teaching English and French to the equivalent of Y7-10.
Having arrived we found Jeff at home and went with him to where a local jimbay band was practising. These are drums of various shapes and sizes along with a xylophone and voices. There were also 4 young dancers and they practised some high energy dances. On Saturday with an overcast sky we climbed Pic D'Agou some 1000m high. Easy stuff really except that it was exceedingly steep. But it is the best way to see the villages that appeared to be clinging onto the side of the hill. The views were quite breathtaking and made the hard work worthwhile. In addition, at the top we were able to pick fresh guavas. Cloud enveloped the peak and it rained as well so the decision was made to walk down via the road as the path down would be dangerous, a distance of 12km so in 5 and half hours we covered about 24 km in total. No wonder we were slightly sore.




Jeff's wife had cooked brilliant traditional meal for us and we made short work of it having had just the bread and bananas we had bought during our walk. We did walk out in the evening, planning to see the play, but their gig had been cancelled. We meet up instead with one of the players from the band.Sleep came easily and we left on a beautiful sunny Sunday morning as Jeff and his family went to church.

The week previous was busy with surgeries, running, and a birthday meal out for one of the surgeons, planned as a surprise by his daughter. A small group have arrived from the UK commonly known as a "vision trip" its an opportunity for people to come for a short time and see the work of the ship. As a Brit I was invited to meet up with them on Monday evening and spend time chatting over...a cup of tea! One of the team is a keen runner and has joined us on a couple of mornings for a run.

Food of course is an important aspect of ship life. Breakfasts have a regular pattern including american pancakes on Wednesday mornings. I was given an opportunity to help out with this labour of love yesterday. As my alarm went off at 4.30am I did wonder if I was completely mad but in fact it was great fun. Making approximately 350 pancakes requires a good team - of 3. Each with our own job we found that we couldn't keep up with demand and there was always a queue but crew are prepared to wait for the pancakes.

However as I review my time here there are always highs and memorable times, the VVF ladies, the children with crossed eyes made straight, the old, and not so old, blind cataract patients give sight and celebrating the light in their lives. The patients with large goitres or facial tumours whose lives are revolutionised by surgery that remain in the memory. Along with a whole new group of friends and acquaintances that make up the experiences of coming back to the ship. This has been quite a different trip to the last one. Much shorter of course but I have worked with people I know, the work has been a little different,and we are nearing the end of the outreach so the atmosphere is about moving onto the next phase in the ship's life. I know this time that I have made a minute contribution to the whole but that my part is just as important as any other crew member.

Sunday July 11

The week was busy as I expected. The surgeon from Uganda remaining onboard has meant that we have been able to have two operating rooms running and an interesting variety of cases. Perhaps most notable was the removal of a 17kg abdominal tumour from a lady. I do have the photographic evidence but it's not going on to this page - for those of you with delicate stomachs!

The arrival of the max fax surgeon (head and neck surgery)was welcomed by other members of staff as he brought chocolate with him! Also though he has been able to offer life changing surgery to patients with large goitres and to help further those who have previous surgery but needed further surgery. For some this meant putting in bone grafts to support metalwork in their lower jaws from where they had had large tumours removed along with the mandible.

This kind of work requires painstaking care and is rarely quick surgery. The difficulty sometimes of even being able to ventilate patients easily or pass breathing tubes down so we can keep them breathing during their surgery means itcan take a while just to have them ready for the surgeon. There are always challenges to our skills but Father always takes control and we are able to safely care for these patients.

There is an age mix with these patients so we have had some very young patients alongside older folk. Frequently our smallest patients require the greater number of skilled staff to care for them. So many bodies around one little person....

Wednesday I was called to desert my post with the anaesthetist for about 30 minutes while I donated blood for a patient in the operating room next door! Such things are acceptable practice on the ship. The giving of blood in this situation is quite different to home where in fact I am not allowed to donate blood...... because I keep coming to Africa. As the blood cannot be spun in the onboard lab, it is given whole and must therefore be a very close match between donor and receipient. It doesn't need to go into a special fridge as it is only drawn at the time it is needed by the patient. Consequently we don't require blood warmers as we would at home since it is already warm at the perfect temperature.

Friday morning is the opportunity for the various programs to report on what they are doing. This week was the turn of the reconstructive surgery team. Again no graphic photos here. It served as a useful reminder that the area of reconstructive surgery encompasses orthopaedics, plastic and max fax surgeries. The changes for some of these patients is huge and does mean a change in attitude when they return to their villages. Most dramatic are the large tumours removed or the faces of those with cleft lips and palates restored to a more "normal" looking face. Many of these patients will have been ostracised by their communities and hidden away by their families. They are welcomed back in to their communities and are able to seek employment and earn a living as people are no longer afraid of them. To share one story however will may be help readers to understand why we do the surgeries which may not seem life threatening. This young man presented with syndactally of his ring and little finger (joined fingers).



When asked about his reasons for wanting surgery he explained that he wanted to be able to wear a wedding ring and could not marry his fiancee until it was sorted. One must remember that in some cultures the wearing a ring is very important. A great case to end the program time but we were also reminded that actually all healing comes from our Father who created us and our bodies in such a way that healing can take place.

And for those concerned that I may be not doing enough to keep vaguely fit, yesterday morning along with 3 others I ran to the Ghana border and back, a distance of 20kms or just over 12 miles. We left at 5.45am and we were back by 7.45am. We were joined by a couple of local guys who were running and I was surprised by just how many Togolese were running up and down the beach road. There were football matches in progress on the beach too and at one point ran passed a group of ladies wearing shirts with "Sports Pour Tous" (Sports for All).

Having been out in the afternoon with a small group I was then invited to join two of the doctors for a swim and meal at a local pool. So a busy day off but a very pleasant day too.

Saturday July 2

This time around the time is simply flying by and only 3 weeks remain for me to be a part of the hope and healing we try to offer to the population we serve in Togo this year.

After I posted last weeks entry I realised I had not mentioned the craft event put on by the peace corp volunteers working here in Togo.The Peace Corps traces its roots and mission to 1960, when then Senator John F. Kennedy challenged students at the University of Michigan to serve their country in the cause of peace by living and working in developing countries. From that inspiration grew an agency of the federal government devoted to world peace and friendship. It is still working in many countries today and I was fascinated to talk with one of the volunteers in Lome as he organised the event over the weekend. Putting the fair on during rainy season at least meant there were tourists to come and see the work. The volunteer along with others spread throughout Togo had persuaded craftsmen and women to bring their wares to Lome and sell them there. The only problem was Thai rain but they were pleased to see us on a soggy Sunday morning. Cloth and wood dominated the stands and was, as one would expect, of variable standard. Sadly my daughter refused to help flatpack a chair with seagrass weaving for the seat and back. Something about not having a large enough rucksac! The volunteers live in the villages having nothing of the luxuries we have of running water and electricity teaching some very basic management of a small business such as accounting, marketing etc.

This week has been full of goodbyes to various folk some of whom have been onboard for a long time. These include one of the second engineers from the UK and the eye surgeon and his wife. But others are returning and there will joyous reunions later tonight.

In order for us to make full use of the Glenns last operating day in the possible presence of strikes called by the unions protesting about fuel prices, we started work early on Thursday morning. First patient was having their surgery by 8.00am and we had finished all 28 cases by 11.00am Teamwork is absolutely key to operating on so many patients this quickly. It meant that all the patients could be seen at the ship for discharge later that day and would not need to return to the clinic on the Friday. What it also proved was that we can offer daycase surgery! All the patients were given lunch in the dining room after the staff lunches had finished. The sight of so many patients coming along the corridors and up the stairs supported by their carers caused heads to swivel.



The photos shows me beginning to lead the first patients from E ward where they are prepared for surgery.

Gateway, which I mentioned last week, was a one month course that I took at the beginning of the year in Texas. The weather, you may recall, was cold at the beginning of the year in the UK. It was even colder in Texas but at least there was no snow. It was very dry too so although exceedingly cold, there were clear crisp sunny days. We were grateful for the cold weather the first week as the 14 of us in basic safety training were expected to don full fire fighting gear and go into a very controlled fire - in a forty foot container. The suits themselves were bulky and generally not designed for 5 foot short people! But the week of working together as we learned about first aid, the basics of safety on a ship, turning over liferafts, donning gumby suits and fighting fires was a great team building week. The following 3 weeks we learned about working and living in developing countries, understanding about different cultures and about spiritual warfare - very important in countries where voodoo/witchcraft are practiced. We had times of laughter and tears and all of us were challenged at some point in those 3 weeks. The friendships continue as we work on the ship in all our different areas of expertise and service.

So of the week ahead? One of the general surgeons who was planning to come has had to withdraw because of illness but thankfully Father had in place on the ship a general surgeon who was here for the VVF surgeon. Dr Frank works in Uganda and is actually a general surgeon. As he said in his talk that he gave about 10 days ago,in Uganda "you have to be able to operate anywhere between the neck and knees". So we are still able to operate on the patients who will come for screening on Monday morning.

We await too the arrival of a head and neck surgeon from the UK. He is what is affectionately known as a "repeat offender" i.e. a returning member of the crew. So our weeks will switch gear completely. There are also returning anaesthetists so it will be a pleasure to welcome them again tonight.

Saturday June 26

Halfway through my time here already and other than work there I seem to have done little else! The local restaurants and hotels with swiming pools have been an added attraction and have been visited. One of the local hotels has a 50m pool so I have made use of it about once a week. I also run in the mornings since that's the coolest time of day. There are always at least two of us and I have gone out with our beloved Ghurkas who thankfully have not run too fast!

The last week has seen the government implement a fuel price increase and it caused something of a disturbance. Nothing that the ship's security couldn't handle well and safely. The traffic jams simply meant that staff couldn't get to their clinics and while this does have a knock on effect as they always do at least that was the main problem.

The 2 main surgeries of eyes and VVF continued during the week with us operating on about 18 - 20 patients. These ladies really do just touch my heart when I bcome involved in their care. Whilst not able to speak their language verbally our non verbal communication often works well and they respond to the human touch of gentleness and kindness. I ended up with a very wet shoulder one day as the doctor struggled with a spinal block. My usually stance is to have the ladies rest their head on my shoulder as it helps to put the spine in the correct poistion for the procedure - remembering that I'm just over 5 feet tall so they have to bend their heads down. The lady wept almost silently and we decided a general anaesthetic would be preferable. She held my hand as she went off to sleep still able to realise that we meant her no harm but were seeking to help her. It is such a privilege to be able to serve these ladies in this way.

The arrival of my daughter at the weekend meant a trip to the border of Ghana. People watching is always interesting and seeing how the border guards deal with the community that makes its living around the border. I had one young lady come to me seeming to want help but she was talking in fast french and kept talking into my face even though I tried to tell her I did not understand her. Finally she left me alone and I noticed how the guards indicated to me to move away from her - they obviously knew her well. I was approached by a couple of folk wanting advice about dental clinics and eye problems and with those I was able to help. yet again some of it was non verbal communication but they understood. By the time my daughter was walking through the border gates I was sat under the shelter of a corrugated tin roof with the policeman who had asked me about his eyes!

The rainy season has been particularly bad this year and many of the rivers are swollen and have broken their banks. Some of our day volunteers have had their homes flooded to the extent that they have no dry space at all and yet they still manage to come in and help us and look clean and smart when they arrive at the ship. We continue to lift these men and women in prayer as we could not manage without them and memories of floods back at home enable me to have a level of empathy with them. 3children have died during the week because of the floods.

There have been yet more arrivals and departures which encouraged my gateway group to have a meal together on Tuesday night as one of our group was leaving and we had a great time of laughing and sharing. Gateway was the course I attended in Texas at the beginning of the year, run by Mercyships at their HQ - otherwise known as the International Operations Centre (IOC). Most of the those attending came to the ship in February and it has been great to meet up with them all again and to be able to have a ready made group of friends onboard! More about Gateway next week!

Saturday June 19

Imagine being 15 and giving birth for the first time. The labour goes on for 3 days and at the end the baby that is delivered is macerated and still born. What is worse you are left with a permanent dribble of urine which leaves you smelling all the time, unattractive and even reviled by those you once thought friends. Family no longer want you in the house and build you a "shelter" near the house...But then 4 years later there is news of a ship where operations can be carried out for free that will stop you from being wet all the time. For a young 19 year old that became the reality this week. Working in the VVF operating theatre for most of this week both in anaesthetics and scrub there were similar stories. Some of our ladies had been wet for over 20 years. I suppose what stuck me most about the 19 year old is that she is 2 years younger than my own daughter. Frightened and yet trusting us to do our best she came into the room and gave us the privilege of serving her in a special way. And yet it is not her that we really serve, but our Father. By serving her we hope we demonstrated that there is a heavenly Father who loves her so much more.

But now imagine the joy when she is given a new outfit to wear, how she can rejoice in not being wet, able to wear something special and it not to be spoilt. The young lady I'm talking about is not in the photo but it is typical of the "gladdie gladdie" celebrations held onboard in the ward when several of the ladies are ready to leave the ship and begin a new life. This is how much it changes their lives, they are now accepted back into their community, can seek work knowing that they no longer smell or are wet all the time.



There are always celebrations going on in the ship life and the Celebration of Sight held at the hospitality centre is another such occasion when there is much singing and dancing, quite sedate all except what has become affectionately known as the "chicken dance" amongst us. The moves resemble something of a chicken fluttering its wings while bobbing up and down at the same time! Many of the patients are older and yet they are happy to move around and sing, clap their hands and give thanks to God for the sight they now have.



This is always balanced out by those who to whom we sadly cannot give the same good news. One of my young patients had cataract surgery several months ago but then had an eye injury to that same eye. She developed a corneal staphyloma which meant she had a large swelling coming out of her eye and we could not save the eye. I have seen her a couple of times now and she is doing OK. Thankfully she has sight in her other eye. She may in time be able to have a prosthetic eye.

Life continues on the ship with people coming and going.There are more staff on board this time that are returning crew - or at least it seems like that. This of course includes myself and it is easier to slip into "ship life" with the relationships already established. It's always good to catch up with old friends and to find out what has been happening in their lives but also to be able to pray with them in a very meaningful way.

Sunday June 12

Probably the youngest patient we have had in the eye rooms turned up unannounced on Thursday morning at 8.00am. No eye surgeries were planned for Thursday as friday was a ships's holiday. However the surgeon, anaesthetist and nurses were all available and so we operated on the child's bilateral cataract eyes. Operating this young gives the child ths best chance of seeing his mother for the rest of his life rather than relying on touch, hearing and smell.

I have spent time this week on the anaesthetic team and sorting through some of the equipment we have. Often people bring bits of equipment with them, some more useful than others. The work for the week has continued with VVF. This is the surgery for ladies who develop holes between the bladder and vagina and as a consequence continually dribble urine, or as the local people describe it "are wet" all the time. Approximately 100 people have hopefully had sight restored as the eye surgeries continue and cleft palattes and lips have been repaired. This next week will see just eye surgery and VVF surgery as the surgeons change over.

The arrival of an english anaesthetist who was here 2 years ago when I first arrived has enabled me to practice skills learned last year. Having looked ahead I see there are yet more english anaesthetists coming that I worked with last year so I look forward to their arrival too. Working with staff from different countries always brings challenges, not necessarily a bad thing as it widens horizons and can demonstrate other ways of doing things but it is easier when "in house" jokes are shared.

Of course the week has seen the start of the world cup football and this has been marked throughout the ship. many of our day volunteers who come from the surrounding areas are mad keen on football and yesterday evening match between US and England saw the largest crowd ever for a football match in the midships lounge with flags, decorated cakes and decorated faces. Football shirts aplenty were worn and of the 1-1result one person commented"just shows that God loves us all equally!"

The week as seen much rain, since it is the rainy season it is to be expected but of course it affects our patients who may then find it difficult to reach the ship with roads becoming impassable. It does however help to cool temperatures down and makes running more pleasant. I have resumed my running with friends that I ran with on my last trip and on Friday morning we actually were given a lift to the Ghanian border and then ran back to the ship, a distance of 6 miles. For one of the group it was several years since she had run that distance so was really pleased to complete it in a very respecatable time.

The photo shows one view from the ship which looks idyllic but sadly is an area where there are bandits and therefore we are strongly advised not to go there. The ghurkhas who supply our security staff were very sure to make sure I understood that as we stood together looking over the rail.



As I look forward to the week and know that I will see some of the young patients that I saw at the eye clinic 10 days ago my prayer is simply that they will see Father through my actions and interactions with them.

Sunday June 6

I'm here!! I arrived in Togo on Tuesday having walked across the border at 9.30am. Both the Ghanaian and the Togolese immigration posts were easy to pass through with the correct visas. I was identified a couple of times as "white woman" but it perfectly described me in the crowd and was certainly not offensive in any way, merely a way of distinguishing me from the crowd.

Having checked the price of taxis from the border to the ship, a ride was soon sorted and the officials at the port gate similarly were happy to direct me to the ship. An hour later I was drinking coffee and saying hello to many folk still on the ship from my last visit.

By 2.00pm I was in the operating department having unpacked, had lunch, sorted out my account and bought a telephone card.

In the theatres I found both surgeons and anaesthetists that I knew along with nursing staff and much time was spent catching up with each other.

On call Thursday evening I was called in for an emergency, the patient is doing well, but I was reminded of just how precious our lives are and how Father protects us and keeps his loving arms around us.

Friday was my late shift for the week so in the morning I was free to go to the hospitality centre where the post op eye clinic is also held. The hospitality centre this year is in a cement building unlike the converted warehouse of last year. it has small rooms which house up to 4 patients each with their carers. Patients stay here usually because they live too far away to be able to return each day e.g. for daily dressing changes or physio. Occasionally some patients travel great distances for their surgery and arrive a day or two early and are housed at the centre.

The centre is in a plot of land surrounded by red sandy soil and with the rain on Friday morning had become more of a mud bath. A tent outside the building provided shelter for the "Celebration of Sight" service held each Friday. This involves much singing and dancing along with some speaking and prayers. It is always an enjoyable experience to see how many patients lives are touched by the restoration of sight.

The clinic on Fridays sees over 100 patients and typically includes nearly 100 patients for YAG laser treatment to their operated cataract eye, and some medical eye patients who come, referred from the field clinics during the week. This week we had just 7 slots left for children to receive eye surgery and of the 10 or so young patients 7 could be helped with surgery so there were no heartbreaking decisions to make about which one would be unable to have surgery. So this next week I shall see some of these young patients as I work with the anaesthetists in the eye room.

Saturday evening saw me operating a popcorn maker in Starbucks, probably the only Starbucks to have a popcorn maker. I was asked at short notice and my apprentice status provided some amusement to those waiting. The discovery of just where the corn for popping was kept took some time and meant a delayed start but I just kept "popping corn" until we reached the end of the line. It's a great way to meet people and there were one or two surprises for customers who hadn't yet seen me on the ship!