ali's african adventures

The president came to visit today. It is, perhaps, a measure of how long I've been here when I realize that I've just written that without a second thought. I have to admit, though, that however blasé I may be about saying that, I was a little less laid-back this morning. Presidents don't drop by every day.

We weren't sure whether he'd make it all the way up the hall to B Ward on his hospital tour; one never really knows with heads of state. But regardless of how far he chose to go, we were going to be ready. At least that was my plan.

My plan, unfortunately, involved a lot of cleaning, because at any given moment, B Ward generally looks like a bomb went off in it. The combination of small children in casts, all their mamas and papas and several extra babies running around means that toys lie scattered all over the floor, odd banana peels and cups of tea thrown in for good measure.

This morning, we needed to get everything cleaned up, all the extra beds made in pristine order, and everything put in its place. Unfortunately, we had to get all this done before nine o'clock, rounds notwithstanding.

My methodology was simple. In between trips running back and forth to A Ward to sort things out over there, I would burst into B Ward to find all our translators sitting around, not cleaning. I would shout something unintelligible, something to the tune of, The President Is Coming To Your House! Start Cleaning! STAT! And they would laugh and start making beds and I would head back to A Ward. It was all going according to plan.

Until, each time, I would fly back into B Ward to find those same translators, sitting on their same chairs, not cleaning anymore. Lather, rinse repeat. Five or six times this happened, and I couldn't figure out if they weren't understanding me, didn't care or just didn't feel like working today. I wasn't asking anything out of the ordinary; their daily assignments include the very jobs I was handing out, but it just didn't seem to be happening.

I was starting to feel a very slight sense of panic as I head the overhead announcement that the president was on the ship while all around me the ward looked like an absolute mess.

My consternation was soon to dissolve into laughter as one of our translators, (the one I had already asked three or four times to sweep and mop) approached me timidly. Please, Afi, I know the president is coming and we cannot go into the hallway, but would it be okay if we started cleaning? The schedule says it is time.


It would seem that they know their jobs a little too well. I know better than to complain, so instead I just nodded and agreed that, yes, with the president on his way up the hall, it was probably a good time to start cleaning.

And after all that, he never made it to B Ward. But at least that place looks good.

It happened this morning. While no one was paying attention, when she saw her chance, Anicette slipped home to Jesus. I could write it a thousand times, using a thousand different words, and it still wouldn't make any sense at all. Airway obstruction. Possible metabolic disorder. Chronic malnutrition. None of those words brings her back, nothing comes close to explaining what happened in the corner of A Ward this morning.

I've done this before. I've had tiny brown babies between my hands, my thumbs crushing relentlessly at their chests, willing back spirits that had already flown. But this time, the entire time, someone's hands were on my back, steadying me as I bent to my task, and if it hadn't been for those hands I wouldn't have kept it together as long as I did.

Even so, by the time the team came, swift on the heels of the call, I knew we had to stop. Knew we had to keep going. Knew there was nothing I could do that was going to make it okay, no decision I was going to make that would come close to mending a mama's shattered heart.

And so we stopped. We lifted our hands and I gathered her into my arms, all bundled in an impossibly cheerful blanket. I've lost track of how many times I heard her mama cry her name when I brought her into the room where she was waiting. Je fait tout, she cried, over and over again. I did everything. Anicette. Why, Anicette. Anicette.

When I undressed her for her last bath, every one of her bones was visible beneath her skin, her spine like a row of tiny stones down her back, and all I could think of was what it must be for her in heaven now. To finally be able to run and play. To not feel pain. For the first time to know what it feels like to not be hungry.

For her mama, though, no such comfort. No release from a pain that's just starting all over again. Because I found out today that Zenabou had another child before Anicette, a child who also died from a mysterious sickness in which it would not eat. She's been through all this before, and now she's doing it with Anicette's little brother or sister growing inside her, a third child to be born into this broken family.

We've gathered together so many times today to pray. To ask for comfort in Zenabou's life. To pray for healing and peace. But most of all, we have gathered to speak life. Life into Zenabou, the second wife who has given her husband nothing but broken children, children who went back far too soon. Life into their village, where hatred and bitterness run deep. Life into the baby, safe for now but facing a world so twisted.


How long? How long before He speaks the words that will make it all whole again? How long do babies have to starve to death before this world has groaned enough?

Speak, Lord. Speak life.

This is how I remember Anicette. She spent most of the year with us in Benin, bouncing around between the ward and the hospitality centre, trying to find the magic formula that would let her gain enough weight for surgery. It worked. By the time she finally went to the operating room to fix her cleft lip, Anicette was a plump little baby, well-loved by her mama and every single nurse who laid eyes on her.

I was sitting in the office yesterday afternoon when our phlebotomist, Maggie, came looking for me. Can you help me draw blood on a tiny baby? I followed her willingly, always happy to do some clinical work in the middle of an admin day. When I opened the door, I saw one of our translators leaning over a crying baby wrapped in a piece of cloth. Only it wasn't a baby. It was a little girl, just a few months younger than my niece.

Anicette.

At fourteen months old, Ani is so underweight that she doesn't even register on the growth charts. Her skin is hanging off her bones, her cheeks just a shadow of their former plumpness. We don't know why. We can't figure out if it's because she hasn't been fed or if she's just not tolerating the food she's getting. We don't know what it is, but it's obvious that something is badly, badly wrong.

So we prayed and bundled her tight and I stuck a needle into a spidery little vein in her head, the only place I could find on her tiny, dehydrated body to get blood. She cried the entire time, weak little sobs that broke my heart. When it was all over, I picked her up, held her close and told her I was sorry.

I walked her back to her mama, unable to stop the tears from spilling down my cheeks. Because it shouldn't be like this. No child should be starving to death. No one should have to travel to another country just to find someone to help.

Please pray for baby Ani. She's here now, tucked into the corner of A Ward, the best place for her to be. But it breaks my heart to see her like this, to know that it might happen all over again when we leave.

Please pray.

Yesterday, I mentioned that sometimes colouring books are as good as morphine for controlling pain after surgery. I felt a little sheepish admitting how often we use crayon therapy. (Enough for it to be the first thing I think of and shout out in front of all my colleagues who were trying to actually get some education out of the session.) But today, we did a clinical trial, testing out different types of pain relief in the pediatric orthopedic patient. This trial was scientific and controlled and peer reviewed and by golly we got some important results!

It turns out that crayon therapy is only marginally effective in the presence of yovophobia. In cases where the patient suffers from a severe case of this disorder (as evidenced by screaming, flailing and shrieking in the vicinity of white people), more intense methods of pain management are in fact indicated. For patients with yovophobia and post-operative pain, it would appear that bubbles are an excellent adjuvant to crayons and colouring books, as long as the yovo operating the bubble wand stays a minimum of three feet from the bed.

In some pediatric patients, the assessment of pain is confounded by a profound sense of the dramatic. Case Study: Rachel. Rachel required only minimal pain medications overnight, when the wards were dark and she couldn't tell that people were actually looking at her. Once the lights were turned on in the morning, Rachel got dramatic, screaming in simulated pain whenever two or more healthcare professionals approached her bed. This drama was especially pronounced when her cast was being re-taped, leading onlookers to believe that she was in serious distress. However, in the case of the dramatic patient, our study has shown that a balloon tied to a magnetic hook on the ceiling and hung above the bed is as effective, if not more so, than any medications available. This was clearly demonstrated in Rachel's ability to squeal with laughter as she batted her balloon around, mere seconds after writhing in what she would have us believe was pain.

One other important case to note is that of four-year old Komlan. Komlan spent his entire pre-operative course wandering around the ward like a tiny cowboy, wrapped in nothing but a towel. In addition, he was often to be found singing in the shower. In patients like Komlan, it is imperative to understand that clothing can increase pain. It's best to allow these patients to be as naked as possible, covered only in a generous layer of baby powder. It's also advisable to sing often and loudly near their beds, as this will make them feel comfortable and will greatly reduce discomfort.

There was only one type of pain we were unable to control on the wards today. It's a type of pain rarely seen in the pediatric patient, but it can be absolutely devastating to the child; the hunger for corn porridge. When the patient suffers from hunger for corn porridge, there is absolutely nothing that can be done. Stickers, bubbles, balloons and crayons will be ineffective in controlling this pain, and the child can be expected to scream nonstop for periods exceeding an hour at a time. Patients suffering from hunger for corn porridge are often young, (in this case under three years of age) and will not understand your reasoning when you explain that crying so hard for corn porridge is going to make the doctors think you're in pain. And if they think you're in pain, home to your corn porridge is the last place you're going. There is an inverse correlation between the distance of the nurse from this patient and the decibel level of his screams.

And there you have it. There's nothing like evidence-based practice for making you a better nurse.

Unless, that is, you have a bowl of corn porridge on you somewhere?

I haven't got much to say. The past couple of weeks have wrenched my heart out and then replaced it so tenderly back into my chest that I don't know whether it's still beating inside me anymore.

Vincent is still here, and our options for getting him home are quickly running out as he gets weaker every day. We sent another pregnant teenager home to face her family with nothing but an appointment after her first trimester and the prayer that there will be an anesthetist who'll be willing to tackle her case then.

And yet. Michael got his chemo this afternoon, the partnership with the local hospital finally having come together and allowing his mama the chance to finally hope again. There are little kids in casts all over the ward who want nothing more than to colour. All. day. long. (It's true; when asked for examples of methods of pain management during an in-service with an anesthetist this evening, the first thing I thought to blurt out was, Colouring books! They laughed at me, if you can believe it.)

I'm coming to realize all over again that this is the rhythm of things around here. That some days will be so incredibly painful that the last thing I want to do is face another one. And other times my heart will be bursting with love because a fuzzy-headed baby drops his cheek to my shoulder and snuggles in tight, cooing back at me as I sing crazy, made-up songs. And there's no way to tell which kind of day it's going to be, so the only thing to do is get in my scrubs, find a matching headband and go to work.

It might hurt, but it might just be the best thing that's ever happened to me.

There is balm for every soul. Mine is named Yaouvi, and he's six. Most of the time he calls me Tata Alice, except for when he forgets and whispers his other favourite name for me. Angel, he calls, beckoning me with the little downward flick of the wrist and curl of the fingers that's so West African. Angel!

And of course I come. I can't resist his fuzzy head and his grin full of pearly white teeth that he tries to hide with a little brown hand when he thinks he's laughing too hard. I love the way he sits on a tiny wooden chair with his casted leg propped up on another one, contentedly playing Jenga with anyone that will stop and stoop.

And I completely lost my heart when I saw him practicing in the hall with his tiny little crutches. He burst into that huge smile when he saw me, laughing his little raspy laugh, and almost fell over because he was so excited. His mama caught him, set him straight, and inch by inch he crutched to where I was standing. He turned around and backed up until he could lean on the wall, at which point he dropped the crutches and hugged my leg like we hadn't seen each other for years and years.

I taught him how to eskimo kiss just now, explaining about those people that live so far north they aren't even in Togo anymore, and his eyes got wide before he solemnly rubbed his nose against mine. I lived in that moment just short of forever, as his little arm draped itself around my neck and things like babies with HIV and men with no families just didn't exist anymore. He stared into my eyes for a little while, our foreheads pressed together, before breaking away and laughing uncontrollably, giggling something in Ewe.

When I asked a translator what he had said, the answer came quickly.

He says you should not go. But if you go, you should come back to him because he would like to play some more.

Which, at the end of the day, is exactly what I needed. Just a moment to be in the world of a six-year old, where the only thing that matters is whether or not your friend is going to come play with you again.

Eeso, Yaouvi. I will come again to play tomorrow.

This will be long. I won't blame you if you don't make it through; it's going to be disjointed and messy and long, because it's another one of those days when I'm not sure where to start and not sure what to write. I know I need to write; it's all I kept thinking over the second half of the week. I just need to sit down and write this out, and then I'll be okay. I've been moving through stories that need so desperately to be told, working with families who need a voice almost as much as they need a miracle. But by the time I got back from work, exhausted after another day, I couldn't find the words. I'd sit at my computer with this New Entry screen open, and twenty minutes later I'd find myself still there, staring at the empty screen, tears running down my cheeks.

There's been no official tragedy, nothing outright that gives me the right to feel like this, and so I feel weak and small and unfit for this work. If I can't face a few sad stories after all this time, then what good am I? And maybe just one of them would have been okay. Maybe if it was just Vincent I'd be strong and clear-eyed. But it's not just Vincent. It never is. It comes in waves and every time I think I'm breaking to the surface to breathe, I'm tossed back down, tumbled in the wake of these families' pain.

And the thing I hate the most is that I'm building walls, hastily throwing bricks and mortar together around my soul because something tells me to shut off. Stop caring so much before you get yourself hurt. Here in the world of NGO's and relief work, it's called compassion fatigue. To me, it feels like going blind. Like shutting my eyes on purpose so I'm not called on to bear witness to more than my heart thinks it can handle. But their stories need to be told.


Vincent

Vincent started it all. He's still with us, alternating good days with really awful ones. We almost lost him last week when he started to bleed and there was nothing we could do. I've been in charge in the ward where hes propped up on pillows in the softest bed we have. And so the lot has fallen to me, along with the physician, to try and figure out what to do. I've asked Beninois day volunteers whether we should try to drive him home to his family. (We have an address now. Drive to the small market near Bokpe. There is a road behind it. Turn left on that road; it is the second house on the left.) As one, they shake their heads. You could find his own mother and she would look at him and say, I do not know this man. They will not take him like this; they would not want to pay for his burial. And so our last hope is to send Caleb home to Benin, to find the small road behind the market and to convince some family to come back with him.

I think that alone would have been enough for me to start shuttering my heart just a little this week. My family is one of the closest I've ever known, and so I don't understand. I don't understand how his family isn't desperately searching for him right now. I can't wrap my mind around the fact that they let him live on the streets, let him come alone in a taxi to the ship. That they have no idea that he's dying surrounded by white faces when all he wants to do is go home, and when going home is the one thing it seems we can't figure out a way to do.


Espoir

But it wasn't just Vincent. It was Espoir, too. He's four months old, a huge, uneven lump distorting his forehead. His mama and papa are HIV positive. It's hardly surprising, given that, in this country of six million, Unicef estimates that up to 150,000 were living with HIV in 2007. That's well over eight times the rate reported in the States, and probably doesn't come close to capturing the true prevalence.

Espoir's mama and papa had another child, some time ago. But this child contracted HIV at birth and died not terribly long after. Determined not to go through that again, Espoir's parents educated themselves. They learned that having a c-section birth will reduce the transmission. They learned that breastfeeding can pass it from mama to baby. And so they gathered more money than most can come by, money for a c-section and formula, and they chose a name for their new baby. Espoir. Hope.

But when their baby was born, there was something so wrong. Instead of a smooth forehead and huge, dark eyes, Espoir has a misshapen lump, the consequence of a skull gone wrong. His brain is pushing out through a hole in the front of his head, the skin stretched tightly over the fluid there. They didn't lose hope, though; they heard that a ship was coming, a ship filled with doctors who could do surgery and fix things when they go so horribly wrong.

And so they came, and we took a scan of Espoir's head, and somewhere in the process we tested him for HIV. And despite everything his parent's did, because anti-retroviral drugs are so hard to come by that the hospitals here won't let you have them until your CD4 counts drops below one hundred, little Espoir also has HIV. And we probably won't be able to do surgery because the hole is too big and his body will be too weak. And my heart broke again, shattering across old fault lines that I thought had healed.


Michael

And even that might have been okay, if Michael hadn't been sleeping in the bed across the room. Little Michael who I first met a week or so ago in the hallway near the x-ray room. He had just peed all over the floor and was happily splashing in the puddle while his mama tried to stop him through her laughter. Even then, his eye looked bad, jutting fiercely out from his head, pushed by the angry, red tumor behind it.

Michael was a twin. His daddy was murdered not too long ago, and his mama didn't have enough money to feed her babies. One of them died just about a month ago, and Michael is all she has now. But that wasn't enough; somehow, this woman hasn't suffered enough, and so baby Michael woke up screaming one night, his eye just a little swollen. The doctors said there was nothing they could do, so Michael's mama watched in horror as, over the course of the next few weeks, the tumor took over his eye socket, destroying his sight and distorting his perfect little face.

I prayed with his mama yesterday as he slept in a lappa on her back, a clean white bandage wound around his head, covering the place they took the biopsy to determine a family's fate. There were two possibilities; burkitt's lymphoma or rhabdomyosarcoma. Both are cancer, but there was no other hope; nothing grows that fast if it isn't cancer, and so we waited together to hear his fate.

I rarely cry at work. When I'm in charge, I try to keep it all together, have to be the strong one to support the nurses around me. But yesterday, when Suey came through the door with her face wreathed in smiles, I lost it. It's Burkitt's, she practically shouted. Burkitt's! Burkitt's! I saw it on the microscope!

And before you think I'm crazy for sitting down with my head in my hands and sobbing with joy because a small boy just got diagnosed with cancer, just know that Burkitt's is the only cancer that's treatable here in Togo. It's the only one that isn't an absolute death sentence, the only one that carries with it a slight chance of a future.


One small ray of light into what seems like impenetrable darkness. One tiny hope to hold on to. I've got nothing profound to say here, no life lessons learned to share with you. Just my heart, held out in trembling hands, in sore need of mending.

One of our new nurses, Myles, just posted a blog entry about the blood donation and transfusion process here on the ship. I love seeing things fresh again through the eyes of new crew members, and I think he writes about it so well.

Check it out here. I love the reminder that God is in this, that his Son bled to make this worthwhile.

Tomorrow I'll write my own words about the past few shifts; today is for thinking and processing and trying not to cry too much. Because that little boy who got the transfusion is going to be just fine, but there are so many others who aren't and it's been a hard week.

There's always something new to learn around here. Today, I headed over to A Ward to write notes in some charts and was greeted by the two teenage girls in beds eighteen and nineteen. They've both been here for a while; one has a mama who can't care for her on her own, and the other has no mama at all. (Or, at least, no mama that we can find at the moment. There's a note on the charge board saying that she's maybe in Ghana for the elections, but we're really not sure. We've decided to be her family until we can find her real one.)

They greeted me uproariously, shouting and giggling from their beds, smiles as wide as the sunrise. Afi-vi! Afi-vi! I shook my head, feigning a frown. No, not Afi-vi. Afi-gan! When they burst into absolutely uncontrollable laughter, I realized I'd probably made some sort of mistake.

Afi is my Mina name. In Togo, you're named after the day of the week you were born on, and since I'm a Friday-born girl, my name is Afi, just like somewhere around one-fourteenth of the population around here. The suffixes -vi and -gan refer to things that are small or large, respectively.

I thought I had it all figured out. They were making fun of my height, calling me Little Friday-born Girl. I was being clever by coming right back and telling them I was actually tall. What I couldn't understand was why it was all funny enough that they were about to pee their beds.

It got even worse a moment later, when one of the girls held out a sticker to me. I took it and saw a little mouse, hiding behind a chunk of cheese. Now thoroughly confused, I turned to the translator standing by, a smile on his face.

Why is she giving me a mouse? What does that have to do with anything? He explained to me that afi actually means mouse, which made no sense to me, since he then went on to explain that afi actually also means Friday-born girl. Who's confused with me here?

It took us a good while, but we finally got it all figured out.

You see, like all the other languages around here, Mina is tonal. The variations are subtle enough that my Yovo ears can only very rarely hear them; I rely on my translators to demonstrate the lilt of the words with hand motions. They've gotten used to waving their hands up and down, pointing to floor or ceiling as I try vainly to master the sounds.

The word afi, when it goes ever so slightly up at the end, refers to the day of the week when I was born. When there's an infinitesimal shift downwards, it turns me into a mouse. The girls hadn't been just calling me small; they were calling me a small mouse and feeling terribly clever about their little play on words. And when I replied that I was actually a big one, they just about lost it.

We spent the next few minutes cracking up while I scuttled around the ward, pretending to be an afi-gan. (All that was missing was the tail.)


My father would be so proud of me; I am a pun in an African tribal language.

There are days when community looks like this. Like a little slice of chocolate soufflé topped with vanilla ice cream, delivered to you door for the simple reason that you happened to be in the galley while it was being created.

These are the days when I think I'd like to live in community forever.


(Thanks for the treat, John!)

This morning, in the corner of A Ward, a little baby smiled at me. Not a huge accomplishment, you might think, since I'm goofy enough that there are very few babies in Africa who won't give me a grin, given enough time and stickers. For this baby, though, it was more of an effort. His top lip just barely moved, held in place by the steri-strips covering a neat row of sutures. The smile was fleeting, the smallest of moments, but his mama saw it and turned to me, her eyes full of wonder.

Konu, she whispered to me, hardly believing that her little broken boy was learning to smile like all the rest of them. A smile. She grabbed my hand and held it tight, gazing at her son who lay on the bed in a pile of blankets, kicking his legs contentedly. She let go after a while, and started to pack her things.

And so, once again, life comes full circle. The little baby who met us on the dock when we arrived (see his tiny little legs?) was back out there today, resting in my arms again. Only this time, he didn't feel like he was going to float away. This time, I noticed the weight of him, felt his soft, round cheek squished against my arm and the rolls of his legs in my hands. This time, instead of a lip split wide, his nose sits atop a perfect, unbroken line.

His mama climbed into the car first and turned immediately, holding out her arms for her baby, her face alight with the promise of new life. I relinquished Francois willingly into those arms because I knew that her heart was as new as her joy.

Just a few days ago, the nurse asked a question of the mama who had tried to leave her baby boy in an orphanage, afraid of his split lip, afraid that she couldn't live with a broken baby. What will you do, she asked. What will you do when you go home? And Pirette, her smile small, revealed that life had won, that hope had finally found a place in her heart.

I want to take him home.


In this season of Lent, I think that mama's words are so much more profound than she will ever know. Isn't that exactly what God said to all of us over two thousand years ago? Isn't that what held our Saviour to the cross while thousands of angels waited with bated breath for Him to ask for it to stop? I sit here, centuries after the fact, and in a mama's words I hear God speak to my heart and it's a revelation all over again.

I want to take you home. I will risk everything to do it. I don't care that you're still a little bit broken. See? I have started to mend you. I have started to make you whole, and I won't stop until you're perfect. I just want to take you home.

Pirette and Francois will come back at the end of the outreach for Francois to have his final surgery, the one to close the hole in the roof of his mouth, the surgery that will finally make him whole again. And until that day and for the rest of her life, that mama will love him with a love that has won out over death.

There's no way I can fathom how much more my Papa loves me.

I've been over here for a while now. I see people with what can only be called extreme diseases. Tumors that have grown to monstrous sizes, legs so crippled they look like they've been put on backwards. I've learned to look straight at suffering without flinching, to face it without turning away. Some days it feels like there's nothing that can shock me anymore.

At least that's what I thought. Until Vincent came back.

It's been less than a month since I saw him, waiting for us outside the gate, waiting like he'd been waiting for more than a week before the ship sailed into port. When I saw him then, I knew he was starting to look bad. I knew his cancer was starting to take over, but I wasn't prepared for how it would be when I would next see him.

Yesterday I met him in the hospital hall where my friend was bringing him, one slow shuffling step at a time, into an empty ward to lie down. I saw him and the first thing I wanted to do was turn away. I wanted to pretend I hadn't seen him, pretend it wasn't true. It took an agonizing eternity to get the shirt off his back, easing the cuff inch by inch over the hand wrapped in dirty strips of cloth. His bones stood out in sharp relief, every rib clearly visible under his skin. The wound under his arm, the place where the cancer had spread, was gaping and raw, and I wanted nothing more than to turn away.

Instead I put my arms around him. With a translator to lift his legs, we lowered him into bed, his body hot with exhaustion. I covered him with a blanket, and he closed his eyes as his head came to rest on the pillow.

No one should live like this, and no one should have to die like this. No one should live on the streets, begging for the hope of one meal a day. No one should waste away to skin and bones with no family to care. No one should ride in a taxi for hours and hours from one country to the next, alone and in pain and so very tired.

No one should have to die like this, so Vincent won't. We'll keep him with us until we can find a hospice for him to be admitted to. We'll change his bandages and give him medicine to dull his pain while he eats three meals a day. He'll be on a soft mattress with clean sheets, and he will not be alone.

We won't let him be alone.

Meet Anne. She weighs a whopping four pounds, with almost half a pound of that weight coming from the tiny little Ponseti casts on her tiny little legs. One of the orthopedic surgeons who is responsible for casting her (the one who sometimes thinks he comes from southern California) says that hers are the smallest clubbed feet he's ever worked with.

Next to Anne in the bed lies her twin, Annie. (Or Anna. Or maybe their mama's name is Anna. It gets confusing. I can't imagine why.) Annie's feet are straight, so she doesn't manage to tip the scales over four pounds. Their mama cares for them in turns, tucking them into soft blankets that envelop them so only their big brown eyes, huge in their little faces, peer out.

Anne got a nice long bath this morning while a surgeon and our orthopedic coordinator soaked off her casts before replacing them with another set that will pull her feet a little more towards straight. Instead of the buckets they use for older kids out on the dock, we used a blue basin with a towel draped over the side, a real Africa Mercy spa treatment. Anne's not heavy, but when mama's back started to hurt from leaning over the table at an awkward angle, I was more than happy to relieve her.

I took Anne in my hands, the weight of her almost nothing, and she rested her head with its spiky baby bird hair in the crook of my thumb and finger. When she started to cry, I spoke soft words in Ewe to soothe her. Evo, evo. Baba de. Baba, baba. It's okay, no more. It's okay.

She stopped crying and fixed those big brown eyes on my face, and right then I realized all over again what it means to be a nurse. What it means to hold my patients' lives in my hands, to ask them to trust that I can fix it when they're scared or hurting. What it means for mamas to relinquish their little ones into our care, complete strangers who are somehow going to be the ones to make it all better.

I leaned over and kissed her little cheek before placing her in the next set of hands that were ready to hold her, the next person ready to lean over her and whisper quiet words to quiet her cries.



(Photos by they very talented Liz Cantu.

She came almost hesitantly around the door, her eyes searching for her son's. When she saw him, propped up on the shoulder of the recovery room nurse, she came close, peering at his face. Her eyes widened, and she threw her hands up to the sky, one short burst of praise before taking him in her arms and beginning to rock him back and forth, back and forth.

On a stretcher across the room sat the surgeon, divested of his gown and gloves after the operation. The hands that had placed the knots so carefully in the little baby's lip were still, folded in his lap while he watched the scene unfold in front of him. The mama who couldn't take her eyes off her baby's face, patting his back to soothe his cries.

I love watching the way their foreheads wrinkle, he told me. The way they just take it all in, like they can't even understand what they're seeing. I stood by his side, watching the mama and her little baby, a tiny family on the road back from brokenness. Later, I saw the tears fall from the grandma's eyes as she stared at the smooth, unbroken line of the little boy's lip.

And like the surgeon, I sat across the room, just watching them take it all in. Watching them turn his face to the light so they could look again and again, making sure that it was true.

Enyo gangi, Francois' mama told me, knowing that I speak just enough Fon to understand the cry of her heart. Gangi gangi.

It's good. It's so, so good.

Last week was hectic, to say the least. After all the rigamarole of opening the wards, orienting new translators (so many of whom don't seem to speak English) and ironing out the kinks in a system that seems to change on a daily basis, I was exhausted. Knowing full well that it was only week one out of thirty for the outreach, I was well aware that I needed to rest or else I wouldn't be able to head back down there this morning. To that end, I spent the weekend in my cabin. I ate zero meals in the dining room; the HoJ brought provisions and I subsisted on popcorn and garlic bread.

This morning, feeling well-rested and energized, I walked onto a completely different ward than the one I left on Friday afternoon. The patients were quiet and relaxed. (All but Bobo, who felt the need to cry all. day. long. The photo to the right is of Bobo; it was not taken today.) The translators moved about their work with quiet efficiency, and the nurses were confident in their tasks.

The best part of the day was the very end. As the evening shift nurses filtered in, I realized that two of our ward disciplers were there too. Could we have worship, I asked them, and before I knew what was happening we were packed into the ward, singing and dancing. Someone had brought a drum from D Ward, and the sasa was shaking. We clapped and shuffled and belted out sings in three or four languages.

In my arms I held two-year old Kodjovi. He had his cleft lip fixed on Friday, the steri strips and little sutures sticking out of that lip the only indication that anything was ever wrong. When I moved, he bobbed his little head in response. When I held up my hand he used it to clap, his little feet rustling against my hips as he danced along with us.

We stood there, all of us, raising our voices to God at the start of the new shift. We put our arms out to each other, and all around the ward we joined hands. Small and tall and brown and white, some laying in their beds, others sitting on stools beside them, we intertwined our fingers and bowed our heads to pray.

While all this was going on, Francois peered over from his bed in the corner, his bright eyes making him look for all the world like a little baby bird. Our little chicken baby, once so scrawny, now weighs in at over eight pounds, complete with round cheeks and little rolls on his thighs. His mama mixes his bottles and baths him in a blue bowl and covers him liberally in baby powder. He is absolutely thriving under all the love.

Tomorrow, Francois will go to the operating room to have his cleft lip repaired. The mama who tried to leave her baby in an orphanage will have the chance to take him home with a smooth, straight lip. So while we all stood around praying, I snuck a peek over at Francois. His grandma was holding him, his mama's eyes shut tight while she mouthed the words of her own prayer along with us.

Tomorrow, we're going to see that prayer answered.