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.